bluuebunny/crossref_metadata_2025 huggingface dataset:
A pilot early psychosis intervention programme in Bolivia
Authors: Rivera Arroyo G.
Published: May 2016

The problem

Less than half of the more than 250 adolescents and young adults who are estimated to experience a first episode of psychosis in the city of Santa Cruz each year are ever diagnosed and receive treatment.

Of those patients who are eventually diagnosed, the average duration of their symptoms of psychosis prior to receiving treatment is estimated to be over 2 years.

The opportunity

Multiple psychosocial variables, such as the reaction of patients and their families to symptoms of psychosis, which play a vital role in determining long-term outcomes, demonstrate their highest degree of flexibility during the period of early psychosis. Psychological, social and evidence-based pharmacological interventions undertaken during this time frame can have a profound impact on the life-course of an individual with psychosis.

Our solution

We propose to establish a pilot early psychosis intervention program that will provide age appropriate biopsychosocial treatment and support for 15–25 years old with first episode psychosis and their families in Santa Cruz. This will improve short and long-term outcomes for those with psychosis, increase speed of recovery, decrease the need for hospitalization, reduce family disruption and decrease rates of relapse.

By utilizing a mobile, multidisciplinary treatment team that emphasizes the roles of trained case managers focused on providing intensive individual and family support in the home, this program will provide culturally appropriate care that will leverage contributions from a limited supply of psychiatrists and shift dependence away from a fragmented medical system.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Factors associated with schizophrenic evolution after a first episode psychosis
Authors: Turki M. , Halouani N. , Naoui R. , Gassara I. , Hamza N. , Aloulou J. , Amami O.
Published: May 2016

Introduction

The evolution of a first episode psychosis is a fundamental question, despite its unpredictability. It affects the type of management and drug treatment. In this context, schizophrenia, a disabling psychiatric disease, remains the most formidable evolution.

Objective

Assess the frequency and factors associated with schizophrenic evolution after a first episode psychosis.

Methods

We conducted a retrospective, descriptive and analytic study including 55 patients hospitalized in psychiatry department, Hédi Chaker Hospital, Sfax, Tunisia, during 7 years (from 2007 to 2013), then managed in the outpatient department. We collected socio-demographic, clinical and evolutive data from clinical observations.

Results

The mean age was 26.5 years. Sex ratio (M/F) was 2.9. Among our patients, 74.5% were single and 49.1% had no profession. A trigger factor of this episode was noted in 43.6% and a break with the previous functioning in 63.6% of cases. A schizoid personality was reported in 74.5% of the population. All patients presented positive symptoms, 96.4% had negative symptoms and 61.8% presented mood symptoms.

Schizophrenic evolution was reported in 38.2% of patients. Factors associated with this evolution were: masculine gender (P = 0.004), social isolation (P = 0.009); absence of mood symptoms (P < 0.001) and mental automatism (P = 0.043).

Conclusion

Our study shows some factors associated with schizophrenic evolution after a first episode psychosis. The identification of these factors, as well as other factors reported in the literature is essential to allow early and adequate support, and ensure a better social integration.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
About an exhibitionism clinical case: Entity's review and state of the art exposure
Authors: Varregoso M.I. , Coelho S. , Borges G. , Xavier R.
Published: May 2016

Introduction

Exhibitionistic disorder may be present when there is sexual arousal from the exposure of one's genitals to an unsuspecting and nonconsenting person. This disorder prevalence is unknown but we know it is highly unusual in females. It generally starts at adolescence and its course is likely to vary with age. There are temperamental and environmental risk factors.

Most of what we know about exhibitionistic disorder is largely based on research with individuals convicted for criminal acts involving genital exposure, and this may represent an important bias. From a clinical case of exhibitionism, the authors intend to review this type of paraphilia from an historical, conceptual and etiologic point of view.

Objective

To review the concept behind this diagnosis and its evolution, the comprehensive theories that attempt to justify and frame it, as well as the type of intervention currently considered to be the state of the art.

Methods

Patient's observation and assessment, along with an extensive review of the relevant literature.

Conclusions

Starting from a real clinical case, the authors present a general theoretical review on the subject.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emerging treatments options for narcolepsy throughout a case
Authors: Alvarez Astorga A. , Gallardo Borge L. , de la Red Gallego H. , Alonso Sánchez A. , Gómez Sánchez S. , Noval Canga C. , Mayor Toranzo E. , Cepedello Pérez S. , Rodriguez Andrés L. , Ballesta Casanova T.
Published: May 2016

Background

Narcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory.

