bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of depression in women attending antenatal clinics in Blantyre District, Malawi
Authors: Chorwe-Sungani G. , Chipps J.
Published: June 2017

Introduction

Depression is one of major health problems affecting pregnant women in low resource settings. It can lead to poor uptake of antenatal services. Data about prevalence of antenatal depression and associated risk factors remain scanty in Malawi. The study settings were eight selected antenatal clinics in Blantyre district, Malawi. The aim of this study was to assess prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Blantyre district, Malawi.

Methods

This was a quantitative study which used a random sample of 97 pregnant women. Ethical approval was granted by relevant bodies. Descriptive and inferential statistics were used to analyse data.

Results

Prevalence of antenatal depression in Blantyre district was 25.8% (n = 25). Risk factors associated with antenatal depression included: “being distressed by anxiety or depression for more than two weeks during this pregnancy”; “feeling that pregnancy has been a positive experience”; “having a history of feeling miserable or depressed for two weeks or more before this pregnancy”; “relationship with partner is an emotionally supportive one”; “experiencing major stresses, changes or losses in the course of this pregnancy”; “having history of physical abuse when growing up”, and “having concerns about being or becoming a mother”.

Conclusion

This study has shown that antenatal depression is prevalent in Malawi. It suggests that psychosocial interventions targeting pregnant women may be necessary to reduce antenatal depression and associated risk factors. However, further research regarding ways for assisting pregnant women to build and strengthen their psychosocial support structures is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Putting it all together: How disordered temporality is core to the phenomenology and neurobiology of mania
Authors: Schwartz M. , Schwartz E. , Moskalewicz M.
Published: June 2017

Disturbances of temporality in mania, underemphasized in present-day accounts, are nonetheless core to understanding both the phenomenology and the neurobiology of the disorder:

– phenomenology: already in 1954, Binswanger had articulated that persons with mania live almost exclusively in the present and hardly at all into the future. Especially in the larger scheme of things, their future is already here. There is no “advancing, developing or maturing,” anticipations have already been achieved, and all that I strive for is basically present if you will just get out of my way! A half century ago, Binswanger summed up the consequence of manic temporality: the manic self, not living into the future, “is not… an existential self.” This presentation will further describe phenomenological characteristics of such a self in mania;

– findings from contemporary neuroscience correlate remarkably well with the above phenomenology, importantly clarifying present and future therapeutic interventions. Of critical importance in mania, clocks in our brains afford receptor sites for the lithium ion. Once bound to the receptor, lithium potently inhibits the circadian rhythm regulator glycogen synthase kinase 3 (GSK3) and profoundly alters the biological cascade that it initiates. In this presentation, by taking a close look, step-by-step, we will clarify how lithium disrupts mania rhythm dysregulation and restores a more “normalized” temporality. The consequence is no less than the return of the existential self. We will also briefly glance, in this presentation, at the window that lithium cellular efficacy offers for treatment options “after lithium.”

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Affective attitudes towards health are more ambivalent among older adolescents
Authors: Arina G. , Iosifyan M. , Pechnikova L. , Nikolaeva V.
Published: June 2017

Introduction

Attitudinal ambivalence is a mediator between attitudes and health behaviors. The present study contributes to our understanding of affective attitudes ambivalence.

Objectives

We studied the ambivalence of affective attitudes towards health among adolescents.

Aims

We compared the affective attitudes ambivalence between younger (10–14 years) and older (15–16 years) adolescents.

Methods

Older (n = 51, Mage = 15.09 ± 0.30) and younger adolescents (n = 28, Mage = 12.96 ± 0.99) performed a modified Etkind Color Test. We calculated the associations between 13 factors related to health (e.g. sport, risky behavior) and positive emotions, as well as the associations between same factors and negative emotions. Thompson, Zanna and Griffin ambivalence index was a measure of attitudinal ambivalence.

Results

Among younger adolescents all 13 correlations between negative and positive attitudes towards health related factors were significant and negative: −0.402 < r < −0.804 (which means the greater is the association between a word and positive emotions, the smaller is the association between the same word and negative emotions; and vice versa). Only 5 correlations were significant and negative among older adolescents (−0.209 < r < −0.463): environment, risky behaviors, family, sleep, my psychological well-being.

The difference in ambivalence indexes was significant in two groups of adolescents [F(14,64) = 5.97, P = −0.0001]. Younger adolescents had significantly lower ambivalence indexes in affective attitudes towards all 13 factors.

