bluuebunny/crossref_metadata_2025 huggingface dataset:
Ensuring patient safety: Physical health monitoring in rapid tranquillisation for aggression and violence of adult acute inpatients
Authors: Talukdar R. , Ludlam M. , Pout L. , Lekka N.P.
Published: May 2016

Introduction

Intramuscular (IM) medications used in rapid tranquillisation (RT) to manage violent/aggressive behaviour can cause serious physical side effects including sudden death, therefore comprehensive physical health monitoring is advised.

Objectives

To assess whether physical health monitoring of patients who received IM medication for RT was completed as per the Aggression/Violence NICE-guideline based local Policy.

Methods

All patients that received IM benzodiazepines or antipsychotics for RT were identified amongst 822 discharges from February 2014 to February 2015. Demographics, diagnoses, non-pharmacological interventions, types/doses of medication, and associated seclusion/restraint episodes were recorded. Notes were examined to determine whether physical health monitoring protocols involving blood pressure, pulse, temperature, oxygen saturation, respiratory rate and level of consciousness were followed.

Results

There were a total of 218 episodes where these medications were used, in which only 19 (8.8%) had any physical observations completed; only one case (0.5%) was completed fully as per the protocol. Of the cases that did not have observations taken, in 12 (5.5%) cases observations were attempted but the patient was too agitated/aggressive. A doctor was contacted in only 53 (24.3%) cases and an ECG was completed in 120 (55%) cases, of which only 11 were completed within 24 hours.

Conclusions

The results show poor compliance (or at least recording) with the guidance, demonstrating the need for further education of nursing and medical staff on the potential dangers of RT and for better physical health monitoring of patients on RT. To improve patient safety, staff training and well-timed recording of physical observations on electronic tablets will commence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Incidence and management of agitation in emergency medical services in Spain – “SOSEGA” Study
Authors: Rodriguez Calzada R. , Suarez Fuentes M.A. , Roset Arisso P. ,   S.G.O.R. Sosega Group Of Researchers
Published: May 2016

Introduction

Agitation is a frequent and complex emergency. Its early detection and adequate treatment are crucial to ensure the best outcomes. Pre-hospital management of agitation requires appropriate measures to preserve patients’ safety, stabilize the patient and alleviate suffering, and transfer to the hospital psychiatric services, including involuntary admission if needed.

Objectives

To describe the management of agitation by the Emergency Medical Services (EMS) in Spain.

Methods

Observational retrospective survey on the protocols and procedures used, the number of in-calls received and the resources dedicated to attend emergencies in 2013.

Results

Seven out of the seventeen EMS in Spain provided information. All of them registered in a database in-calls and actions taken. Four of them had a specific protocol to attend psychiatric emergencies and agitation in-calls, and five coded the initial diagnostic with ICD-9. Paramedics attending emergencies register the diagnostic in 3/7 EMS. Nursing and Medical staff code the final diagnostic with ICD-9 in all. Emergency Coordination Centres received 4,437,388 in-calls (209/1000 inhabitants); 2.6% classified as psychiatric (6.2/1000 inhab.). Healthcare teams attended 2,028,467 emergencies, 84,933 (4.2%) were psychiatric (4.0/1000 inhab.) and 37,951 (1.9%) were patients with agitation (2.0/1000 inhab.). General practitioners attended 17% of all psychiatric emergencies, while ambulances attended 61%.

Conclusions

The incidence of acute agitation accounts for almost half of the total psychiatric emergencies in the pre-hospital setting. Since there are different healthcare providers in charge, specific protocols as well as treatment procedures are needed to provide the most adequate management, in order to ensure the best Psychiatric Emergency Chain.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Psychiatry consultation in primary health care setting at an Oporto Area: Sociodemographic and clinical data
Authors: Dias Amaral A. , Peixoto M.J. , Cortiñas A. , Fonseca S. , Curral R.
Published: May 2016

Introduction

The Psychiatry consultation is a collaborative approach between primary health care services and community mental health teams. Our clinic provides support to three Oporto areas (Bonfim/Paranhos, Campanhã and Maia/Valongo) corresponding to a population of 350,000 inhabitants.

Objectives

To analyze and collect Psychiatry consultation data of the first semester of 2015 in Maia/Valongo region. We aim to describe our population's sociodemographic characteristics, the most common referral motive, diagnosis and therapeutics, and orientation.

Methods

Psychiatry consultation data of the first semester of 2015 were collected and analyzed using SPSS software (version 20).

