bluuebunny/crossref_metadata_2025 huggingface dataset:
Confusion between symptom and disease. Parkinson vs meningioma
Authors: Gordillo Montaño M.J. , Ramos Perdigues S. , Merino del Villar C. , Caballero Roy C. , Latorre S. , Guisado Rico M. , Bravo Romero A. , Boned Torres S.V. , de Amuedo Rincon M.
Published: June 2017

Introduction

Parkinson's disease is caused by decreased dopaminergic neurons of the substantia nigra. Psychosis occurs between 20 and 40% of patients with Parkinson's disease. Dopaminergic drugs act as aggravating or precipitating factor. Before the introduction of levodopa patients had described visual hallucinations but the frequency was below 5%.

Objective

Illustrated importance of treatment, reassessment after its introduction and refractoriness to answer; as well as the importance of a differential diagnosis at the onset of psychotic symptoms later in life.

Method

Clinical case: female patient 75 years tracking Neurology by parkinsonism in relation to possible early Parkinson disease. She was prescribed rasagiline treatment. Begins to present visual and auditory hallucinations, delusional self-referential and injury. She had no previous psychiatric history. She went on several occasions to the emergency room, where the anti-Parkinson treatment is decreased to the withdrawal point and scheduled antipsychotics did not answer. Doses of antipsychotics are increased despite which symptoms persist and even increase psychotic symptoms. In this situation it is agreed to extend the study. Subsequently an NMR of the skull where the image is suggestive of a right occipital meningioma appears.

Results/conclusions

With the emergence of psychotic symptoms later in life it will be important to ask a broad differential diagnosis, since in a large number of cases will be secondary to somatic or to drug therapies.

Parkinsonism can be a symptom of occipital meningioma, presenting in the psychotic clinic. Refractoriness, on one hand to the suspension of treatment for Parkinson's disease, such as poor response to antipsychotics, did extend the study, which ultimately gave us the diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurocognitive profile of patients with early stages of HIV infection
Authors: Garcia P. , Hernandez D. , Fillizola C. , Santacruz J.M. , García H. Santamaría
Published: June 2017

HIV-associated neurocognitive disorders (HAND) may include neurological disorders of various severities such as AIDS dementia complex (ADC) also known as HIV dementia and HIV-associated dementia (HAD), HIV encephalopathy, and Mild Neurocognitive Disorder (MND). As it seems HIV-associated neurocognitive disorders are associated with a metabolic encephalopathy induced by HIV infection and fueled by immune activation of macrophages and microglia. Despite of a group, evidences have described presence of cognitive alterations in HIV patients at different stages of HIV infection so far; little is known about the neurocognitive state of patients at very early stages of HIV infection. Here, we explored the neurocognitive profile of a group of cases of HIV patients at very early stages of HIV infection. We have analyzed of three groups of subjects, thus, we have studied a group of patients with early HIV infection, a healthy control group and a group of patients with mild cognitive impairment due to neurodegenerative causes. Our results suggested that cognitive processes are sensitive to very early neuropathological changes in HIV infection. Noteworthy, our results also showed that neurocognitive profile of HIV patients differs from those cognitive alterations in patients with mild cognitive disorders associated to primary neurodegeneration. Together, our results point out that HIV infection generates neural changes even at early stages of infection. Furthermore, our results highlight the importance of a deep neurocognitive exploration at very early stages of HIV infection as this approach allow improve the accompaniment, clinical attachment and interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Narratives, empathy concern and moral judgments in patients with HIV infection who decided not to tell about their diagnosis
Authors: García H. Santamaría , Paola G. , Hernandez D. , Santacruz J.M. , Filizzola C.
Published: June 2017

Consistent with social-cognitive theory (Bandura 1994), adherence problems to treatments and difficulties to acceptance HIV diagnosis are linked with deficits in self-efficacy as well as problems in perceived social norms and behavioral intentions. In this study we have presented the beliefs and narratives of a group of recently diagnosed HIV patients who voluntarily decided not to tell to family or couples about their diagnosis. According to the patients’ reports they believe they should not tell about their own physical condition. In a second approach, we have explored empathetic and moral behavior (by using a usual procedure used to keep track those cognitive domains) in this group of HIV patients and we compared that behavior with a group of healthy controls. Results revealed a particular and differential empathic concern, and discomfort sensitivity in HIV patients who no tell in contrast to healthy controls. Together, our results highlight the importance of exploring the reasons, fears, and the empathetic and moral determinants of those patients who not to tell about their diagnosis. Our results open a new door to explore new approaches to accompany patients with recent HIV diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Risk factors in emotional and personal development of senior preschool children from different social strata (middle-high and middle-low social layers)
Authors: Burlakova N. , Davidovich P.
Published: June 2017

Introduction

Methodological basis of Vygotsky's scientific school implemented in the study provides possibility to detect risk variants in emotional and personal development of children from different social strata and to explore the mechanisms responsible for pathological development.

