bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical High Risk Symptoms and Criteria in the Community: Prevalence, Clinical Significance and Risk Factors for Their Occurrence
Authors: Schultze-Lutter F. , Michel C. , Schimmelmann B.G. , Ruhrmann S.
Published: June 2017

Introduction

In clinical samples, symptomatic ultra-high risk (UHR) criteria and the basic symptom criterion “cognitive disturbances” perform well in predicting psychosis, and best when both approaches are combined.

Objective

However, little-to-nothing is known about clinical high risk (CHR) and their constituent symptoms in the community.

Aims

We studied the prevalence, clinical relevance, and moderators of CHR criteria and symptoms in the community.

Method

Regression analyses involved 2683 community participants (age 16–40 years; response rate: 63.4%). Semi-structured telephone interviews were performed by well-trained psychologists.

Results

Lifetime and current CHR symptoms were reported by 21.1% and 13.8% of interviewees. Frequency of symptoms was mostly low, only 2.4% met any CHR criterion. A stepwise relationship underlay the association of the two types of CHR symptoms and criteria with the presence of mental disorders and functional deficits, with odds ratios being highest (7.4–31.8) when UHR and basic symptoms occurred together. Report of a family history of mental disorder generally increased risk for CHR symptoms. While younger age increased risk for basic symptoms, lifetime substance misuse and trauma increased risk for UHR symptoms.

Conclusions

Prevalence of CHR criteria was within the to-be-expected range from prevalence rates of psychoses. Clinical relevance of both CHR symptoms and criteria increased in a stepwise manner from basic symptoms via UHR symptoms to their combined presence, reinforcing the clinical utility of their combined use. The risk factors selectively associated with basic and UHR symptoms support developmental models relating basic symptoms to neurobiological and UHR symptoms to psychological factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Impact of Childhood Trauma on the Course of Panic Disorder
Authors: De Venter M. , Van Den Eede F. , Pattyn T. , Wouters K. , Veltman D. , Penninx B. , Sabbe B.
Published: June 2017

Objective

To investigate the impact of childhood trauma on the clinical course of panic disorder.

Method

Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after two years with a DSM-IV-based diagnostic interview and the Life Chart Interview.

Results

At baseline, 56.3% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30 to 60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders.

Conclusion

After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Analysis of the Factors Affecting Stigmatization and Attitudes Toward Depression in Young and Elderly Patients
Authors: Kamış G.Z. , Erden Aki O. , Yıldız İ. , Dolgun A.
Published: June 2017

Objectives

Depression is a frequently seen but under-recognized and under-treated syndrome in community. Stigmatization is an important barrier for care-seeking and treatment.

Aims

In this study, we aimed to investigate the relationship of sociodemographic factors and attitudes towards depression between young and old age groups in a clinical population.

Method

A total of 133 patients (18–88 years old, n = 37 old-age group, n = 96 young-age group) with a diagnosis of depression were recruited in this study. All the patients were evaluated with a semi-structured clinical interview and using stigmatization scales.

Results

As young and old age groups compared, RHIDO total scores, RHIDO alienation sub-scale scores, social withdrawal subscale scores, and resistance to stigmatization subscale scores were found to be higher in young-age group than old-age group. Except working status, other sociodemographic factors were not found to have any effect on the scores of stigmatization scales.

Regarding the clinical features; number of episodes, comorbid physical disorders and time since first admission had an effect on RHIDO total and subscale scores. Negative attitudes towards depression were seen to be common in all the subjects, but no statistically significant difference was found between young and old age groups.

Conclusion

Stigmatization is very common also for depression, and it is found to be related to different features including age, working status, and time since first admission. In order to help for decreasing the negative attitudes and increasing the help seeking behavior, some interventions should be conducted both in psychiatry clinics and society.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efavirenz and Neuropsychiatric Effects–When the Treatment Complicates Matter Further
Authors: Marinho M. , Novais C. , Marques J. , Bragança M.
Published: June 2017

Introduction

Efavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.

Objectives

To provide an overview of efavirenz-induced neuropsychiatric effects.

Methods

Literature review based on PubMed/Medline.

Results

The neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.

Conclusion

Taking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reaching Out to Patients with Antisocial Personality Disorder with Brief Psychoeducation
Authors: Hesse M. , Thylstrup B.
Published: June 2017

Introduction

Patients with antisocial personality disorder incur high costs on society, and are at high risk of dropping out of treatment and are often excluded from treatment, yet very little research has been conducted on how to best help these patients.

Objectives

To test a six-session psychoeducation program, Impulsive Lifestyle Counselling, in outpatients with substance use disorders and antisocial personality disorder.

