bluuebunny/crossref_metadata_2025 huggingface dataset:
Modulation of the Nuclear Factor (Erythroid 2-Derived)-Like 2 Pathway by Antidepressants In Rats
Authors: Martín Hernández D. , Bris Á.G. , MacDowell K.S. , Sayd A. , Azpiazu D. , Alba M.T. , Torres G. , García-Bueno B. , Madrigal J.L.M. , Leza J.C. , Caso J.R.
Published: May 2016

Introduction

Patients with major depression who are otherwise medically healthy have activated inflammatory pathways. It has been described that depression is not only escorted by inflammation but also by induction of multiple oxidative/nitrosative stress pathways. Nevertheless, there are finely regulated mechanisms involved in preserving cells from damage, such as the nuclear factor Nrf2.

Aims

To explore in a depression-like model the Nrf2 pathway in the prefrontal cortex (PFC) and the hippocampus of rats and to analyze which classic antidepressants affect the antioxidant activity of the Nrf2 pathway.

Methods

Male Wistar rats were exposed to chronic mild stress (CMS) and some of them were treated with desipramine, escitalopram or duloxetine. We studied the expression in the PFC and hippocampus of upstream and downstream elements of the Nrf2 pathway and the oxidative damage induced by the CMS.

Results

After exposure to a CMS protocol, in the PFC, there is an inhibition of upstream and downstream elements of the Nrf2 pathway. Moreover, antidepressant treatments, particularly desipramine and duloxetine, are able to recover some of these elements and to reduce the oxidative damage induced by the depression model. In the hippocampus however, Nrf2 pathways are not that affected and antidepressants do not have many actions.

Conclusions

Nrf2 pathway is differentially regulated by antidepressants in the PFC and hippocampus. The Nrf2 pathway is involved in the oxidative/nitrosative damage detected in the PFC after CMS exposure. However, it seems that Nrf2 is not very involved in the effects caused by the CMS in the hippocampus.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Folie à Deux: Shared or “Infected” Madness? About a Case Report
Authors: Soriano M.Á. , Garcia C.
Published: May 2016

The shared madness or Folie à deux was described in France in the nineteenth century by Charles Lasage and Pierre Falret, as a condition where a person (the primary) builds a delusional system, sharing it with another (the secondary), who must be very close to the first affected, becoming delirious with the same subject. Several theories attempt to explain the phenomenon that challenges theories of personality structures, rooted in relational and/or environmental features of psychosis. Theoretically, there are many attempts to classify this psychotic experien in some manuals they distinguish various types of partners: the simultaneous psychosis, where the two people start to became delirious at once; imposed psychosis, in which the disorder arises first with one, then going on to “healthy” individual and symptomatology disappears after being separated; and communicated psychosis, where the first transmitted the psychotic experience to the second, and he or she develops his or her own delusion not interrupted even while separated. Other classifications about shared madness not only between two people, but three, and four, even a whole family show us how complicated the delirium systems can become. In our paper, we will discuss the different theories explaining this rare psychiatric condition based on a case about two brothers of 35 and 37, who live together with the rest of the family, and also come together to the same mental health center, although with different psychiatrists.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cryptococcal Meningitis in Acute Onset Psychosis: A Case-Study
Authors: Michielsen P. , Arts M.
Published: May 2016

Introduction

Cryptococcal meningitis is a frequently observed opportunistic infection in patients with late-stage HIV-infection, especially among people living in South-East Asia and Central Africa. The worldwide incidence is estimated at one million cases. The worldwide mortality of HIV-associated cryptococcal meningitis remains high (10–30%), due to the inadequacy of antifungal treatments and complications of increased intracranial pressure. Clinical symptoms of cryptococcal meningitis are fever, headache, vomiting, and altered mental status. Neck stiffness, papiledema, and focal neurological symptoms are sometimes present.

Objectives

We describe the case of a patient who first developed a delirium, and a few months later an acute-onset psychosis, after a past cryptococcal infection.

Aims

To report a case-study describing acute-onset psychosis as a neuropsychiatric consequence of HIV-infection.

Methods

A case-study is presented and discussed, followed by a literature review.

Results

A 49-year-old African-born male was admitted to hospital with an acute psychosis. He had been treated by an internist after being found to have HIV. As a result of non-compliance over a period of about four months, his cd4-count had dropped to 40. Six months earlier he had developed cryptococcal meningitis, which left him a number of neurological and psychiatric symptoms. During his stay in hospital, there had to be good collaboration with the specialist in internal medicine whose dual task was to manage the patient's dramatically low cd4-count as well as his psychosis.