Conclusions

Older adolescents had more ambivalent affective attitudes towards health related factors compared to younger adolescents.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The link between developmental psychiatry and dual disorders from early attachment to first drugs abuse
Authors: Garcia E. , Moreno R. , Tarjuelo B.
Published: June 2017

Since Dual Disorders expression was used for the first time, the old dilemma between cathegorial and dimensional grew again as a main issue because many authors wondered about its utility. The question was how far we can speak about two different entities, because doing so we are assuming comorbidity instead of a complex syndrome, with different clinical presentations (i.e. Talking about fever and cough instead of pneumonia). Child and adolescence psychiatry uses developmental psychiatry as a very useful tool to understand patients. Syndromes are seen as dynamic as patients. At the same time that patients grow their clinical presentations, evolves new symptoms or signs. We have reviewed retrospectively a group of twenty parents that were named as dual disorders, with different substance abuse but a common path in their childhood; all of them were diagnosed of ADHD and Conduct Disorder. We chose them because of the differences that DSM, ICD and main researchers have about this group, which some consider better described as a Disocial hiperquinetic disorder (ICD) than a AHDH with a conduct disorder associated (DSM), comorbidity again. We agreed with ICD opinion and will discuss how in some way we are somehow as those blind people describing different parts of the same elephant when we talk sometimes about dual. Truth is that opposite dual view or its syndromic treatment developmental psychiatry has all the time underlined the role of reward circuits/executive functions as epigenetic issues, both modulated by gene and environment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Proportions of anxiety and depression symptoms in adult cleft patients and non-cleft patients with skeletal malocclusions
Authors: Medvedev V. , Fofanova Y. , Frolova V. , Drobyshev A.
Published: June 2017

Introduction

Diagnosis and treatment of patients with craniofacial anomalies such as cleft lip and palate and skeletal malocclusions present a challenge to public health. Dentofacial abnormalities may be associated with depressive and anxiety disorders and poor quality of life.

The aim of this screening study was to evaluate and to compare the rates of anxiety and depression in cleft patients and non-cleft patients with skeletal malocclusions.

Methods

The study used psychometric method-HADS and State Trait Anxiety Inventory were used. The first group consisted of cleft patients, the second group consisted of non-cleft patients with skeletal Class II, Class III and anterior open bite malocclusions; the third group was control.

Results

Study sample consists of 42 patients (33 females; 24 ± 7.2 years). In the 1st group, anxiety symptoms were detected in 34.7%; depression symptoms - in 17.2% of patients, high rates of reactive anxiety were registered in 35.8%. In the 2nd group, anxiety symptoms were detected in 29.6% of patients; depression symptoms - in 13,1% of patients, high rates of reactive anxiety were registered in 34.2%. In the 3rd group anxiety (18.7%) and depression (8.3%) symptoms and high rates of reactive anxiety (17.7%) were registered significantly less often than in 1st and 2nd groups (P < 0.005, P < 0.001 and P < 0.001 respectively).

Conclusions

Our data suggest that cleft-patients and non-cleft patients with skeletal malocclusions have statistically significant higher rates of anxiety and depression than controls and require orthodontic-surgical treatment that should be organized with the assistance of psychiatrist.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Causeless appearance discontentment in patients of plastic surgeons and cosmetologists: Risk factors and patterns of dynamics
Authors: Medvedev V. , Frolova V.
Published: June 2017

Introduction

Though phenomenon of dysmorphic disorder has been studied extensively clinical dynamical characteristics of this disorder are still being investigated.

Aim of this study was to evaluate patterns of dynamics and risk factors of body dysmorphic disorder in patients of plastic surgeons and cosmetologists.

Methods

We included adult patients of Maxillofacial Surgery and Cosmetology departments of Moscow State University of Medicine and Dentistry (from January 2010 to May 2016) with unconfirmed “facial deformity” diagnosed with dysmorphic disorder (F45.2 and F22.88 according to ICD-10). The study used clinical psychopathological method with follow-up period 1–3 years. Data from clinical psychopathological assessment were processed using correlation analysis and non-lineal regression analysis by means of logistic regression method.

Results

Study sample consisted of 103 patients (78.6% female; mean age 33.4 ± 4.7 years). Statistically significant chronobiological (age, hormone fluctuations, genesial cycle) and psychosocial (financial changes, forced separation, bereavement, loss of job, reduction of social activity, conflict situation, sexual dysfunction, violation of law, diagnosing of somatic disease) risk factors for dysmorphia in different life periods have been established. Strong correlations were found between dysmorphic disorder heterogenic clinical picture (overvalued–33%, affective–24.3%, hypochondric–23.3%, obsessive-compulsive–10.7%, delusional–8.7%) and patterns of dynamics (phasic–41.7%, recurrent–33%, chronic–25.3%). Our data suggest that dysmorphia manifests in any age group and in 74.7% cases is not continuous.

Conclusion

Our findings allow to conduct focused diagnostic search, prophylactic psychotherapeutic interventions and early psychopharmacological treatment in individuals with identified risk factors for dysmorphic disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Sjogren's syndrome in a patient previously diagnosed as seasonal affective disorder
Authors: Ceylan M.E. , Ünsalver B.Ö. , Evrensel A.
Published: June 2017

Introduction

Sjogren's syndrome (SS) is a common autoimmune disorder that is characterized by chronic inflammation of lachrymal and salivary glands. The well-known clinical manifestations of SS are dry eyes and dry mouth. However, the disease may first present itself with psychiatric symptoms, such as depressed mood, agitation or irritability.

