bluuebunny/crossref_metadata_2025 huggingface dataset:
Model of qualification for physical therapy program: experiences from the Mental Health Support Centre in Tarnowskie Góry, Poland.
Authors: Szczegielniak A. R. , Smolarczyk J. , Pudlo R.
Published: August 2023

Introduction

In terms of physical and mental health benefits, psychiatric rehabilitation requires diverse therapeutic activities offered by an interdisciplinary team. In order for patients to be able to fully participate in social life, it is necessary to strengthen health-promoting activities, control the symptoms and side effects of pharmacological treatment, effectively manage resources and counteract interpersonal and environmental barriers caused by disability. Physical activity and exercise programs answer both psychosocial and biological aspects of health leading to higher self-efficacy, lower self-perceived stigma, longer lifespan and overall better quality of life

Objectives

The aim of this study is to present qualification process of adult patients for physical therapy program at the Mental Health Support Centre’s (Centrum Wsparcia Zdrowia Psychicznego, CWZP) daily rehabilitation unit in Tarnowskie Góry.

Methods

Adult patients with diverse diagnoses (schizophrenia, affective disorders, anxiety disorders or organic mental disorders) and varied degree of functioning who met the admission criteria were accepted to the ward for a period of 12 weeks. During the stay, a wide range of therapeutic activities was offered, including individual psychological support, group work, art therapy, relaxation sessions, culinary/ dietary workshops, individual training and general fitness group exercises, as well as cognitive training (also via computer-based programs). Due to the COVID-19 epidemic, some of the activities have been limited.

Results

Physical exercises, just as any treatment, should be offered in appropriate doses. Patients with mental disorders, especially severe mental illnesses, experience many barriers in engaging in physical activity and are under a greater risk of sedentary lifestyle. Thus, for the qualification, exercise tolerance assessment was performed in the form of 6-min Walk Test (6MWT) with Borg scale for subjective fatigue. Through aerobic capacity and endurance assessment patients’ respiratory system, cardiovascular system, and neuromuscular system functions can be evaluated. Functional fitness was assessed through 3 elements of Senior Fitness Test (SFT) (Back Scratch test, Up and go test, Chair Sit-and-Reach test) along with Romberg Test to evaluate the static and dynamic balance as well as flexibility of the upper and lower body.

Conclusions

Properly planned and carried out qualification for the physical therapy program allows to adjust the activities to the needs of the patient. Additionally, it can be a tool to evaluate the achieved results at the end of the rehabilitation process.

Disclosure of Interest

None Declared
A systematic review and meta-analysis on the main purpose of diagnostic classification systems and their utility for various purposes
Authors: Vrigkou E. , Stamatakis R. , Umla-Runge K.
Published: August 2023

Introduction

The development of the 11th edition of the International Classification of Diseases has rekindled the research interest surrounding diagnostic classification systems (DCSs). According to expert consensus, the main purpose of DCSs is to provide guidance in clinical practice. There are no reviews in the international literature, however, assessing what mental health practitioners believe is the main purpose of DCSs.

Objectives

The aims of this systematic review were to assess what mental health professionals think is the single most important purpose of DCSs and how they rate DCSs’ utility for various purposes. All DCSs were considered.

Methods

Two separate searches were conducted in Medline Via Ovid and PsycInfo: one for articles assessing the main purpose of DCSs according to mental health professionals and one for studies on how practitioners rate the utility of DCSs for various purposes. The first search revealed eight articles on the main purpose of DCSs and the second three articles on how practitioners rate their utility for various purposes. The total number of participants from all included studies for the first search was 9,276 and for the second 2,363. The studies included clinicians from a wide range of world regions, languages, and income-level countries.

Results

The results of the meta-analyses for the first search showed that 44% (95%CI=38-49%) of the responders believe that the main purpose of the DCSs is facilitating inter-clinician communication, 20% (4-35%) to inform treatment decisions, 14% (11-16%) to aid the communication between clinicians and patients, 11% (4-18%) to reflect on aetiology/pathogenesis, 9% (2-16%) to facilitate research, 4% (2-7%) to provide a national statistical base and 1% (0.1-2%) to indicate prognosis. Regarding how responders rate the utility of DCSs for various purposes, the highest ratings were given for meeting administrative requirements and inter-clinician communication in the two of the three included studies, and clinical diagnosis and training in the third.

