bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Correlates of Perceived Stress in Young Medical Undergraduates
Authors: Mihăilescu A. , Matei V.P. , Gâză L.M. , Mihailescu C. , Codreanu M.
Published: June 2017

Introduction

Emotional distress–specifically symptoms of anxiety and/or depression–in undergraduate medical student represent a major health issue for university life and for the entire society, as the onset of negative affectivity in young age is lowering quality of life of the affected individual and implicitly, the professional evolution.

Objective

The purpose of this study is to investigate the prevalence of perceived stress in medical undergraduates and relationship between perceived stress and emotional distress.

Methods

The study comprised a randomised population of 356 students from 1st and 2nd year in Faculty of Medicine who signed the informed consent for the research. Mean age in the group was 20.04 ± 0.9 years old. Instruments used in the study were self-rated Zung Anxiety Scale and Zung Depression Scale and Perceived Stress Scale. Data were analysed with SPSS 16. Statistical significance was at P < 0.05.

Results

Perceived stress of medium and high intensity was found in 62.5% of the students in the study. There is a significant effect of perceived stress on presence of emotional distress (F(3,352) = 36,431, P < 0.001). In the emotional distressed group, perceived stress in the period before the exams session is predicting emotional distress in the period of exams (academic stress) with OR = 1.145, P = 0.04, IC 95% = 1.006–1.303.

Conclusions

There is a high prevalence of perceived stress and perceived stress in the period before session of exams is a predictive factor for having emotional distress in session of exams. Therefore, we are signaling the necessity of implementation of stress management programs in medical undergraduates from the pre-clinical years.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk Evaluation in the Emergency Department: An Algorithm for Suicide Prevention
Authors: Duarte T. , Ferreira C. , Santos N. , Sampaio D.
Published: June 2017

Introduction

Suicide is one of the biggest challenges that psychiatrists face, especially in the emergency room. According to the World Health Organization, there are approximately 3000 suicides every day: one every 40 seconds. About half of all violent deaths in the world are suicides with economic costs of billions of euros. The risk assessment is still based on a subjective approach, with no screening or evaluation tools that support the decision about in-hospital or ambulatory treatment for these patients.

Objectives

Creation of a decision tree algorithm that can be used in the emergency room to guide the clinical decision.

Aims

Increase the number of avoided suicides.

Methods

PubMed database was searched and articles with the words “emergency”, “suicide”, “attempt” “screening” and “prevention” were included. Articles that used the most reliable and valid measurement tools (i.e., Beck Scale for Suicide Ideation and Suicide Probability Scale) for patient evaluation were selected. World Health Organization guidelines and the Portuguese Suicide Prevention Plan were analyzed and an algorithm was designed based on the major risk factors identified.

Results

No isolated risk factor was successful for preventing suicide: most are chronic and non-individualized. Having family history of suicide, a mental health disease, a suicide plan and previous suicide attempts are considered major risk factors. The algorithm is based on these factors and takes into account interpersonal variability.

Conclusions

The best way to prevent a suicide is to ask patients for major risk factors, and then, by using this algorithm, treat them accordingly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effects of Executive Function Stimulation in the Language Improvement of Children with ASD
Authors: Sun I. , Fernandes F.
Published: June 2017

The Autism Spectrum Disorder (ASD) is a neurobiological disorder that involves deficits currently classified into two areas:.

– social communication and interaction across multiple contexts;

– restricted, repetitive patterns of behavior, interests or activities.

Although, these disorders do not have any causal relationship, both are always present. It has increasingly been sought methods aiming at the effectiveness of intervention for this population seeking to include all aspects. A promising research field is the one that considers the interdependence of the language and cognition areas, specifically regarding executive functions. This study was designed to verify the effectiveness of an executive functions stimulation program (EFS) during the regular speech-language therapy sessions and its impact in language development, specifically in the pragmatic aspects, through the evaluation of the functional profile of communication (FPC) in 14 children with ASD. During a 12-week period of regular speech-language therapy, the following areas were focused: working memory, cognitive flexibility, central coherence, inhibitory control and specific language aspects. Data were registered and analyzed statistically. The average performance of children in the stimulation was 85%, ensuring the effectiveness of EFS. The association analysis between pre- and post-EFS performance with FCP a significant improvement was observed in the occupation of the communicative space and the percentage of interactivity. These results are consistent with the hypothesis of the study, which believes in strong association between communication aspects and executive functions skills.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cytogenetic Characteristic the Patients of Both Sexes with Phobic-anxiety Disorders
Authors: P.T.  , Bagatska N. , Mykhailova E. , Glotka L. , Reshetovska N. , Matkovska T. , Goloborodko A.
Published: June 2017

Background and aims

Anxiety-phobic disorders are caused both by environmental and hereditary factors. The study was designed to determine the level of chromosomal aberrations in the peripheral blood lymphocytes (PBL) of children and adolescents of both sexes with phobic-anxiety disorders (PAD).