Conclusion

Cryptococcal meningitis is a risk factor for psychiatric disorders and mortality in HIV-infected persons.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The psychopathology scan from the phenomenology
Authors: Rodrígue Vargas S.
Published: May 2016

Introduction

This is a doctrinal movement that seeks to analyze mental illness without reductionism and seeks to grasp the nearest as possible to the reality of the patient.

Aims

This is the analysis of an event, a concept, a feeling, trying to grasp as it is lived by the subject and in the direction you may have for him.

Methods

Review of literature.

Results

It was the first approach to the knowledge of the pathological experience and was the first scientific model to characterize the mental pathology. It was the central doctrine of psychiatry until the end of World War II, when the hegemony of the German psychiatric science gave way to the views that are primarily developed in Anglo-Saxon countries (psychoanalysis and behavioral psychology), although some European countries such as Germany and Spain continued growing until the 1980s, when it culminated in the publication of the DSM-III (1980).

Conclusions

These approaches are “old fashioned” but are essential to understand and know the reality of human sick, “mentally ill man.”

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Preliminary data from a longitudinal 3-year study of patients with adjustment disorder
Authors: Vallejo-Sánchez B. , Martinez Arnaiz J. , García Blanco C. , Pérez-García A.M.
Published: May 2016

Introduction

Adjustment disorder (AD) is a common diagnosis, but there are relatively few studies, in part because the current definition is still poorly specified, inadequate and controversial. Some clinicians and researchers have pointed out that a psychiatric diagnosis should present a clinical description, as well as date based on psychological, biological and/or sociofamiliar studies, and follow-up investigation about outcome and prognosis, to increase the reliability and validity diagnosis and permits exclusion of other possible disorders and normality. There is much empirical evidence to indicate that AD is a transient disorder with a tendency to spontaneous remission. However, some studies have shown that patients with AD often develop major psychiatric disorders, presenting a higher rate of psychiatric morbidity, e.g., higher suicide rates.

Aim

The aim of this study was to analyze the clinical and sociodemographic characteristics, as well as some possible personal vulnerability factors in patients with AD.

Method

This longitudinal study was carried out on 80 outpatients diagnoses with AD at a Mental Health Unit, who were followed up for 3 years. It was analyzed different clinical and sociodemographic characteristics.

Results

Significant differences between groups were found in some of the variables considered.

Conclusions

The results add empirical evidence to a controversial and little-researched diagnostic category and provide guidelines for assessment and intervention. They also may contribute to improve diagnostic classifications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The importance of descriptive psychopathology in differential diagnosis of dissociative disorders: A case report
Authors: Welte-Santana C.A. , Oliveira L. , Carvalho de Toledo L. , Merola Fontoura N. , Ribeiro Garcia de Rezende M. , Lima de Melo C. , Macedo de Queiroz A.F.
Published: May 2016

Introduction

Some kinds of hallucinations are misdiagnosed due to primary psychotic disorders. Hallucinations can be classified into 3 categories: true hallucinations, pseudo-hallucinations and hallucinosis. True hallucinations are different from the others due to incapacity of insight of the unreal and pathologic character of the phenomenon.

Objectives

This study reports a case initially diagnosed as psychotic depression that after a rigorous psychopathologic investigation revealed to be an unspecified dissociative disorder.

Case presentation

Twenty-four-year-old female, with a past of psychiatric treatment since 18-years-old, reports brief dysphoric episodes associated with visions of bleeding clowns and skulls that were always connected to a psychosocial stressor. At the interview she asserts that she understands those symptoms as pathological and caused by her mind, and associate them with external stressors. These episodes were brief and remitted spontaneously. The mental state examination did not show any psychopathological disturbance. The reduction and suspension of antipsychotics did not result in worsening of these symptoms.

Results

The psychopathological disturbances reported by the patient did not represent a true hallucination. The presence of insight, the evolution and duration of the symptoms, and the association with psychosocial stressors has shown that the phenomena and symptoms are associated to a dissociative disorder. Therefore, the prescription of antipsychotics involves unnecessary pharmacological and clinical risks for this patient at the moment.

Conclusion

Despite the use of psychopathology is considered by some as outdated, it is still an important semiological instrument for an accurate diagnosis and planning therapeutic conduct.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Atypical cognitive dysfunction due to brain damage: A case report
Authors: Welte-Santana C.A. , Macedo de Queiroz A.F. , Merola Fontoura N. , Lima de Melo C. , Ribeiro Garcia de Rezende M. , Ferreira da Silva P.C. , Oliveira L. , Carvalho de Toledo L.
Published: May 2016

Introduction

The diagnosis of a primary psychiatric disorder requires the exclusion of an organic etiology. However, Brazilian public hospitals commonly lack resources. Diagnostic precision requires also the congruence of the clinical history and the natural history of the investigated disorder.

