bluuebunny/crossref_metadata_2025 huggingface dataset:
Connectivity differences between bipolar disorder, unipolar depression and schizophrenia
Authors: Metin S. , Metin B. , Tas C. , Tarhan N.
Published: June 2017

Introduction

Diffusion tensor imaging (DTI) is used frequently to explore white matter tract morphology and connectivity in psychiatric disorders. Connectivity alterations were previously reported for bipolar disorder, unipolar depression and schizophrenia. However, there is limited data on how these disorders differ from one another in terms of connectivity.

Aims

In this study, we aimed to explore connectivity differences between these disorders.

Methods

We analyzed DTI data of 37 patients with schizophrenia, 41 patients with bipolar disorder and 46 patients with unipolar depression. Group analyses were performed for schizophrenia versus bipolar and bipolar versus unipolar contrasts with using age as a covariate.

Results

Threshold corrected results showed that connectivity at internal capsule and corpus callosum were most distinctive between groups. For corpus callosum (splenium), unipolar group showed the highest connectivity and schizophrenia group showed the lowest connectivity (Fig. 1). For internal capsule, schizophrenia group had the highest connectivity and unipolar group had the lowest connectivity (Fig. 2). Bipolar group had intermediate values for both tracts.

Conclusions

These results indicate that connectivity analysis may be helpful for differentiating psychiatric disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Frontal cortex myo-inositol is associated with sleep and depression in adolescents : A proton magnetic resonance spectroscopy study
Authors: Urrila A.S. , Hakkarainen A. , Castaneda A. , Paunio T. , Marttunen M. , Lundbom N.
Published: June 2017

Aim

This study used proton magnetic resonance spectroscopy (1H MRS) to evaluate neurochemistry of the frontal cortex in adolescents with symptoms of sleep and depression.

Methods

19 non-medicated adolescent boys (mean age 16.0 y; n = 9 clinical cases with depression/sleep symptoms and n = 10 healthy controls) underwent 1H MRS at 3 T. MR spectra were acquired from the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex, and frontal white matter. Concentrations of N-acetyl aspartate, total creatine, choline-containing compounds, total glutamine plus glutamate, and myo-inositol (mI) were compared between the two subgroups and correlated with sleep and clinical measures in the total sample. Sleep was assessed with self-report questionnaires and ambulatory polysomnography recordings.

Results

Concentrations of mI were lower in both frontal cortical regions among the depressed adolescents as compared to healthy controls. No statistically significant differences in other metabolite concentrations were observed between the subgroups. Frontal cortex mI concentrations correlated negatively with depression severity, subjective daytime sleepiness, insomnia symptoms, and the level of anxiety, and positively with total sleep time and overall psychosocial functioning. The correlations between mI in the ACC and total sleep time as well as daytime sleepiness remained statistically significant when depression severity was controlled in the analyses.

Conclusion

Lower frontal cortex mI may indicate a disturbed second messenger system. Frontal cortical mI may thus be linked to the pathophysiology of depression and concomitant sleep symptoms among maturing adolescents. Short sleep and daytime sleepiness may be associated with frontal cortex mI independently from depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive disturbances and mood disorders in ischemic stroke
Authors: Davidescu E.I. , Sasu D.A. , Buraga I.
Published: June 2017

Introduction

Ischemic stroke is in increasing incidence, so that long term sequels are of great importance for management of quality of life and economics issues.

Objectives

To determine risk factors associated with cognitive disturbances, after ischemic stroke.

Aims

Assessment of social and medical risk factors in outcome of cognitive disturbances.

Methods

During 6 months, 268 patients with antecedents of ischemic stroke and associated cognitive disturbances installed in first year after major stroke, were assessed in neurology department. We performed neuropsychological tests as mini mental state examination, sunderland clock test and beck depression inventory. Patients and caregivers were also assessed for quality of life. 53% were males, from urban areas (69%) and mean age was 72.2 years.

Results

We found risk factors as hypertension (88%), dyslipidemia (63%), diabetes mellitus (22%), atrial fibrillation (11%), smoking (35%) and drinking (55%). According to DSM-5 criteria, 62.5% of our lot had major cognitive disorder and 37.5% had a minor one; most of the patients with major dysfunction had ischemia in left middle cerebral artery (31.71%) associated with language deficits and executive dysfunctions, and on the second place was the vertebro-basilar localization of stroke (29.86%). Ischemia in right middle cerebral artery was present only in 20.52% of the lot. 27% of our patients developed depression, more in patients with major neurological deficits.

