bluuebunny/crossref_metadata_2025 huggingface dataset:
Amisulpride-induced agranulocytosis: A case report
Authors: Maatallah H. , Ben Ammar H. , AIssa A. , Nefzi R. , Said M. , El Hechmi Z.
Published: June 2017

Introduction

Agranulocytosis is a potentially life-threatening haematological side effect induced by typical and atypical neuroleptic. When agranulocytosis is associated with a specific anti-psychotic, the medication should be discontinued. This severe side effect is troublesome.

Case report

We report the case of a 60-year-old man, treated with amisulpride for schizophrenia, who developed an agranulocytosis. This patient had been treated with first and second generation anti-psychotic drugs during his life and had already been exposed to many neuroleptics without any signs of toxicity. However, after three days of the introduction of amisulpride he presented a rapid onset agranulocytosis (leukocytes 1.2 G/L and neutrophils 0.4 G/L). After discontinuation of amisulpride, blood count returned to normal. The favorable evolution after discontinuation of treatment: the normality of biological and cytological examinations is in favor of a causal relationship between this severe neutropenia al introduction of amisulpride.

Conclusion

This case report highlights the risk of amisulpride in inducing agranulocytosis, a risk underestimated in regard of the clozapine risk to induce agranulocytosis or neutropenia. For this reason, it seems reasonable to recommend performing a blood count before introduction and during the treatment by anti-psychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Benefits of the functional ensemble of temperament framework in assessment of mental disorders: Examples
Authors: Trofimova I.
Published: June 2017

Introduction

An integration between psychiatry, neurochemistry and differential psychology gives an evidence-based framework for the diagnosis of mental illness rooted both in modern neurophysiology and clinical observations.

Objectives

To investigate whether, a neurochemical model of temperament might (FET) provide a better discrimination between major depression (MD), anxiety (GAD), co-morbid depression and anxiety and delusional disorders than existing emotionality-based temperament models.

Methods

Three studies compared the profiles on temperament and personality disorder inventories in patients who were diagnosed and treated for named disorders across four adult age groups (17–24, 25–45, 46–65, 66–84).

Results

The FET distinguished between MD and GAD in line with the DSM descriptors and showed significant differences for the traits of motor endurance and motor tempo (much lower values in MD), and neuroticism (much higher value in GAD). The results showed benefits of differentiation between physical and social types of fatigue as a symptom of MD and that high impulsivity and low plasticity can be also considered symptoms differentiating between mental disorders. Moreover, high sociability appeared as a symptom associated with high dominance–mania tendencies. The FET framework appeared to be sensitive to age and sex differences: higher anxiety and anti-social symptoms appeared to be more prominent in the younger age (unlike depression symptoms), and declined with age.

Conclusions

This study suggest the utility of using a functional approach to both taxonomy of temperament and classification of mental disorders and the benefits of systemic differentiating between 12 functional aspects of behavior, with special attention to non-emotionality-related aspects of behavior.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Manic switch in bipolar patients treated with electroconvulsive therapy for treatment-resistant depression: The experience at the mood disorder unit of Milan (Italy)
Authors: Delmonte D. , Brioschi S. , Barbini B. , Zanardi R. , Colombo C.
Published: June 2017

Introduction

Despite appropriate treatment, 30–40% of depressed patients, both unipolar and bipolar, do not achieve improvement, with high morbidity and mortality. For bipolar patients another risk is the switch into mania due to antidepressant treatment. The concern about the switch, suggests to administer antidepressants at lower doses, in combination with mood stabilizers and second generation anti-psychotics.

Objectives

We performed an observational study on a sample of 23 bipolar patients treated with ECT for severe TRD in last 3 years, in order to evaluate the risk of switch.

Methods

Twenty-three bipolar inpatients, undergoing bitemporal ECT twice/week, with MECTA spectrum device. Main demographic and clinical data collected. Hamilton rating scale for depression (HAM-D). Clinical response defined as 50% reduction of HAM-D score at the endpoint from baseline; remission as HAM-D score at the endpoint < 8. Young Mania rating scale (YMRS) weekly in order to assess switch into mania.

