bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial direct current stimulation in treatment – resistance unipolar major depressive disorder
Authors: Asadi M. , Mahdavi S.
Published: May 2016

Objective

MDD is a common, chronic and recurrent illness .it is essential to reach full remission in acute treatment. tDCS is a non-invasive brain stimulation that uses direct electrical currents to stimulate specific parts of the brain.

Aim

Is to assess the effectiveness of tDCS in patients with treatment resistance MDD.

Method

Eighty outpatients of a psychiatric clinic were selected. Subjects meet (DSM-IV) diagnostic criteria for MDD. All patients had failed to respond to at least two standard antidepressant medication, in the current episode. Patients with bipolar depressive disorder, MDD with psychotic and atypical features, other psychiatric disorders, sever medical condition, acute suicidality and pregnancy were excluded. All patients received stable drug regimens for at least two weeks before enrollment and drug dosages remained unchanged throughout the study. They revised 8 stimulation sessions, using a 2 mA current, for 20 minutes, in 8 consecutive days. The anodal electrode was placed over the left DLPFC. Cathode electrode over the right supraorbital region. Mood was evaluated with 21-item Hamilton Rating Depression Scale and the Beck Depression Inventory.

We designed a pretest–posttest study and evaluate depression at baseline (pre-intervention), immediately after 8 sessions (post-intervention) and two months after treatment onset (follow-up).

Results

There is a significant difference between Pre- vs. post-intervention (FBDI = 246.58, P < 0.001; FHRSD = 214.56, P < 0.001) and pre vs. Follow-up intervention (FBDI = 323.10, P < 0.001; FHRSD = 150.96, P < 0.001).

Conclusion

It can be said that tDCS had effective and enduring variation (Ppostvs.follow-up > 0.05) in improving the clinical symptoms of MDD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Premorbid social adjustment is better in cannabis-using than non-using psychotic patients across Europe
Authors: Ferraro L. , Capuccio V. , Mulè A. , La Cascia C. , Sideli L. , Tripoli G. , Seminerio F. , Sartorio C. , La Barbera D. , Murray R. , Di Forti M.
Published: May 2016

Introduction

A number of authors have hypothesized that psychotic patients who consume cannabis constitute a differentiated subgroup of patients that have better cognitive and social skills, necessary to engage in illegal drug consumption, than non-using patients.

Objectives

Given that the prevalence, and patterns, of cannabis use are culturally driven, we wanted to study first-episode psychosis (FEP) cannabis-using and non-using patients coming from different European countries as part of the EUGEI-STUDY.

Aims

We tested the hypothesis of better premorbid social adjustment in cannabis-using FEP patients, by comparing them to FEP non cannabis users and to their respective healthy controls.

Methods

A total of 1745 people (746 cases; 999 controls) completed the assessment for premorbid adjustment [Premorbid Adjustment Scale (PAS)] and cannabis use (CEQ-Revised). We first extracted the Premorbid Social Adjustment Factor (PSA) from PAS and then performedlinear mixed models with PSA as dependent variable and cannabis lifetime (Yes/No) and subject status (Cases/Controls) as independent variables. We then considered “Country” as random intercept.

Results

Across all countries, PSA scores were better in patients who had smoked cannabis in their lifetime than patients who had not (P = 0.009). The difference in PSA score between cannabis users and non-users was significantly greater in cases than controls (P = 0.038). The relationship between PSA, cannabis lifetime (Yes/No) and subject status among nations (random intercept) is shown on Fig. 1.

Conclusions

Cannabis-using psychotic patients show better premorbid social adjustment than non-using patients, across 5 European countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cerebral hemodynamics in schizophrenia during the Trail Making Test: A functional transcranial Doppler sonography study
Authors: Schuepbach D. , Egger S. , Herpertz S.C.
Published: May 2016

Introduction

Schizophrenia is a severe mental disorder, with complex symptoms involving psychosis, negative symptoms and cognitive impairment. The Trail Making Test (TMT) has been widely used to assess attention and executive function. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries allows monitoring of aberrant cerebral hemodynamics during cognitive tasks in this patient group.

Objectives

We assessed cerebral hemodynamics in the middle cerebral arteries (MCA) using fTCD while patients with schizophrenia and healthy subjects performed the TMT and a control task.

Methods

Fifteen patients with chronic schizophrenia and 15 healthy controls performed the TMT-A and -B during fTCD measurements of the MCA. Dependent measures were performance, mean cerebral blood flow velocity (MFV) and the lateralization.

Results

Patients demonstrated an overall decreased speed of solution (P = 0.002), and there was no significant effect of age. They showed a significantly increased flow pattern for the TMT-B (P = 0.005). There were no lateralization differences between diagnostic groups.