Conclusions

Efforts must be done for primary prevention of stroke, early detection of risk factors and correct treatment, and for cessation of toxic habits. Treating associated depression may improve patients’ quality of life and increase comfort for caregivers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A case series: Efficacy of short term EMDR on patients with persistent complex bereavement disorder (PCBD)
Authors: Usta F.D. , Yasar A.B. , Abamor A.E. , Caliskan M.
Published: June 2017

Grief is a normal response to loss of someone to whom a bond was formed; however, prolonged grief is considered pathological. Persistent complex bereavement disorder (PCBD) is defined as a persistent longing for the deceased over 12 months. Several treatment ways have been used for traumatic loss including eye movement desensitization and reprocessing (EMDR). In the current case series, effectiveness of EMDR on three PCBD patients will be indicated. Three patients applied to the clinic with similar complaints based on different traumatic backgrounds; commonly, all experienced death of a first-degree relative. Complaints of the patients were over-thinking about the deceased, sleep disturbances, self-blaming, social isolation, avoiding talks about lost relative, and loss of interest in activities. After pre-interviews, they were advised EMDR therapy. One session of EMDR was applied to two of the patients, and two EMDR sessions were conducted on one of them. After the sessions, the patients reported not feeling guilty about the loss anymore, returning their normal routines, feeling better, and showing decreased avoidance. Additionally, the scores of scales (CAPS, BAI, BDI, and IES-R) significantly declined. EMDR therapy can show successful results in a shorter time than other treatment ways used for PCBD treatment [1].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Confirmatory factor analysis of the perinatal depression screening scale-24
Authors: Azevedo J. , Xavier S. , Marques C. , Bento E. , Marques M. , Soares M.J. , Mota D. , Macedo A. , Pereira A.T.
Published: June 2017

Introduction

Pereira et al. (2013) adapted to the antenatal period and validated a shorter version of the original 35-items Postpartum Depression Screening Scale (PDSS [1]), composed of 24 items, selected from the exploratory factor analysis matrix. In their study, the researchers considered this version a useful alternative to evaluate depressive symptoms in pregnancy, taking into account its reliability, concurrent validity and satisfactory combinations of sensitivity and specificity to screen for antenatal depression.

Aim

To confirm the four dimensions’ structure of the PDSS-24 using confirmatory factor analysis.

Methods

616 women (mean age: 32.29 ± 4.466) in the second trimester of pregnancy (mean weeks of gestation = 17.13 ± 4.929), with uncomplicated pregnancies, completed the PDSS-24 while waiting for their routine prenatal consultation at local health medical centers.

Results

The 4-dimensional model of PDSS-24 presented good fit (χ2[242] = 893,275; RMSEA = 0.067, CFI = 0.934, TLI = 0.94, PGFI = 0.717; P<.001). The PDSS-24 Cronbach's alpha was α=0.90; all factors presented good/excellent reliability: Derealization and failure (a = 0.87); Concentration difficulties and anxiety (a = 0.81), Suicidal ideation (a = 0.94), and sleeping difficulties (a = 0.89).

Conclusion

This further validation study emphasizes that PDSS-24 in an adequate measure of antenatal depressive symptoms. To better distinguish it from the version to use in the postpartum (PDSS-21 [2]), from now on, we will denominate it perinatal depression screening scale-24.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Selective serotonine reuptake inhibitors or dual antidepressants and syndrome of inapropriate antidiuretic hormone secretion: A systematic search
Authors: Alberdi-Paramo I. , Montero G. , Niell L. , Baena R. , Tenorio M. , Carabias A. , Fuentes D. , Jurado A. , Perez C. , Carrillo R. , Fraga A. , Fernandez De Aspe M. , Soto M. , Gonzalez B.
Published: June 2017

Introduction

Depression is a disease with high prevalence all over the world. Selective serotonine reuptake inhibitors (SSRIs) and dual antidepressants (DA) are worldwide used to treat the different types of depressive episodes. Between the adverse events of these compounds, an unusual but potentially severe side effect is the syndrome of inapropriate antidiuretic hormone secretion (SIADH).

Results and discussion

Several cases published, and an amount of cases series have documented the association of SIADH to the use of SSRIs and DA. All SSRIs and DA are at risk of producing SIADH (fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, escitalopram, venlafaxine and duloxetine). Old age has been found as a risk factor for developing SIADH. There are not enough data to conclude that other risk factors can play a role in the development of this adverse event. Treatment should include the immediate withdrawal of the antidepressant. The introduction of other antidepressants is controversial, as SIADH has been related with all antidepressive treatments; but the risk of relapse into a depressive episode must be considered also. Between symptomatic treatments, the control of water intake and the use of low doses of loop diuretics can be recommended. Severe cases can be treated with higher doses of loop diuretics and saline hypertonic solution.

Conclusions

SIADH has been related with SSRIs and DA antidepressants and it is an infrequent but severe adverse event. Its risk must be considered when prescribing treatment with them. If this adverse event is produced, the substitution of the antidepressant should be done.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prescribing patterns of psychiatric drugs in major depressive disorder – Findings from a large European multicenter, cross-sectional study
Authors: Dold M. , Kautzky A. , Bartova L. , Rabl U. , Souery D. , Mendlewicz J. , Serretti A. , Porcelli S. , Zohar J. , Montgomery S. , Kasper S.
Published: June 2017

Introduction

The multicenter, cross-sectional survey summarizes the current prescription patterns of psychopharmacological medications in patients with major depressive disorder (MDD) treated in European university psychiatric centers.

