bluuebunny/crossref_metadata_2025 huggingface dataset:
An audit to identify factors affecting response to treatment among depressed patients who have documented suicidal ideation/attempts in a bedfordshire community mental health team
Authors: Holt C. , Butler S. , Agius M. , Zaman R.
Published: May 2011

Introduction

In recent years there has been a move towards treating depressed patients in the community.One factor that may reduce the likelihood of discharge from secondary care is suicidality. The aim of this audit was to identify factors associated with continued suicidality among Community patients.

Subjects and methods

We searched an anonymised database of patients and identified all those with previously documented suicidal thoughts or attempts. We also noted the presence of factors such as alcohol problems, drug problems, augmentation therapy and ‘other risk’ factors (e.g. financial problems or homelessness). We assessed the latest clinic letter, to see if patients were still reporting suicidality. We compared the aforementioned factors between the group of patients in which suicidality was still present (group N) and the group of patients in which suicidality was no longer a feature (group Y).

Results

Of the 56 patients with suicidal thoughts or attempts there were 44 in group N (79%) and 12 in group Y (21%). Alcohol problems, drug problems and ‘other’ risk factors were more common among group Y than group N. Conversely, the percentage of patients on augmentation therapy was greater in group N than group Y.

Discussion

The audit provides an insight into the factors that might influence outcomes among depressed patients.

Conclusions

Although the results are suggestive, it is difficult to make firm conclusions about patient outcomes on the present data. The audit provides a useful starting point, especially in considering the treatment of patients within the CMHT.
C-Fos brain mapping of global and subunit-specific NMDA receptor antagonists: Relevance for their potential use as antidepressants
Authors: Inta D. , Lima J. , Filipovic D. , Köhr G. , Sprengel R. , Gass P.
Published: May 2011

Introduction

NMDA receptor antagonists as ketamine represent fast-acting alternatives to monoaminergic-based antidepressants. Major drawbacks of these drugs are psychosis-like states and cortical neurotoxicity, effects correlating with potent activation of the cingulated and retrosplenial cortex. The molecular mechanisms underlying these side-effects have not been deciphered yet.

Aims

We aimed to determine potential molecular components of the NMDA receptor implicated in their psychotomimetic action and investigated whether subunit-specific NMDA receptor antagonists also induce similar neurotoxic changes as ketamine.

Method

To investigate deleterious effects of NMDA receptor antagonists, we used brain mapping with the immediate early gene c-Fos. We analyzed the expression pattern of c-Fos in brain areas responsible for deleterious adverse events, after treatment with ketamine and the NR2B subunit-specific antagonist Ro 25-6981, both in wild-type and knockout mice, lacking either the entire NR2A subunit (NR2A ko mice) or its intracellular C-terminus (NR2A deltaC mice).

Results

In contrast to ketamine (10mg/kg), Ro 25-6981, even at high dosages (50mg/kg) does not induce any c-Fos expression in the cingulated and retrosplenial cortex of wildtype mice. However, Ro 65-2981 evokes, both in NR2A ko mice and NR2A deltaC mice, strong c-Fos expression in these areas.

Conclusions

Our data indicate that blockade of both NR2A and NR2B subunits is necessary to induce deleterious effects specific for ketamine. Deletion of the C-terminus of the NR2A subunit is sufficient to disinhibit, together with pharmacological NR2B blockade, neuronal networks associated with psychosis. Therefore, NR2B antagonists may represent safer alternatives to ketamine as potential antidepressants.
The evaluation of the rate of major depression in those who use norplant at shiraz Hafez hospital
Authors: Kavari S.H.
Published: May 2011

Introduction

Depression is a serious condition that can impact every area of your life. Female depression and even the pattern of symptoms are often different.

Aims

The aim of this research study is to investigate the rate of server depression in those who use propellant. In order to achieve this objective, 260 patients volunteered to participate in this investigation and they were referred to the family planning clinic at Hafez hospital, and were planted capsule of Norplant.

Methods

In order to further fulfill selection process of patients suitable for this project, 200 of the most suitable candidates who suffered from even minor depression but had no history of congenital and familial major depression were selected and considered fit for this research work.

Results

The results drawn from this investigative study can be summarized as follows;

1-The relationships between progesterone in anti pregnancy compound tablets, major depression and anxiety were recognized from many years ago. Norplant which is progestin itself can also be regarded as the cause of these conditions.

2-This investigation concluded that, among those patients studied, only 0.5% started having major depression as a result of the plantation. Therefore, Norplant was removed from their body.

