bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health and suicidal risk in lesbian, gay and bisexual population
Authors: Azevedo P. , Vitória J. , Norton A.
Published: May 2016

Introduction

Nowadays, the lesbian, gay and bisexual (LGB) community still suffers from prejudice and social stigma, including from medical professionals.

Thus, it is urgent to draw attention to this population since these individuals have an increased risk of mental disorders, substance abuse and dependence, suicidal ideation and suicide attempt or complete suicide.

Aims

To underline the prevalence of mental disorders and increased suicide risk in the LGB population.

Objectives

To summarize the latest literature about this field.

Methods

A brief review of the latest literature was performed on PubMed using the keywords “mental health”, “suicidal risk”, “LGB population”.

Results

LGB individuals appear to be at increased risk of mental disorders and suicidal behavior than heterosexuals. According to Meyer, they are exposed to what is called the minority stress: proximal, depending on the subject and related to fear of rejection and internalized homophobia and distal, regardless of the individual including prejudice, social stress, social exclusion (including their own families) and violence.

The odds of attempting suicide are approximately 2 to 7 times higher for lesbians, gay men and bisexuals (LGBs) than for heterosexuals.

Conclusions

Minority stress related to prejudice and stigma against LGB people has a significant risk that can be related to suicide ideation and attempt.

The higher rate of many psychiatric conditions noted in this community underscores the need for clinicians to provide nonjudgmental care and approachable environment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Relationship of suicide ideation with depression and hopelessness
Authors: Alsalman R. , Alansari B.
Published: May 2016

Introduction

The association between suicide ideation, depression, and hopelessness is relatively ignored in the literature of the Arab World, particularly using suicide ideation, Beck Depression, and hopelessness inventories.

Objective

The specific research questions related to this model are as follows: does the relationship between suicide ideation, depression, and hopelessness, postulate the latent factor?

Methods

The participants were 200 girls, first year Kuwait University students. The mean age (18.18 ± 0.38) and BMI (23.50 ± 4.85). The Arabic versions of the Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and demographic surveys were administered to participants in the class. All participants read and signed a consent form before test administration. The correlation matrices, exploratory factor analysis, and reliability analysis are used in this study.

Results

Internal consistency of scores were satisfactory for the BSI, BDI-II, & BHS inventories respectively (Cronbach's alpha = .91, .89, .85). A correlation of (r = .53) between the BSI and BDI-II and (r = .43) with BHS. Meanwhile, a correlation of (r = .58) between BDI-II & BHS. A principal-axis factor analysis with oblique rotation suggested one factor accounting for 67.73% of the common variance.

Conclusion

This trend indicates there is a strong relationship of suicide ideation with depression and hopelessness. The results of the present study suggest that targeting depression may be as important in adolescents as in adults to reduce suicidal ideation and prevent suicidal attempts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dermal reactivity and resilience in a sample of depressed patients
Authors: Coppola I. , Gattoni E. , Gramaglia C. , Di Marco S. , Delicato C. , Marangon D. , Feggi A. , Martelli M. , Guerriero C. , Thorell L.H. , Sarchiapone M. , Torre E. , Zeppegno P.
Published: May 2016

Background

Mental disorders are considered a risk factor for suicide: for example, the lifetime risk of suicide is estimated to be 4%–8% in people with mood disorders. The literature suggests that a history of suicide attempts is significantly related to electrodermal hyporeactivity and that patients with violent suicide attempters exhibit faster habituation of the electrodermal response to repeated neutral tones than patients with non-violent attempts. The impact of depressive symptoms on suicidal ideation may be moderated by resilience. Resilience refers to the ability to maintain o regain mental health despite experiencing adversity. In bipolar and depressive disorders, resilience may influence severity of episodes, frequency of relapse and response to treatment.

Aim

The objective of our study was to assess the possible correlation among attempted suicide, resilience and dermal reactivity in a sample of depressed patients.

Methods

We recruited patients with depressive disorders and bipolar depression; data about socio-demographic, clinical features, severity of attempted suicide and suicidal risk were gathered. Patients filled in the Resilience Scale for Adult (RSA). Moreover, for each patient we performed the Edor test in order to assess dermal reactivity.

Results

Data collection is still ongoing. We expect to find lower levels of resilience in those patients who are hyporeactive and attempted suicide. Moreover, we hypothesize that suicide attempts in the group of hyporeactive patients would be characterized by planning and greater severity. Clinical implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide: A major public health problem
Authors: Hernandez Anton R. , Dominguez Alvarez E. , Alvarez Astorga A. , Rybak Koite E. , Gomez Sanchez S. , Rodriguez Andres L. , Mayor Toranzo E. , Hernandez Garcia M. , Blanco Garrote J.M. , Maderuelo J.M. , Garcia Santos M.V. , De La Red Gallego H. , Uribe Ladron De Cegama F.
Published: May 2016

Introduction

Suicide is the deliberate act of take off life to itself. According to WHO, more than one million people commit suicide every year.