Objective

Review of new treatments for narcolepsy based on recent advances about its ethiopathogenesis.

Method

Seventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response.

Results

Due to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness.

Discussion

Recent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood.

Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Gender differences in suicide ideation among college students in Kuwait
Authors: Alsalman R.
Published: May 2016

Introduction

The Beck Scale for Suicide ideation (BSS) has consistently been regarded as a strong tool for measuring cognitive and somatic aspects of suicide ideation symptomatology in both clinical and non-clinical population. There is no study until this date that examines the BSS within Kuwaiti College students.

Objective

The present study aims at identifying impact of gender (male/female) on suicide ideation.

Methods

The sample was consisted of (584) undergraduates students (284 of males and 300 females). The study applies Beck Scale for Suicide ideation (BSS) and suicide Ideation Questionnaire (SIQ).

Results

Table 1 descriptive statistics for two standardized self-report measures means and standard deviations for these measures were within the expected ranges for college samples. The mean (BSS) score was 5.2 for males and 7.0 for females. The mean (SIQ) score was 11.3 for males and 13.7 for females.

Conclusion

BSS revealed significant gender differences in score indicated that females obtained higher scores than males on suicide Ideation although the magnitude of the difference was small.

Table not available.

Disclosure of interest

The author has not supplied his declaration of competing interest.
In a period of economical crisis who is at risk for attempted suicide?
Authors: Coppola I. , Marangon D. , Gramaglia C. , Delicato C. , Di Marco S. , Gattoni E. , Venesia A. , Avanzi G.C. , Castello L. , Bert F. , Gualano M.R. , Siliquini R. , Torre E. , Zeppegno P.
Published: May 2016

Introduction

According to Durkheim's theory, suicide attempts increase during periods of rapid economic changes and decrease again when stability is achieved, due to the social integration in the community guaranteed by occupational status. Since 2009 in Europe, it was observed an increase in the suicide rates, in line with the increase of unemployment. Although unemployment is considered a risk factor for suicide, it was observed a noticeable increase in suicide rates among Italian employed men during the last years, probably related to the specific economic scenario and to emerging difficulties in keeping an income to adequately maintain one's own family standard of living.

Aim

To study attempted suicides with a specific focus and attention on the current Italian economic scenario.

Methods

Determinants of emergency room visits for psychiatric reasons in patients aged > 16 years were studied prospectively from 2008 to 2015 at the AOU Maggiore della Carità Hospital, Novara, Italy. Each patient was assessed by an experienced psychiatrist with a clinical interview and socio-demographic and clinical features were gathered. Statistical significance was set at P ≤ 0.05.

Results

Preliminary results suggest an increase in suicide attempts according to the rise of the unemployment rate in Novara. Although in absolute figures most attempters are unemployed, it seems that suicide attempts are more frequent in the group of employed subjects, which includes also people under redundancy fund. This subgroup may be considered halfway between employed and unemployed attempters.

Conclusions

Data collection and statistical analyses are still ongoing. Implications for clinical practice will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric consultations in the emergency room: Focus on suicide attempters with and without longitudinal psychiatric disorders
Authors: Delicato C. , Di Marco S. , Gattoni E. , Coppola I. , Venesia A. , Marangon D. , Avanzi G. , Castello L.M. , Gramaglia C. , Zeppegno P.
Published: May 2016

Introduction

The role of mental illness in the pathway leading to suicide is widely discussed in the literature. Nonetheless, the debate about this issue is open, both from a clinical and philosophical point of view.

Aims

The purpose of the present study was to compare suicide attempters with and without a history of psychiatric disorder, in order to highlight the possible differences between the two groups, with a specific focus on intent to die and methods of the attempt.

Methods

Data from all ER referrals undergoing a psychiatric consultation in the period 2008–2015 at the Maggiore della Carità Hospital, Novara, Italy, were gathered. Comparison of qualitative data was performed by means of the Chi2 test. Statistical significance was set at P ≤ 0.05.

Results

We have already gathered data from more than 2000 ER psychiatric consultations, including 495 suicide attempters. Preliminary results suggest that these kinds of behaviours are more common in subjects without psychiatric disorders but with clinical history of previous contact with mental health services and in psychopharmacological therapy. Reasons for self-harming are associated with relational problems rather than psychiatric symptoms. Among Axis II diagnoses, almost half of cases are affected by histrionic personality disorder.