Objectives

Our objective is to highlight the importance of systemic examination, including detailed biochemical workup in psychiatric patients with somatic complaints like fatigue and those patients with partial response to treatment.

Methods

We present a 35-years-old woman who had depressed mood, obsessions and compulsions, chronic fatigue, generalized muscle and joint pain, balance problems, weight loss, dry mouth and dry eyes for the past few years. Her symptoms would worsen during spring. She was diagnosed with seasonal affective depressive disorder and chronic fatigue and was started on mirtazapine 30 mg/day and venlafaxine 75 mg/day. She was partially responsive to this treatment. The detailed biochemical workup came 1/320 positive for anti-nuclear antibodies (ANA). The oral biopsy showed Sjogren's disease. Gluten sensitivity was found as well.

Results

The patient was started on hydroxychloroquine sulfate 400 mg/day in addition to her anti-depressant medication. She was put on a gluten-free diet. She was in full remission in a month and had no depressive attack in spring. Her ANA decreased to 1/80.

Conclusion

Psychiatric syndromes may arise from different pathologies of the central nervous system. In patients with recurrent psychiatric syndromes or patients who are partially responsive to conventional treatment approaches further systemic evaluation of the patient is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Stories of exceptional survivors who visit aboriginal healers: Cross-cultural lessons for psychiatry
Authors: Mehl-Madrona L.
Published: June 2017

Introduction

Indigenous communities exist within most countries. These communities often have their own informal and invisible (to their mainstream neighbors) systems of health care. We wondered what happened to people who approached traditional community healers for help with mental health problems.

Methods

We interviewed 100 people who had received mental health diagnoses from conventional practitioners and then sought traditional community healers for help. We compared them to a matched population from a computer database who did not seek traditional healers. Patients who visited the healers did statistically significantly better than the comparison group. Panels of naïve graduate students evaluated patient interviews and picked themes that consistently emerged. Scenarios were developed to rate patients along these dimensions from “1” to “5”. New panels did the ratings. Comparisons were made between these 2 groups of people, and those who improved with healers had more change from before to after treatment on the dimensions of Present-centeredness; Forgiveness of others; Release of blame, bitterness, and chronic anger; Orientation to process versus outcome; Sense of Humor; Sense of Meaning and Purpose; and Faith and Hope. The patients who worked with the healers had a new and plausible (to the patient, his or her family, and the healers) explanation for why he or she got well, including a story reflecting a belief about how he or she can stay well; supportive community who believes in the person's cure.

Conclusions

The treatment provided by conventional healers produces measurable changes in several parameters associated with improved mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotic episode during a travel to Saint-Petersburg. A variation of Stendhal Syndrome
Authors: Zavala I. Rubio , García G. Martínez-Ales , Cornejo A. De Diego , Castro M.P. Sánchez , Domingo A. Fraga , Rojas I.I. Louzao , Ortiz M. Bravo
Published: June 2017

Introduction

Journeys have been considered life-changing experiences since the first chronicles of humanity. Interest towards the relationship between travels and mental illness started off with the publication, in 1897, of Les aliénés voyageurs.

Case report

We report the case of a 52-year-old gentleman, married and without children, who works as a couch driver and has no past medical records. During a holiday trip, at his arrival to Saint Petersburg, he first experienced haze and cognitive and memory failures, along with malaise and sweating. The day after, while visiting the Hermitage museum, he underwent forthright auditive hallucinations, diffusion of thought phenomena and harm delusions. After ruling out diagnosable organic causes through CT scan, MRI and blood analyses including immunologic studies, he was put on olanzapine 10 mg/day with total symptomatic remission within 2 weeks.

Discussion

Stendhal syndrome, described back in 1989 by Dr. Magherini, refers to anxious, somatic and psychotic symptoms affecting tourists who visit Florence. The celebrated author, himself, experienced intense emotions due to an overdose of beauty at the Italian city. Further clinical pictures related to journeys include Jerusalem Syndrome and Way of Saint James Syndrome. Another entity, Paris Syndrome, differentially affects Japanese visitors, disappointed with the actual experience of visiting the French city.