Conclusions

A good consultation, awareness, correct guidance and efficient method of educating people before using Norplant, seeking prompt referral advice and future follow ups, will result in an effective way of preventing, diagnosis and treatment of these side effect conditions.
Major depressive disorder, anhedonia, and agomelatine: An open-label study
Authors: Martinotti G. , Di Iorio G. , Guglielmo R. , De Berardis D. , Janiri L. , Di Giannantonio M.
Published: May 2011

Introduction

Today there is a large number of antidepressant drugs. However, the effect of treatment is often suboptimal. Unlike other antidepressants agomelatine has a novel neurochemical mechanism. It is an MT1 and MT2 melatonergic receptor agonist and a selective antagonist of the 5-HT2C receptors. In this open-label 8-week study we aimed to investigate the efficacy of agomelatine on depressive symptoms in patients with major depression. Secondary endpoints were the effect of agomelatine on anhedonia.

Methods

Thirty major depressive patients received a flexible dose (25–50 mg; per os, daily) of agomelatine. Depressive (Hamilton Depression Scale) and anxious (Hamilton Anxiety Scale) symptoms, anhedonia (Snaith Hamilton Rating Scale), and sleep quality (Leeds Sleep Evaluation Questionnaire) were assessed.

Results

Twenty-four patients (80%) completed 8 weeks of treatment. Significant improvements were seen at all visits on the HAM-D (p< .05), HAM-A(p< .01), SHAPS (p< .05), LSEQ (p< .05). Nine subjects (30%) were responders and 5 (17%) remitters at week 1; 18 (60%) were remitters by the end of the trial. There was no serious adverse event. No aminotrasferase elevations were noted.

Discussion

In line with previous studies, in which agomelatine was associated with early clinical improvement this study also provides evidence of an early response and the findings of improvements in depression scores. Beside this is the first study where agomelatine was effective in the treatment of anhedonia. Additional trials are needed to delineate the place of agomelatine in the contemporary pharmacotherapy for depressive disorders.
Moderate exercise improves quality of life in patients with non-remitted major depressive disorder
Authors: Mota Pereira J. , Silvério J. , Carvalho S. , Ribeiro J.C. , Fonte D. , Saavedra I. , Ribeiro da Silva M.H. , Ramos J.
Published: May 2011

Introduction

In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.

Aims

To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).

Methods

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.

Results

At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).

Conclusions

Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.
Tinnitus severity and the relation to depressive symptoms: A critical study
Authors: Ooms E. , Meganck R. , Vanheule S. , Vinck B. , Watelet J.-B. , Dhooge I.
Published: May 2011

Introduction

Research indicates that subjective tinnitus severity varies among tinnitus patients. One of the variables held responsible for these differences is depression. However the relationship between depression and tinnitus severity was never investigated more in depth.

Objectives

If depression is responsible for differences in subjective tinnitus severity two conditions need to be fulfilled. First, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group, and second, there should be evidence for a substantial relationship between depressive symptoms and tinnitus severity which can not be explained due to method and content overlap.

Aims

In this study we investigated whether tinnitus severity is a depression related problem.

Methods

136 consecutive help-seeking tinnitus patients were seen by a psychologist and an audiologist. All patients filled in the Beck Depression Inventory (BDI-II), the Tinnitus Handicap Inventory (THI), and underwent psychoacoustic measurement (pitch and loudness).

Results

Mean scores indicate the presence of no or minimal depressive symptoms. There was only a positive correlation (p < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis revealed that only the somatic depression subscale significantly predicted tinnitus severity.

Conclusions

Tinnitus does not seem to be a depression-like problem. There is no substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artefact due to content overlap between de THI and the somatic subscale of the BDI-II.
Are greeks SAD?
Authors: Darai N. , Voura N. , Papanikolaou K. , Koukoulas G. , Angelidis G.
Published: May 2011

Introduction

Seasonal Affective Disorder (SAD) is thought to be related to a lack of serotonin, or according to other theories, the primary cause is melatonin produced in the pineal gland, since there are direct connections between the retina and the pineal gland.

Objective

To demonstrate cases of SAD treated in the CMHC of Katerini(northern Greece), in 2009.

Material

Archives of the adult-clinic of the CMHC in 2009.

Method/results

The CMHC accepted 3294 people (1517:males/1777:females) in 2009. 280 were diagnosed with depression (48:males/232:females). 96 were newcomers (22: males/74:females) seeking for session the fall-spring period, complaining about mood swings as daylight hours began to dwindle.

In September: 72 depression cases were reported (63:women/9:men). In December: 92 (73:women/19:men). The references were amazingly high: 84 (71:females/13:males) in March. More than ¾ of all sufferers were women,most in their 40s, correlating with international literature. The majority complained about decreased levels of energy/difficulty concentrating/fatigue/increased desire to be alone/increased need for sleep (unlike typical depression). They also mentioned interference with their relationships and work productivity. 1/3 of them received antidepressant medication, whereas Cognitive Behavior Therapy (CBT) was applied to the total of them. Although light therapy is widely recommended, there aren’t the means to be applied in the CMHC.