Conclusions

There was a performance deficit in patients with schizophrenia for both TMT-A and -B that fits well with results of existing literature. The aberrant hemodynamic response supports the idea that cognitive performance elicits an aberrant cerebral hemodynamic correlate. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion in patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Soluble Fas ligand (sFasL) as a predictor of reduction of general psychopathology in schizophrenia after antipsychotic treatment
Authors: Szymona K. , Karakula-Juchnowicz H. , Zdzisinska B. , Flis M. , Kaławaj K. , Rosa W. , Kandefer-Szerszeń M.
Published: May 2016

Introduction

Dysregulation of the apoptotic process is associated with the etiopathogenesis of schizophrenia, which is observed at the brain and peripheral blood levels. A significant negative correlation between the duration of the disease and serum sFasL concentration was demonstrated by other authors. It was shown that an increased rate of apoptosis is more pronounced in neuroleptic-free patients with the first-episode of schizophrenia than in patients with chronic disease.

Aim

Search for a predictor of good response to antipsychotic treatment based on the analysis of the sFasL plasma level and its relationship with clinical symptoms.

Methods

Fifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. The concentration of sFasL was measured by ELISA. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted three times: during the active phase of disease (at admission), after 4 weeks of pharmacotherapy, and after reaching remission.

Results

In the schizophrenia group, non-altered levels of sFasL (P = 0.1; U Mann-Whitney test), compared to the control, were detected at admission. The initial level of sFasL correlated negatively (r = −0.33; P = 0.04; Spearman's rank) with blood leukocyte count. Despite clinical improvement, no significant changes in the level of sFasL were observed. However, the sFasL level correlated negatively with the PANSS general psychopathology reduction after 4 weeks of pharmacotherapy (r = −0.7; P = 0.04) and after remission (r = −0.39; P = 0.026).

Conclusions

The results indicate a possible role of sFasL in apoptosis of blood leukocytes and suggest that the reduction of sFasL level can predict level of PANSS general psychopathology after antipsychotic treatment in schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy and safety of brexpiprazole in schizophrenia: Meta-analysis of three double-blind, randomized, placebo-controlled phase 3 studies
Authors: Weiss C. , Zhang P. , Hakala M.J. , Skuban A. , Weiller E.
Published: May 2016

Introduction

Brexpiprazole is a serotonin-dopamine activity modulator that is a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency, and an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors.

Objectives

To evaluate the efficacy, safety, and tolerability of brexpiprazole in patients with acute schizophrenia in a meta-analysis of three phase 3 studies with brexpiprazole.

Aim

The primary endpoint was change from baseline to week 6 in PANSS total score.

Methods

Data from the 3 clinical studies in patients with acute schizophrenia were combined and analyzed using individual patient data meta-analysis. In two similarly designed studies (NCT01396421; NCT01393613), patients with acute schizophrenia were randomized to fixed-doses of brexpiprazole 2 mg/day, 4 mg/day or placebo (a low-dose treatment group was included in each study [0.25 mg and 1.0 mg]; not included in the meta-analysis). In the third study (NCT01810380), patients were randomized to flexible dosing of brexpiprazole (2 to 4 mg/day), placebo, or an active reference (quetiapine extended release). Changes from baseline for brexpiprazole vs. placebo were analyzed using an MMRM approach.

Results

Brexpiprazole 2–4 mg (n = 868) was superior to placebo (n = 517) in change from baseline in PANSS total score (−20.1 vs. −14.3; estimated treatment difference to placebo: −5.8 [95% CI: −8.0; −3.6]; P < 0.001). The proportions of patients reporting TEAEs were similar between the brexpiprazole and placebo treatment groups (57.9% vs. 57.5%). No unexpected safety concerns were observed.

Conclusion

This meta-analysis supports evidence from three individual trials that brexpiprazole is efficacious and safe in treating patients with acute schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of addictive disorders on the HIV and syphilis coinfection
Authors: Chumakov E. , Petrova N. , Smirnova I.
Published: May 2016

Introduction

One of the main risk factors for both HIV-infection and syphilis is addictive behavior.

The objective of the study was to determine the impact of addictions on the HIV and syphilis coinfection.

Method

Sixty-five HIV-infected patients with syphilis were examined by a clinical method.

Results

The sample included 45 men (average age 32.09 ± 9.83) and 20 women (average age 31.7 ± 5.97). All patients were characterized by risky behavior. Seventy-one percent of men belonged to the category of men who have sex with men (MSM). Eighty-five percent of women had drug dependence (as compared to 61% for men who have sex with women (MSW) and 19% for МSМ; P < 0.05). Women were more likely to have opiate dependence (P < 0.001; as compared to men). We revealed a high incidence of drug addiction and alcoholism with the prevalence of dependence on opioids (F11; 55.0%; 7.7%), polysubstance use (F19; 25.0%; 23.1%) and alcoholism (F10; 50.0%; 61.25%) among women and MSW respectively (P < 0.05 as compared to MSM). Only 50% of women and 23% of MSW were in remission. MSM regularly consumed stimulants and cannabinoids without developing dependence.

