bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of a smoking cessation program in primary care
Authors: de la Red Gallego H. , González Silva Y. , Montero Carretero T. , Delgado de Paz Á. , Sánchez Añorga M.F. , Cañibano Maroto E. , Isidro García G. , Álvarez Astorga A. , Alonso Sánchez A. , Martín Fernández M. , Álvarez Hodel A. , Pérez González I. , Nieto Sánchez S. , Calvo Sardón S. , González Gurdiel I. , Hernández Antón R. , Gómez Sánchez S. , Noval Canga C. , Hernández García M.S. , Rodríguez Andrés L.
Published: May 2016

Introduction

Smoking is an addictive and chronic disease. Twenty-four percent of the Spanish population in 2012 smoked daily.

Aims and objectives

To evaluate a smoking cessation program in a Primary Care Center.

Methods

Observational, prospective study. We describe an individualized smoking cessation in Plaza del Ejército Health Center (Valladolid). Inclusion criteria: active smoker, ≥ 18 years old and belonging to the Health Center. Exclusion: severe mental illness. Included patients from November 2013 until January2014. Ended in July 2014. Four Medical residents participated, we present the results of one of them. During the first consultation motivational interviewing was conducted, physical examination and treatment was prescribed (cognitive behavioral therapy or drug treatment: varenicline). In subsequent consultations interview and follow-up. Variables: age, gender, pack-years, nicotine dependence (Fagerstrom) and Prochaska and DiClemente phase, weight, treatment used, dropout rate and final withdrawal of snuff.

Results

Eleven patients, mean age 48.18 (13.61), 7 (63.6) women. Comorbidity: 6 (54.5) anxious-depressive pathology, 1 (9.1) dysthymia, 2 (18.2) endocrine pathology and 1 (9.1) respiratory disease. Four (36.4) showed high dependency and 2 (18.2) extreme. Media packages 20.50/year (19,20). Seven (63.6) were in action phase of Prochaska and DiClemente and 2 (18.2) in preparation. Visits range: 1-11. The average was 4.55 (3.64). Three (27.27) patients attended only the first visit. Four (36.4) achieved complete abstinence, 3 (27.27) met maintenance phase. One (9.1) reduced consumption in half. Patients gained average 0.5 kg (2.47).

Conclusions

The results are similar to those reported in other series. Modest dropout rate. No pharmacological treatment was used due to high coexistence of comorbidities, the only patient who used varenicline suffered insomnia. Average age and media packages were superior to other series.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression, anxiety and panic disorders in chronic obstructive pulmonary disease: Correlations with disease severity and quality of life
Authors: Gherghesanu R. , Trofor L. , Pascal I.O. , Chirita R. , Frunza A.
Published: May 2016

Introduction

Depression, anxiety and panic disorders are often encountered in chronic respiratory disorders, like chronic obstructive pulmonary disease (COPD), especially in severe disease stages with impaired quality of life.

Aim

To assess anxiety, depression and panic disorders among patients diagnosed with COPD and to correlate them with respiratory disease severity and quality of life.

Material and method

We investigated the profile of anxiety, depression and panic attacks in relation to patients’ medical history, demographic data, smoking status, COPD staging and disease severity (estimated by CAT quality of life questionnaire, GOLD guideline staging).

Results

A total of 60 COPD patients were enrolled. Smoking profile showed more intensive smoking in men (35.81 mean packs-years versus 24.38 in women). The COPD high-risk group type D was predominant, with severe dyspnea, decreased lung function, frequent exacerbations and low quality of life (mean CAT score: 21.75). Mean distribution of anxiety and depression symptoms among COPD subjects was corresponding to a 10.65 ± 3.54 SD anxiety score, respectively to 9.93 ± 3.80 SD depression score. Panic attacks were found in 43.3% of the patients.

Conclusions

Anxiety, depression and panic attacks were frequent findings among severe, unstable COPD patients. More carefully screening for anxiety, depression and panic attacks in this category of patients, thus adding a specific psychotherapeutic component to the COPD general treatment plan, would improve patients’ health benefits.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The relationship between previous trauma and alcohol and substance misuse in women
Authors: Husain M. , Moosa K. , Khan K.
Published: May 2016

Introduction

The association between previous trauma and the development of alcohol and substance misuse is well established, however, much of the research is focused on the association of PTSD with alcohol and substance misuse. This research will be focussing on trauma in general and its influence on the development of alcohol and substance misuse in women.

Objectives

The main objective of this study was to investigate the relationship between previous traumatic events and the development of alcohol and substance misuse in women.

Methods

This was a retrospective case note study of 146 female patients from a UK based detoxification and rehabilitation centre. Trauma history from patient files were audited, with the trauma experienced being assigned a category.