Objectives and methods

The study included two groups:(1) children from a middle-high social stratum (n = 31); (2) children from a middle-low social stratum (n = 36). All the children were between ages 5.5–7 years at the moment of research, lived in Moscow and attended extracurricular activities. Following methods were used: objective description of child's development in socio-cultural context; semi-structured interview; long-term overt and covert observations; diagnostics of intellectual, emotional and personal school readiness.

Results

Children from the 1st group demonstrate higher level of intelligence; they are more successful in solving unusual tasks. Children from the 2nd group tend to follow instructions given by teacher. Children from the 1st group unlike those from the 2nd one are characterized by lower level of social competence; they encounter difficulties in establishing contacts and don’t perceive hierarchy in adult–child relationship. Mass protection typical for children from the 1st group and hyper-satisfaction of their needs determine decrease of frustration and don’t deepen their personal experience providing basis for pathological development. Children from the 2nd group are more inclined to demonstrate alarm reactions, but in general they possess higher level of emotional and personal maturity and social flexibility.

Conclusion

Socio-cultural environment has a direct say in potential risk zones of child development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Socio-demographic and cognitive determinants of xenophobia among the GCC citizens
Authors: Al-Kubaisi F. , Soliman A.
Published: June 2017

Introduction

Xenophobia has been referred to as a global phenomenon, linked to the globalization process and noted in countries undergoing transition. It comes from the perceived threat of foreigners’ impact on the citizens’ identity or individual rights. Although the Gulf countries host a large number of migrants from several different cultures and ethnicity, so far no study has examined the conceptualization and pervasiveness of Xenophobia and counter strategies to such phenomenon.

Objectives

Exploring Xenophobia in the Gulf context. Exploring socio-demographic and cognitive factors affecting xenophobia.

Aims

Validating a measure of Xenophobia in the Gulf cultural context. Examining the gender differences in Xenophobia among the GCC individuals. Studying socio-demographic and cognitive predictors of Xenophobia.

Methods

A sample of 513 individuals from the GCC countries completed several measures of socio-demographic and cognitive variables. Likert-type scale of xenophobia was developed and validated on a large sample of Qatari citizens that showed trustworthy indications of validity and reliability and delivered via internet survey.

Results

The findings showed that Xenophobia negatively correlated with age, parents’ level of education, and varied subject to the type of father's job. The females showed Xenophobia more indications than males. Participants from the six GCC countries showed different levels of Xenophobia indicators. Bad experience with expatriates fully mediated the relationship between the socio-demographic of subjects and the number of Xenophobia indicators. Cognitive factors were also good predictors of Xenophobia across all cultures and gender.

Conclusions

Xenophobia in the Gulf region is influenced by several cognitive and socio-demographic factors that is mediated by, but not limited to, negative personal experiences and their cultural backgrounds.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression and multiple sclerosis–pathophysiological links: From biology to treatment
Authors: Pinto S.L. Azevedo , Coelho R. , Silva A.
Published: June 2017

Introduction

Depressive disorders (DD) are the second cause of disability worldwide. DD affect predominantly working age individuals, recurring in 75% of cases. DD pathophysiology is intricate and multi-factorial. Several inflammatory diseases have been linked to mood disorders. Amidst these conditions is multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, characterized by frequent exacerbations and progressive functional loss.

Objective

To review the current knowledge on DD and MS as comorbidities and the underlying pathophysiologic mechanisms.

Methods

We performed a bibliographic search in Pubmed–publications released in the last 5 years, written in English, Portuguese and Spanish, containing the keywords depression, inflammatory disorders, multiple sclerosis.

Results

The inflammatory hypothesis of depression provides a strong foundation to explain its close link with multiple sclerosis. The incidence and prevalence of DD is significantly higher in MS, especially in men. Functional imaging studies have shown that depressive symptoms are closely linked to the extension of inflammatory lesions, especially on the frontal and parietal regions, with particular emphasis to those affecting the grey matter. On the one hand, the clinical course and response to treatment of MS may be hindered by DD; on the other hand, the evolution of MS lesions leads to fluctuations in mood, with significant improvement of DD with successful MS treatment, independently of physical improvement.

