bluuebunny/crossref_metadata_2025 huggingface dataset:
2307 – Narcissistic Destinies - a Phenomenological Approach
Authors: Morariu I. , Nirestean A.
Published: July 2013

Introduction

Over the years, the narcissistic destiny seems to remain a very present theme, due to our patients but also to the society we are in everyday contact - a fact proved by its persistence over different moments in history.

Objectives and method

The main motivation that moves the narcissistic structure is apparently insuficiently explained by a simple psychiatric diagnostic; therefore we preffered for our study a phenomenological approach, which allowed us to see the complexity of the human structure beyond these limitations.

Aim

We chose to compare in our study two representative figures: a real one - Michelangelo and a fictional but based on a real case one - Dorian Gray. Most of the studies on these two themes so far convened over the presence of narcissistic traits and the obsession over beauty in both cases, still, they are not offering answers regarding the differences between destinies. Although Michelangelo and Dorian Gray are sharing the same narcissistic traits, both crossing sometimes limits of antisociality, they are not sharing the same affective and creative intensity, nor the dedication to seeking beauty.

Results

If in Michelangelo's case the emotions work closely with his creativity, thus putting a question mark over his narcissistic traits and also his diagnostic, in Dorian's case creativity without emotions lays a tragic role.

Conclusion

Turning to phenomenology has given us the possibility of understanding the interior, subjective world of two important characters, their personal different dynamics, going deeper than explaining them through a personological diagnostic.
2314 – Psychiatric Comorbidity And Quality Of Life In Patients With Beta Thalassemia Major
Authors: Akyüz Karacan F. , Kaya B. , Pekün F.
Published: July 2013

Objective

The study is aimed to assess quality of life, anxiety and depression levels and investigate the rate of psychiatric disorder in adolescent and young adults with beta Thalassemia major.

Methods

Sample includes 43 patients with β-thalassemia major. Patients were screened by Structured Interview for DSM-IV (SCID-I), Short Form-36 (SF-36) and Hospital Anxiety and Depression Scale (HAD).

Results

Fourty two percent of the patients suffered from a psychiatric disorder. The most common psychiatric disorders were social anxiety disorder (%21) and generalized anxiety disorder (%12). Significantly lower quality of life was found on all 8 SF-36 domains for β-thalassemia major and psychiatric comorbidity patients compared to no-comorbidity patients.The correlation between HAD and SF-36 scores was statistically significant.

Conclusion

Psychiatric disorders are significantly related to impaired quality of life. The correlations between anxiety, depression levels and SF-36 scores indicate that high depressive and anxiety levels are associated with reduced quality of life.
2317 – Stigmatization Of Psychiatric Patients By Medical Students
Authors: Sandoval A. , Jelenova D. , Prasko J.
Published: July 2013

Introduction

Mental illness in the general population are significantly represented, even so psychiatric patients are currently highly stigmatized in the Czech Republic. The main aspect leading to the stigmatization seems to be a lack of information and misinterpretation of psychiatric disorders caused by media.

Aims

Our pilot study aims to monitor attitudes of general medicine students toward mentally ill patients. We were interested in students’ personal experiences with psychiatric disorder, including friends and family and also personal experience derived from movies, literature and documents.

Methods

We contacted students of General Medicine, Palacky University in Olomouc. They filled out the questionnaire with questions designed to describe the characteristics of psychiatric patients and psychiatrists.

Results

The survey indicates that stigmatizing attitudes are less frequent among the students with personal experience with mental illness. Decrease of stigmatization was also found in students which attended the subject connected with psychiatry and also in students interested in career as a psychiatrist.

Conclusions

Personal experience with psychiatric patients, and formal or informal education is associated with lower levels of stigmatization. The key to the de-stigmatization seems to be in the psychoeducation and training.
2318 – Seven Basic Domains Of Disgust: The Multidimensional Disgust Scale
Authors: Sandín B. , Chorot P. , Santed M.A. , Valiente R.M. , Olmedo M. , Campagne D.M.
Published: July 2013

Disgust is a basic emotion elicited in response to a diversity of objects and situations which suggest that possible different functional domains exist. However, to data there is not a consensus about the domains of disgust to be assessed. A second main problem is that all self-report scales have been developed in the Anglo-Saxon culture. The Multidimensional Disgust Scale (MDS) is a new disgust self-report measure based in a Spanish-speaking population. The aim of this study was to examine the structure of the MDS and its relationship to other known measures of disgust. The MDS is a 30-item measure that assesses the level of disgust related to potentially disgusting objects or situations. Confirmatory factor analyses suggested a five-factor structure, which matches to the 5 proposed dimensions of disgust, i.e., hygiene (body products), moral, sexual, body transgression, small-animals, atypical food, and disease; alternative structures were not supported by the data. Reliability and correlations among the seven subscales were also reported. Finally, we found convergent and discriminant correlations between the MDS domains and other disgust scales, including the Disgust Scale—Revised (Haidt et al., 2007), the Disgust Propensity and Sensitivity Scale (van Overvel et al., 2006) and the Three-Domain Disgust Scale (Tybur et al., 2009). Findings suggest that the MDS is a new promising measure of disgust.
2321 – Derealization Due To Dextroamphetamine: a Rare Side Effect Which Could Cause Premature Discontinuation Of Treatment
Authors: Ghaffarinejad A. , Mehdizadeh Zare Anari A. , Pouya F.
Published: July 2013

