bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of depressive disorders in a representative sample of Nicosia, Cyprus
Authors: Papapetrou I. , Charalambous G. , Sissouras A. , Jelastopulu E.
Published: June 2017

Introduction

“Health Profile” of Nicosia was conducted in 2013–2014, within the framework of the program “Healthy Cities” in order to collect and analyse information on the state of health and health-related behaviors of the citizens of Nicosia in Cyprus.

Aims

To estimate the frequency of self-reported depressive disorders and examine burdening as well as factors influencing it.

Methods

Based on the 2011 census, a cross-sectional study was carried out on a representative random stratified sample, which was selected to be interviewed, including 477 men and 525 women, from the city area. Participants answered a questionnaire, which required among other items on self-perceived physical and mental health. Participants were also asked the following questions: “Do you have/had in the past depression or/and anxiety?” and “Have you received a medical diagnosis for this disorder?”

Results

Approximately 70% of the sample reported they had experienced anxiety and depression (37% moderate and 33% severe episodes). Diagnosed depression was reported by 4%. Severe depressive disorders were more frequently reported by women (41%, P < 0.001), older aged citizens (70.2%, P < 0.001) widowed/divorced (45.5%, P < 0.001), persons with lower family income (< 1000 €, 79.7%, P < 0.001) and among people with chronic diseases (45.3%, P < 0.001).

Conclusions

The self-reported prevalence of anxiety and depression in the citizens of Nicosia is very high – probably reflecting a negative effect of the economic crisis –, and contrariwise diagnosis of the disorder is rarely provided and consequently therapy rarely offered. Specific population groups, such as women, elderly citizens, patients with chronic diseases are more vulnerable to depressive disorders requiring specialized medical attention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Views of relatives and friends about the person who is having first episode of depression
Authors: Srivastava S.
Published: June 2017

Introduction

Major depressive episode is having highest lifetime prevalence almost about 18% of all psychiatric disorder. W.H.O has ranked depression the 4th leading cause of disability worldwide and projects that it will be 2nd leading cause of disability by 2020. a number of consistent socio demographic correlates have also been found across countries. Here I am going to give a glimpse of MDD i.e. Depression excluding Bipolar Depression. Although It is the commonest psychiatric disorder, but attitude views about disease is very unscientific and biased.

Objective

Objective of this study was to know the views of relatives and friends about Depression, and acceptance of scientific view about depression.

Aims

As various survey reports are projecting that Depression will be the 2nd commonest cause of disability by 2020. So to create an awareness about depression and its modalities of successful treatments.

Method

In this study, 96 patients were selected who had first episode of MDD without any discrimination of male and female. Their relatives and friends were categorized by their socioeconomic status. All of them were put on open questions regarding the disease.

Results

Amongst them 10% were from upper socioeconomic status, 68% were from middle socioeconomic status and 22% were from lower socioeconomic status. Only 36% accepted depression as a disease, 45.8% suggested to change behavior and thought to get rid off disease; 8.2%believed the disease is due to devils spirit; 20.1% had no comments.

Conclusion

After explaining the disease psycho and pharmacopathology and showing the results of medicines 91.3% accepted it as a disease entity, 4.2% still in favor of devils spirit and 4.5% had no comments.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Merycism – A case report about rumination syndrome
Authors: Rodrigues M.C. Cochat Costa , Brandão I.
Published: June 2017

Introduction

Rumination is a common phenomenon among ruminant animals but in humans, it is always regarded as a symptom indicative of abnormal function of the upper gastrointestinal track. It is characterized by recurrent regurgitation of recently ingested food into the mouth. This syndrome was previously described in children and adults with mental retardation, but this entity is becoming increasingly recognized in children, adolescents and adults with normal mental capacity.

Objectives/aims

The authors describe a clinical case of a 51-year-old woman with rumination syndrome and bulimia nervosa.

Methods

A detailed report of the clinical case was made as well as a literature review of articles published in Pubmed/Medline on the topic “Rumination syndrome” and “Merycism”.

Results

The authors describe a clinical case of a 51-year-old woman who began ruminative behavior when she was 10 years old, describing the regurgitation of the swallowed food back to her mouth shortly after eating and the re-chewing of it. She states that the regurgitated food tastes the same as when she ate it and she denies any pleasure associated with this behavior. When she was 17 years old, by the time she was pregnant, she started bulimic behavior and, as the rumination, it never ceased. Her medical history is significant for chronic gastritis and type 2 diabetes mellitus.