Aims

To test the efficacy of the intervention versus treatment as usual in community outpatient treatment for substance use disorders.

Methods

Pragmatic randomized trial in 13 outpatient community substance abuse treatment uptake areas. Patients were interviewed by blinded interviewers 3, 9 and 15 months post-randomization and tracked through a national substance abuse treatment register. Mixed effects regression were used to assess substance use and self-reported aggression and Cox regression was used to assess risk of dropout.

Results

A total of 175 patients was randomized. At 3-month follow-up, patients randomized to intervention reported more days abstinent and less drug use severity than patients randomized to treatment as usual. In addition, patients randomized to intervention were at lower risk of dropout after intervention. In addition, patients randomized to intervention were more likely to report having received help for antisocial personality disorder at follow-up interviews.

Conclusions

A brief psychoeducational intervention may improve outcomes for outpatients with antisocial personality disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictors of Sleep Difficulties in College Students
Authors: Amaral A. Paula , Soares M. João , Pereira A.T. , Bajouco M. , Maia B. , Marques M. , Valente J. , Macedo A.
Published: June 2017

Introduction

College students are known for their variable sleep schedules. Such schedules, along with other common student practices are associated with poor sleep hygiene. The persistence of the precipitating stressor is one of the factors involved in the persistence of insomnia.

Aims

To examine the role of the perceived stress, perseverative thinking, strategies of cognitive emotion regulation and negative affect as predictors of sleep difficulties.

Methods

The sample comprises 549 college students.

Measures

PSS-10, PTQ, CERQ and POMS-58. Three questions were used to access difficulties in initiating sleep (DIS), maintaining sleep (DMS) and early morning wakening (EMA). A Sleep Difficulties Index (SDI) was calculated by summing DIS, DMS and EMA scores.

Results

In total sample, the multiple linear regression explained 27.7% of the SDI total variance (R2 = .277, F(9, 375) = 15,942, P < .0001). The significant predictors of the total variance of SDI were perceived distress (B = .246, P = .0001), repetitive thought (B = .189, P = .005), cognitive interference and unproductiveness (B = −.188, P = .006), rumination (B = .130, P = .044) and negative affect (B = .156, P = .018).

Conclusions

Preventive interventions focused on predictor factors (perceived stress, perseverative thinking, rumination and negative affect) should be considered in order to promote better mental health in college students.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Are Volunteering and Caregiving Associated with Suicide Risk? A Census-based Longitudinal Study
Authors: O’Reilly D. , Rosato M. , Maguire A.
Published: June 2017

Background

This record linkage study explores the suicide risk of people engaged in caregiving and volunteering. Theory suggests opposing risks as volunteering is associated with better mental health and caregiving with a higher prevalence and incidence of depression.

Methods

A 2011 census-based study of 1,018,000 people aged 25–74 years (130,816 caregivers and 110,467 volunteers; 42,099 engaged in both). All attributes were based on census records. Caregiving was categorised as either light (1–19 hours/week) or more intense (20+ hours/week). Suicide risk was based on 45 months of death records and assessed using Cox proportional hazards models with adjustment for and stratification by mental health status at census.

Results

More intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18); volunteering with better mental health (OR 0.87; 95%CIs 0.84, 0.89). The cohort experienced 528 suicides during follow-up. Both volunteering and caregiving were associated with a lower risk of suicide though this was modified by baseline mental ill-health (P = 0.003), HR 0.66; 95%CIs 0.49, 0.88 for those engaged in either activity and with good mental health at baseline and HR 1.02; 95%CIs 0.69, 1.51 for their peers with poor mental health. There was some indication that those engaged in both activities had the lowest suicide risk (HR 0.34; 95%CIs 0.14, 0.84).

Conclusions

Despite the poorer mental health amongst caregivers they are not at increased risk of suicide. The significant overlap between caregiving and volunteering and the lower risk of suicide for those engaged in both activities may indicate a synergism of action.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cost-effectiveness of a Specialised Medium Secure Personality Disorder Service
Authors: Woodward R. , Lingam R. , Papouli F.
Published: June 2017

Introduction

The Oswin unit located in the North East of England is commissioned primarily for offenders screened on the offender personality disorder (OPD) pathway based on measures of personality disorder being linked to moderate to high risks to other persons.

Objectives

The Oswin Unit was re-designed in early 2014 meeting commissioning specifications to meet objectives based on access, measuring quality and reducing. The primary objective of this pathway is to ensure personality Disorder offenders have access to “community-to-community”, joint-up care and monitoring of risks. The Oswin unit implemented a re-designed service offering individuals formulation based assessments and risk management embedded in the OPD pathway. The overall objective of this project is to evaluate the effectiveness and risk amelioration of this hospital-based service.