Conclusions

“Inter-clinician communication” was the most voted purpose of DCSs and was rated relatively high in the tier of DCSs’ clinical utility. In contrast, “inform management decisions”, even though it was voted as the second most popular purpose of DCSs, was placed on the bottom of the rating tier of DCSs’ clinical utility. Interestingly, none of the included studies asked the responders whether “making a diagnosis” is the main purpose of DCSs. Further research is needed to assess what mental health professionals expect from DCSs, so as to improve their clinical utility in the future.

Disclosure of Interest

None Declared
Composite structure of human mind revealed by HuPoTest
Authors: Dragan G.
Published: August 2023

Introduction

HuPoTest is a mental test and training procedure as well discovered incidentally in 1967 during developing color photos in complete dark in successive baths for seconds. I observed that I was able to count seconds mentally with high repeatability. I was curious to check my skill by comparing my count with a commercial stopwatch with the help of another person. The results were very interesting, so I extending progressively this experiment to other persons and I was able to establish the correlation between more and more calculated parameters with the particular psychic patterns of the persons under test (PUT). In fact, HuPoTest is a calibration of personal mental-timer compared to a standard stopwatch. I test myself periodically and the results are published (Dragan, GDF Databanks Bull., 2021; 25(6), 1-4).

Objectives

Study of a large variety and number of systems in transformation revealed their composite structure, namely these have one component in transformation (Ctr) and an inert one (Cin) (Dragan, GDF Databanks Bull., 2011; 15(2), 1-19).This is the case of the human mind which is in permanent transformation, i.e. in continuous more or less coherent thinking. HuPoTest can establish the size of Ctr, Cin, ctr – the size of kinetic unit constituting Ctr and the coupling strength (CS) between Ctr and Cin.

Methods

PUT has to count mentally 5, 10, 15 and 20 seconds for 8-10 times each value by using a standard stopwatch and comparing the statistically retrieved matrix of measured values with the above mentioned imposed standard values. I was able to test face-to-face approximately 4000 persons during more than 50 years by collecting a huge databank. I explained in many publications the exact procedure, the majority of calculations and the significance of the resulted parameters by correlating the obtained results with the PUT mental pattern (Dragan, GDF Databanks Bull., 2019; 23(1) 1-6).

Results

The final results obtained by myself in the period of 28.05 – 03.07.2022 (A to CII) with overall of 48 tests are presented in attached figures by using a standard stopwatch created by Mihai Dornea developer at National Instruments on LabView® platform with an accuracy of 10 μs. Four distinct behaviors are revealed showing the good evolution of mind by decreasing Ctr and CS and increasing ctr by correct and continuous training.

Image:

Conclusions

HuPoTest is a highly efficient test and mental training procedure as well applied periodically in view to achieve a good and stable mental performance ensuring also a stable and good body health according to the well known quotations “sound mind in sound body” and "mind is the builder and body is the temple”. Such mental training becomes absolutely necessary taking into account that the survivors of the already started global war culminating at around 2035 will be persons with properly trained minds. I am available without any obligation for help anyone willing to try and practice HuPoTest.

Disclosure of Interest

None Declared
LATE ONSET PSYCHOSIS AND VERY LATE ONSET PSYCHOSIS: WHAT ARE THE POSSIBLE ETHIOLOGIES?
Authors: Ramos A. C. , Martins S. C. , Afonso T. M. , Santos N. B. , Gonçalves P. , Maia T.
Published: August 2023

Introduction

Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.

Objectives

To access the definition and main etiologies of LOP and VLOP, based on the current literature.

Methods

Non-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.

Results

51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.

Conclusions

LOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.

Disclosure of Interest

None Declared
DIMENSIONAL DIAGNOSIS IN SCHIZOPHRENIA SPECTRUM DISORDERS: A CASE REPORT
Authors: Cusenza A. S. , Zebi L. , Menculini G. , Grignani M. , Fontana F. , Tortorella A. A. V.
Published: August 2023

Introduction

The use of diagnostic categories, although useful, fails in capturing the psychopathological complexity of the individual case. As for schizophrenia spectrum disorders, positive symptoms are not always included in the presentation, so further dimensions should be considered for a correct diagnosis.

Objectives

To describe the importance of dimensional diagnosis in schizophrenia spectrum disorder based on a clinical experience

Methods

We report the case of a late-onset schizophrenia spectrum disorder with an affective presentation

Results

I. is a 44-year-old woman who accessed the Community Mental Health Center due to subjective memory complains. After clinical evaluation, depressive symptoms and circadian rhythm disturbances emerged. The patient also reported dissociative experiences, which emerged after her brother’s death. She underwent a neurological visit that excluded the possible early manifestation of a neurodegenerative disorder. Quetiapine was at first prescribed, due to the possible action on both insomnia and mood symptoms, with insufficient response. After a few visits, a deeper mental state examination revealed the presence of delusions. The patient also reported having experienced hallucinations. Psychotic symptoms appeared to be persistent and pervasive. We changed the antipsychotic to full-dose olanzapine, with good response. After a six-month observation, the patient was diagnosed with schizophrenia.

