bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychopathy and Twins. A Case Report
Authors: Hernandez Dorta A. , González González I.
Published: June 2017

Introduction

We are going to explain a case of a patient diagnosed with psychopathy and his twin brother with a normal personality.

Objectives

To show the controversia about psychopathy and twins.

Methods

Description of a case of psycopathy. We evaluated his psychopatology using the Psychopaty Checklist (PCL).

Case

A 18-years-old male teenager admitted to a penitentiary facility for several crimes: drug dealing, violent theft and multiple aggressions.

Personal history: early psychological and psychiatric attention for disruptive behaviour as a child: repeated lies, low empathy, defiance to parents and teachers, indifference to punishment, robbery, aggressive behaviour, loitering, escaping from home, cruelty against animals, promiscuity, vandalism and drug abuse. Medium-high class family, well-structured family, none of them with criminal history or mental disorders, his brother is a brilliant student.

Personality assessment: We describe 20 features of his personality according to the PCL and we score them from 0 to 2. Zero if it does not apply at all, one if there is a partial match, two if there is a good match.

Features: Superficial charm, narcicism, pathological liar, manipulator, absence of guilt, superficial affection, absence of empathy, inability to accept responsibility, need for constant excitation, parasitic life, unrealistic goals, impulsivity, irresponsibility, low self-control, conductual problems since childhood, juvenile delinquency, repeal of conditional freedom, criminal versatility, promiscuity and multiple marriages.

Results

Out of a maximum score of 40, the cut-off for psychopathy is 30.

This patient has 34 points so we can conclude he is a psychopath.

Conclusions

We can conclude there is not a clear relationship between twins and psychopathy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Self-esteem in Military Patients with Post-traumatic Stress Disorder
Authors: Ben Zina E. , Krir M.W. , Bel Hadj H. , Lansari R. , El Kefi H. , Ben Cheikh C. , Omaya A.
Published: June 2017

Introduction

Maintaining self-esteem is a fundamental human motivation. Trauma may lower self-esteem, which contributes to the development and maintenance of Post-Traumatic Stress Disorder (PTSD).

Objectives

Assessment of self-esteem in Tunisian military patients suffering from PTSD. Study of correlation between the severity of the PTSD symptoms and the rate of self-esteem.

Methods

Transversal descriptive study of a sample of 22 patients treated for PTSD in the Tunisian Military Hospital during the period between August and October 2016.

The PTSD Cheklist for DSM-5 (PCL-5), Hospital Anxiety and Depression scale (HAD), and the Rosenberg Self-Esteem Scale were administered for patients.

Results

All the patients assessed were male. The mean age of the sample was 29.6 years. Fifty percent of the patients presented with a co-morbid major depression. Based on the score of the Rosenberg Self-Esteem Scale, patients had a self-esteem, which was very low in 45.45% of case, low in 45.45% of cases, average in 4.54% of cases and high in 4.54% of cases. The results also showed that lower levels of self-esteem are significantly correlated to the severity of the PTSD symptoms as measured by the PCL-5 score.

Conclusions

This study highlights the magnitude of self-esteem deficiency among patients suffering from PTSD. It remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. Further studies are required.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Full and Partial DSM-5 PTSD in Parents of Children with Epilepsy: Exploring Gender Differences
Authors: Carmassi C. , Corsi M. , Gesi C. , Bertelloni C.A. , Faggioni F. , Calderani E. , Massimetti G. , Peroni D. , Bonuccelli A. , Orsini A. , Dell’Osso L.
Published: June 2017

Introduction

Increasing literature suggests the need to explore PTSD and post-traumatic stress symptoms among parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy.

Objectives

The aim of this study was to estimate full and partial PTSD rates among parents of children with epilepsy according to DSM-5 criteria. Further, aim of this study was to examine eventual gender differences between mothers and fathers.

Methods

One hundred and thirty-eight parents, 91 mothers (65.9%) and 47 (34.1%) fathers, of children diagnosed with epilepsy were interviewed using the SCID-5.

Results

Full and partial DSM-5 PTSD were reported by 10.4% and 37.3% of patients, respectively. Significant gender differences, with the mother more affected, emerged in the rates of partial A PTSD rates (P = 0.048) and in the endorsement rates of criterion B (intrusion symptoms) (P = 0.047), criterion D (negative alterations in cognitions and mood) (P = 0.010) and criterion E (alterations in arousal and reactivity) (P < 0.001) too.

