bluuebunny/crossref_metadata_2025 huggingface dataset:
Who gains from suicide risk assessment: Health inspectorate and health insurances, or also psychiatrist and patient?
Authors: Gonlag A. , van Baest M. , Rijnders C. , Teijeiro R.
Published: May 2016

Introduction

The number of suicides rises in the Netherlands. In 2008, 1435 suicides were recorded; in 2012: 1753 (CBS). Adequate risk assessment with suicidal behaviour (SRA) is essential for prevention. The Health Inspectorate and Insurances seek to have a stronger grip on the way suicide risk is assessed and insist on using questionnaires. This runs counter to the multidisciplinary guidelines in the Netherlands for diagnosis and treatment of suicidal behaviour, which state that “questionnaires or observation instruments cannot replace clinical diagnostic examination.”

Objective

Do questionnaires rather than ‘care as usual’ (CAU) in SRA lead to different treatment policies?

Aim

To determine whether the use of questionnaires rather than CAU in SRA leads to different treatment policies.

Methods

Patients who were seen by staff at the department of Psychiatry at the ETS Hospital, either for in-house consultation or at the MPU, in connection with attempted suicide, auto-intoxication, or psychological distress with suicidal statements. Patients were examined by conducting a questionnaire, resulting in treatment policy (admission, discharge with an appointment with patient's own practitioner, discharge with referral to a practitioner, discharge without aftercare). Then, the same patient was again examined by another colleague in a free interview (CAU). The colleague was not informed about the outcome of the first assessment. Again, treatment policy was determined as a result. The two outcomes were then compared.

Results

Data collection still continues.

Conclusions

There are signs that there are no differences in the determined treatment policies following SRA based on the use of questionnaires or CAU.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Computational modeling of reinforcement learning using probabilistic selection task and instructional probabilistic selection task
Authors: Frydecka D. , Drapala J. , Kłosińska E. , Krefft M. , Misiak B.
Published: May 2016

Introduction

Humans learn how to behave both through rules and instructions as well as through environmental experiences. It has been shown that instructions can powerfully control people's choices, often leading to a confirmation bias.

Aim

To compare learning parameters in reinforcement learning task with and without instructions.

Methods

We recruited 52 healthy adult control subjects (21 males, 31 females, age 30 ± 6.5 years). Participants completed Repeatable Battery of Neuropsychological Status (RBANSS). Twenty-seven participants completed additionally Probabilistic Selection Task (PST) while twenty-five participants completed Instructional Probabilistic Selection Task (IPST). To analyze learning parameters, we used Q-learning model with 3 parameters: learning rate due to positive and negative reinforcements as well as exploration-exploitation parameter.

Results

Both groups did not differ with respect to cognitive functioning measured with RBANSS (immediate and delayed memory, visuospatial abilities, language and attention); however, participants who completed PST had trend-level statistically faster learning rates due to positive (P = 0.099) and negative reinforcements (0.057) in comparison to participants who completed IPST. Both groups did not differ with respect to exploration-exploitation parameter (0.409).

Conclusion

In healthy adults, interference of confirmation bias can influence learning speed independent of cognitive functioning (immediate and delayed memory, visuospatial abilities, language and attention).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk associated to subtypes of seizure disorders in dementia patients
Authors: Habeych M. , Castilla-Puentes R.C.
Published: May 2016

Introduction

Seizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the subtypes of those seizures have not been characterized.

Objective/aim

To compare the occurrence of seizure disorders (partial and generalized) between patients with and without a dementia diagnosis from the OPTUM database.

Methods

All ages, and patients with full eligibility between January of 2005 to December of 2014, were included. Data from OPTUM, a de-identified, HIPAA compliant database, made up of 40.7 million private insured patient individual electronic health records from the US, were utilized. Using ICD-9 diagnoses, the occurrence of generalized or partial seizure disorders was identified. A comparison between patients with and without dementia was performed.

Results

A total of 150,516 patient records had a dementia diagnosis, and, 56.38% of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [odds ratio (OR) = 6.5 95% CI = 4.4–9.5]; grand mal status (OR = 6.5, 95% CI = 5.7–7.3); partial seizures (OR = 6.0, 95% CI = 5.5–6.6); motor simple partial status (OR = 5.6, 95% CI = 3.5–9.0); epilepsy (OR = 5.0, 95% CI = 4.8–5.2); complex partial epileptic seizures (OR = 4.9, 95% CI = 4.6–5.2); generalized convulsive epilepsy (OR = 4.8, 95% CI = 4.5–5.0); localization-related epilepsy (OR = 4.5, 95% CI = 4.1–4.9); petit mal status (OR = 4.2, 95% CI = 2.9–6.1); fits convulsions (OR = 3.5, 95% CI = 3.4–3.6); and complex febrile seizure (OR = 2.5, 95% CI = 1.6–3.9).

