bluuebunny/crossref_metadata_2025 huggingface dataset:
Doses of antipsychotics in maintenance phase compared to doses in acute phase treatment
Authors: Ivanušić J. , Bilić G. Filipović , Koić O.
Published: June 2017

Maintenance phase treatment with antipsychotic medications is recommended for all patients with schizophrenia. From clinical perspective and based on studies, small proportion of patients after first psychotic episode and far smaller proportion of patients with multiple psychotic episodes do not experience relapse. The use of antipsychotic medications as maintenance treatment reduces relapse rates. The optimal doses of antipsychotics in maintenance phase stay unclear although investigators attempted to identify doses sufficiently high to prevent relapses and at the same time sufficiently low to avoid adverse effects. In maintaining remission, it is usually recommended to use doses of antipsychotic medications that were effective in acute phase treatment as long as they are well-tolerated, but few studies and clinical experience show that lower doses than those usual for the acute phase are sufficient for maintenance treatment. The aim is to investigate doses of antipsychotics used in maintenance phase compared to doses used in acute phase treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect in antipsychotic-induced hyperprolactinemia after switching to long-acting injectable aripiprazole: A 1-year study
Authors: Ruiz M. Juncal , Puente B. Fernández-Abascal , Olivares O. Porta , Revuelta M. Gómez , Rodríguez R. Landera , Blanco L. Sánchez , Jenaro G. Pardo de Santayana , Herrera M. Pérez , Son J. Mayoral Van
Published: June 2017

Introduction

Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.

Aims

To evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.

Methods

This was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.

Results

In basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.

Conclusions

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Influence of clozapine to modified electroconvulsive therapy in the treatment resistant schizophrenia
Authors: Kikuchi Y. , Kanbayashi T. , Shimizu T.
Published: June 2017

Introduction

Clozapine is one of the most effective drugs for the treatment resistant schizophrenia (TRS). It was reported that modified electroconvulsive therapy (mECT) may be an effective clozapine augmentation strategy in TRS.

Objective

The objective of this study was to investigate the influence of clozapine to mECT in the TRS.

Methods

Forty-seven patients were recruited in this study, but eight patients were excluded because clozapine was discontinued by reason of side effects. Ultimately, 39 patients were enrolled.

Results

Seventeen patients received mECT before clozapine therapy. Two patients continued mECT after starting clozapine therapy. There was a significant difference between before–after clozapine therapy (χ2 test, P< 0.01). Intermittent mECT was performed for 3 patients before clozapine and for one patient after starting clozapine.

Discussion

This result suggests that clozapine therapy reduces mECT. In Japan, the first-line treatment for TRS is CLO. mECT is recommended for clozapine resistant schizophrenia patients. Prescription of CLO is limited in the part of medical facility because all physicians who prescribe clozapine must be registered with the clozaril patient monitoring service in Japan. It is considered that mECT is more readily selected than clozapine therapy. Therefore, the number of mECT is not reduced generally.

Conclusion

Clozapine therapy reduces the necessity of mECT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can writing be used to study and improve the socio-cognitive functioning of individuals diagnosed with schizophrenia?
Authors: Lucic L. , Khan A. , Daiute C.
Published: June 2017

Impairments in social and cognitive functioning are some of the most disabling features of the schizophrenia. They result in poorer communication with others, difficulties in maintaining employment status and decrease in community involvement. Recently, cognitive remediation therapy (CRT), which relies on computer-based drill and practice exercises, has emerged as a nonpharmacological intervention that aims to target and improve cognitive and social functions. Given the recent success of CRT based approaches, the question arises: can other nonpharmacological interventions which aim to augment and improve socio-cognitive functions be effective? Building upon Vygotsky's (1934) theorizing, we conducted an 8-week long study involving 19 participants. The study uses the methodology of narrative inquiry to examine participants’ ability to employ varied socio-cognitive functions (affect, causation, perceptive-taking, logical/hypothetical inference, etc.) when writing about everyday activities and attempting to resolve conflicts in narratives. Prompts employed in this study directed participants to write about three different socio-cultural contexts: (1) inpatient; (2) outpatient and (3) a fictional context. The fictional context aimed to examine participant's ability to imagine and express alternative futures/scenarios. Data show significantly higher frequency of occurrence of linguistic devices tied to cognitive functions in (3) fictional narrative context when compared to either (1) inpatient or (2) outpatient context. Use of affect was the only statistically significant difference between contexts (1) and (2). Findings indicate that individuals diagnosed with schizophrenia are able to vary the use of social and cognitive functions across narrative contexts, suggesting that future socio-cognitive interventions can be anchored in mindfully planned narrative activities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Brain-based psychotherapy for psychosis
Authors: Mehl-Madrona L. , Mainguy B.
Published: June 2017

Introduction

Psychotherapy methods are evolving for patients with psychosis.