Results

One hundred and sixty-one patients were evaluated. A total of 26.09% were male and 73.91% were female. The mean age was 51.61 years old. The most frequent referral motives were depressive (47.82%) and anxiety (23.60%) symptoms. The two most common diagnostic groups according to the International Classification of Diseases (version 10) were F30-F39–Mood affective disorders (57.76%) and F40-F48–Neurotic, stress-related and somatoform disorders (18.63%). 22.36% of the patients were referred without medication, but only four were discharged drug-free, corresponding to bereavement situations. 34.16% of our population were previously prescribed two or more psychotropic drugs, increasing to 63.98% after assessment. Only 18.63% met criteria to hospital referral.

Conclusions

The Psychiatry consultation selects the most severe patients and allows a faster evaluation of mentally ill patients awaiting hospital consultation, thus preventing unnecessary access to the emergency room. Authors consider that all the patients referred to a hospital consultation should be previously evaluated by a consultant psychiatrist on a primary health care setting.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Unemployment and the rate of new contacts with mental health services in South London
Authors: Bhavsar V. , Hotopf M. , Boydell J. , Hatch S. ,   SELCOH Investigators
Published: May 2016

Introduction

Unemployment is a risk factor for later development of mental health problems, but characterisation of this in real world clinical data is limited. This study aimed to investigate the association between employment status and time-to-first-contact with mental health services using survey data linked to electronic health records(EHR).

Methods

SELCoH (n = 1698, 2008–2010) was a representative population survey of South East London, with a 71.9% household participation rate. Anonymised survey data for participants was linked with EHR, generating survival data for time-to-first-contact. Cox regression was used to assess associations between unemployment and time to first contact with mental health services.

Results

The rate in the unemployed was 22.84 contacts per 1000 person-years, and in those not unemployed, it was 10 contacts per 1000 person-years. The crude (age-adjusted) hazard ratio (HR) for unemployment was 3.09 (95% CI: 1.66–5.75). The HR for contact for unemployment, after adjusting for age, gender, ethnicity and education, was 2.8 (95% CI: 1.44–5.47). On addition of symptoms of common mental disorder, post-traumatic stress, psychosis and suicide attempts, to the model, unemployed participants remained at elevated risk (HR:2.65, 95% CI: 1.33–5.27). Finally, illicit drugs and alcohol had minimal influence on estimates, giving a fully-adjusted estimate for the association between unemployment and rate of contact of 2.6 (95% CI: 1.31–5.14).

Conclusions

Unemployment was associated with a greater than two-fold increase in risk of accessing mental health care for the first time within the observation time, after adjustment for sociodemographic confounders, psychopathology, and substance use. Explanations for this association could include unobserved confounding, health behaviours associated with unemployment or effects of unemployment on stress processing.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Should I stay or should I go? Mobility and migration among psychiatric trainees in Europe – EFPT Brain Drain Survey
Authors: Pinto da Costa M. , Biskup E. , Giurgiuca A. , Kaaja J. , Kilic Ö. , Mogren T. , Stoyanova M. , Banjac V. , Tomori S. ,   E. European Federation of Psychiatric Trainees
Published: May 2016

Introduction

Workforce migration of mental health professionals seems to have a significant impact on mental health services, both in the donor and host countries. Nevertheless, information on migration in junior doctors within Europe is very limited. Therefore, the European Federation of Psychiatric Trainees (EFPT) has conducted the Brain Drain Survey.

Objectives

To identify, in junior doctors training in psychiatry, the impact of international short-term mobility experiences, towards a future workforce migration across countries, exploring its patterns and reasons.

Methods

In this cross-sectional international study, data were collected from 2281 psychiatric trainees in 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on mobility and migration.

Results

Only one-third of the trainees had a short-mobility experience in their lifetime, being education the main purpose for these experiences. Interestingly, the main predictors for future migratory tendency were not only the having a income and being dissatisfied with this income, but having a short-mobility experience. In fact, people that had short-mobility experiences were two times more likely to express a migratory tendency. Trainees that went abroad were predominantly satisfied with their experiences, reporting that these influenced their attitudes towards migration, positively.

Conclusions

These findings show that short-term mobility has a positive impact into future long-term migration, increasing its probability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association of family stress with other psychosocial factors in female population 25–64 years in Russia: WHO program MONICA-psychosocial
Authors: Gafarov V. , Panov D. , Gromova E. , Gagulin I. , Gafarova A.
Published: May 2016

Aim

To explore association of family stress with other psychosocial factors in female population aged of 25–64 years in Russia.

Methods

Under the third screening of the WHO “MONICA-psychosocial” program random representative sample of women aged 25–64 years (n = 870) were surveyed in Novosibirsk. Questionnaire “Awareness and attitude towards the health” was used to estimate levels of family stress. Chi-square (χ2) was used for assessment of statistical significance.

Results

The prevalence of high family stress level in women aged 25–64 years was 20.9%.