Conclusions

The diagnosis of late-onset schizophrenia should take into account clinical history, drugs response, and the evaluation of different psychopathological dimensions

Disclosure of Interest

None Declared
Schizophrenia and myasthenia gravis: a case report
Authors: Bošnjak Kuharić D. , Sabo T. , Jambrošić Sakoman A. , Herceg M.
Published: August 2023

Introduction

Despite a variety of pharmacological and psychotherapeutic interventions, treatment of schizophrenia can still be challenging, even more when certain comorbidities are present. Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions caused by antibodies against acetylcholine and tyrosine kinase. While co-occurrence of schizophrenia and MG is rare, treatment can be complicated as specific treatment of one condition can lead to worsening of other (e.g. anticholinergic side effects of psychopharmacotherapy, psychiatric side effects of corticosteroids).

Objectives

To discuss treatment difficulties in the case of a patient with schizophrenia and multiple somatic comorbidities, including MG.

Methods

A case report and a review of literature.

Results

We report a case of a 50-year-old female patient who was admitted to psychiatric hospital due to psychotic decompensation presented with dysphoria, paranoid delusions, agitation, verbal aggression and hostility. Clinical presentation and psychopharmacological treatment were complicated with her comorbid disorders, MG, which was recently treated because of a relapse, and hypothyroidism, which worsened as she neglected her regular check-ups. Multidisciplinary approach was needed to control the symptoms of her comorbid disorders, which, especially MG, limited psychopharmacological options. Combination of antipsychotics (aripiprazole, haloperidol) and mood stabilizer (sodium valproate) led to clinical improvement of psychotic symptoms. However, poor insight remained- the patient insisted on demission and was not interested in suggested psychotherapeutic and sociotherapeutic programs.

Conclusions

In complex cases like this, multidisciplinary approach is essential for adequate treatment of both psychiatric and comorbid somatic disorders. Conditions like MS can prolong treatment or even worsen the symptoms of a psychiatric disorder, especially since they limit the use of psychopharmacotherapy. Due to this, psychotherapeutic interventions could be even more important to keep a stable remission with a good insight and adherence to both psychiatric and somatic treatment.

Disclosure of Interest

None Declared
EFFECT OF EMDR THERAPY ON POST-TRAUMATIC STRESS SYMPTOMS, SYMPTOM SEVERITY AND ANXIETY LEVEL IN PSYCHOTIC PATIENTS WITH AT LEAST ONE TRAUMATIC EVENTS
Authors: Yıldız E. , Yıldız Z. Z. , Karadağ M.
Published: August 2023

Introduction

Eye Movement Desensitization and Reprocessing (EMDR) is a powerful psychotherapy approach developed by Francine Shapiro in 1987 when she realized that rhythmic eye movements reduce disturbing thoughts. The effectiveness of the therapy has been proven by many studies after its discovery. EMDR, which was initially used only in the treatment of Post Traumatic Stress Disorder, has become a treatment option used in the treatment of psychiatric disorders of more than 2 million people today. EMDR, which is used today, contains elements from many therapy schools andconsists of a phased protocol (Shapiro, 2018). Increasing evidence acknowledging the relationship between trauma and psychosis indicates that EMDR can be a vital addition to the treatment of psychosis (Sin & Spain, 2017; Valiente-Gomez et al., 2017). However, the effect of EMDR on psychosis has not yet been sufficiently clarified. There is alsoIt has not yet been clarified whether the curative effect on the psychotic symptoms or on the anxiety symptoms.For this reason, in our study, the effect of EMDR on these symptoms will be investigated by comparing the case and control groups.

Objectives

This study aims to evaluate the effect of EMDR therapy on post-traumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients with at least one traumatic event.

Methods

This study is a randomized controlled, prospective follow-up study aiming to evaluate the effect of EMDR therapy on post-traumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients with at least one traumatic event.Written informed consent to participate in the intervention study will be requested from all patients who meet the inclusion criteria. Consent participants receive pre-treatment (T0) measurements. After T0, participants will be randomized to EMDR or waiting list Participants will be randomly assigned to 26 people in each group. These groups will be made by the independent randomization bureau of the Parnassia Institute of Psychiatry using the scientific randomization program on the Internet (www.randomizer.org).