Conclusions

The present study confirms that patients with dementia have higher risks for either generalized or partial seizures disorders when compared with patients without dementia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical morbidity at pregnancy: The role of previous suicidal attempts and repetition
Authors: Soares M.J. , Bos S. , Pereira A.T. , Marques M. , Maia B. , Macedo A.
Published: May 2016

Introduction

Previous suicide attempts are a consistent risk factor for suicide. Repetition has been associated with higher future morbidity and suicidality.

Aim

To examine the relationship between psychological variables at pregnancy and previous repetition of suicidal attempts, first attempts and absence of attempts.

Methods

The sample comprise 568 third trimester pregnant women, mean aged 29.82 years (SD = 4.55; variance = 17–44). Previous suicidal behaviors were assessed with diagnostic interview for genetic studies, depression with PDSS and BDI-II, and affect with POMS. Current suicidal thoughts were assessed with PDSS dimension; hopelessness and helplessness by summing the scores of the POMS items hopeless/gloomy; and lonely/helpless, respectively.

Results

Repeaters (R; n = 11, 1.9%) scored higher than non-repeaters (NR; n = 20, 3.5%) in most of the clinical variables, but only significantly in sleeping/eating disturbances (PDSS).

R and NR when compared to women who never attempted suicide (NA; n = 535, 94.5%) both revealed significant higher levels of depressive/hostility affect (POMS), BDI-II total score, suicide ideation, guilt/shame (PDSS) and anxiety/insecurity or anxiety/somatic (PSDD or BDI-II).

In comparison with NA, R also revealed significant higher levels of negative affect (POMS), PDSS total score, loss of self, mental confusion (PDSS), cognitive and affective symptoms, fatigue (BDI-II), hopelessness and helplessness. NR also differs from NA in their higher emotional liability (PDSS).

Conclusion

Women with previous suicide attempts are at elevated risk for high depressive symptoms, negative affect and suicide ideation at pregnancy. Compared to never attempters, repeaters revealed high morbidity than first attempters. The intervention in pregnancy must carefully assess previous history of suicide attempts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Are suicidal thoughts in adolescents dependent on substance abuse?
Authors: Wypiór M. , Sobieraj A. , Salomon-Perzyński A. , Dyrda W. , Krzyżowska K. , Matusiak A. , Paluch K. , Seweryn M. , Janas-Kozik M.
Published: May 2016

Substance abuse is common issue in youth and may influence youth's suicide thoughts or actions. It can lead to social isolation, low self-esteem, loss of work or school, estrangement from family and friends – all these may create a core of stresses that may lead to suicidal tendencies.

Analysis addictive factors correlating with occurrence of suicidal thoughts and behaviours among adolescents at the age of 18–20.

Study was based on authorial, previously validated questionnaire, included 16 questions about suicidal thoughts. Questionnaires were filled by adolescents (age 18–20) of 21 Secondary Schools in Katowice.

From the group of 965 adolescents, 28.8% had suicidal thoughts. From all respondents: 31.3% smoked, 92.7% drunk alcohol, 16.0% used legal hights and 30.9% – drugs; 35.8% of smoking adolescents had suicidal thoughts. In group of non-smoked adolescents – 25.6%. There was statistical significant difference (P = 0.0012) between these groups. Among adolescents who drunk alcohol, 28.8% had suicidal thoughts. In the group of non –drinking alcohol adolescents – 27.9%. There was no statistical significant differences (P = 0.88233) between these groups. There were 43.7% adolescents with suicidal thoughts who used legal hights. In the group of non-users of legal hights, 26.0% adolescents had suicidal thoughts.

Adolescents that are using examined stimulants are in the group risk of suicidal thoughts and autodestructive behaviours. Results show the need of psychiatric and psychotherapeutic support that is aiming to prevent suicides and autodestructive behaviours in this group. Screening questionnaires that are assessing the problem of addiction within the adolescent may help to identity persons with suicidal tendencies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development and assessment of a mobile phone-based intervention to reduce maternal depression and improve child health
Authors: Husain N. , Kiran T. , Fatima B. , Chaudhry I.B. , Saeed Q. , Masood S.N. , Husain M. , Zafar S.N. , Gire N. , Alvi M.H. , Khoja S. , Naeem F.
Published: May 2016

Introduction

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

Objective

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

Aim

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

Methods

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Results

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

Conclusions

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
MindfulSpot: A mindfulness mobile app for people dealing with infertility
Authors: Monteiro B. , Galhardo A. , Cunha M. , Couto M. , Fonseca F. , Carvalho L.
Published: May 2016

Introduction

Infertility is not only a medical condition and its impact in mental health is well established. Although most couples facing fertility problems and the demands of medical treatment are able to adjust, some of them may show psychological difficulties with clinical relevance, such as depression and anxiety. The Mindfulness Based Program for Infertility (MBPI) is a group intervention designed for infertile women and data from its efficacy study revealed impact in depressive symptoms reduction as well as in internal and external shame, entrapment and defeat. Based on the MBPI, a mindfulness app targeting infertile patients was developed – the MindfulSpot.