Results

Thirteen (56.5%) females, 10 (43.5%) males, mean age 60.1 ± 10.3 years. Mean age at onset 35.5 ± 13.6 years. Mean number of episodes: 7.1 ± 3.6. Mean duration of current episode: 33.4 ± 24.9 weeks. Mean HAM-D basal score: 30.0 ± 5. Each patient underwent a cycle of ECT (mean No. 6.7 ± 3.3). Pharmacological treatment was administered upon clinical need. Response rate 87%, remission rate 43.5%. Three out of 23 (13.04%) patients had transient hypomanic switch, spontaneous recovery within 7 days after the last ECT.

Conclusions

Our experience confirms that ECT is a powerful antidepressant, especially in patients with severe long-lasting depression, refractory to treatment. ECT is also a safe procedure: no adverse effects were reported. The manic switch rate is comparable with antidepressant drugs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Bilateral continuous theta burst stimulation (cTBS) for treatment resistant auditory hallucinations and synesthesia in schizophrenia – A case report
Authors: Jakhar J. , Mehta D.U.
Published: June 2017

Introduction

While 1–Hz repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing auditory hallucinations (AH), its effects are transient. cTBS, a patterned-rTMS technique induces sustained long-term-depression-like effects. Here, we demonstrate efficacy of twice daily, bilateral-cTBS in a patient with treatment-resistant AH, reflex hallucinations and vision-touch synesthesia.

Method

A 25-year-old male with 5 years history of treatment-resistant AH (2nd/3rd person), vision-touch synesthesia and reflex hallucinations. He was on a combination of 200 mg clozapine and 300 mg amisulpride for the last 6 months with no improvement. He received two-weeks of twice daily, bilateral-cTBS [40,1 s-trains (bursts of 3-pulses at 50 Hz every 200 ms) given continuously at 90% motor threshold] over the temporoparietal junctions located using the International 10/20 system. Amisulpride was stopped and clozapine was increased to 300 mg/day. Change in AH and synesthesiae were assessed using auditory hallucination rating scale (AHRS) and clinical interview.

Result

AHRS scores reduced from 35/41 to 0/41 at the end of 2 weeks, with substantial improvement being noticed at the end of the fifth day. Synesthesiae and reflex hallucinations also showed similar trends in improvement. No serious adverse events.

Discussion

Integration of auditory, visual and tactile perceptions is an important function of the temporoparietal junction. administering cTBS to this region bilaterally reduced our patient's perceptual abnormalities. Increasing dose of clozapine could be a confounding factor, however, the rapidity of treatment response enables us to attribute part of the improvement to cTBS.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The New Aspect of Psychotherapy in our Clinical Psychiatric Unit: The Effort it Took to Make it work; and the First Results
Authors: Goujon D. , Berenguer L. , Romann F.
Published: June 2017

Introduction

Our two units take care of a rather big number of people (about 170 000). Various activities are proposed for outpatients and the idea was expressed to initiate art therapy.

Objectives

We first analysed the possibility of starting this new mediation equally in the two units. A team was formed: a clinical psychiatrist and two registered nurses, one being an art therapist as well. We started this activity with a small group of out patients in April 2016.

Aims

The registered nurse – art therapist was provided with appropriate space, art material and furniture by hospital sources. The other unit will send the nurse for training in art – therapy: leave and grant are provided by the hospital. Her project is different and yet complementary.

Methods

The group was validated and evaluated by the art therapist and the psychiatrist. The organization of the activity is left to the art therapist. A questionnaire was filled out by art therapist before beginning the art therapy and at regular intervals.

Results

Patients are engaged by this therapy and come on regular basis. They chose painting to express themselves and leave their productions in the room after they are finished.

