bluuebunny/crossref_metadata_2025 huggingface dataset:
Sources of Meaning in Family Caregivers of Terminally Ill Patients Supported by a Palliative Nursing Care Team – A Naturalistic Three-month Cohort Study
Authors: Valdes-Stauber J. , Lemanczyk R. , Kilian R.
Published: June 2017

Objectives

To identify possible change patterns or robustness in sources of meaning in family caregivers of pre-terminal patients after onset of support at home by an outreach palliative nursing team during a survey period of three months.

Methods

One hundred caregivers of terminally ill patients were included in a prospective observational trial. The Sources of Meaning and Meaning in Life Questionnaire (SoMe) was administered at four points of measurement: T0 (immediately before onset of palliative care); T1 (one week after T0); T2 (one month after T0); T3 (three months after T0). Descriptive statistics, random effects regression analyses; multivariate linear and quadratic regression models were performed for the full (n = 100) as well as for the reduced sample (n = 24).

Results

Growth curve analyses reveal significant parabolic changes for the dimension “order” and for the subscales “social commitment”, “tradition”, “morality”, and “fun”. All other dimensions or subscales remained stable during the time of the study. Cross-sectional multivariate regression models (T0) showed negative associations of some dimensions with patients’ age and psychological burden of the family caregiver while psychological burden of patients was found to be positively associated with some dimensions. No significant effects of interaction variables with time (linear and quadratic).

Conclusions

With few exceptions, family carers seem to keep a stable sense of meaning in life during the final stage of their relatives’ terminal illness. Particular associations between sources of meaning and age of patients as well as psychological burden both of patients and carers have to be taken into consideration in support planning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effectiveness of emotion regulation and distress tolerance skills on improving coping strategies and reduce perceived stress in prisoners
Authors: Davoood R. , Ghahari S.
Published: June 2017

Objective

The aim of this study was the effectiveness of emotion regulation and distress tolerance skills on improving coping strategies and reduce perceived stress in prisoners in Foman city in Iran.

Method

The study population was consisted of 200 prisoners of Foman Penitentiary in 2016. Then, 30 prisoners were selected randomly in two groups (15 persons each group) were replaced. Emotion regulation and distress tolerance training was given to the experimental group for 12 sessions and the control group were in waiting list. Both groups at baseline and end of intervention phase filled coping responses inventory Bellinger and mouse and Cohen perceived stress questionnaire – version 14 questions (PSS-14). Data were analysed by using the software spss22.

Findings

Emotion regulation and distress tolerance skills have been effective on Improving problem-focused coping strategies and reduce perceived stress in prisoners (P < 0/001).

Discussion and conclusion

emotion regulation and distress tolerance skills can improve problem-focused coping strategies and reduce the use of emotion-focused coping strategies and perceived stress in prisoners.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does listening to Mozart's music influence visuospatial short-term memory in young adults?
Authors: Giannoul V. , Popa S.
Published: June 2017

Introduction

Music is claimed to improve mental function and many researchers claim that this effect related to Mozart's music is limited to enhancement of the spatial temporal reasoning and not to other cognitive functions.

Objectives

To explore the influence of Mozart's music on visuospatial memory.

Methods

Sixty adults (37 women and 23 men), with Mage = 21.83, SDage = 2.38, Meducation = 14.03, SDeducation = .99, and without any formal musical education were examined through an experimental process. Participants in groups of ten listened to Mozart's sonata for two pianos in D major, K.448, to Mozart's violin concerto No.3 in G major, K.216, and to a no sounds condition in varying order. The participants after listening to each 10-minute condition were presented with a series of randomly generated patterns made up of black squares on a chess-like surface. This was used in order to test the storage capacity of their visuospatial memory. After 3 seconds of presentation for each drawing, they were asked to reproduce by drawing these patterns that progressively got bigger.

Results

Results revealed for all three conditions that the number of correct grid drawings made by the participants was not significantly statistically different (P > 05), and therefore their visuospatial memory retention was not influenced by any kind of music.

Conclusions

Future research could examine in more detail the retention and manipulation of visuospatial information not only in tasks similar to the visual patterns test, but also in different tests used for clinical and non-clinical populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anxiety and depression in patients with gastroesophageal reflux disorder
Authors: Haji seyed javadi S.A.
Published: June 2017

Introduction

Evidence shows an influence relationship between described symptoms of gastroesophageal reflux disorder (GERD) and emotional state.

Objectives/aims

The current study aimed to evaluate the relationship between anxiety and depression with GERD in the patients referred to the endoscopy unit of Bouali-Sina hospital of Qazvin.

Methods

Two hundred individuals (100 patients with GERD and 100 healthy individuals as control group) were enrolled into the current study. All subjects completed the hospital anxiety and depression questionnaire. GERD was diagnosed based on Los Angeles classification system. Demographic and socioeconomic characteristics in addition to clinical history of subjects were collected and analyzed using proper statistical methods.