Conclusions

Injecting drug use is typical of women and MSW and plays a leading role in the risk factors for HIV infection and syphilis. Addictive behavior among MSM increases risky sexual behavior and thus influences infection with HIV and syphilis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Assessing Comorbidities and service use among patients with benzodiazepine abuse
Authors: Cook B. , Chavez L. , Carmona R. , Alegria M.
Published: May 2016

Prior studies have identified that individuals with comorbid substance use disorder and mental health disorder are at a greater risk of benzodiazepine abuse compared to individuals that present with mental health disorder without an accompanying substance use disorder. These studies were conducted in predominantly white populations, and little is known if the same associations are seen in safety net health care networks. Also, the literature is mixed as to whether or not psychiatrists’ prescription of benzodiazepines places individuals at undue risk of benzodiazepine abuse.

We use 2013–2015 electronic health record data from a Boston healthcare system. Patients with benzodiazapene abuse were identified if they had received treatment under the ICD-9 code 304.1. Benzodiazepine abuse was compared between patients with only mental illness and patients with existing comorbid substance and mental health disorder, in unadjusted comparisons and adjusted regression models. Covariates in regression models were used to identify subgroups at higher risk of benzodiazepine abuse.

Individuals with benzodiazepine abuse had higher rates of emergency room and inpatient use than patients with other mental health and/or substance use disorders. Those with comorbid substance and mental disorder were significantly more likely than individuals with mental or substance use disorder alone to abuse benzodiazepines (P < .01). Among those with benzodiazepine abuse, 93.3% were diagnosed with a mental illness, 75.6% were diagnosed with a substance use disorder (other than benzodiazepine), and 64.4% had comorbid anxiety disorder and substance use disorder. These analyses suggest that patients with benzodiazepine abuse have complex presentations and intensive service use.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Are there more mechanical restraint in patients admitted for substance use disorder?
Authors: Galindo L. , Grifell M. , Peréz E.J. , Dinamarca F. , Chavarria V. , Salgado P. , Pérez V.
Published: May 2016

Introduction and objectives

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. There is a myth that patients with substance use disorder (SUD) are more aggressive and require more forceful measures. There are not clinical studies that compared if there are differences of the frequency of mechanical restrain in patients with SUD.

The aim of this study is to explore the differences of frequency of mechanical restraint on patients with SUD in the psychiatry acute and dual pathology units and others psychiatric diagnostics.

Material and methods

We reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of Neuropsychiatry and Addictions Institute (INAD) of the Parc de Salut Mar de Barcelona, between January 2012 and January 2015. For every discharge the presence of at least one mechanical restraint and the DSM-IV diagnostic were coded. Then was calculated the frequency and proportion of mechanical retrains in every diagnostic group.

Results

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint. The 37% of patients with SUD of cocaine had an episode of mechanical restrain. The patients with SUD of alcohol only the 4%, and there no one case on patients with SUD of Cannabis. Thirty percent of patients with schizophrenia and 28% of bipolar disorder.

Acknowledgements

L. Galindo is a Rio-Hortega-fellowship-(ISC-III;CM14/00111).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Smoking reduction/cessation and psychiatric patients: What about weight control?
Authors: Ganhao I. , Trigo M. , Paixao A. , Cardoso J.
Published: May 2016

Introduction

Smoking cessation has long been associated with weight gain and is one of the many reasons that smokers invoke for not giving up smoking. Many psychiatric medications are also associated with increased weight gain and metabolic syndrome. Unhealthy lifestyles reflect symptoms of illness with poor coping strategies and financial and social difficulties.

There are many reasons why smoking cessation may be viewed as much more difficult for psychiatric patients and weight gain is one of them.

Objective

To study how patients’ weight evolves during smoking reduction and cessation in a smoking reduction/cessation program in a psychiatric hospital.

Aims

To demystify weight gain as a significant problem in smoking reduction and cessation in this patient population.

Methods

Every patient entering the smoking reduction/cessation program is evaluated initially with regard to weight and BMI.

Patients’ weights are evaluated during the duration of the program for each patient as is smoking status.

Results

We are still collecting data at this time.

Conclusions

There are three groups of patient according to weight changes during the program: those who gain weight, those who maintain the same weight (± 1 kg) and those who lose weight.

Most patients who gain weight end up recuperating their initial weight or are able to lose weight later.

