bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive behavioral therapy for chronic migraine
Authors: Onur O. , Ertem D.H. , Uludüz D. , Karşıdağ Ç.
Published: June 2017

Aim

Although current standard treatment for migraine headache is medication, high levels of psychological comorbidity has led to migraine influencing by cognitive, emotional and environmental factors, as well as biological. Viewing migraine in a biopsychosocial framework introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy (CBT). The aim of this study was to evaluate the efficacy of CBT for chronic migraine.

Methodology

Thirty-five participants diagnosed as chronic migraine were recruited from Headache Clinic. According to inclusion criteria 14 participants, underwent bi-weekly lasting 30 minutes CBT sessions for 6 months, were administered Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Scale (VAS) and the Migraine Disability Assessment Scale (MİDAS) before and after CBT.

Findings

Nine of the participants were female and 5 male. Mean age of group was 34.35 ± 8.17. Duration of illness was 13.07 ± 7.18 and 12 of participants had the history of a psychiatry illness whose diagnoses were depression (7), anxiety disorder (4) and post-traumatic stress disorder (1). Nine of the patients had prophylactic migraine treatment. There were statistically significant difference in Hamilton Depression scores between before CBT (29.07 ± 7.74) and after CBT (14.21 ± 7.7); in Hamilton Anxiety scores before CBT (26.8 ± 11.7) and after CBT (11.7 ± 2.6); in VAS scores before CBT (8.07± 0.91) and after CBT (3.71 ± 1.32); in frequency of migraine attacks between before CBT (10.85 ± 3.50 day) and after CBT (4.92 ± 2.70 day) and in MİDAS before CBT (55.5 ± 20.4) and after CBT (20.12 ± 16.6) (P < 0.05).

Conclusion

CBT might reduce the severity of symptoms in migraine patients especially with the comorbidity of psychiatric illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Polydipsia and intermittent hyponatremia
Authors: Ramos-Perdigues S. , Gordillo M.J. , Caballero C. , Latorre S. , Boned S.V. , Miriam G. , Torres P. , De Almuedo M. , Sanchez M.T. , Contreras E. , Gomez E. , Sanchez E. , Segura M. , Torres C. , Gemma G. , Tur M. , Fernandez A. , Merino C.
Published: June 2017

Introduction

Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.

Objectives

To describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.

Aims

To broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.

Methods

A 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.

Results

Haloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.

Conclusions

Hyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clozapine induced diarrhea
Authors: Ramos-Perdigues S. , Gordillo M.J. , Caballero C. , Latorre S. , Boned S.V. , Sanchez M.T. , Torres P. , Guisado M. , Contreras E. , De Almuedo M. , Esmeralda E. , Sanchez E. , Segura M. , Fernandez A. , Torres C. , Herrero G. , Tur M. , Merino C.
Published: June 2017

Introduction

Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.

Objectives

We describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.

Aims

Discuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.

Methods

We present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.

Results

At the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)

Conclusions

Diarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Which are the possibilities of psychiatric liaison-consultation in dentistry? By the way a qualitative study on symbolic meanings reported by dentists on handling of dental-caries
Authors: Leme P.A.T. , Bastos R.A. , Vedovello S.A.S. , Turato E.R. , Meneghim M.C.
Published: June 2017

Dental caries is the main oral disease and there is a possible psychological resistance from dentists to change clinical practice towards in sense of health promotion as opposite to invasive mechanical practice. We hypothesized that the discussion of their practice with mental health professionals, highlighting the humanist view in approaching patients, would imply reviewing usually invasive practices.

Objective

To understand the psychological meanings attributed by dentists to the treatment of dental caries considering the frequent invasive treatment.

Method

Clinical-qualitative method derived from qualitative designs proper to human sciences and applied in assistance settings. Sample composed of all available dentists (ten participants) within an area of basic health units of Piracicaba, Săo Paulo state. Semi-directed interview with open-ended questions, in-depth, was used. After full transcription of the interviews, qualitative content analysis was carried out, including floating readings to emerge core of meanings with consequent categorization for discussion.

Results

Two categories show conflicts in the interpersonal relationship: psychological discomfort due to a perspective of care different from patient and presence of an ideologically vertical relationship. One category showed a successful approach: the patient through openness.