Results

The effects of EMDR therapy on posttraumatic stress symptoms, schizophrenia symptom severity and anxiety level in psychotic patients were obtained from pretest and posttest measurements.

Conclusions

More studies are needed on the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy.

Disclosure of Interest

None Declared
ADDICTION AND THE EVOLUTION AND COMPLIANCE OF SCHIZOPHRENIC PATIENTS
Authors: Azraf F. , Chebli H. , El Omari F.
Published: August 2023

Introduction

Schizophrenia is a chronic illness, affecting approximately 1% of the general population. The more chronic a treatment is, the poorer the quality of adherence. In fact, approximately 60% of patients with schizophrenia are incompletely or non-adherent within one year of the first episode. Poor adherence has consequences in terms of clinical status, quality of life and psychosocial functioning due to associated relapses. One of the main factors of poor compliance is the use of addictive substances. Half of schizophrenic patients have, or have had, an addictive comorbidity during their life. Moreover, schizophrenic patients with addictive comorbidity have a more severe symptomatology and have more associated physical, psychological and social problems, representing a challenge in the management

Objectives

The objective of our work is to evaluate the impact of addictive comorbidity on medication adherence and relapse.

Methods

This is a cross-sectional study, carried out in patients with schizophrenia hospitalized or followed in ambulatory consultation, at the psychiatric hospital Ar-razi of Salé. The data collection (sociodemographic, clinical and therapeutic) is carried out by a questionnaire established for this purpose. The use of substances is evaluated according to the DSM-V criteria

Results

A total of 110 schizophrenic patients were followed or hospitalized, of which 61.8% had a substance use disorder. The average age of onset of substance use was 18 years. The duration of substance use ranged from 1 to 11 years and up to 49 years for tobacco and cannabis. 72% of the addicts tried to stop their use alone or in outpatient settings, only 17% in inpatient settings. The average duration of abstinence was 11 months and ranged from 1 to 18 years. 81% reported remission of the disease after abstinence. The hospitalization rate was 88.2% for addicts versus 85% for non-addicts. The number of hospitalizations was 180 for addicts versus 78 for non-addicts. The cumulative duration of hospitalization is 208 months against 96 months for addicts. The duration of remission is 5 months for addicts and 24 months for non-addicts. 71% of non-addicts patients have well observed their treatment against 57% of addicts

Conclusions

The weight of co-morbid addictions represents between 1/5 and 1/3 of the factors at stake in the compliance and the risk of relapse of patients suffering from schizophrenia. The development of specific care strategies for a global management of addiction and schizophrenia should be a priority.

Disclosure of Interest

None Declared
Comorbid Obsessive-Compulsive Symptoms in Schizophrenia - Diagnostic and Treatment Challenges
Authors: Leal J. A. , Moura J. C. , Rocha T. C. , Cunha J. F. , Torres S. P. , Seabra D. , Lopes I. M. , Carneiro M. E. , Esteves S. M. , Cajão R. , Lima G.
Published: August 2023

Introduction

The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.

Objectives

To assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.

Methods

We performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.

Results

We present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.

Conclusions

Some antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.

Disclosure of Interest

None Declared
Aggressiveness and emotion dysregulation among adolescents first degree relatives of schizophrenia patients
Authors: Ghrissi F. , Fekih-romdhane F. , Stambouli M. , Abassi B. , Cheour M.
Published: August 2023

Introduction

Schizophrenia is a severe debilitating condition, with elevated level of aggressiveness reaching 33% in a large sample of patients. Unaffected biological relatives of schizophrenia patients share similar though less severe neurocognitive and behavioral abnormalities seen in their affected relatives. Recent findings demonstrates that first degree relatives of schizophrenia patients are at increased risk of violence and aggressive behavior, especially during adolescence, with poor outcome. Besides, adolescents aged from 12 to 18 years old, may experience aversive and overwhelming emotions difficult to regulate due to immaturity of neuronal networks. There are evidence of an association of emotion dysregulation and violent conduct among youth. However, to our knowledge, studies among first degree relatives of psychotic patients were not performed.

Objectives

The aim of this study was to evaluate the aggressiveness and emotion dysregulation among unaffected adolescents with fist degree family history of schizophrenia and to investigate the association linking these two entities.