Conclusions

The results described above should be considered as preliminary, as data collection and statistical analyses are still ongoing. Anyway, the observed correlation between previous contact with mental health services, socio-relational issues and suicide attempt, and the significant frequency of attempts in histrionic personality disorders seem to be particularly interesting. Implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide risk assessment and early recognition of risk factors
Authors: Fricchione Parise V. , Addeo L. , Balletta G.
Published: May 2016

Suicide is a common cause of death in people with mental health problems. No specific patient stereotype nor single risk factor can be used to easily identify which person or patient will attempt suicide. Mental health professionals often have to assess or manage suicide risk and this is challenging by reason of accurate methods of predicting remain elusive. Presence of multiple risk factors often suggest the need for additional evaluation for suicidal ideation, but an impending suicide attempt is not always recognized, even after evaluation by healthcare provider. More half of suicidals have seen a psychiatrist or psychologist or other healthcare provider within one month beforehand. The presentation of possible warning signs can be subtle and experience is required. Service provision for suicidal patients is often substandard, particularly at times of highest need such as after discharge from hospital or emergency department. As many as 75% or more of people who die by suicide have a diagnosable mental health disorder at the time of their death. The most common are bipolar disorder and schizophrenia over major depression. Between 25% and 50% of bipolar patients will attempt suicide at least once, and 5% to 20% will die by suicide. In schizophrenia diagnosis, 20% to 40% of patients will attempt suicide and more than 10% will die by suicide. Additional risk factors: alcohol misuse, family history, illegal substance use. The way in which suicide is broached and discussed with patient plays a significant role. Here, a focus on clinical management of suicide risk.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide attempters: Clinical characteristics and management
Authors: Gattoni E. , Feggi A. , Gramaglia C. , Bergamasco P. , Coppola I. , Di Marco S. , Delicato C. , Venesia A. , Marangon D. , Zeppegno P.
Published: May 2016

Background

Suicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.

Aim

The aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.

Material and methods

We collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.

Results

Data collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Who is a survivor of suicide loss? A systematic review
Authors: Gili S. , Delicato C. , Feggi A. , Gramaglia C. , Zeppegno P.
Published: May 2016

Introduction

Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss. The underlying structure of grief for survivors of suicide loss appears complicated.

Aims

The purpose of this study consists in reviewing literature data about survivors of suicide, especially exploring the few informations emerged by researches on the role of psychiatrist as “survivor”.

Methods

A PubMed search was conducted using combinations of the following keywords: survivors suicide or bereavement suicide or suicide psychiatrists and randomized.

The search was conducted through September 10, 2015, and no conference proceedings were included.

Results

Bereavement following suicide is complicated by the psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention.

Conclusions

Suicide bereavement seems to be different from natural loss. Clinicians may react to a patient's suicide both on a personal and professional level, with emotions such as loss of self-esteem or blame. This grief somehow nullifies the core of a helping relationship and may imply a more conservative management of future patients or even avoiding to accept suicidal patients for treatment. Support interventions have been proposed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide attempts: Results from data collected in a psychiatric emergency ward in a general hospital
Authors: Narciso J. , Real M.
Published: May 2016

Introduction

Suicide behavior constitutes a public health problem worldwide. It deserves epidemiological investigation regarding “best clinical practices”, and it is fundamental since the patient's first observation at psychiatric emergencies services. These are the ideal practices to start suicide prevention, and prevent further suicidal behavior. The improvement of healthcare quality includes the adoption of clinical guidelines, which support medical care since the emergencies services. The lack of specific instruments to evaluate suicidal risk urges the scientific community to create them.

Aims

The authors aim to discuss the advantages and limitations of the application of these kinds of instruments, and the creation of models based in scientific evidence available.