Conclusions

Although rare, merycism is an entity in the clinical practice of eating disorders. With this work, the authors share this case report as well as information concerning this topic.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interhemispheric functional connectivity in anorexia and bulimia nervosa
Authors: Amodio R. , Prinster A. , Monteleone A.M. , Esposito F. , Canna A. , Cantone E. , Volpe U. , Monteleone P.
Published: June 2017

Introduction

The functional interplay between brain hemispheres is fundamental for behavioral, cognitive and emotional control. Several pathophysiological aspects of eating disorders (EDs) have been investigated by the use of functional Magnetic Resonance Imaging (fMRI).

Objectives

The objective of the study was to investigate functional brain asymmetry of resting-state fMRI correlations in symptomatic patients with anorexia nervosa (AN) and bulimia nervosa (BN).

Aims

We aimed at revealing whether brain regions implicated in reward, cognitive control, starvation and emotion regulation show altered inter-hemispheric functional connectivity in patients with AN and BN.

Methods

Using resting-state fMRI, voxel-mirrored homotopic connectivity (VMHC) and regional inter-hemispheric spectral coherence (IHSC) analyses in two canonical slow frequency bands (“Slow-5”, “Slow-4”) were studied in 15AN and 13BN patients and 16 healthy controls (HC). Using T1-weighted and diffusion tensor imaging MRI scans, regional VMHC values were correlated with the left-right asymmetry of corresponding homotopic gray matter volumes and with the white matter callosal fractional anisotropy (FA).

Results

Compared to HC, AN patients exhibited reduced VMHC in cerebellum, insula and precuneus, while BN patients showed reduced VMHC in dorso-lateral prefrontal and orbito-frontal cortices. The regional IHSC analysis highlighted that the inter-hemispheric functional connectivity was higher in the ‘Slow-5′Band in all regions except the insula. No group differences in left-right structural asymmetries and in VMHC vs callosal FA correlations were found.

Conclusions

These anomalies indicate that AN and BN, at least in their acute phase, are associated with a loss of inter-hemispheric connectivity in regions implicated in self-referential, cognitive control and reward processing.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Long-standing Pica with compulsive features in a woman with iron and zinc deficiency
Authors: Kwok C. , Lee H.Y.
Published: June 2017

Introduction

Pica is the consumption of non-nutritive substances, which is inappropriate to the individual's cultural practices or developmental level. It is frequently associated with mental retardation, and occasionally observed in pregnant women and children.

Objectives

We describe a case of long-standing pica in a woman with no co-morbid psychiatric condition.

Case

Madam NA is a 27-year old married Malay housewife, with 4 sons and 4 miscarriages. Her mother had addiction problems. She sought help from the Eating Disorders Clinic, Singapore General Hospital, for uncontrollably eating uncooked rice. This started at age 8, when she was left alone at home with no food. Since then, she had been eating up to 10 cups of raw rice daily. She was unable to leave the house without carrying a bag of raw rice; if she forgot, she would feel intense discomfort and would need to return to get the rice. She persisted in eating raw rice despite it causing friction in her marriage. When she tried to stop, she would get irritable and crave it. This behavior only ceased during her pregnancies but would restart soon after delivery. There was no other psychiatric history. Blood investigations showed anemia, with iron and zinc deficiency, as well as newly diagnosed Grave's disease. After iron and zinc supplementation, her raw rice intake decreased substantially.

Conclusions

We report an unusual case of long-standing pica with compulsive features in a young woman with no psychiatric co-morbidity, which improved during pregnancy and with iron and zinc supplementation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Financial difficulties, economic hardship and psychological distress during the economic recession in Portugal
Authors: Antunes A. , Frasquilho D. , Silva M. , Cardoso G. , Caldas-de-Almeida J.M.
Published: June 2017

Introduction

Portugal is one of the European countries most affected by the Great Economic Recession. Mental health outcomes are likely to deteriorate during this period, with greater proportional impact among those more socially disadvantaged. Self-reported measures of financial difficulties and economic hardship are likely to be associated with psychological distress during this period.

Objectives

To characterize the relationship between psychological distress and self-reported measures of financial difficulties and type of material deprivation during the Economic Recession in Portugal.

Methods

A follow-up epidemiological survey was conducted in 2015, with a probability sub-sample of 911 respondents of the 2008 World Mental Health Survey Initiative Portugal. Psychological distress was evaluated by the Kessler-10 scale. Financial difficulties were assessed by asking the responds if they had enough money for their daily activities. Type of material deprivation considered difficulties in acquiring essential goods, paying debts or buying other goods (clothes or leisure activities). Chi-square analysis were used to evaluate the association between psychological distress, financial difficulties and type of material deprivation.