Objectives

This study reports a rare case of hallucinations and retrograde amnesia, due to organic brain lesion but without other cognitive impairments.

Case presentation

Fifty-three-years-old male Brazilian, was evaluated after one year in Brazil after being missing for 25 years in USA. Encountering his family, he did not recognize his mother, did not remember his life in Brazil, including his infancy, nationality and mother language. He was found as a homeless in poor hygiene. In the exam, he only presented retrograde amnesia, without any disturbances of fixation memory, intelligence, formal thought, affect or psychomotor function. Patient reported hallucinations. Blood tests showed no abnormalities. EEG showed diffuse slow rhythms. Brain MRI showed cortical and hippocampal atrophy. After weekly evaluations for 5 months, he remained stable despite lack of prescription. Some weeks after MRI, patient reported frequent alcohol and inhalant use when missing. No hints of secondary gain were found until present.

Discussion

Organic etiology was suspected due to atypical presentation: hallucinations, evocative amnesia, with no further cognitive and affect disturbances. This is not compatible with schizophrenia, dementia or dissociative disorder. The brain abnormalities and recent data highly suggest this etiological hypothesis.

Conclusion

Since this clinical presentation does not fit into any specific psychiatric category, the case will continue to be studied.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Economic evaluation of long acting aripiprazole as maintenance therapy for paranoid schizophrenia
Authors: Gómez Sánchez-Lafuente C. , Reina Gonzalez R. , Mateos Carrasco E. , Moreno De Lara F. , De Severac Cano A.
Published: May 2016

Introduction

Patient adherence to a treatment regimen is of utmost importance for successful outcomes in schizophrenia. Long acting aripiprazole (LAA) is a new drug of depot antipsychotic type placed in the market recently that could prevent non-adherence and in reducing relapse in schizoprenia administered every 28 days.

Objective

A descriptive, observational study designed to explore the efficacy and tolerability of long acting aripiprazole in a sample of patients diagnosed with paranoid schizophrenia that were admitted to Acute Unit in 2014. LAA was introduced on the admission.

Methods

Sociodemographic variables: age, sex, and marital status. Clinical variables: average time since diagnosis, concomitant consumption of toxic substances, reason to change medication, subsequent readmissions after LAA was introduced, evaluation of the modification of the oral regimen. PANSS and CGI. Metabolic profile: weight, glycaemia, and total cholesterol, LDL and HDL, triglycerides. Cost at the beginning and after 6 months.

Results

Mean age: 44.50 years, 54% women. Marital status: 54% single, 27% married, 27% divorced. Mean time from diagnosis: 11 years. Toxic consumption: 27% active, 18% ex-drug users. Three patients were readmitted after introducing LAA, 2 of them were for abandoning medication (including LAA). PANSS at 6 months showed statistically significant differences in negative subscale (3 points). No statistical differences in positive and general psychopathology subscales. No metabolic side effect was found. Average saving per patient 37.05 euros per month (Fig. 1).

Conclusion

This study signalizes that LAA is an effective treatment. Clinically, it has been shown that our patients improve adherence and prevent relapse. Moreover, no metabolic side effects were found. Besides, LAA is also efficient and we would save 407,55 euros per month.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Twenty-four months experience of paliperidone long-acting injection in a Spanish psychiatric service: A mirror image analysis
Authors: Gómez Sánchez-Lafuente C. , Reina Gonzalez R. , Moreno De Lara F. , De Severac Cano A. , Mateos Carrasco E. , González Moreno A.
Published: May 2016

Introduction

Lack of adherence is a common cause of relapse in schizophrenia. Long-acting antipsychotics have shown in recent studies that they improve compliance. However, some randomised controlled trials showed no difference in relapse rates between oral medication and long-acting injections.

Objective

To report the use of paliperidone palmitate in an Acute Psychiatrist Unit in Spain.

Method

Retrospective observational study of 42 patients prescribed paliperidone palmitate (PLAI) during an admission at Acute Psychiatric unit in Málaga. In the mirror image analysis, the main outcome measure was the total number of days of psychiatric inpatient care twelve months before and after patients started Paliperidone palmitate.

Results

Most common reason for starting paliperidone palmitate was lack of adherence to oral medication (54%) followed by lack of efficacy on previous medication (31%). Olanzapine (47%) and risperidone (41%) were most commonly antipsychotics prescribed before PLAI. Thirty-four patients continued PLAI over twelve months (80%). Poor compliance was the most common reason of withdrawal. Three patients had a movement disorder adverse effect. Only one was lost because adverse effects. Total admissions and inpatients days were significantly reduced from the previous treatment to PLAI-treatment period (Table 1).