Discussion

From multiple available studies, the Modified Sad-Persons Scale (MSPS) seems to be one of the most scientifically used in literature, as well as in epidemiological studies of suicide attempts and their repetition, either by nonfatal or fatal attempts. However, even this scale has been questioned by experts, and the lack of specific and sensible tests towards suicide behavior and risk of suicide attempts raises the importance of the need of further investigation towards this area. This evidence would then help the clinician in his work at emergencies wards and provide better healthcare towards preventing new suicide attempts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk factors for attempted suicide: A prospective study on psychiatric consultations in the emergency room
Authors: Venesia A. , Coppola I. , Gramaglia C. , Marangon D. , Di Marco S. , Delicato C. , Gattoni E. , Avanzi G.C. , Castello L. , Bert F. , Gualano M.R. , Siliquini R. , Torre E. , Zeppegno P.
Published: May 2016

Introduction

Studies conducted on Italian samples suggested that 70% of self-harms referred to the emergency room (ER) were suicide attempts. Suicide attempts are associated with societal, relationship and individual risk factors, which vary with age and gender, occur in combination, and may change over time. We conducted a previous study on a sample of psychiatric consultations in ER from 2008 to 2011. We observed that female gender, a permanent job and being in the warmer months of the year were risk factors for suicide attempts.

Aim

To update knowledge about risk factors for attempted suicide analyzing a larger sample of ER psychiatric consultations.

Methods

Determinants of emergency room visits for psychiatric reasons were studied prospectively in a period of 8 years, from 2008 to 2015 at the “Maggiore della Carità” Hospital in Novara. The psychiatric assessment of patients was performed by experienced psychiatrists with a clinical interview. For each patient, a data sheet was filled in order to gather demographic and clinical features. Comparison of qualitative data was performed by means of the Chi2 test while differences between groups for continuous variables were assessed through a t-test. Statistical significance was set at P ≤ 0.05. A multivariate analysis was performed using logistic regression in order to assess the potential predictors of attempted suicide. Results are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).

Conclusions

We have collected data from more than 500 psychiatric consultations for attempted suicide. Data collection and statistical analyses are still ongoing. Implications will be discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of BET inhibitor JQ1 on neurotoxicity in rat primary cortical neurons: A potential therapeutic approach in Alzheimer's disease
Authors: Han S.H. , Kwon K.J. , Shin C.Y. , Chung S.Y.
Published: May 2016

Introduction

The neuropathological features of Alzheimer's disease (AD) are deposition of amyloid plaques, neurofibrillary tangles and neuro-inflammation. Among these, neuro-inflammation is a common pathological substrate of neurodegenerative disease, such as AD, and Parkinson disease.

Aims

Herein, we tested whether the inhibition of bromodomain and extra-terminal domain (BET) protein, a critical regulators of transcription in neurons, could attenuate the neuronal cell death and amyloid beta aggregation using rat primary cortical neurons. We also investigated whether a BET inhibitor could prevent the inflammatory processes and cognitive decline in an animal model of AD.

Methods

The effects of BET inhibition on neuronal cell death were assessed in the followings:

– cell viability and reactive oxygen species generation;

– enzyme activity of tPA/PAI-1 measured by casein zymography;

– the signal pathways including BDNF/CREB and MAPKs using western blotting;

– the effects on inflammatory responses in an animal model of AD using immunohistochemistry.

Results

JQ1, an inhibitor of Brd2/4 protein, significantly decreased the neuronal cell death in mixed cortical neurons in concentration-dependent manner but not in pure neurons. JQ1 increased the enzyme activity of tPA, which decreased the expression of Brd2 protein. JQ1 also decreased the ROS generation and decreased cleaved caspase-3 expression. Moreover, Brd2 inhibition by transfection of Brd2 siRNA reduced amyloid beta aggregation.

Conclusion

Our results suggested that BET inhibition might have therapeutic potential for AD. That is, Brd2 inhibition by JQ1 can prevent the neuronal cell death and neuroinflammation as well as amyloid beta aggregation through regulation of tPA/PAI-1 system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
E-mental health: Updates on recent achievements and pitfalls
Authors: Hilty D. , Fiorillo A. , Krysta K. , Krausz M. , Mucic D.
Published: May 2016

The patient-centered care features quality, affordable, and timely care in a variety of settings – technology is a key part of that – particularly among younger generations and child and adolescent patients. The consumer movement related to new technologies is nearly passing clinicians by, as new ways of communicating with others (text, e-mail, Twitter, Facebook) revolutionizes how we experience life and access healthcare. This paper explores a continuum with healthy, innovative behavior on one end (e.g., social media) and pathological Internet use on the other end – and the range of self-help and e-mental healthcare options being used. Specifically, it focuses on how social media adds to, yet may complicate healthcare delivery, such that clinicians may need to adjust our approach to maintain therapeutic relationships, interpersonal/clinical boundaries, and privacy/confidentiality. We suggest planning ahead to discuss expectations about online communication between doctors and patients as part of the informed consent process, offer other do's and dont's for patients and clinicians, and review applicable guidelines. More research is needed on consumer and patient use of technology related to healthcare, as is an approach to basic and advanced measurement of outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Drug-induced tardive dyskinesia: A case report
Authors: Abida I. , Baati I. , Omri S. , Sallemi R. , Masmoudi J.
Published: May 2016

Introduction

Tardive dyskinesia (TD) is a serious medical condition that affects a significant proportion of patients treated with antipsychotic agents.