Methods

In this purpose wo conducted a cross sectional descriptive study in Razi hospital during three months: from July to September 2022. Unaffected adolescents aged 12 to 18 whom first-degree relatives were diagnosed with schizophrenia according to DSM-5 criteria were included. Adolescents with psychiatric conditions or medical affections associated with psychiatric presentation were not included. Sociodemographic data were collected on a preestablished questionnaire and the following scales were used: The Life History of Aggression LHA, an 11 items self-reported tool, in the Arabic version, The Aggression Questionnaire AQ which is a 29 items self-reported scale in Arabic version and the The Emotion Regulation Questionnaire (ERQ), a 10 items self-reported measure rated on a likert scale, in the validated Arabic version. Written informed consent was obtained from the legal tutor of each adolescent.

Results

Results of this survey are ongoing.

Conclusions

Results of this survey are ongoing.

Disclosure of Interest

None Declared
A case-control study of aggressiveness in adolescents with schizophrenia family history
Authors: Ghrissi F. , Fekih-romdhane F. , Stambouli M. , Abassi B. , Cheour M.
Published: August 2023

Introduction

Violence is a common behavioral and health concern among adolescents, aged 12 to 18 years old. In fact, aggressiveness may result in severe outcome in a critical age characterised by biological, psychological, and social changes. Schizophrenia is a severe and chronic condition, with elevated level of aggressiveness. Since unaffected biological relatives of schizophrenia patients share similar though less severe neurocognitive and behavioral abnormalities seen in their affected relatives, they are at increased risk of violence mainly during adolescence. However, studies including adolescents with schizophrenia first degree history are scarce.

Objectives

The aim of this survey was to evaluate the aggressiveness among unaffected adolescents with fist degree family history of schizophrenia and in a control group of adolescents with no family psychiatric history.

Methods

In this purpose wo conducted a case-control cross sectional study in Razi hospital during three months: from July to September 2022. Unaffected adolescents aged 12 to 18 whom first-degree relatives were diagnosed with schizophrenia according to DSM-5 criteria were included. Adolescents with psychiatric conditions or medical affections associated with psychiatric presentation were not included. Control group was selected amongst the population. Sociodemographic data were collected on a preestablished questionnaire and the following scales were used: The Life History of Aggression LHA, an 11 items self-reported tool, in the Arabic version, The Aggression Questionnaire AQ which is a 29 items self-reported scale in Arabic version. Written informed consent was obtained from the legal tutor of each adolescent.

Results

Results of this survey are ongoing.

Conclusions

Results of this survey are ongoing.

Disclosure of Interest

None Declared
Pre-operative anxiety in the ophthalmological surgery
Authors: Kuzmina S. V. , Rascheskov A. Y. , Kuzmin N. D.
Published: August 2023

Introduction

The question of preoperative anxiety in an ophthalmological patient and its relief in an outpatient setting is becoming increasingly relevant due to the improvement of the technique and equipment of ophthalmic surgery, when the practice of «one-day surgery» is becoming increasingly common. It could not only affecting the course of the operation, but also a factor limited the availability of this type of medical care to patients. Purpose. To analyze the relationship between the level of anxiety during preoperative preparation and the choice of the optimal approach for the relief of preoperative anxiety in an ophthalmological patient in a «one day» clinic.

Objectives

89 adult patients of both sexes aged from 20 y.o. referred for outpatient surgery (refractive and cataract surgery) and were included into trials, all of them are divided into main - 45 and control - 44 groups. Clinical psychotherapeutic interviewing, a scale of situational and personal anxiety C.D. Spielberger (adapted by Y.L. Khanin), a questionnaire for analyzing satisfaction with the quality of medical services provided in outpatient settings were used. Statistical: Microsoft Excel spreadsheet editor for Windows; the STATISTICA application software package version 6.1. were taken. The condition for determining statistically significant differences is the value р≤0,05.

Methods

Two-stage study by the method of contiuous sampling. Clinical psychotherapeutic interviewing, a scale of situational and personal anxiety C.D. Spielberger (adapted by Y.L. Khanin), a questionnaire for analyzing satisfaction with the quality of medical services provided in outpatient settings were used. Statistical: Microsoft Excel spreadsheet editor for Windows; the STATISTICA application software package version 6.1. were taken. The condition for determining statistically significant differences is the value р≤0,05.