Aims

This study addresses the MindfulSpot development.

Methods

The MindfulSpot is a prototype mobile app, which seeks to offer the chance of practicing mindfulness in a comfortable and accessible way. This app covers informative audio and written texts. The audio contents correspond to mindfulness formal practices and suggestions for informal practice, making possible its use throughout different moments of the day. Beyond the practices mentioned above, users are invited to explore the informative menu, including information on the impact that infertility may have in several aspects of the patients’ lives.

Results

The efficacy of the MindfulSpot is still under analysis and results are expected to be available soon.

Conclusions

The MindfulSpot was designed as a medium for training mindfulness skills and it includes useful information regarding specific aspects of the emotional impact of infertility. Additionally to its independent use, it may also be used as a support tool of the MBPI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Towards a gold standard for internet-delivered programs in behavioral and mental health
Authors: Richards D. , Vigano N. , O’Callaghan D.D. , O’Brien E. , Mooney J. , Bonner C.
Published: May 2016

Introduction

Technological innovation has been pervasive and has touched almost every aspect of modern life, including the delivery of behavioural and mental heath care. As telehealth expands, internet interventions are particularly interesting as a medium of delivering effective care. However, standards are required to help inform healthcare policy makers, providers, clinicians and patients.

Objective

Move towards outlining a gold standard for internet-delivered behavioural and mental health interventions.

Aims

Contribute and build upon existing standards and guidelines for the practice of telehealth, but to now extend these to include internet-delivered interventions.

Methods

Drawing from research, experience and practice, the authors propose a matrix for the evaluation of what might be considered a gold standard for internet-delivered behavioural and mental health interventions.

Results

Seven elements are proposed and considered aspects of what would constitute a gold standard and they include, the use of evidence-based and empirically supported content, robust, engaging, secure and responsive technologies, shaped by behavioural health subject matter experts, employ user-centred design and development principles, have a focus on accountable care-achieving clinical outcomes, have research and evaluation that supports its effectiveness, and a well developed implementation science and support.

Conclusion

The paper proposes some characteristics that could compose a gold standard for internet-delivered interventions for behavioural and mental health care. The contribution is neither exhaustive nor conclusive, but offers an invitation to the discussion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A psychiatrist's poll on their methods to treat schizoaffective disorder
Authors: Aguado L. , Girela B. , Calvo P. , Muñoz-Negro J.E. , Cervilla J.A.
Published: May 2016

Introduction

Schizoaffective disorder (SAD) is the second most frequent psychotic disorder after schizophrenia. There is a relative scarcity of specific studies looking into SAD treatment and evidence on drug treatment of SAD is patchy. We aimed to study naturalistically, interviewing psychiatrists systematically, what do they think is most useful in SAD treatment.

Objectives/aims

To know the actual management of SAD in real clinical practice and provided data for effective clinical studies.

Methods

We administered an online poll to 65 psychiatrists (52% male, 48% female), 75% of which described themselves as having a holistic background. The poll was completed using a Google doc's questionnaire. The three main questions made were:

– what is your first treatment choice for SAD;

– do you tend to use mono- vs. poly-therapy;

– provide a level of utility for each drug between 1 (little use) to 4 (maximum use).

Results

Atypical antipsychotics were considered the most common first choice in the treatment of SAD according to 66.2% of psychiatrists. The second most selected first choice answer was combining drugs and psychotherapy, which was answered by 20% of the sample. Monotherapy was preferred (60%) to polytherapy (40%). Finally, the most useful drug for SAD according to the sample was aripiprazole followed by mood stabilizers, olanzapine and paliperidone.

Conclusions

Real practice in SAD treatment may differ grossly to what is advocated for in clinical guidelines and seem to also deviate from officially approved indications of some drugs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pharmacotherapy of acute psychotic states: The reason for benzodiazepines and valproic acid augmentation
Authors: Veraksa A. , Egorov A.
Published: May 2016

Acute psychotic states (APS) usually are diagnosed as schizophrenia spectrum and affective disorders and make up about 45% of cases. The goal of the study was to elucidate the effect of benzodiazepines (BDZ) and valproic acid augmentation in the APS pharmacotherapy. The study was carried out on 102 inpatients diagnosed up to ICD-10 as schizophrenia (n = 24), acute and transient psychotic disorders (n = 40), other mental disorders due to brain damage and dysfunction and to physical disease (n = 17), schizoaffective disorder (n = 12), bipolar affective disorder (n = 9). Patients were randomized into four therapeutic groups:

– benzodiazepines (BDZ);

– one neuroleptic or combination of one neuroleptic and one BDZ (NBDZ);

– combination of valproic acid with BDZ or neuroleptic (VBDZN);

– polypragmasy (PP): from two drugs of one group up to four and more drugs at the same time.