Objective

To report a patient who developed tardive dyskinesia after initiation of antipsychotic and antidepressant treatment.

Case report

Miss H. is 24-year-old Tunisian woman who had been diagnosed with bipolar disorder 6 years ago. She received various drugs: olanzapine, haloperidol, amisulpride, sertraline, paroxetine, etc. On November 2013, she first complained of hand tremor and then developed severe dystonia of the trunk and chorea. A series of laboratory tests was performed after the onset of these involuntary movements. It included complete blood count, liver, renal, and thyroid function tests, blood prolactin level, blood glucose level, blood copper level and ceruloplasmin level. A brain MRI was also performed. These examinations showed no specific findings. The diagnosis of TD was presumed. The patient was first treated with amisulpride, lorazepam, avlocardyl and piracetam until May 2014. Then, amisulpride was substituted by olanzapine until August 2015. The luck of improvement led to her admission. We stopped antipsychotic treatments and prescribed her vitamin E (900 mg/day), clonazepam (6 mg/day) and vitamin B6. The follow-up led to the decline of the Abnormal Involuntary Movement Scale (AIMS) score of 7 points over 6 weeks.

Conclusion

TD remains a serious side effect that worsens the prognosis and affects the quality of life of patients. Cluster randomised trial should be done in order to develop practice recommendations for prevention and management of TD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prescription profile of antipsychotics in inpatients with psychotic disorders
Authors: Mahía M.D.C. García , Quintana Á. Fernández , Millares M. Vidal
Published: May 2016

Introduction

Previous studies of prescribing in psychiatric services have identified the relatively frequent use of combined antipsychotics in schizophrenia.

Aims

– To analyze the proportion of patients treated with more than one antipsychotic;

– to study clinical as sociodemographic variables associated with types of prescription.

Methods

Retrospective descriptive study of treatment prescribed to psychiatric inpatients treated in an acute care unit of Psychiatry Service in a large teaching hospital during a period of 3 years. Consecutively admitted inpatients receiving concurrent antipsychotics were compared with those treated with a single antipsychotic. Prescription drug records at discharging were revised, n = 263.

Results

From the total sample, 61% received more than one antipsychotic. The most common types of combinations were atypical plus a typical antipsychotic followed by two atypical antipsychotics, being less frequent combination of three or more antipsychotics. There were 19 different drug combinations. Concurrent antipsychotics were most frequently prescribed in schizophrenia and schizoaffective disorder. Patients with more previous episodes of illness received more frequently concurrent antipsychotics than patients with low number of previous episodes of illness (P < 0.03). Patients with longer time of hospitalization, and age between 30 and 50 years were treated more frequently with several antipsychotics. Analysis with other variables is presented in the study.

Conclusions

There is a significant difference in the strategies of treatment with antipsychotics depending on diagnosis and number of previous episodes of illness. The concurrent use of multiple antipsychotics in psychiatric inpatients appears to be a response to treatment resistance and is frequent in schizophrenic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clozapine induced blood dyscrasias and a therapeutical approach
Authors: Peinado A. Gomez , Ruiz P. Cano , Fraile S. Cañas , Cano M. Gonzalez , Fajardo G.E. Barba
Published: May 2016

Introduction

Clozapine is a neuroleptic commonly used in treatments resistant to schizophrenia. However, despite the benefits, clozapine might cause some serious side effects. Hence, it is of the utmost necessity to keep an exacting control of the patients.

Objectives

To study some of the therapeutical approaches to the treatment of clozapine induced neutropenia and agranulocytosis.

Methods

Review of some articles in Mental Health Journals.