High family stress was higher in age groups 25–34 years and 45–54 years: 27.6% and 30.5%, respectively. Among women with family stress, 58.7% had high level of trait's anxiety. Women with stress at family had high rate of major depression (11%). There were tendencies of higher prevalence of hostility and vital exhaustion in those with stress (41.1% and 27.4%, respectively). Among those in female population with stress at family, 60.6% had sleep disturbances. Social support like close contacts and social network tended to be lower in women with family stress: 59.1% and 80.3%, respectively. Rates of serious conflicts in family were more often in younger age groups and reached 48.6%. In women aged 25–34 years, 54.9% have no possibilities to have a rest at home after usual working day (P < 0.001).

Conclusions

The prevalence of high stress in family in female population aged 25–64 years is more than 20% in Russia. High family stress closely associated with anxiety, major depression, high hostility and vital exhaustion, poor sleep and low social support.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Oxidative stress – A promising candidate in explaining the neurobiology of autism spectrum disorders
Authors: Bækgaard Thorsen M. , Bilenberg N. , Benedikz E. , Fex Svenningsen Å. , Munk-Jørgensen P. , Sheldrick-Michel T.
Published: May 2016

Introduction

The diagnoses of autism spectrum disorders (ASDs) are based on a phenotype, characterized by impaired social interaction and communication and by repetitive and restricted interests. However, this might not represent a single clinical entity, but a behavioral manifestation of different neurodevelopmental deficits with a multifactorial etiology. Small studies have shown elevated levels of oxidative stress and lower levels of anti-oxidants in patients with ASD, and correlations with the severity of ASD. Therapies targeting oxidative stress have shown improvements regarding behavior, social interaction and verbal communication in patients with ASD, supporting the oxidative stress theory.

Objectives

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD.

Aims

There is a need to understand the neurobiology of ASD, therefore this study analyzes the level of oxidative stress in a larger cohort of patients with ASD and compares to controls.

Methods

The study includes 350 patients over 18 years of age diagnosed with ICD-10 diagnoses F84.0, F84.1, F84.5 or F84.8 and compared to gender and age matched neurotypical controls. The included probands will have their serum and plasma analyzed for levels of oxidative stress (superoxide dismutase 1 and 2, catalase, glutathioneperoxidase, malonialdehyde, thiobarbituric acid reactive substances and xanthinoxidase).

Results

The preliminary results will be presented at the EPA in March 2016 in Madrid.

Conclusion

With this study we aim to elucidate some of the neurobiology in ASD. This could lead to new potential targets for treatment and prevention of the disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Agreement and equation between Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in an old age psychiatry outpatient clinic population
Authors: Adamis D. , Helmi L. , Fitzpatrick O. , Meagher D. , McCarthy G.
Published: May 2016

Introduction

Both MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.

Aims

To explore their level of agreement within a particular clinical setting.

Objectives

(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.

Methods

Prospective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.

Results

The total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) was 0.86 (P < 0.001), and Lin's Concordance Correlation Coefficient (CCC) was 0.57 (95% CI 0.45–0.66). In the second sample, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).

Conclusions

Although the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
First psychiatric hospitalization in patients older than 65 years
Authors: Ballesteros J. , Uría A. , Rico P.
Published: May 2016

Introduction

Medical assistance for elderly people with mental health problems increases at the same time that life expectancy does.

Objectives

The aim of this work is to describe several demographic and clinical characteristics of elderly patients admitted for the first time to an acute inpatient psychiatry unit.

Methods

Observational, descriptive, and retrospective study from June 2013 to May 2015, where it is analysed patients older than 65 years admitted to the acute psychiatric ward of Hospital de Getafe in that period without psychiatric hospitalization in their personal background.

Results

Seventeen patients were included of a total of 428 patients admitted in that period (3.97%). Mean age: 70.7 ± 4.7. A total of 10 male (58.9%). The average stay in the studied group was 18.5 days, slightly lower than general average stay in that period (19.2 days). No psychiatric background was found in 4 patients. The most common diagnoses was depressive episode (5 patients) followed by manic episode (4 patients) and delusional disorder. Every of them but one, were taking at least one antipsychotic drug at discharge.

Conclusions

Elderly patients represent a low percentage of the total of patients admitted to an acute inpatient psychiatry unit. Many of them, despite having long-term ambulatory psychiatric follow-up, require a first psychiatric hospitalization after 65 years, as well as other patients begin their treatment in the mental health services in that hospitalization. It is noteworthy that antipsychotic drugs are used very commonly in those patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Delirium related distress in family: A non-systematic review
Authors: Martins S. , Fernandes L.
Published: May 2016

Introduction

Delirium is a common neuropsychiatric syndrome, particularly in elderly hospitalized patients, and is associated with an increase in morbidity and mortality. Although these negative consequences are well documented, only a few studies describe the experience of delirium from the families’ perspective.