Methods

The study included a total of 1181 MDD patients who were recruited in 9 academic sites across 8 European countries. Socio-demographic, clinical, and psychopharmacological characteristics were collected within a detailed clinical interview and the current depressive symptom severity was measured by the Montgomery and Åsberg Depression Rating Scale (MADRS). Symptom reduction during the present MDD episode was analyzed by calculating retrospective MADRS scores. Descriptive statistics, analyses of variance (ANOVAs), and Spearman correlation analyses were performed to examine the impact of various features on the applied pharmacological strategies.

Results

Regarding first-line antidepressant medication, the most frequently prescribed drug classes were selective serotonin reuptake inhibitors (SSRIs) (53.4%), serotonin-norepinephrine reuptake inhibitors (SNRIs) (23.6%), noradrenergic and specific serotonergic antidepressants (NaSSAs) (8.2%), tricyclic antidepressants (TCA) (5.1%), and the melatonergic antidepressant agomelatine (5.0%). The most commonly used individual antidepressants were escitalopram (18.4%), venlafaxine (15.2%), sertraline (12.9%), paroxetine (9.1%), mirtazapine (8.2%), duloxetine (7.0%), and fluoxetine (6.5%). Among the patients, 59.4% were treated with polypsychopharmaceutical medications (mean: 2 drugs) and for the number of individual drugs, we found a significant correlation with the present MADRS total score and the MADRS total score change during the current depressive episode.

Conclusion

Consistent with surveys investigating primarily municipal psychiatric treatment centers, we could replicate the observation that SSRIs are the most commonly used antidepressants in MDD for the first time for European university centers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Underreporting of adverse drug reactions: Results from a survey among physicians
Authors: Gahr M. , Eller J. , Connemann B.J. , Schönfeldt-Lecuona C.
Published: June 2017

Introduction

Drug safety surveillance strongly depends on the spontaneous and voluntary reporting of adverse drug reactions (ADR). A major limiting factor of spontaneous reporting systems is underreporting (UR) which describes incorrectly low reporting rates of ADR. Factors contributing to UR are numerous and feature country-dependent differences.

Objectives/aims

Understanding causes of UR is necessary to facilitate targeted interventions to improve ADR reporting and pharmacovigilance.

Methods

A cross-sectional questionnaire-based telephone survey was performed among physicians in outpatient care in a federal state of Germany.

Results

From n = 316 eligible physicians n = 176 completed the questionnaire (response rate = 55.7%). Most of the physicians (n = 137/77.8%) stated that they report ADR, which they have observed to the competent authority rarely (n = 59/33.5%), very rarely (n = 59/33.5%) or never (n = 19/10.8%); the majority (n = 123/69.9%) had not reported any ADR in 2014. Frequent subjective reasons for ADR non-reporting were (specified response options): lack of time (n = 52/29.5%), the subjective evaluation that the required process of reporting is complicated (n = 47/26.7%) or requires too much time (n = 25/14.2%) or the assessment that reporting of an ADR is needless (n = 22/12.5%); within free answers the participants frequently stated that they do not report ADR that are already known (n = 72/40.9%) and they only report severe ADR (n = 46/26.1%).

Conclusions

Our results suggest a need of interventions to inform physicians about pharmacovigilance and to modify the required procedure of ADR reporting or to offer other reporting options.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Changes in the cytokine profile in first episode, drug-naïve patients with psychosis after short-term antipsychotic treatment
Authors: Petrikis P. , Voulgari P. , Boumba V. , Archimandriti D. , Skapinakis P. , Mavreas V.
Published: June 2017

Introduction

An increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial.

Objective

Our aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naïve, first-episode patients with psychosis before and after six weeks of antipsychotic medication.

Methods

Thirty-nine first episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotic medication. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment.

Results

Serum levels of IL-2 were significantly higher in the study group six weeks after the initiation of antipsychotic treatment (P < 0.001) while TGF-β2 levels were decreased (P < 0.001) and IL-6 levels were slightly reduced (P < 0.004).

Conclusion

The changes in cytokine levels may be attributed to the action of antipsychotic medication and the remission of psychopathology. The reduction in TGF-β2 levels is observed in all patients and with all antipsychotic medications used. TGF-β2 may be a marker of clinical efficacy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Relationship between taste thresholds and antidepressant response: Preliminary findings
Authors: Srivastava S. , Kumar A. , Agarwal V. , Chubey P. , Donaldson L. , Potokar J.
Published: June 2017

Introduction

In healthy volunteers, light acting through serotonin pathways, decreases the threshold for sweet, but not salt taste; similar to SSRI paroxetine. In depressive disorders, there is deficiency of serotonin throughput, which is remedied by SSRI medications, and results in improvement in symptoms of depression. Thus, we report on taste thresholds before and after SSRI treatment.

Objectives

To study the variation in thresholds for sweet with SSRI treatment in depressed patients in short- and long-term.

Aims

To compare the threshold for sweet (test) and salt (control) after 1 and 4 weeks of SSRI escitalopram therapy in depressed patients.