Results

Out of 146 women with alcohol and/or substance misuse, 132 (90%) had experienced a previous trauma. The types of trauma experienced include; domestic (53%), traumatic grief (36%), sexual abuse (35%), physical (15%), bullying (4%) and neglect (4%). These results show that women who suffer from alcohol/substance misuse are highly likely to have suffered a previous trauma.

Conclusions

The results from this study suggest that women who have suffered previous trauma are high risk for alcohol and substance misuse problems, therefore early intervention and a robust psychological support system should be provided to women who have a history of trauma. Furthermore in addition to addiction treatment and behaviour focused therapy already in place trauma focussed therapy may prove beneficial.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association between circadian rhythm, sleep disturbances and temperament in major depression, bipolar disorder and schizophrenia
Authors: Tunç S. , Yağcı İ. , Yenilmez Bilgin Y. , Canbek Ö. , Atagün M.İ. , Hüseyinoğlu N. , Ardıç S.
Published: May 2016

Introduction

Circadian rhythms and quality of sleep have been associated with temperament characteristics in healthy populations. Since temperaments are personality traits concerning the behavioral, motivational and emotional responses, adaptive capacity for sleep and circadian rhythm may also be related with temperament traits.

Aims

To identify the determinants of sleep quality (SQ) and biological rhythm (BR) in bipolar disorder, schizophrenia and depression among temperament measures.

Methods

Patients with bipolar disorder (BD, n = 49), major depression (MD, n = 35), schizophrenia (SZ, n = 30) and a healthy control group (HC, n = 36) were enrolled. Pittsburgh Sleep Quality Index (PSQI), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and the Temperament and Character Inventory (TCI) were the measures. One-way ANOVA, Spearman Correlation Test and Linear Regression analyses were the other comparisons.

Results

Determinants of sleep quality were self-directedness in MD [F(1,26) = 6.10, P = 0.020] and BD [F(1,31) = 10.88, P = 0.002] groups. Self-transcendence (P = 0.004), self-directedness (P = 0.038) and persistence (P = 0.05) were the determinants of sleep quality in schizophrenia group [F(3,21) = 9.71, P < 0.001]. Harm-avoidance was the determinant of sleep quality in the HC group [F(1,28) = 7.97, P < 0.001]. Determinants of biological rhythms were harm-avoidance in the BD group [F(1,32) = 9.65, P = 0.004] and self-directedness in the SZ group [F(1,23) = 11.09, P = 0.003] and harm-avoidance (P < 0.001) and self-transcendence (P = 0.039) in the HC group [F(2,27) = 15.81, P < 0.001].

Conclusions

Self-Directedness was associated with circadian rhythm and sleep quality in MD, BD and SZ groups. Extreme temperament features may contribute to emotional and behavioral dysfunction, which may lead to abnormal sleep patterns in psychiatric disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gamma-hydroxybutyrate (GHB) withdrawal syndrome: First case report in Lithuania (Kaunas addiction treatment center)
Authors: Jucys K. , Leleikiene A. , Jokuboonis D.
Published: May 2016

Gamma-hydroxybutyrate (GHB) is a γ-aminobutyric acid (GABA) precursor and metabolite that naturally occurs in the human body. Initially, GHB was used as an anaesthetic agent but was later also found to have anabolic, hypnotic, antidepressant, anxiolytic as well as cholesterol lowering effects. Recently though, research into GHB has been carried out primarily in assessing its effectiveness in treating alcohol and opioid withdrawal syndrome. There are no epidemiological data about GHB consumption in Lithuania, however during last decade there were observed many fatal cases of GHB users due to GHB intoxication or withdrawal abroad. In this article we will present the clinical case and problems which face the patient of 2-year daily GHB consumption. There were observed mild to moderate abstinence state presented with its clinical course and peculiarities. Whereas using GHB is becoming more popular in Lithuania, it is very important to pay attention to this substance and problems related to its usage.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Qualitative study of patients with dual pathology in treatment with aripiprazole extended-release injectable suspension
Authors: Fernández Mayo L. , Baño Rodrigo D. , Barbero García E. , Agujetas Rodriguez M.
Published: May 2016

Introduction

Studies describe patients with dual pathology as subjects with worse clinical evolution and worse therapeutic response. These subjects have high percentages of worse therapeutic compliance and low adherence to psychopharmacological treatment. The conventional antipsychotics can induce dysphoria and worse craving and drug use. The long duration-injectable antipsychotics could serve as a good therapeutic alternative because they combine efficacy and tolerability.

Objectives

We analyzed subjects treated with aripiprazole injectable to demonstrate its effectiveness on symptomatology, the reduction of craving and consumption of substances.