Dextroamphetamine is one of the main medications for treating ADHD. It may cause several psychiatric side effects including hallucinations. As far as we know there is no previous report of clear derealization. In this report we present a 6 years old female patient with proved impression of ADHD. Her symptoms subsided with 10 mg/day Dextroamphetamine. A few months later she refused taking medication. She complained of feeling objects and persons are different and horrible way. Symptoms disappeared when the drug shifted to Ritalin. We present her history, describing symptoms of derealization and reflections of drug side effect in her drawings. We also discusses the role of side effects of Dextroamphetamine in poor compliance.
2323 – Sexuality Of Tunisian Women And Body Image: Impact Of Culture
Authors: Sellami R. , Feki I. , Masmoudi J. , Ouali U. , Mnif L. , Jaoua A.
Published: July 2013

Introduction

Research on body image suggests a link between women's perceived body image and sexuality.

Aim

The aim of our study was to determine the relationship between body image and sexual satisfaction among Tunisian women and the impact of culture on sexuality.

Subjects and methods

One hundred women completed a self-administered questionnaire which included:

-

Clinical data: weight, height …

-

Women's perception of their body.

-

The perception of sexuality by women and their spouses.

-

the impact of body image on sexuality.

Results

The mean age was 36 years and 7 months. They were married for 12 years on average. The rate of menopausal women was 21%.

Two per cent of women were underweight, 38% were overweight, 6% were obese and 54% of them had a normal body mass index (BMI).

Women who were satisfied with their looks had significantly a higher self-esteem (p = 0.013).

Eighty six per cent of women are recognized as good sexual partners and 85% were satisfied with their sexual activity: Eighty seven per cent of these women considered their body a source of sexual pleasure. These women thought they had an erotic body (p = 0.009) and a source of self-confidence (p = 0.002).

Conclusion

This study indicates that there is a difference between western and eastern culture in the impact of body image on sexuality. So, it is imperative for female adolescents to have adequate and appropriate sexual education.
2329 – Memory For Homicide a Severe Violence In Non-psychiatric Offenders
Authors: Ptacek R. , Zukov I.
Published: July 2013

Introduction

Defendants commonly claim amnesia for their criminal actions especially in cases involving extreme violence. While some claims are malingered or result from physiological factors, other cases may represent genuine partial or complete amnesia resulting from the psychological distress and/or extreme emotion associated with the perpetration of the crime. Detecting malingering in such cases is substantial part of forensic psychological and psychiatric assessment.

Objectives

To identify possible psychological differences among homicide or severe violence offenders presenting amnesia for the event and those who do not.

Methods

We examined homicide or severe violence offenders presenting amnesia for the event (n=15) and those who do not (n=15). Methods for assessment of cognitive functions (WAIS-III, WMS), dissociation (DES-20, MID), impact of events scale (IES), and personality (ROR, MMP-II) were used. Further we evaluated social and criminal anamnesis. Offenders with psychotic or schizophrenic symptoms were excluded.

Results

No differences in cognition or personality was found (p < 0.01). Elevated levels of dissociation and score in IES questionnaire was found in offenders presenting amnesia for the event.

Results and conclusion

This pilot study supports hypothesis that there are no any neuropsychological impairments in nonpsychiatric offenders of murder or severe violence presenting amnesia. Higher level of dissociation and score of impact of events scale (p < 0.05) suggest, that this group of offenders may be more predisposed to dissociative and stressful reactions in overloading events. Thus the question whether the amnesia is malingered or not is still unclear.
2332 – Relevance Of The Concept Of Demoralization In Schizophrenic Patients
Authors: Boursier S. , Jover F. , Pringuey D.
Published: July 2013

Introduction

Depression is difficult to diagnose in schizophrenic patients although it represents a frequent motive for suicide. In clinical practice nonspecific sadness is more often observed than major depressive episodes. Our analysis of these states led us to the concept of demoralization.

Objectives

The objective of our study was to demonstrate the existence of demoralization in psychotic patients as a real entity and to see how it could be correlated with other dimensions.

Methods

A total of 55 ambulatory patients diagnosed with a schizophrenic disorder were included and distributed in 2 groups according to the level of demoralization. The correlation with residual psychotics symptoms (PANSS), depression (CDSS), despair (BHS), and quality of life (SQoL) as well as the sociodemographic characteristics and past history of suicide attempts was assessed.

Results

More than 94% of our patients were found demoralized, 16,36% of them severely. The degree of demoralization was correlated with the intensity of positive symptoms (p = 0.016), depression (p < 0.001), despair (p = 0.015), suicidality (p < 0.01) as well as poor quality of life (p = 0.007) and low self-esteem (p < 0.000).