Conclusions

There appears to be a biological link between DD and MS, with a bidirectional interference in the clinical course, prognosis and treatment response. Thus, both conditions must be correctly identified and treated.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Validation of the Tunisian version of the patient health questionnaire (PHQ-9)
Authors: Belhadj H. , Jomli R. , Ouali U. , Zgueb Y. , Nacef F.
Published: June 2017

Introduction

The PHQ-9 has been recommended as the best available screening and case-finding instrument for primary care based on its brevity, and ability to inform the clinicians on both depression severity and diagnostic criteria.

Objective

Our study evaluated the reliability and the validity of the Tunisian version of the PHQ-9 in detecting major depression in general population.

Method

We undertook a cross-sectional and analytical study. A total of 134 participants, representative of the Tunisian general population, were enrolled. The PHQ-9 was validated against the HAD reference standard. The types of validity determined for the PHQ-9 in this study were: translation validity, internal reliability and criterion validity.

Results

Test-Retest reliability was determined by intraclass correlation. This scale is stable over 2 weeks (ICC = 0.97). The Tunisian version of the PHQ-9 was found to have good internal reliability (Cronbach's alpha = 0.84). As for criterion validity of the PHQ-9, the Pearson's correlation coefficient between the PHQ-9 and HAD was 0.94 and the Spearman's correlation coefficient was 0.81. This indicated a positive association of good strength between the two instruments. A cut-off score of 10 or higher on the PHQ-9 had a sensitivity of 86.2 and a specificity of 83.8. The VPP was 0.6 and the VPN was 0.9.

Conclusion

The Tunisan version of the PHQ-9 has several potential advantages. It was found to be a valid and reliable casefinding instrument for detecting depression in general population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence and risk factors of postpartum depression among preterm infant mothers
Authors: Ellouze S. , Aloulou J. , Thabet A. Ben , Halouani N. , Gargouri A. , Amami O.
Published: June 2017

Introduction

The birth of a preterm infant evokes considerable psychological distress in mothers and is associated with an increased risk for postpartum depression.

Objectives

The aim of this study was to assess the prevalence of postnatal depression among preterm infant mothers and to identify highlighting associated factors.

Methods

We conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the Edinburgh Postnatal Depression Scale (EPDS) for screening postpartum depression.

Results

Average age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Almost all the mothers were married (99%), had a satisfactory couple relationship (93.7%), almost two thirds were multiparous (64.9%), and 77.3% gave birth by caesarean section. Prematurity was unexpected by 56.7% of women. Regarding newborns, digestive problems were noted in 25.8% of cases and sleep disturbances in 20.6% of them. Prevalence of depression in the population studied was 39.2%. It was significantly associated with unexpected prematurity (P < 0.001), impaired couple relationship (P = 0.001), digestive problems (P = 0.013) and sleep disturbances (P = 0.002).

Conclusion

Mothers of preterm infants seem to be particularly vulnerable to postpartum depression. Systematic screening for depressive symptoms in this obstetric population can help to have an optimal psychological outcomes for mothers and infants during a crucial period of development of mother–infant coregulation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression among elderly cancer patients
Authors: Ghanmi L. , Aloulou S. , Mechri A. , Zitoun K. , Hmida A. Ben , Zouari L. , Maalej M.
Published: June 2017

Introduction

Depression is one of the most common mental illnesses in the elderly and its consequences are severe.

Aims

To measure the prevalence of depression in elderly cancer patients and subsequently determine the sociodemographic and clinical factors correlated with this disorder.

Methods

We conducted a descriptive and analytical cross-sectional study of patients aged over than 65 years old, suffering from cancer and who had no cognitive impairment, admitted in 2013 in the Oncology and palliative care unit of Gabes regional Hospital (Tunisia). We used a self-rating questionnaire to detect sociodemographics and clinical variables, the Geriatric depression scale (GDS) to assess depressive symptoms, and the Activity of Daily Living to determine the degree of autonomy.

Results

At the end of our investigation, we included 60 patients. The prevalence of depression was 48%. Depression was significantly correlated with: marital status (widower subjects were more depressed (74% vs. 34%, P = 0.007)), less degree of autonomy (80% vs. 38%, P = 0.04), fatigue (62% vs. 26%, P = 0.007), pain (59% vs. 26%, P = 0.02), family psychiatric history (80% vs. 20%, P = 0.02), family history of death by cancer (72% vs. 38%, P = 0.01), WHO condition (67% vs. 34%, P = 0.04) and the presence of co morbidity in particularly diabetes (69% vs. 41%, P = 0.05).