Conclusions

The newly opened psychotherapy – art therapy has brought many positive changes in our hospital for working staff as well as for the patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acknowledgements

We want to thank the Chiefs of our Department of Psychiatry, Grandin Pascal, MD and Benzaken-Charlier Catherine MD for their acceptance and support of this project.
The Use of Art Therapy in Complex Treatment on the Quality of Remission in Patients with Melancholy in Major Depressive Disorder
Authors: Kozhyna H. , Korostiy V. , Hmain S. , Mykhaylov V.
Published: June 2017

Introduction

According to studies done in recent years regarding the treatment of patients with melancholy in major depressive disorder, a shift of interest from studies evaluating the effectiveness of therapy to the study of remission is seen. Despite significant progress in the development of pharmacotherapy of depressive disorders, difficulty in achieving rapid reduction in depressive symptoms and stable remission in patients with melancholic depression necessitated the search for new approaches to the treatment of this pathology.

Aims

Evaluating the effectiveness of art therapy in treatment in patients with melancholy in major depressive disorder on the quality of remission.

Methods

The study involved 135 patients – 60 male and 75 female patients aged from 18 to 30 years old. The main group of patients apart the combined treatment also participated in group art therapy with the use of drawing techniques, while the control group – statutory standard therapy.

Results

The results of the use of art therapy in complex treatment in patients with major depressive disorder is detected primarily in reducing of the level of anxiety at the early stages of treatment (60% of patients have noticed decreasing of melancholic state), as well as improving the quality of life in remission period.

Conclusion

These results support the use of art therapy in treatment in patients with melancholy in major depressive disorder during period of active treatment, and after achieving clinical remission contributes to achieving and maintaining high-quality and stable remission with full restoration of quality of life and social functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Attempting Reconciliation with Cross-Examination in Couple Therapy
Authors: Latecki B.
Published: June 2017

Many traps and conflicts can be encountered by the therapist trying to facilitate communication and to promote agreement between couples or between an angry teenager and his/her parent. The cross-examination technique is a useful tool in such situations. It involves humour but it is also confrontational, it shifts the burden of initiating and continuation of the dialog onto the parties involved, it teaches responsibility, respect and sensitivity to the other's points of view and, after exposing the “sore points”, it leaves the couple in a position to discuss possible solutions. Elements of other psychotherapeutic approaches (mirror technique, paradoxical intentions, empty chair technique, Ericksonian approach) are included as well. Elements of logic aimed at recognizing the fallacies and assumptions between the couple are also used.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Roll of the Third Wave Therapies in the Treatment of Schizophrenia
Authors: Asensio Aguerri L. , Nuevo L. , Mata B. , Segura E. , Lopez E. , García F.
Published: June 2017

Introduction

The schizophrenia is a frequent mental disorder. The symptoms affect the emotions, cognition, perception and other aspects of the behaviour. In the last years have been developed different interventions and psychological treatments in order to improve the personal and social functioning of these patients. Among the new proposals is the called “third wave”.

Objectives

Determine the efficacy of third generation therapies in the treatment of schizophrenia.

Methods

We have performed a systematic review of the existing bibliography in PubMed/Medline, Cochrane and Dialnet, using the combination of different keywords “acceptance and commitment therapy, mindfulness, psychosis, schizophrenia, third wave of therapies, based cognitive therapy”.

Results

The based cognitive therapy for the psychosis (CBT) was designed for the treatment of the residual symptoms of schizophrenia, however in the present there are over 30 randomized trial publications were is evaluated the efficacy of CBT in psychosis, on positive and negative symptoms, functionality and affectivity. It is most effective in acute episodes.

Conclusions

The treatment with the third generation therapies reduces the positive symptoms of schizophrenia and improves depressive and anxiety symptoms. The CBT and the mindfulness are the most studied. There are scientifically therapeutic options for the treatment of patients with schizophrenia in combination with pharmacotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interoceptive Exposure at the Heart of Emotional Identification work in Psychotherapy
Authors: Suchocka Capuano A. , Karar A. , Georgin A. , Allek R. , Dupuy C. , Bouyakoub S.
Published: June 2017

Introduction

Emotional avoidance is a target process, offered by modern psychotherapies. Emotional exposure is often difficult to put in place when there is a major cognitive and behavioral avoidance. Education on emotional processes is necessary but often insufficient during individual follow-up.