Results

Among the recruited patients, 50 subjects had erosive esophagitis (ERD) and 50 had non-erosive esophagitis (NERD). The anxiety score was significantly higher in the NERD group than ERD and control groups (P < 0.001; P = 0.017). In addition, the anxiety score was significantly higher in the ERD group than the control group (P = 0.014). The score of depression was higher in NERD group than ERD and the control groups, but not significant regarding the ERD group (P < 0.001). There was no significant difference among the groups regarding age, gender and body mass index (BMI). The number of smokers was significantly higher in the ERD group than the ERD and control groups (X2 = 39.59, DF = 6, P < 0.001).

Conclusion

The current study showed that mental factors (anxiety and depression) play important roles in the development of GERD, especially NERD; therefore, it is recommended to consider these factors to select suitable treatment plan.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Pharmacological Management of Impulsivity and Compulsivity
Authors: Dom G.
Published: June 2017

Increasingly patients present themselves to psychiatrists and other care providers with a specific request for treatment of one or more behavioral addictions. From a pathogenic point of view impulsivity and compulsivity are important drivers of these behavioral disorders, and as such may represent a target of pharmacological and broader neurobiological, e.g. Neuro-stimulation, treatment. Although currently treatment as usual has a focus on psychosocial and cognitive behavioral interventions, interest is growing toward the pharmacological interventions. In the presentation a state of the art will be presented regarding the pharmacological treatment of behavioral addictions, with a focus on Gambling Disorder and Gaming Disorder.

Disclosure of interest

Member Advisory Board Lundbeck - Belgium.

Received funding from Belgian LOTTO for research into Cognitive Behavioral Therapy for Gambling Disorder.
Neuropersonaltrainer-mh: A New Computerized Platform for the Cognitive Remediation in Schizophrenia and Bipolar Disorders
Authors: Cardoner N. , Cebria A. , Lopez-Sola C. , Serra-Blasco M. , Massons C. , Muriel V. , Navarra G. , Via E. , Cobo J. , Golberg X.
Published: June 2017

Schizophrenia and mood disorders -including unipolar depression and bipolar disorder-, are severe mental diseases with a highly heterogeneous symptomatology, among which cognitive dysfunction has progressively emerged as a key cornerstone. Patients suffering from these illnesses show significant deficits in different neurocognitive and social cognition domains. These deficits are evident during acute episodes, and in a high percentage of patients persist in periods of recovery, playing a decisive role on functional and clinical outcome. Nowadays, different pharmacological therapies have been tested, obtaining non-conclusive results. In this context, non-pharmacological strategies, such as neurocognitive remediation, have emerged as promising therapeutic intervention. Neurocognitive remediation comprises a program to rehabilitate cognitively impaired subjects, aiming either to restore their cognitive functioning or to compensate them in specific cognitive domains. One evolving approach, beginning to receive attention for its initial promising results, is computerized cognitive training. This technique employs tasks or games that exercise a particular brain function which target specific neural networks in order to improve cognitive functioning through neuroplasticity in a given neural circuit. In this scenario, we report our recent results with neuropersonaltrainer®-MH; a module for neurocognitive remediation consisting in a computerized telerehabilitation platform that enables cognitive remediation programs to be carried out in an intensive and personalized manner. Our group has applied NPTMH® in a pilot study treating patients with early onset psychotic disorder with positive and promising results, involving an improvement in functionality, neurocognition, and social cognition performance. Furthermore, new trials in bipolar disorder and major depressive disorder have been recently started.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric treatment-associated stigmatization as viewed through eyes of rural health clinic patients
Authors: Sendler D. , Markiewicz A.
Published: June 2017

Introduction

Having a mental disease is frequently a stigmatizing experience for patients. We know little about urban inhabitants who travel to rural health clinics to receive mental treatment.

Objectives

Recruit and interview urban-based psychiatric patients who, to avoid stigmatization; travel to rural community clinics with the intention of receiving treatment.

Methods

Study included participants (n = 32) who exchanged treatment in government subsidized city clinics for rural community centers. Qualitative interviews lasting thirty minutes were recorded and transcribed for content analysis. MAXQDA, version 12, was used to annotate transcripts with topic specific nodes, followed by cluster theme and trend analysis.

Results

Trend analysis yielded three areas of concern for subsidized urban psychiatry: cost/insurance, lack of staff professionalism, and family-driven ostracism. Seven respondents cited cost as the main factor, influencing the choice of rural-based care over city clinic. Patients with stable income, but without insurance (n = 14), felt unwelcome in city clinics as their ability to pay was frequently questioned by supporting staff. Lack of trained social workers caused additional distress, as participants could not receive access to additional resources. Only four patients said that their psychiatrists acknowledged poor clinic environment and encouraged remaining in treatment. For 18 respondents, family demanded that they receive treatment in rural clinic so that no one finds out about their mental disease.