Methods

The project was approved by the institutional ethics committee. Following informed consent, depressed patients were initiated on escitalopram 10 mg/d (increased to 15 or 20 mg, if required after 1 week,). Taste recognition threshold, intensity and pleasantness were measured for sweet and salt. Each tastant was made −1 to −3 (100 mM–1 mM). Regional recognition thresholds were determined at the tip of the tongue using a cotton bud well soaked in the tastant.

Results

Three males and 4 females of mean ages 39.1 years completed the study. There was significant shift to the left for sweet thresholds between days 0 and 7, and 7 and 28 [F(Dfn, Dfd) = 9.242 (4.162) P < 0.0001]. A similar shift to the left was seen for salt but day 7 only [F(Dfn, Dfd) = 6.213 (4.162)].

Conclusion

The increase in serotonin throughput as envisaged through SSRI treatment was paralleled by decrease in sweet thresholds.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prolonged theta burst stimulation: A novel rTMS paradigm in neuropsychiatry
Authors: Klírová M. , Hejzlar M. , Novák T. , Rokyta R.
Published: June 2017

Introduction

Repetitive transcranial magnetic stimulation (rTMS) has important role in treatment of neuropsychiatric disorders. Theta burst stimulation (TBS), a modification of rTMS, seems to produce greater changes in cortical excitability (CE) than those observed in conventional rTMS protocols. TBS is used in different protocols: intermittent TBS (iTBS) and continuous TBS (cTBS). While iTBS facilitates CE, cTBS leads to CE inhibition. However, a prolonged cTBS produces facilitatory effect similar to that of iTBS. Prolonged TBS (pTBS), a novel rTMS paradigm, is of great clinical interest for its short duration, but also because it may induce stronger effect.

Aim

To prove the effect of pTBS of motor cortex on changes of motor threshold (MT), CE and pain threshold (PT) in healthy volunteers (HV). To compare the effects of two different forms of active pTBS (pcTBS, piTBS) with placebo.

Methods

A double-blind, placebo-controlled, cross-over study compared the effects of different pTBS of contralateral M1 area on MT, CE and PT. We enrolled 24 HV to the study, who underwent all types of pTBS in randomized order and were assessed before and after each pTBS application. We used MagPro R30 (with coil focused to contralateral M1 area, 1200 pulses/session, 90% MT).

Results

A significant changes in CE and MT were found after application of continuous pTBS. Intermittent and placebo pTBS did not confirm the effect. There were no significant changes on PT after pTBS. Continuous pTBS was better tolerated than intermittent pTBS.

Conclusion

pTBS should be considered as an effective and safe treatment option for neuropsychiatric disorders.

Disclosure of interest

Supported by AZV 16-31380A.
From theory to practice: The contribution of John Farquhar Fulton (1899–1960) to psychosurgery
Authors: Michielsen P. , De Jonge L. , Petrykiv S. , Arts M.
Published: June 2017

Introduction

John Farquhar Fulton was an American neurophysiologist and historian, who pioneered psychosurgery based on animal experiments. Together with psychologist Carlyle Jacobsen, Fulton presented the results of bilateral frontal lobe ablation in chimpanzees. This study prompted neurologist Egas Moniz and neurologist Walter Freeman to perform similar brain surgery on human subjects.

Objectives

To present the scientific papers of John Farquhar Fulton on psychosurgery.

Aims

To review available literature and to show evidence that John Farquhar Fulton made a significant contribution to the development of psychosurgery.

Methods

A biography and research papers are presented and discussed.

Results

Fulton and Jacobsen experimented with ‘delayed response tasks’ in chimpanzees. The aim was to test the animal's capability to memorize the correct location of the food. They found that after sequential ablations of the left and right frontal association cortices these memory tasks became significantly difficult for the monkeys to perform. The researchers saw parallel conclusions in clinical cases of human frontal lobe damage.

Conclusions

An investigation into the role of the limbic system is one of the crowning achievements of John Farquhar Fulton, as this has influenced even today's thinking about the role of the limbic system. We should thank Fulton for his pioneering work as modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Life events, quality of life, autonomic nervous system, and cardiovascular risk factors
Authors: Slepecky M. , Majercak I. , Gyorgyova E. , Kotianova A. , Kotian M. , Zatkova M. , Chupacova M. , Popelkova M. , Ociskova M. , Prasko J. , Gallová I.
Published: June 2017

Background

Psychological distress is considered as a component of the cardiovascular risk. The present study aims to determine which psychophysiological, electrocardiographic and anthropometric factors are correlated with life events, depression and quality of life in healthy adults.

Method

A total of 114 adults were examined using the Social Readjustment Rating Scale, the EuroQol Group 5-Dimension Self-Report Questionnaire, Beck Depression Inventory – Second Edition, Zung Self-Rating Depression Scale. Physiological measures included heart rate variability, skin conductance level and skin temperature. Anthropometric characteristics included weight, height, hip size, waistline, blood pressure, heart rate at rest and after mental activity, muscle mass, fat stock, percentage of the body fat, segmental distribution of muscle and fat mass, fat-free mass and the water content in the body. Finally, data from electrocardiographic examination included aortic pulse wave velocity, central aortic pressure and augmentation index.