Objectives

The longitudinal study seeks to verify whether work on exposure and emotional identification influences the decreased level of anxiety and depression.

Aims

Introduction of interoceptive exposition in psychotherapy decreases the frequency of emotional avoidance.

Method

Group psychotherapy composed of two modules: interoceptive exposure and emotional identification was proposed to patients with anxiety and depressive disorders. A group of 6 participants was evaluated at three times: T0 before the start of the group, T1 post-module 1 and T2 post-group. Assessments of HAMA anxiety, MADRS depression, QEC cognitive avoidance, UPPS impulsivity, MCQ-30 metacognition and emotional regulation REQ-21 have been proposed.

Results

Significant differences were observed between pre- and post-intervention scores (Friedman test). The HAMA anxiety rate (P = 0.006) and the MADRS depression (P = 0.047) decreased. Participants in the group were less likely to use QEC thought substitution (P = 0.009) and urgency in their UPPS reactions (P = 0.03). Moreover, their external dysfunction REQ. 21 decreases (P = 0.03).

Conclusion

Faced with emotional avoidance, work on emotional identification requires prior interoceptive exposure. It is a first stage of work that involves sensitizing to the presence of emotional bodily sensations. Group work facilitates exposure to emotion and its identification; decentration leading to emotional intensity decrease. The work on the interoceptive exhibition facilitates the emotional exposure while participating in the deactivation of the associative emotional network.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive Behavioral Therapy in Internet Addiction – A Case Series
Authors: Vasile D. , Vasiliu O. , Vasiliu D.G. , Vasile F.
Published: June 2017

Internet use increased significantly in the last decade through the development of portable technologies, like laptops, smart-phones, tablets etc. Time spent on Internet could became a problem for many users, some of them reporting a sense of control loss, as they begin to stay more on-line than they initially wanted. Gaming, shopping, gambling, social networking, visiting pornographic sites, e-mailing, all these activities could transform an apparently inoffensive mean of communication into the trigger of a behavioral addiction. We applied individual cognitive-behavioral therapy (CBT) in three cases of Internet addiction, with cognitive re-structuring based on a diary of dysfunctional thoughts, relaxation techniques, and coping skills training, with good results. CBT was structured in bi-weekly sessions, of 30 minutes duration, for 6 weeks. Time spent on-line and daily functioning were the main variables monitored. A very important issue is to address all potential factors that could maintain the disorder, like social skills deficits, personality disorders, other co-morbid addictions, anxiety or depressive symptoms etc. Elements of motivational interview could be helpful especially at first visit, but also during therapy, when danger of relapse surfaces. Cue exposure with prevention of response is another technique that had proven itself useful in several sessions, when automatic thoughts challenge appeared to have reached a dead point. An informant like a close relative of the patient should be involved in the therapy whenever possible, due to the fact that Internet addiction therapy, like any other addiction therapy, need a third party to offer feed-back regarding patient's changes under treatment.

Disclosure of interest

The presenting author was speaker for Astra Zeneca, Bristol Myers Squibb, CSC Pharmaceuticals, Eli Lilly, Janssen Cilag, Lundbeck, Organon, Pfizer, Servier, Sanofi Aventis and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo, Servier.
Parental stress in autistic parents: The counseling effects
Authors: Ferrara R. , Esposito M.
Published: June 2017

Introduction

In parents of autistic children there are high levels of stress. For parents, counseling can help them face the world of autism through the many stressors they experiment.

Objectives

To evidence a possible effect of the counseling intervention on parental stress.