Conclusions

This is the first study to identify post-traumatic symptoms in caregivers of pediatric patients with epilepsy with the use of current diagnostic criteria and the relevance of the results suggests the need for further studies on this risk population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Action Plan of the WPA: Action Plan Which Follows the Objectives of the Association Relating to Refugees and Asylum Seekers
Authors: Bhugra D.
Published: June 2017

Recent mass movement of human beings in various parts of the world has brought several challenges. Not only refugees from Syria and Libya to Europe but also refugees, migrants and asylum seekers in Latin America bring specific set of issues with them. It is critical that clinicians are aware of both the vulnerability of individuals to mental ill health as a result of migratory experiences but equally importantly their resilience. The impact on the mental health of those who may be involved directly or indirectly in delivering care along with those new communities who receive these groups need to be taken into account when planning and delivering psychiatric services. It is essential to recognize that experiences of being a refugee or asylum seeker are heterogeneous. Being an asylum seeker carries with it legal definitions and legal imperatives agreed at international levels.

Policymakers and clinicians need to be aware of differential rates of psychiatric disorders in these vulnerable individuals and specific needs related to language, religious values and other cultural factors. Mental health problems may be related to experiencing cultural bereavement where individuals feel that they have lost their cultures, relationships and cultural values. Judicious and careful use of trained culture brokers and mediators should be encouraged as these individuals can inform the team about community needs and inform the community about the team functioning and its principles so that community expectations can be managed appropriately. Such approaches may also help reduce stigma against mental illness.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Five Sessions of in Vivo Exposure Therapy for Post-traumatic Stress Disorder: A Case Report
Authors: Tuvia T. , Rego S.
Published: June 2017

Introduction

Prolonged exposure (PE) is recognized in many guidelines as an effective, evidence based treatment for post-traumatic stress disorder (PTSD), with the active ingredients being in vivo and imaginal exposure. Despite this, patients and clinicians are often reluctant to engage in this form of treatment. Imaginal exposure can be perceived as too anxiety proving, leading to discomfort among both patient and clinician. In vivo exposure alone, however, has also been established as an effective treatment for anxiety disorders that can provide significant results in a rapid manner.

Methods

A 31-year-old female with no prior psychiatric history presented to treatment in an acute depressive episode following a motor vehicle accident two years prior. She also met criteria for PTSD. Her Beck Depression Inventory (BDI) and PTSD Checklist for DSM-5 (PCL–5) scores were 42 (severe depression) and 64, respectively. Due to constraints, a modified form of PE was initiated, with five in vivo exposure sessions conducted.

Results

After five sessions of in vivo exposure, the patient's PCL–5 score decreased from 64 to 36 and her BDI score decreased from 42 to 13 (minimal depression).

Conclusions

This case report underscores the effectiveness of a modified form of PE, using in vivo exposure alone as a treatment for PTSD. This has significant implications in particular for patients or clinicians who are unable to initiate imaginal exposure (e.g., patient finding it too difficult to tolerate/refusing to engage, language barriers, etc.). In such situations, in vivo exposure appears to be an alternate, effective, short-term treatment option.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
CEVUP Program: An Analytical Epidemiological Cohort Study
Authors: Bazziconi P.F. , Lemey C. , Bleton L. , Walter M.
Published: June 2017

Introduction

Over the past few years, several teams have built programs to detect patient at clinical high-risk state for psychosis and to develop interventions at an early stage of psychiatric troubles. The aim of this study is to provide an overview of the functioning and the results obtained by the specialized program developed in Brest, France (CEVUP).

Methods

We retrospectively analyzed the medical records of patients addressed to the CEVUP between June 2010 and April 2014. Data were double collected by two different investigators and we tested the inter-raters reliability. We included 49 help-seeking patients, aged from 15 to 30 years old, addressed by psychiatrists and general practitioners. The initial evaluation included a clinical evaluation, CAARMS scale, Rorscharch test and neurocognitive tests. Subjects were classified in two groups: not at risk for developing psychosis (NA) or at risk for developing psychosis (AR).

Results

The main results at initial evaluation showed that 16 (32.7%) patients were AR and 33 (67.3%) NA. Among AR patients, 8 (24%) developed psychosis in two years against 2 (12.5%) for NA patients. These patients have psychiatric comorbidities, essentially depression or anxiety. Secondarily, there are more disturbances of psychomotor and affective development in subjects AR: 14 (41.1%) against 7 (20.5%) in group NA.

Conclusion

The present study describes the procedures and the main results established by a specialized program for patient at high risk to develop psychosis. The characteristics of the sample remain consistent with descriptions of such populations worldwide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Forgiveness and armed conflict in a Colombian Caribbean region: Differences between genders
Authors: Romero Otalvaro A.M. , Munoz M. , Uribe A. , Katia C. , Maria R.
Published: June 2017

The forgiveness within the framework of social-political conflict is a factor that affects the coexistence and welfare. In the Colombian Caribbean, there are a significant number of people who have been victims of land dispossession and/or forced displacement.

The aim of this study is to compare the forgiveness ability between men and women who have been displaced and are in the process of lands restitutions. Displaced and in restitutions process people were participated (n = 38), which 20 of them were women and 18 were men (Mean = 57.81; SD = 13.86). The CAPER Scale, was administered. A cross sectional and comparative design was carried out. The comparison was performed using a t-test for independent samples (Table 1).