Conclusion

In large urban clinics, stigma in psychiatry comes in many flavors, especially projected by unprofessional clinic staff and ashamed family. Lack of support forces patients to travel to rural premises to receive unbiased, stress-free care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect of original anticonvulsant meta-chloro-benzhydryl-urea on behavioral and immune parameters in mice with active and passive behavior types in experimental alcoholism
Authors: Markova E. , Knyazheva M. , Savkin I. , Shushpanova T.
Published: June 2017

Objective

Violation of the functional activity of the nervous and immune systems is an essential link in the pathogenesis of chronic alcohol dependence. The search for new psychopharmacological agents whose action is directed to correction of neuroimmune interaction opens new perspectives for the treatment of alcohol dependence.

Methods

(CBAxC57Bl/6) F1 mice with active and passive behavioral types in a state of chronic alcohol dependence owing to 6 month 10% ethanol exposure were undergoing intragastric administration of original anticonvulsant meta-chloro-benzhydryl-urea. Animal's behavioral and immune parameters, brain cytokines synthesis before and after anticonvulsant receiving were estimated.

Results

In the formation of experimental alcohol dependence in animals the most pronounced changes in motor and exploratory activities in open field test, brain cytokines synthesis and suppression of immune response were registered in mice with passive type of behavior. Daily consumption of ethanol solution in mice with chronic alcohol dependence decreased sharply starting from 2 days of anticonvulsant administration and led to the cessation of ethanol consumption by the 5 day. After anticonvulsant administration for 10 days behavioral parameters in mice were comparable with those in the control group of healthy animals. It also restored brain cytokines synthesis and significant stimulated humoral immune response, estimated by the relative number of antibody-forming spleen cells.

Conclusion

Behavior and immune changes following chronic ethanol exposure depended on the behavior status of animals; administration of the original anticonvulsant meta-chloro-benzhydryl-urea may correct both immune and behavior disorders in mice with chronic alcohol dependence, so it has promise in the treatment of alcoholism.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Lymphocytes with Fas-receptors of readiness to apoptosis in non-psychotic mental disorders
Authors: Nikitina V. , Vetlugina T.P. , Lobacheva O.A. , Rudnitsky V.A. , Axenov M.M.
Published: June 2017

Introduction

Apoptosis is a complex physiological process of the organism which supports cellular homeostasis, provides important aspects of development and functioning of the immune system. In various pathological conditions the process of apoptosis can be impaired that leads to decrease or increase in pro-apoptotic activity.

Materials and methods

We conducted investigation of relative and absolute number of CD3+CD95+–lymphocytes in groups of patients with adjustment disorders (n = 90), PTSD (n = 100), organic emotionally labile (asthenic) disorder (n = 232), organic personality disorder (n = 93). Clinical verification was conducted according to ICD–10. Control group included 190 practically healthy persons. Fas protein (CD95) expression on CD3 lymphocytes surfaces was detected using flow cytometry. Cytometric measurements were conducted on flow cytofluorimeter FacsCalibur (Becton Dickinson, US).

Results

In the control group relative number of CD95+–lymphocytes was 11.6%, absolute–0.21 × 109/L. In all examined patients as compared with control the reliable increase both in relative and absolute number of lymphocytes of CD3+CD95+–phenotype was identified. So, in persons with adjustment disorder content of this indicator made 17.0% and 0.28 × 109/L (Р = 0.0015), in PTSD–18.0% and 0.33 × 109/L (Р = 0.0007) and in patients with organic asthenic disorder–19.0% and 0.32 × 109/L (Р = 0.0048), respectively. The highest content in blood of CD3+–lymphocytes, expressing on the surface of membrane the basic marker of apoptosis CD95 is observed in patients with organic personality disorder: 26.0% and 0.44 × 109/L (Р = 0.0003).

Conclusion

In case of intensification of psychopathological symptoms especially in persons with non-psychotic organic mental disorders a receptor-mediated signaling pathway of apoptosis is activated – process of programmed cell death.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Combination of aripiprazole and olanzapine in first episode psychosis patient with metabolic syndrome: A case report
Authors: Licanin I. , Senad H.
Published: June 2017