Methods

We present a psychotherapy of psychosis that is brain-based, along with results of working with patients using these methods. Patients with psychosis are known to have decreased connectivity of the elements of the default mode network, also known as the story-making brain. These patients are known to tell narratives that lack coherence, of both excessive elements and inadequate elements. These stories are rigid and either cacophonous or rigidly monologic. The key brain area of the precuneus shows diminished connectivity to other brain areas. We present a narrative approach in which patients are assisted through rehearsal and modeling to tell more coherent stories about their life experiences. We work toward achieving a future orientation in which a sequence of actions leads toward an achievement of a future goal. The protagonist encounters obstacles and learns how to overcome them. Through iterative rehearsals, the story achieves more vivid mental imagery and emotional connectivity. Delusions and voices are accepted and incorporated into those stories in ways that provide the patient with improved capacity to cope with their delusions and voices.

Results

We present the results of 59 patients who worked with these techniques and compare them to a matched cohort of patients treated conventionally. The treated patients show statistically significant improvement in positive and negative symptoms and in quality of life.

Discussion

Brain-based narrative psychotherapy approaches can improve the quality of life and reduce symptoms.

Conclusion

These techniques are worthy of further exploration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Functional Connectivity of Reward Circuits in Eating Disorders
Authors: Favaro A. , Santonastaso P.
Published: June 2017

Objective

Anorexia nervosa display alterations of reward systems and some authors hypothesize the presence of a “starvation addiction”. The aim of the study is to explore the resting-state functional connectivity of dorsal and ventral striatal nuclei.

Method

51 subjects with lifetime anorexia nervosa (AN) (35 acute and 16 recovered) and 34 healthy controls underwent high resolution and resting-state functional magnetic resonance imaging.

Results

The AN group showed a reduced functional connectivity of the putamen in comparison to healthy women and this reduction appeared to be stronger in patients with lifetime binge eating or purging. Both acute and recovered AN groups showed larger left accumbens area in comparison to healthy women. Moreover, the functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with the number of obstetric complications in the AN group.

Discussion

the present study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks and unveils a possible role of obstetric complications in the pathogenesis of striatal dysfunction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sexual and mental health of patients with cardiovascular disease: A review
Authors: Szczegielniak A.R. , Krzystanek M.
Published: June 2017

More than 4,000,000 people die from cardiovascular diseases in Europe every year. Even though a significant reduction in mortality of patients suffering from heart and blood vessels disorders can be observed across the continent, a number of hospitalizations in this group constantly increase. Large disparities in the assessment of population's health awareness, prevention activities and the availability of specialized treatment between different regions of Europe are still recognized with the highest incidence rates in Central Europe, Eastern Europe and the countries of the former Soviet Union. Both researchers and clinicians pay increasingly more attention to the cardiac patients’ quality of life. It determines not only the daily physical, mental and social functioning, but also a general response to the further treatment conducted in outpatients clinic. Sexuality is an integral part of the human personality. Disorders appearing in the area make it difficult to fully achieve the comprehensive well-being from the individual, interpersonal and social dimension. Reduction of satisfaction and decrease in sexual activity are commonly observed in cardiac patients and frequently associated with depression and anxiety disorders. Older age, pharmacological treatment, and variety of cardiovascular risk factors (diabetes, hypertension, dyslipidemia, physical inactivity, smoking) also negatively influence sexual functioning. Thus, cardiac rehabilitation programs must be designed in a way to include recommendations regarding clinical management of sexual dysfunction, improving functional capacity, quality of life, morbidity and mortality of the patients with cardiovascular disease across Europe. Psychiatric assessment and general psychological well-being appraisal seem to be inseparable in these regards.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Insomnia and sleep state misperception: Clinical features, diagnosis, management and implications
Authors: Isaac J. , Santos C. , Matos Pires A.
Published: June 2017

Background

Insomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.