Aims

To analyze studies regarding the experience and distress caused by delirium in the families/caregivers of adult/elderly hospitalized patients.

Methods

A non-systematic review of published articles until October 2015 in the database PubMed was carried out. The keyword “Delirium” was combined with: “experience”, “distress”, “anxiety” and “family”, “carer” and “relatives”. Inclusion criteria were: standardized diagnosis of delirium, systematic/prospective assessment of distress level. Clinical cases were excluded.

Results

Sixteen studies met the inclusion criteria for analysis. In most of them, family members (mostly younger) showed high levels of distress, even higher than health care professionals and patients. Several predictors of family distress were found, including poor functional status, psychomotor agitation, delusions, emotional lability, incoherent speech, inattention and disorientation. Higher distress was associated with long-term consequences (e.g. generalized anxiety). In the qualitative research, family members interpreted delirium as a sign of approaching death, result of pain/discomfort or an effect of medication. In addition, distress was associated with rapid and unexpected changes or unable to recognize the loved ones.

Conclusions

Delirium in patients was associated with significant distress in family members. These findings underline the importance of providing information and the development of appropriate supportive and psychoeducational interventions in order to help families throughout this process and reduce the associated distress. This work is supported by FCT (SFRH/BPD/103306/2014).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A proactive geriatric liaison service to assess and manage medical problems on old age psychiatry wards
Authors: Narayana U. , Corrado O.J. , Kaur S.
Published: May 2016

Introduction

Older people with mental ill health are more likely to receive lower quality of healthcare, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality1,2,3. The NHS mandate 2015 to 2016 emphasises the need to deliver care, which is joined up and seamless for users of services4.

Aims and objectives

To identify the common medical comorbidities on the Old Age Psychiatry Wards and to assess the management outcomes.

Methods

We audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds, which consists of 4 Old Age Psychiatry Wards. Data was collected in October 2015 and included referral date, patients’ age and sex, number of referrals, reason for referral and the outcome.

Results

We assessed 339 (142 F, 197 M) patients with a mean age of 77 (range: 56–94). Cardiovascular problems were the biggest group of referrals (in particular oedema, hypotension and rhythm disturbances) (34%) followed by central nervous system problems (11%), respiratory (8%), gastrointestinal (8%) and infection (8%). Some unusual problems were diagnosed including a spontaneous pneumothorax, primary biliary cirrhosis. The most common intervention was advice on treatment or investigation, very few patients needed acute admission and some unnecessary admissions were aborted as a result of the physician's intervention.

Conclusions

This audit emphasises the need for a joint coordinated approach between psychiatry and medicine in managing health problems in older people. A dedicated Geriatric Liaison service can improve care, avoid unnecessary acute admissions and is more convenient for patients who would otherwise attend repeated outpatient appointments.

References are not available for this abstract.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression, physical illness and mortality in a Spanish community-dwelling elderly people
Authors: Olivera-Pueyo J. , Benabarre-Ciria S. , Lorente-Aznar T. , Rodríguez-Torrente M. , Pelegrín-Valero C. , Acín-Sampietro A. , Aguaviva-Bascuñana J. , Alastrué-Pinilla C. , Alcubierre-Cura J.
Published: May 2016

Objectives

The aim of this study is to investigate the association between depression, physical factors and mortality in elderly people living in the community.

Methods

Prospective longitudinal multicenter study for 5 years. Cohort of 293 people aged 65 years and older living in the province of Huesca (Spain). Individual face-to-face interviews and with appropriate caregiver. The following information was collected:

– demographic data;

– psychosocial factors: sex, age, education, marital status, live-in family members, social relationships, life events;

– physical factors: severity of physical illness, comorbidity (Cumlative Illness Rating Scale);

– psychiatric factors: cognitive function (Spanish version of Mini-Mental State Examination), depression (Geriatric Depression Scale), diagnostic criteria according DSM-IV-TR.

Statistical analyses:

– a bivariate analysis;

– a multivariate analysis. Cox regression model (explanatory variables).

Results

Two hundred ninety-three participants, simple representative of people aged 65 years old or more in province of Huesca (Spain). Monitored 5 years follow-up study. Sixty-four people died (21.8%), annual mortality rate: 5.3%. Depression: 66 people (22.5%), (32.2% women, 13.3% men). Cognitive impairment: 51 people (17.4%). Bivariate: factors associated (P < 0.005) with mortality: functional impairment, living in nursing home, sensorial impairment, polypharmacy, severe physical illness and psychiatric comorbidity: depression (34.8 vs 18.1%), cognitive impairment (49.1 vs 15.8%). Association between some factors and mortality was nullified after multivariate statistical model; the case for depression (Hazard Ratio: 1.1), cognitive impairment (HR: 1.2) or functional impairment (HR: 1.3).