Materials and methods

We studied subjects with dual disorders at a Center for Attention to drug addicts treated with aripiprazole extended-release injectable. All of them met criteria for the diagnosis of disorders for cannabis and cocaine use. All of them had been previously treated with oral antipsychotics and/or injectable of long duration. Evolution of craving and consumption were evaluated through clinical interviews and urine analysis.

Results

Cannabis was the main substance for all the patients. Three of them also often abused of cocaine. All of them were taking other treatments previously. The main causes of the change were: side effects and/or poor compliance. Only one patient discontinued follow-up. The rest of them showed good therapeutic adherence and better tolerability with aripiprazole injectable. The monthly dose was 400 mg.

Conclusions

Aripiprazole extended-release injectable is a good choice for dual disorders. A good therapeutic adherence involves not only a psychopathological improvement but also respect to craving and consumption, which makes aripiprazole injectable a suitable therapeutic option.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Aripiprazole oral treatment in a sample of patients with dual diagnosis
Authors: Llanes Álvarez C. , San Román Uría A. , Caldero Alonso A. , Garzón de Paz M.Á. , Franco Martín M.Á.
Published: May 2016

Introduction

Aripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.

Objectives

The aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.

Methods

Descriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.

Results

From a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.

Conclusions

Apart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cannabinoid hyperemesis syndrome
Authors: López-Romeo S. , Ledesma-Iparraguirre G.
Published: May 2016

Case report

A 25-year-old man was attended in multiple times at Emergency Department by referring abdominal pain and vomiting. No organic disease was found and he was referred to Psychiatric Emergency to assess him. He had history of cannabis use (4–5 times/day) during last 5 years. He referred recurrent episodes of abdominal pain and vomiting since 4 years ago, he had found that having hot showers alleviate his symptoms. Urine screening was positive for THC and negative for other drugs. In results of blood tests, abdominal X-ray, abdominal ultrasonography, abdominal tomography and fibrogastroscopy didn’t find any abnormality. He was diagnosed from suffering a somatoform disorder. Treatment with Setraline 50 mg/day was prescribed and cannabis abstinence was recommended. He was referred to Mental Health outpatient service. He maintained cannabis abstinence for 1 month and some symptoms disappeared. However, 2 months later, he relapsed in cannabis use and all symptoms reappeared. Later he achieved cannabis abstinence again and he got full recovery, then he was diagnosed from cannabinoid hyperemesis syndrome.

Conclusion

Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and colicky abdominal pain in patients with long-term cannabis use. These symptoms have been reported to be alleviated temporarily by taking a hot shower or more permanently by abstaining from the use of cannabis. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently. For this reason, it is necessary to take it into account in order to recognize it and help provide these patients early and better approach.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The experience of using synthetic cannabinoids: A qualitative analysis of online user self-reports
Authors: Newman M. , Denton G. , Walker T. , Grewal J.
Published: May 2016

Introduction

The number of novel psychoactive substances (NPS) available is increasing. Synthetic cannabinoids (SC) are one of many NPS sold. SC aim to emulate the effects of natural cannabis by acting on cannabinoid receptors. Despite much research into pharmacology, there is limited data on the user experience of SC.

Aim

It is useful for psychiatrists, to understand what experiences people have whilst on illicit substances. The aim of this qualitative study is to gain an initial understanding of what characterizes the experiences of those who use SC.

Method

Fourty anonymously written online reports were collected from the “Erowid experience vaults” and analysed using the Empirical Phenomenological Psychological Method.

Results

The analysis yielded 488 meaning units (MU). These were grouped into 36 categories revealing 5 broad themes: (1) physical affects; (2) sensory distortions and distortions of perception; (3) emotional and psychological effects; (4) re-dosing, addiction and comedown effects; (5) similarities to other substances.

Conclusion

Synthetic cannabinoids have a mixed effect on users with a myriad of experiences reported. Some experienced positive results from their usage such as euphoria and relaxation, however these were counter balanced by those who experienced some serious negative emotional and physical side effects such as anxiety, paranoia, palpitations and convulsions. SC appear to often emulate that of their natural counterpart, yet there is an unpredictability to them which can end with serious consequences. Online forum content gives us a strong base understanding of users experiences of SC. Further research is required to elucidate a more nuanced understanding.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Profile of users of a new E-Mental Health ecological momentary assessment web-based program: MEmind
Authors: Bonal C. , Barrigon M.L. , Carballo J.J. , Baca-Garcia E. ,   MEmind studygroup
Published: May 2016

Background

e-Mental Health is an emergent area within e-Health. In the evaluation area, ecological momentary assessment (EMA) has been used to investigate separately on different psychiatric disorders while a comprehensive tool to cover the entire spectrum of mental health has not yet been developed. In this study, we aimed to present the MEmind wellness tracker and to characterize the group of patients who use it.