Conclusion

During journeys, people often abandon everyday life in order to open up to unknown sights and feelings. These can eventually, lead to certain sorts of mental illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The role of disturbed circadian clocks in the development of depression-like behavior and metabolic comorbidity in mice
Authors: Landgraf D. , Barandas R. , Long J.E. , Proulx C.D. , McCarthy M.J. , Malinow R. , Welsh D.K.
Published: June 2017

Major depressive disorder (MDD) is often associated with disturbed circadian rhythms. However, a definitive causal role for functioning circadian clocks in mood regulation has not been established. We stereotactically injected viral vectors encoding short hairpin RNA to knock down expression of the essential clock gene Bmal1 into the brain's master circadian pacemaker, the suprachiasmatic nucleus (SCN). In these SCN-specific Bmal1-knockdown (SCN-Bmal1-KD) mice, circadian rhythms were greatly attenuated in the SCN. In the learned helplessness paradigm, the SCN-Bmal1-KD mice were slower to escape, even before exposure to inescapable stress. They also spent more time immobile in the tail suspension test and less time in the lighted section of a light/dark box. The SCN-Bmal1-KD mice also showed an abnormal circadian pattern of corticosterone, and an attenuated increase of corticosterone in response to stress. Furthermore, they displayed greater weight gain, which is frequently observed in MDD patients. Since the circadian system controls important brain systems that regulate affective, cognitive, and metabolic functions, and neuropsychiatric and metabolic diseases are often correlated with disturbances of circadian rhythms, we hypothesize that dysregulation of circadian clocks plays a central role in metabolic comorbidity in psychiatric disorders. In fact, circadian rhythm disturbances have been linked to individual psychiatric and metabolic disorders, but circadian aspects of such disorders have not been considered previously in an integrated manner. Treating and preventing disturbances of circadian clocks in patients suffering psychiatric and metabolic symptoms may be a central element for therapies targeting both disorders concurrently.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pathologies related to depression in elderly patients
Authors: Batistella J. , Hida G. , Malheiros D. , Rodrigues G. Taniguchi , Peláez F.J. Ropero , Magalhães J. , Taniguchi S.
Published: June 2017

Introduction

The occurrence of chronic diseases, motor limitation, cognitive impairment and social isolation could be related to late life depression.

Objective

To describe the pathologies related to elderly patients with depression. To study possible relationship between depression and others pathologies in elderly patients.

Methods

This retrospective study included 124 geriatric patients enrolled in a private long-term care institution with mean age of 86.2 ± 6.5 years old, mean weight of 60.28 ± 2.00 kg and mean period of hospitalisation of 4.4 ± 2.3 years. For data analysis, double-entry tables and tests of proportion Qui-square were used.

Results

Cardiovascular, respiratory, endocrine metabolic, skeletal muscle, sense organs, hematological, digestive tract; neuropsychological and genitourinary, diseases were analyzed.

We observed a significant correlation between depression and endocrine-metabolic (P value of 0.0003), sense organs (P value of 9.298 E-5) and skeletal muscle pathologies (P value of 6.843 E-6)

Conclusions

We observed in that population that depression could be prevalent in elderly patients with endocrine-metabolic, sense organs and skeletal muscle pathologies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy of an active implementation process of a computerized CPG of major depression disorder in primary care
Authors: Cavero M. , Monreal J.A. , Cardoner N. , Moreno M.D. , Solá V. Pérez- , Palao D.
Published: June 2017

Introduction

The application of scientific evidence in clinical practice management of Major Depressive Disorder (MDD) is complex. Generally, the usual dissemination process and implementation of Clinical Practice Guidelines (CPG) induce modest changes. A computerized version of a Clinical Practice Guideline for Major Depression (e-CPG-MD) has been integrated in Electronic Clinical Records of Primary Care in Catalonia (Spain). It offers an opportunity to improve clinical results. The design allows access to precise help in the visit itself, improving diagnosis, treatment and follow-up.

Objectives

To evaluate the effects of a multifaceted implementation process of e-CPG-MD, analysing their use and changes in MDD diagnosis.

Methods

A cluster randomized clinical trial was performed in 10 primary care centers (PCC) in Barcelona. In five of ten centers, a multifaceted implementation process of the e-CPG-MD was developed during 6 month. The active process includes: interactive training program, regular feedback audit, educational outreach visits and periodic reminders.

Results

The multifaceted implementation of e-CPG-MD was associated with a significant increase in use during the first 6 months (4.1% + 3.1% vs. 52.7% + 7.3%, P < 0.001). In the active centers, the MD diagnosis increased significantly (rate quotient = 1.56, P < 0.001) and the proportion of moderate and severe MD increased (13.6% vs 41.1%, P = 0.002).