Conclusions

There were feelings of impotence in face of difficulties in interpersonal communication. It was possible to observe the influence of bio-power that weakens the possibility of empowering patients. In this way, a mechanical way of practice “saves” professionals from thinking about these human dilemmas. On the other hand, the liaison-consultation psychiatry, at primary care, allows dental professionals to have a personal affective support to rethink approaches on use of technology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of shame and cultural beliefs on mental illness and treatment adherence: A case report
Authors: Albassam A. , Ameen A. , Chiappetta V. , Hanif A. , Gonzalez L.
Published: June 2017

Introduction

Shame, especially when enmeshed in cultural beliefs about mental illness and cultural roles, could be a detrimental factor in psychiatric illness in context of adherence to treatment and continuation of care. Shame is defined as a painful experience which embodies multiple components including: collapse of self esteem, feeling of humiliation, rupture of self continuity, sense of isolation, and feeling of being watched by critical others.

Objective

Understanding the psychodynamics of shame, in a particular cultural milieu and its components which could impact psychiatric treatment and care.

Method

Here we present a case report of a 41-years-old Arab male patient from Yemen, with a history of paranoid schizophrenia who was admitted to inpatient psychiatric service for bizarre and aggressive behavior.

Results

Initially the depth of patient's delusions and psychotic symptoms were not fully appreciated due to the cultural gap between the patient and the treatment team. He was then re-valuated through the implementation of the cultural formulation interview (CFI) by clinicians from same cultural background. This team was able to elucidate the deep feelings of shame and inadequacy in patient's presentation and provide a culturally tailored treatment plan.

Conclusions

Evaluation of psychiatric patients in a different cultural setting where western values do not apply might not be sufficient to assess the breadth of psychotic symptoms especially when an underlying feeling of shame contribute to presenting symptoms. Treatment of those patients with neuroleptics without assessing the cultural dynamics might result in poor adherence to medication and follow up.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Hikikomori goes global: A Portuguese case
Authors: Macedo P. , Pimenta V. , Alves M. , San Roman Uria A. , Salgado H.
Published: June 2017

Introduction

Hikikomori, a form of severe social isolation, once characterized as a Japanese cultural-bond behavior with social and economic consequences, it is now being described in other countries. Its presentation mimics some clinical features of various classified mental diseases, such as prodromal phase of schizophrenia, personality disorders, Internet dependence, social phobia or depression, without fulfilling their defining criteria.

Objectives/method

This work aimed to do a brief review of this subject, describing one case that is probably the first ever reported in Portugal, comparing it with similar cases around the world.

Results

The patient was a 22-year-old male, taken to psychiatry evaluation after 4 years of social withdrawal, avoiding or blocking any contact even with family members, which resulted in work and school impairment. He spent most of his days locked at his room, investing his time in particular interests and Internet use, only leaving to eat or do his basic hygiene. At that time, he presented no affective or psychotic symptoms and perceived his behavior as egosintonic. After six appointments with psychotherapeutic approach, he was able to get a job and improved his communication with the others, especially with family.

Discussion/conclusion

This case fits most of the reports found on literature, in its presentation and clinical management. Hikikomori is not considered yet a disorder and further documentation of these cases is still needed to define its place in psychiatric nosology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychometric of questionnaire about cultural factors comorbidity of obsessions and major depressive disorders in Iranian samples
Authors: Nikpour G. , Homayouni A.
Published: June 2017

Background and purpose

Cultural signs may be found among people that speak a local dialect or live in a specific region or historical period. These cultural signs could influence psychopathology. The aim of this study was to design and validate a questionnaire that could evaluate the cultural factors causing concurrent obsessions and major depressive disorders in Iran.

Materials and methods

To design the questionnaire, 10 psychologists and psychiatrists who were members of academic boards were questioned by an open questionnaire. Then, the answers to the questions were classified and based on exploratory factor analysis the questionnaire containing 11 factors and 79 questions was confirmed. Internal homogeneity was analyzed by Cronbach's alpha.

Results

The results of Cronbach's alpha for all factors showed that the highest reliability was 0.90 and the lowest was 0.42. In exploratory factor analysis using Varimax rotation 11 factors were extracted that predict 47.3% of the scale variance. 25 factors were extracted of which14 had less than three items, therefore they were omitted because of not being able to acquire reliability as sub factors. Accordingly, a questionnaire containing 11 factors and 79 questions was constructed.