Results

A statistically significant association (P < 0.05) between psychological distress and financial difficulties was found. Among the respondents that reported not having enough money, 22% reported psychological distress. Regarding the type of material deprivation, a statistically significant association was only found for essential goods.

Conclusions

During the economic crisis, financial difficulties and material deprivation in essential goods were associated with increased levels of psychological distress, potentially widening social and health inequalities across the Portuguese population.

Funding

EEA Grants, Programa Iniciativas em Saúde Pública.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The psychiatric services of Saratov region and directions of its’ improvement (Clinical, statistical and epidemiological aspects)
Authors: Barylnik Y. , Samoylova D. , Pakhomova S. , Abrosimova J. , Kolesnichenko E. , Filippova N. , Deeva M. , Bachilo E. , Antonova A. , Sizov S.
Published: June 2017

Introduction

The determining of the actual number of people with mental disorders and their spreading by nosology still remains actual, especially according to different regions.

Objectives

The determining of the psychiatric services effectiveness in Saratov region on the basis of comprehensive analysis of its’ clinical, statistical and epidemiological characteristics.

Methods

The analysis of mental state indicators based on the example of adults’ schizophrenia Saratov region in dynamics for 10 years (2005–2015) in comparison with Russian Federation.

Results

Over the past 10 years the number of clinically supervised patients with schizophrenia decreased at 0.9% in the city and 2.2% in region population. This is consistent with the tendency of schizophrenia morbidity in Russian Federation over the same period. The number of supervised adult patients with primary diagnosed schizophrenia in Russia remained at the same level and amounted to 10.8 per 100 thousand population. At the same time the noticeable fluctuations in the number of this patients’ category were observed in Saratov and Saratov region. Over the past 10 years, the proportion of patients with primary diagnosed schizophrenia disability in the class structure of mental disorders is quite high, averaging of 41.1% in Saratov region. Analyzing the number of patients with re-confirmed disabilities the gradual decline from 1846 to 755 people (at 59.1%) was found.

Conclusions

The mental health analysis of Saratov region population allows to suggest the long-term forecast of mental disorders’ morbidity, to analyze the level of disability due to schizophrenia, to develop recommendations for the optimal regional model of psychiatric services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The assessment of social disabilities with GSDS-II in persons hospitalized in psychiatric day units and inpatient wards
Authors: Gondek T.M. , Królicka A. , Misiak B. , Kiejna A.
Published: June 2017

Social disabilities due to mental disorders have a similar or even more severe impact on daily activities than some of the chronic, severe somatic disorders. The second version of the Groningen Social Disabilities Schedule (GSDS-II) is used in the assessment of social disability in persons with mental disorders. To date, in Poland the conducted research studies focused on this matter only in patients consulted in outpatient clinics and day units. Our study is the first in the country that aims to measure the social disabilities in persons hospitalized in psychiatric inpatient wards. The objective of the study is to assess the degree of social disability using GSDS-II as well as to analyze the impact of clinical, socio-demographic and economic factors on social disabilities in patients diagnosed with psychotic, mood or anxiety disorder (diagnostic codes: F20-F29, F30-F39 and F40-F48, according to ICD-10), aged 18–65, in a day unit and an inpatient ward settings. The excluding criteria are: substance abuse co-morbidity and/or a diagnosed dementia process. The study presents the data gathered from a sample of 50 patients of both genders diagnosed with the aforementioned mental disorders who gave their informed consent to participate in the study. Due to important socio-economic implications of mental disorders that frequently result in the loss of ability of the patients to fulfill their societal roles, a study leading to a better insight on social disabilities will provide useful data for the possible improvement of the mental health care and social policy designed for these persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Protecting the incapable–Interdiction of in-patients in centro hospitalar De São João in the last two years
Authors: Machado A.S. , Pereira E. , Grangeia R.
Published: June 2017

Introduction

The interdiction of citizens is embodied in the Portuguese civil code and is untouched since 1966 regardless of the profound changes in our society. In 2006, Centro Hospitalar de São João (CHSJ) created protective measures for inpatients that are incapable; the procedure encompasses multidisciplinary evaluation of patients and the elaboration of a final report by liaison psychiatrists.

Objectives

To describe the interdiction proceedings initiated at CHSJ in the last two years, establishing parallels with our socio-demographical and epidemiological reality.

Methods

Retrospective study of the internal requests for psychiatric consultation concerning interdiction proceedings made in the CHSJ from January 2015 to December 2016.