Patients and methods

Cytogenetic analysis was performed in 27 children and adolescents of both sexes with PAD, aged 9–15 years; the control group consisted of 50 healthy peers of both genders. Statistical analysis-Excel and SPSS statistics 17.0.

Results

Cytogenetic analysis of patients with PAD and in healthy age-matched individuals has established normal female (46,XX) and male (46,XY) karyotypes. The frequency of the chromosomal aberrations (CA) spontaneous level in the PBL is 4.6 times higher than the CA frequency in healthy persons. In children and adolescents with the disease, the spontaneous frequency of aberrations of chromatid and chromosome types is also significantly higher than the same in healthy children and adolescents. Single acentric fragments and exchanges prevail among the chromatid–type aberrations; pair acentric fragments prevail among the chromosome–type aberrations. An increase in the frequency of the chromosome-type aberrations has been revealed in boys with PAD (1.72 vs.0.55 per100 cells in healthy boys, P < 0.001 by pair acentric fragments), in comparison with healthy boys; and the chromatid–type aberrations have been observed in girls with PAD (3.22 vs.0.94 per 100 cells in healthy girls, P < 0.001 by single acentric fragments), in comparison with healthy girls. A pronounced individual variability of CA frequency, which ranges in our patients from 2.0 to18.0 per 100 metaphase plates, has been found along with an increase in the CA level in patients with PAD.

Conclusion

Children and adolescents with PAD require a careful cytogenetic analysis and the consequent therapeutic measures for genome stabilization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Human neuropsin gene – new target in depression?
Authors: Gałecki P. , Jasionowska J. , Talarowska M.
Published: June 2017

Introduction

Neuropsin (NP, kallikrein 8, KLK8)–a kallikrein gene-related (KLK) endoprotease–plays a key role in neuroplasticity processes. Neuropsin expression takes places both extracellularly and inside neurons within the area of the hippocampus. Various forms of electrophysiological stimulation (kindling, LTP, stress) increase neuropsin expression within the hippocampus and in many other regions of the brain (e.g. neocortex, amygdala). Neuropsin is mainly engaged in the early stage of LTP and in the process of synaptogenesis. Social cognition deficits (difficulties with identification, naming and analysing experienced emotional states) in the group of people suffering from depression have been described in scientific papers published in recent years. They are considered the core features of major depressive disorders.

Aims

The aim of this study is to link the human neuropsin gene (hNP) expression with the ability of the examined subjects to use nonverbal communication in social interactions.

Methods

120 individuals meeting the diagnostic criteria for a recurrent depressive disorders (rDE) were qualified to participate in the study. The Emotional Intelligence Scale–Faces task and two subtests from The Right Hemisphere Language Battery (RHLB) were used in the study.

Results

Significant interrelations between expression on the mRNA level for the hNP gene and the variables used to assess social competences were confirmed. Results of the statistical analysis make it possible to confirm an inversely proportional correlation between the analysed variables.

Conclusions

Increased hNP expression is associated with a reduction of interpersonal abilities in the people affected by depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of residual symptoms on relapse and quality of life among Thai depressive patients
Authors: Tantrarungroj T. , Nakawiro D. , Wongpakaran T. , Wongpakaran N. , Bookkamana P. , Pinyopornpanish M. , Lueboonthavatchai P. , Apisiridej N. , Saisavoey N. , Wannarit K. , Srichan T. , Ruktrakul R. , Satthapisit S. , Temboonkiat A. , Tubtimtong N. , Rakkhajeekul S. , Wongtanoi B. , Tanchakvaranont S. , Srisutasanavong U. , Nivataphand R. , Petchsuwan D.
Published: June 2017

Introduction

Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates and quality of life among Thai patients with depressive disorders.

Methods

Hamilton Rating Scale for Depression (HAM-D) and EQ-5D were used to measure the symptoms of depression and quality of life, respectively. Prevalence of residual symptoms of depression was collected. Regression analysis was administered to predict relapse and patients’ quality of life at the 6 months post-baseline.

Results

Two hundred and twenty-four depressive disorder patients were recruited. Most of patients (93.3%) had at least one residual symptom, and the most common residual symptom was anxiety symptoms (76.3%; 95% CI, 0.71 to 0.82). After 3 months post-baseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (OR = 5.290, 95% CI, 1.42 to 19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ5D scores at 6 months post-baseline (B = −2.670, 95% CI, −181 to −.027, and B = −3.109, 95% CI, −172 to −.038, respectively).