The mental state of the patients was evaluated daily and estimated before, weekly and after APS termination by BPRS and CGI scale. The APS in all groups lasted from 1 to 50 days (mean 11.4). The shortest duration of APS was In BDZ group – 4.7 days; in VBDZN and NBDZ, the duration was 7.0 and 7.4 days (P < 0.05); in PP group, the treatment lasted 24.5 days (P < 0.001). Before therapy, average BPRS rate was 43.5 ± 8.1, CGI – 6.2 ± 0.8; after APS, BPRS was 18.9 ± 2.1, CGI – 1.1 ± 0.3. All rates did not differ among subgroups. APS therapy by BDZ and its combination with neuroleptics and valproic acid was effective compared to the polypragmasy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Therapeutic children's book: “I Managed to Overcome my Fears”
Authors: Lima C.
Published: May 2016

The book “I Managed to Overcome my Fears” was written based on the experience of the author. The sleep disorders in children are sometimes emotional fragility of reflection lived at the time. Caused by routine changes or adaptive and considered normal in child development. This book is meant to be a major therapeutic instrument to be used by therapists and other technicians engaged in the mental health of children. It contains the story, therapeutic indications and therapeutic homework. Getting help children overcome the fears that torment sleep, it will be easier with this feature.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
DECIDE Study: Antipsychotic treatment profile. Comparison of antipsychotic polytherapy in patients discharged after acute episode of UHSM, taking decisions shared vs. usual care strategies
Authors: Revuelta J. Pérez , Celis M. Ayerbe de , Juan J.M. Mongil San , Gomez C. Rodriguez , Moreno J.M. Villagran
Published: May 2016

Introduction

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.

Aims

Analyze the degree of antipsychotic politherapy or monotherapy in patients discharged after their inclusion in the study and randomized to Share Decision-Making or Treat as Usual. Present preliminary conclusions after 20 months of follow-up.

Methods

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Previous antipsychotic treatment is collected by interviewing patient and family and as included in digital history and health card, discharge and reviews conducted at 3, 6 and 12 months.

Results

Interim analysis shows there are no differences between groups (SDM and TaU) before intervention, we note the following results:

– the degree of antipsychotic politherapy prior to admission for the entire sample decreased at discharge;

– at discharge, there is a difference between SDM and TaU. Antipsychotic polytherapy in SDM decreases in a higher level.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Delirium associated with sertraline, a case report
Authors: Salgado N. , Benavente S. , Macias B. , Duran M. , Leganes P.
Published: May 2016

Introduction

Delirium is a clinical entity consisting of acute loss of consciousness, with attention deficit and fluctuating evolution. Antidepressive medication can cause these symptoms or worsen them.

Case report

We report the case of a 84-year-old blind female who was diagnosed of delirium in relation to intoxication with sertraline. The patient was admitted into a short-stay psychiatric unit for three days. She presented behavioural disturbances consisting in auto and heteroaggressive behaviour, altered consciousness and visual hallucinations (rocks, turtles). When dosage of sertraline was doubled from 50 mg/day to 100 mg/day visual hallucinations started. There were not other medical causes found, so sertraline was suspended, achieving clinical improvement.

Discussion

This case report shows how a patient with antidepressive treatment can display delirium. The three main causes of delirium that are infections, side effects and methabolic syndrome.

Conclusions

In the case of treating a patient with delirium, the presence of previous illness has to be investigated. It is indispensable to describe the presence of previous illness, medication and recent changes of the dosages in the medical history in a patient with Sertraline.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Nutrition interventions in people with severe mental illness: Novel strategies for addressing physical health co-morbidity in a high-risk population
Authors: Teasdale S. , Ward P. , Samaras K. , Rosenbaum S. , Curtis J. , Lederman O. , Watkins A. , Stubbs B.
Published: May 2016

Introduction

Nutrition interventions are critical for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). As mental health teams evolve to incorporate nutrition interventions, evidence needs to guide clinical practice.

Aims

A systematic review and meta-analysis was performed to assess whether nutrition interventions improve:

– anthropometric and biochemical measures,

– nutritional intake of people experiencing SMI.

To evaluate the effectiveness of a dietician-led nutrition intervention, as part of a broader lifestyle intervention, in the early stages of antipsychotic prescription.