Results

The treatment with clozapine, substratum of aminergic and muscarinic receptors, entails a 0.9% risk of causing agranulocytosis, and approximately a 2.7% risk of causing neutropenia. Both occur, over 80% of them, during the first 18 weeks of treatment. Thus, before starting it, it is necessary to draw some blood and analyze the complete blood count (CBC). Also, we must analyze CBCs weekly during the first 18 weeks. Other dyscrasias like leukopenia, leukocytosis, anaemia, eoshinophilia, thrombocythaemia or thrombocytopenia can also be observed. When agranulocytosis appears, it can be treated by discontinuing the clozapine treatment, but also using granulocyte-colony stimulating factor or lithium, both separated or combined with clozapine. Lithium produces reversible leukocytosis onceplasma levels of > 0.4 mmol/L are reached. Despite the simultaneous treatment with lithium, clozapine can trigger some neurological side effects, it seems that seizure risk remains invariable.

Conclusions

Some of the clozapine's side effects, like neutropenia or agranulocytosis, are potentially lethal. Their treatment consists of discontinuing clozapine or initiating granulocyte-colony stimulating factor or lithium. These are good options that can give rise to a later continued treatment with clozapine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development and psychometric testing of a Scale for Evaluating Self-management Needs of Knee Osteoarthritis (SMNKOA) in Taiwan
Authors: Kao M.H. , Tsai Y.F.
Published: May 2016

Introduction

Knee OA is a chronic and multifactorial disease; self-management needs are complex, which requires a multidimensional management plan. There is a need for healthcare providers to provide patients with knowledge of knee OA and how to effectively manage the disease.

Objective

Self-management-needs scales are one means of determining the management requirements of an individual patient. There is no suitable instrument available for assessing self-management needs of adult patients with knee OA in Taiwan. This study developed an instrument that could assess the self-management needs of knee OA patients using Orem's self-care theory as a theoretical framework.

Aims

This study developed and psychometrically tested a new instrument for measuring adult patients’ self-management needs of knee OA (SMNKOA).

Methods

Development of the instrument involved three phases: item generation and scale development; content and face validity of the initial instrument; and evaluation of validity and reliability of the new instrument. Participants (n = 372) were purposively sampled from orthopaedic clinics at medical centres in Taiwan.

Results

The self-care theory guided the development of the 35-item SMNKOA scale. The content validity index was 0.83. Principal components analysis identified a 3-factor solution, accounting for 53.19% of the variance. The divergent validity was –0.67; convergent validity was –0.51. Cronbach's α was 0.95, Pearson correlation coefficient was 0.88, and the intraclass correlation coefficient was 0.95.

Conclusions

The SMNKOA scale can measure and identify the individual self-management needs of knee OA patients. It will help healthcare providers better evaluate strategies that can help these patients cope with this chronic disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Long-acting injectable antipsychotics: Diagnostics and patient profile
Authors: Gómez L. Pérez , Fernández A. Gónzalez , Ortíz D.F. Frías , Rodríguez O.W. Muquebil Ali Al Shaban , Mercado C.M. Rodríguez , Urbina M. Jalón , González L. García
Published: May 2016

Introduction

Long-acting injectable antipsychotics (LAIs) were developed in the sixties with the purpose of improving schizophrenia maintenance treatment. The main advantages are: the ability to ensure compliance, maintaining stable plasma concentrations and allowing better clinical management of drug therapy. Long-acting atypical injectable antipsychotics start to develop in the late nineties. Currently, they are the most widely used depot treatment for severe mental illness.

Objective

Checking patient profile and diagnosis where we use LAIs.

Methods

Review of 217 patients treated with LAIs in CSM El Coto–Gijón.

Results

In our sample, the average age of the patients was 48.94 years old. Most of them were men (135 vs. 82). More than half of treated patients were diagnosed with schizophrenia (112), the paranoid subtype was the most repeated (93). Other severe mental illnesses were also treated with LAIs: emotionally unstable personality disorder (31), delusional disorder (19), bipolar disorder (15), schizoaffective disorder (12) and other less frequently. For all groups, paliperidone palmitate was the most used injectable antipsychotic. The new aripiprazole long-acting injectable starts being used in psychotic patients with a significant affective component.

Conclusions

The schizophrenic patient remains being the prime candidate for this therapy although other severe mental disorders may also benefit of LAIs treatment. Most classical long-acting injectable antipsychotics have been replaced by new atypical injectable antipsychotics with a more tolerable side effects profile.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Therapeutic attitudes and clinical global impression: A 2-year follow-up study of 33 outpatients with a mental disorder in treatment with paliperidone palmitate
Authors: Lopez M.D. Perez , laguna M. Soto , Gomez J. Prados , Oria I. Zarranz Herrera , Asenjo R. Perez , Mendoza S. Bolaño , Daza M. Fernandez Torrija , Rivera P. Gonzalez , Teodoro B. Herrejon
Published: May 2016

Introduction

Maintaining antipsychotic therapy in mental disorder is important in preventing relapse, rehospitalization, and suicide. Lack of awareness of illness may be a leading cause for non-adherence. Long-acting depot can prevent non- adherence and thus potentially contribute to better patient outcomes.