Discussion

Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorders, so that prompt action can be taken to mitigate the risk of relapse.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
From Hampstead to Norwich: Ritual violence or coaching?
Authors: Kurz R.
Published: June 2017

Introduction

Video-recorded disclosures of two siblings emerged describing ritual violence activities in a Hampstead “cult” including human sacrifice murder. The UK court processes judged that the mother “coached” the children to make false allegations. In parallel, Marie Black, Jason Adams and Michael Roger were found guilty of child sexual abuse purely based on historical accounts of five children.

Objectives

The presentation outlines two cases that illustrate the “unbelievable” nature of organized child abuse and what aspects make court rulings “unsafe”.

Aims

The presentation aims to compare the Hampstead where the videos were watched by 4 million individuals world-wide with the little that is known about the “Norwich Three” case due to court reporting restrictions.

Methods

Materials posted on websites, books and videos were reviewed alongside discussions with whistle-blowers, relatives and friends of people involved.

Results

The disclosures in the Hampstead case were very extreme but similar accounts can be found in books by Sara Scott (UK) and De Camp (US). Those accused of sexual abuse claim that the children have been coached by their mother to make these allegations–the view that the judge adopted. In the Norfolk case, 7 of the 10 defendants were cleared of child sexual abuse allegations but three individuals were found guilty. It remains unclear what the basis was for the conviction as the disclosures could have been classed as the result of “coaching”.

Conclusions

Anyone operating in forensic settings should familiarise themselves with the “hall of mirrors” that cases involving child sexual abuse routinely constitute.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Methylphenidate challenge followed by therapeutic drug monitoring in adults with attention deficit/hyperactivity disorder: Clinical effects and its predictors
Authors: Piacentino D. , Giupponi G. , Maniscalco I. , Holzer S. , Pompili M. , Girardi P. , Conca A.
Published: June 2017

Introduction

Attention deficit/hyperactivity disorder (ADHD) affects 5–6% of adults. Methylphenidate challenge is used to test functions such as concentration. Therapeutic drug monitoring (TDM) identifies optimal drug ranges in plasma.

Objectives/Aims

We aimed to: assess the clinical impact of the drug challenge in adults with ADHD; analyze the relationship with the drug plasma levels after the challenge; identify predictors of the challenge's clinical impact.

Methods

In 2015–2016, we recruited 45 consecutive adult DSM-5 ADHD outpatients (mean age ± SD = 35.3 ± 2.1 years; females = 64.4%) at the Bolzano hospital department of psychiatry. Before and after administration of methylphenidate 10 mg, we measured concentration, impulsivity, tension, and general well-being with a VAS and an interview. After two hours, TDM was performed. Deltas were calculated for pre-/post-challenge measures. Correlations were measured with Pearson's r/point-biserial coefficient. A generalized linear mixed model estimated the size of association between tension/general well-being improvement and patient characteristics.

Results

After the challenge, the mean improvement ± SD was 24 ± 22 for concentration, 17 ± 23 for impulsivity, 21 ± 28 for tension, 16 ± 24 for general well-being. The mean TDM ± SD was 4.6 ± 0.5 ng/mL. A negative correlation between TDM, tension (P = 0.009), and general well-being (P = 0.028) after the challenge emerged: higher drug plasma levels relate to less tension and greater general well-being. At the GLMM the main predictor for tension/general well-being improvement was psychopharmacological treatment (P = 0.011/P = 0.05, respectively). Older age and difficult tasks prevented improvement.

Conclusions

Methylphenidate challenge had a positive effect on all patients’ performance. TDM values were lower than literature ones, although the latter are usually obtained after the administration of methylphenidate 20 mg.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dissemination of DBT for borderline personality disorder in Egypt, facts and challenges
Authors: Abdelkarim A. , Rizk D. Nagui , Ivanoff A.
Published: June 2017

Background

DBT proved to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning in Borderline personality disorder. As a step towards increasing utilization of evidence based treatments in the Egyptian healthcare system, the team at Alexandria university started a comprehensive DBT program.

Aim

To describe the implementation and dissemination experience of DBT in Egypt.

Methods

The implementation of DBT is examined quantitatively. Numbers were calculated retrospectively from the records at the implementation start in December 2013 and after 3 years in September 2016.

Results

Number of therapists increased from one team of 2 therapists and one observer to 16 therapists organized in 3 teams plus 4 observers. The initial team, 7 psychiatrists and 2 clinical psychologists, could host and attend the first DBT Intensive Training in the middle east in 2014. DBT intensive training is the official training model developed by Dr. Linehan. We started with 8 clients one group for adults in Alexandria at 2013, increasing to 150 clients in 12 groups for adults, adolescent and SUD patients in 2016 with an average increase of 18.75 folds. The team participated and presented about DBT in 23 local and regional scientific meetings and hosted two workshops in collaboration with BehavioralTech, the official training institute.