Conclusion

The findings showed that the instrument could identify the cultural factors that cause concurrent obsession and major depressive disorders in Iran.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Between creativity and death: Abstract expressionists and alcohol use disorders
Authors: Vasiliu O. , Vasile D. , Androne F. , Patrascu M. , Morariu E.
Published: June 2017

American Expressionists were a group of American artists who valued free expression of unconscious elements, combining emotional intense expressions with anti-figurative abstract style. Their main place of creative debates was Cedar Tavern in New York City, considered by art critics an important incubator of the Abstract Expressionism. Jackson Pollock, one of the most prominent figures of this movement, suspected of having bipolar disorder, abused alcohol during long periods of his life, for which he even underwent psychotherapy. Unfortunately, he died in a car accident while driving under influence, after decades of innovative work, during which he created a new painting method and produced compositions which are nowadays between the most expensive works of art. Mark Rothko also had periods of heavy drinking, and finally he died by cutting his arms with a razor. He is considered a genius, who created a completely new perspective over painting, and his works are also between the most expensive paintings in the world. Willem de Kooning was affected by alcoholism since his early years, and developed dementia, at least partially induced by abusive drinking. Although affected by neurocognitive disorder, he continued to produce amazingly creative paintings until his final years and in 2016 one of his works obtained the record for the most expensive painting ever sold. Using alcohol as a tool for increasing creativity risks to expose the creator to severe disorders or even death, the subject walking on a narrow line between sublimation of unconscious impulses and tragic resignation before them.

Disclosure of interest

The presenting author was speaker for Bristol Myers Squibb and Servier, and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo.
Correlation between depression and happiness among Kuwait university students
Authors: Baqer G.
Published: June 2017

Background

The Beck Depression Inventory (BDI-II) has become one of the most widely used instruments for evaluating the severity of depressive symptoms in psychiatric patients and in normal populations. The Oxford Happiness Questionnaire (OHQ) has been derived from the Oxford Happiness Inventory (OHI). The OHI follows the design and format of BDI-II, which provided, when reversed, a set of 20 multiple-choice items relevant to subjective well being. Further items were added to cover aspects of happiness and 29 items were retained in the final scale. OHQ was translated into Arabic for the first time in the present study. The aim of the study is to examine the correlation between depression and happiness.

Materials and methods

BDI-II (alpha .87) and the Arabic version of OHQ (alpha .92) were completed by a sample of (380) Kuwait university students (180) males and (200) females with mean age of 22.19 ± 2.8 years old. Pearson correlations were calculated.

Results

Significant (P > 0.01) reverse correlation was found between depression and happiness (r = –54).

Conclusion

Although significant negative relationship existed between BDI-II and OHQ, the coefficient for determination of this correlation shows that nearly only half of depression changes are described and assessed with happiness score! It seems that the two psychometric tools do not completely stand against each other. However, further evaluation of this relationship is needed.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Depression, anxiety and stress [DASS21] symptoms in menopausal Arab women: Shedding more light on a complex relationship
Authors: Bener A.
Published: June 2017

Aim

The objectıve was to determine correlation between depression, anxiety and stress in menopausal and post-menopausal women and shedding more light on a complex relationship.

Methods

A cross-sectional based on Arabian women at the Primary Health Care (PHC) Centers in Qatar during July 2012 and May 2014 and 1101 women agreed to participate and responded to the study. Depression, anxiety and stress were measured using the Depression Anxiety Stress Scales (DASS-21). Data on body mass index (BMI), clinical and other parameters were used.

Results

The mean age and SD of the menopausal age was 49.55 ± 3.12, and postmenopausal age was 58.08 ± 3.26 (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Also, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, and diseases. Depression and anxiety were more common among postmenopause women. The multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were predictor for depression. Meanwhile, diastolic BP, occupation and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation and sheesha smoking habits were considered as the main risk factors associated with stress.

Conclusion

A large number of factors were associated with experiencing menopausal and psychosocial problems and which had negative effects on the quality of life among Arabian women. Depression, anxiety and stress should be considered as an important risk factors for osteoporosis.