Conclusions

Demoralization appears to be a relevant concept during schizophrenia, bound in schizophrenic and depressive process, and impacting the suicidal risk. It could represent an important stake in the care of schizophrenic patients especially for the prevention of relapse and suicidal risk.
2339 – Relationship Between Compliance And Abdominal Obesity In Patients With Paranoid Schizophrenia
Authors: Korostiy V. , Sinayko V. , Korovina L. , Zemlyanitsyna O.
Published: July 2013

Introduction

Modern antipsychotics can successfully fight productive symptoms and prevent the development of negative symptoms of schizophrenia. Among them - the development of metabolic disorders, including abdominal obesity. According to researches 40–80% of patients receiving antipsychotics has increased body weight of 20% or more, and obesity in patients with schizophrenia occurs in 2 times more often than in general population. Abdominal obesity pathogenetically linked to hypertension, type 2 diabetes mellitus, it also determines decrease of life quality of these patients and their compliance.

Aims

To study other factors which impact on the condition of these patients and determine the quality of their lives.

Methods

Clinical, PANSS.

Results

Patients reported a lower life quality as compared to patients with normal weight. Their body mass index was 30–35 kg/m2, corresponding to 1 degree of obesity. Analysis of adherence to therapy of the patients showed that compliance was good in patients with a predominance of productive symptoms. At the same time, some of the patients often had thoughts to stop treatment due to the development of obesity. Thus, the results show the relationship between degree of abdominal obesity and adherence to therapy in patients with paranoid schizophrenia.
2343 – Eating Disorders And Alcoholism - About Three Case Reports
Authors: Esteves-Pereira M. , Sertório T. , Brandão I.
Published: July 2013

Introduction

Eating disorders (EDs) and alcoholism are frequently co-occurring in the presence of other psychiatric and personality disorders. Eating-disordered patients are already at an increased risk for morbidity and mortality, so alcohol and other drug use pose additional dangers for these patients. Particular personality traits, such as impulsiveness, have been connected to both eating disorders and alcohol/drug abuse.

Objectives

To present case-reports of EDs with comorbid alcohol abuse and a review study regarding the theme available in Medline.

Aim

Brief literature review.

Method

Three case-reports are presented and literature of this theme shortly reviewed.

Results

The authors present three cases of adult females followed up in our Department with EDs (restricting anorexics and bulimics) and alcoholism that have already tried many detoxifications with no success.

Conclusions

Literature research has demonstrated that there are several similarities between the physiological conditions and mechanisms of addictive conditions, such as EDs and Alcoholism. Restricting anorexics, binge eaters, and bulimics appear to be distinct subgroups within the eating-disordered population, with binge eaters and bulimics more prone to alcohol.

Personality traits such as impulsivity have been linked to both bulimia nervosa and substance abuse. Many researchers have proposed that an addictive personality is an underlying trait that predisposes individuals to both eating disorders and alcohol abuse. More studies are needed to understand psychobiological mechanisms of this comorbidity, and to develop treatments for individuals with comorbid eating disorders and substance misuse.
2348 – Effects Of Sex And Age On Methylphenidate Treatment In Adult Adhd: a Magnetic Resonance Spectroscopy Study
Authors: Ünal G.A. , İnci Kenar A.N. , Herken H. , Kıroğ lu Y.
Published: July 2013

Objective

To investigate the effects sex and age on the methylphenidate HCl treatment in adult ADHD.

Methods

Sixty ADHD subjects were included into the study aging between 18 and 60 years. Levels of N-acetyl aspartate (NAA), creatine and choline in anterior cingulate cortex, cerebellum, striatum and dorsolateral prefrontal cortex were measured with magnetic resonance spectroscopy. Then, 10 mg oral methylphenidate HCl was given to the subjects and the same metabolite levels were measured after an interval of 30 minutes.

Results

Twelve (20%) of the subjects were women and 48 (80%) of them were men. Age distribution of subjects is as follows: 15 were between 18–24 years, 26 were between 25–30 years, 19 were older than 30 years. No difference was determined between NAA levels before and after methylphenidate in both sexes. Creatine levels were determined higher after methylphenidate in women in prefrontal cortex and in men in cerebellum. Choline levels were determined higher after methylphenidate in women in striatum. NAA levels were determined higher after methylphenidate in prefrontal cortex of 18–24 years old age group and in striatum and cerebellum of 25–30 years old age group. Creatine levels in striatum after methylphenidate were determined higher in 18–24 years old age group than 25–30 years old age group. No difference was determined between choline levels before and after methylphenidate in each age groups.

Conclusion

It is thought that pharmacotherapy can be effective on brain metabolites and this effect can vary upon sex and age.
2350 – Pain Engagement And Disengagement, Self-reported Health And Illness Behaviour In Irritable Bowel Syndrome
Authors: Martin M. , Chapman S.C.E.
Published: July 2013

Introduction

Irritable Bowel Syndrome (IBS) is characterised by persistent symptoms in the absence of structural abnormality.

Objectives

To discover if people with IBS exhibit atypical patterns of attention to symbolic pain stimuli.

Aims

To investigate whether IBS is linked to enhanced engagement with pain words and slower disengagement.

Methods

Exogenous cueing was carried out with 20 IBS and 33 healthy participants. Participants responded to a dot following on the same or other side of the screen, allowing measurement of engagement and disengagement.