Methods

We developed an EMA web application: MEmind, accessed through the web page http://www.memind.net. Since 20th May 2014 on, adult outpatients (n = 13,883) attended in all psychiatric services within the Psychiatry Department of Fundación Jimenez Diaz in Madrid were proposed to use MEmind and then registered. Data collected from first year of implementation of the tool were transferred to an SPSS sheet and then analysed. A comparison between patients using and not using MEmind were performed.

Results

MEmind users (n = 2842) were significantly younger than MEmind non-users (n = 11,041) (42.2 ± 13.5 vs. 48.5 ± 16.3; P = 0.000) and mostly women (65% vs. 61.4%; P = 0.001). Also, patients with neurotic disorders were the main users of MEmind (see Table 1). Furthermore, patients with thoughts about death and suicide were more likely to use MEmind (Table 2).

Conclusions

Women, young people and patients with neurotic disorder were the main users of MEmind. Furthermore, people with suicidal thoughts were willing to use MEmind. Novel interventions for suicide prevention could be developed with the use of EMA web-based tools. Further studies are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is methylphenidate a prescription drug being sold in the illegal market? Analysis of samples submitted to a drug checking facility
Authors: Quintana-Mathé P. , Grifell-Guàrdia M. , Palma Á. , Fornís-Espinosa I. , Gil-Lladanosa C. , Caudevilla-Galligo F. , Galindo-Guarin L. , Farré-Albaladejo M. , Torrens-Melich M. , Ventura-Vilamala M.
Published: May 2016

Introduction

Methylphenidate is a CNS stimulant approved for treatment of ADHD. It is generally considered well tolerated and exhibiting low dependence potential, although diversion for recreational use has been described. Provided that its effects are comparable to those of more popular drugs of abuse, such as cocaine and amphetamines, we hypothesized that it could be sold as such.

Objective

The aim of this study was:

– to describe the presence of methylphenidate from the samples handled to, and analyzed by, Spanish harm-reduction service energy control between August 2009 and August 2015;

– to determine whether it is being sold as other drugs.

Materials and methods

All samples presented to energy control (EC) were analyzed. EC is a Spanish harm-reduction non-governmental organization that offers to users the possibility of analyzing the substances they intend to consume.

Samples in which methylphenidate was detected using Gas Chromatography–Mass Spectrometry were selected for this study.

Results

From a total of 20062 samples, 17 contained methylphenidate (0,09%), with no clear variations among the years studied. The samples were mostly sold as amphetamine (29%), methylphenidate (23%) and ethylphenidate (18%).

Conclusion

Presence of Methylphenidate in the Spanish illegal drug market seems anecdotic and stable over the studied timeframe. Moreover, it was sold as substances with similar dosages, lowering potential for life-threatening intoxications. Therefore, our results suggest that diversion of methylphenidate into the drug market as adulterant is not a concerning phenomenon.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Preventing weight gain and increased waist circumference during the first two years after antipsychotic initiation in youth with first-episode psychosis
Authors: Ward P. , Curtis J. , Rosenbaum S. , Watkins A. , Teasdale S. , Lederman O. , Kalucy M. , Samaras K.
Published: May 2016

Background

We recently demonstrated that weight gain could be prevented in young people experiencing a first-episode of psychosis commencing treatment with antipsychotics. A 12-week, intensive lifestyle and life skills intervention – the Keeping the Body in Mind program, – was delivered by dedicated nursing, dietetic and exercise physiology clinicians, for new referrals with < one month of antipsychotic exposure. (Curtis et al., Early intervention in psychiatry, in press). At the conclusion of the intervention the 16 young people participating in the program experienced a mean weight gain of 1.8 kilograms, and a mean increase in waist circumference of 0.1 centimeters. The participants were followed up for two years after initial referral.

Methods

During the two-year follow-up, participants had continuing access to an in house gym and weekly cooking groups, but without the same intensity of follow-up. Two year follow-up data were obtained from 11 participants form the original cohort.

Results

Mean weight gain at two-year follow-up was 0.90 (SD 8.7) kilograms, and this difference was not statistically significant [t (10) = 0.3, NS]. Waist circumference decreased by 0.7 (SD 7.7) centimeters, which was not t statistically significant [t (10) = 0.3, NS]. Nine of the participants (82%) did not experience clinically significant weight gain two years after initiation of antipsychotic medication.