Disclosure of interest

The author ha not supplied his/her declaration of competing interest.
Poststroke depression
Authors: Brigadeiro D. , Nunes J. , Gil T. Ventura , Costa P.
Published: June 2017

Psychiatric symptoms are the complications most often ignored in patients who suffered a stroke. Depression is the most common psychiatric complication in post-stroke patients with a prevalence of about 20–50% in the first year and with a peak in first six months after the stroke. Depression in turn, constitutes itself a factor of cerebrovascular risk. Despite its high prevalence this disorder remains under diagnosed and under treated. One explanation for this fact is that depressive symptoms are often misinterpreted as consequences of stroke itself. This reality is even more striking in patients with aphasia. Poststroke depression (PSD) results from the interaction between biological, as the location of the stroke, social and psychological factors. The presence of this disorder is associated with deleterious consequences for rehabilitation process. These patients suffer more often from attention deficits, cognitive difficulties, lower response to rehabilitation programs, poor quality of life and increased mortality.

Objectives

To review epidemiology, pathogenesis, risk factors, consequences and current recommendations for therapeutic intervention.

Methods

Medline/Pubmed database search using the terms poststroke depression, depression and stroke, depression and cerebral vascular accident, stroke patients, published in the last 16 years.

Conclusion

The treatment of PSD has been shown effective in improving the evolution and prognosis of these patients, therefore it is very important early diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Childhood trauma: A factor for increased risk of major depression in psoriatic patients
Authors: Erfanian M.
Published: June 2017

A history of childhood maltreatment (CM) is an important determinant for understanding the development of psychiatric and physical disorders. CM is associated with sensitization of central nervous system (CNS) that leads to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis [1]. Early life stress is a well-known contributor to major depression [2]. The dysregulation of HPA axis and sympathetic nervous system activity also impact skin. Epidermis shows a high vulnerability to such psychological stressors resulting to increase risk for psoriasis [3]. The current study investigates the association between childhood trauma and major depression, childhood trauma and psoriasis, and also severity of major depression in female and male patients with psoriasis. Sixty-four psoriatic patients (female = 34, mean age = 46.87) were evaluated with the Childhood Trauma Questionnaire (CTQ) for the history of CM and with the MINI International Neuropsychiatric Interview for the diagnosis of major depression. CM was associated with major depression, indexed by a higher CTQ in emotional (χ2(3) = 26.002, P < .0005) and physical abuse scores (χ2(3) = 23.764, P < .0005). CM limited to sexual abuse was associated with higher severity of psoriasis (χ2(3) = 9.81, P < .02). There was no indication of a difference between men and women in severity of major depression (U = 444, P = .304). Our findings highlight the importance of recognizing psychiatric comorbidity, in particular major depression, among psoriatic patients. Depressive disorder with the presence of psoriasis may constitute a separate etiology with a greater contribution of early environment.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Modifications of depression-like behavior in the adult ovariectomized female rats treated with different doses of cholecalciferol
Authors: Fedotova J. , Dudnichenko T.
Published: June 2017

The aim of the preclinical study was to examine the effects of chronic the effects of chronic cholecalciferol administration (1.0, 2.5 or 5.0 mg/kg/day, s.c., once daily, for 14 days) on depression-like behavior following ovariectomy in rats. Cholecalciferol was administered to the ovariectomized (OVX) rats and OVX rats treated with 17β-estradiol (17β-E2, 0.5 μg/rat, s.c., once daily, for 14 days). Depression-like behavior was assessed in the forced swimming test (FST) and the spontaneous locomotor activity was assessed using the open field test (OFT). Treatment with cholecalciferol in high dose (5.0 mg/kg/day, s.c.) significantly decreased immobility time of OVX rats in the FST. Co-administration of cholecalciferol in high dose with 17β-E2 exerted a markedly synergistic antidepressant-like effect in the OVX rats on the same model of depression-like behavior testing. Cholecalciferol in high dose administered alone or together with 17β-E2 significantly enhanced frequency of grooming of the OVX rats in the OFT. Moreover, cholecalciferol in high dose administered alone or together with 17β-E2 significantly decreased the elevated corticosterone levels in the blood serum of OVX rats following the FST. These results indicate that cholecalciferol in high dose has a marked antidepressant-like effect in the adult female rats with low levels of estrogen. The data also indicate that the combination of cholecalciferol in high dose and 17β-E2 is more effective than 17β-E2 alone in OVX rats inducing a more profound antidepressant-like effect in the FST.