Results

Life events in last two years correlate with worse quality of life and a higher level of depression. Life events in last two years also correlate with the increase of the risk factors for cardiovascular problems in terms of several anthropometric and physiological measures. Finally, life events in last two years was also related with the overweight.

Conclusions

Results suggest some possible mechanisms by which stress may exert adverse effects on cardiovascular morbidity and mortality in healthy persons. Primary preventive strategies with the stress management training may prove beneficial.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perseverative Thinking Questionnaire: Confirmatory factor analysis with two different samples
Authors: Azevedo J. , Pereira A.T. , Amaral A.P. , Nogueira V. , Soares M.J. , Mota D. , Macedo A.
Published: June 2017

Introduction

Perseverative Negative Thinking (PNT) is a transdiagnostic cognitive process [1] characterized by repetitiveness, intrusiveness and difficulties to disengage (Ehring, 2011). The Perseverative Thinking Questionnaire (PTQ-15; [2]) is a self-reported instrument, developed to evaluate these characteristics. The Portuguese version assess two meaningful dimensions – Repetitive thoughts (RT); and Cognitive interference and unproductiveness (CIU) [3].

Aim

To confirm the bi-dimensional structure of the PTQ-15 using Confirmatory Factor Analysis, in two distinct samples.

Method

A sample composed of 256 students (Mean age = 20.58 ± 1.870; 78.1% girls) and a sample composed of 480 adults from the community (parents of the students; mean age = 50.84 ± 5.310; 53.1% women) filled the PTQ-15. We used software AMOS.

Results

The second-order model of PTQ-15 with two dimensions presented good fit, in both students (CMIN = 2.449; RMSEA = 0.075; CFI = 0.958, TLI = 0.949, PGFI = 0.776; P < 0.001) and their parents (CMIN = 3.46; RMSEA = 0.072, CFI = 0.955, TLI = 0.942, PGFI = 0.632; P < 0.001). Internal consistency of the total scale, measured though Cronbach's alpha was α = 0.95/0.94; both factors presented good/excellent reliability: repetitive thoughts (a = 0.93/0.92); cognitive interference and unproductiveness (a = 0.88/0.92).

Conclusion

Taken together, both CFAs provided additional evidence that PTQ-15 is an adequate measure for perseverative thinking.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Using junior doctors to improve patient care: Creating a clinic to monitor the physical health of patients prescribed clozapine
Authors: Tonkins M. , Hardy P. , Foster S. , Mullins S.
Published: June 2017

Introduction

In the United Kingdom, compliance with guidelines on physical health monitoring of patients prescribed clozapine is poor. Our community team established a ‘clozapine clinic’, led by junior doctors, to monitor the physical health of this population.

Aims

The aims of this audit were:

– to ascertain levels of compliance with guidelines on the physical health monitoring of patients taking clozapine;

– to compare the current level of compliance with that prior to the establishment of the clinic.

Methods

Eleven standards were drawn from National Institute for Health and Care Excellence guidelines and the Maudsley Prescribing Guidelines in Psychiatry.

Three audit cycles were conducted: two prior to the establishment of the clinic and one after. In each cycle, searches of patient records were conducted and blood results were reviewed. This was supplemented by telephone calls to general practitioners to ensure a complete data set.

Analysis was conducted in Microsoft Excel™ and changes between the cycles were analysed using a two-tailed Z-score.

Results

Each audit cycle included 28–30 patients. In the current cycle compliance levels varied between 66% (annual ECG recording) and 100% (monthly full blood count). The average compliance level was 73% across all standards. This represents an overall improvement on previous audit cycles. Since the clinic was established there has been a statistically significant improvement in compliance with annual monitoring of weight (P = 0.147), body mass index (P = 0.0178), and ECG monitoring (P = 0.0244).

Conclusions

Improvements in the care of a vulnerable population may be achieved through setting clear standards, regular audit, and harnessing the leadership and enthusiasm of junior doctors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictors of insight in patients with schizophrenia
Authors: Softic R. , Sutovic A. , Osmanovic E. , Becirovic E. , Avdibegovic E. , Mirkovic Hajdukov M.
Published: June 2017

Aim

To establish predictors of insight in patients with schizophrenia with regard to symptoms severity, executive functioning, level of education, marital status, age, and number of hospitalizations.

Subjects and methods

A cross-sectional study was conducted on 60 consecutive outpatients with schizophrenia. Positive symptoms were established with 4-item Positive Symptom Ranking Scale (PSRS), and negative symptoms with Brief Negative Symptoms Assessment (BNSA). The level of insight was established with Self-Appraisal of Illness Questionnaire (SAIQ). Executive functions were established with Wisconsin card sorting test, and three verbal subtests from Wechler's Intelligence Test: information, similarities, and calculating. All neuropsychological tests were administered by psychologist educated in administration of these and other neuropsychological tools.

Results

Predictive statistical model identifies age and illness duration as negative, and higher level of education, and being married as a positive predictors of insight with 38.5% variance explained. Scores on subscales “Similarities” and “Calculating” had positive association with insight score. Model explains 24.7% of variance. When model was adjusted on alpha 5% level of concluding only three significant positive predictors appears: higher level of education, higher score on “Similarities” subscale, and being married. Model explains 38.5% of variance.