Conclusion

Though SAD is prevalent in most of the Nordic countries and mid-latitude places, our patients followed the SAD pattern with an onset of depressive symptoms in the fall, continuation of symptoms throughout winter and remission of them in the spring according to other international references.
Practice of ECT in the austrian region of upper carinthia
Authors: Rados C. , Pramsohler B.
Published: May 2011

Introduction

ECT is a save and one of the most effective treatments of depression and other severe mental diseases.

Despite these facts rates of ECT use are highly variable in different regions. In Villach there has been a continous use of ECT for many years.

Objectives

We investigate the agreement of the rate of ECT between our clinical practice and and international recommendations.

Additionally we want to show our data about indications, frequency and outcome in the use of ECT.

Results

Data will be reported and discussed.
Depressive disorder among the breast cancer patients in outpatient department of a tertiary care hospital in Pakistan
Authors: Rahman R.U. , Nisar A. , Hussain N. , Chaudhary I.
Published: May 2011

Objectives

To determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.

Background

Cancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.

Methodology

This cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.

Results

Eighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.

Conclusion

This study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.
Survey of relationship between attitude and practice toward prayer and depression in student of kurdistan university of medical sciences of Iran, in 2009
Authors: Ranaie F. , Zaheri F. , Ardalan F.
Published: May 2011

Background and aims

Mental disorders are of diseases that modern societies encounter with and among them depression is one of the most common disorder especially in young people as prayer and blessing has positive effects on different aspects of life, this study was done to determine relationship between attitude and practice toward prayer and depression in students of Kurdistan university of medical sciences.

Subject and methods

This was a descriptive - analytic study. The study population consisted of 400 students of Kurdistan university of medical sciences that were selected though stratified random sampling method. The data were collected by 2 questionnaires, one that contained questions related to attitude and practice toward prayer and another was beck test.

Results

37.5% has depression (mild to severe). 71% had positive attitude and 29.5% had good practice toward prayer. There was significant relations ship between attitude toward prayer and depression (p = 0/03). So that depression average ranking was lower in those who had positive attitude toward prayer.

With higher mean scores of practice toward prayer depression rates were lower but these. Differences were not significant.

Conclusion

As depression rate is high in these students and because of positive effect of prayer on decreasing prevalence and severity of depression so not only exploring for risk factors of depression in university students is necessary but also reinforcing and promoting doing prayer and religious duties: it is recommended to pay more attention to student's mental health.
Gender characteristics of cerebral hemodynamics during complex cognitive functioning
Authors: Schuepbach D. , Duschek S. , Richter A. , Grimm S. , Boeker H. , Seifritz E.
Published: May 2011

Functional Transcranial Doppler sonography (fTCD) has been applied to assess peak mean cerebral blood flow velocity (MFV) with a high temporal resolution during cognitive activation. Yet, little attention has been devoted to gender-related alterations of MFV, including spectral analysis. In healthy subjects, fTCD was used to investigate a series of cerebral hemodynamic parameters in the middle cerebral arteries (MCA) during the Trail Making Tests (TMT), a means of selective attention and complex cognitive functioning. After the initial peak, there was an MFV decline during complex functioning. Further, in females, we observed a dynamic shift in hemispheric dominance during that condition and there was a frequency peak at 0.375 Hz in both MCA. These novel results suggest condition-specific features of cerebral hemodynamics in females, and it adds to the notion that gender is a fundamental confounder of brain physiology. It is intriguing to speculate whether condition-related alterations of spectral frequencies in females represent a marker of increased vulnerability for psychiatric diseases such as depression.
Depression along with age, weight, smoking, sunlight exposure and alcohol drinking may affect the titer of autoantibodies in lupus patients
Authors: Sharifi E. , Bagheri K.
Published: May 2011

Introduction

Systemic lupus erythematosus (SLE) as a prototypic autoimmune disorder are characterized by autoantibody formation against nuclear antigens.

Objectives

To evaluate the effect of depression, age, weight, smoking, sunlight exposure and alcohol drinking on antinuclear (ANA) and anti-double-stranded-DNA-antibody (anti-dsDNA) level in lupus-patients.

Aims

To evaluate the effect of depression and some individual or lifestyle-habits on lupus.

Methods

Comparison of 46 variables along with their intercorrelations was done in ANA-positive patients and ANA-negative healthy subjects.