Methods

The sample consisted of 24 parents (mean age = 38.7) of children diagnosed with autism spectrum disorder related to the treatment centre “Una breccia nel muro”. Parents’ group was randomly divided into two subgroups, the first (EG experimental group) consists in 12 parents, which were included in a counseling treatment of six months (one meeting of 2 hours every 15 days), while the other subgroup parents, (CG control group) were not included. We used parenting stress index–short form (PSI-SF) before counseling intervention (T0) and after (T1) with every parent. PSI values stress level in following scales: parental distress (PD), parent-child dysfunctional interaction (PCDI) and difficult child characteristics (DC). Figure 1 shows all the variables in each group at T0 and T1.

Results

Then a 2-tail t-test was separately carried out for each group (Counseling Yes; Counseling No). Counseling Yes: PD (t22 = .70, P = .49); PCDI (t22 = .72, P = .47); DC (t22 = 2.23, P = .03); Tot Stress (t22 = 1.04, P = .3). Counseling No: PD (t22 = .82, P = .42); PCDI (t22 = 1.7, P = .09); DC (t22 = .59, P = .56); Tot Stress (t22 = .72, P = .48)

Conclusions

Our data confirm the positive effects of counseling especially on the difficulties related to children (DC scale).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Early Signs of Crisis in the Perception of Users and their Family
Authors: Fucci G. , Ratti N. , Ignarra R.
Published: June 2017

The identification of the early signs of crisis is globally considered one of the fundamental elements in the illness management practice of the psychiatric user. For this reason the mental health center of the city of Ravenna wanted to offer a personalized questionnaire to a 15 random-selected users and their families, with the aim of evaluating and analyzing the alarm signals in the participant's perception. The questionnaire has been created on the basis of other tests in the literature. It is divided in two parts, a “symptomatic”, related to the early signs of crisis, and an “environmental”, focalized on the potentially stressing situations for the individual. The administration took place within the individual and the family talks at the center. This project was implemented not only as a psycho-educational activity for the users and their family's, but also to amplify the knowledge of the staff on these signs. The results have shown how often there are points of difference in the perceptions of the early signs of crisis of the users and their families and it is believed this could turn out to be an important factor to be worked on within the projects of psycho-education of the mental health center.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosis in Epilepsy Patients
Authors: Agudo M. , Guillán M. , García M.G.
Published: June 2017

Introduction

Psychosis in patients with epilepsy was known in antiquity and was already described in detail in the nineteenth century.

This kind of psychosis can be categorized in relations to seizures: preictal psychosis (before the seizures), during them (ictal) or after the seizures (postictal psychosis)

Aims

Through several cases of patients that were treated in our department with the diagnosis of psychosis, previously or during the treatment diagnosed with epilepsy, we analyse the characteristics and diagnostic criteria of these pathologies.

Methods

Systematic literature review in up-to-date and Pubmed, looking for reviews on psychosis and epilepsy, in international scientific journals of neurology and psychiatry.

Conclusions

Being able to recognize this several types of psychotic states associated with epilepsy has a clinic and prognosis utility, because made important differences in treatment and in the evolution of the illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosis and Creativity. Genetic and Structural Relation Between Them
Authors: Alonso Sánchez A. , Red Gallego H. De la , Álvarez Astorga A. , Gómez García M. , De Uribe Viloria N. , Calzón M. De Lorenzo , Gómez Sánchez S. , Cepedello Pérez S. , Blanco Garrote J.A.
Published: June 2017

Introduction

Madness and creativity are thought to be related from ancient ages. Nowadays, thanks to new scientific developments and researches we are able to identify common genetic and brain patterns between creativity and psychosis.

Objectives

Taking the inspiration of a psychotic patient with some shocking drawings, we want to get deep into the actual knowledge about the relation between creativity and psychosis.

Methods

Case report and bibliographic review.

Results

A 19-year-old man was brought to the hospital after having been found making strange rituals in the public way. In the anamnese he showed to have experienced mystic delusions and hallucinations. He made some particularly creative drawings.