Conclusions

A greater tendency was observed in women for forgiveness himself, noneless a statistically significant gender difference was not identified. It was a greater tendency in men toward forgiveness to others, however there are no statistical differences between the two groups. In forgiveness situations, a similar trend is evident in gender. As for beliefs, it was observed that men scored higher, this allowed statistically significant differences were observed [F (1, 38) = 6.271; P > 0.05].

Table 1Means and SD – Caper Scale1. Women; 2. MennMeanSDStandard error of meanForgiveness himself12028.004.8991.09521826.004.2290.997Forgiveness to others12028.355.4021.20821829.114.1290.973Forgiveness situations12028.005.0161.12221828.003.7570.886Beliefs12011.802.8210.63121813.331.1880.280

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Student psychiatry audit and research collaborative (SPARC): A new UK initiative to improve recruitment in psychiatry
Authors: Ellis N. , Quraishy M. , Grubb C.M. , Codling D. , Harrison J.
Published: June 2017

Introduction

The UK has longstanding problems with psychiatry recruitment. Various initiatives aim to improve psychiatry's image among medical students, but involve research and none are student-led. Providing opportunities to take part in psychiatry research and quality improvement could increase the number of students who choose to enter the speciality.

Objectives

We have developed the student psychiatry audit and research collaborative (SPARC), a student-led initiative for nationwide collaboration in high-quality research and audits.

Methods

Our model is inspired by the success of the UK Student audit and research in surgery (STARSurg). Area teams, located in medical schools, take part in multi-centre projects. The area teams consist of medical students, who have the main responsibility for collecting data; a junior doctor, to supervise the process; and a consultant, with overall responsibility for patient care. The data collected centrally and analysed by a team of medical students and doctors. Student leads from each site are named authors on resulting papers. All other students are acknowledged and are able to present the work.

Results

We have completed our first audits in Cardiff and London; other sites will return data in 2017. Student feedback indicated a high level of satisfaction with the project and interest in psychiatry as a future career.

Conclusions

This initiative aims to tackle the recruitment problems in psychiatry by giving students a chance to take part in high quality research and audits.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Concerted action by multidisciplinary stakeholders: The development phase of a complex public health intervention in regards to adolescent self-harm
Authors: Parker R.
Published: June 2017

Self-harm has a strong prevalence within adolescent populations in Europe, and a potent relationship with suicide. In the UK, adolescent self-harm hospital admissions are rising each year. These statistics reflect the “tip of the iceberg”, with the majority of incidents hidden from public health networks. This invisibility creates barriers to: epidemiological information; the planning and evaluation of evidence-based support; health management within the complexity of adolescent self-harming behaviours to ensure recovery and healthy adolescent trajectories. It is also a serious health risk for this population group, and accidental death from self-harm is one of the common causes of injury-related adolescent death.

Within the aforementioned context, this paper describes a UK county-wide complex public health intervention (2013 to 2015) in regards to adolescent self-harm, with concerted action by key stakeholders in health, child welfare, education and social science due to concerns about the increasing self-harm rate within the adolescent population group. As self-harm is a complex behaviour, and the evidence-base for effective interventions is sparse, the development of protective factors within education, health and social care environments were targeted. A synergy of theoretical models from neuroscience and social science informed the intervention's logic model. The intervention's development phase utilised the Medical Research Council's guidance on complex interventions to improve public health, which this paper will exposit.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
A comprehensive training program for professionals working in mental health promotion centers in Hungary
Authors: Toth M.D. , Kallaine Harangi R. , Sumegi A. , Wernigg R.
Published: June 2017

Background

In a 12 month long mental health promotion pilot programme funded by the Norway Grants, 6 mental health promotion centers (MHPCs) are being set up in various locations in Hungary, employing 2 mental health professionals each, whose main commitment is to develop a local network of key stakeholders. The aim of the project is to enable MHPC professionals to perform network building tasks involving knowledge transfer and attitude changes regarding the following key areas: depression, suicide, dementia, stress and risk assessment.

Objective

To measure the effectiveness of the training and education process by using indicators for feedback, knowledge transfer and attitude changes.

Methods

The comprehensive TTT (train the trainers) process of MHPC professionals targets 3 main domains:

– improving presentation skills;

– knowledge transfer (measured with tests);

– elaborative workshops about mental health problems (measured by attitudes at baseline, post-training and 3 months post-training).

Results

The satisfaction assessment of the initial 3 days long training averaged 4.73 on a 5-point Likert-scale. Altogether, 12 (2/centres) knowledge transfer trainings are being delivered evaluated by attitude change and general satisfaction questionnaires. One elaborating workshop per center has been delivered during the study period. Being a process still underway, the outcome results will only be available by the conference.