Method

An electronic database search was conducted to identify all trials with nutritional components. Included trials were pooled for meta-analysis. Meta-regression analyses were run on potential anthropometric moderators. Weekly individualised dietetic consultations plus group cooking classes were then offered to clients attending a Community Early Psychosis Programme, who had recently commenced antipsychotics for a 12-week period.

Results

From pooled trials, nutrition interventions resulted in significant weight loss (19 studies, g = –0.39, P < 0.001), reduced BMI (17 studies, g = –0.40, P < 0.001), decreased waist circumference (10 studies, g = –0.27, P < 0.001) and lower blood glucose levels (5 studies, g = –0.37, P = 0.02). Dietician-led interventions (g = –0.90) and trials focussing on preventing weight gain (g = –0.61) were the most effective. The 12-week nutrition intervention resulted in a 47% reduction in discretionary (junk) food intake (P < 0.001) and reductions in daily energy (–24%, P < 0.001) and sodium intakes (–26%, P < 0.001), while improving diet quality (P < 0.05).

Conclusion

Evidence supports the inclusion of nutrition interventions as part of standard care for preventing weight gain and metabolic deterioration among people with SMI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The clinical effect an Nao Wan Merger risperdal on schizophrenia
Authors: Zhang Y.
Published: May 2016

Objective

To evaluate the clinical curative effect of risperdal merger An Nao Wan for schizophrenia.

Methods

Screening a mental health center in the first half of 2012 hospitalized patients with schizophrenia, which alone give risperdal or merger An Nao Wan give risperdal with 28 days treatment cycle, were as a clinical observation objects. Efficacy was assessed using symptoms scale (PANSS), evaluation of adverse reactions was with side effects scale (TESS). And through collecting the clinical data, related testing results, the daily detailed medical records to record adverse reactions.

Results

Fifty cases of screened 427 patients meet the conditions, including 11 cases with risperdal merger An Nao Wan, and 39 cases only used risperdal. All of 50 cases after two weeks treatment, the symptoms were down significantly (P < 0.01). The adverse reactions rate of patients only with risperdal was 53.8%, of patients with risperidone merger An Nao Wan was only 27.3%.

Conclusion

Risperdal merger An Nao Wan can improve the therapeutic effect of risperidone, short the recovery time of schizophrenia, prevent the adverse reaction of psychotic drug, also improve the safety and patient drug compliance.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Women, madness and psychiatry: Insane or persuaded?
Authors: Garcia C. , Soriano M.A.
Published: May 2016

During the nineteenth and early twentieth century, feminist movements proliferated in Europe and USA in order to vindicate the rights of women both in the workplace and political issues, such as women's suffrage and birth policies, among others. At the same time, psychiatry tried to gain a foothold as a medical specialty, which created a positivist discourse where it was important to measure and quantify mental disorders and their possible causes. As many feminist writers have argued (Chesler, Showalter, Jordanova, and others) this occurs at the same historical moment that a “feminization of madness” was taking place in several ways: madness begins to be described in feminine terms, Freud was developing his research on hysteria; diagnostics, such as puerperal and involution psychosis were taking hold; the interest about the influence of hormones in women's mood were raising, and gynaecology was thought as the organic etiology of female madness. The hegemonic psychiatric discourse appeared to have been a catalyst for logical social inclusion and exclusion, notably influencing the design of a new feminity, distant from the danger of feminism that began to gain prominence. The boundaries between insanity and mental health were really diffuse in case of women. The aim of my work is to highlight how attitudes and attributes of women were transformed into psychiatric symptoms, as the feminist theorist support. I will make a retrospective about clinical women reports of the public asylum of Malaga from the beginning of twenty century.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Co-dependency in mothers of addicted persons: Data from Bulgaria
Authors: Ivanova D. , Giannouli V.
Published: May 2016

Introduction

Co-dependent relationships are characterized as a type of dysfunctional helping relationship in which there is an excessive reliance on other people for approval and identity. This is very common for female relatives who support/enable another person's addiction, poor mental health, immaturity, and/or irresponsibility.

Objective

The aim of the present study is to reveal the co-dependence profile of mothers of addicted persons in Bulgaria.

Method

Four hundred Bulgarian women coming from Blagoevgrad, Sofia and Stara Zagora (Mage = 53.55, SDage = 5.58; level of education: 71% with high school degree, 29%with university degree; all mothers of addicted persons) were examined at the Municipal Council on Drug Addiction Blagoevgrad with the STAI-state questionnaire, the ZUNG Self Rating Depression Scale and the Questionnaire of Establishment of Codependency.

Results

Results indicated that in a scale of scores ranging from 2 = minimum to 4 = maximum of co-dependence, this group of women had high self-reported levels of co-dependence (M = 3.6375, SD = .52610), a high depressive profile (M = 49.07, SD = 3.23, and high state anxiety (M = 66.60, SD = 5.58).