Conclusion

Depression is prevalent in oncogeriatric environments. This could compromise quality of support and care of these patients. Close collaboration between oncologist and psychiatrist is needed to support and relieve these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Seasonal affective disorder (SAD) and light therapy: State of the science
Authors: Glod C.
Published: June 2017

Major depression with a fall/winter seasonal pattern, also known as seasonal affective disorder (SAD), is a recurrent and prevalent disorder. Treatment may include either pharmacological (antidepressant) or non-pharmacological options, most commonly light therapy. Over the years, light therapy has been explored using various delivery methods including light-emitting diode (LED) devices. For over 20 years, cool-white fluorescent sources that yield 10,000 lux of polychromatic white light have been the standard treatment for SAD. Many investigations have confirmed the clinical effectiveness of white light, its overall tolerability, and adverse reactions, such as agitation, insomnia, and headache. Building upon this, more recent studies have compared alternative light sources and different wavelengths of light, such as white, red, green, and blue. If certain wavelengths are more potent and effective, lower intensities of light could reduce side effects and increase tolerability and adherence. Furthermore, studies of the ocular system particularly, intrinsically photosensitive retinal ganglion cells, discovered differences among specific wavelengths of light. While some reports have suggested that 446–477 nm wavelengths of blue light may be the most potent, published clinical trials have revealed mixed results. The purpose of this session is to review the state of the science on light therapy in the treatment of SAD, and suggest recommendations for clinical practice and implications for patients.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Body appreciation: A buffer against the impact of shame on depression
Authors: Marta-Simões J. , Ferreira C. , Mendes A.L.
Published: June 2017

Shame is defined as a painful affect, associated with the perception that one's personal characteristics and/or behaviours are seen by others as unattractive. Since it signals the possibility of rejection, high levels of shame associate with high psychological suffering and several psychopathological conditions, namely depression. In contrast, body appreciation is considered a set of attitudes of acceptance and affection towards one's body image, even when one is displeased with certain body characteristics, being therefore a disposition to self-soothing and care. Taking into account the association of body appreciation with healthy mental functioning, this study aimed at exploring the buffering effect of body appreciation against shame's impact on the display of depression symptoms. This hypothesis was tested through path analysis in a community sample of adult men and women. Results revealed body appreciation as a significant moderator of the association between external shame and depressive symptomatology. The tested model explained 45% of the variance of depressive symptomatology. A graphical representation allowed understanding that this moderator effect is particularly expressive in those who experience medium to high levels of shame. In these cases, men and women who present higher body appreciation tend to display fewer depression symptoms. These results seem to emphasize the importance of establishing a positive relationship with one's own body image, which appears to be protective either for men's and women's mental health. Considering its buffering effect of shame's impact on depression, upcoming interventions in this area could benefit from the assessment and cultivation of positive body image.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comorbid depression and ulcerative colitis – is there a connection?
Authors: Melada A. , Krišto-Mađura I. , Vidović A.
Published: June 2017

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Personality disorders and affective temperament in unipolar and bipolar mood disorder
Authors: Nivoli A. , Floris L. , Antonioli M. , Folini L. , Nivoli L.F. , Milia P. , Vento L.I. , Depalmas C. , Lorettu L.
Published: June 2017

Introduction

Personality disorders (PD) and Affective temperaments (AT) have been considered vulnerability factors for the development of mood disorder (MD).

Objective

To study the simultaneous presence of PD and AT in patients with DU and differences between unipolar depression (DD) and bipolar disorder BD.

Methods

An observational study was conducted. Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A) for AT and the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) for PD. The interrelationships of the different PD and AT were studied by factor analysis (principal component analysis, PCA) (orthogonal rotation, Varimax).

Results

Participants were 156 adult patients with MD, 37.1% with DD and 62.9% with BD. DD patients presented with significantly more paranoid PD (P = 0.009), depressive (P = 0.029), anxious (P = 0.009) and irritable temperament (P = 0.006) compared to BD. PCA results showed four significant factors, explaining the 63.1% of total variance, corresponding to four potential groups of patients with specific PD and AT associations.

Conclusion

The comorbidity between MD and PD and AT may differentiate DD from BD. Specific patterns of comorbidity may be useful as they may substantially influence the course of the mood disorders and how patients respond to treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Exploring perinatal depression symptom clusters as predictors of childbearing outcomes
Authors: Records K. , Rice M.J. , Apugan Z.D.
Published: June 2017

Introduction

Perinatal depression is related to poorer outcomes for women and their children. Measurement indices that categorize perinatal depression as present or absent are commonly used in clinical practice and research efforts. Categorization minimizes the health effects of potentially different symptom clusters and may confound understanding of health outcomes.