Conclusions

A multifaceted implementation method of e-CPG-MD increased significantly its use in active centers at 6 months. Diagnosis of MDD and the proportion of moderate and severe cases also increased significantly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The psychiatric emergency service in the Netherlands
Authors: Streitz S.
Published: June 2017

Every region in The Netherlands has got an emergency service. This is a team of people that immediately goes to see the psychiatric patient after an instruction of for instance the general practitioner or the police. This special team works 24 hours a day, 7 days a week. The patient is then visited by members of the team, a social worker accompanied by a psychiatrist, or the patient will go to the ambulant unit (the polyclinic) directly. This is a very effective procedure, because behind the two people that visit the psychiatric patient, is a whole team of people who have the opportunity to start an ambulant treatment the day after. Through this team we have the opportunity to treat patients intensively without a needed admission in the clinic. The basis of this team are social-nurse-therapists who are very skilled. These people take lead in the treatment and have a psychiatrist as a back-up. Suicidal patients are through a special procedure included in a clinic upon a juridical decision. If it is expected that the patient is dangerous, the police will accompany the emergency teams. If psychiatric medication is needed, the treatment will start directly. Other forms of treatment are psychotherapy, a short treatment by conducting 5 meetings with the patient, or intensive ambulant treatment. In my opinion it is a very good example of how ambulant treatment of psychiatric patients works and is effective for everybody involved.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
The impact of the economic crisis on the use of psychotropic medication in Portugal: Preliminary results of the national mental health survey follow-up
Authors: Silva M. , Antunes A. , Frasquilho D. , Cardoso G. , Caldas-de-Almeida J.M.
Published: June 2017

Introduction

Economic crises can contribute to a worsening of mental health problems and, consequently, to a possible increase of the use of psychotropic medication.

Objectives

To assess the use of psychotropic medication in Portugal before and after the onset of the economic crisis, and to better understand the impact of the economic crisis in this highly hit country.

Methods

This 2015 follow-up epidemiological study re-interviewed a probability sub-sample of respondents to the 2008 national mental health survey, the first nationally representative study of psychiatric morbidity and treatment patterns in Portugal. Socio-demographic and clinical variables were assessed using a structured interview in 2008 (n = 2060) and 2015 (n = 911). All participants were questioned about the last 12 month use of psychotropic medication for mental health problems. Descriptive analysis was conducted to assess the use of psychotropic medication by group and gender in 2008 and 2015.

Results

Between 2008 and 2015 there was an overall increase in the use of the main groups of psychotropic medication (22.5% to 28.6%), with a particularly relevant increase in the consumption of anti-depressants and anxiolytics. The use of psychotropic medication was higher among women in 2008 and 2015 (31.1% and 36.7%) compared to men. However, the increase in consumption was more relevant in men (13.3% to 20.0%), particularly in relation to anxiolytics (6.0% to 11.6%).

Conclusions

The economic crisis was associated with a substantial increase of psychotropic medication's use in Portugal, consistent with the increased prevalence of mental health problems that this study also found.

Funding

EEA Grants Programa Iniciativas em Saúde Pública.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A biopsychosocial look on the violence in Colombia. Understanding violence to understand the role of psychiatrist in the post-peace agreement era
Authors: Suelt M.J.
Published: June 2017

Introduction

The armed Colombian conflict is one of the bloodiest and most extensive in the contemporary history of Latin America, with multiple factors and causes implicated.

Objectives

Determine the factors involved in the emergence of Colombian political violence from neurobiological, anthropological, social and psychoanalytic models.

Methods

We revised the report Basta Ya! of The National Center for Historical Memory, which approximates the casualties and victims of the armed conflict in Colombia. In addition, we conducted a rigorous review of current scientific and clinical literature on the neurobiology of violent behavior, social psychiatry and psychoanalytic papers about war, death, and survival instincts.

Results

Violent behavior can be explained by the neurobiological model of aggressive response as an imbalance between the prefrontal cortex and the limbic system. There is evidence to support a geographically-based violence in Colombia with a fragmentation of the territory, the State, and the Colombian identity. Moreover, we found the psychological component raised by Freud and in psychoanalysis, about war, and life and death instinct, as antagonistic manifestations of life-present in acts of violence.

Conclusions

The violence from the armed Colombian conflict has been one of the longest in modern history, determining its causality has been complex. However, understanding violence multifactorially allows us to improve social psychiatry and our role as clinicians in this new post-agreement era, in order to better establish mental health policies for victims and perpetrators in future reparation.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Demographic and criminal data among psychiatric patients in Greece
Authors: Tzeferakos G. , Papagaliaga M. , Papageorgiou C. , Bali P. , Douzenis A.
Published: June 2017

Introduction

To our knowledge, a limited number of studies address criminality among psychiatric patients as depicted in legal files.

Objectives

The objective of the present study was to provide demographic, psychiatric, legal/criminal data about psychiatric patients in Greece.

Methods

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were reviewed.