Conclusion

Level of education and marital status, among all other factors, have important impact on level of insight in patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The association of schizophrenia symptoms clusters with obsessive compulsive symptoms
Authors: Theochari E. , Tsaltas E. , Kontis D.
Published: June 2017

Introduction

Thirty percent of individuals with schizophrenia demonstrate obsessive compulsive symptoms (OCSs). There is conflicting data on the effects of antipsychotic medication on OCSs in schizophrenia. The delineation of the relationship of OCSs with positive, negative and general psychopathology symptoms has theoretical and treatment implications.

Objectives

To investigate the relationship among OCSs with the symptoms clusters in schizophrenia.

Methods

We recruited 110 chronic schizophrenia patients and assessed OCSs (Yale-Brown Scale) and schizophrenia symptoms (Positive and Negative Syndrome Scale). In order to investigate the relationship of OCSs with clusters of schizophrenia symptoms, we conducted correlation analyses between YBOCS total scores or obsession or compulsion subscores with the PANSS symptoms scores (total, positive, negative and general psychopathology) and the cognitive scores derived from CANTAB. We re-conducted these correlations for the sub groups with clinically detectable OCSs (YBOCS > 8) and clinically significant OCSs (YBOCS > 14).

Results

The only significant correlation was that of scores of OCSs with PANSS general psychopathology scores (rho = 0.190, P = 0.047). Obsessions and compulsions did not significantly correlate with positive or negative symptom clusters. No significant correlation between OCSs and schizophrenia symptoms were detected in the subgroups with clinically detectable or significant OCSs.

Conclusions

OCSs appear to be a separate symptom cluster in the context of schizophrenia, suggesting that OCSs cannot be expected to be influenced by standard antipsychotic treatments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Obsessive compulsive symptoms, social functioning and executive functions in chronic schizophrenia
Authors: Theochari E. , Tsaltas E. , Kontis D.
Published: June 2017

Introduction

Schizophrenia leads to functional deficits. A third of schizophrenia patients have obsessive compulsive symptoms (OCSs). The existing studies, which have investigated the effect of OCSs on social functioning (SF) of schizophrenia patients have produced contradictory findings and, interestingly, they have not adjusted for the role of executive functioning.

Objectives

To investigate the predictive role of OCSs on SF in schizophrenia controlling for the effects of executive functioning.

Methods

In a cross-sectional study of 110 chronic schizophrenia patients we assessed OCSs (Yale-Brown Scale), SF (Strauss Carpenter Scale) and composite executive function (cognitive flexibility: Intra–extra dimensional set shifting task and planning: Stockings of Cambridge task) using the Cambridge Neuropsychological Test Automated Battery (CANTAB). We also measured total symptoms (PANSS total scores) and illness duration. Regression analysis tested the predicting role of OCSs (YBOCS total score) on functioning taking into account executive function (composite score) duration of illness and schizophrenia symptoms.

Results

OCSs were associated with better SF (B = 0.099; 95% CI = 0.019, 0.180; t = 2.449; df = 88; P = 0.016). This result was driven by the association of OCSs with job functioning (B = 0.043; 95% CI = 0.006, 0.081; t = 2.289; df = 88; P = 0.024). Executive functions were not significantly associated with social functioning.

Conclusions

OCSs and not executive functions are associated with social functioning in schizophrenia. Future studies should examine whether OCSs represent a compensatory mechanism aiming at preserving social functioning in the disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Brainstem audiometry as a diagnostic tool in psychiatry: Preliminary results from a blinded study
Authors: Wahlström V. , Wynn R.
Published: June 2017

Background

Some prior studies of brainstem audiometry have found illness-specific aberrations, suggesting that this procedure can be of use to clinicians in diagnosing certain psychiatric illnesses.

Aims

The study aimed to examine the diagnostic properties of a brain stem audiometry procedure (SD-BERA®) for patients suffering from schizophrenia and bipolar disorder.

Methods

A blinded study including 12 patients with schizophrenia, 12 patients with bipolar disorder, and 12 healthy controls was performed in 2014/2015. The patients were recruited from psychiatric specialist services and a primary care office in the County of Troms, Norway. The patients and controls were examined with brainstem audiometry. The clinical diagnoses were not known to the researchers who analysed the brain stem audiometry data at the Swedish company SensoDetect. Sensitivity and specificity for each group (compared to healthy controls) was calculated.

Results

The brain stem audiometry procedure had a high degree of sensitivity (1.00), but a lower degree of specificity (0.45) when patients suffering from bipolar disorder were compared to healthy controls. For the diagnosis of schizophrenia, the brain stem audiometry procedure had a high degree of specificity (0.91), but a lower degree of sensitivity (0.33) when patients were compared to healthy controls.