Goals

Compare data of suicide attempts between 1996 and 2014 in the University Hospital of Valladolid. Influence of the economic crisis on suicide data. Expose the risk factors. Provide prevention strategies.

Material and methods

We have performed a study of epidemiological surveillance collecting descriptive data of suicide attempts; using the same methodology as in 1996. The variables studied were: sex, age, day, month, residence, method, personal status, education, employment status, religious believes, family history of suicide, psychiatric history and family and personal psychiatric history.

Results

Increase in the rate of suicide attempts 27%. Distribution by sex is similar, but in 2014, a higher proportion was observed in males. The percentage of women is significantly higher than that of men in the group of teenagers (10–19 years old) (20% women vs. 4.5% of men; P = 0.005); 83.5% have a psychiatric diagnosis (54.2% of them have a depressive disorder). Unemployment and economic problems stand out as environmental stressors in 2014. The main suicide method used in Valladolid is the hanging, and the second method used is the precipitation.

Conclusions

The primary, secondary and tertiary prevention strategies are very important. Suicide is the major cause of mortality in the young age group (15–24 years old). Mortality in the general population has been on a downward trend; but suicide rates per 100,000 population has remained stable over the last decade.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Physician suicide prevention
Authors: Poças A. , Pinto Almeida S.
Published: May 2016

Every year there is a medical school full of physicians who commit suicide. Depression is a major risk factor and physicians frequently fail to recognize their own depression and that or their colleagues. Even when they do, many of them avoid treatment. The greater knowledge of lethality of drugs and easy access to means can contribute to the higher suicide rate among physicians.

Some studies say that training physicians are at particularly high risk of suicide, with suicidal ideation increasing more than 4-fold during the first three months of internship year. In Portugal, there are no reliable statistics about resident's suicide. We do not even talk a lot about it and the collective silence only compounds the problem – the refusal to speak perpetuates the stigma that mental health problems are signs of weakness or failure. Assess existing resources and best practices should be the next step to establish training programs to suicide prevention in these professionals, addressing response programs. As primary prevention, we should act in order to prevent healthy medical students or physicians from developing a condition that would lead to suicide. A randomized clinical trial in US with 199 residents from multiple specialties found that a free, easily accessible, brief web-based cognitive behavioural therapy program is associated with reduced likelihood of suicidal ideation among medical residents.

It is also essential too early diagnose and treat after the illness onset. Moreover, it should exist a rehabilitation of suicidal physicians and their return to maximal function with minimal risk for recurrence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictors of suicidal behaviour persistence and recurrence
Authors: Untu I. , Cartas N. , Mutică M. , Ciubară B.A. , Ciubară A. , Roxana C.
Published: May 2016

Introduction

Suicidal behaviour represents a global public health issues; personal suicidal history is the most common predictor of the persistence and recurrence of suicidal ideation and behaviour in general.

Objective

This paper proposes to elaborate a synthesis of the scientific literature, concerning the main predictive factors of the persistence and recurrence of suicidal behaviour, considering that the current diagnostic criteria available fail to make a distinction and to specify clearly the differences between all psychiatric disorders without self-harming behaviour and the same nosological entity accompanied by suicidal behaviour.

Materials and methods

I conducted a literature review, by analyzing the data concerning the predictors of the persistence and recurrence of self-harming behaviour, obtained from articles published between January 2013 and January 2015. I browsed the PubMed website, by keywords such as suicide, suicidal risk, suicide predictor, persistent suicidal ideation, and suicidal behaviour recurrence.

Results

The scientific literature underscores that that entrapment and defeat are two elements often neglected; however, they should be a priority criterion, alongside traditional predictive factors, such as the following: gender, age, history of suicide attempts, socio-familial status, etc. All of these factors must be considered within the complex endeavour of assessing suicidal risk. However, there is still only scarce validated data concerning the mechanism that leads to entrapment and the one that determines its relation with self-harming behaviour.

Conclusions

This paper proposes to synthesize the current data concerning suicide predictors, in order to obtain new research assumptions. The final purpose is to develop proper preventive and therapeutic approaches.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive engagement profile of the fluency tasks performance by patients with schizophrenia
Authors: Karakula-Juchnowicz H. , Krukow P. , Morylowska-Topolska J. , Flis M.
Published: May 2016

Introduction

Fluency tasks, e.g. verbal, design fluency test, etc. are often used in the evaluation of cognitive function in patients with schizophrenia. In the standard approach, the test result is the sum of stimuli generated in a given time period. However, this approach does not allow to determinate of what strategies are used by subjects to regulate the cognitive engagement during task execution.