Conclusion

This two-year follow-up data demonstrated that it is feasible to prevent weight gain in youth with first-episode psychosis over the first two years of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical and demographic characteristics of treatment seeking online video game players
Authors: Simon O. , Chebbi R. , Godall A. Ochoa , Eicher J. , Zumwald C. , Dickson C.
Published: May 2016

Background and aim

Within Switzerland, video game players seeking specialised treatment are usually referred to gambling addiction services. The Centre for Excessive Gambling (CJE) is a specialised gambling addiction unit in Lausanne University Hospital. Between 2003 and 2015 the service offered also support to 64 adults seeking treatment for videogaming-related disorders.

According to international literature, Internet disorder treatment programmes have been developed. However, little is known about clinical profile of users seeking treatment. Studies into Internet or gaming disorders typically employ Internet survey methods or use student samples. The current presentation will outline demographic and clinical features of video gamers receiving treatment at the CJE.

Method

Data were collected from the medical records of 57 video gamers seeking treatment at the CJE between 2003 and 2015.

Results

The sample includes 93% men, mostly single (91%), with an average age of 25 years ± 7. On average the sample spent 9 hours ± 5 per day playing video games. A disorder had emerged an average of 3 years ago ± 3. The crisis preceding the first consultation was familial (50%), emotional (29%) or professional (16%). Sixty-five percent of the sample had a mood disorder and 20% reported suicidal ideations.

Discussion

Treatments should address comorbidities and family problems associated with video game disorders. Offering consultations for parents could be useful, even in absence of the young player.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A case of marchiafava bignami disease with frontal cortex involvement and late onset, long-lasting psychiatric symptoms
Authors: Vecchi C. , Gramaglia C. , Feggi A. , Coppola I. , Di Marco S. , Venesia A. , Delicato C. , Chieppa N. , De Marchi F. , Cantello R. , Zeppegno P.
Published: May 2016

Aims

To describe the case and management of a patient with marchiafava bignami disease (MBD) with frontal cortical lesions, no specific symptoms at first referral to the emergency room, and late onset of atypical psychiatric symptoms.

Methods

We report the case of a 44-year-old patient with a history of chronic alcohol abuse, eventually diagnosed with MBD.

Results

Magnetic resonance showed lesions in the splenium and in the body of corpus callosum and bilateral lesions of the frontal cortex. The patient showed late-onset atypical psychiatric symptoms, which were drug resistant.

Conclusions

The case we describe seems to support the existing few ones describing cortical involvement in MBD, which suggest that this is associated with a poorer prognosis. Psychiatric symptoms may be challenging to treat because of drug resistance. The involvement of psychiatrists together with neurologists and radiologists, with a consultation–liaison approach has proved important for the achievement of diagnosis and of the most appropriate management and treatment for this patient.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gender differences in anxiety among secondary school in Kuwait
Authors: Kareemi S.
Published: May 2016

Introduction

Anxiety disorders are the most common mental disorders, and their prevalence is substantially higher in women than in men. Research has confirmed the existence of gender differences in several types of anxiety disorders.

Objectives

The current investigation sought to determine whether any observable gender differences existed in anxiety for a nonclinical sample.

Methods

the sample consisted of 300 males and 300 female students from a secondary school in Kuwait. The genders were matched in age (males = 16.52 ± 0.90 & females = 16.37 ± 0.96, t = 1.93, P > .05). The inclusion criteria for all participants: sample of the population of Al-Jahra city, aged between 15 and 18 years old, school grades 10, 11, 12, and the social status of the parents (married). The Arabic version of Beck Anxiety Inventory (BAI) was administered to participants. BAI reliabilities ranged from .88 to .87 with a mean .87 (alpha) denoting good internal consistency. The convergent correlations in eight samples between BAI and Kuwait University Anxiety Scale KUAS (mean r = .52) for validity coefficients.

Results

The results revealed that females (18.67 ± 11.11) had significantly higher mean anxiety than their male (14.52 ± 10.37) counterparts (f = 22.27, P < .000).

Conclusion

Therefore, we can conclude that female preponderance of anxiety has been a consistent finding within literature.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Relationship between cognitions and perceived self-efficacy with the severity of panic disorder with agoraphobia
Authors: Leon-Quismondo L. , Lahera G.
Published: May 2016

Introduction

The influence of cognitions and the perceived self-efficacy on mental health has been studied for a long time. Some studies have linked the perceived self-efficacy and apprehensive cognitions with the severity of panic disorder with agoraphobia.

Objectives

To study the relationship between self-efficacy and dysfunctional beliefs of patients with panic disorder with agoraphobia and severity of the disorder.

Method

A systematic review of the literature was performed to examine the evidence of relationship between self-efficacy and cognitions with the severity of panic disorder. PubMed and PsycInfo databases were searched.