Conclusions

Depression and cognitive impairment are associated with mortality in elderly community living people in bivariate analysis, therefore, this association disappears after multivariate analysis. Severity physical illness seems to nullify the effect of other variables, such as depressive symptomatology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Abnormal Stroop-related event related potentials in patients with late onset depression in remission period
Authors: Pišljar M. , Pirtošek Z.
Published: May 2016

Introduction

Depression in late life follows a relapsing course and it has been related to impaired cognitive control. Information processing speed, memory and executive abilities are most frequently impaired.

Objectives

Cognitive changes are difficult to confirm during depressive episode, as signs of both disorders largely overlap. Therefore, it makes more sense to assess cognition after a remission has been reached. Electrophysiology may be particularly convenient as a tool in such studies, as it can separate central cognitive processing from the motor processing.

Aims

The study of cognition was focused on executive function and speed of information processing. It was measured with Stroop-related event related potentials (ERPs) and reaction times (RTs) in a modified computer version of the Stroop test which is highly sensitive to frontal functions.

Methods

Thirty-four patients with late-onset depression were included after they had reached remission. They were compared to twenty-four age-, gender- and education-matched healthy controls. Each participant completed a single item computer version of the Stroop task using verbal response mode. EEG and RT were simultaneously recorded.

Results

Revealed abnormal late positive Stroop-related potentials in the period of about 500–600 ms period corresponding to the latency of the so-called P300b wave.

Conclusion

Study supports the view that patients with late onset depression are also cognitively impaired and that this impairment persists in the period of early remission. Using more sensitive ERP measurement of the Stroop task, we demonstrated impaired information processing at an earlier, pre-response related stage.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Patients with anxiety disorders: Pathways of care and their outcomes in Germany – A secondary data analysis
Authors: Kowitz S. , Zielasek J. , Gaebel W.
Published: May 2016

Introduction

Anxiety disorders are among the most common mental disorders in Germany. Different sectors and disciplines participate in mental healthcare of these patients, but there is a lack of empirical evidence of the treatment outcomes in different settings.

Objectives

The study focuses on analyzing the care pathways of patients with anxiety disorders and the effects of such pathways on critical events like sick leave, early retirement and mortality.

Aims

The analysis aims at developing recommendations for optimizing treatment with a view to minimize the rate of occurrence of critical events during the care pathway.

Methods

Secondary data of three statutory health insurance companies and of the German Pension Funds of the years 2005–2007. The analyses are based on 744,742 persons with at least one diagnosis of an anxiety disorder.

Results

The analyses reveal a low rate of changes between primary and specialized care. There was a high number of care pathways (n = 2.608).The most common type was care by primary care physicians/somatic specialists only (60.5% of patients), followed by a treatment by a psychiatrist only (9.5%). Patients, who were only treated by general practitioners/somatic specialists, had significantly lower rates of sick leave and early retirement. This may indicate that cases with more favourable prognoses are found with this care pathway.

Conclusions

Analyses of care pathways using secondary data can contribute to identify potential for optimizing mental health care services and provide information about intersectoral interface problems, which should be considered in the quality management of mental healthcare.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors affecting restraint practices in psychiatric inpatient units: A sample from a mental health hospital in Turkey
Authors: Ceri U. Ozer , Uzun U. , Sancak B. , Ceri V. , Ozen S.
Published: May 2016

Introduction

New guidelines aimed to minimize restraint in psychiatry clinics due to ethical reasons.

Objectives

Further studies investigating factors affecting the decision of restraint and its potential benefits and harms are needed.

Aims

We aimed to determine current rates of restraint in psychiatric clinics and sociodemographic/clinical variables which may be related with restraint practices.

Methods

The study was conducted in 64-bed male and 28-bed female psychiatric inpatient units, between March 1–May 31 2015. Sociodemographic and clinical data forms were completed using case files and restraint records.

Results

In a total number of 481 inpatients (351 males, 130 females), number of restrained patients was 98 (20.3%) (90 (25.7%) males, 8 (6.2%) females). There was no significant difference in sociodemographic characteristics between restrained and unrestrained patients, but duration of the illness and electroconvulsive therapy rates were significantly different. Substance abuse (44.4%) was higher in restrained male patients. Also, restraint rates were higher in patients having a diagnosis of substance-related disorder compared to other diagnoses. Restraints occurred most commonly in the first day (48%) of hospitalization.