Some patients had weight control issues and their fear of gaining weight led them to overcompensate leading to weight loss.

We have included interventions on healthy lifestyles that have aided patients in controlling their weight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interventions targeting physical health problems in patients with concurrent mental illness and substance use
Authors: Juel A. , Kristiansen C.B. , Povl M.J. , Hjorth P.
Published: May 2016

Introduction

Physical comorbidities are common in patients with concurrent mental illness and substance use disorder. Interventional studies addressing health promotion for this group of patients are scarce.

Aims

To examine the physical health condition of a non-selected group of patients with substance use disorder comorbid to other psychiatric disorders. Further, to analyze for possible changes in their health condition during a two-year intervention study in relation to physical measures and substance use. Finally, to analyze for possible associations between changes in physical measures and in substance use.

Methods

The patients were enrolled in the project continuously from October 2013 through May 2015. Physical health measures were obtained at the enrolment date and continuously as part of daily clinical practice. Interventions consisted of individual consultations with a research nurse, group sessions and an opportunity to do physical exercise together with the research nurse. Interventions included health promotion activities, i.e. guidance on healthy food intake, smoking cessation and a physically active life.

Results

In total, 64 patients (mean age 32.7 years, SD 10.7) were included in the study. Patients were mostly diagnosed with psychotic disorders (11%), affective disorders (44%) or developmental disorders (34%). Baseline measures showed that 89% of the patients smoked cigarettes daily, 61% had used cannabis and 20% had used amphetamines within the past month. Further, few patients did moderate or vigorous physical exercise. Further results are in progress.

Conclusions

These interventions seem relevant and manageable in an outpatient setting.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Video game addiction: Providing evidence for Internet gaming disorder through a systematic review of clinical studies
Authors: Lopez-Fernandez O. , Kuss D. , Pontes H. , Griffiths M.
Published: May 2016

Introduction

The American Psychiatric Association introduced in Internet Gaming Disorder (IGD) in the appendix as a tentative disorder in the last edition of the Diagnostic and Statistical Manual of Mental Disorders. However, currently no systematic review exists about excessive gaming viewed from a clinical perspective.

Objectives and aims

To review clinical studies on gaming addiction in order to ascertain characteristics of both clinical and research studies to provide retrospective evidence in relation with the proposed IGD classification (including criteria, measures and therapies).

Methods

A systematic literature review of studies published from 1980 to 2015 has been conducted using three major psychology databases: Academic Search Complete, PsycInfo, and PsycArticles. A total of 5033 results from peer-reviewed journals were obtained, where 32 were identified as empirical clinical papers focused on gaming addiction.

Results

The clinical research studies on gaming identified were published between 1998 and 2015, most of which included patient samples. Categorizations identified in the research papers included: (i) patients’ characteristics (e.g., socio-demographics), (ii) criteria and measures used (e.g., scales to diagnose), (iii) types of gaming problems (e.g., game genre), (iv) and treatments (e.g., type of therapy).

Conclusions

Findings will be discussed against the background of the controversial IGD diagnostic criteria proposed in the DSM-5 in order to assess the extent to which previously published clinical knowledge matched the current proposal for including gaming addiction as behavioral addiction in the next diagnostic manual.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Addictive behaviour and bariatric surgery: Case report and literature review
Authors: Pavez F. , López N. , Saura E. , Roca M. , García A. , Russo J. , Sánchez M. , Moral E.
Published: May 2016

Even though the scientific evidence supports the benefits of bariatric surgery, its indications and contraindications must be continually revised in order to avoid psychiatric complications. Substance use is more common in patients subjected to bariatric surgery than in the general population. There are reports of increased incidence of alcohol abuse in patients after bariatric surgery.

Objective

To review the available evidence, after treat the case of a 50-year-old man with addiction history whose addictive behaviour worsened after undergoing bariatric surgery, with decreased tolerance to alcohol effect and increase of the intake, as well as changes in the graduation of alcohol used (including antiseptic). As a result, a dangerous revolving door that led him to repeated admissions, including Intensive Care Unit.

Results

The case is consistent with the literature that suggests that there is an increased risk of later alcohol-related problems after bariatric surgery. This risk is higher several years post surgery, in patients with previous history of problems related to alcohol, young, men, and Roux-en-Y Gastric Bypass procedure.