Results

ANCOVAs were carried out. The IBS group engaged more with Pain and Social Threat words, and had greater difficulty in disengaging from Pain but not from Social Threat (see Figures 1 and 2). Difficulty in disengaging from Pain was linked to greater symptom severity.
2351 – Clinical Improvement And ‘perceived Quality Of Life’ After The Partial Psychiatric Hospitalization In a General Hospital
Authors: García Acuña M. , Hidalgo Mazzei D. , Barrio Giménez P. , Torras Farrés Á. , Martín-Santos R.
Published: July 2013

The Day Hospital (DH) provides an intensive, multidisciplinary, coordinated, group and customized care for patients admitted for treatment. The therapeutic approach improve their clinical situation, their quality of life and facilitate their reintegration into everyday life. Our objective is to evaluate overall clinical improvement and perceived quality of life of patients admitted in a general hospital DH (2010–2012). Clinical diagnosis (DSM-IV-R) grouped (NSUD, SUD and DUAL), clinical variables, baseline/ high clinical situation (CGI-S), global impression of improvement (CGI-I) and related quality of life perceived (EQ5) at baseline / high were recorded. Data were analyzed using SPSS v15. 174 patients were evaluated, 58% women, mean age 47 years and schooling medium-high (76%). The average stay (DT) was 35 days. Patients came from 47%: acute hospitalization, 51%: Mental Health Center (MSC) or outpatient and 4%: other units. The reasons for admission were detoxification (34.5%), stabilization (33.3%), consolidation of detoxification (15.5%), decompensation (9.2%) and re-structuring of treatment (7.5%). The overall clinical improvement of the whole sample at the end of stay assessed by the CGI-I was: 35% = “much better” 38% = “moderately better”, 5% = “slightly better”, 21% = “no change” and only 1% “worse” (p = 0.001). An overall clinical improvement and quality of life perceived was observed in the three groups of patients. While it remains to know the persistence of these parameters in the long term, the Day Hospital proved to be an important therapeutic resource for overall clinical improvement of patients towards their incorporation into daily life.
2354 – Alexithymia And Emotional Salience In Item Selection
Authors: Martin M. , Jones G.V. , Dawes C.N.G.
Published: July 2013

Introduction

Evidence associates alexithymia with a range of psychopathology including, in particular, depression.

Objectives

To investigate whether alexithymia is linked to enhanced levels of dysphoric salience in the individual's environment.

Aims

To determine whether item selection among individuals with lower and higher levels of alexithymia is sensitive to euphoric and dysphoric linkages.

Methods

A set of items was selected by each participant (N = 106), and for each item its perceived value established via the relation v(i, n) = (n - i)/(n - 1). A set of five affective saliences was elicited for each item.

Results

Regression established that whereas perceived values for lower levels of alexithymia were associated with emotional comfort and past happiness, for higher levels they were associated with present sadness (Figures 1 and 2).

Fig. 1

Low alexithymia: Standardized dependence of perceived value on affective saliences (*p < .05)

Conclusions

Enhanced salience of present sadness in the judgements of those with higher alexithymia levels may play a role in depression.
2355 – Keratoconjunctivitis Sicca Due To Antipsychotic Use
Authors: Balibey H. , Balikçi A. , Ateş A.
Published: July 2013

Objective

Anticholinergic side effects of antipsychotic drugs has long been known. Although dry mouth and constipation due to the anticholinergic side effects are common, dry eye has not been reported in the literature as far as we investigate.

Case

A 41-year-old, married, with two children, male patient. Outpatient clinic follow-up were performed for five years with a diagnosis of psychosis with complaints of suspiciousness, agitation, restlessness, drowsiness, emotional numbing, insomnia and feeling guilty. He was in remission with the treatment of olanzapine 5 mg/day. The patient was admitted with the complaints of eye blinking, eye burning sensation, sensitivity to light increasing over the past year.

Discussion and conclusion

We discussed treatments applied after the development of dry eye, clinical course and whether or not ocular dryness was due to the use of antipsychotic in a patient using olanzapine 5 mg/day for five years.

To our knowledge, antipsychotic-induced dry eye case has not been reported in the literature. We believe that our patient was a case of dry eye developed by antipsychotics.

Common side effects of antipsychotics as well as the side effects that are less common and less taken into account should be considered, they should be assessed in co-operation with other clinics and it should be noted that besides monitoring psychotic symptoms and signs, being vigilant in terms of the side effects and adverse events and following them is extremely important for the quality of life of patients.
2361 – Obesity, Body Image And Sexual Life: a Comparative Study Of 40 Cases
Authors: Ben Thabet J. , Sallemi R. , Maâlej Bouali M. , Charfi N. , Charfi N. , Zouari L. , Zouari N. , Abid M. , Maâlej M. , Ayadi S.
Published: July 2013

Aim

To evaluate the impact of the perception of body image on sexual activity of obese patients compared to a sample from the general population.

Patients and methods

A cross-sectional case-control study. It involved 40 obese married patients (BMI ≥ 30 kg/m2) and 40 normal weight subjects of the general population. A questionnaire was presented with sociodemographic data, somatic and psychiatric personal histories and data on obesity. Besides, there were seven items assessing perception of body image and five items assessing the impact on sexuality.