Conclusions

The studies carried out in psychiatric hospitals suggested major differences in the rates and types of restraints among different countries and institutions. In our study, a higher restraint rate is obtained compared to other studies. Consistently with the literature, substance abuse was higher in restrained patients, and restraints occurred most commonly in the first day of hospitalization. Many factors including substance abuse should be considered to reduce restraint rates, which are still quite high in mental health hospitals in Turkey.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Domiciliary care service in psychiatry – Impact on hospital admissions and follow up in patients with bipolar and schizophrenia disorders
Authors: Sobreira G. , Gomes F. , Capeto Coelho I. , Oliveira J.
Published: May 2016

Introduction

Several community psychiatry projects have been developed in Lisbon; nevertheless, there are patients whose needs are not fulfilled by the existing structures. For this reason, our institution created a domiciliary care unit (PreTrarCa).

Objectives

To assess if this program has an impact in admission rates, length of stay and follow-up appointments.

Aims

To improve the quality of care provided by PreTrarCA.

Methods

All active patients followed by PreTrarCA in 2015 were selected (n = 90); only those with F20 and F31 (ICD-10) diagnoses, admitted to the program after 2013, and who had information regarding duration of illness were chosen (n = 21). A control group with similar characteristics (age, gender, ICD-10 diagnosis, disease duration) was paired to our sample. Information concerning social/demographic data, disease duration, hospital admissions and appointments, before and after the patients started the program was retrospectively collected. All data and statistical analyses were performed via SPSS program.

Results

Our patients were mostly female (n = 12); mean age 54,92; 10 and 11 had F-20 and F-31 diagnosis respectively. The test patients had fewer admissions (P = 0.027). No statistical significance was found concerning number of appointments, missed appointments or length of stay, between the groups before or after the patients had started the program.

Conclusions

Results suggest that domiciliary care may reduce costs associated with mental health care due to a decrease in admission rates. Our sample was paired to a similar group, which can account for the similar length of stay in both groups. Further studies should take into account other confounding variables.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuroimaging correlates of insight in obsessive compulsive disorder: A fMRI study
Authors: Gadad A. , Reddy D.Y.C.J. , Venkatasubramanian D.G. , C.N. D.J.
Published: May 2016

Aim of the study

To study the neural substrates of insight in OCD by comparing patients with good insight, patients with poor insight and matched healthy controls using functional MRI.

Methodology

Subjects were recruited from among patients attending OCD clinic, adult psychiatry services and psychiatry ward inpatients of National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. They were further divided into ‘good insight’ (n = 30) and ‘poor insight’ (n = 14) using Brown's assessment of belief's scale. Control subjects (n = 30) were recruited from consenting volunteers. 3 T MRI was used, mental rotation task was paradigm used for fMRI and analysis was done by SPM 8.

Results

Poor insight patients and Ggood insight patients comparison revealed differential activation in Left superior/Medial frontal gyrus (corresponding to the DLPFC). A negative correlation between BABS score and activation of right inferior parietal lobule. Mental Rotation task behavioural data results: OCD patients as a group had significantly lower accuracy compared to healthy controls. Poor insight group had significantly decreased accuracy ratio compared to Good insight group and healthy controls. A negative correlation was noted between BABS score and accuracy ratio, indicating that poorer the insight, greater the errors during the active task.

Conclusion

Insight has been important prognostic factor in OCD. Poor insight patients had specific deficits in left medial frontal gyrus and right inferior parietal lobule as compared to good insight patients and healthy controls. Together, these indicate that insight has a strong neurobiological underpinning in OCD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Adjuvant treatment of resistant obsessive-compulsive disorder with memantine: A case report
Authors: Mota D. , Oliveira A. , Silva J. , Fernandes M. , Ribeiro J. , Martins V. , Duarte F. , Marques M. , Pereira A.T. , Andrade J. , Macedo A.F.
Published: May 2016

Introduction

OCD could be a very disabling condition, implying severe impairment of social and occupational functioning and decreased quality of life. OCD is treated with a combination of psychopharmacological treatments and cognitive-behavioural therapy. Clomipramine was the first anti-obsessive drug, and was followed by selective serotonin re-uptake inhibitors (SSRIs), both modulating serotoninergic transmission. Low dose atypical anti-psychotic are sometimes used to potentiate serotoninergic agents. Growing evidence based on animal models and on neuroimaging shows that glutamatergic transmission could play an important role in the aetiology of OCD. Therefore, glutamate modulators such as N-methyl-D-aspartate (NMDA) receptor antagonists became the focus of the search of novel treatments for OCD. One of this drugs, memantine, already approved for Alzheimer disease treatment, was used off-label the first time ten years ago in resistant case of OCD with positive results. Besides some further successful case reports, there are a single-blind case control study and a couple of randomized, double-blind, placebo-controlled trials showing improvement of OCD symptoms with memantine adjuvant pharmacotherapy.

Objectives and aims

To describe a case report of off-label treatment of a severe resistant case of OCD with memantine, after 15 weeks of treatment.