Conclusions

The indications for bariatric surgery should thoroughly consider the history of addiction, an adequate assessment of the patient's mental status and psychoeducation about the possible psychiatric side effects, in order to develop preventive strategies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alcohol use disorder following traumatic brain injury: Lessons learned from bench to bedside
Authors: Santos G. , Lima C. , Vitória J.
Published: May 2016

Introduction and objectives

Traumatic brain injury (TBI) can result in a variety of neuropsychiatric disturbances ranging from subtle deficits to severe intellectual and emotional disturbances, including cognitive impairments, mood and psychotic disorders and behavioral disturbances. Alcohol use disorder (AUD) and TBI are closely related. The reward-mediated behaviors central to alcohol addiction seem to interact with the cognitive dysfunction of TBI. First, a significant proportion of patients with TBI have a history of alcohol abuse. Second, AUD might jeopardize TBI recovery and trigger or lower seizures threshold. Third, both AUD and TBI share a negative impact on mental functioning (from memory and cognitive performance to mood impairment). Finally, there is some limited and recent evidence that TBI can increase AUD in patients with no history of substance use prior to the injury, by disrupting incentive-motivation neurocircuitry.

Methods

We aim to present a 27-year-old Portuguese male patient without prior psychiatric history who developed AUD and epilepsy after TBI (from a work-related fall).

Results

After 3 years of treatment, the patient's hasn’t achieved abstinence. His treatment included pharmacological therapy with mood stabilizers, flufenazine injections and naltrexone, psychotherapy and rehabilitative interventions.

Conclusions

Given the sparse knowledge about this dual diagnosis, the approach of AUD after TBI is still challenging and the best treatment remains to be determined. Monitoring alcohol consumption should be considered in all patients presenting with TBI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Calcium as a treatment option for alcohol dependence
Authors: Schuster R. , Koopmann A. , Kiefer F.
Published: May 2016

In the last couple of decades anti-craving drugs have been developed. Acamprosate was described as an effective treatment option to support alcohol abstinence with a low side effect profile. Moreover its molecular mode of action is highly controversial. Recently, calcium salt was described to be the active part of Acamprosate.

Using a clinical sample of placebo (n = 10) vs. Acamprosate-treated (n = 19) abstinent alcohol-dependent patients, we measured calcium plasma concentrations after the 1st, 2nd and 3rd month after the treatment commenced. Before treatment, the same physiological calcium concentration of about 2.4 mmol/l was found in both groups respectively. We found significant correlations in the Acamprosate group while no correlations in the placebo group were observed.

The very well regulated extracellular calcium serum concentration seems to get out of balance in association with the severity of alcohol dependence in inpatients during withdrawal.

Accordingly, in another clinical sample (n = 57) we found a negative correlation between calcium serum concentration and craving (r2= 0.125; P = 0.011) on day 1 of detoxification. The measurement of craving was carried out by a self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS). Furthermore a low calcium level correlated with high breathalyser readings and the number of alcohol inpatient detoxification's.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Chronic psychiatric changes in a severe post-traumatic brain injury patient
Authors: Silva J. , Mota J. , Azevedo P.
Published: May 2016

Introduction

Severe traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.

Objectives

To summarize the latest literature about this field and to present a case report.

Aim

To explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.

Methods

A brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.

Results

Although SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.

Conclusions

Although the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Problem-solving appraisal as mediator, moderator and predictor of smoking-abstinence effects
Authors: Soliman A.
Published: May 2016

Introduction

There are extensive investigations explaining smoking abstinence effect, yet little is known about the cognitive and metacognitive mechanisms that underlie the severity of smoking abstinence effects. Several studies reported that that problem-solving appraisal is associated with psychological maladaptive behaviors, such as depression, anxiety.

Objectives

Examining the role of problem-solving appraisal as mediator, moderator and/or predictor of the severity of withdrawal symptoms and probably relapse.

Aims

Studying the role of problem-solving appraisal in the severity of smoking abstinence withdrawal symptoms.

Methods

The present study utilized a two-group pretest and posttest design to examine the mediating, moderating and predicting role of problem-appraisal of smoking-abstinence effects. A total of 92 adult men smokers were administered the problem-solving inventory (PSI-Ar) as well as several self-report measures of most reported smoking abstinence effects (pre-test), and then were asked to stop smoking for 48 h and administered again the same measures except the PSI-Ar (post-test).

Results

The results revealed that problem-solving appraisal acts as a possible mediator and predictor but not moderator of the severity of smoking-abstinence effects. The individuals with who appraised themselves as ineffective problem solvers have shown more sever abstinence effects i.e. somatization, depression, general anxiety, panic, mood states, smoking urges, insomnia and habitual sleep duration.

Conclusions

Problem-solving appraisal plays a key role in severity of smoking-abstinence effects by means of mediating the relationship between abstinence effects before and after smoking abstinence. The findings are discussed in the context of future research and possible intervention recommendations.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Differences between countries in adult acute psychiatric hospitalization: Clinical features and drug prescription in Spain and the United States of America
Authors: Gonzalez-Blanco L. , Bestene-Medina S. , Torio-Ojea E. , Abad-Acebedo I. , Rodriguez-Revuelta J. , Paniagua-Calzon G.
Published: May 2016

Introduction

Diverse prescription patterns and differences in length of psychiatry inpatient stay among European and American countries have been reported [1,2].