Results

The sex-ratio (men/women) of obese patients was 0.53. Obese women were less frequently satisfied with their body image than men (p = 0.002). Obese subjects were statistically more dissatisfied with their bodies than controls (p = 0.039). In Obese patients, avoidance of sexual intercourse was significantly related to dissatisfaction with body image (p = 0.025) and to the perception of unattractive body (p = 0.026). Sexual satisfaction was statistically correlated with the perception of a positive attracting body (p = 0.015). Sexual desire was statistically correlated to the satisfaction of body image (p = 0.019), positive perception of an attractive body (p = 0.017) and positive perception of a youthful body (p = 0.041). Sexual pleasure was correlated with the perception of an attractive body (p = 0.016).

Conclusion

The stigmatization of obese subjects leads to a weakening of the healthy perception of body and might be an obstacle to sexual fulfillment.
2362 – Is It a Prodrome Of Psychosis? Or Is It Naanxious Disorder? a Case Report
Authors: Canha J. , Oliveira S. , Pereira S.
Published: July 2013

Introduction

The concept of prodromal symptoms in schizophrenia is an old matter of debate. There have been reported several signs and symptoms that are considered to have a predictive value in a first psychotic episode, namely in the mood or anxious spectrums. However, these symptoms are not specific and can overlap with other disorders that have to be considered in the differential diagnosis.

Objectives

To present a young adult with marked anxious symptoms, namely in obsessive-compulsive spectrum, and psychotic (subclinical) symptoms, questioning the extension of the comorbidity between anxious disorders and schizophrenia.

Methods

A case report is presented and a literature review of the theme is shortly surveyed.

Results

The case report is about a 20 years old man, who have been developing for about two years obsessive thoughts of doubt concerning his sexuality, death and his mental health. Additionally, he described sensations of depersonalization, derealization and an intense distress that have been interfering with his function and daily activity. Several studies report substantial presence of anxious symptoms (including OCD symptoms) in schizophrenia, suggesting its early appearance in the development of the disease. Moreover, they can act as predictor of poorer outcome and may promote transition from psychotic symptoms to schizophrenia.

Conclusions

In schizophrenia prodromal stages, anxious symptoms may increase the risk and predict the development of psychosis disorder. On the other hand, the existence of mild psychotic symptoms can be present in neurotic disorders, witch compels clinicians to be cautious in the differential diagnosis that enclose these symptoms.
2368 – Intravenous Drug Users- Screening & Vaccination Programme
Authors: Sharma J. , Manarkattu M. , Ravi P. , Naughton C.
Published: July 2013

Introduction

Prevalence and incidence rates of both Hepatitis B and C is on the rise in United Kingdom, and worldwide. Intravenous drug users (IVDU) are particularly at risk due to their chaotic lifestyle. Testing enables early treatment, and vaccination is an effective method of prevention.

Objectives

Assess awareness of screening and vaccination programmes (VP) amongst IVDUs, and willingness to engage in these if they were available and accessible.

Aims

Our sample population was IVDUs presenting to a Community Substance Misuse team, in central England and the criteria we assessed were: whether they admitted to needle-sharing, awareness of screening and VPs, previous screening and vaccination history, and willingness to engage in VPs.

Methods

Data was collected through a performa with related questions, after identifying and communicating to key workers; and presented in graphs. We looked at the first 100 responses.

Results

More than a third of IVDU in the population shared needles, one-third had not even been tested for Hep B/C, a half had been immunised. Most of them are aware of the risks, and would agree to the immunisation programme if available, at Lantern House.

Conclusions

Prevalence of IVDU presenting to a Substance Misuse clinic is quite high. Screening and vaccination against Hepatitis of IVDU is lacking, despite it being feasible, necessary and acceptable by patients. Screening for the disease will aid diagnosis and hence early treatment, and will create a gateway for prevention by using VPs.
2370 – Altered Physical Identity Of Self As a Variant Of Capgras Syndrome In a Patient With a Schizoaffective Disorder
Authors: Vicente F. , Chai M.
Published: July 2013

Among the delusional misidentification syndromes, Capgras is the most common delusional disorder. Is characterized by the belief that a person, usually related to the patient, has been replaced by an impostor. In a more rare presentation, delusion affects the recognition of the self, either his physical or his psychological identity. In this paper, the authors aim to describe a clinical case of false recognition of the patient's own physical identity. The patient was diagnosed with a Schizoaffective Disorder. The authors also describe summarily the different misidentification syndromes.
2377 – Introduction Of a Baby-mother -(father) Unit Into The Hungarian Health Service System. Results After Five Years
Authors: Kurimay T. , Németh T. , Hedervari-Heller E. , Babus E. , Madarasi A. , Tary V. , Atkári G. , Kovács Z. , Seres G. , Fenyves T. , Simon Z. , Hegedűs E. , Pelikán A. , Táncsics D. , Tunyi T. , Zalatnai Z. , Hámori E.
Published: July 2013

The Baby-Mother-(Father) program started in 2007, after a preparatory phase in a collaboration with the Zentrum Für Soziale Psychiatrie - Mutter & Kind Behandlung, Heppenheim, Germany. In Hungary, this is the first dedicated program for a babymother unit, were initiated by National Institute of Child Health (OGYEI), and Saint John Hospital Psychiatric and Psychiatric Rehabilitation Department in Budapest.