Results

Seventy eight percent of the subjects had at least one psychiatric evaluation prior to the commitment of the crime. The main diagnoses at the time of the criminal act were: schizophrenia spectrum psychosis (18%), anti-social/borderline/mixed personality disorder (15%), substance use disorder (15%), alcohol use disorder (10%), depressive affective disorder (6%), mixed anxiety/depressive disorder (6%), bipolar disorder (5%), anti-social personality disorder/substance use disorder (5%), schizophrenia/substance use disorder (3%). In 11% the diagnosis was unknown. Eighty four percent of the crimes committed were homicides/attempted homicides, 6% assaults/(attempted) homicides, 3% property crimes/(attempted) homicides and below 3% assaults, property crimes, sexual offences, drug crimes. The weapon used was a knife/sharp object (42%) or a gun (40%). Perpetrator and victim were strangers in 25% of the cases, just acquaintances in 14%, had a professional relationship in 7%, their relationship was conjugal (15%), they were partners (13%) or relatives (7%). In persons with schizophrenia spectrum psychosis the victims were relatives/spouses in 41.2%, while in other diagnoses the respective percentage was 21.5% (P = 0.044).

Conclusions

In accordance to the international literature, there is a vast need for further research in order to improve forensic psychiatric services and prevent criminality among psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Descriptive study of people, with intellectual disability, presenting with challenging behavior in north London, UK
Authors: Perera B. , Courtenay K.
Published: June 2017

Prevalence of intellectual disability (ID) ranges from 0.05 to 1.55%. A total of 10–15% of the people with ID present with challenging behaviour (CB). This causes a significant strain on mental health services. People with ID often end up staying in psychiatric inpatient units for longer periods. Most people with ID move out of their family home to various care settings due to severity of their behavioural difficulties. This descriptive study shows characteristic features of people with ID and CB and financial costs to look after them in the community. This study highlights the importance to improve services to manage challenging behaviour, which may lead to better quality of life to the person with CB and reduction in financial pressures.

Disclosure of interest

COI: Bhathika Perera has received grants to attend conferences and speak at ADHD conferences by pharmaceutical companies.
Adapting the assertive community treatment (ACT) for the needs of different communities: A comparative case study of KUINA ACT Japan and Mt. Sinai ACT Canada
Authors: Chow W. , Shiida M. , Andermann L.
Published: June 2017

In this workshop, we will present the assertive community treatment (ACT) model in both Japan and Toronto, Canada. We will compare the adaptations of ACT models in both teams in order to serve their target populations efficiently and effectively.

We will also compare the demographic data, clinical data and the outcomes of both ACT teams by analysing the hospitalisation days, number of emergency admission and the number of admissions into hospitals. We will also highlight differences in the mental health systems in Japan and Canada in an attempt to formulate guidelines to ensure the effectiveness of ACT Teams in both countries. We would also like to open up discussion with the audiences and incorporate their ideas and suggestions in an attempt to formulate a competent mental health system which would effectively cater to the needs of people suffering severe mental health symptoms to ensure successful integration into the community.

Learning objectives:

– To explore adaptation in implementation of ACT in Japan and Canada;

– to develop a framework or model for assessing issues critical in establishing ACT in different countries;

– to develop guidelines to establish programs which will continuously be revised implementation based on needs, systems and feedback from the field.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neighbourhood Ethnic Density and Incidence of Psychosis – First and Second Generation Migrants Compared
Authors: Schofield P. , Das-Munshi J. , Becares L. , Agerbo E.
Published: June 2017

Introduction

Living in an area with few people from the same ethnic background has been associated with increased incidence of psychosis (the ethnic density effect).

Objectives

Compare associations between neighbourhood ethnic density and incidence of non-affective psychosis for first and second generation migrants.

Methods

Population based cohort (2.2 million) of all those born 1st January 1965 or later and living in Denmark on their 15th birthday. We looked at a total of 106,000 migrants, including 62% first generation migrants. Ethnic density was determined at age 15 and we adjusted for age, gender, calendar period, parental psychiatric history and parental income at age 15.

Results

For the first generation, we found no evidence that rates of non-affective psychosis were related to neighbourhood ethnic density for migrants from Africa (comparing lowest and highest quintiles): IRR 1.02 (95% CI 0.6–1.73), and the Middle East: IRR 0.96 (CI 0.68–1.35) and only weak evidence for migrants from Europe (excluding Scandinavia): IRR 1.35 (CI 0.98–1.84). Conversely, for the second generation rates of non-affective psychosis were increased for migrants from Africa in lower ethnic density neighbourhoods (comparing lowest and highest quintiles): IRR 3.97 (95% CI 1.81–8.69), Europe (excluding Scandinavia): IRR 1.82 (CI 1.28–2.59) and the Middle East: IRR 2.42 (CI 1.18–4.99).

Conclusions

There is strong evidence for an area ethnic density effect on psychosis incidence for second generation migrants, but not for first generation migrants. This could reflect a greater resilience among the latter group to the adverse effects of minority status.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Personality Traits and Disorders Among Adult ADHD Patients: Is Borderline Personality Disorder as Common as we Expect?
Authors: Oliva F. , Bramante S. , Portigliatti Pomeri A. , Carezana C. , Nibbio G. , Mangiapane C. , Maina G.
Published: June 2017

Introduction

Patients with Attention Deficit/Hyperactivity Disorder (ADHD) have shown a high risk to develop a DSM cluster B (i.e., Borderline, OR = 13.16; Antisocial, OR = 3.03; Narcissistic, OR = 8.69) and DSM Avoidant personality disorder (OR = 9.77). Similarly, higher rates of DSM cluster B personality disorder were found among adult ADHD patients (6-25%) than general population. Although some authors investigated the prevalence of personality traits and disorders among adult ADHD patients, no studies have been yet reported about the assessment of Millon's Evolution-Based Personality profiles in adult ADHD patients.