Objectives

The objective of this investigation is to explore the symptom clusters resulting from administering two commonly used depression screening instruments during pregnancy and postpartum.

Aims

(1) Identify the depressive symptom clusters for perinatal depression; (2) Test whether symptom clusters predict maternal and newborn outcomes, and if so, whether these differ from categorization analytics.

Methods

A secondary analysis was conducted on data from a longitudinal study of 139 women. They participated from their 3rd trimester of pregnancy through 8 months after birth and completed surveys at five times using the center for epidemiologic studies Depressed Mood Scale (CES-D) and the Edinburgh Postnatal Depression Survey (EPDS). Analysis procedures included cluster analysis and hierarchical regression.

Results

Individual symptoms were reported by 2.9–31.7% of the sample. Separate clusters (CES-D = 4; EPDS = 2) were identified and, of these, two clusters were primary predictors of maternal and newborn outcomes. Results differed from that obtained with cut-score analytics.

Conclusions

Examination of depression symptom clusters as related to health outcomes during childbearing has significance for clinical practice and research, particularly for women who would not score as depressed on established screening instruments.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Folate and pyridoxine to ssri in major depression and residual cognitive Decline
Authors: Savic V. , Golubovic O. , Nikolic S.
Published: June 2017

Introduction

Depressive disorders are very common conditions, lifetime risk for experiencing major depression is approximately 15%.

Objective

Patients with major depression having an insufficient response to SSRI may benefit from addition of methylfolate and pyridoxine.

Aim

The aim of our study was to determine the effect of folate and pyridoxine augmentation to SSRI on emotional, physical and cognitive symptoms in major depression.

Methods

Eighteen patients with MDD were enrolled, were on citalopram 20 mg/day when folate/15 mg per day/and pyridoxine/40 mg per day/were added. They have been monitored for three months using standard scales for depression and assessment by interview.

Results

After three months of using folate and pyridoxine to SSRI there was a significant improvement in depression as measured by the scales. In 8 patients were recorded improvements of 30–50%. The most prominent changes were in cognitive sphere of depression such as attention, reasoning and problem solving, working memory and speed of processing.

Conclusion

Low levels of folate and pyridoxine have been associated with the presence of depression and residual poor cognitive function. Our study confirms that folate and pyridoxine as adjunctive therapy to SSRI-partially refractory major depression is useful in particular to issues of residual cognitive interference conditions such as impaired concentration and memory, slow mentation, attention/vigilance, problem solving, working memory and speed of processing.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical and neurocognitive characteristics associated with treatment-resistant depression
Authors: Serafini G. , Adavastro G. , Canepa G. , Conigliaro C. , Pompili M. , Girardi P. , Amore M.
Published: June 2017

Introduction

Treatment resistant depression (TRD) is a disabling condition associated with a relevant psychosocial impairment worldwide.

Objectives

This exploratory study is aimed to evaluate the main clinical and neurocognitive characteristics in a sample of 21 subjects admitted to the Psychiatric Clinic of University of Genoa as inpatients between 2015 and 2016 and diagnosed with TRD according to Thase and Rush staging method.

Methods

Patients have been assessed using the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale, and Clinical Global Impression (CGI). The Continuous Performance Test (CPT), Trial Making Test (TMT-A/B), Stroop Color Word Interference Test, Verbal Fluency Test, and Rey auditory-verbal learning test (RAVLT) have been administered as well.

Results

Subjects with early-onset (< 50 years) depression had a longer illness duration, higher depressive episodes and more impaired performance at RAVLT while individuals with late-onset (> 50 years) depression showed a higher severity of depressive symptoms and more anxiety symptoms. Depressive symptoms were positively associated with anxiety (r = 0.82; P = 0.00) and negatively with TMT-A/B (r = −0.56, P = 0.01), Stroop Color Word Interference Test (r = −0.72, P = 0.005 and r = −0.616, P = 0.008), and RAVLT (r = −0.60; P = 0.02) performances. According to regression analyses, anxiety symptoms were the only significant predictor of depression severity (P = 0.02).

Conclusions

Early-onset depression is associated with more disability and worse neurocognitive performance whereas late-onset depression is linked to more anxiety symptoms and more depressive symptoms severity. Clinicians should closely monitor patients with TRD for the presence of anxiety symptoms that may represent a significant risk factor of poorer long-term outcome.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depression screening in primary care patients
Authors: Thabet J. Ben , Turki M. , Mezghanni M. , Bouali M. Maalej , Charfi N. , Omri S. , Zouari N. , Zouari L. , Maalej M.
Published: June 2017

Introduction

Depression is a common mental disorder that can be associated with more functional disability than most chronic medical illnesses and the increased reporting of medically unexplained somatic symptoms.