Conclusion

This procedure enables professionals to disseminate trainings and build networks for mental health promotion in their micro-regions. The optimized version of this pilot program will be delivered on a national level in future projects.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Behavioral disorders: Within the limits of psychiatry or neurology? About a case
Authors: De Jaime Ruiz P. , Fernández Logroño J.
Published: June 2017

It has been a clinical case of a polimorphic psychotic disorder in a male of 26-year-old, affected by brain palsy, previously with adequate cognitive function, undergoing remarkable confusional fluctuations and a waking state apparently well-preserved. As possible comorbidities or triggers we could count on a tonsillitis and/or a depressive reaction a few days before. Serious consideration must be given to a differential diagnosis with an encephalitis but, despite the presence of an intermittent febricula, it was rejected by both units: internal medicine and neurology, after performing some complementary tests, albeit some more specific tests are still pending. His psychiatric background was also checked, which initially was orientated as a questionable bipolar disorder. At all events, symptoms stopped progressively until, almost complete remittance in the moment he was discharged from the hospital. He recovered his normal functionality. The treatment given was risperidon 2 mL/day, quetiapin 50 mg/8 h and baclofen 10 mg/12 h. This can be used as an example of how many difficulties we usually found to catalogue an acute disorder in first phases, even to encompass the clinical profile within the limits of psychiatry or neurology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The role of dissociation in patients with a diagnosis of borderline personality disorder and adverse attachment experiences
Authors: Galletta D. , Vangone N. , Califano A.I. , De Simone S. , Suarato V. , Mastrola A.M.
Published: June 2017

In literature, the link between childhood abuse stories, trauma, unresolved attachment and psychopathological manifestations characterized by the presence of significant dissociative symptoms are well documented. The treatment of this kind of clinical pictures is very problematic because of dysfunctional relational dynamics acted by patients. As we know, borderline personality disorder patients and those with unresolved attachment show poor emotion regulation. About that, a very recent study found an alteration of the neural mechanism involved in the top-down control process of emotional distress both in BPD patients and in those with unresolved attachment. In this context, to make an accurate psychological assessment is essential to define and understand the overall patient functioning and identify the most appropriate therapeutic strategies. In this study, we have selected 22 women characterized by a diagnosis of borderline personality disorder, dissociative experiences and childhood abuse stories. The psycho-diagnostic examination of this sample involved the use of the following tools: Rorschach, MMPI-2, WAIS-R and drawing tests. Consistent with the literature, the outcomes confirmed the presence of response patterns related to trauma, abuse stories and dissociation in both Rorschach and MMPI-2. At the same time, in a significant portion of the sample, we have found an intact cognitive functioning; this aspect, as showed by other authors, highlights the adaptive function of the defensive mechanism of dissociation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric patients show different coping styles during aggression compared to controls
Authors: Orlando S. , Callovini G. , Altavilla B. , D’Ambrosio L. , Iasevoli F.
Published: June 2017

Introduction

Aggression and violence are common phenomena, potentially experienced by everyone.

Objectives

To demonstrate that coping patterns to face aggression and violence may exhibit differential group features.

Aims

To find differences in coping styles during moments of high aggression in psychiatric patients compared to non-affected controls.

Methods

We evaluated 34 outpatients from the section of psychiatry of university Federico II of Naples by two psychometric scales: AQ to evaluate aggression levels and Brief-COPE for coping patterns. Outcomes were compared with that of 34 non-affected controls, recruited from the university student population. Pearson's correlation was used to find relationships between aggression levels and coping skills in these two groups.

Results

We found significant differences between groups in multiple scale items and in the correlation measures, e.g. the use of expression was completely reversed in this two samples according to aggression levels.

Conclusions

These results show that aggression is experienced differentially and with different coping styles by psychiatric patients compared to non-affected controls.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clozapine: Since the very beginning?
Authors: Garcia Ayala L. , Gómez Revuelta M. , Martín Requena C. , Garcia de Acilu E. Saez de Adana , Porta Olivares O. , Juncal Ruiz M. , Nuñez Morales N. , Zubia Martín M. , Laborde Zufiaurre M. , González Hernández B. , Aranzabal Itoiz A. , López Peña M.P. , González-Pinto Arrillaga A.M.
Published: June 2017

Introduction

Psychosis in childhood and adolescence could be defined as having hallucinations, with the hallucinations occurring in the absence of insight. A broader definition includes symptoms such as delirious thoughts, disorganized speech, disorganized behavior, cognitive and mood symptoms and what is called negative symptoms. Several researches have been done focused in the treatment of first episode of psychosis showing clozapine as a keystone in the treatment of psychosis, especially in refractory first episodes.