Results

Depression status and its prevalence in lupus-patients were higher than controls. Furthermore, more depressed patients had higher ANA and anti-dsDNA level which their level had a direct correlation with the age and weight of patients. However, ANA was more correlated with age and anti-dsDNA with weight. Higher ANA titer was also associated with higher consumption of alcohol and permanent hair products which after controlling for age and weight, only the first correlation remained significant. Anti-dsDNA titer was also positively associated with some of lifestyle habits which after controlling for age and weight, only the correlations with hookah consumption and sunlight exposure remained significant. Moreover the percentage of eosinophils was directly correlated with the level of tow aforesaid autoantibodies.

Conclusion

These findings suggest that depression score along with age and weight of ANA-positive lupus-patients as well as some of their health-related habits such as hookah smoking, direct sunlight exposure and alcohol drinking may affect the titer of autoantibodies in these patients. Further studies are required to evaluate the role of these factors in the exacerbations of SLE.
Predictors of dropout from inpatient treatment for eating disorders
Authors: Catellani S. , Arnone F. , De Bernardis E. , Ferrari S. , Pingani L. , Ziosi G. , Turrini G. , Rigatelli M.
Published: May 2011

Introduction

Drop-out from treatment for Eating Disorders is increasing (Campbell; 2007), and it is a risk factor for relapse and more chronic and severe course of the illness (Fassino et al.; 2009). Drop-out can be caused by interaction of concurrent, individual, familiar ad environmental factors (Sly; 2009).

Aim of the study

To examine possible risk factors of drop-out from inpatient treatment for eating disorders.

Materials and methods

The sample included 41 patients who voluntarily left the treatment before completion (’droppers’) and 88 patients who completed it (’completers’), in the period between 1st January 2006 and 31st December 2009 at Villa Maria Luigia Hospital (Monticelli Terme, PR, Italy). Patients were administered 2 self-report questionnaires and 3 psychometric tests: Eating Disorders Questionnaire, Predisposing, bringing on and maintaining risk factors for eating disorders, EDI-II, BUT, SCL-90.

Results

Droppers appear to be more aggressive (p = 0.022), get worse scholastic results (p = 0.016) and have less friendships and less social interaction (p = 0.021). Parental break-up (p = 0.015), moving house (p = 0.006), father's death (p = 0.005), abortition (p = 0.040), father's alcohol abuse (p = 0.011) and a mother who suffers of eating disorder (p = 0.008) are more frequent in droppers than completers. Catholic religion seems to be a protective factor from drop-out (p = 0.005).

Conclusion

Drop-out is a multifactor phenomenon; identification of risk factors can improve treatment strategies and outcome.
The implicit “Thin Ideal” in eating disorders
Authors: Fadda E. , Fronza S. , Galimberti E. , Bellodi L.
Published: May 2011

Introduction

Greenwald and co-workers developed The implicit Association Test (IAT) to measure implicit automatic concept-attribute associations. Evidences have suggested that Anorexia Nervosa (AN) and Bulimia Nervosa (BN) were characterized by “Ideal Thin” construct.

Objectives

The aim of this study was the evaluation, at an implicit level, of Ideal Thin construct in a sample of Eating Disorders (ED) patients.

Methods

An “Ideal thin” Implicit Association Tests (Ideal thin IAT) has been modeled, to evaluate the implicit ideal thin in ED patients compared with an healthy control group. IAT test has been administered to a sample composed by 17 AN patients, 14 BN patients, 17 Binge Eating patients (BED) and 32 healthy controls (HC). The target categories, were “OVERWEIGHT / UNDERWEIGHT” and “POSITIVE / NEGATIVE”. Stimuli included pictures of overweight and normal weight models and positive/negative words. A positive IAT effect underlines an implicit tendency to associate the category “UNDERWEIGHT” with negative attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with positive attributes.

Results

Results showed no significant difference between HC and clinical groups in implicit “Ideal Thin construct”. All groups showed positive IAT effect. No correlations between implicit attitude and clinical variables were found.

Conclusion

Results show a common implicit tendency generalized in the sample to positively judge underweight. This implicit tendency was stronger in patients with Anorexia Nervosa (0,30), than patents with Bulimia Nervosa (0,41), than Healthy Control (0,42), followed by patients with BED (0,56).
Successful treatment of 27 patients with anorexia nervosa with escalating doses of olanzapine + citalopram + high dose vitamin B6
Authors: Pirkalani K.K. ,   Anorexia Nervosa Study Group
Published: May 2011

Objective

Pharmacological therapy for anorexia nervosa is not enough successful. Mild to moderate anorexia nervosa is very prevalent in Iran. We wondered whether combination of antidepressants with appetizers (to block multiple neurotransmitters) could reverse the disease course.