Conclusions

Although the DBT implementation in Egypt represented a great challenge, results are showing a promising increase in the number of trained therapists and participating clients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A RCT of a staff training intervention to promote quality of care in long-term residential facilities–the PromQual study
Authors: Cardoso G. , Papoila A. , Caldas-de-Almeida J.
Published: June 2017

Introduction

The shift of hospital-based to community-based mental health care, introduced the need to assess and promote quality of residential services.

Objectives

This RCT aimed at assessing the effectiveness of a staff training intervention to improve quality of care in residential facilities.

Methods

Twenty-three units with at least 12-hour on-site staff support per day in Portugal were assessed with the quality instrument for rehabilitative care (QuIRC) filled online by the manager. A random sample of service users were interviewed using standardised measures of autonomy, experiences of care, quality of life, and the time user diary (TUD) for level of activity. The intervention group units (n = 12) received workshops and a four-week hands-on training of the staff versus TAU in the control group (n = 11). All units and users were reassessed at 8-months. The staff knowledge gained during the workshops was assessed using pre- post-test. Generalized linear mixed effects models were used.

Results

The residential units were mainly in the community (n = 17, 73.9%), and had QuIRC mean scores above 50% in the following dimensions : living environment, self-management and autonomy, social inclusion, and human rights. Service users’ level of activity (TUD) at 8-months did not differ between intervention and control groups. At 8 months, all QuIRC dimensions scored higher in the Intervention group, without reaching statistical significance. Pre- post-tests comparison showed a significant increase in the knowledge acquired by the staff.

Conclusions

The intervention had impact on the staff's knowledge without reaching significant change of users’ activity and quality of care of the units.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Satisfaction with psychiatric in-patient care across 11 countries: Final report of the IDEA-study (inpatient discharge: experiences and analysis)
Authors: Krupchanka D. , Khalifeh H. , Thornicroft G. , Sartorius N. ,   IDEA research group
Published: June 2017

Introduction

Satisfaction of patients with in-patient care is a relatively rare focus of research in mental health.

Objectives

The IDEA-study (inpatient discharge: experiences and analysis) was initiated to shed the light on the issue internationally.

Aim

The IDEA project aimed to:

– develop a collaborative network of young psychiatrists;

– use this network to explore satisfaction of people treated in psychiatric in-patient facilities in a range of high-, middle- and low-income countries.

Methods

Study was conducted in 25 hospitals across 11 countries. We measured satisfaction with in-patient care using the 5-item study-specific questionnaire. Individual and institution level correlates of “low satisfaction” were examined by comparisons of binary and multivariate associations in multilevel regression models.

Results

A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards positive responses. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.

Conclusion

We could successfully establish a collaborative network of early career psychiatrists from different parts of the world and collect data in regards to the study aims. The positive skew of satisfaction scores need to be carefully considered in the context of literature and study limitations. In particularly, we suggest further studies on patients’ satisfaction to pay more attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, power imbalance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Program for the use of antipsychotics with metabolic monitoring in North Carolina medicaid children
Authors: Wegner S. , McKee J. , Trygstad T. , Wegner L. , Stiles A.
Published: June 2017

Introduction

Children are at greater risk than adults for weight gain and metabolic disorders including hyperlipidemia and diabetes with newer antipsychotics. A web-based safety-monitoring program using a prior documentation model required submission of patient safety data (prior documentation) for insurance coverage at the pharmacy point of sale. This program launched in April of 2011, covering all NC Medicaid and Health Choice recipients under age 18. Clinical monitoring parameters and interactive educational features were developed with pediatric psychiatric experts and key mental health stakeholder groups.

Objectives

Using a four-year run in period and a full 9 months of post implementation claims data, evaluate the rates of antipsychotic prescribing and safety monitoring before and after the implementation of the A + KIDS program.

Results

Implementation of this program was associated with a consistent monthly decrease in overall antipsychotic use and increases in patient monitoring of glucose and lipid (Figure. 1, Table 1).

Conclusions

The prior documentation registry was effective in decreasing antipsychotic use and increasing safety monitoring. The impact of changing to more traditional prior authorization on the same clinical endpoints is currently under evaluation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effort-based reward task, a behavioral measure to study negative symptoms in schizophrenia
Authors: Arcos A. , Berge D. , Pretus C. , Pous A. , Diez-Aja C. , Gomez L. , Vilarroya O.
Published: June 2017