Objectives

Clozapine has unique efficacy in improving treatment-resistant patients with chronic schizophrenia but the moment of instauration remains unclear. There have always been doubts about the right moment to start clozapine, after two or more previous anti-psychotics or as first option.

Materials and methods

We report a 18-year- old woman with family history of severe psychosis. Her mum reasserted patient's symptoms contributing to a longer period of non-treating psychosis (about 10 months). Auditory hallucinations, incongruent mood and incoherent language appeared for the first time at the age of 17. High doses of two consecutive anti-psychotics were tried without remission and finally clozapine was initiated with clinical improvement.

Discussion

In clinical practice, a subgroup of psychotic patients experience, significant ongoing positive symptoms despite of using first line anti-psychotic medication.

Conclusion

Most recent research; suggest that clozapine may have an important role in the early treatment of first-episode patients, even becoming a first line option to consider.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rechallenge clozapine after agranulocytosis in refractory schizophrenia. A case report
Authors: Landera Rodríguez R. , Juncal Ruiz M. , Martín Gutiérrez R. , Gómez Revuelta M. , Río Hortega I. Madrazo del , Sánchez Blanco L. , Santayana Jenaro G. Pardo de , Abejas Díez D.
Published: June 2017

Introduction

Clozapine, is widely prescribed for treatment of refractory schizophrenia, but its use may be limited by potentially serious adverse effects. The most feared complication remains agranulocytosis [absolute neutrophil count (ANC) < 500/mm3], which occurs in 1% of patients. Guidelines recommend immediate cessation until the granulocyte count normalizes, but little is known about the subsequent treatment and the possibility of restoring clozapine.

Objectives

To know procedures that allow clozapine rechallenge after induced agranulocytosis in refractory schizophrenia.

Methods

We present a clinical case of agranulocytosis and evolution after simple reinstitution of clozapine.

Results

A 38-year-old woman diagnosed refractory schizophrenia. After 10 years with clozapine (300 mg/day), we find neutropenia (ANC 1420/mm3) in a monthly control blood count with progression to agranulocytosis (ANC 460/mm3) in the following month. We suspend clozapine and started olanzapine (20 mg/day) with restoration of haematological values in a period of one month. The patient had psychotic decompensation at two months after the change with lack of response to different psychopharmacological strategies for five months. According to the hematology department we decided to re-introduce clozapine (200 mg/day) in combination with olanzapine with complete clinical remission. Between the 3rd and 9th week after rechallenge we observe a progressive decline in ANC, while remaining within the range of normal. From the 9th week and in the last 6 months neutrophil counts remained stable.

Conclusions

Although, more research is needed to establish the safety to rechallenge of clozapine after agranulocytosis, it must be an alternative to consider when other treatment strategies fail.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The legacy of Walter Jackson Freeman II (1896–1972): The lobotomist
Authors: Arts M. , Michielsen P. , Petrykiv S. , De Jonge L.
Published: June 2017

Introduction

Walter Jackson Freeman II was born the grandchild of William Williams Keen, one of world's most renowned surgeons from Philadelphia and the son of an otorhinolaryngist, which may have been contributed to his interest in medicine. Freeman started his medical career in a psychiatric hospital and over the years, he operated thousands of patients. He was a protagonist in American psychosurgery and therefore, he often has been referred as the “lobotomist”.

Objectives

To present the scientific papers of Walter Jackson Freeman on psychosurgery.

Aims

To review available literature and to show evidence that Freeman made a significant though controversial contribution to the development of psychosurgery.

Methods

A biography is presented and discussed followed by a literature review.

Results

In this whole career, “the lobotomist” operated more than 3500 patients and performed mainly operations on the frontal areas. However, he operated human brains without due regard for his patient's mental abilities and emotional well-being after their lobotomy. Despite his work was praised, there was also a lot of criticism on his methods.

Conclusion

Despite the dubious reputation, Freeman can be remembered as an ambitious doctor who made a significant contribution to the development of psychosurgery. However, unfortunately he crossed medical and legal boundaries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Intergenerational Transmission of Well Being–Genetic and Epigenetic Mechanisms
Authors: Unternaehrer E. , Greenlaw K. , Hari Dass S. , Chen L.M. , Bouvette-Turcot A.A. , Cost K. , O’Donnell K.J. , Gaudreau H. , McEwen L. , MacIsaac J. , Kobor M.S. , Fleming A.S. , Atkinson L. , Lydon J.E. , Steiner M. , Ciampi A. , Greenwood C.M.T. , Meaney M.J.
Published: June 2017

Introduction

Maternal mental well being influences offspring development. Research suggests that an interplay between genetic and environmental factors underlies this familial transmission of mental disorders.

Objectives

To explore an interaction between genetic and environmental factors to predict trajectories of maternal mental well being, and to examine whether these trajectories are associated with epigenetic modifications in mothers and their offspring.