There are numerous factors that predispose patients with schizophrenia to develop metabolic syndrome and become overweight including: physical passivity, unhealthy diet and anti-psyhotic treatment. The prevalence of anti-psychotic-related metabolic disturbances has been reported to vary from 23% to 50% and clozapine and olanzapine had the most pronounced potential to cause metabolic syndrome. We present the case of 32-year-old male who has been diagnosed with first episode schizophrenia spectrum psychosis and has been treated for 3 months in the community mental health center. He was medication–compliant and was prescribed olanazapine 10 mg a day and had initial remission of symptoms. The reason behind referral to our department of psychiatry was development of metabolic syndrome. Immediately upon admission to our department basic panel blood tests (minerals, creatinin, glucose, tryglicerides and cholesterol) as well as complete blood count were done. Patient reported gaining weight of more than 5 kilograms since the initiation of the olanzapine treatment. Results of the performed metabolic tests in addition to abnormal BMI and slightly higher blood pressure have indicated presence of metabolic syndrome. In order to try to reverse metabolic syndrome aripiprazole was commenced adjunctive to olanzapine. During the first week the dosage of aripiprazole was 2.5 mg/day, second week 5 mg/day and then increased to 10 mg a day. Three weeks after adding aripiprazole to olanzapine lab values of holesterol, triglycerides, fasting glucose as well as BMI were significantly lowered and symptoms of the metabolic syndrome were mitigated. Treatment was well tolerated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rasagiline and venlafaxine: The serotonin syndrome
Authors: Rodriguez Campos A. , Rodríguez Andrés L. , Medina Ojeda G. , Gallardo Borge L. , Rybak Koite E.
Published: June 2017

Rasagiline is a highly potent irreversible monoamine oxidase (MAO)-B inhibitor, antiparkinsonian drug that may be used with caution in patients treated with antidepressant drugs because of the possible appearance of severe adverse effects. It is presented the case report of a woman treated with rasagiline and venlafaxine that presents confusion and a serotonin syndrome. Pathogenesis, physiopathology and treatment are discussed. Growing evidence suggests that Parkinson disease and depression are linked. Antidepressant drugs and PD treatment should be used with caution because of possible drug interaction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A case report of an acute confusional state related with perampanel
Authors: Solerdelcoll Arimany M. , Bruguera P. , Guzmán P. , Balcells Oliveiró M.
Published: June 2017

Introduction

Perampanel (PER) is a new selective, non-competitive AMPA glutamate receptor antagonist. PER is generally well tolerated, with dizziness, somnolence, headache, and fatigue as the most common treatment-emergent adverse events, however neuropsychiatric adverse reactions; particularly irritability and aggressiveness can be expected.

Objective

We describe a patient who developed and acute confusional state presumably related to treatment with PER.

Aims

At the conclusion, the participants should be able to remember that PER is associated with psychiatric side effects.

Methods

Collect the data of the clinical history of the patient, who was admitted in the acute psychiatry ward of our hospital.

Results

A 32-year-old woman diagnosed with pharmacoresistant juvenile myoclonic epilepsy, was referred to the emergency department because of severe behavioral disturbances, insomnia, irritability and aggressivity after increasing the dose of PER from 6 to 12 mg. Physical exploration, drug screen and blood tests were all normal. No abnormalities were found in CT, EEG and MRI, and then she was referred to psychiatric ward. At her admission, she presented fluctuations of her mental state and level of consciousness. She was diagnosed with acute confusional syndrome induced by PER, and consequently PER was stopped and risperidone was initiated. In the 4th week symptomatology remitted.

Conclusion

Anti-epileptic drug's (AEDs) are associated with psychiatric side effects. Patients with epilepsy have higher risk develop psychiatric symptoms and behavioral disturbances. There is evidence to suggest that AMPA receptors are involved in the pathogenesis of psychiatric conditions. Such mechanisms could be responsible of the psychiatric symptoms observed. Neuropsychological profiles of AEDs are important considerations for treatment selection, particularly in children and adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Traumatic Brain Injury as Psychosis Development Factor
Authors: Alonso Sánchez A. , Álvarez Astorga A. , Red Gallego H. De la , Calzón M. De Lorenzo , Viloria N. De Uribe , Gómez García M. , Noval Canga C. , Mayor Toranzo E. , Blanco Garrote J.A.
Published: June 2017

Introduction

The pathophysiology of psychosis is not fully discovered yet. However, during the last years many different risk factors are shown to prove to have a strong influence within the development of this pathology. Traumatic brain injury (TBI) is one of them.

Objectives

Show TBI as a psychosis development risk factor.

Methods

Case report. A clinical vignette is presented followed by the results obtained in a bibliographic review.

Results

A young 19-year old immigrant man, who lives with his parents in a social exclusion situation is brought to the hospital after having been observed making estrange religious rituals within a local river. During the anamnese he declares that God is “getting in touch with him” while he shows to be changed, with suspicion about being pursued. He also reveals to have suffered a mild-severe TBI with 8 years, having right ear audition problems since then. During the hospitalization some medical test were done, such as MRI, showing the lack of the inner right ear, as well as white matter abnormalities in his right hemisphere, which could be consequence of the TBI. Those findings make us think that this pathology might have been influenced, within other factors, by the traumatic brain injury.