Conclusion

PLAI was associated with a reduction in total inpatient days. The financial saving from reduced admissions stays exceeded the acquisition and administration cost of PLAI. Improved compliance because of PLAI is the most plausible explanation of this result (Fig. 1).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical predictors of clozapine response
Authors: Hajji K. , Laajmi I. , Marrag I. , Fathallah S. , Nasr M.
Published: May 2016

Introduction

Schizophrenia is a chronic, severe, and disabling mental disorder. An evaluation of clinical predictors to clozapine was described.

Object

Identify clinical predicting factors to clozapine.

Methods

This is a cross-sectional study including patients diagnosed with schizophrenia or schizoaffective disorder according to the DSM 5 criteria and treated with clozapine.

Results

Of the 33 patients, 78.8% were males and 69.7% of them were single. The mean age was 36 years old. The mean age at the onset of the disorder was 24 years old. The mean number of hospitalizations was 6. The beginning of the mental disorder was acute in 21.2% of the cases. The mean duration of the disease course before starting clozapine treatment was 11 years. The mean duration of treatment was 19 months. The diagnosis according to DSM 5 criteria was schizophrenia in 87.9 and schizoaffective disorder in 12.1% of cases. The outcome was assessed by PANSS and BPRS scales with a symptomatic remission in 63.63% of cases. The analytical study revealed a significant correlation between favorable evolution and the latest onset of the disorder (P = 0.04), the number of previous hospitalizations (P = 0.009), disorder's duration (P = 0.032), male sex (P = 0.0004) and secondary resistance (P < 10−3).

Conclusion

The evaluation of clinical factors is important in our practice in order to improve the response to clozapine. Otherwise, adherence to treatment and quality of insight are determining factors of the treatment response.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of typical and atypical antipsychotics on spontaneous neuronal network activity in vitro
Authors: Lange-Asschenfeldt C. , Henning U. , Görtz P.
Published: May 2016

Introduction

Microelectrode arrays (MEAs) with cultured neuronal networks are highly suitable to quantify neuroactive activity and neurotoxicity of applied substances.

Objective

Multiparametric characterization of functional alterations of in vitro-neuronal network activity by different typical and atypical antipsychotics.

Aims

To identify differential effects of antipsychotics on spontaneous neuronal network activity as a functional readout.

Methods

Cultured networks of dissociated cortical cells of postpartal mice coupled to MEAs were exposed to increasing doses of aripiprazole, clozapine, haloperidol, olanzapine, raclopride, and risperidone.

Results

We found a concentration-dependent inhibition of firing patterns for all substances except olanzapine. All other substances mediated a concomitant irreversible suppression of burst and spike rates, a decrease of the burst duration and the number of spikes in bursts as well as dose-dependent network desynchronization (decrease of Cohen's kappa). The comparison of the different antipsychotics with regard to their half-maximal effective dose values (EC-50) for inhibiting the spike rate yielded an increasing order of EC50 values, i.e. a declining order of toxic potency, of aripiprazole (8.77 μM) < clozapine (9.36 μM) < haloperidol (9.77 μM) < risperidone (15.9 μM) < raclopride (22.7 μM). No significant correlations were identified between EC50 values of the distinct antipsychotics and their binding affinity to the dopamine D(2), the serotonin 5-HT(1A), 5-HT(2A), 5-HT(2C), and the M(1) and M(2) muscarinic acetylcholine receptors.

Conclusion

In MEAs, a dose-dependent neurotoxic effect of typical and atypical antipsychotics alike occurred at supratherapeutic doses via a yet unknown mechanism that did not involve actions on major receptor targets of these compounds.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Doctor I have painful erections
Authors: Medini F. , Menif L. , Jmii G. , Ghali F. , Zeghal M. , Robbana L. , Derouiche S. , Melki W.
Published: May 2016

Introduction

Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.

Materials and methods

An Internet search was initiated using the search engines: Direct Sciences; Medline and keywords “Penile erection; priapism; Antipsychotic agents; Side effects” and we illustrated our literature review by a clinical vignette of a man aged 38 years followed for schizophrenia placed under Fluphenazine 125 mg/month from 5 years who consulted us in may 2015 because of priapism and he described painful and prolonged erection episodes evolving for approximately 5 days.

Discussion

Medical literature mentions many cases of venous priapism in patients treated by conventional or atypical neuroleptics. About 30% of venous priapisms could be related to drugs of which approximately 50% to neuroleptics. This side effect is related to alpha1-adrenergic blocking properties of these treatments, more or less important depending on the drugs in this class. After emergency treatment, the priapism is the problem of the continued neuroleptic treatment. The substitution of one molecule by another alpha-1 blocking properties to the less marked is recommended.