Method

We assessed maternal childhood trauma and rearing experiences, prenatal and postnatal symptoms of depression and stress experience from 6 to 72 months postpartum, and genetic and epigenetic variation in a longitudinal birth-cohort study (n = 262) (Maternal adversity, vulnerability and neurodevelopment project). We used latent class modeling to describe trajectories in maternal depressive symptoms, parenting stress, marital stress and general stress, taking polygenetic risk for major depressive disorder (MDD), a composite score for maternal early life adversities, and prenatal depressive symptoms into account.

Results

Genetic risk for MDD associated with trajectories of maternal well being in the postpartum, conditional on the experience of early life adversities and prenatal symptoms of depression. We will explore whether these trajectories are also linked to DNA methylation patterns in mothers and their offspring. Preliminary analyses suggest that maternal early life adversities associate with offspring DNA methylation age estimates, which is mediated through maternal mental well being and maternal DNA methylation age estimates.

Conclusion

We found relevant gene-environment interactions associated with trajectories of maternal well being. Our findings inform research on mechanisms underlying familial transmission of vulnerability for psychopathology and might thus be relevant to prevention and early intervention programs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparisons of Narrative Psychotherapy to Conventional CBT for the Psychotherapy of Psychosis and Bipolar Disorder
Authors: Mehl-Madrona L. , Mainguy B.
Published: June 2017

Introduction

There is ongoing debate about about both the value of psychotherapy in psychotic disorders and the best type of psychotherapy to use if necessary.

Methods

We conducted narrative psychotherapy with 18 adults, all diagnosed as having bipolar disorder with psychotic features and/or schizo-affective disorder. Outcome data consisted of the Positive and Negative Symptom Scale, the Clinical Global Impressions Scale, the Young Mania Rating Scale, the Hamilton Anxiety and Depression Scales, the My Medical Outcome Profile, Version 2(MYMOP2), and the Outcome Rating Scales of Duncan and Miller. We compare the outcomes of our patients to those of a matched comparison group receiving conventional psycho-education and cognitive behavioural therapy. Patients were seen for a minimum of 16 weeks over an average of 22 weeks. Average age was 31.5 years with a standard deviation of 8.1 years.

Results

The narrative therapy group showed statistically significant reductions in all outcome measures compared to the conventional treatment group. They continued treatment significantly longer and had fewer re-hospitalizations. They were less distressed by voices.

Conclusions

A narrative psychotherapy approach using dialogical theory and therapy ideas is a reasonable approach for the psychotherapy of psychosis. Review of psychotherapy notes showed that narrative approaches allowed the therapist to align with the patient as collaborator in considering the story presented and was therefore less productive of defensiveness and self-criticism than conventional approaches. The therapy included techniques for negotiating changes in illness narratives, identity narratives, and treatment narratives that were more conducive of well-being and recovery.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Development of an Interview Schedule for Assessing Factors Influencing Educational Outcome in Students with Schizophrenia
Authors: Chattopadhyay A. , Kumar C.N. , Thirthalli J. , Mehta U. , Thanapal S.
Published: June 2017

Introduction

Schizophrenia is a severe mental disorder with a relatively high toll on the quality of life of the patient and caregiver. It has a high financial, emotional and psychosocial burden. Surprisingly, optimum academic and educational outcomes in individuals with schizophrenia have been a neglected area of research and service provision.

Objectives

Development of an interview schedule assessing the helpful and hindering factors affecting the educational attainment in persons with schizophrenia.

Methods

Twenty-one participant were recruited (11 patients and 10 caregivers) from August 2014 to 2015 using purposive sampling and interviewed in a semi-structured qualitative fashion. Patients were between 16–25 years of age. Data collection and interpretation continued iteratively till saturation of factors was achieved. The list of factors (hindering/helping) was compiled and sent to a panel of 14 experts. They rated the schedule and the individual factors on a Likert scale. Reliability and validity parameters were tested and the final schedule was formulated.

Results

The final schedule contained 17 hindering and 18 helping factors. Detailed instructions to the interviewer for administration of the schedule are included. The factors have been further subdivided into illness related and illness unrelated. Some of the major hindering factors were symptoms of illness, medication side effects, delay in treatment initiation, perceived conflict in parents, lack of motivation. The major helpful factors were adequate symptom control, withholding inpatient care, spirituality, and peer group acceptance.