Methods

Twenty seven patients with mild (8), moderate (12) and severe anorexia nervosa (7) were treated with escalating doses of three drugs (Olanzapine, Citalopram and Vitamin B6 in combination). The initial doses were 2.5 mg at night, 10 mg at noon and 40 mg TID and the increments were 2.5, 10 and 40 mg every 4 days, respectively. All patients were studied by way of the MCMI-III and clinical interview at admission and 6 weeks later. Additional behavior and cognitive therapy were used in compliant cases.

Results

Almost all patients responded (overall response rate of 100%) and complete response of around 67%. Five and two partial responses were among the severe and moderate group. Weight gain was between 3–16% of primary body weights with a mean of 9% at 6 weeks. Depression and anxiety scores were reduced substantially studied by way of the MCMI-III and clinical interview. Maximal tolerated doses were 12.5, 40 and 360 mg respectively and most could be maintained with 5, 20 and 240 mg.

Conclusion

This combination regimen is extremely effective, well tolerated and without major side effects. Scheduled escalation increases compliance. High dose VitB6 has been used by us in the content of many psychological and auto immune disorders with much success. Longer follow up and larger studies are recommended.
Dropout in the treatment for anorexia nervosa and bulimia: A systematic review from the international databases
Authors: Seidinger F.M. , Garcia C. , Böttcher-Luiz F. , Turato E.R.
Published: May 2011

Introduction

Anorexia nervosa and bulimia have the highest mortality rates among psychiatric disorders. High dropout rates 30 to 50% stand obstacle to outcomes.

Objectives

To search and to analyze articles based on studies about inpatients and outpatients dropout in AN and BN.

Methods

The search was conducted through PubMed/Medline, Lilacs, PsycINFO and Cochrane databases. The selection included all the articles about AN/BN focused on dropout. Furthermore, cited articles were included when related. The articles were fully summarized, classified and submitted to categorization.

Results

Most of the articles came from Europe; scarce results from Latin America. dropout-rates are not significantly different between inpatients and outpatients; lower rates among adolescents. Emerging categories are discussed: socio-demographic, clinical and psychological characteristics; family; therapeutic alliance. Impulsive/compulsive behaviour is the strongest predictor explaining the higher dropout rate for AN purging-subtype. The correlation with lower educational level and family background are also supported. The correlation between depression and lower dropout risk founded by some studies was not confirmed by others. Age, previous hospitalizations, length of illness, symptoms severity, weight/BMI are emerging as not consistent predictors. Dropout is not always a negative outcome.

Conclusions

The common discrepant results are attributed to the difficulty in composing adequate samples and to the lack of standardization of the term “dropout”. The focus on patient characteristics in research was questioned; this tendency is changing toward to take into account the answer to treatment process. Highlights: patient's difficulty in intrapersonal relationships, the therapeutic alliance and its management to adherence and continuation of treatment.
Bioethics in psychiatry
Authors: Gomez Juanes R. , Herbera Gonzalez P.
Published: May 2011

Introduction

Bioethics in psychiatry is a research area that is gaining more relevance each year. To understand what bioethics is we need to clarify some concepts.

Morals are the rules that govern the behaviour of humans being in relation to society and themselves but that does not imply alone the concept of good or bad.

Ethics consider what is moral, how to rationally justify a moral system and how it is applied then to different areas of our social life. We therefore conclude that bioethics is responsible for studying what is moral in the field of human behavior.

Objectives

We provide a historical review of bioethics in psychiatry from the Middle Ages to the present day.

Methodology

Having reviewed documents we will cover the key historical events which changed the course of bioethics in psychiatry as well as in other areas of medicine.

Results

In our field, Psychiatry, Bioethics is a relatively new discipline which has changed over the centuries to find a model based on patient autonomy and beneficence. These two basic ethical principles were specially established since the Belmont Report was published in the 70s.

Conclusions

Despite the changes and evolution through the history, bioethics is a subject that still requires more research and analysis. There are still few professionals who have an adequate training in bioethics.
Lipid monitoring of patients taking clozapine in a high secure forensic hospital
Authors: Ahmed U. , Brown A.
Published: May 2011

Aims

To review current practice of lipid monitoring for patients prescribed colzapine and to improve the health of patients taking clozapine.

Methodology

This was a retrospective audit targeting all patients who were taking Clozapine from May 2008 to April 2009 inclusive. Data was collected from pharmacy records, the heath centre records and patients’ personal care records. Current practice within the hospital was then compared with the standards proposed by the Maudsley Guidelines.

Results

The total number of patients who were prescribed clozapine between May 2008 to April 2009 was 65. Of these patients 54 met the identified standards. We identified two patient groups; 56 patients were taking clozpaine for more than one year and nine patients were taking clozapine for less than one year. Out of those patients who were taking clozapine for more than one year, standards were met for 89% of patient (n = 50) compared to only 44% (n = 9) of those patients who were taking it for less than 1 year. Also, of those patients who had been taking clozapine for less than one year and do not meet the standard, none of them had lipid monitoring at three monthly intervals.