Conclusion

The venous priapism is a uro-andrological emergency requiring prompt treatment to prevent erectile sequelae.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The role of long-acting antipsychotic treatment in schizophrenia with comorbid drug use. The case of paliperidone palmitate
Authors: Portilla Fernández A. , Reula L. , Manrique Astiz E. , Núñez Domínguez L.A. , Arbeo Ruiz O. , García Nicolás M. , Fernández de la Vega O.
Published: May 2016

The patient suffering a schizophrenic disorder with a comorbid drug use is a challenge for the technical team of psychiatrists who provide to control this disorder. In some guides that include a revision of the efficacy of several psychopharmacological and/or psychological treatment shows that there any treatment has no efficacy in this group of patients. But it suggests that long-acting antipsychotic may play a role in some cases with no adherence. We study prospectively some data in a group of patients of these characteristics treated with paliperidone palmitate as main psychopharmacological treatment, using as measurements of outcome the number of psychiatric admissions, dosage of oral treatment, use of drug before and after the beginning of Paliperdione Palmitate. Our results show that it exists a decrease of number of admissions, dosage of oral concomitant treatment and drug use, with a very good adherence and no dropouts in the follow-up. We conclude that Paliperidone Palmitate may be a very good alternative for the psychopharmacological treatment in schizophrenic patients with comorbid drug use.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The treatment of autism with pipamperone: A case report
Authors: Petrosino B. , Signorelli M.S. , Magnano di San Lio F. , Petrosino C. , Aguglia E.
Published: May 2016

Introduction

Adults with autism spectrum disorders (ASD) often have behavioral disorders, like aggression, agitation and self-injury. These problems are frequently severe enough to limit educational and developmental progress. Only risperidone and aripiprazole have so far been approved by the FDA for the treatment of behavioral disturbance associated with autism. These drugs are not very effective in the long term, with little benefits to the social functioning and they are associated with side effects. This case report describes the use of pipamperone, in treating behavioral disorders of a patient with autism spectrum disorder and severe mental retardation.

Case presentation

Here is presented the case of a 32-year-old man with autism spectrum disorder, severe mental retardation (caused by undiagnosed phenylketonuria for the first 3 years of life) treated with antipsychotics since childhood. He showed numerous episodes of psychomotor agitation, hetero-direct physical aggression and self-injury, and movement disorders induced by drugs. Treatment with pipamperone reduced drastically crises of psychomotor agitation, and behavioral disorders, without extrapyramidal side effects, and led to an improvement in social functioning. The control of behavioral symptoms associated with adherence to treatment was maintained for 6-month follow up. These clinical observations are supported by ratings using: ABC, CGI-S and CGI-I, VABS, SAS, AIMS.

Conclusion

This case report provides the first potential evidence that pipamperone may be effective in treating behavioral problems associated with autism spectrum disorders. Moreover, the improvement of social functioning and the lack of extrapyramidal side effects make this drug notable for its effectiveness and tolerability.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect of metformin treatment on metabolic parameters in atypical antipsychotic-treated schizophrenic patients
Authors: Prisco V. , Sorice S. , Franza F. , Fabrazzo M.
Published: May 2016

Few studies have compared the effect of Metformin treatment on metabolic parameters in atypical antipsychotic-treated schizophrenic patients. The present study examined metabolic abnormalities due to clozapine or olanzapine in schizophrenic patients and, secondly, the effect of metformin treatment on these parameters. Twenty-six patients (19 M and 7 F) from neuropsychiatric nursing home “Villa dei pini” (Avellino) were enrolled, in collaboration with our Department of Psychiatry, University of Naples SUN. All patients had been diagnosed according to DSM-IV criteria. They were recruited from July 2013 to January 2015. Clozapine or olanzapine-related hyperglycemia required metformin introduction in therapy. All prescribed drugs were maintained at the same therapeutic daily dose during our study. We performed 1, 3 and 6 months follow up after metformin initiation. For each patient fasting cholesterol, glucose, triglycerides, body weight (BW), body mass index (BMI), systolic and diastolic blood pressure (BP) were evaluated. SPSS 16.0 (Statistical Package for Social Science) was used for data analysis. After antipsychotic treatment BMI, fasting glucose and triglycerides were significantly higher respect to basal values (P < 0.01, P < 0.0001, P < 0.05, respectively). After metformin treatment, a significant improvement in fasting glucose, cholesterol and triglycerides was registered (P < 0.001). Conversely, BMI values, although not significant (P < 0.168), showed a trend in increasing. This observational study underlines that metformin in antipsychotic-treated patients could be useful in preventing clozapine or olanzapine related metabolic abnormalities in schizophrenic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Nicotine as therapeutic agent in treatment of mood disorders
Authors: Tsopelas C. , Petros N. , Maria D. , Dimitris P. , Angelica G.G. , Dimitra K. , Charalampos T.
Published: May 2016

Introduction

The plant that has as active ingredient nicotine was chewed or smoked for many years from American natives, for its therapeutic properties. Nowadays after the extensive negative attitude towards smoking, the main provider of nicotine, researchers are now pointing out the therapeutic possibilities of nicotine in mood disorders, as a substance that is acting in the acetylcholine receptors in the brain.