Objectives

Describe the main differences between primary insomnia WSM and wSM regarding:

– clinical features;

– diagnosis;

– management;

– implications.

Methods

We conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.

Results

The prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.

Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.

Conclusions

The clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep environment of preschool children effects on children's sleep disorder and parents’ mental health
Authors: Lee S. , Ji-Hye H. , Duk-Soo M. , Soyoung Y. , Boram P. , Seockhoon C.
Published: June 2017

Introduction

In Korean culture, co-sleeping of parents and children are quite common, which is different from the Western culture where solitary sleeping of children is preferred. In this study, we evaluate the sleep environment factors that effect on children sleep disorder, and parent's parenting stress and mental health.

Methods

Surveys were conducted to 115 participating parents of preschool children sleeping behaviour lecture. Seventy-one completed surveys were analyzed for the study. The mean age of target children was 53 ± 23 months. Parents’ mental health was evaluated by using several forms such as Insomnia Severity Index, Korean-Parenting Stress Index short form, and The Patient Health Questionnaire-9. Children's sleeping environment and quality were assessed by Child Sleep Habit Questionnaire and Sleep environment survey.

Results

Pearson correlation analysis (P < 0.05) was conducted to evaluate the relationship between the sleep disorder of children, and the parent's parenting stress and mental health. Analyzing the data through the partial least square path modeling, co-sharing would have negative effect; bed-sharing could have negative effect on the depressing emotion of parents (P = 0.065). Solitary sleeping of children could have positive effect on parent's mental health (P < 0.01).

Conclusion

Preschool children's sleeping disorder occurs more often in co-sleeping children with parents than solitary sleeping children. Parents’ parenting stress is related to the parent's age and depression, further related to the children sleeping disorder and their sleep environment. Although, it is difficult to generalize the exact cause, evaluation and improvement of children's sleep environment would help to reduce the parent's parenting stress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep duration and suicidal behavior: A systematic review
Authors: Pereira T. , Martins S. , Fernandes L.
Published: June 2017

Introduction

Suicide is a serious public health problem, being the second leading cause of death among 15–29-year-olds. Many risk factors have been associated with suicidal behavior, such as psychiatric disorders, family history of suicide, loss of a close friend/relative, physical/sexual abuse, lack of support network, or sleep disturbances where nightmares and insomnia have been consistently reported to increase the risk of suicidal behaviors.

Objective

To conduct a systematic review to examine the association between short sleep duration and suicidal behaviour (suicide ideation/attempt/suicide).

Methods

This is a systematic review of published research articles in the electronic database PubMed in the last 10 years. The query “sleep” or “sleep disorders” and “suicide” was used. Studies that assessed the relation between sleep duration and suicidal behaviour, with a well-defined index for sleep disorders and with an outcome measure of suicidal behavior were included.

Results

Of the 522 references founded, 33 articles met the inclusion criteria (1 review, 1 qualitative and 31 quantitative studies). An association between short sleep duration and suicidal behaviour was found in most of the studies with children/adolescents and adult samples. However, this relation was not verified in the research into the elderly.

Conclusion

The results point to a significant association between short sleep time and the presence of suicidal behaviours, for both adults and children/adolescents. The effect of short sleep duration seems to be more consistent with suicidal ideation, but not for attempts, needing further studies to highlight the importance of this link between sleep duration and suicide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Eating Disorders and Sexuality: A Complex Relationship
Authors: Ricca V. , Castellini G. , Lelli L. , Rotella F. , Monteleone A.M. , Maggi M.
Published: June 2017

Introduction

The relationships between Eating Disorders (EDs) and sexuality are complex, and of interest for researchers and clinicians.

Objective

To identify psychopathological and clinical factors associated with restoration of regular menses and sexual function in EDs patients.

Aims

To evaluate the role of sexuality as a moderator of the recovery process after an individual Cognitive Behavioural Therapy (CBT).

Methods

39 Anorexia Nervosa (AN) and 40 Bulimia Nervosa (BN) female patients were evaluated by means of a face-to-face interview, self-reported questionnaires, including Eating Disorder Examination Questionnaire and Female Sexual Function Index, and blood sample for hormonal levels and biomarkers. The assessments were repeated at baseline, at one year follow up, and at three years follow up.