Conclusion

Although the vast majority of patients in the hospital who were prescribed Clozapine had their lipids monitored appropriately, a small percentage did not. Monitoring of lipid levels was particularly lacking in the first year of treatment.
Punitive incarceration or corrective seclusion: a critical review of the state of nigerian juvenile justice system
Authors: Atilola O.
Published: May 2011

Introduction

Nigeria has a predominantly youthful population living in an adverse social environment created by a combination of factors, which creates a situation for a large number of children to be exposed to life of want, danger, abuse and social isolation. Such children are known to have a higher risk of coming into contact with the juvenile justice system (JJS). An ideal JJS should provide statutory guardianship for children in need of care, protection or reformation. There are reports that Nigerian JJS may have some shortcomings.

Objectives

To review internationally accepted standards of care for children within the JJS and compare this with the current practices in Nigeria with a view to make recommendations for improvement.

Aims

To examine the level of compliance of the Nigerian JJS with international standards.

Methods

Information and data on the history, structure, facilities, current practices and enabling laws of the Nigerian JJS were obtained by review of literatures, perusal of available records, on-site visits and direct interview of officials of the Nigerian JJS.

Results

The Nigerian JJS was modelled after the British system, with few modifications to accommodate local customs. The current state may have deviated beyond customary differences to include systematic ones. For instance, incarcerating forms of custodian care is the norm in Nigeria as non-incarcerating methods are not well developed. These facilities are also in deplorable states. Furthermore, the current enabling laws are obsolete.

Conclusions

Nigerian JJS currently have major shortcomings that may preclude serving its intended purpose. Recommendations were made.
Organic personality disorder in forensic psychiatric juvenile practice
Authors: Bulatowa M.
Published: May 2011

Topicality

Diagnostic category “ganic Personality Disorder”OPD) is widely used in forensic psychiatric practice for juveniles. Clinical pattern of psychopathological disturbances, masked in the OPD structure, is polymorphous; its shaping is influenced by polyetiological factors, organism compensatory facilities, pathoplastic mechanism of pubertal period.

Objective

To single out structural syndromic, etiological pathogenetic and clinical dynamic components of a juvenile OPD.

Methods

Clinical psychopathological with psychological, neurological and paraclinical data; clinical statistic.

Object

80 male juvenile delinquents diagnosed OPD (in accordance with ICD-10: F07.00; F07.08; F07.09). Among law infringements prevailed personal crimes notable for extreme gravity.

Results

While correlating clinical manifestations and statistical data processing, there were singled out 3 groups designated as Organic Disorders Models.

Model 1 - cerebral asthenic syndrome with vegetative dysfunction;

Model 2 - syndrome of organic cognitive and organic emotional volitional immaturity; Model 3 - encephalopathical (oligophrenia-like) syndrome.

Etiological factors analysis proved exogenous influence prevalence in Model 3 juveniles.

Clinical dynamics study demonstrated: most patients suffered from mental manifestations of organic disorder in the way of volitional regulation derangement and cognitive dysfunctions during preschool period.

The above-mentioned diagnostic models are taken into account by experts during conducting forensic psychiatric evaluations.

Conclusions

The results may be used in forensic psychiatric practice to work out criteria of OPD expert evaluation, and in general psychiatry under the framework of early prevention of criminal activity. Timely adjustment of early manifestations of behavioural and cognitive disorders contributes to full compensation of organic disorder and mental disturbances arresting.
Differences in clinical and needs assessment between inmates with high versus low risk of suicide
Authors: Cardoso A.M. , Talina M. , Fortes F. , Leal T. , Caldas de Almeida J.M. , Xavier M.
Published: May 2011

Introduction

Drugs addiction, suicide and mental health disorders are the major problems of inmates health. In Portugal the suicide is the second cause of death and is increasing in a panorama of general decreased mortality in prisons.

Objectives

To characterize and compare the inmate population with high versus low risk of suicidality, according several variables including the needs for care.

Methods

A descriptive study of a non-probabilistic sample constituted by all male inmates referenced to a forensic psychiatric clinic in Lisbon region, during a year (April 2009–2010), was performed. The data was collect from user and professional interviews and user file. The instruments, besides a specific questionnaire, includes MINI; BPRS and the Camberwell Assessment of Need, Forensic Version (CANFOR). The suicide risk was defined by C section from MINI and defined as a dichotomic variable: null/low or moderate/high suicide risk.

Results

The sample was composed of seventy nine inmates (median age 36). Major depression was the only diagnostic significantly associated with suicide risk. There was a significant association between moderate/high risk of suicide and the unmet needs rated by users in psychological distress, safety to self, drugs and company domains and unmet needs rated by staff in daytime activities, psychological distress, safety to self and drugs domains.