Objective

The aim of this prospective, observational, non interventional 2-year-long study is to assess severity and post-intervention changes and attitudes toward medication of a group of patients treated paliperidone palmitate (PP).

Methods

Thirty-three outpatients stabilised with PP during the last 24 months. Inclusion criteria were: patients’ age (> 18 years), a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder stabilised during the last 12 months with PP, without a diagnostics from axis I or II (except for nicotine of caffeine) and able to sign the inform consent. Data collected: general sociodemographic and clinical data (age, sex, level of education, socioeconomic situation, family support, psychiatric diagnosis, years of evolution, use/abuse of substances, treatment, previous and later number of hospitalisations. Evaluations included disease severity (Clinical Global Impression-Severity (CGI-S) and Drug Attitude Inventory, (DAI)).

Results

Thirty-threeoutpatients were followed during 24 months [mean dose 132,58 (44,4) mg], 75,8% were men, age 45,05 years old, 87,8% with a diagnoses of paranoid schizophrenia. Antipsychotic monotherapy increased over the time with PP. Significant improvements were observed on both Clinical Global Impression and Drug Attitude Inventory. The number of rehospitalizations and mean stays decreased from the beginning until the end of these 24 months.

Conclusions

Our results suggest an improvement in the patient's clinical vision and attitude towards medication with long-acting depot.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prolactine borderline, a case report
Authors: Salgado N. , Macias B. , Benavente S. , Ruiz R.
Published: May 2016

Introduction

It is known that antipsychotic drugs can increase prolactinaemia, we report a case in which the use of aripiprazole after treatment with paliperidone helped regaining normality levels.

Case report

During treatment with PALiperidone12 mg/day the patient, a 27-year-old female diagnosed with borderline personality disorder, developed hyperprolactinaemia with galactorrhea and menstrual disorders. During hospitalization, aripiprazole is introduced while paliperidone is progressively decreased. Antipsychotic were prescribed because delusions of reference and auditory pseudo-hallucinations arose suddenly in a woman without history of previous psychotic breaks. Before treatment with aripiprazole, prolactinaemia was 156,96 ng/mL (pregnancy test was negative) and after stopping, paliperidone was 23,60 ng/mL.

Discussion

If hyperprolactinaemia symptoms appeared (galactorrhea…), aripiprazole is a good option if antipsychotic treatment is required. In this case, paliperidone was decreased slowly, while aripiprazole was increased, until minimum effective dose was reached.

Conclusions

Hyperprolactinaemia is a common side effect in antipsychotic treatments and if symptoms appeared aripiprazole is a good option.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Drug eruption due to bupropion, a case report
Authors: Salgado N. , Benavente S. , Coll J.M. , Vives A.
Published: May 2016

Introduction

We present a clinical case of eruption caused by the use of bupropion. Bupropion is known to cause hypersensitivity reactions.

Case report

We report the case of a 48-year-old female who was diagnosed of depressive disorder. She went to emergency because a few days after prescribing bupropion (150 mg/24 h) scaly skin eruptions were found distributed along the skin. In the present case, after its introduction, bupropion was found to be a probable etiological agent. The patient was successfully treated with corticosteroids. Because of that, bupropion dosage was stopped and replaced with fluoxetine. No remissions and exacerbations were noticed in a month's follow up.

Discussion

In this case report, we present a patient with an eruption related to bupropion. The aetiological spectrum of eruption include drugs, infectious agents and food additives. Drugs attributing eruption include nonsteroidal anti-inflammatory drugs, antibiotics, and anti-epileptic drugs, antidepressive medication amongst others.