Results

After CBT, both AN and BN patients showed a significant improvement of sexual functioning, which was associated with a reduction of core psychopathology. AN patients who recovered regular menses demonstrated a better improvement across time of psychopathological and clinical features, and were more likely to maintain these improvements at follow up. Recovery of regular menses and improvement of sexuality at the end of CBT were associated with a higher probability to have a full recovery at three years follow up.

Conclusions

These results challenge a concept of recovery in EDs exclusively based on weight restoration or behavioral changes. An assessment including sexual functioning and core psychopathology might identify the residual pathological conditions, and it is able to provide information regarding the long term recovery process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Personality and insomnia: The role of gender
Authors: Amaral A.P. , Soares M.J. , Pereira A.T. , Bos S. , Roque C. , Macedo A.
Published: June 2017

Introduction

Several epidemiological studies have been conducted to document the prevalence and correlates of insomnia. Most of them confirm their high prevalence in the general population, and a gender difference in the risk for insomnia.

Aims

To study the role of gender in the relationship between personality (perfectionism and neuroticism) and insomnia ([IG] insomnia group, [ISG] insomnia symptoms group, and [GSG] good sleepers group).

Methods

A total of 549 college students (80.1% females) filled in the MPS (Frost et al., 1990; Hewitt and Flett, 1991), EPI (Barton et al., 1992, 1995), and a self-reported questionnaire to assess insomnia symptoms.

Results

No differences were found between female and male samples, concerning the dimension of perfectionism – doubts about actions. The IG and the ISG showed higher levels of doubts about actions than the GSG. However, only in female sample the IG and the ISG showed higher levels of concern over mistakes in comparison with the GSG. In males, no significant differences between the sleep groups were found, in which respects concern over mistakes. The level of extroversion was higher in the GSG, but only in male sample. In females, there were no significant differences between the sleep groups in relation to extroversion.

Conclusions

No gender differences were found for the role of doubts about actions in insomnia. Only in females, the dimension – concern over mistakes is important in insomnia, and only in males the dimension – extroversion is important to have a good sleep. These results warrant further research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A comparison and contrast of cannabis and amphetamine-type stimulant induced psychoses
Authors: Alharbi F.
Published: June 2017

Background

The term “psychosis” is very broad. Substance users represent one group with particularly high rates of psychotic symptoms.

Objective

This review will present an update on cannabis and amphetamine-type Stimulant (ATS) and will try to differentiate and compare their associated psychotic features.

Method

A systematic literature search was conducted from 1980 to date in the following databases: MEDLINE, PsycINFO and PubMed. Articles were included if they were highlighting substances induced psychoses, with particular emphasis on stimulants/amphetamine/methamphetamine and cannabis/marijuana induced psychoses, schizophrenia-spectrum disorder or schizophrenia.

Results

There are many differences between these two substances regarding source, neurobiological processes, average latency periods before developing psychosis, clinical features as compared to schizophrenia, risk of using drugs and developing psychosis and drugs use and development of schizophrenia and urine screening test. With the recent proposals to regulate cannabis use, a further investigation of the association of this use with psychosis is required.

Conclusions

Our search elicited many studies of one substance and its association with psychosis but few comparative studies across substances. Yet in our opinion, these comparisons could shed further insight on the development of psychotic features.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Self-care concept developed by drug users
Authors: Antonia Oliveira S. , Vasconcelos S.C. , Piagge C.S.L.D. , Veras D.L. , Souza F.P. , Frazão I.S. , Alves K.L. , Alves M.R.R. , Ramos V.P.
Published: June 2017

Introduction

The care to the alcohol and/or other drugs’ user focuses on the logic of care for extended clinical and harm reduction, under the focus of the user and his family co-responsibility towards treatment.

Aim

This study aimed to understand the concept of self-care developed by drug users.

Methods

It is about a descriptive exploratory study with a qualitative approach. It was conducted in a center of psycho-social attention (CPSA), in Recife, Pernambuco, Brazil. The study participants were alcohol and/or other drugs users, over the age of 18 years, both sexes and were in treatment in the mentioned service in morning, afternoon and evening shifts. Data collection occurred in consultation records and individual interviews for the sample characterization, and three operating group sessions, one per shift, guided by the question: “what is self-care for you?” The interviews and sessions were audio-recorded, transcribed and submitted to analysis by ALCESTE software.