Aim

To investigate the specific dynamic profile of fluency tests performance comparing with healthy controls.

Methods

Thirty patients diagnosed with schizophrenia and 30 demographically matched healthy controls took part in the study. Participants performed two tests: COWAT (3 trials) and Ruff Figural Fluency Test in accordance with the original instructions. During the generation of these stimuli, the investigator wrote down their quantity in 15-second intervals, which enables the assessment of cognitive engagement variability in different parts of the whole time (1 minute).

Results

Comparison of cognitive engagement variation in both fluency tests showed statistically significant differences. The differences in repeated measures ANOVA with group as an independent variables reached P < 0.0001. Factor differentiating the profiles in verbal and figural fluency was first 15 seconds after the tasks started.

Conclusions

The beginning of task was the most difficult part for patients with schizophrenia, which may indicate that the overall worse performance of fluency tests is associated with significant difficulties in mobilizing the cognitive activity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Erotomania: A case and review
Authors: Almada A. , Luengo A. , Casquinha P. , Heitor M.J.
Published: May 2016

Introduction

Erotomania (“Clérambault's syndrome”) is a rare syndrome characterized by a delusional belief of being loved by another person, usually of higher social status.

Objective

This case report aims to describe and discuss a case of erotomania, providing an updated review on this disorder.

Methods

Regular clinical interviews were performed during admission period to collect information about the clinical case and to promote an intervention approach to the patient. A literature review in Science Direct database, with the keyword “erotomania”, was also conducted.

Results

A 51-year-old woman was admitted in Beatriz Ângelo Hospital psychiatric ward with delusional beliefs of being loved by the ex-boss. Positive misperceptions and persecutory delusions regarding her husband as the obstacle for the love were manifested. The lack of insight for the situation and the necessity of treatment created some difficulties. A clinical report and a bibliographic review were made to allow a better understanding about the case and to orient the case evidence based.

Conclusions

Despite the evidence about the good response of atypical antipsychotics (e.g. risperidone) in erotomania, in our case study, the partial remission was only achieved with high dose of the old typical antipsychotic, pimozide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Temporal correlates of intuition and cognitive control in moral decision, making in different social contexts
Authors: Keshvari F. , Rezvani Z. , Ghassemi F. , Pouretemad H.
Published: May 2016

In the stream of flurry of publications grappling different paradigms to tackle underlying mechanisms of moral decision-making, EVENT RELATED POTENtial (ERP) studies is beginning to explore psychophysiological components in the moral domain, focused on observing various moral behaviors in the experimental situations. This research was aimed at providing a new method of study investigating neural correlates of subjective moral decision-making in which we hypothesize that the social congruent or in-congruent context, could emerge a salience brain response in intuitive or cognitive control related responses toward moral dilemmas. Electrophysiological data were recorded from the scalp a 32-channel recording system complying with the international 10–20 system. The average N2 (175–300 ms) and LPP (300–600 ms) amplitude and latency were measured after the onset of putative counterpart response. Repeated measure ANOVA revealed that there was a difference between congruent versus in-congruent social response to high conflict scenarios in LPP amplitude in right lateral and frontal electrodes F(4, 174) = 5.812, P < 0.001 (Fig. 1). The findings also, suggest that N2 latency in less conflict moral scenarios may appear earlier compared with high conflict moral scenarios during in congruent social response in frontal electrodes especially left area F(3, 174) = 3.013, P < 0.05 (Fig. 2, figures are not available for this abstract). In conclusion, these results were either extend previous neurophysiological findings on classic moral scenarios and consistent with the notion that right hemisphere would be much more representative of cognitive control process during high conflict moral decision-making, while left frontal electrodes engaged in early intuitive process.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Brief psychotherapy in eating disorders
Authors: Garcia E. , Leon M. , Polo F. , Martinez R.
Published: May 2016

First time we began to work with eating disorders, we used to hear the chronic course of the illness and the long-term treatment that our patients would need. When you have a team trained in brief psychotherapy, but not in this specific area, it sounds as just the opposite you try to reach with your patients. National guidelines however are full of psycho-educational and cognitive-conduct treatment's models, without any other validated kind of treatment. However, it was our experience that solution focused or problem focused therapy were also two clinical effective approaches to many psychiatric problems. In fact, we had a mature consult, in which as far as two thirds of patients had become, some way chronic. Problem was, as far as we can imagine, if that was a disease's effect or a lack of a deeper intervention, which were wider than those classic. So, we classified our patients in resistant or not resistant, and doing so we add brief therapy to the first group, reevaluating every week each intervention and the course of the illness. By doing so, we found that chronicity was, in same cases, just the result of limited treatments. Here we have analysed some chronic patients with a bad course and the alternatives that let them to recover.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Misuse of trihexyphenidyl: Factors associated to the prescription
Authors: Hajji K. , ilyes M. , Soumaya F. , Samira Y. , mohamed N.
Published: May 2016