Aim

As part of a broader service development and evaluation project, the cost-effectiveness of the current model of the unit was compared to that of the unit prior to the redesign of the service.

Method

Collection of data on number of admission and length of stay and calculation of expenses per capita. Retrospective analysis of costs of care.

Results

Analysis of comparative figures post-implementation of this new model of care found 41% more episodes of care. Cost-analysis indicated a saving of £200,000.

Conclusion

The new Oswin Model meets commissioning objectives in offering access to hospital-based care and focused treatments for prisoners ‘stuck’ in prison pathways. This finding led to further investigation using thematic measures of quality of care to evaluate the effectiveness of this service and risk amelioration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
What is the Relationship Between the Levels of Work-stress and Burnout?
Authors: Ptacek R. , Raboch J. , Vnukova M. , Dubacova D.
Published: June 2017

Objective

Burnout is constantly becoming more exhaustively researched topic. It is assumed there is strong relationship between burnout and work-stress. The aim of this study was to investigate the relationship between burnout and work-stress in order to test the hypothesis that there is an association between these two variables.

Method

The study sample comprised of economically active Czech population, that was a representative sample. Data was gained through combination of interviews and questionnaires depending on the age of the participants. Data was then analyzed using multiple linear regressions.

Results

The total sample comprised of 1027 participants; 675 persons aged 25–50 years and 352 persons aged 51–65 years. The sample contained roughly equal number of men (52.8%) and women (47.2%) The full model explained 59,79% variance and was highly significant F (18,1008) = 85,76, P = 001. Some factors that participants feel like could help them reduce the stress in workplace and subsequently reduce the burnout are longer holidays, lowering the administration burden, better work place conditions and lastly increasing the authority a person has in a given work place.

Conclusion

The study has shown an association between work-stress and burnout and thus in order to prevent burnout with it related job absence certain precaution steps should be made. The reoccurring theme that would seem to improve the situation is decreasing the administrative work that is unrelated to the profession as well as increasing the powers the employees have in their position.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Impact of Premorbid Functioning on Outcome Indices in a Large Sample of Italian Patients with Schizophrenia
Authors: Bucci P. , Galderisi S. , Rossi A. , Rocca P. , Bertolino A. , Mucci A. , Maj M.
Published: June 2017

Introduction

An impairment of premorbid adjustment (PA) has been regarded among poor prognostic indicators of schizophrenia. Some discrepancies in the literature suggest the usefulness of further characterizations of its impact on different aspects of the disease.

Aims

The present study aimed to investigate the association of poor PA with psychopathology, neurocognition and real-life functioning in patients with schizophrenia recruited within the multicenter study of the Italian network for research on psychoses. functioning during childhood and adolescence (early adjustment) was assessed also in a group of healthy controls (HC) and one of unaffected relatives of patients (UR).

Methods

Group comparisons were performed between patients with poor and those with good PA. Differences in frequency of poor early adjustment were investigated among patients, HC and UR.

Results

Patients with poor PA, as compared to those with good PA, showed earlier age of onset, more severe negative symptoms and disorganization, greater impairment on all cognitive domains with the exception of attention/vigilance and worse real-life functioning in the considered areas (interpersonal relationships, community activities and work abilities). The pattern of poor early adjustment was more frequent in patients with respect to UR and HC and, to a less degree, in UR with respect to HC.

Conclusions

Our findings confirm that poor PA in schizophrenia is associated with poorer illness outcome, and offer a further characterization of PA impact on different psychopathological and cognitive domains. They also suggest that poor early adjustment is a candidate endophenotype of schizophrenia, occurring in patients and their unaffected relatives.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Electrophysiological Correlates of Negative Symptom Domains in Schizophrenia
Authors: Giordano G.-M. , Koenig T. , Mucci A. , Vignapiano A. , Amodio A. , Di Lorenzo G. , Niolu C. , Altamura M. , Bellomo A. , Galderisi S.
Published: June 2017

Introduction

Negative symptoms are a core feature of schizophrenia but their pathophysiology remains elusive. They cluster in a motivation-related domain, including apathy, anhedonia, asociality and in an expression-related domain, including alogia and blunted affect.

Aim

Our aim was to investigate the different neurobiological underpinnings of the two domains using the brain electrical microstates (MS), which reflect global patterns of functional connectivity with high temporal resolution.