Aim

To assess the prevalence of depression in a Tunisian population, as well as the associated factors.

Methods

We conducted a cross-sectional, descriptive and analytic study, among 707 subjects consulting in 20 primary care units in Sfax and Tunis, Tunisia. These participants, randomly chosen, were asked to answer a questionnaire after their consent. Depressive symptoms were evaluated using the “Beck Depression Inventory” (BDI).

Results

The mean age of participants was 39.84 years. Among them, 38.6% had a low educational level (illiterate or primary school level); 45.3% were professionally inactive and 92.9% had a low to medium socio economic level. Medical, psychiatric and suicide attempt histories were reported respectively in 51.2%, 7.6% and 1.8% of cases. According to BDI, a mild depression was noted in 22.9%; moderate 16.1%; severe 4.1%. Among those presenting a moderate to severe depression (MSD), only 16.8% were followed up in psychiatry, 4.2% were receiving antidepressant and 9.8% benzodiazepine. MSD was associated with low educational level (P < 0.001); low to medium socio economic level (P < 0.001); psychiatric histories (P < 0.001); suicide attempt histories (P < 0.001); somatic histories (P < 0.001).

Conclusion

Our study highlighted a high prevalence of depression that is still under diagnosed and therefore poorly managed. General practitioners should be made aware of the importance of screening for depression in medical patients because it not only complicates their overall medical treatments, but also impedes their physical and social functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The ICT4LIFE Project–Design and development of a new information technology platform for patients with Alzheimer's disease
Authors: Osvath P. , Voros V. , Kovacs A. , Greges I. , Fekete S. , Tenyi T. , Fekete S. ,   C.ICT4Life
Published: June 2017

Aim

With an increasingly growing population in Europe, cognitive impairment is a major social and health issue. According to the World Alzheimer Report (WHO, 2014), dementia, including Alzheimer's disease is one of the biggest global public health challenges our generation is facing. There are many efforts at European level to promote active and healthy ageing. This three-year project has the ambition to provide new services for integrated care with breakthrough research and radical innovation by employing user-friendly Information and Communication Technology (ICT) tools, ultimately increasing patients’ quality-of-life and autonomy at home.

Methods

ICT4Life proposes an innovative platform for integrated care by the use of sensor-based analytics for human behaviour. Novel ICT services are used to determine the relation between cognitive decline, related psychopathological symptoms and the quality-of-life of the patients, and to assess how these affect patients’ and caregivers’ daily living. ICT4Life platform uses advanced sensor-based analytics; to maximize elderly empowerment and self-care abilities thanks to a properly designed and reconfigurable recommendation system that will be able to exploit user-generated data; and to improve decision-making processes in care professionals’ daily activities. All solutions are developed following a user-centred methodology and tested in real-life scenarios.

Results

The study design and the preliminary results of the ICT4Life project are presented on the poster.

Conclusion

ICT4Life programme develops a solution for individuals with early stage cognitive impairment that will permit doctors and caregivers to extract useful information about patients, while contributing in a user-friendly way to extending their independence.

Disclosure of interest

COI: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement N° 690090. Tamas Tenyi and Sandor Fekete are supported by the National Brain Research Program Grant N° NAP KTIA NAP-A-II/12.
Non-invasive brain stimulation treatment in a group of adolescents with anorexia
Authors: Costanzo F. , Maritato A. , Menghini D. , Castiglioni M.C. , Zanna V. , Vicari S.
Published: June 2017

Introduction

Anorexia nervosa (AN) is characterized eating behaviors and body image disturbances. Given poor treatment outcomes are available for AN, treatment innovations are urgently needed. Recently, non-invasive neuromodulation tools have suggested having potential for reducing AN symptomatology targeting brain alterations.

Objectives

The objective was to verify whether an excitatory transcranial direct current stimulation (tDCS) over the left prefrontal cortex may aid in altering/resetting inter-hemispheric balance in AN patients, re-establishing control over eating behaviors.

Aims

Research is aimed to evaluate the potential of tDCS treatment in determining a more rapid improvement compared to classical treatments in adolescents with AN.

Methods

Twenty-two adolescents with AN, underwent the treatment as usual (AU) plus the tDCS treatment (TDCS + AU: n = 8, age M 13.7 ± 1.9 years) or a family therapy (FT + AU: n = 14, age M 15.1 ± 1.75 years), for six weeks. Psychopathological scales (EDI-III, EAT 26, BUT, MASC, CDI) and anthropometric indicator of nutritional status (BMI) were assessed before and after treatment.