Introduction

Trihexyphenidyl (THP) is an anti-Parkison and anticholinergic drug. It is essentially prescribed by psychiatrists in order to treat abnormal movements and Parkinsonism induced by antipsychotics. However, in unusual practice, the THP is widely used by patients.

Aims

To assess different factors associated to the prescription of trihexyphenidyl in patients treated with neuroleptics.

Methods

A cross-sectional, descriptive, comparative and analytical study among 153 patients followed in outpatients clinics and treated by antipsychotics.

Results

During a six-month period, 153 patients were interested by the study. In total, 79.73% of them were receiving a treatment by THP. Mean age was 47.79 years old. Almost patients were married (44.1%), having a primary level education (46.7%) and jobless (66.7%). Mean factors associated to THP prescription were: hospitalization in a psychiatry unit (P = 0.025), good evolution of mental disorder during hospitalization (P = 0.008), regular follow-up (P = 0.005), episodic evolution and existence of residual symptoms (P = 0.001), personality disorder (P = 0.025) and somatic comorbidities (P = 0.001). Prescription was crucial in order to indicate necessity of THP. Doses of neuroleptics were a determinant factor (P = 0.0001). Forty-one percent of patients were receiving more than one treatment (P = 0.0001). In most cases, prescription consists of classic antipsychotics (67.60%).

Conclusion

Prescription of THP should be argued, considering different factors associated to the prescription, in order to prevent misuse of the drug.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Some side effects of antipsychotics
Authors: Montes Reula L. , Ballesteros Prados A.
Published: May 2016

Background

Pharmacological treatments for chronic diseases cause side effects. It is important to identify which of these effects could be avoided because it is a cause to drop the treatment. In the chronic psychiatric illness, one of the problems is the induction of changes in prolactin (PRL) serum.

Purpose

Review of the literature that has been published to assess the association between different types of antipsychotic drugs and prolactin levels.

Method

Literature search on PubMed, NCBI literature in the last three years using MeSH terms: “prolactin” and “antipsychotics”.

Conclusions

The increase of prolactin is a common effect poorly studied in the past. After several studies have been able to achieve treatments, called “atypical”, which cause less effect on this substance. For example, asenapine, olanzapine and zyprasidone have a slight effect on PRL levels. Aripripazole could even result in lower levels probably by partial agonism on dopamine receptors. Therefore, we have to make a good clinical practice taking into account the effectiveness and tolerance and interpersonal variation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depressive pseudodementia in Greek patients: How differential diagnosis can lead to early diagnosis
Authors: Lyrakos G. , Tsioumas N. , Spinaris V. , Margioti E. , Sakka P. , Spyropoulos I.
Published: May 2016

Background

The term Pseudodementia, as presented by Kiloh, is being used to describe the clinical image characterized by depression combined with impairment in cognitive functions which reacts positively in treatment with antidepressants.

Aim

To explore the aspects that make this condition unique, so that mental health professional will be able to use the proper psychometric tools when they face patients with confusing symptoms.

Method

Hundred and thirty-one participants were recruited from the B’ Psychiatric Clinic of G.H.N.P “Agios Panteleimon” and Day Center of Alzheimer's Disease in Amarousion, with 56 (42.7%) males and 75 (57.3%) females. All participants were administered the MoCA and the DASS21 questionnaires. Statistical analysis was performed with SPSS21.

Results

The findings reported a significant difference in the scores of MoCA done by patients with dementia (M = 13.9, SD = 5.4) and patients with depression (M = 20.5, SD = 4.9) while both groups scored below the accepted scores indicating cognitive impairment [CI]. However, analysis showed that in the following sectors of MoCA, depressive patients scored significantly higher than demented ones: visuospatial (MD = 0.651), clock (MD = 1.288), orientation (MD = 1.212) and delayed recall (MD = 1.329).

Conclusion

Findings shows a significant pattern in the difference between depressed and patients with cognitive impairment. These findings suggest that mental health professionals should use neuropsychological measurements like MoCA when evaluating such cases in order to be able to diagnose effectively cases of pseudodementia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effect of relaxation techniques and trigger points therapy on stress reduction of patients with mental health disorders in a Greek hospital
Authors: Lyrakos G. , Menti D. , Spyropoulos I. , Spinaris V.
Published: May 2016

Background

Patients with mental health disorders usually suffer from high stress levels. Trigger points therapy has been shown to be very effective in providing prompt relief from stress in these patients.