Method

We recorded multichannel resting EEGs in 142 schizophrenia patients (SCZ) and in 64 healthy controls (HC), recruited to the Italian network for research on psychoses study. Four microstates (MS) classes were computed from resting EEG data using the K-Mean clustering algorithm. Pearson's coefficient was used to investigate correlations of microstates measures with negative symptom domains, assessed by the Brief Negative Symptoms Scale (BNSS).

Results

SCZ, in comparison to HC, showed increased contribution and duration of MS-C. Only the avolition domain of BNSS correlated with the contribution and occurrence of MS-A. Within the same domain, anticipatory anhedonia, apathy and asociality, but not consummatory anhedonia, were positively correlated with contribution and occurrence of microstate A. Asociality was also negatively correlated with contribution and occurrence of MS-D.

Conclusion

Our findings support different neurobiological underpinnings of the negative symptom domains, avolition and expressive deficit. Furthermore, our results lend support to the hypothesis that only anticipatory anhedonia is linked to the avolition domain of the negative symptoms. Mixed results in the literature concerning the presence of MS-A and D abnormalities in schizophrenia might be related to the syndrome heterogeneity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Current Smoking in Real World Schizophrenia: Relationship to Psychopathology and Clinical Characteristics. Results from the FACE Dataset
Authors: Mallet J. , Fond G. , Le-Strat Y. , Llorca P.-M. , Dubertret C.
Published: June 2017

Background

Tobacco smoking is common in schizophrenia. Some characteristics are usually associated to tobacco smoking in schizophrenia, such as younger age, earlier onset of the disease, number of hospitalizations or higher treatment doses. However, little is known about positive symptoms or aggressiveness, as well as trauma history.

Objectives

to study the relationship between smoking status and clinical characteristics in patients with schizophrenia.

Method

A total of 474 patients with were consecutively included in the network of FondaMental Expert Center (FACE) for schizophrenia and assessed with the structural clinical interview for DSM-IV axis 1 disorders (SCID), validated scales for psychotic symptomatology and childhood trauma questionnaire. Tobacco abuse or dependence was defined according to the SCID. Ongoing antipsychotic treatment was recorded. Aggressiveness was measured with Buss-Perry Aggression Questionnaire (BPAQ).

Results

A sample of 474 patients with schizophrenia was included in this study (non-smokers, n = 215; non-smokers, n = 259). Mean age at tobacco onset was 17.19 years old (SD = 3.93). In multivariate analysis, smoking was associated with SGA use (P = 0.028), with higher scores of physical aggressiveness (P = 0.042), with current alcohol-dependence (P = 0.002). However, no association was observed with sex, age of onset, trauma history, global functioning, observance or psychotic symptomatology.

Conclusions

Tobacco smoking was associated with physical aggressiveness, but not with earlier onset of the disease nor traumas or psychotic symptomatology. Besides, the results of the present study are in favor of a superior efficacy of second-generation antipsychotics in the treatment of comorbid tobacco use. These results need further investigation in longitudinal studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive Screening Scale for Schizophrenia (CSSS): The Development and the Structure of the Scale
Authors: Szulc A. , Gierus J. , Koweszko T. , Mosiolek A.
Published: June 2017

Objectives

The study presents the construction of CSSS: a short screening scale intended for diagnosis of cognitive deficits among people with schizophrenia. The final version of the scale consist of 6 subscales which measure basic cognitive functions.

Methods

A total of 160 persons (124 with schizophrenia and 36 healthy controls) were tested using the initial version of the CSSS scale consisting of 11 subscales. Correlation analysis between the subscale results was carried out, as well as confirmatory factor analysis, internal consistency analysis of the scale, IRT (item response theory) analysis of the item's difficulty, and analysis of the scale's accuracy as a classifier.

Results

One factor explains 37% of the variance of the subscales’ results. The scale has satisfactory internal consistency (0,83). Subjects with schizophrenia achieved significantly lower scores than healthy subjects. The area under the ROC curve (AUC) for discriminating between subjects with schizophrenia and healthy subjects was 0.83. Cut point of 16 raw points is 86% sensitive and has 70% specificity.

Conclusions

The form of the tool that has been achieved as a result of presented analyses suggests that this scale has a potential to fulfill the assumed goals, which will be tested during continuing validation studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Disorganization in Schizophrenia: A Resting EEG Study
Authors: Vignapiano A. , Koenig T. , Mucci A. , Giordano G.-M. , Amodio A. , Di Lorenzo G. , Niolu C. , Altamura M. , Bellomo A. , Galderisi S.
Published: June 2017

Introduction

In subjects with schizophrenia (SCZ), the disorganization factor was found to be a strong predictor of real-life functioning. “Conceptual disorganization” (P2), “difficulties in abstract thinking” (N5) and “poor attention” (G11) are considered core aspects of the disorganization factor, as assessed by PANSS. The overlap of these items with neurocognitive functions is debated and should be further investigated.