Methods

Literature review and case description. Before beginning treatment with memantine, the patient made a psychological assessement (baseline) with a battery of tests (MINI Plus, Y-BOCS, QPP-15, WDQ, ECPAD, OP2, OAS2, MPS-H&F, MPS-F, HEXACO-PI-R, MOCI, BDI-II). This battery will be repeated after 15 weeks of treatment, to evaluate symptom improvement.

Results and conclusions

To be announced after 15 weeks of treatment course.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Borderline personality disorder and working memory: A systematic review
Authors: Marini S. , Ranalli C. , Di Gregorio C. , Cinosi E. , Corbo M. , Lupi M. , Carlucci M. , Mancini V. , Santacroce R. , Vellante F. , Acciavatti T. , Di Giannantonio M.
Published: May 2016

Purpose of the study

The purpose of this study was to investigate cognitive functioning in Borderline Personality Disorder subjects, with particular reference to the Working Memory functioning. The Working Memory seems to be relate to core features of the disturb. The final aim was to better understand the disorder and to implement a cognitive training to improve the deficits.

Methods

A literature search was conducted in April 2015. Pubmed and Scopus databases were used to find studies to include in the systematic review. The keywords used for the literature search were: “borderline personality disorder”, “borderline personality”, “working memory”, “executive functioning”. In each search, the keywords were used together with the logical operator “and”.

Three studies were included in this systematic review (Table 1). In each study, the working memory was investigated using N-back test. In two of those studies significantly differences were found between patients and healthy group in N-back task. In the third study, which used more tests to investigate working memory domain, no differences were found between the two groups.

Conclusions

Borderline personality disorder patients performed significantly worse on the N-back test compared to healthy controls and the impairment increased with increasing working memory load. In the third study the working memory domain was investigated using four different tests and single scores were not included therefore it was impossible to compare N-back data.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Importance of C-PTSD symptoms and suicide attempt
Authors: Pinheiro M. , Mendes D. , Mendes T. , Pais J. , Cabral T. , Rocha J.C.
Published: May 2016

Introduction

Traumatising experiences have been shown to be important in suicide ideation and attempt. A prolonged and continuous exposure to stressing interpersonal events can have more complex consequences. Therefore, the concept of Complex Post-Traumatic Stress Disorder (C-PTSD) has been emerging.

Objectives

Our goal is to relate the symptoms of C-PTSD with suicide attempt and to evaluate the differences between C-PTSD and PTSD on those patients. Moreover, we compared our findings with a control population without prior suicide attempts.

Methods

Fifty patients that had been hospitalised in the Psychiatry ward following a suicide attempt were evaluated one week after the event with the ICD-11 Trauma Questionnaire (PTSD and C-PTSD). The same evaluation was performed on a control population without known suicide attempts.

Results

There is a statistically significant relationship (P < 0.001) between the symptoms of C-PTSD and PTSD and suicide attempt, which effect is higher for C-PTSD. These symptoms are almost absent in the control group.

Conclusion

C-PTSD seams to be a more relevant risk factor for suicidal attempts. This aspect is important to define preventive and treatment programs and for suicidal attempts follow-up. The importance of traumatic events and of traumatic stress symptoms as moderator factors should be considered in future research.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Physical exercise and students’ mental health
Authors: Theodoratou M. , Dritsas I. , Saltou M. , Dimas V. , Spyropoulos A. , Nikolopoulou E. , Bekos V. , Kloni P. , Psychogioy A. , Valsami O.
Published: May 2016

Introduction

Studies have shown that sport participation is connected with a more positive self-image and higher self-esteem in adolescents (Bowkers, 2006, Kirkcaldy et al., 2002), whereas sedentary behavior is associated with negative mental health characteristics (Primack et al., 2009).

Purpose

The aim of this study was to investigate whether physical activity influences adolescents and young people's emotions, self-esteem and generally mental health.

Material

Questionnaires were redacted by the research team investigating participants’ habits, emotions and health benefits concerning physical activities.

Method

Questionnaires were administered to 150 adolescents, aged 18–20 years old in Technological Educational Institutes, colleges and fitness centers in Patras, Southern Greece during 2015's spring.

Results

Eighty-seven percent of the respondents worked out in fitness centers or in natural environment. Most of them answered that exercise contributed to revitalization and euphoria feelings (63%), stress relief (78%), better self-image, and better health (49%). According to 63% of the adolescents, exercise improved their school performance and 61% of them felt that exercise affected positively mental health.

Conclusions

Present study's results underline physical activities’ benefits in students’ mental health, self-esteem, feelings and school performance being in line with other studies’ results [Biddle et Asare (2011), Ekeland et al. (2005), Brown et al. (2013)]. Restrictions refer mainly to small size sample.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of anti-inflammatory drugs on the risk of anxiety disorders after critical illness
Authors: Medici C.R. , Østergaard S.D. , Sørensen H.T. , Christiansen C.F.
Published: May 2016

Introduction

Critical illness increases the risk of mental illness, including anxiety disorders. As critically ill patients exhibit high levels of inflammation and inflammation plays a role in mental illness, critical and mental illnesses may be linked by systemic inflammation.