Objective

Baby-mother unit introduction into the local and the Hungarian health service.

The aim of the program is to apply a collaborative therapeutic and rehabilitation model utilizing the multidisciplinary team work in the treatment of the pre-, peri- and post-natal period of mothers suffering mental disorders as well as to facilitate the early interactions and attachment with the baby.

Since 2007, 82 mothers, 1 father entered into the program. 54 mothers were participated as inpatient, 29 were treated only as outpatient. 24.9% of the cases were diagnosed (ICD 10 – F20–F29) schizophrenia or spectrum disorders, 27,6% were in the major affective disorders, including bipolar, (F 31, 14.5%). 38,6% were diagnosed in the anxiety disorders spectrum. 23% entered in the prenatal period (pregnancy), while 76,3% entered post-natal.

Therapeutic methods used

Case-management, individual, group and family interventions (psychotherapy), pharmacotherapy, case conferences, individual and staff supervision, video-feedback, mother-child consultation.

Results

New treatment model introduction in Hungary, which may reduce the risk of the separation of the baby, enhances the mother recovery, as well as the utilization of the family's and the supportive network resources. Further research is needed to prove the higher efficacy.
2383 – Deep Brain Stimulation of Nucleus Accumbens and Posterior Subgenual Cingulate do Not Result in Lasting Benefits For Patients with Chronic and Severe Treatment Resistant Depression
Authors: Malizia A.L. , Rich A.S. , Durant C.M. , Javed S. , Patel N.K.
Published: July 2013

Deep Brain Stimulation (DBS) is emerging as a possible treatment for treatment refractory depression. in this pilot study 8 patients who had depression and had not responded or had stopped to respond to treatment accepted to participate in this double-blind partial cross-over study of DBS. on average they had received 18 psychotropics alone or in combination, 45 ECT sessions and all had had psychotherapy. Our neurosurgical technique allows to confirm the precise location of contacts during surgery. Four electrodes were inserted, two bilaterally in the subgenual cingulate with a trajectory of about 30 degrees to the horizontal and two bilaterally in the posterior part in the nucleus accumbens and in the ventral anterior capsule. There were 2 men, the average age was 49, patients had MDD diagnosed 19 years previously, an average current episode of 11 years and were above the 99th centile in SCL-90 scores. Average MADRS was 39 and GAF was 30. Sustained response and remission was obtained in three patients with stimulation in the ventral anterior capsule and in the anterior subgenual cingulate. Two patients achieved response/ partial response with stimulation if both targets. Three patients had no response. While temporary improvements were recorded with accumbens and posterior subgenual cingulate stimulation these were transient. Accumbens stimulation was associated with more serious adverse events. This approach needs to be studied in a larger group of people to confirm or refute these informative findings.
2395 – EPA Guidance Paper on Conflict of Interest
Authors: Höschl C. , Fialová L.
Published: July 2013

The presentation summarizes follow-up of EPA initiative on Guidance on Conflicts of Interests (CoI) results of which were presented at 19th and 20th European Psychiatric Congresses and published in extenso in European Psychiatry (Höschl and Fialová, 2012). Guidance paper focuses on situations in which primary interest (well-being of patients, independence of medical education, and objectivity of medical research) might be influenced and compromised by secondary interests, such as financial profit, recognition and professional career advancement. CoI might arise in clinical practice, research, and education, and might include not only individuals but also institutions. The main purpose of EPA guidance paper on CoI is to contribute to CoI policy in psychiatry on the European level and therefore to the integrity of the psychiatric profession, to protection of the interests of our patients, and to public trust in our discipline.
2454 – Mental Health Promotion and Illness Prevention: EPA Guidance and Strategies
Authors: Bhugra D.
Published: July 2013

This session summarises the EPA Guidance on prevention of mental ill health and promotion of mental well being using the development of UK policy as structure and presented within the European and global context. The promotion of mental health and the prevention of mental illness are a significant component of any clinician's clinical work load. However, often this aspect is omitted from training and service delivery due to insufficient resources and the sheer volume of clinical load. Considerable evidence confirms that prevention can significantly reduce the onset of and subsequent related burdens to mental illness, and associated personal, social and economic costs. Acute mental illness usually prevents positive mental health or wellbeing, yet similarly someone without mental illness can have poor mental health and poor well being. Prevention of mental illness relates closely to and can result from promotion of mental health and associated resilience. Prevention can be categorised in many ways and most clinicians regularly utilise secondary and tertiary prevention. Primary prevention addresses wider determinants across whole populations. Selective prevention targets groups at higher risk of developing disorder. Secondary prevention involves early detection and intervention and corresponds to indicated prevention.
2474 – Presentation on Con
Authors: Gaebel W.
Published: July 2013

Introduction:

ICD-11 and DSM-5 differ in the role of functional impairments for the diagnosis of a mental disorder in general. While a DSM-5 diagnosis of a mental disorder includes functional impairment as a mandatory component, ICD-11 does not.