Conclusions

This bibliographic review shows that traumatic brain injury may increase the risk of developing psychosis up to 65% from healthy controls, with a medium gap of 3.3 years between the TBI and the appearance of psychotic pathology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Peripheric Metabolic Abnormalities in Schizophrenia Patients
Authors: Amorim M. , Moreira A. , Marques A. , Summavielle T.
Published: June 2017

Introduction

Schizophrenia (SCZ) is frequently associated with metabolic symptoms including dyslipidaemia, hyperinsulinemia, type 2 diabetes and obesity. In fact, SCZ patients have been reported to present higher prevalence of these conditions than general population, commonly associated to second generation antipsychotic therapy. Recent studies, however, have demonstrated that peripheral metabolic disturbances can appear at disease onset or drug-naïve patients.

Objectives/aims

To assess metabolic disturbances in first episode and/or drug-naïve SCZ patients.

Methods

We conducted a literature review through Pubmed search for MeSH: schizophrenia, metabolism, glucose, insulin. Controlled studies on first episode and/or drug-naïve SCZ patients were included.

Results

Several studies showed no change in SCZ patients’ fasting blood glucose, while others found increased glucose levels and impaired glucose tolerance in SCZ patients compared to healthy controls in several recent studies. Hyperinsulinemia and insulin resistance have also been identified in antipsychotic-naïve SCZ patients and it has been suggested that early onset patients are more likely to present insulin resistance. In addition, there's evidence of increased circulating levels of chromogranin A, pancreatic polypeptide, prolactin, cortisol, progesterone, thus emphasising that multiple components of the hypothalamic-pituitary-adrenal-gonadal axis may be affected in SCZ. These elevations were associated to normal glycaemia suggesting there may be insulin intolerance during early stages of SCZ, requiring an increased secretion from pancreatic Bcells to maintain normal glucose levels.

Conclusions

Recent studies of first onset and/or drug-free schizophrenia patients have shown impaired fasting glucose tolerance, hyperinsulinemia and insulin intolerance, suggesting that metabolic abnormalities may play a role in SCZ onset and pathophysiology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Validation of the delusional ideation inventory for the Portuguese population
Authors: Pimentel S. , Cunha M. , Galhardo A. , Couto M.
Published: June 2017

Introduction

The dimensional approaches regard delusions as a continuum of the daily beliefs, not being limited to the clinical population and it can also be found in the general population. Due to the multifaceted conceptualization of delusions, the analysis of the dimensions of distress, preoccupation and conviction may be more revealing than the content of the belief itself, whereby an evaluation that incorporates these dimensions is fundamental.

Objective

Translation, adaptation and study of the psychometric properties of the Peters et al. delusions inventory (PDI-21) for the Portuguese population.

Aim

Assessing the multidimensionality of the delusional ideation in the community.

Methods

The sample consists of 249 adults from the general population, aged between 18 to 65. The brief symptom inventory, the social desirability scale of the eysenck personality questionnaire and the World Health Organization quality of life–bref were used in this study beyond the PDI-21.

Results

The Portuguese version of the PDI-21 has shown good psychometric properties regarding its internal consistency and test-retest reliability. It demonstrated significant positive correlations with the psychopathological symptoms and negative associations with social desirability and with the quality of life, confirming its divergent and convergent validity. The analysis of the frequency of delusional ideas for the total of the sample and on the basis of gender has revealed prevalence rates very similar to the ones found in previous studies.

Conclusions

The Portuguese version of the PDI-21 has adequate psychometric properties and it can be used to assess the delusional ideation in the general population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Metabolic health in patients with schizophrenia – CVD risk in a Norwegian outpatient population
Authors: Engh J. , Andersen E. , Martinsen E. , Egeland J. , Holmen T.L. , Bigseth T.T. , Bang-Kittilsen G.
Published: June 2017

The mortality of schizophrenia patients is approximately twice that of the general population and there is a 20% reduction in life expectancy in this patient group. Cardiovascular disease (CVD) is responsible for as much as 50% of the excess mortality associated with schizophrenia. One important source of the high CVD prevalence is the cluster of metabolic characteristics defining the metabolic syndrome (MetS: 3 or more of the following features: abdominal obesity, high blood pressure, elevated levels of triglycerides and fasting glucose and low levels of high-density lipoproteins). Patients with schizophrenia seem to be undertreated for these vascular risk factors relative to the general population. More knowledge is needed concerning broadened risk factors of cardiovascular disease in a representative sample of schizophrenia patients. We conducted preliminary cross sectional analyses in a sample of 64 consecutive outpatients with schizophrenia with a mean age of 37 years consisting of 59% men, who were enrolled in a treatment study. All used antipsychotics, and 71% were smokers. We found that (percentage of patients under treatment for the respective somatic condition in parenthesis) 82% were overweight, 49% had hypertonia (17%), 24% hyperglycemia (3%), 48% hypertriglyceridemia and 13% hyperlipidemia (10% triglycerid or cholesterol lowering medication). Forty percent had metabolic syndrome compared to 11% in the normal population (Norway, age corrected). Additionally, estimates of insulin resistance will be conducted. We found that the prevalence of MetS components was high in outpatient schizophrenia. A substantial discrepancy was found between metabolic ill health and medication treatment of such conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Frontotemporal dementia misdiagnosed as schizophrenia or other psychotic disorder
Authors: Giamarelou A. , Polychronopoulos P. , Skokou M. , Messinis L. , Gourzis P.
Published: June 2017

Introduction

Frontotemporal dementia (FTD) encompasses a group of clinical features that include personality and behavior changes (disinhibition, social isolation, antisocial behavior, compulsion) and executive dysfunction (poor planning, loss of judgment and loss of insight). These features may lead to an incorrect diagnosis of a primary psychiatric disorder.