Aims

Within the Italian network for research on psychoses study, electrophysiological and neurocognitive correlates of the disorganization factor and its component items were investigated.

Methods

Resting state EEGs were recorded in 145 stabilized SCZ and 69 matched healthy controls (HC). Spectral amplitude (SAmp) was averaged in nine frequency bands. MATRICS consensus cognitive battery (MCCB) was used for neurocognitive assessment. Band SAmp differences and correlations with psychopathology and MCCB scores were explored by global randomization statistics.

Results

SCZ showed increased delta, theta, and beta1 and decreased alpha2 SAmp. A negative correlation between alpha1 and disorganization was observed in SCZ. At the item level, only N5 showed this correlation. MCCB neurocognitive composite was associated with P2 and N5 but not with alpha1 SAmp.

Conclusions

Our findings suggest an heterogeneity of the disorganization dimension and a partial overlap with neurocognitive domains. The N5, “difficulties in abstract thinking”, had a unique association with alpha1 SAmp, which is thought to be involved in the formation of conceptual maps.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differential Susceptibility Properties of the 5HTTLPR Gene in Relation to Depressive Symptoms and Delinquency
Authors: Nilsson K.-W. , Åslund C.
Published: June 2017

Introduction

The candidate gene-environment interaction (cG × E) research field in psychiatry has traditionally been dominated by the diathesis–stress framework, where certain genotypes are assumed to confer increased risk for adverse outcomes in a stressful environment. In later years, theories of differential susceptibility or biological sensitivity have been presented, suggesting that cGs that interact with environmental events do not exclusively confer a risk for behavioural or psychiatric disorders but rather seem to alter the sensitivity to both positive and negative environmental influences.

Aims

The present study investigates the susceptibility properties of the 5HTTLPR gene in relation to depressive symptoms and delinquency in two separate adolescent community samples: n = 1457, collected in 2006; and n = 191, collected in 2001.

Results

Two-, three- and four-way interactions between the 5HTTLPR, positive family environment, negative family environment, and sex were found in relation to both depressive symptoms and delinquency. However, the susceptibility properties of the 5HTTLPR gene were distinctly less pronounced in relation to depressive symptoms.

Conclusions

If the assumption that the 5HTTLPR gene induces differential susceptibility to both positive and negative environmental influences is correct, the previous failures to measure and control for positive environmental factors might be a possible explanation for former inconsistent findings within the research field.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A pilot Project Exploring the Utility and Acceptability of a Socially-assistive Robot in an Assessment Unit for People with Neuropsychiatric Symptoms
Authors: Loi S. , Khosla R. , Nguyen K. , Lautenschlager N. , Velakoulis D.
Published: June 2017

Objectives

Socially-assistive robots have been used with older adults with cognitive impairment in residential care, and found to improve mood and well-being. However, there is little known about the potential benefits in adults with other neuropsychiatric symptoms.

Aims

The aim of this project was explore the utility and acceptability of a socially-assistive robot in engaging adults with a variety of neuropsychiatric symptoms.

Methods

Betty, a socially-assistive robot was installed in a unit which specialises in the assessment and diagnosis of adults presenting with neuropsychiatric symptoms. She is 39 cm tall, has a baby-face appearance and has the ability to engage individuals through personalised services which can be programmed according to individuals’ preferences. These include singing songs and playing games. Training for the nursing staff who were responsible for incorporating Betty into the unit activities was provided. The frequency, duration and type of activity which Betty was involved in was recorded. Patients admitted who could provide informed consent were able to be included in the project. These participants completed pre- and post-questionnaires.

Results

Eight patients (mean age 54.4 years, SD 13.6) who had diagnoses ranging from depression and schizophrenia participated. Types of activities included singing songs, playing Bingo and reading the news. Participants reported that they were comfortable with Betty and did not feel concerned in her presence. They enjoyed interacting with her.

Conclusions

This pilot project demonstrated that participants found Betty to be acceptable and she was useful in engaging them in activities. Future directions would involve larger sample sizes and different settings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Nursing consultation and the care to depression in elderly
Authors: Carvalho C.M. , Cardoso Vernaglia T.V. , Correa Sória D. de Assis , da Silva T.D.J. Espirito Santo , Souza S.R. , Mello R.
Published: June 2017

Depression is a major mental illness affecting the elderly. About 15% of the elderly have some depressive symptoms and about 2% have severe depression. This study was conducted in an Extension Program of the Federal University of the State of Rio de Janeiro (UNIRIO) and the aims are: to identify the prevalence of depression in the elderly attended by the community center “Project Rebirth” in Rio de Janeiro-RJ, and discuss strategies developed in consultation to care the depression.