Negative symptoms in schizophrenia, and specifically amotivation/apathy, have been correlated with impaired general functioning. Its neurobiological basis are thought to rely on an aberrant reward system. To study the association of reward deficits and negative symptoms, 25 schizophrenia patients and 35 controls underwent a new reward behavioral task. Briefly, patients had to choose a level of effort (1 to 3), each one corresponding to a progressively increasing number of required button presses and 3 different probabilities to win an economic reward. We compared the chosen effort between groups and correlated this output with the score of the Brief negative symptoms scale in the group of patients. Patients chose less effort than controls but without reaching significance level (mean patients effort: 2.49 vs controls: 2.76, P = 0.064). A negative correlation was found between BNSS score and effort chosen for the maximum reward corrected by sex (t: −0.021, P = 0.045). When the group of patients was split according to negative symptoms score, patients with more negative symptoms (BNSSS score > 23) chose significantly less effort than patients with less negative symptoms and controls (Fig. 1). Our reward task correlates well with negative symptoms. Thus, it could offer a behavioral measure of negative symptoms. It could be a good instrument to study the neurobiological basis of negative symptoms using functional techniques.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neural correlates of behavioral inhibition in healthy people and in patients with borderline personality disorder and ADHD
Authors: Linhartová P. , Kuhn M. , Damborská A. , Lamoš M. , Mikl M. , Barteček R. , Theiner P. , Kašpárek T. , Bareš M.
Published: June 2017

Introduction

Deficits in behavioral inhibition leading to impulsivity occur frequently in many otherwise different psychiatric diseases, mainly ADHD and borderline personality disorder (BPD). However, the research is complicated by using of different tests and their parameters. Further, the role of frontoparietal network in behavioral inhibition has been questioned recently.

Objectives

The aims of our studies were:

– to present the influence of differences in inhibition tasks parameters;

– to describe neural correlates of behavioral inhibition in healthy people;

– to compare them with BPD and ADHD patients.

Methods

We implemented two different variants of Go/NoGo Task, one designed for behavioral research and the second for neuroimaging. Thirty healthy participants (37% of women, age range 15 to 33 years) underwent behavioral and fMRI measurement. Further, groups of patients with BPD, ADHD and their healthy controls underwent the Go/NoGo Task under both fMRI and EEG.

Results

The results show differences in behavioral performance based on different task parameters. The fMRI results in healthy people show specific activation patterns within the frontoparietal network associated with inhibition trials (mainly inferior frontal gyrus, insula, cingulate gyrus, SMA, inferior parietal lobule). Further, we present differences between patients with BPD, ADHD and controls in BOLD signal and ERPs.

Conclusions

Go/NoGo Task design substantially influences the subjects’ behavioral performance. Our results with methodologically upgraded Go/NoGo Task design provide support for the inhibition frontoparietal brain network and its different activations in BPD and ADHD patients. The research was supported by Ministry of Health of the Czech Republic, grant nr. 15-30062A.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Factors influencing the rate of incidents in a United Kingdom high secure psychiatric hospital: Weekend, ward round and diagnostic effect?
Authors: Lewis F. , Blott H. , Bhattacherjee S.
Published: June 2017

Introduction

Broadmoor is a high secure psychiatric hospital divided into personality disorder (PD) and mental illness (MI) pathways. Whenever an incident occurs, it should be recorded. To better understand which factors influence the rate of incidents, such as diagnosis or intervention by medical and psychological staff, we examined the difference in the number of incidents recorded on weekdays versus weekends, ward round (WR) versus non-WR days and the PD versus MI pathways.

Method

All incidents recorded over a one-year period (3.11.2014–2.11.2015) were examined. Extraneous incidents were excluded, leaving subgroups of “aggressive” (physical and verbal) and “physical” (excluding verbal) incidents which were analysed. Data were adjusted for the difference in number of beds in each pathway.

Results

Of the 2369 incident reports included, more were recorded per day on weekdays than weekends, with little difference on WR versus non-WR days. The rates of both types of incidents were similar on both PD and MI admission wards, although the rate of “physical” incidents was 2.6 times higher and “aggressive” incidents 3.3 times higher in PD compared to MI rehabilitation wards.

Conclusion

The findings suggest the presence of medical and psychological staff during the week, and possibly the requirements they place on patients, may increase the rate of incidents within the hospital. Despite comparable rates on admission, MI rehabilitation wards have far fewer incidents than PD rehab wards, which may reflect the more intractable nature of PD versus MI. More work is required to confirm these findings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The presence of a subthreshold autism spectrum is associated with greater prevalence of mental disorders in parents of children with autism spectrum disorders
Authors: Gesi C.C.C. , Lagomarsini A. , Barberi F.M. , Guzzetta A. , Calderone S. , Cioni G. , Muratori F. , Dell’Osso L.
Published: June 2017

Introduction

Autism spectrum disorders (ASD) are highly heritable and first degree relatives (especially fathers) of autistic probands have been shown to often manifest a set of subthreshold autistic features. It is not known, however, the clinical significance of this subthreshold autism spectrum.

Objectives

– to evaluate the prevalence of a subthreshold autism spectrum respectively in fathers and mothers of children with ASD;

– to describe clinical correlates of parents with and without a subthreshold autism spectrum respectively.

Methods

36 fathers and 39 mothers of preschoolers with ASD were administered the autism-spectrum quotient (AQ), the adult autism subthreshold spectrum (AdAS spectrum), the trauma and loss spectrum (TALS), the SCID-5 and the social and occupational functioning assessment scale (SOFAS).