Conclusions

This method may help clinicians by lending support to a clinically suspected diagnosis of schizophrenia. The relatively low specificity for bipolar disorder could suggest that the method needs further development before it can be useful clinically when the diagnosis of bipolar disorder is suspected. Further scientific testing is needed to verify these findings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Unexpected variations in official UK statistics related to rates of suicide and those of undetermined intent: An exploration of causes
Authors: O’Reilly D. , Rosato M.
Published: June 2017

Background

Official rates of suicide are perhaps the most important and enduring measures of population mental health. They are however prone to variations in reporting usually relating to deaths where the intention was uncertain, though most official statistics circumvent this by including ‘events of undetermined intent’ (ICD10 Y10-34 and Y87.2) along with ‘intentional self-harm’ in their official statistics. It is however unclear how successful this strategy has been and whether significant sources of bias still persist.

Aim

To systematically examine the dramatic change in rates of death from suicide (and undetermined intent) in Northern Ireland, that coincided with a major overhaul and reorganisation of the Coroners Service in 2005/6, to understand the extent to which the initial investigation by the coroners’ office, legal processing, registration and coding practices can influence official suicide statistics.

Methods

In the space of one year, Northern Ireland went from having a standardised rate of suicide (incl undetermined intent) of 12.6/100,000 in 2004 to 26.6/100,000 in 2006 (a 111% increase) and in doing so went from having consistently the lowest to consistently the highest registered rate of suicide in the UK.

Results

Initial analyses rules out changes in the police service, pathology service or registration coding practices as causative and suggest that the introduction of a coroner's liaison officer (with a formal data gathering role) was the most likely factor. The centralisation of the coroners’ service also reduced variations according to age, sex, geography and coding.

Conclusions

The process underpinning official statistics need to be routinely scrutinised.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
HEALTH TECHNOLOGY ASSESSMENT IN SERBIA
Authors: Atanasijevic Dragana , Zah Vladimir
Published: June 2017

Objectives: This study provides an overview of the Republic of Serbia healthcare system and describes the process of developing and conducting health technology assessment (HTA).

Methods: The authors performed pragmatic, nonsystematic literature review based on available statistical data, legislation, and studies.

Results: Healthcare law creates conditions that allow implementation of the principle “value for money.” The institutions directly vested in the implementation of HTA are the National Health Insurance Fund (NHIF) and the Ministry of Health (MoH). There are some reflections of the efforts by NHIF and MoH toward achieving this goal.

Conclusions: Despite the highly set objectives, there is still a lot of work to be done to build an adequate model to support decision-making processes to bridge the discrepancies between broadly defined rights to health care and limited resources in the country.
Inactivation of Pol θ and C-NHEJ eliminates off-target integration of exogenous DNA
Authors: Zelensky Alex N. , Schimmel Joost , Kool Hanneke , Kanaar Roland , Tijsterman Marcel
Published: June 2017

Off-target or random integration of exogenous DNA hampers precise genomic engineering and presents a safety risk in clinical gene therapy strategies. Genetic definition of random integration has been lacking for decades. Here, we show that the A-family DNA polymerase θ (Pol θ) promotes random integration, while canonical non-homologous DNA end joining plays a secondary role; cells double deficient for polymerase θ and canonical non-homologous DNA end joining are devoid of any integration events, demonstrating that these two mechanisms define random integration. In contrast, homologous recombination is not reduced in these cells and gene targeting is improved to 100% efficiency. Such complete reversal of integration outcome, from predominately random integration to exclusively gene targeting, provides a rational way forward to improve the efficacy and safety of DNA delivery and gene correction approaches.
Broadband Absorption and Efficient Hot-Carrier Photovoltaic Conversion based on Sunlight-induced Non-radiative Decay of Propagating Surface Plasmon Polaritons
Authors: Hu Mengzhu , Yang Liu , Dai Hao , He Sailing
Published: June 2017

Localized surface plasmon polaritons (SPPs), which can decay non-radiatively into hot carriers, have been widely employed to extend the responses of traditional semiconductor-based photocatalytic and photovoltaic devices to sub-bandgap photons. However, radiative decay is unavoidable and adverse to device performances. Here, we propose to take advantage of propagating SPPs, another form of SPPs, which possess non-radiative decay only. A special gold-titanium dioxide nanowire array with each nanowire capped with a nanocone is proposed. The adjacent nanocones forming top gradual openings attribute to efficient sunlight harvesting, while the neighbouring nanowires forming bottom nanoslots allow sufficient absorption due to the propagating SPPs. With the combined advantages, almost 100% of light is absorbed by a very thin gold film in the visible range, and 73% in the whole considered range of 400–1170 nm, superior to the nanocone cell based on localized SPPs, let alone the nanowire-based and planar counterparts. Therefore, much better photovoltaic conversion performance is achieved with short-circuit current density of 0.74 mA/cm2 and open-circuit voltage of 0.41 V. This work confirms the superiority of non-radiative decay of propagating SPPs to the localized SPPs in terms of generation of hot carriers, providing a promising way of extracting electrons in metal into photocurrent.
Does Patient Perception of Pain Influence How Patients Rate Their Experience after Total Knee Arthroplasty?
Authors: Gwam Chukwuweike , Mistry Jaydev , Delanois Ronald , Chughtai Morad , Khlopas Anton , Ramkumar Prem , Piuzzi Nicolas , Harwin Steven , Mont Michael
Published: June 2017