Aim

To investigate the effect of the combined use of relaxation techniques and trigger points therapy on stress levels of patients with mental health disorders.

Method

Thirty-one patients participated in this study, 14 (45.2%) males and 17 (54.8%) females, with a mean age of 39. Out of them, 10 (32.3%) suffered from anxiety disorders, 6 (19.4%) from obsessive compulsive disorder, 10 (32.3%) from depression and 5 (16.1%) from chronic condition stress. Data analysis was conducted with t-test analysis and ANOVA, using the SPSS software.

Results

The findings revealed significant differences on stress levels before and after the use of relaxation techniques and trigger points therapy as t(30) = 18.316, P < 0.0001. Before the use of relaxation techniques and trigger points therapy, individuals reported higher stress levels (M = 6.129, SD = 1.087) compared to after the therapy (M = 1.741, SD = .889). Moreover, significant differences were found in stress reduction with regard to psychiatric illnesses (F(3,27) = 5.027, P = 0.007). More specifically, individuals with depression reported lower reductions in their stress levels after the therapy compared to both those with chronic condition stress (M = –2.1, SD = 0.61, P = 0.013) and anxiety disorders (M = –1.4, SD = 0.503, P = 0.05).

Conclusion

The findings of this study highlight the importance of using trigger points therapy, combined with relaxation techniques, to reduce stress levels of patients with mental health disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The utility of omega-3 fatty acids in depression
Authors: Quintanilla M.A. , Salas A. , Pedrosa S. , Bosqued L. , Perez C. , Villagrasa B. , Aguado B. , Gracia P.
Published: May 2016

Introduction

Recent studies have reported therapeutic benefit from the use of omega-3 fatty acids (EPA and DHA) as adjunctive treatment of depression.

Objectives

The goal of this work is to assess the effectiveness and tolerability of dietary supplementation with omega-3 in the treatment of depressed patients.

Method

Prospective, descriptive, observational study in a general psychiatry outpatient clinic. Consecutive inclusion of depressed patients started on dietary supplementation with omega-3 because of partial response to antidepressants and/or intolerance to high doses or combination of antidepressant drugs between January and May 2015. Sociodemographic variables, clinical data and information about tolerability were recorded. Clinical response to treatment over time was assessed at 4–6 months follow up using the 5-item CGI (Clinical Global Impression) scale.

Results

We included 30 depressed patients started on omega-3. None of them reported side effects. Seventy-three percent of patients reported clinical improvement (40% much improvement, 33% some improvement). None of them got worse. We did not find association between clinical response and age, sex, type of depression nor duration of illness.

Conclusion

Despite the limitations of this study, our work support previous positive results on the use of omega-3 fatty acids (EPA and DHA) as adjunctive treatment of depression. Giving the safety of its use, clinicians might recommend omega-3 as adjunctive treatment of depression in cases with a partial response to antidepressants.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Codependency in mothers of addicted persons: Cross-cultural differences between Greece and Bulgaria
Authors: Giannouli V. , Ivanova D.
Published: May 2016

Introduction

The people who maintain close relationships with relatives suffering from addiction to psychoactive substances may become more sensitive to develop a physical, mental and emotional state, similar to an emotional addiction.

Objective

The aim of this study is to give a cross-cultural perspective to codependence and reveal the profile of female relatives of addicted persons in Greece and Bulgaria.

Method

Thirty-nine Greek mothers of addicted persons from Greece (Mage = 43.97, SDage = 18.34, all high school graduates), a similar group of forty Greek female participants (32 mothers of non-addicted persons, Mage = 40.97, SDage = 17.22, all high school graduates), and thirty Bulgarian women (all mothers of addicted persons, Mage = 53.55, SDage = 5.58, all high school graduates) were examined with the STAI-state questionnaire, the ZUNG Self Rating Depression Scale and the Questionnaire of Establishment of Codependency.

Results

Results indicated that there are statistically significant differences between the Greek and the Bulgarian female relatives of addicted persons on the scores ofZUNG (MGreek = 51.64, SDGreek = 2.07, MBulgarian = 73.63, SDBulgarian = 4.04) and STAI (MGreek = 53.89, SDGreek = 2.68, MBulgarian = 74.16, SDBulgarian = 4.84), but not for the Questionnaire of Establishment of Codependency. Statistically significant differences in all three questionnaires were found for the groups of Greek mothers of dependent and non-dependent persons (P < .005).