Russian Science Foundation (RSF) funded the reported study accordingly to the research project № 16-15-10053.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Korean medication algorithm for depressive disorder (KMAP-DD) 2017: Maintenance treatment
Authors: Jon D.I. , Kim W. , Wang H.R. , Woo Y.S. , Seo J.S. , Park Y.M. , Jeong J.H. , Shim S.H. , Lee J.G. , Min K.J. , Bahk W.M.
Published: June 2017

Introduction

The international guideline for treating depression has been widely used.

Objectives

The current study focused on the maintenance treatment section of the third revision of Korean Medication Algorithm for Depressive Disorder (KMAP-DD)

Methods

A 44-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for depressive disorder. Of the 144 committee members, 79 psychiatrists responded to the survey. Each treatment strategy or treatment option was evaluated with the nine-point scale.

Results

Most clinicians answered to maintain both antidepressants (AD) and atypical antipsychotics (AAP) for psychotic depression in remission state. The duration of AD maintenance: from 19.8 weeks to 46.8 weeks for patients in remission of the first episode, from 34.8 weeks to 78.4 weeks for the second depressive episode, and long-term continuation for three or more depressive episodes. Aripiprazole was the most preferred AAP. The preferred doses of AD and AAP in maintenance treatment were about 75% and 50% of those in acute treatment The maintenance of AAP in the psychotic depression in remission was similar to the AD, although shorter and less.

Conclusions

The maintenance strategies of KMAP-DD 2017 were similar to those of KMAP-DD 2012. Most clinicians preferred to maintain AD for substantial duration after achieving remission. The maintenance of AAP was also preferred, but the duration was shorter than AD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Specificity in perceived social support in multiple sclerosis patients
Authors: Nikolaev E. , Vasil’eva N.
Published: June 2017

Introduction

Social support is one of the functions of social relationships that modify stress. Social supportive resources play important role in helping patients to adjust to the disease. Not much is known about social support in multiple sclerosis patients while it is one of the available interpersonal resources.

Objectives

and aims To examine the specificity in perceived social support in multiple sclerosis patients.

Methods

The sample were 104 in-patients diagnosed with multiple sclerosis (both men and women; mean age 38, SD = 10). All patients included in this study filled out the 22-item Russian version of the social support questionnaire (F-SOZU-22, G. Sommer, T. Fydrich in 1989, adaptation developed by A. Kholmogorova in 2006). Among them there were patients with relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis.

Results

The entire sample reported the normal level of social support. One can mention that multiple sclerosis patients did not differ in general level of perceived social support from the healthy subjects. The exception was the overall satisfaction of social support, which reflected its statistically higher level in multiple sclerosis patients (P < 0.05). Further analysis showed no significant differences in perceived social support in patients associated with gender factor and clinical forms of multiple sclerosis (P > 0.05).

Conclusions

The perceived social support in multiple sclerosis patients is characterized by normal levels of its emotional and instrumental components and inclusion in the network of close social relationships. However, the patients of both genders do not feel stability of these relations and have a deceased sense of security that can be a significant risk factor for depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
An item response theory based analysis of the Hamilton depression rating scale-an Indian perspective
Authors: Sanyal D. , Mukherjee B.
Published: June 2017

Introduction

Hamilton Depression Rating Scale (HAMD) remains the most widely used outcome measure though many consider the scale to have many defects.

Objectives

To use IRT analysis to identify HDRS items which are problematic in terms of IRT parameters, thus suggest changes to the scale.

Methods

Patients attending psychiatric OPD meeting DSM-5 criteria for unipolar depression were selected for the study. Patients were between 18-65 years of age, had no major medical problems and were not on any medicines at present. 17 item HDRS was administered using the anchors developed by William Guy as part of the ECDEU NIMH Collaborative Study To determine the relationship between scores on the individual HAMD items and overall depressive severity in an outpatient population Option Characteristic Curve (OCC) which is a graphical representation of the probability of endorsing the different options for a given item across the range of depressive severity) and Item Characteristic Curve (ICC) which is a graphical representation of the mean item score (expected value) and confidence interval as a function of depressive severity was used.