Results

Fathers and mothers did not differ for both AQ and AdAS spectrum total and subscale scores. Overall, 13 parents (17.3%) scored higher than 45 on the AdAS spectrum, as indicative of the presence of a subthreshold autism spectrum. This group showed greater prevalence of mood, anxiety and feeding/eating disorders, greater utilization of antidepressants and higher scores on the TALS and the SOFAS than the group scoring lower than 45 (all P < 0.05).

Conclusions

Fathers and mothers of children with ASD show autistic traits in equal measure. The presence of a subthreshold autism spectrum is associated to greater prevalence of mood, anxiety and feeding/eating disorders, to greater susceptibility to traumatic events and to lower levels of functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The prevalence of post-traumatic stress disorder (PTSD) in Korean parents lost their children by the tragic sinking of ferry Sewol
Authors: Kim S.J.
Published: June 2017

A South Korean passenger ferry, the Sewol, carrying 476 people, capsized and sank in 2014 resulting in 295 deaths and 9 missing. Most were high-school students on a school trip (246 deaths, 83.4%) and many parents who lost their children had suffered from a wide range of mental and physical health consequences. This research examines the extent and intensity of ongoing psychological distress and PTSD symptoms among the parents 2 years after the disaster. The 141 parents of the high-school victims agree with research participation were surveyed using a questionnaire on sociodemographic data. We conducted the structured clinical interview including PTSD and suicide assessment for them. Among the 141 subjects, 56.0% (n = 79) meet the PTSD diagnostic criteria, suggesting that, after two full years, more than a half of them are still suffering from chronic psychological pains. This result is higher than any other PTSD study about indirect victims. In particular, 42.6% (n = 60) reported suicidal ideation and 4.3% (n = 6) actually attempted suicide but failed. These figures are on the order of 10 to 100 times higher than the national prevalence. This research is characterized by homogeneity of the subjects in that they were all the parents of young adolescent victims. After two years of traumatic experiences, more than a half of the interviewed parents who lost their children are still suffering from the PTSD. These findings suggest that post-disaster PTSD can be larger and last longer when the relationship was more intimate and the death of the victim was less expected.

Disclosure of interest

The author has not supplied his declaration of competing interest.
An evaluation of the use of electroconvulsive therapy in a United Kingdom high secure psychiatric hospital
Authors: Blott H. , Bhattacherjee S. , Harris E.
Published: June 2017

Introduction

Electroconvulsive therapy (ECT) is an effective NICE-approved treatment for severe depression, treatment-resistant mania and catatonia; the Royal College of Psychiatrists’ (RCPsych) guidelines also support its use fourth line for treatment-resistant schizophrenia.

Objectives

Evaluate the use of ECT at Broadmoor High Secure psychiatric hospital, focusing on the indications for its prescription and patients’ capacity to consent.

Method

Analyse case records of all patients who received ECT, and of all patients referred for Second Opinion Appointed Doctor (SOAD) certified ECT treatment under Section 58 of the Mental Health Act 1983 (MHA) due to incapacity, between 01.09.11 and 30.07.15.

Results

All patients lacked capacity to consent to treatment during this time. Thirty-three referrals were made to the SOAD service for 15 patients, and of these 30 resulted in certification (T6) of which 10 were not subsequently used. Improvements in mental state and agreement to take clozapine were common reasons for T6s either not being certified or used. Urgent treatment under Section 62 of the MHA was employed 7 times for 4 patients during this period. Of the referrals to the SOAD service, 25 were for treatment-resistant schizophrenia, 5 for mania, 3 for catatonia and none for depression.

Conclusions

Those patients requiring ECT within this population tended to be the most unwell and all lacked the capacity to consent to it. The majority (76%) of patients receiving ECT at Broadmoor do so outside of NICE (but within RCPsych) guidelines. ECT may be an effective strategy for promoting compliance with clozapine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Compare “family atmosphere” in informal caregivers of patients with psychotic symptoms compared to their inclusion or not in self-help associations
Authors: Mentis M. , Gouva M. , Kotrsotsiou E. , Angelopoulos N.V. , Dardiotis E.
Published: June 2017

Introduction

The participation of informal caregivers in the café of patients with psychotic symptoms in coordination with self-help groups have been found to reduce the expressed emotion in combination with psychoeducations interventions help create a supportive environment.

Objectives

This study investigates the differences in the family atmosphere of informal caregivers of patients with psychotic symptoms.

Aims

To compare whether or not the participation of informal caregivers of patients with psychotic symptoms in self-organized associations helps to foster a supportive family environment, hence reducing the risk of relapse.

Methods

Snowballing sampling consisting of 510 informal caregivers of patients with psychotic symptoms was used in the current study. The Family Environment Scale of Moos and Moos and socio-demographic questions were implemented to collect the data. Control Cronbach's Alpha reliability of scale gave value a = 0.795.