Conclusions

This research suggests that although there is more anxiety and depression reported by the Bulgarian mothers of addicted persons, no cross-cultural difference was found for codependence in mothers of addicted persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Acute psychosis induced by short-term treatment with methylprednisolone – a case report
Authors: Andrei I.A. , Cristache A.M. , Parfene-Banu M.E. , Frunză A.A. , Boer M.C. , Puiu M.G. , Patrichi B.E. , Manea M.
Published: May 2016

Steroid treatment has been widely used for immunologic and inflammatory disorders. Psychiatric symptoms are not uncommon complications of the corticosteroid treatment. Correlations between the hypothalamic-pituitary-adrenal (HPA) axis and various psychoses have been already established in the specialty literature (modified HPA activity by drugs or not, glucocorticoid receptors downregulation, reduced hippocampal volume). The prevalence of corticosteroid-induced psychotic disorders varies around 5–6%. Most corticosteroid-induced symptoms start during the first few weeks after treatment initiation, but their onset can also be in the first 3–4 days. We would like to report the case of a 30-year-old woman who was taken to the psychiatry emergency room for psychomotor agitation, auditory and visual hallucinations, and bizarre delusions, disorganized thinking and modified behavior. The patient had no personal or family history of psychiatric illness. One month earlier, she was admitted in a neurosurgery ward and underwent lumbar surgery for L4–L5 disc protrusion; at discharge, eight days later, she began treatment with methylprednisolone 80 mg/day for three days. One week later, psychotic symptoms emerged that resulted in her hospitalization in our ward for apparent steroid-induced psychosis. Treatment with risperidone (up to 6 mg/day) and diazepam (10 mg/day, rapidly discontinued) was initiated. The endocrinology examination revealed modified plasmatic cortisol. The psychosis resolved several weeks later and the patient was discharged. Psychiatric complications induced by steroids underline the role of physicians that have to educate the patients and their families about these side effects and their early recognition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Typical profiles of multiple DWI indivisuals on MMPI-2
Authors: Shim I.H. , Woo W.S. , Seo H.J. , Jon D.I. , Kwon Y.J. , Lee K.H. , Min K.J. , Yoon B.H. , Lee J.H. , Lim E. , Bahk W.M.
Published: May 2016

Introduction

Alcohol intoxication is often involved in the commission of criminal behaviors that are risky and involve personal confrontation. Individuals who reported having three or more drinks before driving exhibited greater impulsivity when under the influence of alcohol than did those who did not report heavy drinking before driving.

Objectives

The present study utilized the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) to compare the characteristics of individuals with a single driving while intoxicated (DWI) offense with individuals who were multiple DWI offenders and to identify whether there was a typical profile for multiple offenders.

Methods

The charts of patients were examined in terms of demographic characteristics including age, sex, employment, and education; the MMPI scores of the two groups were compared using an independent t-test, and we identified the typical profile of multiple DWI offenders by using hierarchical cluster analysis with Ward's method.

Results

Scores on the F and the depression (D) scales of the MMPI-2 were significantly higher among multiple offenders than among first offenders. The multiple offenders-I group obtained relatively high scores on the D and psychopathic deviate (Pd) scales, and the multiple offenders-II group had low scores on both the hypomania (Ma) and social introversion (Si) scales. Thus, some multiple offenders may have poorer emotional adjustment, characterized by tendencies toward psychopathic deviance, mania, and depression, as well as psychopathological characteristics associated with patients with alcohol-use disorders.

Conclusion

The present findings suggest that multiple offenders should be considered a high-risk group for alcohol-use disorders and recurrent drunken driving.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Excerpt from the history of the “Hochschulpsychiatrie Erlangen” (1818–2016): On the history of a connection between University and Institutional Psychiatry, Unique in Germany (1903–1974)
Authors: Braun B. , Kornhuber J.
Published: May 2016

Objective

To examine the more than 70-year history of a connection between University and Institutional Psychiatry.

Method

Relevant archival material as well as primary and secondary literature were examined.

Results

As early as 1818 Johann Michael Leupoldt (1794–1874) held a seminar on “madness” as an assistant professor in Erlangen. But the University Psychiatric Clinic did not begin until 1903 within the association of the mental asylum founded on a contract agreement between the Friedrich-Alexander, University Erlangen and the County Senate of Middle-Franconia. The history of the “Hochschulpsychiatrie Erlangen” reflects part of the history of German psychiatry. The plans to accomplish independence were doomed to impracticability by the social-political situation before, during and after the First and also Second World Wars. Clinic patients were registered as “Institutional residents”, the Clinic had no income of its own, the Head of Department and Director of the Clinic was formally considered as the “senior doctor of the asylum”.