Results

BMI improved only in the TDCS + AU group (P < 0.01). Mean BMI percentage of improvement was 14.43% + 10.8 in the TDCS + AU and 4.83% ± 5.4 in the FT + AU. Both groups improved in the total scores of the EDI, EAT-26, MASC and CDI scales (all P < 0.01).

Conclusions

tDCS treatment improved BMI values more than classical treatment and determined comparable to the classical treatment improvement in the psychopathological scales. This results may be an important starting point to further explore the beneficial effect of brain based treatments for AN.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive fusion: Maladaptive emotion regulation endangering body image appreciation and related eating behaviours
Authors: Marta-Simões M. , Ferreira C. , Mendes A.L.
Published: June 2017

Body image-related cognitive fusion is described as the perception that undesired and distressing internal events related to body image are reliable representations of reality. This maladaptive emotion regulation process is known for its impact on human suffering, namely eating psychopathology. On the contrary, body appreciation is a positive body image construct, defined as an attitude of acceptance and affection toward one's body image characteristics, despite some level of dissatisfaction. Although body appreciation associates negatively with several pathogenic processes, its relationship with body image-related cognitive fusion is still unexplored. The present study intended to analyse the power of body image related cognitive fusion regarding its impact on body appreciation, and also on the engagement in disordered eating. The study's sample comprised 308 women, aged between 18 and 35. A path model tested the mediator role of body image related cognitive fusion in the relationship between body image dissatisfaction and body appreciation, and eating disorders symptomatology, controlled for the effect of body mass index.

The tested model accounted for 67% of the variance of disordered eating. Body image related cognitive fusion appeared as a significant mediator of the association between body dissatisfaction and body appreciation. Body appreciation presented a significant direct effect on eating disorders symptomatology. These findings highlight the disturbing effect of cognitive fusion related to body image on the construction of a positive body image, presenting an impact on the engagement in disordered eating. In this line, cognitive fusion may be a pertinent target in clinical practice and also within eating disorders prevention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Incidence of dissociative stupor and possession in a private psychiatry clinic
Authors: Dua D. , Dua P.
Published: June 2017

Introduction

Dissociative and conversion disorders are reported to have a present incidence of about 85–100per 1000 by different studies, which are very few. The present research is a part of a longitudinal study of 15 years but here; only 3 years are represented, which could be briefly analyzed.

Objective

Latest reports suggest a decline in incidence of hysteria (conversion and dissociation) and this research just tries to reconfirm.

Methods

All new patients attending a private psychiatry OPD in a small township of India at Lakhimpur Kheri in Uttar Pradesh, were screened to identify cases of dissociative disorder according to ICD 10, F44.2 and F44.3 from the 1st of January 2016 to 31st of October 2016 (10 months). These screened cases, only those presenting with fits of unconsciousness and possession, were analyzed and compared with the previous years for the same period.

Results

Out of a total of 3671 patients seen, (2122 males and 1549 females) a total of 319 presented with the above mentioned symptoms (58 males and 261 females) about 87 per 1000 of psychiatric patients.

Conclusion

The results, when compared with two previous years for the same period were quite similar, 2015 getting incidence of 97 per 1000 and 2014, an incidence of 89 per 1000. The inference thus is that there does not seem to be any decline of incidence and the figure would be much higher if both conversion and dissociative symptoms are included – a really serious situation.

Disclosure of Interest

The authors have not supplied their declaration of competing interest.
Services utilization for mental health problems in Portugal during the economic crisis: 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

During economic crises additional mental health risks emerge and social inequalities in health can widen. In order to ensure universal coverage of mental health care and to reduce the impact of the crisis, it is crucial to assess the needs of the population to be able to reorganize mental health care accordingly.

Objectives

To analyse the use of services for mental health problems in Portugal during the economic crisis.

Methods

In this follow-up epidemiological study, a probability sub-sample of respondents to the 2008 national mental health survey (n = 911) was re-interviewed in 2015. Socio-demographic variables and treatment patterns were assessed using a structured interview, and psychological distress was measured using the Kessler-10 Scale. Descriptive analysis was conducted to characterize the use of services for mental health problems.

Results

In total, 27.9% of the respondents sought treatment for mental health problems in the previous 5 years, and GPs were the most contacted professionals. Only 57.7% (n = 119) of the respondents with moderate or severe psychological distress (n = 197) reported recognizing they needed treatment. Among people with moderate or severe psychological distress who recognized their need for treatment, most received treatment (80.5%, n = 105), which was minimally adequate for 74.4% (n = 81). Low perceived need and structural barriers were the main obstacles for access to care.