Press Ganey (PG) is an increasingly used measure to determine patient satisfaction. It has yet to be determined which factors influence the PG scores most amongst patients with inadequate pain control after total knee arthroplasty (TKA). Therefore, we assessed (1) which PG factors influence overall hospital rating (OHR) in patients who had poor pain control in comparison to those with good pain control and (2) whether pain control influences OHR during hospital admission following TKA. An institutional database search was performed between November 2009 and January 2015 for all TKA patient responders to the PG questionnaire. This yielded 148 patients (mean = 61 years; range, 24–92 years). Pain control was graded on a scale from 1(least satisfied) to 4 (most satisfied). Patients were separated into two cohorts: those who had poor pain control (score ≤ 2) and those who had good pain control (score > 2). Multiple regression analysis assessed the weighted means (β) of all PG categories on OHR. To compare the demographics and survey responses between the two cohorts, χ
2 and t-tests were utilized. For patients with poor pain control, the responsiveness of hospital support staff had the highest influence on OHR (β = 2.103), followed by communication about medications (β = 1.230). For patients with good pain control, communication with nurses had the strongest effect on hospital rating (β = 0.233, p = 0.056), followed by communication about medications (β = 0.200, p = 0.049). The patients with good pain control had significantly higher OHR (6.0 vs. 9.1, p = ≤ 0.001) and scores in each category of PG. Communication about medications and responsiveness of hospital staff had a significant effect on OHR. Well-controlled patients were highly influenced by communication of medication and communication with nurses. Moreover, patients with good pain control had significantly higher scores in all areas of PG survey, signifying that patient perception of pain affects patient satisfaction with the hospital. Orthopaedists should be involved in direct efforts to improve pain control as well as address the aforementioned PG domains.
Fortschreibung von Desintegrationskarrieren statt Förderung beruflicher Wiedereingliederung: Eine qualitative Studie zur Arbeitgebereinbindung in den Reha-Prozess
Authors: Schwarz Betje , Specht Timo , Bethge Matthias
Published: June 2017

Ziel der Studie Exploration der Arbeitgebereinbindung in den Reha-Prozess aus Betroffenenperspektive.

Methodik 8 Teilnehmende einer medizinisch-beruflich orientierten Reha wurden 4 Wochen nach Reha-Ende telefonisch interviewt. Die Auswertung erfolgte qualitativ-inhaltsanalytisch.

Ergebnisse Neben einer mangelnden Arbeitgebereinbindung ließen sich in den Interviews ungenutzte Möglichkeiten in der Reha, Schnittstellenprobleme im Gesundheits- und Sozialsystem sowie eine allseitige Strategie des Abwartens identifizieren, in deren Folge Desintegrationskarrieren befördert und berufliche Wiedereingliederung behindert wurden.

Schlussfolgerung Um berufliche Wiedereingliederung zu fördern, bedarf es nicht nur einer verbesserten Arbeitgebereinbindung, sondern auch der Überbrückung von Schnittstellen und Ausschöpfung vorhandener Maßnahmen und Instrumente.
The Final Months
Authors: Robins Eli
Published: June 2017

During a one-year period in the city of St Louis and surrounding counties, authorities determined that 134 of all deaths registered were suicides. This title is the report of a clinical study that attempts to determine the antecedents of those suicides, using information and observations contributed by the victims’ close associates. Based on a statistical computation of the information collected, the researchers were able to answer a number of previously open questions about suicide. This title includes a set of fully detailed case histories. Presented without interpretation, the allow readers to judge for themselves the clinical development of illness and the validity of diagnoses. In addition, a ‘score card’ for each case illustrates the study team’s step-by-step diagnostic procedure. Of particular interest to mental health workers will be a discussion of predictors of suicide and the process by which diagnoses were assigned.
Diagnostic Criteria Used in St. Louis to Determine Four Major Groups
Authors: Robins Eli
Published: June 2017

This chapter outlines the diagnostic criteria used in this study of 134 suicides, including affective disorder, alcoholism, organic brain syndrome, schizophrenia, and drug dependence, as well as the prevalence of each of these conditions in the sample. It also explores the sex and race demographics of the sample.
Design of Interview Schedule to Determine the Prevalence of Symptoms Compared in the Four Major Diagnostic Groups
Authors: Robins Eli
Published: June 2017

This chapter describes the design of the interview schedule used in the study on suicides to determine the prevalence of symptoms, and explores the frequency with which individual symptoms occurred in the sample. It also presents a reproduction of the interview form used in the study.
Alcoholism—Description of the Sample Comprising the Second Largest of the Four Major Diagnostic Groups
Authors: Robins Eli
Published: June 2017

This chapter focuses on the members of the sample that were diagnosed as having alcoholism, which represented the second largest diagnostic group of the sample. It presents diagnostic criteria, and symptoms shown by members of this diagnostic group, before presenting study records and case notes of each member of the group.
Epilogue
Authors: Robins Eli
Published: June 2017

This chapter presents a conclusion to the study. It returns to the questions that the study intended to answer and summarises the findings of the study by answering each of these questions in turn.