Discussion

The complicated duty dependence of the Head of Department on the Director of the asylum undoubtedly contributed to their decades spanning “mésalliance tradition”. A public scandal arose in 1978 from an accusation of dereliction of duty to the government of Middle-Franconia because of lacking protection of patient documentation and medications during the relocation of the former institution departments to the newly constructed Regional Hospital on the Europakanal.

Outlook

Cooperation between the University Clinic and the Regional Hospital exists in altered form today. The Psychiatric Clinic can thus include patients from the Regional Hospital in scientific studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Characteristics of inpatients admitted to National Asylum of Leganés in the early twentieth century (1900–1931)
Authors: Candela Ramírez R. , Vázquez de la Torre Escalera P. , Conseglieri Gámez A.
Published: May 2016

Introduction

Leganés Psychiatric Hospital has been the subject of several studies about its institutional history, clinical activity and demography of its institutionalized population. The first decades of the twentieth century are the less explored years; however, important events for the development and establishment of the discipline of psychiatry happened in Spain during this period.

Objectives/aims

To describe the sociodemographic and hospitalization characteristics of the patients who were admitted to Leganés National Asylum between 1900 and 1931.

Methods

This is a retrospective case series study. We reviewed medical records found in the Historical Archives of Psychiatric Institute Germain (n = 1043) of inpatients admitted between 1900 and 1931. We analyzed sociodemographic and hospitalization related variables of medical records with SPSS v21. We consultedbibliography, such as asylum documents and diverse primary and secondary literature.

Results

Most inpatients were male, single, with an average age of 38 years, came from home and were admitted as fee-paying boarders. Circa 64% of them remained in the institution until death and the average stay was 7.92 years.

Conclusions

Even though the Leganés Asylum was born amidst debate on the asylum model, it did not meet the expectations. Among other reasons, it presented serious architectural deficiencies and was unable to classify inpatients according to the French tradition (agitated, dirty, quiet) or to separate populations, such as minors or criminal inpatients, thus becoming a charity institution asylum instead of a therapeutic mental hospital.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Disruptive behaviour's treatment with paliperidone in autistic disorder: Review and case report
Authors: García Moreno M. , De Cós Milas A. , Beatobe Carreño L. , Poza Cano B.
Published: May 2016

Introduction

Autistic disorder (AD) is a neuropsychiatric disorder that often presents significant disruptive symptoms such as irritability, aggression and self-injury in addition to impairment of social skills and communication. These symptoms interfere both individuals with AD and their families and social environment.

Objective

Show paliperidone effect in behavioural symptoms in AD.

Methods

Literature review about behavioural symptoms in AD and paliperidone effect in its treatment, followed by a case report of clinical improvement after treatment with paliperidone in a patient with autism. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores was compared prior and 4 weeks after paliperidone treatment, and clinical improvement was assessed with Clinical Global Impression-Improvement Scale (CGI-I).

Results

Although risperidone has been one of the most studied atypical antipsychotic to treat this symptoms, its use should be limited in order to avoid extrapyramidal and metabolic symptoms. Paliperidone – the major metabolite of risperidone – has shown effectiveness in the treatment of behavioral symptoms in patients with autism, even in subjects with a prior ineffective trial of risperidone. Our patient, 21-years-old male with AD and significant disruptive symptoms was treated with paliperidone 9 mg/day. We observed a 20-points reduction in ABC-I scores 4 weeks later, with most significant improvement in items like auto-agression, heteroaggressivity, irritability and slams. CGI-I scores showed a much better improvement, and no significant adverse effects appeared.

Conclusions

Paliperidone is an effective and safe treatment in behavioral symptoms associated to AD, with reduction in ABC-I subscale scores. More studies are needed to confirm our data.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mechanical restraint and staffing level in a psychiatric ward
Authors: Kodal J.S. , Kjær J. Nørgaard , Severinsen J. Dahlstrøm , Larsen E. Roj
Published: May 2016

Introduction

The use of coercion raises ethical dilemmas, as it deprives patients of their autonomy. In Denmark, the subject has gained political attention, and decreases in the use of coercion are demanded. In the attempt of reducing the use of coercion, it is of interest to obtain more knowledge about the circumstances bound to it.

Aim

The aim of this study was to investigate a possible correlation between the incidence of mechanical restraint (MR), and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts.

Methods

A naturalistic descriptive method was used to study cases of mechanical restraint in patients admitted to a psychiatric ward. In the study period of one year, 114 cases of MR were carried out. In 66% of cases, the patient was diagnosed with borderline personality disorder. Each case of MR was obtained from Statens Serum Institut's Electronic Reporting System. The care workers from each shift were identified using duty rosters. The statistical package SPSS version 20 was used for data processing, including a logistic regression analysis.