Results

The studies conclude that a higher level of self-efficacy decreases anticipatory anxiety and negative emotional states in panic disorder with agoraphobia, reducing the severity of panic disorder. There is a temporal relationship between dysfunctional beliefs, self-efficacy and fear of a panic attack: changes in fear are preceded by changes in beliefs, changes in efficacy or changes in both beliefs and self-efficacy. Therefore, a higher level of self-efficacy and positive beliefs have been studied as a significant predictor of lower severity of the disorder and a greater improvement during treatment.

Conclusions

These results support the hypothesis that cognitive changes precede improvement and the importance of cognitive appraisals for anticipatory anxiety and severity of the panic disorder with agoraphobia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Outcomes of promotion, prevention, treatment and care
Authors: Muijen M.
Published: May 2016

The WHO European Mental Health Action Plan encompasses promotion, prevention, treatment and recovery, within the context of a model of mental health that proposes a set of socio-economic and biological determinants that predispose to vulnerabilities and increase the risk of disorders. These determinants also negatively affect access to and quality of care. Such risk factors are shared with common non-communicable disorders, increasing the risk of morbidity and early mortality for people with mental disorders.

Mental health promotion and prevention actions should therefore be addressing determinants such as alcohol and smoking. However, such determinants are not equally distributed in the population, but cluster among vulnerable groups, such as those with a low income, the unemployed and minority groups. These groups overlap with the populations services struggle to reach. In addition, both primary care and specialist mental health services struggle to identify and treat people with co-morbidities. This suggests that connections need to be established between public health, primary care and specialist mental health services.

WHO is focussing on the strengthening of primary care and the interface with mental health services. In particular, there is an urgent need to screen people who present with symptoms of NCDs or mental disorders for common determinants and co-morbidities. Effective health promotion activities need to be offered to populations at risk, in addition to universal health promotion interventions such as taxation or advertising bans. Some examples will be presented.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Psychosocial functioning impairment in euthymic patients with bipolar disorder II: The role of clinical factors
Authors: Ilhan R.S. , Senturk-Cankorur V.
Published: May 2016

Introduction

Growing body of evidence have showed that euthymic bipolar patients have poor psychosocial functioning. Most of the studies have focused on the psychosocial functioning in euthymic bipolar disorder (BD)-I patients. On the contrary, there have been limited researches investigating psychosocial functioning in euthymic BD-II patients. Moreover, the factors associated with psychosocial functioning in euthymic patients with BD II have been also understudied.

Objectives/aims

Aim of our study was to investigate the association between clinical variables and poor psychosocial functioning in euthymic BD-II patients. Hypothesis of this study was that euthymic BD-II patients would have low level of psychosocial functioning compared with healthy individuals.

Methods

BD-II (n = 37) and healthy subjects (n = 35) were compared in terms of their psychosocial functioning which were assessed by Functional Assessment Short Test (FAST). The euthymic state was confirmed by low scores both on the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS). Anxiety symptoms were also assessed by Hamilton Anxiety Rating Scale (HARS) in both groups. Clinical variables were taken as independent variables and FAST scores were taken as dependent variable in order to run correlation analysis in BD-II group.

Results

No socio-demographic differences were found between two groups. Euthymic BD-II patients had significantly higher FAST, HARS, HDRS YMRS scores compared with healthy individuals. Only HDRS scores correlated with FAST scores of BD-II patients.

Conclusions

This study indicated that euthymic BD-II patients had poorer psychosocial functioning. And subclinical depressive symptoms were associated with poor psychosocial functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Recognition and treatment of bipolar mixed states
Authors: Leite F. , Salgado H. , Olga C. , Carvalho P.
Published: May 2016

Introduction

Mixed features refers to the presence of high and low symptoms occurring at the same time, or as part of a single episode, in people experiencing an episode of mania or depression. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed features experiences symptoms of both mood “poles” – mania and depression – simultaneously or in rapid sequence.

Aims and objectives

To review the nosological status of bipolar mixed states and its treatment.

Methods

Online search/review of the literature has been carried out, using Medline/Pubmed, concerning “mixed states”, “affective disorder”, “bipolar disorder”.

Results

The presence of depressive symptomatology during acute mania has been termed mixed mania, dysphoric mania, depressive mania or mixed bipolar disorder. Highly prevalent, mixed mania occurs in at least 30% of bipolar patients. Correct diagnosis is a major challenge. The presence of mixed features is associated with a worse clinical course and higher rates of comorbidities. There is ongoing debate about the role of antidepressants in the evolution of such states.