Objectives:

To clarify the reasoning behind the decision of WHO not to include functional impairment as a mandatory diagnostic criterion.

Aims:

To present arguments for not including functional impairment in the diagnostic criteria for mental disorders.

Methods:

Presentation of con arguments.

Results:

WHO prefers functional criteria not to be included among the clinical criteria (Reed et al., 2011) and suggests using the International Classification of Functioning (ICF) to assess and code such functional impairments. Functional impairments are not always present in persons with schizophrenia, they are not disorder-specific and a WHO study has shown that their occurrence in persons with psychosis-like experiences in the general population does not inevitably indicate schizophrenia or other mental disorders (Nuevo et al., 2010).

Conclusions:

DSM-5 will retain the mandatory criterion of functional impairment, while ICD-11 will not include it. The question of caseness with and without mandatory functional impairments in the diagnostic criteria will be one of the research issues for the upcoming ICD-11 field trials.
2475 – European Guidance - A Project of the European Psychiatric Association
Authors: Gaebel W.
Published: July 2013

Introduction:

The European Psychiatric Association (EPA) created the European guidance project which will provide a series of guidance documents on topics related to the quality of mental healthcare service structures and the prevention of mental disorders, for which evidence- and consensus-based guidelines are currently lacking.

Objectives:

To provide information on good clinical practice, using problem solving examples, guidelines and quality standards of care for European providers of mental healthcare, national societies and health authorities, to address health care gaps, and to give advice on developing research programs.

Aims:

The aim of the “EPA Guidance on the quality of mental health services” is the provision of recommendations for optimal structures of mental healthcare services by identifying and evaluating the current evidence and comparing the efficacy of different service structures wherever possible.

Methods:

Recommendations, which were divided into structure recommendations and process recommendations, were developed on the basis of systematic literature researches and a peer review process within the EPA. Recommendations were supplemented by quality indicators and their evidence base was graded by a three-part evidence rating system.

Results:

In total, 30 evidence- and consensus-based recommendations were developed, which comprise ten general and six service-type-specific structure recommendations, and four general and ten specific process recommendations.

Conclusion:

The initial panel of recommendations on European mental healthcare service structures needs to be tested in each European country with the aim to further develop the recommendations based on the feedback from users.
2514 – Eu Proposed Strategies to Diminish the Burden of Mental Disorders
Authors: Hübel M.
Published: July 2013

Mental disorders are a leading cause of chronic disease and disability in the EU.

Supporting Member States in addressing depression and suicide (including under use of eHealth), replacing institutional by community-based,socially-inclusive treatment and care models (including through the use of EU-Structural Funds), strengthening promotion and prevention as core mission of mental health systems are key objectives of EU-mental health policy. Increasing the mental health literacy of citizens and empowering patients are further priorities.

Psychiatry plays a key role: where necessary, it needs to strengthen patient-centred treatment models and their practice in the community, engage more in multisectorial cooperation for early interventions, promote social inclusion of people with mental health problems, support other sectors (workplaces, schools, local communities), strengthen ties with other medical disciplines to improve their training on mental health and better treatment of co-morbidity of physical and mental disorders.

In 2008, the European Commission launched the European Pact for Mental Health and Well-being. Ministers of Health adopted Council Conclusions in 2011. A Joint Action on Mental Health and Well-being co-financed from the EU-Health Programme was launched early 2013, involving more than 20 Member States. The Joint Action will review the scientific evidence and country situations, deliver country-specific policy recommendations and develop a common framework for action on mental health and well-being.

Mental health is embedded in the context of EU-health policy on chronic disease.

Good practices in policy and stakeholder action are collected and disseminated through the database EU Compass for Action on Mental Health and Well-being (http://ec.europa.eu/health/mental_health/eu_compass/index_en.htm).
2518 – Internet-Based Treatment for Mental Disorders
Authors: Lindefors N.
Published: July 2013

Internet-based cognitive behaviour therapy (ICBT) is a new and promising treatment for psychiatric and other medical disorders. The aim of this presentation is to determine the applications, clinical efficacy and cost-effectiveness of ICBT.

Results from several studies using RCT protocols provide consistent evidence to support clinical efficacy with large effect size of ICBT for depression, panic disorder and social phobia. in addition, preliminary evidence for large effect size is seen for several other disorders such as e.g. severe health anxiety, irritable bowel disorder, eating disorders, cannabis use and pathological gambling. Moderate or small effects are indicated for some other conditions.

Cost-effectiveness analyses suggest that ICBT is cost-effective compared to no treatment or to conventional CBT, respectively. in addition, each therapist can treat at least four to five times more individuals with ICBT as compared to conventional CBT. This is critical since the number of qualified CBT therapists is small compared to the treatment needs.