Aims

In this review we are trying to explore the possibilities of nicotine use as a therapeutic agent.

Methods

We did a detailed research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness for inclusion in the study.

Results

Diadermal administration of nicotine has a positive effect in depressive disorder in 3–8 days, an effect that in one study was reversed after cessation of nicotine. Patients with depression and/or healthy subjects show improvement of attention and working memory after diadermal use of nicotine. Research is not conclusive in the sustainability of these positive affects as other researchers emphasize their short effect in mood.

Conclusion

Nicotine presents as part of novel and promising therapeutic agents with complex interactions with other neurotransmitters in the brain. Before condemning nicotine along with smoking we should acknowledge the potential use of nicotine as a therapeutic compound since research shows that some of these positive effects appear not only to smokers after abstinence but also to non-smokers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Indication of depot antipsychotic treatment in the view of slovak psychiatrists
Authors: Zelman M.
Published: May 2016

With the increasing number of atypical antipsychotics in depot form, there emerges question about plus and cons of their use in schizophrenia patients. We focused on the opinion of Slovak psychiatrists about use of this treatment in some specific situations of schizophrenia treatment. Research was realized via questionnaire on psychiatrists (n = 47) from ambulant and hospital care, during one conference in June 2015. First part of the questionnaire was focused on the preference of oral or depot form of antipsychotic treatment. Depot form would be indicated by psychiatrists (in more than 89%) when low compliance, anosognosia or frequent episodes. On the contrary, oral antipsychotic treatment is preferred in young patients or employed patients. The type of symptoms (e.g. positive, negative) has relatively small impact on the preference of treatment, where the preferences of each type were the lowest (fewer than 36%). According to the opinion of psychiatrists, depot antipsychotic treatment is not suitable in first episode of disorder (according to 81% of respondents), otherwise in second or third episode it would not be chosen by 6% of asked psychiatrists.

From the aspects of the choice between atypical or typical depot, atypical antipsychotics in depot form were favored when presence of adverse reactions (80%), occurrence of negative symptoms (65%) and short duration of disorder (58%). Typical depot was preferred by psychiatrists in patients with chronic states.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Asenapine modulates nitric oxide release and calcium movements in cardyomyoblasts
Authors: Zeppegno P. , Gramaglia C. , Gattoni E. , Gili S. , Gambaro E. , Di Tullio E. , Rizza M.C. , Farruggio S. , Camillo L. , Mary D. , Vacca G. , Grossini E.
Published: May 2016

Objective

To examine the effects of asenapine on NO release and Ca2+ transients in H9C2, which were either subjected to peroxidation or not.

Materials and methods

H9C2 were treated with asenapine alone or in presence of intracellular kinases blockers, serotoninergic and dopaminergic antagonists, and voltage Ca2+ channels inhibitors. Experiments were also performed in H9C2 treated with hydrogen peroxide. NO release and intracellular Ca2+ were measured through specific probes.

Results

In H9C2, asenapine differently modulated NO release and Ca2+ movements depending on the peroxidative condition. The Ca2+ pool mobilized by asenapine mainly originated from the extracellular space and was slightly affected by thapsigargin. Moreover, the effects of asenapine were reduced or prevented by kinases blockers, dopaminergic and serotoninergic receptors inhibitors and voltage Ca2+ channels blockers.

Conclusions

On the basis of our findings we can conclude that asenapine by interacting with its specific receptors, exerts dual effects on NO release and Ca2+ homeostasis in H9C2; this would be of particular clinical relevance, when considering their role in cardiac function modulation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A tribute to Johann Gottlieb Burckhardt-Heussler (1836–1907), the pioneer of psychosurgery
Authors: Arts M. , Michielsen P. , Petrykiv S. , de Jonge L.
Published: May 2016

Introduction

Johann Gottlieb Burckhardt-Heussler was a Swiss psychiatrist, who pioneered controversial psychosurgical procedures. Burckhardt-Heussler extirpated various brain regions from six chronic psychiatric patients under his care. By removing cortical tissue he aimed to relieve the patients of symptoms, including agitation, rather than effect a cure.

Objectives

To present the scientific papers of Johann Gottlieb Burckhardt-Heussler on psychosurgery.

Aims

To review available literature and to show evidence that Burckhardt-Heussler made a significant contribution to the development of psychosurgery.