Results

The comparison showed that informal caregivers of patients with psychotic symptoms irrespective of their participation or not in self-help associations do not show significant differences in Family Environment Scale. Significant statistical difference between the two groups (P < 0.05) only occurred in the subcategory “organization”, as the first group (m = 4.68, df = ± 2.233) were found to have lower values compared to the other group (m = 5.21, df = ± 2.233).

Discussions

The study demonstrated that informal caregivers of patients with psychotic symptoms involved in self-help groups do not show to have a particular difference in the family atmosphere than families who do not participate in self-help associations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy of F17464, a new preferential D3 antagonist in a placebo-controlled phase 2 study of patients with an acute exacerbation of schizophrenia
Authors: Bitter I. , Groc M. , Delsol C. , Fabre C. , Fagard M. , Barthe L. , Gaudoux F. , Brunner V. , Brackman F. , Tonner F.
Published: June 2017

Introduction

F17464 is a new highly potent preferential D3 antagonist, 5-HT1A and weak D2 partial agonist, with confirmed antipsychotic-like activity in animal models. In healthy volunteers, F17464 had a good safety and tolerability profile. A PET-scan study determined a high D3 occupancy rate up to 22 h after a single dose.

Objectives

The primary objective was to evaluate the efficacy of 40 mg/day of oral F17464 in comparison to placebo.

Methods

This double-blind, parallel group, multicenter study included patients with acute exacerbation of schizophrenia treated for 6 weeks as antipsychotic monotherapy. Patients were hospitalised for the first 3 weeks of treatment, then continued as outpatients.

Results

The 144 randomized patients had a baseline PANSS mean (SD) total score was 89.6 (9.5). The change from baseline of PANSS total score to Day 43 on the FAS (LOCF), showed a statistically significant difference in favor of F17464 over placebo: adjusted mean (SE) change −13.5 (2.1) on F17464 and −7.8 (2.2) on placebo with a treatment effect estimate −5.7 (2.7). The 20% or 30% response rate was statistically higher in the F17464 group (47.2% and 25.0%) compared to the placebo group (30.6% and 13.9%). The incidence of treatment-emergent adverse events was slightly higher in the F17464 group (70.8%) than in the placebo group (62.5%). There were no clinically-relevant hepatic, metabolic, or cardiovascular abnormalities. No EPS was reported under F17464.

Conclusion

This is the first D3 antagonist that proves efficacy. The results of this phase 2 study also demonstrate the favorable safety profile of F17674 when compared to placebo.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stigma in early detection of psychosis: Subjective experiences of those concerned
Authors: Uttinger M. , Rapp C. , Studerus E. , Beck K. , Riecher-Rössler A.
Published: June 2017

Introduction

Despite the large scientific debate concerning potentially stigmatizing effects of informing an individual about being in an at-risk mental state (ARMS) for psychosis, studies investigating this topic are rare and quantitative assessment of this kind of stigmatization does not exist so far.

Objectives

This study presents first results regarding potentially helpful or stigmatizing effects of being informed about an ARMS assessed with a newly developed quantitative self-rating (FePsy-Stigma questionnaire).

Methods

Forty ARMS patients participating in the prospective Basel Early Detection of Psychosis (FePsy) study as well as patients clinically assessed in the early detection service of the Psychiatric Services of Solothurn, completed the FePsy-Stigma questionnaire during their follow-up assessments at least six months after they had been informed about their increased risk of developing psychosis. The questionnaire was constructed based on a previous qualitative study and on adapted versions of formerly used instruments for assessing stigma in mental health (Internalized Stigma of Mental Illness Scale, Personal Beliefs and Experiences Questionnaire).

Results

Stigmatization appeared to be low overall except for social withdrawal due to suspected stigma. Stigma resistance, stereotype awareness and expected discrimination scored considerably higher than actually experienced discrimination, alienation and stereotype endorsement.

Conclusions

The results suggest that early detection services help individuals cope with symptoms and build certain resilience toward potential stigmatization, rather than enhancing or causing the latter. In line with previous studies, our results indicate that there is a considerable difference between expected and actually experienced discrimination as well as between stereotype awareness and stereotype endorsement.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Long-term metabolic effect of second-generation antipsychotics in first episode of psychosis
Authors: Vázquez Bourgon J. , Pérez-Iglesias R. , de la Foz V. Ortiz-García , Crespo-Facorro B.
Published: June 2017

Introduction

There is growing evidence indicating that the use of second-generation antipsychotic (SGA) treatments in psychosis is related to potential metabolic side effects. Previous studies have shown clear metabolic side effects at short-term (12 weeks). However, to detect clinically-relevant impairment in metabolic parameters a long-term follow-up is preferred.