Results

The level of anxiety in patients who received anxiolyticsLevel of anxietyexamination day, %day of operation %SAPASAPAlow22*22,535*21medium53,564,55767high24,5*138*13*

- р≤0,05; SA-situational anxiety; PS – personal anxiety

The study revealed an average and high level of situational anxiety in 66% of patients referred for refractive surgery, in 81% of patients referred for cataract surgery. Into main group, against the background of the performed anxiolytic therapy in the preoperative period, the proportion of people with a high level of reactive anxiety decreased significantly (p≤0.05) (from 24% to 8%), while personal anxiety did not significantly change. Among control group patients show a lower level of satisfaction with the quality of medical services provided in an outpatient setting.

Conclusions

The study showed the possibility of providing better quality medical services in «one-day» eye surgery, which expands the availability of outpatient ophthalmic surgical care to patients with high level of anxiety and anxiety disorders.

Disclosure of Interest

None Declared
Akathisia rate among psychiatric patients treated with Clozapine compared to Risperidone.
Authors: Stryjer R. , Shelef A.
Published: August 2023

Introduction

Patients’ cooperation, especially in medication taking, constitutes a significant challenge in psychiatric care. Psychiatric patients are often reluctant to take a specific pharmacological treatment because of side effects. Akathisia and other extra pyramidal symptoms are side effects that could result into real danger and are thought to be the main reasons of discontinuing pharmacological treatment. Despite this, some gaps in research knowledge exist on the rate of psychiatric patients that suffer from Akathisia. For example, Clozapine treatment, despite its efficacy, is often disqualified due to side effects concern. The research literature barely refers to the development of extrapyramidal symptoms, and more specifically Akathisia. There are few reports about Akathisia when taking Clozapine. It results into a lack of objective studies and knowledge based only on subjective clinical evaluations.

Objectives

This study aims at comparing Clozapine and Risperidone in general, with or without polypharmacy and more especially, in terms of Akathisia.

Methods

This research was carried out in Abarbanel Mental Health Center over a period of six months. The study population included 100 patients, including hospitalized and ambulatory patients. They were equally divided into two groups: 50 patients who received Clozapine, and 50 patients who received Risperidone. It should be noted that due to polypharmacy, 17 patients in the Clozapine group and 6 patients in the Risperidone group received additional anti-psychotic treatment. Akathisia was evaluated using Barnes Akathisia Scale (BAS).

Results

The demographic and clinical data was found identical in both groups. We found that Akathisia symptoms appeared 1.4 times more in patients who took Risperidone only, compared to those who took Clozapine only (p < 0.05). This research emphasizes the irrelevance of existing data on anti-psychotics’ treatments, while 24% of the patients treated with Clozapine and 34% of the patients treated with Risperidone showed Akathisia symptoms.

Conclusions

Akathisia symptoms are very common in patients who take anti-psychotic treatment as Clozapine and Risperidone. Previous research revealed that Akathisia is very common for Risperidone patients, however the symptoms are often neglected in patients taking Clozapine. We show in our research that the rate of Akathisia is high in both treatments. Therefore, the importance of diagnosing akathisia should be emphasized in patients treated with Clozapine. Moreover, Akathisia should receive much more importance when choosing anti-psychotic treatment.

Disclosure of Interest

None Declared
Psychosis in Parkinson’s Disease: a Case Report of Diagnosis and Management
Authors: Andrade R. P. L. , Gil N. P. , Costa A. L. , Brás J. , Castro N. , Sousa R. , Vaz R. P. , Martins J. , Almeida E. , Abreu J. , Afonso H.
Published: August 2023

Introduction

Psychosis is a frequent complication in patients diagnosed with Parkinson’s Disease (PD). Characterized mainly by visual hallucinations and paranoid delusions, it occurs most frequently, but not exclusively, as an adverse effect of antiparkinson medications. Nevertheless, cognitive impairment and dementia, as a frequent feature of PD, needs to be considered for differential diagnosis.

Objectives

Our main objective is to report a case of PD Psychosis, its diagnosis and management and complement it with a non-systematic review of literature.

Methods

Patient file consultation and an additional research, based on the key words “Psychosis” and “Parkinson’s Disease”, using Pubmed as database.

Results

A 53-year-old female, diagnosed with Juvenile Parkinson’s Disease since age 45 and, as expected, polimedicated with antiparkinson medication. Without any relevant psychiatric background, she was admitted to the emergency department for disorganized behaviour, with 2 weeks of evolution. There, it was also possible to determine the presence of auditive hallucinations and persecutory delusions, associated with marked anguish.