Results

It was noted that self-care was conceptualized by the drug users from different points of view. For some, self-care is to self-protect, for others it means taking medications. The family, religion and CPSA were identified as a support network for the self-care maintenance. Furthermore, the self-care was related to the desire to recover losses.

Conclusion

This study provided the understanding improvement of the self-care concept, supporting the care practice for the interventions planning, targeting the co-responsibility of the alcohol and/or other drugs users.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pychiatrists and Legal Issues in Dementia Care
Authors: Carrasco M.M.
Published: June 2017

During more than half a century, Psychiatry has extensively accepted a biomedical model studying mental disorders (including schizophrenia, affective disorders and the large group of stress-related disorders, including anxiety disorder. Thus, the classical dichotomy between functional and organic psychiatric disorders is obsolete and from a theoretical point of view there should be no obstacle for Psychiatry to deal with the study of dementias from gene to clinical levels using empirical methods, including neurotransmitters and scanning techniques. However, in many European countries, the dementias have been claimed as belonging primarily to Neurology, leaving the role of psychiatrists to treat psychotic symptoms and bizarre behavioral disturbances.

However, psychiatrists have a long tradition of detailed psychopathological description and great skill in coping with the many psychological, ethical and social problems that are such important features of mental disorders and particularly the dementias, and so, the specific skills of psychiatrists will certainly be warranted in managing the many significant psychological and social problems of the patient both within the family and in society. The discussion must overcome the sterile debate between specialties to focus on the skills needed to adequately address the needs of patients with dementia and their caregivers.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Drug safety related to agents used for opioid maintenance therapy
Authors: Gahr M. , Eller J. , Hiemke C. , Freudenmann R.W. , Connemann B.J. , Lang D. , Schönfeldt-Lecuona C.
Published: June 2017

Introduction

There is only little data regarding drug safety related to agents used for opioid maintenance therapy (OMT).

Objectives/aims

To study drug safety and the reporting behaviour of adverse drug reactions (ADR) related to OMT.

Methods

A cross-sectional questionnaire-based telephone survey among physicians providing outpatient OMT in a federal state of Germany (n = 176; response rate = 55.7%) was conducted.

Results

Most of the respondents (n = 97/55.1%) reported that they observe ADR related to buprenorphine, [dihydro]codein and [levo]methdone rarely (n = 38/21.6%), very rarely (n = 39/22.2%) or never (n = 20/11.4%). Methadone was reported to be most frequently associated with the occurrence of ADR (n = 82/46.6%), followed by levomethadone (n = 33/18.8%), buprenorphine (n = 6/3.4%), and dihydrocodeine (n = 3/1.7%). Frequently observed ADR related to these agents were gastrointestinal, nervous system and psychiatric disorders, and hyperhidrosis. Methadone and levomethadone (not buprenorphine) were reported to be frequently associated with fatigue, weight gain, and sexual dysfunction. Only buprenorphine was reported to be frequently associated with withdrawal and rebound effects, and drug intolerance. Hundred twenty-nine participants (73.3%) stated that they never report ADR related to OMT, whereas n = 19 (10.8%) did so when referring to ADR related to their complete medical practice (Chi2 = 141.070; df = 1; P < 0.001).

Conclusions

Our data revealed similar patterns of ADR related to outpatient OMT as those reported in the product information or in pain therapy. Motivation to report ADR related to agents used for OMT may be reduced compared to ADR related to the general medical practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Population characteristics of methamphetamine shabu users
Authors: Oviedo Peñuela L. , Torrens M. , Fonseca F. , Rossi P.
Published: June 2017

Introduction

Shabu is a crystal methamphetamine whose consumption is common among the community of Philippine immigrants in Spain.

Objectives

To describe the sociodemographic, healthcare and clinical characteristics of patients using shabu who have been treated by the psychiatry and addiction department of a tertiary hospital.

Methods

We describe the cases of patients treated in the psychiatry and addiction department of the hospital del Mar in Barcelona, Spain with methamphetamine use disorder. We collected sociodemographic variables, monitoring features and psychiatric comorbidity from the review of medical records.

Results

Ten cases of patients with severe use disorder of shabu were identified. Eight patients are from the Philippines. Nine are men (90%). At the beginning of the medical follow-up the average age was 30 years (21–41 years). All of them reported being unemployed. Four patients were referred urgently to the hospital from an ambulatory care center, two belonged to a specific program for children and adolescents, two were treated at the emergency department and two were assessed during their admissions in other departments. Regarding clinical characteristics, six had associated psychiatric disorders: two have paranoid schizophrenia, two had induced psychotic episode, one had unspecified psychosis and other had conduct disorder.