Conclusions

Clinical vigilance and careful evaluation are required to ensure mixed states are not missed in the clinical context. Atypical antipsychotics are emerging as the medications of choice in the pharmacological management of mixed states.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Control of attention in bipolar disorder: Effects of perceptual load in processing task-irrelevant facial expressions
Authors: Grave J. , Soares S. , Madeira N. , Rodrigues P. , Santos T. , Roque C. , Morais S. , Pereira C. , Santos V.
Published: May 2016

Bipolar disorder (BD), along with schizophrenia, is one of the most severe psychiatric conditions and is correlated with attentional deficits and emotion dysregulation. Bipolar patients appear to be highly sensitive to the presence of emotional distractors. Yet, no study has investigated whether perceptual load modulates the interference of emotionally distracting information. Our main goal was to test whether bipolar patients are more sensitive to task-irrelevant emotional stimulus, even when the task demands a high amount of attentional resources.

Fourteen participants with BD I or BD II and 14 controls, age- and gender-matched, performed a target-letter discrimination task with emotional task-irrelevant stimulus (angry, happy and neutral facial expressions). Target-letters were presented among five distractor-letters, which could be the same (low perceptual load) or different (high perceptual load). Participants should discriminate the target-letter and ignore the facial expression. Response time and accuracy rate were analyzed.

Results

showed a greater interference of facial stimuli at high load than low load, confirming the effectiveness of perceptual load manipulation. More importantly, patients tarried significantly longer at high load. This is consistent with deficits in control of attention, showing that bipolar patients are more prone to distraction by task-irrelevant stimulus only when the task is more demanding. Moreover, for bipolar patients neutral and angry faces resulted in a higher interference with the task (longer response time), compared to controls, suggesting an attentional bias for neutral and threating social cues. Nevertheless, a more detailed investigation regarding the attentional impairments in social context in BD is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report
Authors: Oliveira P. , Roque C. , Santos V. , Madeira N.
Published: May 2016

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.

This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.

The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Significant response to amantadine in a patient with malignant catatonia: A case report
Authors: Maki M. , Kato O. , Kunimatsu J. , Sato T. , Fujie S.
Published: May 2016

Purpose

Catatonia is a complication of bipolar disorder, which is a constellation of symptoms such as catalepsy, mutism, and stupor. Standard therapy for catatonia contains benzodiazepines and electroconvulsive therapy. An uncomplicated catatonia is usually a benign condition. On the other hand, malignant catatonia is a life-threatening condition that is complicated with fever, autonomic instability, delirium, and rigidity. The syndrome is typically fulminant and progresses rapidly within a few days without appropriate intervention. Several previous reports suggested that some catatonia are associated with the overstimulation of N-methyl-D-aspartate (NMDA) receptor, and that amantadine may have an effectiveness for catatonia, as a NMDA receptor antagonist. We report a case of successful treatment for malignant catatonia refractory to benzodiazepines, by using amantadine.

Materials and methods/case

A 64-year-old Japanese woman with bipolar disorder was referred to our hospital because of 8-week prolonged fever. On admission, she was in febrile and stuporous states. Severe rigidity was observed in her extremities. Blood tests, lumbar puncture, and blood cultures were all negative. Brain MRI was normal. Consequently, we reached a diagnosis of malignant catatonia, and thus we gave additional benzodiazepines for her catatonic symptoms. However, there was no improvement, and we finally add a 50 mg/day amantadine for her malignant catatonic state.

Result

Her fever resolved in a few days. Gradual dose-titration of amantadine led her clinical manifestation to completely disappeared.

Conclusion

Amantadine can be a potential option as one of the pharmacological therapies for refractory malignant catatonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Age at menarche is related to number of previous depressive episodes in patients with bipolar disorder
Authors: Dunjic-Kostic B. , Pantovic Stefanovic M. , Lackovic M. , Damjanovic A. , Jovanovic A. , Totic-Poznanovic S. , Ivkovic M.
Published: May 2016

Introduction

Oestrogen fluctuations may be an important factor in the etiology of bipolar disorder and age at menarche is associated with the clinical course of BD. Moreover, it is associated with traits related to mood.

Aims

The aim of our study was to explore the differences in age at menarche between euthymic BD patients and healthy controls, as well as to explore the relationship between age at menarche and lifetime psychopathology within BD.

Methods

The study group consisted of 83 patients diagnosed with BD, compared to the healthy control group (n = 73) and matched according to age, gender, and body mass index (BMI). Lifetime psychopathology has been assessed according to predominant polarity as well as previous history of suicide attempts and psychotic episodes.

Results

Age at menarche in BD patients was similar to that in controls. After covarying for confounders, we observed that age at menarche is negatively related to number of previous depressive episodes in euthymic BD patients, but not other indicators of lifetime psychopathology.