Objectives

To describe and compare clinical features and drug prescriptions in two Acute Psychiatric Units from Spain and USA.

Methods

Cross-sectional and comparative study. Sample: 73 inpatients from Reno (USA-Inpatients) and 65 from Oviedo (Spain-Inpatients) admitted to public Adult Acute Psychiatric Unit over a two-month period. Sociodemographic/clinical data and drug prescription were collected.

Results

Sociodemographic/clinical comparison (Table 1) and drug prescription differences (Table 2) are shown.

No significant differences in antipsychotics’ prescription except for the most frequently used [risperidone in Spain (36%)/ziprasidone in US (19.6%), Chi2 = 39.7**].

Conclusions

(A) Psychiatric inpatients in US are younger, have longer hospitalization, show more comorbid substance use disorder and differ from Spanish inpatients in frequency of diagnostic categories (schizophrenic disorders represent a larger proportion).

(B) Inpatients in Spain usually receive polytherapy, and are more frequently treated with antidepressants and anxiolytics, especially benzodiazepines. In contrast, USA-Inpatients take lithium more often [1,2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Metacognitive factors in a sample of Greek alcohol dependent patients
Authors: Stefanatou P. , Giannouli E. , Tsellos P. , Antonopoulou Z. , Paparrigopoulos T. , Ermiliou V. , Typaldou M.
Published: May 2016

Introduction

The harmful use of alcohol causes a large disease, social and economic burden in societies. Metacognition is a complex concept referring to the cognitive control and regulation of many types of cognitive processes.

Objectives

Metacognitions are considered to be an important factor in the development and continuance of psychological disorders.

Aims

The purpose of this study is to examine the probable relations between alcohol abuse and Metacognitions with the Metacognitions Questionaire – 30 (MCQ-30).

Method

Twenty-three men and 16 women, aged between 22 and 64 years, inpatients in Eginition Hospital, due to alcohol dependence, completed the Greek-Version of the MCQ-30.

Results

The mean total scores of alcoholics were higher than the ones of the healthy subjects. Namely, the group of the alcohol abused patients presented a higher score in comparison with the normal group in three of the five metacognitive dimensions. Additionally, alcoholic men outscored alcoholic women in two of the five factors. Specifically, alcoholic men appeared to be less confident about their memory and attention than alcoholic women. Furthermore, alcoholic men, compared to alcoholic women claimed in a significant greater level that worrying helped them to function.

Conclusions

The above findings suggest that metacognitions could play a role in the orientation and maintenance of alcoholic abuse behavior. Moreover, these results may pose the question of whether these metacognitive beliefs could be seen as an indicator of differentiating alcoholic men from women. Overall, further research could provide additional information concerning the relation between Metacognitions and alcoholic dependence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Respiratory panic disorder in acute clonazepam treatment and long-term follow-up
Authors: Nardi A. , Freire R.C. , Machado S. , Amrein R.
Published: May 2016

Objective

to describe with prospective methodology the therapeutic response to clonazepam in the respiratory panic disorder (PD) subtype versus the non-respiratory subtype in a long-term follow-up.

Methods

A total of 67 PD outpatients (DSM-IV) were previously divided into respiratory (n = 35) and non-respiratory (n = 32) subtypes and then openly treated with clonazepam for 8 weeks. Those who responded were then treated for 3 years. Demographic and clinical features were compared in the two groups. The instruments used to evaluate response were the Clinical Global Impression, the Sheehan Panic and Anticipatory Anxiety Scale, and the Panic Disorder Severity Scale.

Results

In the first 8 weeks of treatment (acute phase), the respiratory subtype had a significantly faster response on all the major scales. During the follow-up and at the end of the study (week 156), there was no difference in the scale scores, and the reduction in panic attacks from baseline to end-point did not differ significantly between the two groups. After the acute phase treatment, the patients could undergo psychotherapy. In the respiratory subtype, the disorder had a later onset, was associated with a high familial history of anxiety disorder. The non-respiratory subtype had significantly more previous depressive episodes. Clonazepam had a safe adverse event profile during both phases of treatment.

Conclusion

The respiratory PD subtype had a faster response to treatment with clonazepam at 8 weeks than did the non-respiratory subtype and an equivalent response after 6 months of treatment. The response of clonazepam is clearly maintained during the long-term follow-up.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical staging in panic disorder and agoraphobia
Authors: Pavlichenko A.
Published: May 2016

There is an increasing literature about the implementation of the staging model in many mental disorders. According to this approach, there are four stages of a psychiatric disorder: prodromal stage, acute manifestations, residual phase, chronic. In this study, we empirically investigate whether additional clinical variables such as clinical manifestations and comorbid disorders may be useful to modify the staging model to panic disorder (PD).