Methods

A biography and private papers are presented and discussed, followed by a literature review.

Results

The theoretical basis of Burckhardt-Heussler's psychosurgical procedure was influenced by the zeitgeist and based on his belief that psychiatric illnesses were the result of specific brain lesions. His findings were ignored by scientists to make them disappear into the mists of time, while the details of his experiments became murky. Decades later, it was the American neurologist Walter Freeman II, performing prefrontal lobotomies since 1936, who found it inconceivable that the medical community had forgotten Burckhardt-Heussler and who conceded that he was familiar with, and probably even influenced by, Burckhardt's work.

Conclusion

It is partly thanks to Burckhardt-Heussler's pioneering work that modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Electroconvulsive therapy outpatient program recently established in a psychiatric day hospital
Authors: Duque Domínguez A. , Duque Domínguez R. , García Montero C. , Martín Díaz L. , Palomo Monge M. , Pérez Arévalo E. , Vaquero López M.D.L.N. , Barreiro de Lucas A.
Published: May 2016

Introduction

ECT outpatient program recently created in the Psychiatric Day Hospital in Ávila was designed to assess the safety and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in patients after ECT remission.

Objectives

Description of the activity and objectives of an ECT outpatient program in a Psychiatric Day Hospital.

Methods

Retrospective cross-sectional descriptive Study. The three patients who received the continuation/maintenance electroconvulsive therapy during the 10 months this unit has been opened were chosen as a sample.

Results

From the opening of Psychiatric Day Hospital 10 months ago, 58 patients have been admitted; among them, three patients come to the hospital monthly to receive the electroconvulsive therapy, maintaining their psychopathological stability over time.

Conclusions

With the creation of this new program we considered three types of objectives:

– therapeutic: a therapy applied in a more comfortable and satisfactory for the patient and family regime. To prevent relapse and exacerbations;

– management: benefits on the best use of existing resources:

– reduction in hospital admissions and readmissions,

– decrease in the average stay,

– reduction in visits to Emergency Services,

– allow referrals from outpatient department,

– individual monitoring of patients that complements the check at their Mental Health Team;

– teaching, training and investigation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case
Authors: Valverde Barea M. , Cartas Moreno F. , Ortigosa Luque M.E.
Published: May 2016

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Social media group parallel to dialectical behavior therapy skills training group, the pros and cons
Authors: Abdelkarim A. , Nagui Rizk D. , Esmaiel M. , Helal H.
Published: May 2016

Introduction

In the past few years, social media has gained a high popularity as a dynamic and interactive computer-mediated communication tools. Although it has become a part of everyday life for most of our clients, yet we did not have the opportunity to study its impact on compliance to therapy.

Objective

Assessment of impact of parallel social media group to dialectical behavior therapy (DBT) skills training group in a sample of Egyptian patients suffering from borderline personality disorder (BPD).

Aim

The aim of the current study was to estimate impact of parallel social media group on compliance to DBT skills training group and its adverse events.

Methods

Patients with BPD enrolled to an outpatient comprehensive DBT program in Alexandria were assigned either to group (A) skills training, where a parallel Facebook group was crated aiming at increasing to compliance to the original group, or group (B) skills training alone and dropout rates were calculated based on completion of 6 months full skills training. We considered patients out of the group if they missed 4 sessions in a raw.

Results

Two patients of 15 patients who joined group (A) missed four consecutive sessions with a dropout rate of 13%, whereas group (B) showed 43% drop out rate as 10 out of 23 patients did not complete the group. The difference was statistically significant. We reported only one privacy issue dealt with it immediately.

Conclusion

Utilization of social media group could lead to increase patient compliance to DBT skills training group.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Can mindfulness bring post-traumatic stress disorder patients to focus on the present?
Authors: Figueiredo A.R. , Abreu T. , Freitas C.
Published: May 2016

Introduction

Over the last years, literature has dedicated increased interest to post-traumatic stress disorder (PTSD), a mental disorder that was initially included in Diagnostic and Statistical Manual of mental disorders in 1980. Trauma is any event that overwhelms the individual coping strategies. Patients with PTSD experience symptoms of hyper-vigilance, intrusive thoughts, flashbacks, re-experiencing the trauma event, avoidance of stimuli related with trauma or exaggerated startle response. Mindfulness is the process of being aware, paying attention in the present moment, in a non-judgmental way. Research has been showing that mindfulness has positive effects on mental health.

Objectives and aims

Assessment of eventual benefits of mindfulness in patients with PTSD.

Methods

Literature research.