Methodology

The elderly are registered in the program and accompanied by a multidisciplinary team. In nursing consultations, whose base is in the realization of Nursing Process, there is the application of the Geriatric Depression Scale named Yesavage – reduced version (GDS-15) held by students under the supervision of the teacher. After classification of the patient on the scale, they develop the care plan based in the Nursing Interventions Classification (NIC), and the nursing diagnoses that have among their factors related to depression and its symptoms.

Results and conclusions

In addition to interventions carried out in consultation, involving recovery of self-esteem, encouragement of leisure and recreational activities, and supported self-care, the program staff (psychologists, doctors, nurses and occupational therapists) works in partnership in support group health education, encouraging the integration of the elderly. The well-being and self-esteem of the elderly, thus, reduce the triggers of depression, with the integration of participants, students and professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“Mom, there is a monster in the closet”: The impact of early attachment trauma (EAT) on the development of anxiety disorders and treatment possibilities
Authors: D’Hooghe D.
Published: June 2017

Objectives

In this workshop, I want to broaden the vision on attachment trauma and highlight the importance to acknowledge EAT as a hidden epidemic.

The significance of EAT in the development of anxiety symptoms becomes more and more apparent.

Methods

Recognizing the effect, that the quality of the attachment relationship has on the development of a secure attachment bond, is important to understand the factors underlying the development of anxiety symptoms.

The availability, responsiveness, mentalizing possibilities… of the parent create a secure base from which the child can explore and develop.

The absence of those features in the child–parent relationship, causes traumatic stress in the child and impacts his psychological and neurological well-being.

Results

Insecure attachment influences the neurobiology and results in dissociative processes (hyper- and hypo-aroused) expressed in different types of anxiety disorders.

Derived from the neurobiology there is a clear link between anxiety, depression and aggression.

The internal working model (IWM), rises from insecure attachment, influences adversely the child's capability to regulate and relate.

From an intergenerational point of view, an insecure attachment style of the parent implements the absence of affect en stress regulation capabilities and leave the child with the inability to regulate his anxiety.

Conclusion

There is a clear link between EAT and different types of anxiety disorders.

Treatment strategies should integrate neurobiological, attachment and trauma insights resulting in body oriented therapy, development of affect – and stress – regulation strategies, restructuring the internal working model, the therapeutic relationship as attachment bond…

Disclosure of interest

The author has not supplied his declaration of competing interest.
Somatic-type delusional disorder and comorbidity mood disorder
Authors: Martí Garnica V. , Ortega Garcia M.D. , Bernal López M.Á. , Russo De león J.R. , García Marín S.
Published: June 2017

Chronic delusional disorder encompasses what classical termed as paranoia and paraphrenia. This disorder is characterized by the presence of one or more non-bizarre, permanent and systematized delusions. Cognitive functions of the patient not affected, judgment and reason are not affected if the subject is not addressed delirious. Delusional theme includes life-like experiences, including: persecution – persecutory type –, suffering from a disease – somatic type –, to be loved by someone famous – erotomaniac type –, the partner is unfaithful – jealous type – or having a special quality or gift – megalomaniac type –. Usually, patients lack awareness of mental illness and often prior to contact with mental health, made a pilgrimage by different specialists looking for an organic explanation.

The description of a case report of a 47-year-old male who has a delusional belief body deformity secondary to manipulation by a physiotherapist suffering a muscular pain in the lumbar region is performed. Prior to psychiatric diagnosis, begins a long journey by different specialists.

As a consequence, somatic-type delusional disorder is a challenge in the diagnosis and treatment in the medical field because it is required a multidisciplinary approach for these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Deep brain stimulation – Is there hope for obsessive compulsive disorder?
Authors: Batista A. , Melim J. , Nunes J. , Carvalho A.R. , Duarte M. , Maia J.
Published: June 2017

Introduction

Deep brain stimulation (DBS) is a neurosurgical procedure under investigation for a range of psychiatric and neurological disorders. One of them is obsessive compulsive disorder (OCD), which is a neuropsychiatric illness that often develops in childhood, affects 2% of the general population and causes significant impairment across the lifespan. Some cases are refractory to pharmacotherapy and psychotherapy and that is why new treatments have been investigated over the last decades.

Objectives/aims

In this paper, we intent to do a review of the literature about the efficacy of DBS in the treatment of OCD.