Objective

To investigate whether anti-inflammatory drugs reduce the risk of subsequent anxiety disorders among intensive care patients requiring mechanical ventilation.

Aims

To assess the risk of anxiety disorders after intensive care requiring mechanical ventilation according to pre-admission use of non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, statins or combination. To compare risk in users with non-users.

Methods

This nationwide, registry-based, cohort study includes all patients receiving mechanical ventilation in Danish intensive care units during 2005–2013. Preadmission use of NSAIDs, glucocorticoids, statins or combinations will be identified from filled prescriptions. Risk of anxiety disorders in users and non-users of these anti-inflammatory drugs will be estimated using the cumulative incidence method, accounting for death as a competing risk. After propensity-score matching, risk in users and non-users will be compared using hazard ratios from a Cox regression.

Results

N/A. The estimated number of patients is 100,000. Expected preadmission use is 14% for statins, 15% for NSAIDs, and 10% for glucocorticoids. The study will have 95% power to detect a 10% decrease in risk between users and non-users.

Conclusions

N/A. The study potentially will contribute knowledge about the pathogenesis of anxiety disorders and a mechanism linking critical illness and mental illnesses. If anti-inflammatory drugs reduce risk of anxiety disorders, this may guide trials.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Thought overactivation as a marker of bipolar disorder
Authors: Ferrari M. , Ossola P. , Lucarini V. , Accardi V. , De Panfilis C. , Tonna M. , Marchesi C.
Published: May 2016

Introduction

Recent studies have underlined the importance of considering the form of thoughts, beyond their content, in order to achieve a better phenomenological comprehension of mental states in mood disorders. The subjective experience of thought overactivation is an important feature of mood disorders that could help in identifying, among patients with a depressive episode, those who belong to the bipolar spectrum.

Objectives

Patients with a diagnosis of bipolar disorder (BD) were compared with matched healthy controls (HC) on a scale that evaluates thought overactivation.

Aims

Validate the Italian version of a scale for thought overactivation (i.e. STOQ) in a sample of bipolar patients.

Methods

Thirty euthymic BD and 30 HC completed the Subjective Thought Overactivation Questionnaire (STOQ), the Ruminative Responses Scale (RRS), the Beck Depression Inventory-II (BDI-II) and global functioning (VGF).

Results

The 9-items version of the STOQ has been back translated and its internal consistency in this sample was satisfactory (alpha = .91). Both the brooding subscore of RRS (b-RRS) (r = .706; P < .001) and STOQ (r = .664; P < .001) correlate significantly with depressive symptoms whereas only the first correlate with VGF (r = –.801; P < .001). The two groups did not differed in the b-RRS (HC = 8.41 vs BD = 9.72; P = .21), whereas BD where significantly higher in the STOQ total score (HC = 6.62 vs. BD = 14.9; P = .007).

Conclusion

Our results, although limited by the small sample size, confirm the validity of the STOQ and suggest that this scale could grasp a feature characteristic of BD, independently from their tendency to ruminate. The latter seems to impact more on global functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Automatic attentional processing of faces with disease cues
Authors: Soares S. , Magalhães A.C. , Oliveira A.F. , Silva B. , Dias J. , Godinho M.J. , Xavier S. , Ferreira J.
Published: May 2016

Introduction

Stimuli that are relevant to our survival, especially those that signal the presence of a threat in the environment (e.g., threatening faces), automatically attract our attention.

Objective

The same may be true for faces displaying subtle disease cues as they may signal danger of potential contamination and, hence, disease-avoidance behaviour, which was the focus of the present research.

Aim

The present study investigated, for the first time to our knowledge, whether faces with disease cues (DF), compared to control stimuli (faces without such cues) (CF), interfered with the participants’ performance in a letter discrimination task.

Method

Eighty-six (44 women) university students volunteered to participate in a letter discrimination task where 240 DF and 240 CF were presented.

Results

The results confirmed our hypothesis by showing that for DF, compared to CF, participants took longer to discriminate the target letters. Moreover, the results from a further rating task showed that DF, compared to CF, were rated as significantly more disgusting and associated with disease, thus confirming our experimental manipulation and suggesting that disgust may be driving automatic attention to DF.

Conclusions

Our findings provide important insights on the possible influence of exogenous attention to disease cues in social avoidance behaviour, which may have relevant implications in clinical disorders with disgust at its core.

Disclosure of interest

The authors have not supplied their declaration of competing interest.