Results

Results showed that Items Depressed Mood, Work and Activities show good relationship between item responses and overall depressive severity. Items Hypochondriasis, somatic symptoms general and retardation appeared to be more problematic with regard to their ability to discriminate over the full range of depression severity.

Conclusions

Further studies are needed to critically review one of the most commonly used scale for one of the commonest malady of humans.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Previous and posterior psychopharmacological treatment in bariatric surgery patients
Authors: Angelats M. , Laia P. , Elena R. , Laura M. , Iciar E. , Adinson B. , Lucía P. , Elena B. , Víctor P. , Purificación S.
Published: June 2017

Introduction

Bariatric surgery is an effective treatment for obesity. It has been demonstrated that it improves the prognosis of vascular risk factors. However, the long term effect of surgery on psychiatric pathology, as depression, and the treatment adjustment needed is not clear.

Aim

To describe the previous and posterior psychopharmacological treatment of patients operated of bariatric surgery in Hospital del Mar.

Material and methods

We used a database of 292 bariatric surgery patients who have been operated in Hospital del Mar from January 2010 to November 2015. In this database, sociodemographic information, psychiatric antecedents, and anterior and posterior treatments among other data are included. We have made a descriptive analysis about more used treatments and their evolution.

Results

In the sample, 27.1% of patients started with some psychiatric treatment the months before the bariatric surgery (16.4% had already a previous treatment prescribed). The medications the most frequently started before the surgery were selective serotonin reuptake inhibitors (SSRI, 11%), second were benzodiazepines and third a combination of the two previous treatments. Among antidepressants, Fluoxetine was the most prescribed (45.5%). Six months after surgery, 72.9% of patients were not taking any treatment.

Conclusion

The large variety of psychiatric drugs used in our sample indicates that clearer guidelines are needed about the most appropriated treatments for those patients. Further studies on the impact of this surgery on pathologies and their psychopharmacological treatments are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Body Image in Bariatric surgery candidates
Authors: Rosta M.L. , Porfiri F. , Zaccaria A. , Giannetti G. , Scoppetta M. , Giustacchini P. , Iaconelli A. , Chieffo D. , Mingrone G. , Raffaelli M. , Janiri L.
Published: June 2017

Introduction

Body image is a multidimensional concept that has assumed a significant role in eating disorders in which affective and perceptual distortions have been documented. Obesity is not a psychiatric disorder according to DSM-5 but several studies highlighted the presence of body image diseases in obesity.

Objectives

The aim of this work is to evaluate the presence of body uneasiness in obese seeking for Bariatric surgery and to correlate it with psychopathological symptoms, psychosocial and anamnestic variables.

Methods

From June 2014 to June 2016, we enrolled 537 Bariatric surgery candidates. Body image was investigated using the Body Uneasiness Test (BUT-A), a 34-item self-report questionnaire which measures weight phobia (WP), body image concerns (BIC), avoidance (A), compulsive self-monitoring (CSM), detachment and depersonalization (D). Psychopathological symptoms and personality traits have been evaluated using SCL90R and MMPI-2.

Results

Descriptive analyzes showed that BUT subscales were altered in most of our sample. Correlations of Pearson underlined significant associations between BUT subscales and SCL90R subscales. No correlation was found between BMI, marital status and BUT scores, while young, female and unemployed people had more difficulties with body.

Conclusions

Our data highlight the presence of considerable body uneasiness in obese, correlated with the severity of psychiatric symptoms but independent from the severity of obesity. This seems to reflect the mind-body split detected both in obesity and in eating disorders. Therefore, a multidisciplinary integrated approach including psychological work on cognitive, emotional and perceptual aspects of body image will help patients to improve coping with corporeal changes achieved through surgery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A new measure of psychological inflexibility related to eating behavior in adolescence: Confirmatory factor analysis and validity assessment
Authors: Duarte C. , Ferreira C. , Pinto-Gouveia J.
Published: June 2017

Introduction

On the onset of adolescence there is an increased vulnerability for mental health problems, namely disordered eating symptomatology. Disordered eating symptomatology has been described as a problem of psychological inflexibility. Psychological inflexibility related to eating behaviors, i.e., the adoption of inflexible idiosyncratic dietary rules without considering external and internal contingencies, is associated with disordered eating symptoms in adult populations. Nonetheless, the study of psychological inflexibility related to eating behaviors in adolescence is scarce.