Results

A significant association was found between the use of MR and the presence of male care workers on the ward, OR = 1.639, 95% CI: 1.163–2.311, P = 0.005. The risk of MR is increased during evening shifts, compared to day and night shifts, OR = 1.868, 95% CI: 1.165–2.995, P = 0.009. No significant associations were found between MR and staffing level, age, education, or experience of care workers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Evidence-based mindfulness
Authors: Maldonado Fernandez M. , Rubio Rodriguez L. , López Fernández J.
Published: May 2016

Introduction

Mindfulness is a form of meditation that cultivates present moment awareness in a non-judging way. It has a Buddhist origin but has been practiced in the last 40 years without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.

Objectives

To carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.

Aims

To summarize the existing evidence on the efficacy of mindfulness.

Methods

We searched for systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library).

Results

We found nine Cochrane reviews (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders, reducing sedentariness at work, anxiety, somatoform disorders, and post-stroke fatigue), two Cochrane review protocols (stress reduction of patients with breast cancer, and substance use disorders), 50 non-Cochrane reviews (29 provisional abstracts and 21 structured abstracts from the Centre for Reviews and Dissemination) on the efficacy of mindfulness. The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time. For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term.

Conclusions

According to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas where high quality clinical trials are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Autoimmune limbic encephlitis. A rising differential diagnosis between diseases with psychiatric symptoms
Authors: Martín Álvarez C. , Cadenas Extremera F. , Alonso García V. , del Valle Loarte M. , Bravo Arraez M. , Mainar de Paz V.
Published: May 2016

Introduction

In psychiatric clinical practice, we can face numerous organic diseases in the differential diagnosis between primary psychiatric disorders. As an example of this, we can see the autoimmune limbic encephalitis(LE), which in a significant percentage of cases begins with psychiatric symptoms. Currently, one of the theories of the origin of the LE is as a idiopathic autoimmune entity, leaving behind the idea of been generated only by a viral or paraneoplastic etiology.

Objective

To achieve a better knowledge about this underdiagnosed entity, presenting a case of an anti-LGI1 limbic encephalitis.

Case

A 60-year-old Caucasian woman who starts with neuropsychiatric symptoms as: behavioral disorders, manic symptoms, memory impairment and attention deficit.

Results

Finally, the diagnosis was confirmed when the patient had positive results in both serum and CSF samples for anti-LGI1 antibodies. Gastric neuroendocrino tumour type I was discovered. Neither paraneoplasic syndrome nor onconeuronal antibodies were shown. A thin hyperintense signal was identified in the left hippocampus using a brain MRI. Despite the patient had been treated with corticosteroids, immunosuppressants and immunoglobulins, she still showed positive antibodies in CSF samples with poor clinical results, especially psychiatric symptoms. The patient required one psychiatric hospitalization due to reference and persecutory delusions and manic symptoms.

Conclusion

Our patient had an unsatisfactory evolution with little response to immune treatment. Given the possible underdiagnosis of this condition, the importance of a differential diagnosis and an early treatment, we consider that there is an important need for a greater knowledge and scientific divulgation of this clinical entity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The chaos involved in Münchausen syndrome and Münchausen syndrome by proxy
Authors: Gherman L.D. , Ciobanu A.M. , Căpraru N. , Mihăilescu A.I. , Gâză L.M.
Published: May 2016

Background

Encountering a patient with Münchausen syndrome (MS) or with MS by proxy is more frequent than it is assumed. Treating this type of patient is indeed a challenge, thus, knowing to depict the signs is important for every doctor. A specific therapeutic approach is needed and sometimes, even law enforcement must be involved.

Objective

We plan to highlight the signs and consequences of Münchausen syndrome and Münchausen syndrome by proxy.

Method

Clinical data were collected during admissions of patients in the psychiatric hospital. A literature review has been performed.

Results

We report the case of a nurse diagnosed with MS, who had multiple admissions with different diagnostics, before the patient was exposed with the factious disorder diagnosis. We also report the case of a mother diagnosed with MS by proxy and the case of another mother where the obsessive-compulsive elements of her depressive disorder are combined with signs of MS by proxy, both of them inflicting consequences upon the child in care.

Discussion and conclusions

Patients suffering from Münchausen syndrome and Münchausen syndrome by proxy can be a burden for society and for themselves. The relationship with them is sabotaged from the start. The diagnostic is difficult to establish. Numerous expensive procedures are being taken and a considerable amount of funds is spent. Most importantly, the abuse of a child with a parent or guardian suffering from this disease is incommensurable and can even lead to death. It is vital to take action as soon as these syndromes are discovered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.