We distinguished inpatient sample (n = 79) with a diagnosis of “panic disorder” according to the DSM-IV criteria. We propose that the inclusion of prodromal stage of PD does not make clinical sense since the different unspecific neurotic symptoms may proceed to a variety of anxiety and depressive disorders. First stage was characterized by the situationally predisposed panic attacks (PA) with both somatic and cognitive symptoms. Comorbid disorders included somatoform disorders and generalized anxiety disorder (GAD). During second stage individuals experienced agoraphobic avoidance until traveling in public transport. On the other hand, spontaneous PA were accompanied by the only somatic but not cognitive symptoms. The most common patterns of comorbidity were GAD and alcohol misuse. Third stage was associated with the absence or limited symptom attacks and chronic agoraphobia. Major depression and obsessive-compulsive disorder might be an integral part of the clinical manifestations. This study supports that the staging model in PD might be updated by the detailed description of clinical manifestations and comorbid disorders at each stage that may help the practitioners to choose the best strategy for the treatment of a particular patient.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Use of lithium in acute mania in adolescents
Authors: Aksoy Poyraz C. , Özdemir A. , Günay G. , poyraz B.Ç. , Enginkaya S. , Karaçetin G. , Tomruk N.
Published: May 2016

The aim of the present study was to investigate whether the use of lithium followed recommended practice in acutely manic adolescent inpatients. This study was a 12-month retrospective review of patients with manic episode admitted to Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital. Length of stay, medication data, serum levels and adverse effects were recorded for patients who started lithium treatment within average of 7 days of admission (n = 52). Average length of stay was 23.63 (SD = 17.6). The maximum dose prescribed within 24 h of starting treatment was 721.15 mg (SD = 239.5). The maximum daily dose was reached in an average of 7 days to 1136.5 mg (SD = 336.4). The average time after starting treatment until the first recorded serum level was 5 days. The average serum level reached was 0.5 mEq/L (SD = 0.22), which was raised to 0.6 mEq/L (SD = 0.3) at discharge with an average daily dose of 1038.46 mg (SD = 460). In 8 admissions (15.4%), one adverse effect was recorded that could have been related to lithium treatment but adverse events did not lead to discontinuation of drug. The literature supports that rapidly attained high serum levels are associated with positive outcomes. In this current study, clinicians used a relatively slow dose titration and lower serum levels were obtained suggesting that lithium was not considered as a primary agent for treating mania. Taking advantage of lithium especially for the maintenance treatment of bipolar disorder and tolerability may have driven these findings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional intelligence in bipolar disorder
Authors: Chapela E. , Quintero J. , Félix-Alcántara M. , Morales I. , Javier C. , Jorge G.A.
Published: May 2016

Introduction

Emotional intelligence is defined as the ability to process, understand and manage emotions. In bipolar disorder seem to be more conserved, with less functional impairment than other severe mental disorders as schizophrenia. So far, there are few studies analyzing emotional intelligence in bipolar disorder.

Objective

The objective of this research is to better understand the different characteristics and the factors affecting these social-cognitive dysfunctions in bipolar disorder.

Aims

To explore possible factors related to emotional intelligence in these severe mental disorders: symptoms, cognitive functioning, quality of life and psychosocial function.

Material and methods

Twenty-six adults bipolar type I patients were examined using MSCEIT (the most validated test for emotional intelligence), BPRS, YMRS, HDRS, WAIS-IV, TMT and Rey Figure in order to determine the level of emotional intelligence and factors relate.

Results

Bipolar patients show lack of emotional intelligence when compared with general population. Cognitive impairment and age are the principal factors related.

Discussion

Results are discussed and compared with recent literature.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Insight in bipolar disorder through the course of manic episode and its clinical correlates
Authors: Ince E. , Aksoy-Poyraz C. , Arikan M.K. , Poyraz B.C. , Turan S. , Sakalli-Kani A. , Aydin E.
Published: May 2016

Introduction

Insight is a well-documented phenomenon for psychotic disorders. It has been studied extensively in schizophrenia and its association with clinical outcomes has drawn increased attention. Although less is known for affective disorders, recent studies point out that impaired insight in bipolar disorder may take part in patients’ overall well-being.

Aims

Exploring the main components of insight in psychiatry, particularly in bipolar disorder.

Objectives

With this study, we wanted to examine how clinical and cognitive insights change in patients with bipolar disorder through their hospitalization period and how they correlate with symptom severity and neuropsychological functioning.