Conclusions

Shabu is a drug that the Philippine community in Spain consumes in their daily life in a social context. However, consumption of this drug could be linked to the onset of psychotic symptoms. Registration is necessary to standardize the consumption pattern in order to establish a relationship between consumption and the appearance of psychotic and organic symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychological approach in headache patients with pain medication misuse in an outpatient center for drug treatment in Barcelona
Authors: Ros-Cucurull E. , Perea M. , Romero D. , Palma-Álvarez R.F. , Pozo-Rosich P. , Torres-Ferrús M. , Grau-López L. , Abad A.C. , Martínez N. , Esojo A. , Robles-Martínez M. , Roncero C.
Published: June 2017

Introduction

Pain medication misuse is commonly found in patients under headache treatment and may produce co-morbid anxiety and depressive symptomatology. Management of this issue requires a comprehensive and integrative treatment including psychotherapy. Group interventions have been scarcely studied in addictive disorders, those interventions aims to decrease drug misuse and improve related psychiatric symptoms.

Aim

To study the efficacy of group interventions base on cognitive-behavior approach in patients with pain medication misuse.

Method

Patients with pain medication misuse were included and were evaluated with BDI, STAI, SF36 and HIT scales (basal and at the end of treatment sessions). Patients were recruited from headache outpatient unit. Twelve sessions of one hour were performed with a cognitive-behavior approach (weekly).

Results

We present preliminary results about the efficacy of group interventions in patients with pain medication misuse. Descriptive results pre- and post- treatment were analyzed in depressive symptoms (M = 20.14, SD = 12.25; M = 14.67, SD = 19.50) and in areas of quality of life: physical functioning (M = 48.75, SD = 31.13; M = 60.50, SD = 41.68), bodily pain (M = 12, SD = 9.25; M = 42.75, SD = 34.09), general health perceptions (M = 25.75, SD = 16.96; M = 44.25, SD = 22.33), vitality (M = 33.75, SD = 13.82; M = 48, SD = 34.82).

Conclusions

Pain medication misuse is commonly found in chronic headache patients, consequently worst outcomes for both pathologies. Group interventions may be useful in management of pain, anxiety and other comorbidities. Furthermore, it may favor drug use decrease and even abstinence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alcohol-related cue-reactivity predicts abstinence duration in individuals with severe alcohol-use disorders
Authors: Karthik S. , Holla B. , Bharath R.D. , Venkatasubramaniyan G. , Benegal V.
Published: June 2017

Introduction

Alcohol use disorder (AUD) is an important global public health problem with complex aetiology and relapsing remitting course. Clinical measures of alcohol dependence severity and alcohol-craving, are largely unreliable in identifying individuals at high-risk for relapse. Functional human neuroimaging methods that employ symptom provocation paradigms have shown promise in identifying critical brain regions with cue-elicited alcohol-craving response.

Objective

The present study aimed at examining the utility of fMRI cue-reactivity (CR) in predicting relapse risk.

Methods

The study was conducted on inpatients of a tertiary care neuropsychiatric hospital. Thirty-two treatment-seeking right-handed men were recruited for the study after informed consent. Following detoxification and 3-day drug-washout period, they underwent a task-based fMRI while viewing images of alcohol-related and control cues presented to them using a previously validated fMRI paradigm. All patients received anti-craving medications (baclofen: 60–80 mg/d, n = 16; naltrexone: 50–100 mg/d, n = 16) and were prospectively followed-up till their first alcohol lapse.

Results

Random-effect analysis using one-sample test revealed significant CR to alcohol-related cues (relative to implicit baseline) with activation in salience-reward related regions [insula, cingulate, dorsal striatum (DS)], visual-attention regions [occipito-temporal] and deactivation of default-mode regions [posterior cingulate (PCC)] (all significant at PFWE < 0.05, whole-brain corrected). Cox-proportional hazard regressions revealed that greater CR in Insula (Chi2 = 10.33; P = 0.001; HR = 3.1; 95% CI = 1.5–6.3) and DS (Chi2 = 10.87; P = 0.001; HR = 2.8; 95% CI = 1.5–5.2) predicts faster subsequent time to first drink after accounting for the role of clinical measures.