Methods

We present a literature review of some scientific articles found on Pubmed search using “deep brain stimulation and obsessive compulsive disorder/DBS and OCD”.

Results

Clinical outcome of DBS for OCD shows robust effects in many studies. It appears that most patients regain a normal quality of life after DBS, reporting changes in perception, feeling stronger and more confident, and doing things unreflectively. It seems that DBS is a valid alternative to lesional ablative neurosurgery for severe, therapy-refractory OCD patients, although with partially discrepant results probably related to differences in anatomical targeting and stimulation conditions.

Conclusions

DBS seems to be a promising modality for the treatment of some refractory psychiatric disorders such as OCD, but the search for the best target still continues. Randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychogenic nonepileptic seizures
Authors: Queiroga L. , Rodrigues R. , Mesquita Reis J.
Published: June 2017

Introduction

Psychogenic nonepileptic seizures (PNES) are defined as a somatoform conversion disorder manifesting as paroxysmal events not associated with electroencephalographic (EEG) epileptiform correlates. This entity is poorly understood and often misdiagnosed as epilepsy. It is important to recognize that misdiagnosis leads to inappropriate use of antiepileptic drugs, which may worsen the course of the disease.

Recent studies have suggested that the frequency of psychogenic nonepileptic seizures ranges from 10 to 23% of referrals to a pediatric epilepsy center, as well as 60% of children with PNES achieve symptom improvement and event freedom of symptoms following appropriate treatment.

Objectives

The aim of this study is to conduct a literature review of studies which the purpose was better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting.

Conclusion

A early identification of the risk factors for comorbid psychopathology, diagnosis and appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emetophobia (a specific phobia of vomiting): A case study
Authors: Roy D.
Published: June 2017

Introduction

Case presentation of a young woman Ms. A.M., referred by her GP with an eating disorder, who was thereafter diagnosed with an uncommon type of phobia (emetophobia – a specific phobia of vomiting) and treated accordingly.

Objectives

To highlight the diagnostic dilemma with such uncommon cases, who are often misdiagnosed as having anorexia nervosa or bulimia nervosa or suffering from other anxiety disorders (like OCD or GAD).

Methods

A comprehensive mental state examination was conducted including a diagnostic clarification interview. She was followed up by the mental health team on a regular basis with support and also providing appropriate psychotherapy.

Discussion

Ms. A.M. refused medications and only agreed to non-pharmacological treatment. She was therefore commenced on once weekly psychotherapy (CBT), which she undertook for a period of 4 months. She showed good response to the psychotherapy with significant attenuation of her core symptoms, although she still continued to exhibit some avoidance behaviors.

Conclusions

This particular patient showcases a relatively uncommon and often misdiagnosed specific phobia (emetophobia) and highlights the positive response seen in this case with psychotherapy.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Care pathways for patients with bipolar disorders at Psychiatry Clinic Affektiva, Gothenburg: Identifying and solving issues for a more efficient and safe care
Authors: Dellepiane M. , Boldt-Christmas C. , Jungestrand G. , Asplund P. , Ahmed R. , Nordin T.
Published: June 2017

Introduction

The Psychiatry Clinic Affektiva has developed a care pathway for patients with bipolar disorder (BD). It consists of one outpatient clinic and two inpatient wards. Clinical observations suggest that patients with BD benefit from treatment in a dedicated unit with tailored care programs and that better outcomes are achieved in terms of reduced average length of stay and safer transitions to outpatient care for this group.

Aims

The aim is to improve the care of bipolar patients by increasing bed-availability and overall continuity in the care pathway and monitoring core aspects in the management of outpatients in order to reduce admissions and to facilitate standardized treatment and collaboration between in- and outpatients unit.

Method

We developed a structure to monitor and measure specific outcomes such as readmission within 28 days, relapse within 12 months and the use of lithium in this group. We also developed a standardized care protocol in order to improve the safety and the equality.

Results

At this stage our preliminary results from our efforts are promising but further monitoring is needed to confirm our hypothesis. More data will be collected during 2017.

Conclusions

Affektiva Psychiatry Clinic has developed a model for continuously monitoring several essential aspects in the care of patients with BD and providing a specific care program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Late-onset bipolar illness: Literature review and case report
Authors: García-Jiménez J. , Porras-Segovia A. , García-López R. , Muñoz-Negro J.E. , Gutiérrez-Rojas L.
Published: June 2017

Introduction

Late-onset bipolar-illness (LOBI) diagnosis comprises those patients whose first mania episode occurs aged 60 or older. Traditionally, it has been considered as a secondary disorder, accompanying other conditions such as dementia. While this is true for some cases, LOBI is a wider concept, which has its own features and also includes other entities.