Results

Many studies have reported on correlations between self-reported mindfulness and mental health. Literature suggests that mindfulness training can enhance life skills and its effectiveness is being studied in several mental disorders. Its positive effects on enhancing emotion regulation and decreasing anxiety, hyperarousal and depressive symptoms, led to investigation in the context of PTSD's treatment. Some studies show decreased perceived stress and post-traumatic avoidance symptoms and increased positive states of mind. Most studies reviewed were related with war veterans with PTSD and showed that mindfulness-based treatments could enhance their quality of life. Other results imply that mindful awareness alone may not be sufficient to help reduce symptoms.

Conclusions

Mindfulness based therapies could be useful on improving PTSD symptoms but, to assess its efficacy, further research is needed, in different samples of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Motivational interview in drug abuse
Authors: Guillen Rodrigo H. , Alonso Díaz R. , Cortázar Alonso E.
Published: May 2016

According to the treatment plan from the motivational interviewing model, we have worked with a 25-year-old male, single and childless. He is currently unemployed and he lives with his grandparents. His parents divorced about 20 years ago, he has a paternal brother of two years and his mother lives in Barcelona. He went to the USMC Huelva for the first time in 2014.

The patient and the family reported emotional and behavioral disorders for several years, which were getting worse since 4 months. He has been convicted for rash driving and he resisted to police officers for several times. The patient was also abusing of several substances like cigarettes, cannabis, MDMA and cocaine.

In order to work with the motivational interviewing with this patient, we proposed five clinical principles: express empathy, create discrepancy, avoid discussion, put a spin on his strength and promote self-efficacy.

The clinical evolution of the proposed patient was positive. As we could see, the motivation for change occurred when the patient perceived a discrepancy between the place where he was and the place he wanted to get. As we saw, the important thing was to define acceptable and accessible targets that represented the progress toward recovery.

In this style, we avoid the persuasion based on the discussion with the patient, instead we assume the validity of the experiences and the subjective perspectives of the patient. The motivational interview represents an alternative to unleash the change, instead of direct persuasion and aggressive confrontation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Family therapy preventing the recurrent major depression with alcohol dependence patient against recurrent episode: A case study of three cases
Authors: Hsu H.C. , Lee F.Y. , Chen Y.C.
Published: May 2016

Major depressive disorder with alcohol dependence is an easily recurrent disorder, and its dysfunction has increased risk of recurrence. The main purpose of the family therapy model at issue is to prevent the recurrent major depression with alcoholism patient against recurrent episode.

All three patients have had more than 10 relapses and hospitalizations during the past 5 years. Focuses of the therapy are on the apples drawn by the patient (DDAA), the patient, the couple, and the patient–child relationship. Keywords are gathered from every participant during the therapy session. Besides, the subjects to have verbalized meaningful ideas or successful experiences are immediately, intensely praised by applause. DAILY DRAW AN APPLE (DDAA) homework is that the patient has drawn an apple on a calendar everyday and shares with family members about the apple as well as the patient's feelings of the day. The participants of the therapy are the patient, wife/husband, children and the therapists (psychiatrist, social worker). The frequency of the model is from once weekly to twice monthly. Each session consists of the 10 minutes pre-session, the 40 minutes therapeutic session, the 10 minutes post-session. All patients have never been relapsed over the past 18 months after receiving our family therapy under medications.

Finally, with the aid of the family therapy, they have been almost free from affective symptoms and the ambivalence, guilty feeling toward family, frustrations have been steadily gradually improved. To prevent the recurrent major depression with alcohol dependence patient against recurrent episode has been achieved in family therapy presented here.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trichotillomania – A case report on online treatment
Authors: Onrust S. , Nunic V.
Published: May 2016

Introduction

ICD-10 classifies trichotillomania (TTM) as one of the habit and impulse disorders. It is characterized by noticeable hair-loss due to a recurrent failure to resist impulses to pull out hairs. The hair pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification. Persons suffering from TTM often hide it. TTM is often unrecognised by doctors, treated by dermatologists or untreated, causing a lot of suffering.

Objective

To present treatment of trichotillomania.

Aim

To present one case report of trichotillomania treated online.

Methods

This is case report of female patient with TTM untreated 13 years. She had earlier been treated for depression and had multiple traumatic experiences. Patient both self-diagnosed TTM and asked for treatment online. During two months, there were 7 sessions and 2 follow-ups. Sessions were online and based on Habit Reversal Training (HRT) and Rational Emotional Behavioural Therapy (REBT). The following issues were addressed: hair pulling, shame, guilt, low self-confidence, assertiveness, low frustration tolerance, panic attacks, sadness. No medications were used.

Results

Hair pulling has almost completely stopped. Social functioning and self-acceptance were improved. Guilt and shame have reduced, self-confidence and frustration tolerance have increased.

Conclusion

HRT and REBT online treatments have reduced hair pulling and the associated emotional problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.