Methods

In this prospective study, inpatients with bipolar I disorder who were presented by manic episode with psychotic features were included. The patients were assessed with Young Mania Rating Scale, Beck Cognitive Insight Scale, Schedule for the Assessment of Insight-Expanded Version (SAI-E) and a neuropsychological test battery both at the time of admission and discharge.

Results

As of October 2015, a total number of 20 patients with bipolar I disorder participated in the study. Preliminary results revealed a significant improvement in the total score of clinical insight, which was measured with SAI-E by the time of discharge (P = 0.001). This transition was strongly correlated with the decrease in symptom severity (P = 0.006, r = −0.61). Improved clinical insight exhibited significant correlation with the increase in patients’ memory span (P = 0.007, r = −0.596).

Conclusion

The preliminary results suggest that changes in symptom severity and working memory might be the determinants of improvement in clinical insight of inpatients with bipolar disorder through manic episode.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Thyroid dysfunction in inpatients with affective disorders
Authors: Leitão Moreira A.M. , Pacheco Alves R. , Lazaro M. , Mota A.M. , Nobre M.A.
Published: May 2016

Introduction

Thyroid dysfunction has been linked to psychiatric disorders, particularly to affective disorders. Moreover, aging of the population receiving mental health care leads to an increased epidemiological risk of thyroid disease.

Objectives

Assess the prevalence of abnormal thyroid function, and its correlations to clinical factors, in an acute psychiatric inpatients ward dedicated to affective disorders.

Aims

Reflect on the clinical relevance of thyroid function screening on admission in mental health care.

Methods

Retrospective, descriptive study, concerning inpatient episodes from a 12 month period (January to December 2015) in a ward dedicated to affective disorders, in a tertiary psychiatric hospital.

Results

The prevalence of thyroid dysfunction across all psychiatric diagnostic groups was 11%. Preliminary data has shown higher prevalence in non-elderly women with personality disorder as a main diagnosis (30%, P = 0.017). Only women were under thyroid replacement therapy, which was significantly more prevalent in those diagnosed with bipolar disorder.

Conclusion

The relatively high prevalence of thyroid dysfunction underlines the relevance of its screening in mental health inpatients. Our results were consistent with the known epidemiology of thyroid disease. Correlations with bipolar and personality disorder were noted, which can contribute to improve the understanding of clinical-epidemiological relationships between thyroid disease and specific psychiatric disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differences in plasma concentration of acylethanolanydes and acylglycerols in paired samples of bipolar patients and first- and second-degree relatives
Authors: Romero-Sanchiz P. , Guzman-Parra J. , Mayoral-Cleríes F. , Rivas-Guerrero F. , Araos-Gómez P. , Pedraz-Fernández M. , Serrano-Criado A. , Pavón-Morón F.J. , De la Torre-Fornell R. , Pastor-Bosch A. , Rodríguez de Fonseca F.
Published: May 2016

Introduction

Endocannabinoid System (ECS) has been highlighted as one of the most relevant research topics by neurobiologists, pharmacists, basic scientists and clinicians (Skaper and Di Marzo, 2012). Recent work has associated major depressive disorder with the ECS (Ashton and Moore, 2011). Despite the close relationship between depression and bipolar disorders, as far as we know, there is no characterization of ECS and congeners in a sample of patients with bipolar disorders.

Aims and objectives

The objective of this work is to characterize the plasma levels of endocannabinoids and congeners in a sample of patients with bipolar disorders.

Method

The clinical group was composed by 19 patients with a diagnosis of bipolar disorders using SCID-IV (First et al., 1999). The control group was formed by 18 relatives of first- or second-degree of the patients.

The following endocannabinoids and congeners were quantified: N-palmitoleoylethanolamide (POEA), N-palmitolylethanolamide (PEA), N-oleoylethanolamide (OEA), N-stearoylethanolamide (SEA), N-arachidonoylethanolamide (AEA), N-dihomo-γ-linolenoylethanolamide (DGLEA), N-docosatetraenoylethanolamide (DEA), N-linoleoylethanolamide (LEA), N-docosahexaenoylethanolamide (DHEA), 2-arachidonoylglycerol (2-AG), 2-linoleoylglycerol (2-LG), and 2-oleoylglycerol (2-OG).

Results

The result showed statistically significant lower levels of AEA, DEA and DHEA in clinical sample. Previous research also identified lower levels of AEA in depressed women (Hill et al., 2008, 2009). Until date, it is unknown if DEA and DHEA have some effect on EC receptors, and whether they have some direct effects on endocannabinoids.

Conclusions

It would be necessary to carry our other research with a larger sample, which could allow the control of potential confounding variables.

Disclosure of interest

The authors have not supplied their declaration of competing interest.