Conclusions

The present research suggests that mothers of dependent individuals in Bulgaria show a high level of co-dependency, anxiety and depression. Future research should clarify the reasons of this overall negative emotional profile.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Post-partum psychosis
Authors: Leite F. , Campos O. , Salgado H. , Carvalho P.
Published: May 2016

Introduction

Postpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth. A typical example occurs when after childbirth, a woman becomes irritable, has extreme mood swings and hallucinations with the possibility of needing psychiatric hospitalization. Often, out of fear of stigma or misunderstanding, women hide their condition.

Aims and objectives

To review the evidence regarding prophylactic treatment and acute management of postpartum psychosis and affective disorders in the puerperium.

Methods

Online search/review of the literature has been carried out, using Medline/Pubmed, concerning “postpartum psychosis”, “postpartum”, “mental disorders”, “mania” and “depression”.

Results

Postpartum psychosis is a rare and severe psychiatric condition requiring rapid restoration of health in view of significant risks to both mother and the infant. The known risk factors and negative consequences of postpartum psychosis point to the importance of preventive and acute treatment measures. The majority of patients who develop psychosis immediately following childbirth suffer from bipolar disorder.

Conclusions

Understanding the relationship between postpartum psychosis and affective disorders has implications for perinatal and long-term treatment. The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
ADHD, one of the most challenging mental disorders in adult psychopathology
Authors: Cancino Botello M.C. , Hernández Sánchez J.M. , Molina López F. , Canseco Navarro M.D.L.A. , Peña Serrano A.
Published: May 2016

Introduction

In 40 to 60% of children with ADHD, the disorder persists into adulthood. Nevertheless, diagnosis in adulthood sometimes becomes a challenge because, even the etiology is not very clear yet, ADHD shares several clinical features or may coexist with other psychiatric disorders. This issue leads to confusion and also to a delayed treatment or a wrong treatment, causing negative effects on patient outcomes.

Objective

To highlight the importance of making an accurate differential diagnosis and to consider the coexistence of other mental disorders, in the diagnosis of a patient with ADHD.

Methods

Systematic review of the literature in English (Pubmed). Keywords: “adult ADHD”; “bipolar disorder”; “substance abuse”; “personality disorders”.

Results

Adult ADHD has a prevalence in Europe of 3,4% and it seems to appear more frequently in developed countries. In adults, the clinical presentation differs from children. There often are symptoms of impulsivity, attention deficit, restlessness, and emotional dysregulation and risk behavior, causing difficulties in everyday functioning. The coexistence of substance abuse and the similarity between bipolar disorder and personality disorders with ADHD, translate in a difficult diagnosis, especially for patients with mild presentations.

Conclusions

So far, the authors conclude that a detailed clinic history plus the validated scales for adult ADHD are the most reliable tools for diagnosis. Neuroimaging and EEG studies do not provide conclusive data to consider them as diagnostic methods.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurosyphilis and early-onset major neurocognitive disorder – Case reports
Authors: Exergian A.M. , Ladea M. , Hagiu R.
Published: May 2016

Introduction

Neurosyphilis has been called “the great imitator” because of its atypical clinical presentation ranging from motor dysfunctions to psychotic episodes to dementia. This, and the fact that it has become a rare disease, makes diagnosis challenging.

Objective

This work will present three early onset Major Neurocognitive Disorder cases for which neurosyphilis was considered as a possible cause.

Aims

In this presentation, we underline clinical characteristics that should raise the suspicion of neurosyphilis and the importance of an adequate diagnosis.

Methods

The three patients presented as case-reports were admitted to an acute psychiatric ward, presenting with psychomotor agitation and aggression. The initial clinical evaluation (including the patient's medical history) did not suggest the presence of syphilis. Subsequent blood-tests were performed, including RPR (Rapid Plasma Reagin) or VDRL (Venereal Disease Research Laboratory) which were positive in all three cases. Other tests were performed in order to confirm the presence of neurosyphilis.

Results

All three patients had positive treponemal and nontreponemal test results. For only one of the three patients, imagistic abnormalities of the brain were present. For two of the patients, a positive diagnosis of Major Neurocognitive Disorder due to neurosyphilis was established.

Conclusions

Neurosyphilis can be a cause for Major Neurocognitive Disorder. The diagnosis of this pathology is important because cognitive function can be improved by adequate treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Does community care works? Evaluate the effectiveness of mental health services
Authors: Giacomin M.
Published: May 2016

Introduction

Improving quality require the capability to evaluate clinical and operational processes and improve patients outcomes. Just in the view of evidence-based practise (EBP) it's used HONOS rating Scale, adopted since May 2012, by Mental Health Center of Villorba (Treviso-Italy) There are 3 package treatments: rehabilitative, territorial and clinical.