Results

During the study period, the liaison psychiatry service received 37 requests for evaluation of patients’ decision-making capacity through the internal consultation system. The typology of the patient targeted in the interdiction process is male, more than 70 years old, hospitalized due to infectious intercurrences whose dependency of others enables him to return to his residence. More than a half (51%) of the requests were performed by internal medicine services. Twenty-one reports declaring the patient's inability to govern his person and property were made. The most common pathology underlying this cognitive impairment was dementia (57%).

Conclusion

Our results reflect the aging of Portuguese population and the increased prevalence of dementia. The evaluation of the capacity for self-governance will be increasingly required in our clinical practice and demands a holistic approach to the patient while taking into account the preservation of his autonomy, dignity and rights.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Epidemiology of depression in Azerbaijani urban female population. Cross-cultural comparison of depression incidence/prevalence indicators
Authors: Mammadova F. , Sultanov M. , Hajiyeva A. , Aichberger M. , Heinz A.
Published: June 2017

Introduction

The aim is to determine the prevalence and incidence of depression for an Azerbaijani female sample and explore the impact of cultural factors on depression.

Objectives

To determine: the optimal cut-off point of ZDRS; the point prevalence and 3 month incidence of depression; risk factors for depression. To compare the depression prevalence in the two language groups of the Azerbaijani population (Azerbaijani-speaking and Russian-speaking) for determining possible impact of cultural factors on depression.

Methods

The first screening with ZDRS (Az) and ZDRS (Ru) were carried out with 1500 research participants, who filled out the questionnaires at their homes. All the screened subjects who score 40 and more on ZDRS were examined by MINI. True-positive and false-positive results were defined. Ten percent of the screened subjects, who score less than 40 on ZDRS were randomly chosen for clinical interviews to define true-negative and false-negative results. According to the analysis the optimal cut-off point of ZDRS in the Azerbaijani female population was found with the definition of its sensitivity, specificity, positive predictive value and negative predictive value. Based on the optimal cut-off point of ZDRS, point prevalence and incidence of depression was determined in Azerbaijan. The follow-up screening was conducted to determine the 3 month incidence of depression.

Results

The determined prevalence and incidence of depression will be reported with the optimal cut-off point of ZDRS.

Conclusions

The results of the current study suggested that the ZDRS was a valid tool for use in screening patients with depression disorders but need a modification.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes
Authors: Mansuri Z. , Patel S. , Patel P. , Jayeola O. , Das A. , Shah J. , Gul M.H. , Karnik K. , Ganti A. , Shah K.
Published: June 2017

Objective

To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.

Background

While post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.

Methods

We used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).

Results

We analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.

Conclusions

Our study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psycho-social factors associated with maternal neonaticide
Authors: Amirejibi T.
Published: June 2017

Current research presents five case studies of maternal neonaticide in Georgia. Participants were under the age of thirty, with incomplete secondary education, unemployed, dependent on their families’ low income, living in the rural areas of Georgia. In three cases, participants resided with their family of origin. They were not married or in a relationship with the father of the child. They described their families and communities as conservative, holding strong cultural/religious beliefs against premarital sexual relations/childbirth out of wedlock. They lacked problem solving and coping skills, avoided making decisions concerning the pregnancy by concealing it. This being their first pregnancy, they gave birth alone followed by panic and fear of detection, committed neonaticide and hid the body of the infant. None of them had a prior criminal record. In the remaining cases, participants were married, lived with their spouses and children, had financial hardships. Both reported psychological and physical abuse from their spouses. One of them had a prior criminal offense for possessing controlled substances. The motive for neonaticide was an unwanted child due to an extramarital affair and threat of financial abandonment from extended family. In both cases, infants suffered fatal injuries. All participants reported lack of social support and emotional neglect from family members. These results are in line with international research, suggesting that certain patterns among these mothers are shared. Psychosocial factors associated with neonaticide should be utilized in the process of planning and implementing preventive strategies in health, social and legal frameworks.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Forensic neuropsychiatry and neurocrimen applied to the study of violent, criminal and corrupt behavior
Authors: Jemar G.N. , Ramiro I. , Bartoli G. , Ezequiel M.
Published: June 2017

Objectives

– Define the scope of the study of Forensic Neuropsychiatry inherent in violent, criminal and corrupt behavior psychopathological processes;

– characterize to Neurocrimen;

– describe the neurobiological underpinnings of violence;

– analyze the corrupt behavior as a derivation of cognitive bias and distorting processes that lead to social maladjustment;

– propose therapeutic tools addressing violent, criminal and corrupt behavior.