Aims

The current study aimed at examining the factor structure and psychometric properties of the Inflexible Eating Questionnaire for Adolescents (IEQ-A).

Methods

Participated in this study, 728 adolescents (513 girls and 215 boys), aged 14 to 18 years, who completed self-report measures of psychological inflexibility related to eating behaviors, body image, disordered eating symptoms and general psychopathology symptoms.

Results

Results of the confirmatory factor analysis indicated that the IEQ-A replicated the 11-item one-dimensional structure previously identified in adult samples. A multigroup analysis also demonstrated the scale's structure invariance between genders. The scale presented high internal reliability for both boys and girls (95). Correlation analyses confirmed the scale's convergence with psychological inflexibility with body image. IEQ-A was also positively associated with disordered eating symptoms and depression, anxiety and stress symptoms.

Conclusions

Findings corroborated the adequacy of the IEQ-A factor structure and supported that this is a valid measure to assess psychological inflexibility related to eating behavior in adolescence. This measure is therefore of potential utility for clinicians and researchers focusing on eating-related difficulties in this vulnerable developmental stage.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Confirmatory factor analysis of the eating attitudes test short version in a sample of Portuguese women
Authors: Marques C. , Pereira A.T. , Marques M. , Soares M.J. , Roque C. , Macedo A.
Published: June 2017

Introduction

The Eating Attitudes Test-40 (EAT-40) is a valid index of symptoms frequently observed in eating disorders. The EAT-40 was adapted and validated for the Portuguese population. Thereafter a short-version composed of 25 items selected from the exploratory factor analysis (EAT-25) was developed. Apart from the total score, the TAA-25 evaluates three dimensions: Diet, Bulimic Behaviours and Social Pressure to Eat.

Objective

To examine the factor structure of the EAT-25 using confirmatory factor analysis (CFA) in a sample of Portuguese women.

Methods

The sample was composed of 433 women (mean age = 36.07; SD = 15.15). CFA was used to test the model suggested by prior exploratory factor analyses of EAT-25. AMOS software was used.

Results

After four items were deleted and some errors were correlated, CFA indicated a good fit for the second-order factor (χ2/df = 3.066; CFI = 0.918; GFI = 0.883, RMSEA = 0.069; P[rmsea ≤ 0.05] < 0.001). The 19-item TAA showed excellent internal consistency (α = 0.91) and the three dimensions presented good Cronbach's alphas (α > 0.80).

Conclusions

These findings suggest that the 21-item TAA model obtained through CFA is a reliable and valid measure to assess disordered eating attitudes among women.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The 4-hour window: UK Government targets versus clinical priorities
Authors: Cumming D.
Published: June 2017

Introduction

In 2002, the Department of Health (United Kingdom) introduced a 4-hour target due to long waiting times. It is expected that 95% of patients who attend the A&E (Emergency) Department should be registered and admitted/discharged within 4 hours. Exceeding this is termed a “breach”.

Objectives

The aim of this re-audit was to assess for a response following recommendations after an initial audit with concerning results. Forth Valley Royal is an acute public hospital in Central Scotland with 860 in-patient beds, covering a population of 300,000. It contains two general adult wards (42 beds), one IPCU (12 beds) and two Elderly wards (40 beds).

Methods

Referral data was sourced across 4 consecutive months: April–July 2015 (initial audit) and October 2015–January 2016 (re-audit). These included all referrals from A&E to Psychiatry. Times were calculated for the 4 subprocesses listed in Table 1 below.

Conclusion/discussion

Following the initial audit, interventions such as training A&E staff to better manage psychiatric patients and encourage earlier referrals, led to a positive response in the re-audit (Subprocess 1). Breach rates reduced to 28% (from 35%) on re-audit. Less breaches (81% compared to 88%) were referred after 2-hours by A&E. Overall, the breach rates have reduced and they are less attributable to the A&E referring patients late. The outcome of patients leaving A&E without being seen by a psychiatrist was unknown – adverse outcomes would strengthen the debate to enforce the 4-hour window.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.