Aims

To explore the prevalence of personality traits and disorders among adult ADHD patients.

Methods

Millon's personality traits and disorders were assessed in a consecutive sample of 35 adult ADHD outpatients accessing the Service for Adult ADHD of the AOU San Luigi Gonzaga (Orbassano, TO) using the Millon Clinical Multiaxial Inventory–III (MCMI-III).

Results

According to the MCMI-III manual, ADHD patients in our sample showed more frequently both Cluster C and Cluster A traits and disorders, with a high prevalence of avoidant/depressive (8.6%/14.3%) and negativistic/self-defeating (20%/5.7%) personality disorders. Conversely, we found a low prevalence of Narcissistic (5.7%) and Histrionic (5.7%) traits, and no patient showed Borderline personality traits or disorder.

Conclusions

Unexpectedly, the dimensional assessment of adult ADHD personality reveals a high prevalence of cluster C and cluster A personality traits and disorders, and a low prevalence of cluster B personality disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Results of Using Micronutrients as Adjunctive Treatment for Psychotic Disorders
Authors: Mehl-Madrona L. , Mainguy B.
Published: June 2017

Objective

To evaluate the use of micronutrients (minerals and vitamins) as adjunctive therapies for psychosis when added to conventional medications.

Setting/locations

Rural primary care and psychiatry clinic in Northern New England, USA.

Subjects

People over age 18 diagnosed with a psychotic disorder on medications.

Intervention

Fifty consecutive clients during one month's time were invited to participate; 19 completed a one-month open-label phase of the addition of a micronutrient to their medication regimen; all 19 then withdrew rather than risk randomization to a placebo. We then compared the response of those 19 over 24 months of micronutrients + medication to the 31 people who declined participation enriched by an additional 28 consecutive patients recruited over the second month of the study for a total of 59 who received medication without micronutrients.

Outcome measures

All clients were evaluated with the Positive and Negative Symptom Scale and the Clinical Global Impression scale at study baseline and after 3, 6, 9, 12, 15, 18, and 24 months. Psychosis was confirmed with clinical interview using DSM IV-TR criteria. All participants had normal physical examinations and laboratory studies.

Results

Outcomes were similar for both groups until 15 months, though the micronutrient group used significantly less antipsychotic medication throughout that time (P < 0.001). At 15 months, the micronutrients + medication group exhibited significantly fewer symptoms than the medication only group, a difference that was even stronger at 24 months.

Conclusions

Micronutrients may be a beneficial long-term, adjunctive strategy for people with psychotic disorders, allowing for smaller doses of antipsychotic medications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Executive Function Assessment in Young Hospitalized Schizophrenic Patients with the “CANTAB Schizophrenia Battery” (Russian Sample)
Authors: Rupchev G. , Alekseev A. , Morozova M. , Kaleda V. , Tkhostov A. , Tikhonov D. , Listova A.
Published: June 2017

Introduction

Impairment of executive function is the fundamental feature of the cognitive dysfunction in schizophrenia has to be measured throughout the illness regularly. Computerized technologies for assessment of cognitive dysfunction are widely used. However, their applicability in hospitalized schizophrenic patients setting should be specially examined.

Objective

Executive function in schizophrenia.

Aims

To test the applicability of “CANTAB” neurocognitive battery for measurement of executive function in young hospitalized schizophrenic patients in Russian sample.

Methods

Fifteen inpatients diagnosed with schizophrenia according to ICD-10 (F 20.хх), 13 males and 2 females, aged 23.5(SD 3.2), disease duration is 5(SD 1.6) years and 16 healthy individuals, 7 males and 9 females, aged 21.3(SD 0.7). Spatial Working Memory (SWM) (Mnemonic Executive function), Stockings of Cambridge (OTS) (Planning Executive function), Intra/Extra-Dimensional Shift (IED) (Cognitive flexibility) were administered.

Results

The majority of patients and controls easily understood the test instructions. Both groups did not have any difficulties with the touchpad. The “CANTAB” demonstrated sensitivity to the impairments of executive function. As a group, patients with schizophrenia performed significantly worse than controls on almost all tests: SWM–Between errors (P = 0.028), Total errors (P = 0.019), Strategy (P = 0.03), Mean time to last response (P = 0.001); OTS–Mean choices to correct (P = 0.044), Problems solved on first choice (P = 0.009), Probability of error given correct (P = 0.021); IED–Total errors (P = 0.015), Total trials (P = 0.002).