Development

Violent, criminal and corrupt behavior currently occupy an enormous preponderance in terms of distorting behaviors collevan degradation of the harmonic organization of social convicencia frequently appear in the media presented under the judicative and moral value, preventing a comprehensive analysis of this issue. We intend dilucidaar under this scenario if these behaviors have a neurobiological basis, or if we neuropathological arguments that lead us to interpret any of these processes in terms signosintomatológicos, and therefore be liable to approach from mental health. For this analysis we implement knowledge from cognitive neucociencia, specifically forensic neuropsychology and neuropsychiatry, the neurocrimen and neuroderecho.

Conclusions

Violent, criminal and corrupt behavior have a neurobiological support in statistical terms that allow us to infer distortionary neurobiological processes that result in changes in adaptation to social life. Many of these neurobiological aspects may be characterized in terms neuropathological and, therefore, make some of these behaviors in symptoms and signs. These findings implanted the need to revise legal conclusions static, although still insufficient to transform legal medical paradigms, but we require constant analysis and case by case ratification thereof.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Adult with autism – oxidative stress, co-morbidity and predisposition
Authors: Bækgaard Thorsen M. , Bilenberg N. , Munk-Jørgensen P. , Fex Svenningsen Å. , Heegaard N. , Maria Michel T.
Published: June 2017

Introduction

The etiology of autism spectrum disorder (ASD) is unclear. Studies involving children with ASD suggest that oxidative stress could explain some of the pathology. Few reports have investigated the role of oxidative stress into adulthood. Furthermore, the knowledge on psychiatric and somatic comorbidities, as well as socio-economic status in a trajectory across lifespan is sparse.

Objectives

Investigating oxidative stress related markers in ASD, along with trajectories in socio-economic functioning and comorbidities.

Aims

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD and assess the socio-economic level of functioning and comorbidities.

Methods

Plasma levels of antioxidant super-oxide-dismutase isoenzymes (SOD1 and SOD2) and pro-oxidant xanthineoxidase (XO) were measured in 56 patients ≥18 years of age, diagnosed in childhood with ASD (F84.0, F84.1, F84.5 or F84.8), along with gender and age matched controls. Participants were interviewed regarding their health, familial predisposition and social status.

Results

Cases showed higher levels of SOD1 (268.2 ng/mL vs. 205.6 ng/mL). We found no differences regarding SOD2 and XO. Patients had a higher BMI (27 vs. 24), fewer drank alcohol (40% vs. 75%), more had a psychiatric co-morbidity (50% vs. 2%), more had family member with a psychiatric diagnosis (80% vs. 50%). None of the bio-psycho-social factors showed association with biomarker levels.

Conclusion

Oxidative stress seems to play a role in ASD. Furthermore, patients with ASD often have psychiatric comorbidities; more often have a family history of psychiatric diagnoses, and are less healthy physically.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Genetic determinants of psychic resilience after a diagnosis of cancer
Authors: Christensen M. , Drago A.
Published: June 2017

Introduction

Co-morbidity between cancer and psychiatric disorders including adjustment disorder, depressive disorders or angst can seriously influence the prognosis and the quality of life of patients.

Aim

The identification of the psychological and biological profile of patients at risk for such co-morbidity is not yet available. Classical candidate genes such as the BDNF, the 5-HTLPR and genes whose products are involved in inflammatory events have received some attention, but results are inconclusive.

Object and methods

In the present review the association between cancer and psychiatric disorders is reviewed, a focus on the investigation of the Gene X environment and the epigenetic control over the activation of the HPA axis is proposed as a tool to refine the definition of the biologic profile at risk for co-morbidity between psychiatry and cancer.

Results and conclusion

A number of genes and socio-demographic variables that may influence risk to suffer from a psychiatric disorder after a diagnosis of cancer is identified and discussed. The identification of such biologic and socio-demographic profile is instrumental in the identification of subjects at risk of a double diagnosis, both somatic and psychiatric. An early identification of such profile risk would pave the way to the implementation of early intervention strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is 22q11.2 deletion syndrome a genetic subtype of schizophrenia?
Authors: Hernandez Anton R. , Red Gallego H. De La , Gomez Garcia M. , Alonso Sanchez A. , Mayor Toranzo E. , Blanco Garrote J.A. , De Lorenzo Calzon M. , Hernandez Garcia M. , Dominguez E. , De Cegama F. Uribe Ladron , Molina Rodriguez V.
Published: June 2017

Introduction

22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.