Conclusions

Service provisions for ensuring optimal educational achievement can be formulated by assessing the felt needs and hindrances of patients and their caregivers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Predictors of Social Function and Quality of Life in Patients with Traumatic Brain Injury
Authors: Ubukata S. , Sugihara G. , Murai T. , Ueda K.
Published: June 2017

Cognitive deficits as well as affective and physical symptoms are common after traumatic brain injury (TBI). However, little is known about how these deficits affect functional outcomes. The purpose of this study was to investigate the relationship between neuropsychological, affective and physical sequelae and outcomes such as social function and quality of life in patients with TBI. We studied these relationships in 57 patients with TBI over the course of 6 months post-injury. The patients completed neuropsychological assessments, including the Wechsler Adult Intelligence Scale-III, the Rivermead Behavioural Memory Test, and verbal fluency test. Affective and physical symptoms were assessed by beck depression inventory-II, Chalder fatigue scale, and Pittsburgh sleep quality index. Functional outcomes were assessed using the world health organization (WHO) disability assessment rated by others and the WHO quality of life assessment (WHO/QOL 26). The patients showed impairments in executive function assessed by verbal fluency test. The affective and physical assessments showed mild depressive mood and fatigue problem. Multiple regression analysis revealed that executive function and depressive mood were the best predictors of social function and quality of life, respectively. The findings of this study suggest that executive function and depressive mood are important factors to predict functional outcomes in patients with TBI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Subjective Graphic Representation as the Neural Pathway of the Information Processing: Dyslexia as an Example
Authors: Bernardini A.
Published: June 2017

Introduction

The new theory of the cognitive process by A Bernardini.

Objectives

to single out and recover deficits of the information processing by a new research method.

Aim

to demonstrate dyslexia/language can be considered as an answer to what we are able to perceive. This depends on the way in which the C.N.S. elaborates the two aspect of energy of the internal and external space according to the new theory of the cognitive process by A. Bernardni which underlies her relevant re-educative methodology.

Methods

this study was carried out in Italy, in pre-high school education where students with moderate learning abilities and special needs are integrated into mainstream education. The performance of F 81 subjects was examined. They were divided into two groups: the first supported by A. Bernardini's method, the second one supported by a remedial teacher (traditional method) and the control group being the rest of the class. For five months, tailored programs were followed three times a week, for one hour and a half.

Results

At the end of the treatment the second group did not show significant results while the first group showed marked improvement. Among the students of the first group, Tobia was the student who best represented dyslexia; for this reason he has been taken as an example.

Conclusion

Dyslexia and disturbances in language depend on perceptive deficits and can be singled out and recovered by A. Bernardini method. The last revolutionizes the current research method.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Ambientation/Acculturation of a Psychologist as “Methodological Internship” for Developing Qualitative Research to Study Clinical Supervisions at a Psychiatric Outpatient Service of Brazilian General Hospital
Authors: Bremberger M.E.D.F. , Bastos R.A. , Alves V.L.P. , Turato E.R.
Published: June 2017

Qualitative research in a psychiatric setting requires methodological updates on its modus operandi for professionals who migrated paradigmatically from other academic areas. The mere adoption of the concept of acculturation, from anthropology to field of health services, may not correspond to specificities of assistance and research in this field.

Objective

To discuss results of a certain environment and acculturation strategy for development of humanistic research that took place in a psychiatric outpatient service of a university hospital.

Method

Observation of environment of psychiatric supervision for qualitative method in health setting, in period of six months. The first author, doctoral student, psychologist, systematically attended discussions of clinical cases, observing relationship between supervisors and residents. Data were recorded in field diary, followed by free-floating readings and critical analyses. These were also submitted to peer reviewers of the LPCQ-laboratory of clinical-qualitative research.

Results

– The experience, similar to an “internship”, has been confirmed as necessary to conduct qualitative research in this field;

– It allowed accurate apprehension of features of environmental functioning and, above all, cultural dimensions of language of participants;

– This proved pertinent for clearing the theme-problem to be researched;

– Postgraduate researchers, in particular those graduates under other paradigms, have strengthened their methodological knowledge on this field, and have been inserted epistemologically for which they will have built new knowledge;

– Finally, this methodological stage improved the so-called active observation and phenomenological listening of the researchers regarding those observed.

Conclusions

The experience contributed significantly to establishing and validating the qualitative methodological course.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A gender approach in prodromes of psychosis
Authors: Calahorro C.M. , Jiménez M. Guerrero , Serrano B. Girala
Published: June 2017

Background

Only 21% of patients included in the South of Granada's First Episodes Program in the year 2014 were women. Studies do not use to focus on sex differences at first-episode samples and it can be masking some relevant variables in this population.

Aims

In this exploratory study, we aim to focus on gynaecological consultations during the period of untreated psychosis (DUP) at first episodes of psychosis in women.

Methods

A retrospective clinical-cases review of medical histories was made searching for sociodemographic variables, consultations during DUP and psychotic prodromal outcomes.

Results

The average age of the sample was 23 years. The average of DUP was one to three months. Sixty percent of referees to mental health services were from primary care and 20% from emergency services. The main symptom was persecutory or prejudice delusions. Thirty-six percent of them were related to sexuality or pregnancy. In most cases, the demands were not bizarre. When a wide history was made and they were properly explored, a delusional theme was appreciated and the reason for consultation was not justified. Eg. Postcoital pill order for not taking precautions, in a telepathic relationship. Forty percent of claims were made in primary care. Half of them were assessed by a gynecologyst. Sixty percent were treated in the emergency room.