Objectives

To describe the main features of LOBI.

Methods

Critical review of the literature and description of the case of a 72-year-old woman diagnosed with LOBI.

Results

While only 6–8% of all new cases of bipolar disorder (BD) occur in people older than 60, recent research suggests an increase of first episodes in this age group. LOBI is less associated with family history compared to early onset BD and seems to occur more frequently in women.

LOBI presents with better premorbid functioning and atypical psychopathology as compared to early onset. Also, there is a higher prevalence of mixed episodes and a higher frequency of episodes per year, with a great risk of suicide. LOBI patients have more cognitive impairment and higher rates of comorbid psychiatric disorders.

These patients show some specific neuroimaging signs, including subcortical hyperintensities.

Quetiapine and valproate have proved useful, but the pharmacokinetic and pharmacodynamic characteristics of older patients must be taken into account.

Conclusion

The reported case identifies similarities between LOBI and classical BD. However, both this case and the literature review reveal that LOBI has specific features that differentiate it from classical BD. Further research is needed to characterise the condition and improve its management.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Misdiagnose bipolar disorder: About a case report
Authors: Novais C. , Marinho M. , Mota Oliveira M. , Bragança M. , Côrte-Real A. , Fonseca S.
Published: June 2017

Introduction

Early stages of bipolar disorder are sometimes misdiagnosed as depressive disorders. This symptomatology can lead to misinterpretation and under diagnosis of bipolar disorders.

Objectives/aims

To describe a patient with a new diagnosis of bipolar disorder after 23 years of psychiatric care.

Methods

We report a case of a 66-year-old man, with a previous psychiatric diagnosis of recurrent depressive disorder for the last 23 years, after a hospitalization in a psychiatric inpatient unit because of a major depressive episode. In subsequent years, he was regularly followed in psychiatric consultation with description of recurrent long periods of depressed mood requiring therapeutic setting, alternating with brief remarks of not valued slightly maladjusted behaviour. At 65, he came to the emergency room presenting with observable expansive and elevated mood, disinhibited behaviour, grandiose ideas and overspending, leading to his hospitalization with the diagnosis of a manic episode. In the inpatient unit care, we performed blood tests, cranial-computed tomography (CT) and a cognitive assessment. His medication has also been adjusted.

Results

Laboratory investigations were unremarkable. Cranial-CT showed some subcortical atrophy of frontotemporal predominance, without corroboration by the neuropsychological evaluation. The patient was posteriorly transferred to a residential unit for stabilization, where he evolved with major depressive symptoms that needed new therapeutic adjustment. Later he was discharged with the diagnosis of bipolar disorder.

Conclusions

Our case elucidates the importance of ruling out bipolar disorder in patients presenting with depressive symptoms alternating with non-specific maladjusted behaviour, which sometimes can be a challenging task.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does gender matter? A comparative study of post-traumatic stress disorder among children and teenager
Authors: Ben Mabrouk N. , Bourgou S. , Staali N. , Hamza M. , Ben Hammouda A. , Charfi F. , Belhadj A.
Published: June 2017

Introduction

Post-traumatic stress disorder (PTSD) symptomatology seems to depend of many variables like age, exposition to trauma, environment…

Objectives

Compare, basing on gender, socio-demographic and symptomatology of patients with PTSD.

Methods

A retrospective and comparative study was conducted at the Child and Adolescent Psychiatry Department of Mongi Slim Hospital (Tunisia) from January 2013 until July 2016. We included all cases of patients followed for PTSD (DSM-5). They were divide into 2 groups according to the gender. Data was collected from patients’ records.

Results

Our study featured 30 patients: 16 boys and 14 girls. The average age was similar for both teams (boys: 8.43 years; girls: 8.53 years). Boys had twice more personal history of somatic, psychiatric illness (70%), and low socioeconomic status (62.5%). The beginning of the facts were significantly later for the female group (P < 0.001). Females were more likely to be a witness, while males tented to be directly exposed to the trauma. Physical abuse was the major aggression for both groups.

Female gender was associated to parental trauma exposure (P = 0.023) and to an ongoing event (P = 0.004). Meanwhile, male gender was associated to a maternal history of psychiatric illness (P = 0.012), a single traumatic event (P = 0.010), and to a school located aggression (0.04). Girls have developed more hypervigilance, guilt symptoms and aggressive behaviors. Low self-worth, regression, specific phobia and suicidal ideations occurred more frequently among boys.

Conclusions

Health professionals must be aware of the youth PTSD warning signs in order to have the earlier right intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.