Methods

Twenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.

Background

Prematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.

Results

We considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.

Conclusions

Definition of velocardiofacial Syndrome and lack of consensus on terminology:

– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;

– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does the Use of Psychotropic Medication go up During Focused Efforts to Bring Coercion and Restraint Down?
Authors: Højlund M. , Høgh L. , Munk-Jørgensen P. , Stenager E.
Published: June 2017

Introduction

Antipsychotic or anxiolytic medicine is widely used in agitated patients in risk of coercion. However this medication is also known to contribute to cardio-vascular disease and reduced life expectancy. Department of Psychiatry in Aabenraa, Denmark participates in a nation-wide Danish project supporting efforts to reduce coercion and restraint. Our hypothesis is that reduction of coercion might lead to unwanted increase in doses of psychotropic medication.

Objective

To document the use of psychotropic medication during the project period, in order to learn more about the impact of interventions to reduce coercion and restraint on psychopharmacological treatment.

Aim

To compare type and doses of psychotropic prescriptions during the project period with the time before implementation.

Methods

Cohort study of patients in risk of agitation and coercion admitted to the wards during first quarter of 2013 and 2016. Eligible patients were diagnosed as having organic mental disorders, substance abuse, psychotic disorders, mania, bipolar affective disease or personality disorders (ICD-10: F0x, F1x, F2x, F30-31, F60). Primary outcome is the exposure to antipsychotic medication measured as defined daily doses, and secondary outcomes are exposure to benzodiazepines, polypharmacy and compliance with guidelines on agitated patients.

Results

Data collection is carried out during autumn of 2016, and the results will be presented at the congress.

Conclusions

Results from this study will contribute to our understanding of the implications of the initiative to reduce restraint and coercion in psychiatry. The results will also sharpen our awareness of possible inexpedient practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Microanalysis: The Ethical Minefield
Authors: Nagpal R. , Mital A.K.
Published: June 2017

Mental health professionals had always yearned for an intervention, which was restricted to them alone, was safe and had a commercial potential. Narco analysis or chemical hypnosis with or without the supervision of an anesthetist presented such an opportunity in India's largely poorly regulated medical practice. The turning point however was the unrestricted use of narco analysis for forensic reasons often against the will of the recipient that caught the attention of the judiciary. Professionals in candid confessions spoke of the tool replacing normal polite enquiries and unnecessary voyeuristic information being fettered out. Anecdotal evidence suggested police resorting to this tool without client consent or judicial permission. A series of fiats after searching enquiry on the statute has led to complete disarray. The legal issues have relegated the ethical issues of consent, the usefulness of “forced” information, the aftermath of “forced” information to the backburner. Currently, the tool is regulated by the judiciary and selectively applied with consent. In the clinical setting, it is fast disappearing.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Access to Mental Health Services Among Internally Displaced Persons in Ukraine: Results from a Nationwide Survey
Authors: Roberts B. , Makhashvili N. , Javakhishvili J.
Published: June 2017

Background

There are an estimated 1.4 million internally displaced persons (IDPs) in Ukraine as a result of the armed conflict in Ukraine.

Objectives

(i) Measure the burden of key mental disorders (PTSD, depression and anxiety); (ii) examine rates of utilization of health and psychosocial support services; (iii) examine the patterns of utilisation of services.

Methods

The study used a cross-sectional survey design and was conducted throughout Ukraine between March and May 2016 with 2203 IDPs aged 18 years and over. Time-location sampling was chosen as a probabilistic sampling method. Outcome measures were the PCL-5 for PTSD, the PHQ-9 for depression and the GAD-7 for anxiety. Descriptive and multivariate regression analyses were used.

Results

Of the 2203 respondents, 703 reported experiencing a mental health or emotional problem over the previous 12 months and were also screened positive with PTSD, depression or anxiety. Of these 703, 180 had sought care (with sources of care to be given in the presentation). Therefore, 523 respondents did not seek care, equating to an overall treatment gap of 74%, (74% for PTSD, 71% for depression and 70% for anxiety). Key reasons for not utilising treatment included preferring to use their own medications (n = 176); unaffordability of health services (n = 118) or medications (n = 140); poor understanding by health care providers (n = 123); poor quality of services (n = 78) and stigma/embarrassment (n = 41).