Conclusion

These findings indicate that CR can serve as potential marker to identify individuals at high-risk for relapse. Further examination of intervention-related CR change may aid in personalizing treatment of AUD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Role of alcohol use in suicidal behavior in public places
Authors: Baca-Garcia E. , Barrigon M. , Cegla Schvartzman F. , Sedano-Capdevila A. , Villoria-Borrego L. , Sanchez-Alonso M.
Published: June 2017

Introduction

Suicide in public places is a relatively common emergency in which alcohol use could be a factor involved.

Methods

A total of 169 patients were attended for SB in Madrid public places by SAMUR (Municipal assistance service for emergency and rescue) and transferred to FJD emergency room where all of them were assessed by the psychiatrist on duty. For all (but 47 of them), blood alcohol level was measured and other variables were collected: age, sex, history of suicide attempt and characteristic of the attempt. A descriptive analysis was made and then differences between those using alcohol and those not was made.

Results

Our sample comprises 169 patients, 40.2% woman and 59.8% man (median age = 39.36 years). Alcohol was measured in 122 patients, being positive in 52.4% (median alcohol level = 95.09 mg/dL). We found that 64.6% of man had consumed alcohol against the 30.2% of women (P = 0.000). 64.8% of alcohol users were discharged, against the 35.2% that not users. We admitted 28.1% of the alcohol users and 56.8% of the non-users (P = 0.007). We did not found statistically significance differences when compared patients that consumed against patients who did not regarding previous attempts, behavior (ideation, intent, non suicidal self-harm) and method.

Conclusions

When assessed SB, we found that most of the patients were man under the alcohol influence and most of them were discharged after being evaluated. The data does not reflect the seriousness of the SB, which opens the possibility of correlating the levels of alcohol with suicidal risk.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Developing a guide to choose psychiatry in Spain
Authors: Gómez Sánchez-Lafuente C. , Reina Gonzalez R. , Rodríguez Sánchez E.M.
Published: June 2017

Introduction

Choosing a medical specialty is not easy. In Spain, when medical students finish the university degree, they have to take an exam called popularly MIR if they want to start a specialty. If the exam is passed, that person receives a number result of his academic record during university and test result. The number indicates the order of election, so number 1 chooses specialty and hospital first and so on. The Spanish healthcare system offers between 220 and 250 places to start the Specialty of Psychiatry in 121 hospitals across Spain.

Methods

We designed a semi-structured questionnaire with 30 questions specific for the purpose of this work. The questionnaire was spread by social networks and email to reach as many medical doctors undertaking postgraduate training in psychiatry as we could.

Results

One hundred and thirty people responded to the questionnaire. Fifteen were not psychiatry trainees. We obtained information from 80 hospitals (66%). Thirty-three hospitals (41%) have specific training in psychotherapy. Sixty-nine (86%) apply electroconvulsive therapy regularly. Teaching during training is given together with psychologists and nurses in 36 hospitals (45%), with psychologists in 32 (40%), only psychiatry trainees in 12 (15%). Psychiatry trainees do general emergency guards in 62 hospitals (77%).

Conclusion

At the moment of writing this, the guide has been consulted by 14,600 people and visited over 40,000 times. This guide may help medical students to discover Psychiatry Training and to choose the best hospital that fits their interests.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“Hear me out”: Experiences of mothers suffering from severe mental illness with health care providers – A qualitative perspective
Authors: Banerjee D. , Desai G. , Chandra P.S.
Published: June 2017

Background

Contrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.

Objectives

To assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting.

Methods

The study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.

Results

Most women considered motherhood “central” to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.

Conclusion

Women who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
World maternal mental health day
Authors: Bowen A.
Published: June 2017

Introduction

As many as 20% of mothers experiences some type of perinatal mood and anxiety disorder (PMAD) worldwide. Women of every culture, age, income level, and race are at risk for PMADs with potential effects to mother and child.

Objectives

To promote awareness of maternal mental health and PMADs.

Method

An international task force met via online videoconference to make plans for the inaugural World Maternal Mental Health Day. The task force soon grew to include representatives from around the globe with a common goal to increase awareness of and influence policy about maternal mental health. This presentation will discuss the process, successes, challenges, and engage participants in future social marketing strategies for World Maternal Mental Health Day. International reach and impact will be discussed.