Objectives

To identify which variables are positively correlated to HONOS improvement in patients group who frequented Mental Health Centre along 36 months. All patients present severe mental illness.

Aims

Evaluate the effectiveness of interventions and correlate to treatment package and individual feature. Analyze treatment process for quality improvement.

Method

A psychiatric team (4 nurses, 1 psychiatrist) administered Honos Rating Scale along 3 years: on starting point and 6, 12 and 36 months later: T 0,1,2,3,4. Patients are also described by diagnosis, mental, social and autonomy skill, time, utilization of MHC and anagraphic information.

Results

All 15 groups’ patients realize lower scoring, after 36 months’ treatment. Seven have got reliable improvement (i.e. = > 8-point lowering T3–T4) and positively correlate with: (1) 36 months’ treatment, at 12 months in rehabilitative Package; (2) days in residential/semi-residential community from 82 to 311 days. Related tables are included in paper.

Discussion and conclusion

HONOS score correlates directly with clinical and riabilitation improvement, i.e. mental, social capacity, and personal autonomy. It needs more investigation to clear which other factors are involved with improvement.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
A glance at potential neuropsychological theories and explanations for the higher creative functioning of Leonardo da Vinci
Authors: Kumar S.
Published: May 2016

Introduction

It has been universally regarded that Leonardo da Vinci was one of the all time geniuses in terms of his contribution to art and sciences. A number of theories have been proposed to explain his genius that range from neurological, psychological uniqueness, and enhanced functional intelligence.

Aim

The primary aim is to explore these theories in detail and register their pros and cons alongside contextualizing their credibility and weightage against the extant evidence in science.

Method

A detailed literature search has been undertaken to identify variety of models and theories either:

– dealing with neurological, psychological or neuro-philosophical explanations;

– have been proposed by psychiatrist or psychologist and neurologists pertaining to Leonardo's brain or mind;

– theories around occult and religion have been excluded.

Discussion

The results are synthesized and presented in a tabular form. The discussion expands on the various theories and the relevance of Leonardo da Vinci to the merging unified field of neurology, psychology, technology and philosophy (consciousness studies)

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Challenging patients: Human misery
Authors: Ganhao I. , Paiva S. , Cardoso J.
Published: May 2016

Introduction

Psychiatry has seen significant progress in recent decades due to scientific advances. However, beyond genes, neurotransmitters and neurocircuits, there is a truly human dimension that escapes all the science. The choices each one makes, even if biologically mediated, and the consequences, even if mediated through individual vulnerabilities, dictate an outcome. That outcome may be a biopsychosocially ill individual. Health professionals trained and up-to-date on the latest research are confronted with challenges that far outweigh what they expected and know what to do with, defying the humanity of even the most humane.

Objective

To reflect upon a clinical case of human misery.

Aims

To promote growth at a professional and personal level through the process of treating challenging patients.

Methods

Presentation of a clinical case.

Results

A homeless person with a history of and current drug use, prostitution, untreated HIV-AIDS, hepatitis B and C, untreated Mycobacterium lentiflavum pulmonary infection, bleeding rectal prolapse, prolonged psychotic manic episode and a very difficult personality has trouble finding and ultimately rejects help from medical professionals and ends up involuntarily admitted to a psychiatric inpatient unit.

Conclusions

Many unsolvable or only partially solvable puzzles end up under psychiatric care. The complexity of human nature escapes all scientific advances. We can put many pieces together but the whole often remains a challenge, a challenge of our values, our motivation, creativity and resilience.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
“Incomprehensibility” as an approach to the contemporary understanding-explanation dichotomy
Authors: Valdes-Stauber J.
Published: May 2016

Background

Traditionally, “understanding” is related to the comprehension of the particular and of individualities as historical unique; “explanation” is conversely related to the sciences of general laws, preferential expressed mathematically. Within the “Methodenstreit”, first method is related to an idiographic second to a nomothetic approach. This dichotomy was transferred by Jaspers into psychiatry.

Objective

How the understanding-explanation dichotomy could be dialectically kept, but also surmounted in contemporary psychiatry and psychosomatics in the light of a broader concept of “comprehensibility” as dialectically opposed to “incomprehensibility”.

Method

Possible steps in development of the understanding-explanation dichotomy are rebuilt historically from Neo-Kantian and hermeneutic approaches onwards. Starting from reflections on analytic action theory as well as from a critique of Descartian dualism of substance and from the assumption of incomprehensibility, we try to state an integrative conceptual network.

Results

Ways of comprehensibility and incomprehensibility as well as understanding and not understanding are explored by crossing epistemological and ontological perspectives. Four implicit categories of understanding and a dialectically built conceptual network of dimensional dualities are stated.