Conclusions

The findings support the need for a scaled-up, comprehensive and trauma informed response to provision of the mental health care of IDPs in Ukraine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Fit Note Use in UK Clinical Practice 2010–2016: A Systematic Review of Quantitative Research
Authors: Dorrington S. , Roberts E. , Hatch S. , Madan I. , Hotopf M.
Published: June 2017

Background

The fit note, introduced in England, Wales and Scotland in 2010, was designed to radically change the sickness certification process from advising on individuals’ inability to work to what they could do if adjustments were made available. Our review aimed to evaluate: (1) the percentage of fit notes utilizing the new “may be fit for work” option or advising on work adjustments, (2) the impact of the fit note on sickness absence and return to work, (3) demographic variation in fit note use.

Methods

We systematically searched in Embase, Cochrane CENTRAL, Pub Med, Worldcat, Ovid and PsychInfo from 1 Jan 2010–30 Nov 2016 for studies on working aged adults which included the search terms “fit note” or “fitnote”. Relevant abstracts were extracted and we assessed the quality of the papers and assessed bias using the modified Newcastle Ottawa Scale.

Results

Nine papers met the inclusion criteria, four of which were based on the same cohort. Maybe fit notes made up just 6.6% of all fit notes. Work adjustments were most often recommended for patients who were less deprived, female and patients with physical health problems. Fit note advice for patients with physical health problems increased over time, but the opposite was seen for patients with mental health problems.

Conclusions

Further research needed to evaluate the use, impact and potential of the fit note, especially for patients with mental illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Connection Between Coping Strategies and Quality of Life in Outpatient with Depression – Cross-sectional Study
Authors: Holubova M. , Prasko J.
Published: June 2017

Background

The quality of life is a multidimensional phenomenon which represents all aspects of patient's well-being and various areas of the patient's life. Specific coping strategies may be connected with the quality of life and also with the severity of the disorder. The objective of this study was to explore the relationship between the coping strategies and quality of life in outpatients with depressive disorder.

Methods

Eighty-two outpatients, who met ICD-10 criteria for depressive disorders, were enrolled in the cross-sectional study. Data on sociodemographic and clinical variables were recorded. Individuals with depression filled out the standardized measures: The Stress Coping Style Questionnaire (SVF-78), The Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), and The Clinical Global Impression (CGI).

Results

The patients overuse negative coping strategies, especially, escape tendency and resignation. Using of positive coping is in average level (the strategy Positive self-instruction is little used). Coping strategies are significantly associated with quality of life. Higher using of positive coping has a positive association with QoL. The main factors related to QoL are the subjective severity of the disorder, employment and positive coping strategies according to regression analysis.

Conclusions

This study revealed the connection between coping strategies and quality of life in patients with depressive disorders. Strengthening the use of positive coping strategies may have a positive effect on the quality of life, mental conditions and treatment of patients with depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Features of Formation and System of Psychoprophylaxis of Suicidal Behavior in Young Patients with Depression
Authors: Kozhyna H. , Mykhaylov V. , Zelenskay K.
Published: June 2017

The work covers the study of the formation of suicidal behavior in young adults with depressive disorders and developing of pathogenetic based system of its prevention. There were clinical and psychopathological signs of depressive disorders in young patients analyzed. Anxiety, asthenia, asthenic-apathetic and melancholy variants of depressive disorders in young patients with suicidal behavior were highlighted. In this study, there were the markers of suicide risk for young patients with depressive disorders determined: high suicide risk, low death self-consciousness, high anhedonia level, clinical manifestations of anxiety and depression by the hospital anxiety and depression scale, severe anxiety and depression by the Hamilton anxiety rating scale, major depressive episode by the Montgomery-Asberg depression rating scale. It has been proved that in observed young patients with depressive disorders with suicide behavior increased concentrations of serotonin, cortisol, noradrenaline and decreased levels of adrenaline and melatonine in plasma were observed. These changes were determined as neurohormonal background for depletion of adaptation resource in stress situations. There were approaches to differentiated prevention of suicidal behavior in depressive disorders in young people validated that include pharmacotherapy (selective SSRI, melatonin, serotonin and norepinephrine), psychotherapy and psychoeducation. Psychotherapeutic complexin patients with depressive episode must include personality-oriented psychotherapy, cognitive behavioral therapy, family therapy and autogenous training; in disorders of adaptation – rational psychotherapy, cognitive-behavioral analytic psychotherapy, family therapy, autogenic training. Psychoeducation should be carried out using information modules, training a positive self-image, improved compliance; formation of communication skills, problem solving, interpersonal interaction and problem-oriented discussions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive Function Before and After Electroconvulsive Therapy in Patients with Major Depression
Authors: Tmava A. , Eicher I. , Seitz D.E. , Mörkl S. , Blesl C. , Wurm W. , Ebner C. , Painold A. , Holl A.
Published: June 2017

Background

Despite its high effectiveness, electroconvulsive therapy (ECT) is not a widely used method to treat depression. One of the reasons for this could be the fear of cognitive side effects. The aim of this study was to investigate effects of ECT on cognitive function.