Result

Organizations from 12 countries were involved in this event, with twitter and landing page activity across the globe. A unique logo was developed and numerous organizations endorsed the event. An international social media campaign included a Twitter Feed “#Maternal Mental Health Matters” starting in Australia, Facebook page, and landing page. The first World MMH Day was held May 4, 2016.

Conclusion

Increased awareness will continue to drive social change with a goal of improving the quality of care for women worldwide who experience all types of PMADs and to reduce the stigma of maternal mental illness. World Maternal Mental Health Day will be held each year on the first Wednesday of May, close to “mother's day” and “mental health week” in many countries.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Clinical Use of Biomarkers in Suicidal Behaviors
Authors: Courtet P.
Published: June 2017

The epidemiology, risk factors, and biological basis of suicidal behaviors have been the object of an ever–increasing research in the last three decades. During this period, researchers all over the world have identified potential biomarkers of risk and developed several theories about the mechanisms leading to suicidal behavior. However, the lack of common terminology, instruments, and cooperation has been a major deterrent. Today, the community has established the bases for this collaboration and evidence coming from neuroscientific studies can already be applied to the field of suicidology. We present here a potential semiology based on current evidence coming from biological, clinical, and neuroimaging studies.

Disclosure of interest

The author declares that he has no competing interest.
Explanatory and Confirmatory Factor Structure of Beck Anxiety Inventory in College Sample
Authors: Kareemi S. , Alansari B.M.
Published: June 2017

Introduction

The Beck anxiety inventory (BAI) is a widely used 21-item self-report inventory used to assess anxiety levels in adults and adolescents in both clinical and non-clinical populations. The values for each item are summed yielding an overall or total score for all 21 symptoms that can range between 0 and 63 points. A total score of 0–7 is interpreted as a “Minimal” level of anxiety; 8–15 as “Mild”; 16–25 as “Moderate”, and; 26–63 as “Severe”. There is no study until this date that examines the Explanatory and confirmatory factor structure factor structure of BAI in college student in Kuwaiti.

Objectives

The current study investigated the original four-factor structure of the (BAI) in non-clinical sample of college students.

Methods

Sample one consisted of 540 males and females while sample two consisted of 600 males and females from Kuwait University undergraduates. The Arabic version of BAI was administered to participants. Explanatory factor analysis based on sample one and conformity factor analysis based on sample 2.

Results

The results revealed four factor structures of BAI in the two samples of Kuwaiti students. Which included neurophysiological, subjective, autonomic, and panic factors.

Conclusions

The results of both confirmatory and exploratory factor analysis indicated that the original four-factor structures of the BAI do provide the best fit for the college sample.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Music Performance Anxiety: Perceived Causes and Coping Strategies
Authors: Osório F.L. , Burin A.B. , Nirenberg I.S. , Barbar A.E.M.
Published: June 2017

Introduction

The understanding of the causes of music performance anxiety (MPA) and of strategies to cope with it is important for the comprehension/management of this common condition in musicians.

Objective

To investigate the causes of MPA reported by Brazilian musicians and the efficacy of the most commonly used strategies to cope with it.

Methods

Two hundred and fourteen Brazilian musicians (53% professional/musicians from orchestras, 67% male, mean age: 34.02 years, 65% with over 11 years of education, 42% of which played string instruments) completed different self-rating scales to assess the presence/absence of MPA.

Results

Thirty-nine per cent of the musicians had indicators of MPA. The most commonly reported causes were repertoire difficulty (57%), concerns about audience response (52%), and self-pressure (51%). The most common coping techniques included breathing/relaxing techniques (66%) and increased practice (53%), regarded as efficient by at least 49% of the musicians. Strategies like seeing a doctor/psychiatrist/psychologist and taking antidepressant/anxiolytic medication were among the least frequently used in the sample. Also, 18% of musicians with MPA used beta-blockers and 6% used non-prescribed medications. Comparatively, musicians with MPA believed that it was associated with a higher number of conditions and regarded coping techniques as less efficient.

Conclusion

Musicians consider internal situations to be the most frequent causes of MPA and use different coping strategies with average effectiveness. Results highlight the poor use of well-established therapeutic resources and the occurrence of self-medication in the sample, which together point to the need for attention on the part of mental health professionals to this specific group.

Disclosure of interest

The authors have not supplied their declaration of competing interest.