It is concluded that ICBT currently is a well-established and highly cost effective treatment for depression, panic disorder and social phobia. Moreover, in general ICBT is as effective as conventional CBT for respective disorders, i.e. if conventional CBT works then ICBT works.
2521 – Clinical Challenges in Switching Antipsychotics
Authors: Naber D.
Published: July 2013

Whenever antipsychotic medication is not effective, the first intervention should be to check adherence. If the intake of the oral medication is “relatively” sure and no relevant side effect occurs, the dosage should be increased, if necessary to the maximal tolerated dosage. If side effects do not allow any further increase of the dosage and the antipsychotic drug is taken without any relevant improvement, switching to another antipsychotic is an option most often used. Several issues should be considered:

Change only one drug at a time, switch to an antipsychotic with a different pharmacological profile, ask the patient for his/her collaboration, document psychopathology and tolerability before switching and plan to do again two to four weeks after switching to assess success of switching. The switching strategy has been investigated in several studies and no major difference has been found. However, cross tapering for a period of three to seven days is most often used and probably the safest procedure. The efficacy of switching the antipsychotic, although often used in daily practice, has not well been investigated yet. The few clinical studies will be presented. Data can be summarized: to switch from the first atypical antipsychotic to the second, is effective in 20 to 30%, the switching to a third atypical antipsychotic (if not clozapine) is very seldom successful. After two unsuccessful attempts a switch to clozapine should be thoroughly considered.
2526 – Cultural Understanding of Stigma: A Qualitative Study in Families of Patients with Severe Psychiatric Disorders in Iran
Authors: Karamlou S. , Mottaghipour Y.
Published: July 2013

Introduction:

The Stigmatization of psychiatric patients has been observed across the world, and the family members who care for them are the first-hand witnesses of any discriminatory attitudes. Little is known about how the problem manifests differently across cultures.

Aims:

Study the cultural differences of the experience of stigma in families of patients in Iran.

Methods:

The qualitative data obtained was based on the responses of 20 families to 10 open-ended questions about stigma. The effect of stigma was rated by two coders with high inter-rater reliability. The rating ranged from “no effect” to “severe effect” of stigma.

Results:

In 40% of the interviews, family members reported that stigma had had a moderate effect on their lives. The content analysis of the data developed some various categories that showed the caregivers’ perceptions of stigma. Main categories included: concealment (unsupported network, blame for causing the illness, embarrassment); limitations (work, education, relation with other); genetic attribution (tainted other family members via genetic connection with patients); traditional beliefs in society about patient (patients seen as weak and unworthy people); God's wish, burden (burden because of covering and burden of caring) and the importance of gender differences in the stigma of the illness.

Conclusions:

Patients with psychiatric disorder and their families suffer from stigma with a broad range of negative attributes which may interfere with various aspects of their lives. Concealment and limitations are common experiences in families. Gender differences and God's wish conception are specifically related to cultural factors.
2537 – Talking About Suicide in the Mass Media: From Harmful to Protective Effects
Authors: Niederkrotenthaler T.
Published: July 2013

Background:

Media reporting of suicide has repeatedly been shown to trigger suicidal behavior, with evidence being most consistent for reports on celebrity suicide. Very little is currently known about preventive ways of reporting on suicidality that allow for destigmatization of suicide without harm for those at highest risk.

Objectives and aims:

This presentation will review what we currently know about the relationship of suicide and media reporting and underlying mechanisms. Public health interventions currently used to prevent copycat behavior will be reviewed, including interventions that restrict media reporting on suicide, and interventions that focus on changing the quality of reporting. Recent findings on a possible preventive effect of media reports on constructive coping in adverse circumstances will be presented and discussed with regard to implications for suicide prevention, in particular for suicide awareness campaigns and the prevention of copycat behavior.

Methods:

The presentation will include a selective literature review of research on the relationship of media and suicide, intervention studies to prevent imitation effects, and studies at the interface with suicide awareness campaigns. Particularly experiences gained in the translation of the Austrian Suicide Prevention Plan will be presented and contextualized with international developments in the topic area.
2555 – Violence in the Mental Patients: Risk Factors and Comorbidities
Authors: Arfaoui S. , Meziou O. , Charfi N. , Zalila H.
Published: July 2013

Introduction:

Several studies suggest that people with serious mental illness represent a higher risk of violent acting out than the general population.

Objective:

To evaluate the prevalence of violent behavior in psychiatric patients and compare the group of patients who committed violent acts with nonviolent patients to identify risk factors for violence.

Methodology:

A retrospective-comparative study was conducted among 160 patients hospitalized in the psychiatric service D of the hospital Razi during the period between 1 July 2011 and 15 October 2011.

Results:

Among the patients in our sample 78.75% (N = 126) had submitted an act of violence during the month before hospitalization. The male gender was correlated with violence (OR = 2.7). History of violence and criminal history had significant correlations with violence with OR = 2.5. Schizophrenia diagnosis was the most represented among the mentally ill violent. Monitoring irregular and poor adherence to treatment were important risk factors with OR = 2.6. Addictive behavior was found among 49.2% of violent patients. Substance use was correlated with violence (OR = 4.5).

Conclusion:

It is interesting to note that in recent years the interest of clinicians to the question of violence among the mentally ill has increased. There is also an evolution of psychiatric practice with dimensions of legal framework more rigorous. Clinicians and forensics must continue to work together in this area.