Objectives

To emphasize the difficulties in making a clinical distinction between early frontotemporal dementia and other psychiatric diseases.

Methods

We describe 11 patients who suffered from FTD, while initially had diagnosed with primary psychiatric disorders. The correct diagnosis was achieved by psychiatric and neuropsychological evaluations (WAIS SCALE, ACE-R, MMSE), neuroimaging studies (MRI 7/11, SPECT 8/11) and applying the international consensus criteria for FTD.

Results

All patients (5 males and 6 females) were initially diagnosed with psychiatric disorders: schizophrenia (2/11), bipolar disorders (4/11), depression (5/11), schizoaffective disorder (1/11), somatization disorder (1/11), personality disorders (2/11), malingering (1/11), alcohol dependence (1/11), while 5 patients had more than one diagnosis. The age of onset varied from 19 to 53 years old. Final diagnosis of FTD was delayed on average 6,5 years from the onset of symptoms.

Conclusion

Clinicians should be familiar with the clinical entity of FTD and its difficult distinction from other psychiatric disorders. A possible hospitalization of a patient with FTD in a psychiatric department and the social impact that it brings may be avoided. On the other hand, the proper care of FTD patients (pharmacological and psychosocial) improves the quality of life of patients and their caregivers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotic polypharmacy among schizophrenia outpatients
Authors: Maatallah H. , Ammar H. Ben , Aissa A. , Nefzi R. , Said M. , Hechmi Z. El
Published: June 2017

Introduction

Since their introduction by Delay and Deniker in the 1950s, neuroleptic drugs have significantly modified the evolutionary prognosis of schizophrenia. Their combination has also become a widespread practice.

Objectives

The aim of this study was to analyze the associations of neuroleptic drugs by describing the characteristics of types and doses, understanding the reasons for these associations and studying the relationship existing in such situation regarding adherence to treatment, tolerance and the number of hospitalizations.

Methods

Our study was retrospective, descriptive and analytical. It has been conducted from March, 1st to May, 30th 2015 and involved 70 stabilized patients diagnosed with schizophrenia according to DSM 5. Clinical characteristics were collected from patients and their medical records. Evaluations were conducted using PANSS, MARS and GAS.

Results

Overall, 70 male patients were recruited. The mean age was 40 years old: 30% received classical monotherapy while 70% were treated only by an atypical antipsychotic. Among patients receiving two drugs, 85% received classical bitherapy while 9% were under both classical and atypical drugs. Only 6% received atypical bitherapy. Chlorpromazine equivalent doses in case of monotherapy was 325.92 mg/day, while it reached 1148.65 mg/day in case of drugs association. Administration of a combined therapy had poor tolerance rate and all patients suffered from adverse effects. Adherence to treatment was better while receiving monotherapy (88% versus 45%) and the number of hospitalizations was lower with an average of 3 against 10.

Conclusion

Our study revealed several shortcomings in our current management of patients with schizophrenia and addressed the implication of socioeconomic status on therapeutic outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment patterns in schizophrenia: Clinical case of successful management with a series of long acting injectable antipsychotics
Authors: Palomo Monge M. , Calvo Mauri J.F. , Tascon Guerra M.F. , Duque Domínguez A. , Díaz Conde S. , Padilla Romero P. , Alcocer Lanza M.F. , Ochoa Blanco R. , Lara de Lucas B.
Published: June 2017

Introduction

We report the successful management of a 57-year-old woman with a 20 year diagnostic of paranoid schizophrenia (first visit November, 1995). She presented several comorbidities (arterial hypertension, diabetes mellitus and morbid obesity), with a history of five previous hospitalizations (1995, 2012, January and May 2014, and April 2016).

Aims/methods

The patient was always prescribed depot antipsychotics: she was treated for 14 years with Zuclopentixol depot (discontinued due to dermic adverse reactions and weight gain). After a period with oral paliperidone (from 2012 until 2013) and due to lack of adherence to oral therapy, in August 2013 she was prescribed paliperidone palmitate. The treatment was discontinued after nine months (May 2014) due to weight gain, a significant increase of serum prolactin levels and two psychotic relapses that led to hospital admissions.

Results

She was then prescribed Fluphenazine decanoate depot for one year and 4 months, but she was switched to Aripiprazole once monthly (AOM) in September 2015 to avoid metabolic syndrome.