Conclusion

The suicide prevention is a crucial issue in prisons. The assessment of suicide risk, psychiatric care and care delivery in unmet needs domains may have a positive impact in self harm and suicide incidence.
Understanding violence: a qualitative study of violence and types of violence in neuropsychiatry practice
Authors: Faruqui R. , Tajer A. , Moffat B.
Published: May 2011

Introduction

Patients with acquired brain injury and other neuropsychiatric conditions may present with a significant risk of violence.

Objectives

To conduct a qualitative evaluation of violence to inform risk assessment, patient management, service planning, and workforce training in neuropsychiatry

Aims

To provide thematic or qualitative categories based exploration of violence to enhance understanding of risk factors and risk presentations while clarifying the nature and types of violence in this patient population.

Methods

A service evaluation exercise was conducted using routinely collected clinical information for patient group admitted at a neuropsychiatric service. Data files were converted in word format and transferred on qualitative analysis software NVIV0-8. This software was used for further qualitative analysis through creating free nodes in order to generate qualitative themes or categories of violence in this patient population.

Results

65 Male and 23 Female patients were admitted at the time of this review (working age adults). The qualitative data analysis using NVIVO-8 generated qualitative categories of violence in this patient population

1.

Violent Offending: Wounding, murder, criminal damage, sexual offending, arson

2.

Institutional violence: Directed towards patients and staff included, scratching, biting, slapping, punching, kicking, grabbing, groping.

3.

Sexual Violence: Stalking, rubbing, groping, exposing, masturbating, person directed sexual threats.

4.

Types of Violence: Impulsive violence, instrumental violence, grudges based violence, opportunistic violence, predatory violence, erotic violence

Conclusions

Qualitative categorisation of violence amongst a neuropsychiatric population is feasible and provides supportive evidence for further clinical practice and guideline development in violence risk assessment for this patient population.
The current status of forensic psychiatry in japan
Authors: Fujii R. , Fujimoto M. , Kuga M. , Kudo Y. , Suzuki H. , Haki K. , Nishimon S. , Nakane J.
Published: May 2011

In 2005, the Medical Treatment and Supervision (MTS) Act was enacted in Japan to hospitalize the criminally insane and to promote a self-supporting lifestyle after deinstitutionalization. As of October 2010, 490 patients remain hospitalized in 23 highly secure forensic hospitals. Most patients are diagnosed with chronic schizophrenia and exhibit symptoms of drug resistance. Battering is the most common criminal act they have committed.

The increased prevalence of the combination of criminal insanity with drug dependence is a common problem in other countries as well. It is a serious problem that diversity in prison medical care has not been achieved.

A characteristic feature of care for criminally insane patients in Japan is that they must live in a residential district where a public health center is located and close to forensic hospitals after deinstitutionalization. Although there may be concerns about social prejudice against psychiatric disorders, this limited area would help support rehabilitation of patients because medical staff can easily know the whereabouts, psychiatric condition and aspects, of daily life for each patient through frequent reports obtained from home-visiting nurses. As a result, patients who have been successfully deinstitutionalized lead a self-supporting lifestyle without treatment interruption or repetition of similar criminal acts.

In this presentation, we will show the current status of forensic care in Japan, analyze its characteristics and problems described above, and make suggestions for the treatment of the criminally insane in countries with a small national land area such as Japan.
Personality disorders and insanity
Authors: Gorinov V.
Published: May 2011

One of the pressing problems of Forensic Science is to define criteria for assessing Personality Disorders (PD)with a view of Article 21 of the Russian Federation Criminal Code. Forty cases with paranoid, schizoid and mixed types of Personality Disorders were studied for the purpose of passing judgment on their inability, during the acts of aggression, to be recognize the true character and the societal danger of their actions and to control themselves.

Half of the cases demonstrated situational development, with marked exacerbation of suspiciousness and a bend towards forming extremely valuable ideas, followed by pronounced depressive conditions, persistent adjustment disorders, and impaired ability for critical judgment and prognosis. Twenty-five per cent of the cases showed pathological (constitutional) personality development. Delirious ideas of jealousy and anger (litigiousness) were systemic, deeply and heavily loaded emotionally, they developed in the “self-development” mode, with loss of content of the emotion and with psychogenic reactions. In 17.5% of cases our conclusions were based on the assertion that during the criminal act, “acute reaction to stress” was experienced, with deep emotional involvement, impaired consciousness, loss of ability to adequately assess the obtaining situation, and general disorientation.