Conclusion

The “CANTAB” is an applicable instrument for assessment of the executive function in young hospitalized schizophrenic patients. It can be used both for experimental and clinical needs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Outcomes in a Group of 7–8-Year-Old Children in a Developmental-Based Intervention in Autism Spectrum Disorder
Authors: Sindelar M.T. , Furland N.
Published: June 2017

Healthy parent-child interaction is essential for child development. Parents play a central role in the acquisition of social and communicative skills, both in typical and atypical children. Increased support for parent-mediated intervention in autism has been demonstrated. Developmental approaches for ASD are based in establishing strong interpersonal relationships through natural play to foster developmental capacities. This work reports outcomes from an intensive approach based on a developmental, individual difference, home-based intervention program with children with severe ASD. Parents were trained with DIR approach by a specialist. An individual intensive rehabilitation program was set up for each child and implemented at school, home and rehabilitation center. The intervention program also focused on semi-structured activities to promote problem solving, and meliorate sensory dysfunction. Standardized scales were administered pre– and post-intervention, with ABC). The Childhood Autism Rating Scale (CARS), the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales.

Results

Before initiating the intervention all children presented severe difficulties in communication, social interaction, lack of language, and gestures of communication, auto– and hetero-aggressive behaviors. After 6 months, children showed significant changes in mean scores for emotional functioning, communication, and daily living skills and diminution of aggressive behaviors. The present results provide strong support for the effectiveness of a developmental-based intervention, specifically in the domains of social skills behavior, social responsiveness, in a group of children with severe autism. These results highlight the positive effects of a rehabilitative approach that works in harmony with the family, school and professional team.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Exome Sequencing Detection of Genetic Markers for Thai Autism Spectrum Disorder
Authors: Sukasem C.
Published: June 2017

Background

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by abnormalities in 3 domains; social interaction, communication/language, and restricted and repetitive behavior. The study of ASD prevalence in Thailand showed that it is approximately 9.9 children per 10,000 population for children 1–5 years old. ASD has a strong genetic basis, although the genetics of autism are complex and it is unclear. The objective of this study was to identify the genetic markers of Thai ASD.

Methods

Exome sequencing was performed with twelve unrelated ASD affected individuals from twelve families. Each sample was sequenced on SOLiD 5500xl genetic analyzer, and the resulting data was processed and analyzed on LifeScope Genomic Analysis software. Exome sequencing with two additional samples was performed Ion Proton System and the data was processed on Ion Reporter server. Tertiary data analysis with all fourteen exome sequencing data were performed by using Golden Helix software. In filtering process, data were annotated to various databases including UCSC KnownGenes for non-coding and synonymous variants filter, 1000 Genomes Project for high frequency variants filter, and dbNSFP for functional prediction.

Results

The genetic markers were identified for Thai ASD associated variants (c.2014G > A in EIF2AK3, c.2951G > A in FGD6, and c.6119A > G in CHD8).

Conclusions

these genetic markers were the most possible of causing variants Thai. We also demonstrated a potential of exome sequencing and bioinformatics pipeline to identify the possible causative variants of ASD, which could by applied in the case that unable to identified variants by other technique.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Hyperuricemia and Metabolic Adverse Effect in Children and Adolescents with Autism Spectrum Disorder Treated with Risperidone
Authors: Sukasem C.
Published: June 2017

Background

Atypical anti-psychotics have been found to be associated with hyperuricemia. The aims of this study were to determine the prevalence of hyperuricemia and metabolic adverse events in children and adolescents with ASD treated with risperidone.

Methods

In this cross-sectional study, we recruited 127 Thai ASD children and adolescents aged 3–20 years receiving risperidone for more than 4 weeks. The clinical data and laboratory data were obtained and analyzed. Hyperuricemia was defined as serum uric acid > 5.5 mg/dL.

Results

Hyperuricemia was present in 57.48% of total ASD patients treated with risperidone. Uric acid levels were significantly higher in adolescents as compared to children. Uric acid levels correlated with risperidone dose (P = 0.01), duration of treatment (P < 0.0001), BMI (P < 0.0001), waist circumference (P = 0.003), triglyceride (TG; P < 0.0001), triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C; P < 0.0001), insulin (P = 0.04), homeostatic model assessment index (HOMA-IR; P = 0.03), high-sensitivity CRP (hs-CRP; P < 0.0001), and leptin levels (P < 0.0001). HDL-C and adiponectin levels were negatively correlated with uric acid levels (P < 0.0001). In multiple regressions analysis, age, BMI, TG/HDL-C, and adiponectin level remained significantly associated with uric acid levels (P < 0.0001).

Conclusion

Hyperuricemia may play a role in metabolic adverse effects in children and adolescents with ASD receiving high dose and/or long-term treatment with risperidone.

Disclosure of interest

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