After exclusion of any underlying cause for this symptomatology, inpatient treatment was proposed and accepted by the patient. In collaboration with the Neurology Department, a gradual reduction and optimization of antiparkinson drugs was conducted, associated with introduction of low doses of antipsychotic drugs, in this case Olanzapine. With this medication adjustments, clinical improvement was accomplished, with eventual fading and cessation of psychotic symptoms. Additionally, an irregularly intake of antiparkinson drugs was considered the most probably cause of this clinical decompensation.

Conclusions

As present in literature, due to the chronicity and complexity of PD, stopping all antiparkinson drugs is not an option, even when psychotic symptoms, that could be a consequence of these drugs, are present. Therefore, a rigorous evaluation and management are mandatory, including the exclusion of other underlying causes and a careful therapeutic adjustment, with gradual reduction of antiparkinson drugs, addressing an eventual temporal relationship between the beginning of a specific drug and the onset of symptoms, and verification of therapeutic compliance, including an involuntary overdose. In cases of refractory symptoms, and after a risk-benefit assessment, pharmacologic treatment directed at these symptoms, low doses of anti-psychotics, may be necessary.

Disclosure of Interest

None Declared
Mothers and fathers with schizophrenia: Treatment and quality of life
Authors: Perez-Sanchez S. , Martin Herrero I.
Published: August 2023

Introduction

Schizophrenia is a chronic disease that deteriorates the functionality of patients, especially when raising a family and caring for children. We are interested in analyzing the characteristics of mothers and fathers diagnosed with schizophrenia and their degree of global activity when switching from oral treatments to injectable treatments.

Objectives

1 To evaluate the quality of life and functional level of mothers with schizophrenia treated with quarterly paliperidone palmitate. 2. To compare the quality of life and functional level when switching from oral treatment to long-acting injectables.

Methods

Participants were 3 mothers and 3 fathers, 33-40 years old, with a diagnosis of schizophrenia in monotherapy who changed treatment with monthly paliperidone palmitate to quarterly paliperidone palmitate LD IM (525 mg/every 12 weeks). Retrospective data collection. QLS quality of life scale.

Results

Six patients were included, caregivers of 1 child (80%), 2 children (20%) who met the inclusion criteria and completed the questionnaires. After its application and correction by means of non-parametric tests (N<30). During oral treatment, scores are observed in the QLS questionnaire of: intrapsychic functions mean 34.2, interpersonal relationships mean 19, instrumental role mean 8, daily activities mean 8. After 12 months of treatment with intramuscular paliperidone palmitate (injectable every 12 weeks ) scores were obtained: intrapsychic functions mean 36, interpersonal relationships mean 23, instrumental role mean 15, daily activities mean 11. A better functioning of the patients was observed in the instrumental categories and daily activities. As well as the patients referred better adherence to treatment.

Conclusions

In our experience, injectable long-acting Paliperidone Palmitate every 12 weeks is associated with the perception of a better quality of life in parents with schizophrenia and increases administration facilities as well as planning in their daily lives.

Disclosure of Interest

None Declared
PSYCHOTIC PATIENT AND AFFECTATION OF THE SEXUAL SPHERE. ABOUT A CLINICAL CASE
Authors: Susana Perez S. , Martin-Herrero I.
Published: August 2023

Introduction

Clinical case description.

A 44-year-old male, with paranoid schizophrenia, polydrug addict and IVDU since he was 14 years old. Live alone. He is brought by the Local Police for heteroaggressiveness when he was arrested for trespassing and resisting authority. He has presented 14 hospital admissions and therapeutic communities for detoxification since 2000.

Objectives

1. To analyze the causes of abandonment of treatment

Methods

1.

Complete medical history

2.

Blood test with hormone profile

3.

PRAEQ Questionnaire

Absence of child psychopathology until the age of 6, at which time his parents separate and he becomes introverted, with solitary activities and distractions. On examination, the patient is restless. Psychotic contact. Delusional speech centered on ill-structured ideas of harm, persecution and grandiose, being difficult to explore due to lack of collaboration on the part of the patient, who only accepts treatment with aripiprazole 5 mg due to sexual dysfunction with the rest of the treatments.

Results

During his admission, he has evolved from a very unstructured delusional theme and social isolation, with lax and tangential speech and refusal to take any treatment except aripiprazole, towards a cooperative, trusting attitude, with attenuation of his delusional ideation, with appropriate, organized and releasable. Treatment with IM aripiprazole is agreed upon for discharge.