Thus, the main prerequisite for inability to appreciate the factual character and societal danger of one's actions or to control them is the statement of reactions of psychotic level, or of pathological development with the presence of pathologically overvalued or maniac ideas of interpretative nature, transforming into a paranoid system.
Prevalence of violent committed acts by inpatients in forensic setting department of psychiatry -in kosova
Authors: Ibishi N. , Musliu N.R.
Published: May 2011

The aim

In this study we evaluated the prevalence of committed acts in the group of male inpatients in forensic setting with major mental disorder and past history of aggressive behavior in community.

Methodology

In the study we included 80 male inpatients, 41 of them have meet DSM-IV criteria for Personality Disorder, 28 were psychotic, 11 were Drug/alcohol abusers. Past aggressive history was collected from patient interviews and reviews of clinicalforensic records and collateral source of documents.

Results

The inpatients were adults with mean age 35,22±10,50 in Schizophrenia spectrum disorders group and the mean duration of the illness was 11,7±9,48, Personality disorders group with mean age 31,35±9,85 and mean duration of illness 10,70±8,34, Drug/alcohol abusers with mean age 19,1±8,6 and mean duration of illness 4,5±2,6.Personality disorder and Drug/alcohol abuser group of inpatients offenders were more prevalent on homicide acts 40%, and threatening 35%, while Schizophrenia spectrum disorder inpatients were more prevalent in domestic violence 49,2%, threatening acts committing with 33,3% and homicide prevalence 7,9%.

Conclusion

The studies until now showed that the prevalence of Schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of Personality disorder or of Drug/alcohol abuse is higher: 10% to 38% respectively. Our results showed the same results with prevalence of Schizophrenia spectrum disorder in homicide with 7,9%, and respectively Personality disorder with homicide prevalence 40%.
Differencial diagnosing of schizotypal personality disorder
Authors: Klembovskaya E. , Fastovtsov G. , Pechenkina O.
Published: May 2011

Background and aim

Clinical definitions and differencial diagnosis criteria of «Schizotypal personality disorder» is not enough investigated yet, especially how it differs from schizoid personality disorder and continuous sluggish schizophrenia. It is impossible to consider diagnostic indications (that the symptoms of schizophrenia couldn’t be observed before and during actual examination) sufficient to explain the special place of this mental disorder. Some criteria of diagnosis of schizotypal disorders (for example, suspiciousness and paranoid ideas, episodes of quazi- psychotic disorders) are not applicable.

With the aim to define the clinical features of schizotypal personality disorder 58 patients were examined. All patients were characterized by mainly personality disorders.

Results

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Schizotypal personality disorder is similar to deficit states, observed at schizophrenia, clinically limited to personality sphere, without the signs of flow of endogenous process and psychotic disorders.

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Schizotypal personality disorder on the clinical content reminds schizoid, but insignificant ideatory disorders are rather typical. Dymamic of psychopathy - disposition to decompensation - is never observed.

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Schizotypal personality disorder can be diagnosed as latent, prodromal schizophrenia, because the clinical picture of these states is very similar. The special value acquires a dynamic aspect, allowing to find the signs of «flow» and dynamics typical of the endogenous process.

Conclusion

Thus, the main differencial diagnosing criteria of schizotypal personality disorder are the dynamic aspects and changing of clinical features.
Xq28 duplication in a boy with mental retardation, hyperkinesia and dysmorphic features - a case report
Authors: Budisteanu B. , Arghir A. , Tutulan-Cunita A. , Chirieac S.M. , Budisteanu M. , Lungeanu A.
Published: May 2011

Introduction

X-linked mental retardation (XLMR) is a common, clinically complex and genetically heterogeneous disease arising from many mutations along the X chromosome. Although research during the past decade has identified >90 XLMR genes, many more remain uncharacterized. In XY males, duplication of any part of the X chromosome leads to functional disomy of the corresponding genes.

Objective

In this paper we present the case of a boy with a syndrome of Xq28 duplication. Methods: We present a 6 years old boy, admitted in the Department of Pediatric Psychiatry for evaluation. He presented sever mental retardation, autistic features, speech delay, hyperkinesia, and dysmorphic features (high forehead, partial palpebral ptosis, small nose, carp-shaped open mouth, micrognathia), recurrent infections. Cerebral MRI was normal. Genetic investigations, including katyotype with GTG banding and array-CGH, were performed.

Results

Array-CGH indicated a dup(X)(q28) of less than 1.5 Mb. There were 15 duplicated genes, including MECP2 gene, which is involved in autism and mental retardation.

Conclusions

Duplications at Xq28 are often associated with autistic features/non-syndromic MR; alterations in MECP2 gene (duplicated in our patient) are described in Rett syndrome or as a specific phenotype. The alteration occurring at Xq28 band is responsible for the patient’s phenotype. Clinical manifestation of this child will be compared with those of other patients with the same duplication previously described to further delineate this syndrome.