Conclusions

BD patients with earlier age at menarche are more likely to present with more depressive episodes in the course of illness. Systemic, longitudinal monitoring of the course of illness, and potential hormonal fluctuations within particular groups of patients are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Manic episode secondary to maca
Authors: Quandt P. , Puga M.
Published: May 2016

Introduction

Maca (Lepidium meyenii) is a plant grown in the Andes Mountains, formerly used for nutritional purposes. Nowadays is used as a nutritional supplement and energizing.

Objectives

To describe a case of manic episode secondary to maca consumption, as an ingredient of an energizing product.

Aims

To report on antidepressant properties of maca, based on a clinical case.

Methods

X. is a 27-years-old male without any psychiatric history. He came to the emergency service because of the presence of sudden onset behavioral disorders, presenting a manic-like episode of seven hours of evolution. His symptoms consisted in psychomotor restlessness, hyperactivity, insomnia, verbose and loud speech, hyperthymia, megalomaniac verbalizations, and unsuitable future plans. The patient had self-awareness of his symptoms and was self-critical with his behavior. He reported he was consuming an energizing supplement containing maca from about two weeks ago. Treatment with olanzapine 20 mg was initiated, and the patient remained under observation for 24 hours.

Results

Symptomatology subsided completely after 24 hours. The patient is discharged from the hospital with diagnosis of manic episode secondary to maca, without any treatment. He was advice to not take stimulants.

Conclusions

There are studies reporting that maca plant has antidepressant properties, associated with the activation of noradrenergic and dopaminergic systems, as well as the attenuation of oxidative stress. However, more studies are needed to identify specific compounds that produce these effects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Educating, implementing and auditing nice standards for bipolar disorder
Authors: Tremblay M. , Palin S.
Published: May 2016

Introduction

The National Institute for Health and Care Excellence (NICE) sets standards of clinical practice in the UK. An extensive update on guidance regarding bipolar disorder was released in September 2014. Practitioners face the challenge of translating this guidance into practice. NICE suggests that interventions might be better delivered by bipolar specialist clinics. Updated NICE standards were integrated into a Bipolar Clinical Effective Practice Screen (BICEPS), allowing existing community psychiatric teams to deliver these revised clinical standards in bipolar care.

Purpose

To assess the effectiveness of the BICEPS in delivering interventions aligned with NICE clinical standards.

Method

Three psychiatric community teams were audited; two teams (1 and 2) used the BICEPS to support their interventions whilst a third team provided management as usual. Team 1 was previously familiarized with the concept.

Results

Table 1.

Conclusion

The teams using BICEPS show better concordance to NICE standards. Superior outcomes by the team previously acquainted with the concept suggest longer-term benefits and adaptability. Using BICEPS may offer a cheaper alternative to developing specialist clinics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interactions between mephedrone and alcohol in humans: Cardiovascular and subjective effects
Authors: Farré M. , Perez-Maña C. , de Souza E. , Mateus J. , Theunisen E. , Kuypers K. , Ramaekers J. , Fonseca F. , Torrens M. , Olesti E. , de la Torre R. , Papaseit E.
Published: May 2016

Introduction

Mephedrone is a synthetic cathinone derivative included in the class of “New-Novel Psychoactive Substances”. Synthetic cathinones are marketed as “bath salts” or “plant food” and gained notable popularity for similar effects to 4-methylenedioxymethamphetamine (MDMA, ecstasy), or amphetamines. Mephedrone is commonly consumed simultaneously with alcohol.

Objectives and aims

The aim of the present study was to evaluate the interactions between mephedrone and ethanol in humans.

Methods

Twelve healthy male, recreational users of psychostimulants participated as outpatients in four experimental sessions. They received a single oral dose of mephedrone (200 mg) and alcohol (0.8 g/kg), mephedrone placebo and alcohol (0.8 g/kg), mephedrone (200 mg) and placebo alcohol, and both placebos. Design was double-blind, double-dummy, randomized, cross-over and controlled with placebo. Study variables included: vital signs (blood pressure, heart rate, temperature, and pupil diameter), subjective effects (visual analogue scales-VAS, ARCI-49 item short form, and VESSPA questionnaire).

Results

The combination produced an increase in the cardiovascular effects of mephedrone and induced more intense feeling of euphoria and well-being in comparison to mephedrone and alcohol. Mephedrone reduced the drunkenness and sedation produced by alcohol.

Conclusions

These results are similar to those obtained with the combination of other psychostimulants as amphetamines and MDMA. Abuse liability of the combination is greater that induced by mephedrone.

Disclosure of interest

The authors have not supplied their declaration of competing interest.