Clinical judgement: Paranoid schizophrenia (F20.0)

Conclusions

With this case, we intend to remember that antipsychotics affect different spheres of the patient’s life that can hinder adherence to treatment, and that we often do not take into account. In this specific case, Abilify Maintena is useful because it does not cause sexual dysfunction, which facilitates treatment adherence and greater patient involvement, which gives us greater opportunities for social integration.

Disclosure of Interest

None Declared
What’s new on the treatment of pedophilia and hebephilia?
Authors: Castro Rodrigues J. , Vieira M. , da Silva B. F. , Ribeiro L. M.
Published: August 2023

Introduction

Paraphilias constitute a set of psychiatric conditions that are often chronic and require a combination of treatment approaches, such as pharmacotherapy and psychotherapy. Sexual interest toward prepubescents and pubescents (pedophilia and hebephilia) is frequently identified in criminal settings, within numerous child sexual abuse and child pornography offenses. The high prevalence rates and negative consequences of these acts, causing distress in multiple important areas of health and functioning, reveal the importance of preventing these offenses as a clinical and social matter. Secondary prevention programs, which provide treatment and support for those with paraphilia disorders before sexually abusive behaviors and legal system involvement, show as ethically and socially necessary.

Objectives

We aim to discuss and bring insights into the knowledge on pedophilia and hebephilia treatments and prevention programs, in the fields of psychotherapy as well as pharmacologic strategies.

Methods

We present a non-systematic review of the updated literature on this subject from the data found on the PubMed and PsycInfo databases.

Results

Preliminary results of recent works show that at-risk individuals with paraphilia disorders are often willing to seek treatment without external pressure from the legal system, and report benefits from early treatments. Most studies found that gonadotropin-releasing hormone agonists reduce the risk of child sexual abuse in men with pedophilia. An injectable form has shown to lower this risk 2 weeks after the initial injection, suggesting its use as a rapid-onset treatment option. Cyproterone acetate and medroxyprogesterone acetate are other anti-androgen drugs that inhibit hypersexual behavior, with important side effects to be considered. The combination of androgen deprivation treatment and psychotherapy has a greater effect on preventing fantasies, urges, and behaviours in paraphilic patients. Cognitive-behavioural psychotherapy shows the best results and should soon be initiated in all patients. Biomolecular studies revealed that serotonin and prolactin inhibit sexual arousal, being SSRIs used as first treatment in younger patients, particularly in less severe cases.

Conclusions

Evidence-based treatments from randomized clinical trials for paedophilic and hebephilic disorders are lacking. These current numbers reveal the need for widespread implementation of primary and secondary prevention initiatives, that go beyond the prevention of a repeated offense. There is a need for further research using controlled, randomized trials to examine the effectiveness of sexual offender treatment including psychotherapeutic and pharmacologic interventions. The development of more specific, more effective, and better-tolerated medications for these disorders should be recognized as a program worthy of greater support from government and pharmaceutical industry sources.

Disclosure of Interest

None Declared
Gender dysphoria: Psychological impact and social repercussions
Authors: Belabbes I. , Chtibi M. , Douk K. , Kisra H.
Published: August 2023

Introduction

Gender dysphoria is defined as a multisystemic medical condition in which a person has a marked mismatch between their biological sex and the gender with which they identify.

Objectives

To highlight the psychological impact and social repercussions of gender dysphoria and to discuss the different aspects of management aimed at optimising a better quality of life for these patients.

Methods

We describe the clinical cases of 5 patients followed at the child psychiatry department and the adolescent diagnostic centre of agdal, who were diagnosed with gender dysphoria.

Results

Clinical vignette:

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A.B: 15-year-old patient, followed in our training for a recurrent depressive disorder comorbid with borderline personality and gender dysphoria. This patient is a victim of school bullying altering his psychosocial functioning and generating thoughts of death.

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H.A: 16 year old patient, followed in our training for gender dysphoria comorbid with adrenal hyperplasia, indicating feminization surgery.

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I.D: 17 year old female patient, victim of sexual assault, admitted to our training for suicide attempt. She presents a gender dysphoria, comorbid with a borderline personality.

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C.G: 22 year old patient, followed in our training for gender dysphoria comorbid with a panic disorder. She is a patient describing an anxious experience with dysthymia.

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L.K: 23-year-old patient, followed in our training for gender dysphoria. He is a patient who would have been a victim of verbal and physical aggression generating a post-traumatic stress disorder having had a significant impact on his socio-professional life.

Conclusions

Primary care physicians need to be aware of gender-related disorders and the importance of early recognition of these emerging disorders. A multidisciplinary approach is needed to manage these disorders.

Disclosure of Interest

None Declared