Table 1Initial audit = 222 referrals (35% breach rate)Re-Audit = 348 referrals (28% breach rate)
Neuroleptic malignant syndrome: Case report and literature review
Authors: Martín Gutierrez R. , Medina Blanco R. , Suarez Pinilla P. , Landera Rodriguez R. , Juncal Ruiz M. , Río Hortega I. Madrazo del , Gómez Revuelta M. , Porta Olivares O. , González Gómez J. , Vázquez Bourgon J. , Hernando Fernández R.
Published: June 2017

Introduction

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.

Objective

To review the incidence, clinical characteristics, diagnosis and treatment of NMS.

Aim

We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.

Methods

A literature review of the NMS was performed using the PubMed database.

Results

The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.

Conclusions

NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Change with the times exploring psychiatric inpatients’ attitudes towards physical restraint
Authors: Spinzy Y. , Maree S. , Segev A. , Cohen-Rappaport G.
Published: June 2017

Introduction

When other options fail, physical restraint is used in inpatient psychiatric units as a means to control violent behavior of agitated inpatients and to prevent them from harm. The professional and social discourse regarding the use of restrictive measures and the absence of the inpatients’ attitudes towards these measures is notable. Our research therefore tries to fill this gap by interviewing inpatients about these issues.

Objectives and aims

To assess the subjective experience and attitudes of inpatients who have undergone physical restraint.

Methods

Forty inpatients diagnosed with psychiatric disorders were interviewed by way of a structured questionnaire. Descriptive statistics were conducted via use of SPSS statistical software.

Results

Inpatients reported that physical restraint evoked an experience of loneliness (77.5%) and loss of autonomy (82.5%). Staff visits during times of physical restraint were reported as beneficial according to 73.6% of the inpatients interviewed. Two thirds of the inpatients viewed the use of physical restraints as justified when an inpatient was dangerous. Two thirds of the inpatients regarded physical restraint as the most aversive experience of their hospitalization.

Conclusions

Our pilot study explored the subjective experience and attitudes of psychiatric inpatients towards the use of physical restraint. Inpatients viewed physical restraint as a practice that was sometimes justified but at the same time evoked negative subjective feelings. We conclude that listening to inpatients’ perspectives can help caregivers to evaluate these measures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Primary Health Care. Suicide Prevention Proposal. Santiago del Estero. Argentina
Authors: Sanchez Cantero T. , Costilla R. , Chávez M.
Published: June 2017

Background and aim

Suicide is a serious and growing problem worldwide. According to the World Health Organization, for each death there are twenty attempts on record. Every year over 800,000 people commit suicide, that is, one in every forty. 45% of the people who commit suicide visit their Primary Health Care physician in the previous month. Seventy-five percent of suicides take place in countries with medium or low income and Argentine heads the suicide rate in Latin America. In the last twenty years the death by suicides rate in young people (aged 15–35) and has decreased in older age groups (+ 55), which historically presented the highest rates. In the inner zone of the province of Santiago del Estero, suicides have increased among teenagers [1].

Aims

To know suicide statistics in young people in the last decade so that a prevention scheme can be produced.

Methods

Descriptive observational study.

Results

In the province of Santiago del Estero suicides occur more frequently among young people, aged 15–35, and the rate has increased significantly in the inner zone of the province.

Conclusions

The analysis carried out reveal that this problem in increasing in our province and it requires analysis and consensus in order to design a model of Primary Health Care Prevention.

Disclosure of Interest

The authors have not supplied their declaration of no competing interest.
Protective and risk socio-economic – environmental factors affecting mental health
Authors: Hussain M.I.
Published: June 2017

Over all generic, biological, environmental and socio-economic factors are attributing towards mental health and well being of a person. But among these socio-economic – environmental factors play a great role. It is very important to understand socio-economic – environmental protective and adverse factors affecting mental health. There is very dynamic interaction between individual attributes like socio-economic circumstances and environmental factors. The dynamic interactions of all these three factors determine the final outcome and status of mental health social well being. So, for our professionals particularly and community in general, it is very important to have full knowledge about all these factors. Because lack of managing and integrating of socio-economic-environmental factors, we will not be able to deliver quality psychiatric/psychological services. Community at large will also be ignorant of it and will not be able to play their roles towards healthy mental health formation. Moreover, these socio-economic – environmental factors are within our reach and can be modified.

Disclosure of interest

The author has not supplied his declaration of competing interest.