Conclusions

Non-personalized antipsychotic treatment in a patient with a complicated comorbidity history can result in lack of compliance and a risk of relapse, and in a worsening of her medical conditions, with the consequential negative impact in her functioning and quality of life. Based on our results, the treatment with AOM resulted in a positive evolution of the patient, with a good tolerability profile, in an improvement of treatment-caused adverse events (weight loss, and prolactin serum levels normalization); all factors that enable treatment adherence and good clinical response.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Patients with schizophrenia assessing psychiatrists’ communication skills
Authors: Pestana Santos A. , Santos V. , Carvalho I.
Published: June 2017

The doctor-patient relationship constitutes the matrix of the entire medical practice. One way in which doctors develop a positive rapport with their patients is through appropriate communication. Evidence suggests that doctors do not communicate with their patients as they should. Important gaps are observed in doctors’ communication with patients with schizophrenia.

Aim

Examine psychiatrists’ communication skills as assessed by their patients with schizophrenia and through external observation, considering patients’ socio-demographic and clinical variables and analyse the importance that aspects of communication have for patients.

Methodology

This cross-sectional study involved a sample of 30 patients and 11 doctors. An adapted and culturally validated version of the Communication Assessment Tool was used for data collection. Data were analysed in IBM SPSS Statistics®, version 24.

Results

Male patients constituted 86.7% of the sample and mean age was 46.7 ± 13.3. The overall mean percentage of items rated as excellent by patients was 57.4%. On the other hand, external observer percentage of excellent scores was much lower when compared with patients’ scores. Single, divorced or widower/widow patients, patients with higher educational level and patients with shorter number of years in medical treatment gave significantly higher scores to psychiatrists’ communication. Patients’ sex, age, occupation residence and family type did not yield statistically significant effects on patients’ ratings.

Conclusions

Communication is at the heart of psychiatrists’ daily practice. Many communication styles might be needed, depending on the nature of clinical encounters and patient expectations. Specific training is required to optimise psychiatrists’ communication skills on everyday practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Nicotine dependence is associated with depression and childhood trauma in smokers with schizophrenia. Results from the Face-SZ dataset
Authors: Rey R. , D’amato T. , Llorca P.M. , Fond G.
Published: June 2017

Introduction

In a perspective of personalized care for smoking cessation, a better clinical characterization of smokers with schizophrenia (SZ) is needed. The objective of this study was to determine the clinical characteristics of SZ smokers with severe nicotine (NIC) dependence.

Methods

Two hundred and forty stabilized community-dwelling SZ smokers (mean age = 31.9 years, 80.4% male gender) were consecutively included in the network of the FondaMental Expert Centers for schizophrenia and assessed with validated scales. Severe NIC dependence was defined by a Fagerstrom questionnaire score ≥7. Major depression was defined by a Calgary score ≥6. Childhood trauma was self-reported by the Childhood Trauma Questionnaire score (CTQ). Ongoing psychotropic treatment was recorded.

Results

Severe NIC dependence was identified in 83 subjects (34.6%), major depression in 60 (26.3%). 44 (22.3%) subjects were treated by antidepressants. In a multivariate model, severe NIC dependence remained associated with major depression (OR = 3.155, P = 0.006), male gender (OR = 4.479, P = 0.009) and more slightly with childhood trauma (OR = 1.032, P = 0.044), independently of socio-demographic characteristics, psychotic symptoms severity, psychotropic treatments and alcohol disorder.

Conclusion

NIC dependence was independently and strongly associated with respectively major depression and male gender in schizophrenia, and only slightly with history of childhood trauma. Based on these results, the care of both nicotine dependence and depression should be evaluated for an effective smoking cessation intervention in schizophrenia. Bupropion, an antidepressant that has been found as the potential most effective strategy for tobacco cessation in schizophrenia to date, may be particularly relevant in male SZ smokers with comorbid major depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Urban Spaces and psychic disease: A case series from Florence
Authors: Rondini E. , Bertelli M.
Published: June 2017

People with schizophrenia or other psychoses present alterations of multi-sensory processing and impairments in cognitive functions. They seem to be more sensitive to external stimuli than the general population, which can negatively impact on their emotional state. The purpose of the study was to assess how elements of urban milieu combine with spatial experiences of people with these disorders, affecting their spatial perceptions and social interactions. The group of participants consisted of 10 patients aged between 20 and 40 years, with schizophrenia or other psychoses. We used qualitative methods to assess behaviours in different urban routes, including a period of participant observation and a series of semi-structured interviews. Pathways within the city were recorded using a Global Position System (GPS), in order to link perceptual and behavioural data to specific urban spaces. The data analysis has revealed positive interactions between most of participants and the city. Different places have been differently perceived in terms of stress and comfort. The wide squares and the art-rich sites of the city center, as well as public parks and gardens, have been connected with positive feelings and senses of pleasure. Conversely, the presence of a high number of people and the movement experiences through public transport services have emerged to be associated with negative emotions. A deeper understanding of mechanisms and processes that interest the link between urban space and psychological disease can contribute to show new directions for the improvement of urban life quality and to progress both in psychiatry and in urban planning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Restraint or not restraint. Involuntary transport from home of schizophrenic patients
Authors: Samso B. , Ramos S. , Malagón A. , Gonzalez A. , Bellsolà M. , León J. , Llobet M. , Alba L. , Pérez V. , Martín L.M. , Córcoles D.
Published: June 2017