Conclusions

No specific diagnostic criterion exists for eruption and the diagnosis is purely based on clinical presentation. Diagnostic features, which suggest eruption, are the acute onset (or recurrent nature) and skin lesions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antipsychotics and women: Yes, prolactin is important
Authors: Garrido-Torres N. , Fernandez S. , Rodríguez A. , Reina M. , Prieto I. , Viedma A.S. , González C. , Hernandez L.
Published: May 2016

Introduction

The hormonal imbalance produced by antipsychotics can be detected by symptoms, such as: infertility, acne, hirsutism, sexual dysfunction and galactorrhea. We consider especially important the study of women's diseases, which may develop due to hyperprolactinemia, specifically: breast cancer, endometrial cancer and osteoporosis.

Objective

To undertake a systematic review about the relationship between hyperprolactinemia as a result of the treatment with antipsychoticsand endometrial and breast cancer.

Method

An exhaustive search was performed on PUBMED and COCHRANE (from 2006 to 2015).

Fifteen papers were selected including comparative studies, clinical trials and clinical reviews.

Results

With respect to endometrial carcinoma, there is no direct relationship with the use of antipsychotics. However, most papers have suggested that the blood prolactin elevation is a risk factor in the development of endometrial engrossment, which could lead to endometrial hyperplasia, polyps and endometrial cancer. Related to the use of antipsychotics as a treatment for schizophrenic women and breast carcinoma, a significant association was found and this association is strengthened through the interaction of other factors like the fact that women with schizophrenia are less worried about going to the clinical screening reviews in their health centre, smoking, and lower physical activity than healthy women.

Conclusions

Aripiprazolis associated with a low prevalence of hyperprolactinemia. Menopausal women, the obese, and women who smoke receiving antipsychotics that produce hyperprolactinemia have the greatest risk of developing endometrial pathology. Schizophrenic women with hyperprolactinemia due to antipsychotics and loss of motivation to go to screening activities have a greater risk of breast cancer. Sexual dysfunction could be a non-adherence treatment factor.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurocognitive and functional performance in psychotic and non-psychotic bipolar patients and schizophrenia patients
Authors: Aparicio A. , Sánchez-Morla E.M. , Santos J.L.
Published: May 2016

Introduction

It has been suggested that psychotic bipolar patients have more severe cognitive deficits and lower functioning that non-psychotic bipolar patients.

Objectives

To evaluate neurocognitive and functional performance in stabilized psychotic bipolar patients (BP+), non-psychotic bipolar patients (BP−) and schizophrenia patients (SZ).

Aims

To examine whether BP+ might be defined as a more homogenous subtype of bipolar disorder with more severe cognitive deficit and more severe functional impairment.

Methods

Fifty TB+, 50 TB−, 50 SZ and 51 controls were evaluated with a comprehensive neurocognitive battery (WCST, FAS, TMT-A and B, Stroop Test, Digits span, letters and numbers – WMS-III−, CVLT, ROCFT, CPT-DS). Moreover, patients were evaluated with clinical scales (PANSS, MADRS, YMRS) and functionality scales (WHOs Disability Assessment Scales, QLS and GAF). IBM SPSS Statistics (version 19.0) was used to the data analysis.

Results

No significant differences were found between three patients’ samples (P < 0.0001). No significant differences in neurocognitive measures were found between BP+ and BP−. Significant differences were found between both groups of bipolar patients and schizophrenia in working memory measures (P < 0.0001). BP+ and BP− showed significant higher functionality than SZ (P < 0.0001), without significant differences in functionality between BP+ and BP−.

Conclusions

The pattern of neurocognitive and functional deficit is similar in BP+ and BP−. The neurocognitive deficit is very similar in both groups of bipolar patients groups in comparison to SZ; functionality is better in both bipolar groups than in schizophrenia patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Women coping strategies to infertility stress can impact IVF outcome EV1357]
Authors: Kitanovic B. , Tulic L. , Soldatovic I.
Published: May 2016

Infertility is defined as a failure to achieve a pregnancy after a woman has attempted to get pregnant for more than 12 months. The impact of psychosocial factors on IVF outcome is a growing field of research. This is the first study estimating the impact of psychosocial stress and women coping on IVF outcome in Serbia. In the cohort of Serbian women, it has been remarked that they predominantly use active confronting coping style. We found statistically significant differences ways of coping styles between pregnant and non-pregnant group. Women from the pregnant group had significantly lower scores of marital distress, and significantly higher use of meaning based coping styles. It is found that the use of active avoidance coping correlates negatively with the level of depression and personal, marital and social distress, and total fertility distress. Clinicians should be aware that infertility is a stressor itself and that coping strategies can influence IVF outcome. Therefore, psychosocial assessment should be a part of an IVF unit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.