Discussion

The methods of “understanding” and “explanation” maintain in contemporary psychiatry a heuristic importance, but not in a segregative manner. This epistemological dichotomy might be integrated in a network of superordinate dualities.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Suicide attempts associated with sexual violence: Women – Ecuador
Authors: Valdez V. , Santana C. , Cajas M. , Avila E. , Reyes D.
Published: May 2016

Objective

Determine the incidence of suicide attempts in women exposed to sexual violence in Ecuador.

Materials

We applied a transversal descriptive study accomplished by the National Institute of Statistics and Census (INEC). The INEC recruited Ecuadorian women from 15-years-old and ahead, the surveys were focused on this population. Eighteen thousand and eight hundred (18,800) rural and urban housings were selected all over the country, 24 provinces. Date of the survey: November 16–December 15 of 2011. The sample included 737 women of several marital status (single, married and separated woman) who reported had been victims of sexual violence.

Results

The average age of the sample was 28-years-old. The standard deviation was 21 years, ages: 15–25 years old: 14.265 (21.6%), 25–35-years-old: 9.324 (14.1%), 35–45-years-old: 8.132 (12.3%), 45–55-years-old: 6.283 (9.5%), 55–65-years-old: 4.302 (6.5%) and > 65 years old: 23.745 (35.9%). The incidence of women who had attempted suicide due to sexual violence was 73.95% (545 of 737 women surveyed). According to the marital status, the incidence was 79.3% on single, 65.5% on married and 79.0% on separated women.

Conclusion

The rate of suicide attempts in Ecuadorian women undergoing situations of sexual violence is very elevated. The traumatic incident in descending order according to the classification by marital status is: single, separated and married. It was identified the population of unmarried women in our society to be the most vulnerable to develop suicidal behaviors (8 out of 10 women). However, we must keep in mind that these statistics could be even higher due to the fear and rejection to expose personal traumatic experiences in conservative societies such as the Ecuadorian. These results represent a powerful call to the Mental Health Systems. They must increase protection and follow-up programs on sexually abused women in Ecuador and other Latin-American countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Agitation in the patient with dual pathology
Authors: Hernández Plaza L. , García Navarro M. , Delgado Parada E. , Ochoa Mangado E. , Salvador Vadillo E. , Molins Pascual S.
Published: May 2016

Introduction

The consumption of toxic substances often causes agitation, which makes more difficult the pharmacological management of the symptoms.

Objective

About one case, a search was performed of the different therapeutic options in the agitation takes place in the context of intoxication.

Methods

Thirty-five-year-old male patient diagnosed of dual pathology under treatment since 2003 in our outpatient. The patient shows paranoid schizophrenia disorder due to alcohol, cannabis and cocaine use disorder, summing up different pharmacological treatments with no remission. Whilst the examination is taking place the patient is under alcohol and cannabis effects. His physical and verbal behaviour are aggressive showing psychotic instability. The therapeutic team administers loxapine to its patient.

Results

The inhaled loxapine turned out to be a good alternative in the case given.

Conclusion

Handling agitation when toxics are involved is complex. The new formulation of inhaled loxapine helps to control agitation quickly and it might be a feasible option for this kind of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbidity between delusional disorder and sensory deficits. Results from the deliranda case register
Authors: Porras Segovia A. , Guerrero Jimenez M. , Carrillo de Albornoz Calahorro C. , Cervilla Ballesteros J.
Published: May 2016

Introduction

Sensory deficits such as blindness and deafness are very common forms of disability, affecting over 300 million people worldwide according to World Health Organization estimates. These conditions can lead to misinterpretations of the environment, which may contribute to the development of a delusional disorder in predisposed people.

Objectives

The objective of this study is to establish the prevalence of blindness and hearing loss across delusional disorder.

Aims

The aim is to provide useful information regarding this frequent, often disregarded, comorbidity.

Methods

Our results proceed from the Andalusian delusional disorder case-register (DelirAnda). We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis following DSM-V criteria, we recollected data on the prevalence of blindness and hearing loss, which were defined based on clinical diagnosis.

Results

One thousand four hundred and fifty-two patients matched DSM-5 delusional disorder criteria. Among them, 49.8% of our sample were women. The overall prevalence of sensory deficits was 7.4%, 3.5% of the patients with delusional disorder were blind, while 3.9% of them suffered from hearing loss.

Conclusions

Our results are consistent with previous studies, such as the Deliremp study, which found a 5.7% prevalence of sensory deficit among delusional disorder patients. These results show a higher prevalence of sensory deficit among delusional disorder patients compared with the general population. However, causality could not be established. Further study should be undertaken regarding the relationship between these two conditions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.