Introduction

Although physical restraint (PR) is a non-rarely practice on psychiatry there are few studies that focus the attention on the risk factors for this intervention. PR is a legitimacy practice when is needed and well applied but is not free from side effects. Knowing risk factors might be useful to improve the application of PR.

Objectives

Study the risk factors involved with the use of PR at patient's home in individuals with schizophrenia before the involuntary transport (IT) to a psychiatric facility.

Methods

Is a descriptive and observational study of 267 psychotic patients that were assisted by a psychiatric home care unit (EMSE) in Barcelona during their IT. The sample was divided in two groups, depending on the need of PR. Socio-demographic data were collected as well as positive and negative syndrome scale (PANSS), WHO disability assessment schedule (WHO/DAS), global assessment of functioning scale (GAF), Scale to assess unawareness of mental disorder (SUMD). Aggressiveness was assessed by PANSS-EC consisting of 5 items: excitement, tension, hostility, uncooperativeness and poor impulse.

Results

From the 267 psychotic patients 109 required PR. 154 were male and the average of age was 47. The results were significant in the PR group versus no PR for PANSS-EC (P = 0.000), as well as WHO/DAS (P = 0.017), GAF (P = 0.042), Positive PANSS (P = 0.000), age (P = 0.001) and substance use (P = 0.012). Were no significant for gender, insight or Negative PANSS.

Conclusions

Aggressiveness and violence were the most important PR related factors followed by positive symptoms, age, substance use and global functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional Eating in Eating Disorders and Obesity: Sensorial, Hormonal and Brain Factors Involved
Authors: Fernandez-Aranda F. , Steward T. , Mallorqui-Bague N. , Agüera Z. , Jimenez-Murcia S.
Published: June 2017

Obesity (OB) and eating disorders (ED) are two complex weight/eating conditions that share phenotypic traits, including psychopathological variables, specific environmental risk factors and biological vulnerabilities. Both OB and ED are associated with maladaptive eating styles that may be relevant to their development and maintenance. In abnormal/excessive eating behavior, a complex interplay among physiological, sensorial, psychological, social and genetic factors influence appetite, meal timing, and the quantity of food intake and food preferences. Neurobiological functioning has also been found to be altered in extreme weight conditions, namely with regards to reward processing, emotion regulation and decision making. In this presentation we will discuss the relevance of such components as well their interaction using findings from cross-sectional and longitudinal studies conducted in extreme eating/weight conditions, when compared with healthy controls. The development of innovative treatments considering neurobiological factors will also be covered.

Acknowledgment

Researchers supported by FIS (PI14/290) and CIBEROBN from ISCIII. Spain.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sleep disturbances, mental toughness, and physical activity in patients with multiple sclerosis (MS) compared to healthy adolescents and young adults
Authors: Sadeghi Bahmani D. , Gerber M. , Kalak N. , Lemola S. , Clough P.J. , Calabrese P. , Holsboer-Trachsler E. , Brand S.
Published: June 2017

Background

Multiple sclerosis (MS) is the commonest chronic autoimmune demyelinating and inflammatory disease of the CNS, afflicting both body and mind. Typical symptoms are fatigue, paraesthesia and depression, along with cognitive impairments. Whereas there is extant research on fatigue, depression, and cognitive impairment of patients with MS during the clinical course, no research focused on sleep, psychological functioning, and physical activity (PA) at the moment of the diagnose. The aims of the present study were therefore to assess possible state markers of mental toughness (MT) as a dimension of psychological functioning, sleep disturbances (SD), PA among patients at the moment of the diagnose, and to compare these data with those of healthy adolescents and healthy young adults.

Methods

A total of 23 patients with recently diagnosed MS (M = 32.31 years), 23 healthy adolescents (M = 17.43 years), and 25 healthy young adults (M = 20.72 years) took part in the study. They completed questionnaires covering socio-demographic data, MT, SD, and PA.

Results

Patients with MS reported similar MT traits as adolescents, and an equal amount of moderate PA and SD as young adults. Further, patients reported a lower level of vigorous PA, compared to healthy adolescents and young adults.

Conclusions

Compared to healthy adolescents and young adults, patients at the moment of the diagnose of MS reported similar MT traits, SD and moderate PA. The pattern of results suggests that at the moment of the diagnose MS is not predictable by poor MT, poor sleep, and decreased level of moderate PA.

Disclosure of interest

The authors have not supplied their declaration of competing interest.