Objectives

The aim of this study was to investigate the effect of aripiprazole, ziprasidone and quetiapine on metabolic measures in medication-naïve first episode psychosis patients after 1 year of treatment.

Methods

One hundred and sixty-eight, drug-naïve patients, suffering from a non-affective first episode of psychosis, were included in the present study. Patients were randomly assigned to quetiapine, ziprasidone or aripiprazole treatment lines. Weight and glucemic/lipid parameters were recorded at baseline and after 1 year of treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.

Results

Weight (t = −10.85; P < 0.001), BMI (t = −11.38; P < 0.001), total cholesterol (t = −5.37; P < 0.001), LDL-cholesterol (t = −5.21; P < 0.001), triglycerides (t = −5.18; P < 0.001) and the triglyceride/HDL insulin resistance index (t = −4.09; P < 0.001), showed statistically significant increments after 1 year of treatment.

Moreover, on comparing the percentage of patients with pathological levels before and 1 year after the antipsychotic treatment, we detected higher percentages of patients with obesity (5.1% vs. 15.3%; P < 0.001), hypercholesterolemia (23.2% vs. 39.6%; P < 0.001) and hypertriglyceridemia (5.8% vs. 14.2%; P = 0.021) after 1 year of treatment.

Conclusions

The primary exposure to SGAs during the first year of psychosis was associated with significant increments in weight and metabolic parameters leading to a significant increment in the proportion of obesity, hypertriglyceridemia and hypercholesterolemia in our sample.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dysregulation of emotions among pathological gamblers: The role of savoring
Authors: Rogier G. , Velotti P.
Published: June 2017

Introduction

Theories have conceptualized pathological gambling as an attempt to cope with emotional states. However, there is a lack of research about emotion dysregulation in this population. In a similar way, few is known about the nature of emotion regulation strategies used by pathological gamblers. Furthermore, it is not clear if pathological gamblers have difficulties to regulate negative emotions (as sadness) or positive ones (as excitement).

Objectives

We sought to explore the associations among pathological gambling, emotion dysregulation and different types of emotion regulation strategies, comparing a clinical sample with community participants.

Aims

To highlight similarities and differences in emotion dysregulation between pathological gamblers and healthy participants.

Methods

A sample of pathological gamblers and a sample of healthy men, were administered the South Oaks Gambling Screen (SOGS), Difficulties in Emotion Regulation Scale (DERS), Difficulties in Emotion regulation Scale-Positive (DERS-P), Emotion Regulation Questionnaire (ERQ) and the Ways of Savoring Checklist (WOSC).

Results

As expected, both levels of emotion dysregulation and suppression were significantly higher in the clinical sample while levels of savoring and reappraisal were significantly higher in the community sample.

Conclusions

Such results confirm the theorization of pathological gambling as a dysfunctional response to emotional states and underline the role of positive emotions. Specifically, pathological gamblers may be prone to suppress negative emotions instead to engage in functional strategies as reappraisal. Gamblers also fail to regulate positive emotions showing a poor capacity of savoring positive moments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Relationship between insomnia and tobacco smoking in alcohol-dependent patients
Authors: Wnorowska A. , Jakubczyk A. , Klimkiewicz A. , Mach A. , Brower K. , Wojnar M.
Published: June 2017

Introduction

Insomnia and tobacco use are frequent and important problems in alcohol-dependent patients. However, the relationship between sleep problems and cigarette smoking was not thoroughly investigated in this population.

Aim

The purpose of the study was to investigate the relationship between tobacco smoking and severity of insomnia in alcohol-dependent patients in treatment. We also aimed at assessing other predictors of insomnia in this population.

Methods

The study group comprised 384 alcohol-dependent patients. Standardized tools were used to assess: tobacco dependence (Fagerström Test for Nicotine Dependence [FTND]), sleep problems (Athens Insomnia Scale [AIS]), severity of alcohol dependence (Michigan Alcohol Screening Test [MAST]) and drinking quantities before entering treatment (Timeline Follow Back [TFLB]). Other comorbid psychiatric symptoms were assessed using Brief Symptom Inventory (BSI) and Barratt's Impulsiveness Scale (BIS-11).

Results

The study group included 79.1% of current smokers, 62% of participants reported insomnia (AIS). The mean FTND score was 6.05 ± 2.18. The multivariate regression analysis revealed that the severity of tobacco dependence was significantly associated with the severity of insomnia (FTND, beta = 0.140, P = 0.013). Other factors associated with insomnia that remained significant in multivariate model were severity of psychopathological symptoms (BSI, beta = 0.422, P < 0.0005) and intensity of drinking (TLFB, beta = 0.123, P = 0.034).

Conclusion

Tobacco use may predict severity of insomnia in alcohol-dependent patients. This finding may have important clinical implications and influence strategies applied in treatment of alcohol use disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.