Conclusions

We conclude that these data are relevant for specialists. Both for efficient resource management and for early detection of incipient psychosis. Gynecological abnormal demands are common in consultations to health services for specific malaise during the period of untreated psychosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Paliperidone palmitate: Experience in a community mental health unit
Authors: Expósito L. Carrión , Chauca G.M. Chauca , Guadalupe E.L.
Published: June 2017

Introduction

There are many jobs that offer advantages of treatment with long-acting injectable in psychosis.

Objective

To know the changes in the different variables after the start of paliperidone palmitate (PP).

Material and method

We performed a descriptive and retrospective study. Were evaluated patients who received maintenance therapy with PP during 48 months.

Results

The sample was composed of 29 patients: 72.4% men and 27.6% women. Average age of 46.21 years. In Figures 1, 2 and 3 show data obtained in relation to compliance with treatment, relapse, maintenance dose, number of admissions and visits to emergency departments respectively.

Conclusions

The administration of PP is associated with a higher level of compliance with treatment. The patients presented a lower number of relapses, hospitalizations and visits to the emergency room. The maintenance dose more used is 150 mg.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Quetiapine in treatment of first episode schizophrenia
Authors: Zivkovic N. , Djokic G.
Published: June 2017

Introduction

Although there is no cure, schizophrenia is highly treatable disease. Successful first episode schizophrenia (FES) treatment is crucial to minimize personal, vocational and social deterioration. Quetiapine is atypical, second generation antipsychotic, serotonin-dopamine antagonist. Quetiapine is potent blocker of D2, 5HT2A and 5HT1A receptors.

Objective

To estimate efficacy of quetiapine in treatment of first episode schizophrenia.

Methods

This study included 70 patients with FES diagnosed by ICD-10 criteria, who are divided into haloperidol (H) 35 patients and quetiapine (Q) group 35 patients. Patients were observed for 6 months in hospital and extra hospital conditions, according to protocol which included Positive and Negative Symptom Schedule Scale (PANSS) and the number of withdrawals attributed to adverse event (AE). Control group was treated with haloperidol 5–20 mg/24 h and experimental group was treated with quetiapine 400–800 mg/24 h.

Results

Average pretrial PANSS score was 110.1 in quetiapine and 108.5 in haloperidol group. Average PANSS score after 180 days was 50.6 in Q and 60.4 in H group. There is no statistical difference in pretrial scores between groups for PANSS score (P = 0.647). There is significant statistical difference in PANSS score reduction after 180 days in both groups (P < 0.001). There is significant statistical difference in PANSS score reduction between Q and H group after 180 days (P < 0.001). Overall, 8.6% AEs occurred in Q, and 25.8% in H group.

Conclusion

Quetiapine has shown better efficacy in treatment of FES comparing to haloperidol, with statistically significant lower adverse effects rate.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Objectively measurable equilibriometric locomotor ataxia in schizophrenia
Authors: Dzhupanov G. , Haralanov S. , Terziivanova P. , Haralanova E.
Published: June 2017

Introduction

The basic role of cerebellar dysfunctions in schizophrenia pathophysiology is already well-known. Importantly, cerebellar signs such as gait and balance coordination deficits are objectively manifested and measurable. However, both early detection and treatment monitoring of the illness are still-based mainly on subjective psychopathological symptoms.

Aims

To introduce an objective and quantitative approach to the cerebellar gait and balance disorders in schizophrenia.

Methods

An original (internationally patented) method for objective equilibriometric quantification of stepping locomotion (a kind of motion analysis system) was developed and then applied repetitively in 230 schizophrenic patients and 230 well-matched healthy controls.

Results

Subclinical but objectively measurable equilibriometric locomotor ataxia (ELA) was identified in a large proportion of the investigated patients. Its severity fluctuated along with the changes in the clinical state. As a rule, the degree of ELA transiently increases during psychotic exacerbation and gradually returns to its prepsychotic level during therapeutic remission. Data analysis revealed that the basic (prepsychotic and postpsychotic) ELA could be viewed as a new schizotaxic biomarker (trait-marker) for schizophrenia, while the degree of its severity could serve as a new objectively measurable state-marker for psychosis. Besides, its dynamics during antipsychotic treatment might be used as an objective measure of the therapeutic response (a kind of surrogate pharmacodynamic biomarker).

Conclusions

Objective quantification of the ELA allows for early detection of subclinical signs of cerebellar ataxia (or schizotaxia) in individuals at high-risk for schizophrenia, whereas in psychotic patients it permits their objective antipsychotic-treatment monitoring.

Disclosure of interest

The authors have not supplied their declaration of competing interest.