Methods

We conducted a prospective study with a sample size of 23 patients (10 male), who met the criteria of treatment-resistant depression according to ICD–10 and gave their informed consent for ECT treatment. Before and after ECT, the following investigations have been performed: Beck depression inventory (BDI), Montgomery-Asberg depression rating scale (MADRS), Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B), trail making test (TMT) A and B, stroop-test, mini mental state examination (MMSE) and the German version of the California verbal learning test (MGT).

Results

After ECT treatment, we found highly significant changes of depression-scales BDI (P = 0.028) and MADR-Scale (P = 0.001). IQ as measured by the MWT-B (P = 0.851), executive functions as measured by trail making test A (P = 0.568) and B (P = 0.372) and stroop-test, memory functions as measured by the MGT (P = 0.565) (Figure 1) and MMSE (P = 0.678) did not differ significantly after ECT treatment.

Conclusion

There were no significant differences in cognitive function before and after ECT treatment. To confirm these findings, it would be necessary to perform larger studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Substance use Disorder in the Offspring of Antenatally Depressed Mothers in the Northern Finland 1966 Birth Cohort: Relationship to Parental History of Severe Mental Disorder
Authors: Mäki P. , Taka-Eilola T. , Veijola J.
Published: June 2017

Introduction

Maternal depression during pregnancy is common. However, reports of the adult offspring with maternal antenatal depression are scarce.

Objectives

Our aim was to study whether offspring of antenatally depressed mothers have increased risk for substance use disorder when taking account parental mental disorder.

Methods

In the Northern Finland 1966 Birth Cohort, the mothers of 12,058 children were asked at the antenatal clinic if they felt depressed. The offspring were followed for over 40 years. Substance use disorders were detected using the Finnish Care Register for Health Care, which was also used for identifying severe mental disorders in the parents till 1984.

Results

Of the mothers, 14% had rated themselves as depressed during pregnancy. Of the parents, 10% had had a hospital-treated mental disorder. The risk for substance use disorder was slightly increased in the offspring of antenatally depressed mothers (crude OR 1.6; 95% CI 1.2–2.1), when compared with the cohort members without maternal antenatal depression. The risk for substance use disorder was higher in the offspring with both maternal antenatal depression and parental mental disorder (2.8; 1.7–4.7) than in those with maternal depression but without parental mental disorder (1.4; 1.1–2.0) or those without maternal depression and with parental mental disorder (1.5; 1.1–2.2). The reference group was cohort members without maternal antenatal depression and without parental mental disorder. The association remained significant after adjustment [1].

Conclusions

Offspring with both maternal depression during pregnancy and parental severe mental disorder have elevated risk for substance use disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Study of Patient's Perspective of Schizophrenia Using Emic Perspective
Authors: Sanyal D. , Das D.
Published: June 2017

Introduction

Knowledge about how patients perceive mental illness and how it possibly influences help seeking behaviour is important in development of proper plan for mental health reform.

Objective

This study planned to study disease related perception, first help seeking behaviour and stigma among schizophrenia patients admitted at a hospital.

Aims

(1) To know about patient's view regarding the problems; (2) attempt to predict help seeking behaviour.

Methods

Fifty-one patients suffering from schizophrenia according to DSM-5 and fit to be interviewed were assessed using EMIC (Explanatory Model Interview Catalogue) to get emic (insider or person's own cultural) perspective of disease related perception, help seeking behaviour and stigma.

Results

Terms used to describe their illness included “depression” (21.6%), “mental” (17.6%) “matha kharap” (9.8%). Most common perceived cause was stress (25.5%) and sorcery (23.5). Mental health specialist was visited by 27.5% Faith healer consultation was high (29.4%). Stigma score was higher with marriage related issues and social isolation. Using exhaustive CHAID analysis, it was found that patients with negative themes as disease name like “matha kharap” (loosely meaning crazy) are more likely to visit faith healers, while patients naming the condition with some medical related term like depression were more likely to visit mental health specialist.

Conclusion

Clearly perception of patients regarding mental illness and its causation varies greatly from the way psychiatrists’ viewpoint and this perception is likely to influence help seeking behaviour. Understanding these issues is likely to enable better patient awareness and proper formulation of plans to address mental health issues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.