Conclusions

Under-treatment, low continuity of care and low adequacy of treatment are problems that the Portuguese health system must address in order to meet the mental health challenges of the economic crisis.

Funding

EEA Grants: Programa Iniciativas em Saúde Pública.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Is a psychiatrist-patient confidentiality relationship subservient to a greater good?
Authors: Berrios G.E.
Published: June 2017

Before embarking in a fruitless exchange the title question must be unpacked:

– is the ‘psychiatrist-patient confidentiality relationship’ a subset of the general doctor-patient confidentiality relationship?

– if different, what causes the difference? Is it the nature of mental disorder, for example the fact that some mental disorders may impair ‘mental capacity’ in ways different from general medicine?

– given that in addition to psychiatrists, psychologists, nurses, and social workers also enter into ‘confidentiality relationship’ with patients, should all be considered as tokens of the same type or as different types? If the latter, should such differences be considered as intrinsic or extrinsic? Intrinsic differences refer to structural dissimilarities; extrinsic differences to dissimilarities created by the respective legal frames imposed by each profession to its practitioners.

– is ‘subservience to a greater good’ an acceptable good way to describe the metier upon which the ethical scrutiny will be applied? Given that it does describe a ‘consequence’ of the process then it would seem that it prematurely opts for utilitarianism, an ethical theory that many may feel is not adequate to the case.

The general question and the pre-formulated debating positions are setting up a pseudo-debate. A more useful question should be: “Given the strong political and economic pressures being currently brought to bear upon all confidentiality relationships (held by priests, medics, lawyers, bank workers, etc.), what ethical system may be more convenient to:

– justify blatant breaches in confidentiality relationships;

– placate our moral conscience?”

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Towards an EU research framework on forensic psychiatric care: Introduction, structure, activities and results of cost action Is1302
Authors: Castelletti L. , Scarpa F.
Published: June 2017

Introduction

Forensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally ill offenders. For some mentally disordered offenders long forensic psychiatric care is required. Due to different legal framework, policies and resources in member countries, treatment programs and care provided for these subjects may vary substantially across Europe.

Objectives

COST Action IS1302, a EU project aimed at establishing a European network of researchers, clinicians and service providers about long-term forensic psychiatric care, has involved nineteen European countries for 2013 to set the basis for comparative evaluation and research on effective treatment and the development of best practice in long-term forensic psychiatry in Europe.

Method

It is constituted by three main areas of interest and research. One group works on determination of patient characteristics, looking into prevalence, duration of stay and the most determinant characteristics of long term patients. The second area of research aims at obtaining better understanding of complex external factors that influence the poor progress of patients residing for an above average time in forensic services. Third group of research focuses on knowledge about specific needs brought about by psychiatric symptoms and how these specific needs might optimize the quality of life of patients in long term forensic psychiatric care.

Results/conclusions

Launched four years ago, the action is at its last of activities. We display features, activities and data emerging from the research conducted so far.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Substance use among male forensic patients
Authors: Mezghani M. , Fkih-Romdhane F. , Ghali F. , Jmii G. , Zghal M. , Jouini L. , Ghazeli I. , Ridha R.
Published: June 2017

There is a widespread use of substances abuse which might cause violence, suicide, interpersonal conflicts, lawsuits, psychiatric commitment, and even crimes. Psychiatrists are under increasing pressure to develop strategies to address the problem of coexisting criminal behaviour, addiction, and mental illness. The aim of this study was to examine the association between demographic profile, psychiatric symptomatology and substance use in forensic psychiatric inpatients, and to consider the treatment needs and opportunities for intervention among the same sample.

Methodology

A retrospective study was done on patients admitted to the department for Forensic Psychiatry at the Razi Hospital from 1996 to 2016, initially jailed for detention and drug consumption and judged irresponsible by reason of insanity. Data were collected by record review.

Results

Thirty-two patients were included in the study. Mean age was 27.81 years. Thirty-six percent of the participants were illiterate and 45% were single. More than half of the subjects (54%) had personal psychiatric history and 27, 27% had family history of psychiatric problems. About one third (31.81%) of participants had judicial background: 33% were arrested for public drunkenness, 44% were arrested for violence, and 22% were arrested for theft. Concerning the diagnosis, 45% were suffering from schizophrenia, 22.77% were diagnosed with personality disorder and 27.27% of them would not have any mental trouble. About 50% of the patients did not follow up with treatment.

Conclusion

Addictive disorders are authentic psychopathological disorders. Effective treatment is hindered by the paucity of research on clinical application of treatment models for addictive disorders in this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.