We made a review which showed that this patients may have a diminished latent inhibition, which could make them experiencing usual live irrelevant stimuli as something very exciting and creative at the same time. Genome wide association studies show also that people having creative jobs and psychotic patients share some genes, which could be linked to this abnormal latent inhibition.

Conclusions

Latent inhibition abnormalities could be related with psychosis and creativity. There are differences within the course of people having this oversensibility, which could be explained due to the presence of protective and risk factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical and genetic predictors of the severity and activity of paranoid schizophrenia
Authors: Barylnik Y. , Kolesnichenko E. , Abrosimova Y. , Pakhomova S. , Samoylova D. , Filippova N. , Bachilo E. , Antonova A. , Sizov S. , Ledvanova T. , Kuryshev V.
Published: June 2017

Clinical symptoms, course and outcomes of paranoid schizophrenia are polymorphic. Reliable predictors of severity and activity of schizophrenic process could provide clinicians important prognostic information for adequate and timely implementation of therapeutic and rehabilitative measures. Overall, 206 patients with paranoid schizophrenia were examined. Clinical predictors were collected from hospital records and interviews. BDNF gene Val66Met polymorphism (rs6265 G>A), DRD2 gene C939T polymorphism (rs6275C>T) and 5-HTR2A gene T102C polymorphism (rs6313 T>C) were studied as potential markers of prognosis for paranoid schizophrenia. Results of research testify that the DRD2 gene C939T polymorphism and 5-HTR2A gene T102C polymorphism cannot be used as predictors of the severity and activity of paranoid schizophrenia. The MetMet genotype of BDNF gene Val66Met polymorphism can be used as marker of favorable prognosis for paranoid schizophrenia. Schizoid, epileptoid, psychasthenic and conformal accentuation of personality in the premorbid, early onset of psychosis, paranoid and hallucinatory-paranoid variants of onset predicted more expressed severity of paranoid schizophrenia. These prognostic factors can be taken into account in clinical practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
QTc interval in patients diagnosed with schizophrenia receiving different defined daily dose (DDD) of antipsychotics
Authors: Christensen T. , Jeppesen R. Møller
Published: June 2017

Introduction

Both 1st and 2nd generation of antipsychotics are associated with prolonged QTc interval. Prolonged QTc can lead to ventricular tachycardia and Torsade's de pointes, ultimatime resulting to cardiac arrest and sudden death. Prolonged QTc interval due to increased DDD has not yet been investigated.

Objective

To investigate whether increased DDD of antipsychotics, causes further prolonged QTc, by patients diagnosed with schizophrenia.

Aims

To learn more about antipsychotics impact on the QTc interval in patients diagnosed with schizophrenia.

Methods

An observational study of unselected patients diagnosed with schizophrenia. Enrolled from January 2013 through March 2015 with follow-up until June 2015 in the region of central Denmark. Data was collected from ECG records and patient journals.

Result

ECGs were available in 58 patients. We observed no relation between increased DDD of antipsychotics and prolonged QTc. There were no differences in average QTc interval for the whole sample of patients receiving different DDD of antipsychotics.

Conclusion

We do not recommend increased attention to patients treated with higher DDD of antipsychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ziprasidone and pulmonary embolism, report of a case
Authors: Marin S. Garcia , Pedrosa N. Martínez , García I. De Haro , García M.D. Ortega
Published: June 2017

Introduction

Several scientific studies support the relation between pulmonary embolism and antipsychotic treatment (acute or chronic). We present a case of possible association of venous thromboembolism (VTE) and ziprasidone.

Personal antecedents

Man, 55-year-old, with mild hypertension. He has neither toxics habits nor allergies. He does exercise every day. He started with behavioral and perception disorders during 9 months before being diagnosed of paranoid schizophrenia in 2002. He began with risperidone 3 mg per day and amisulpride 25 mg per day as hypnotic. It allowed a good development and he keeps stable since then. The treatment produced sedation and weight increase, so it was changed to ziprasidone 60 mg per day and later 40 mg per day. A few months ago, he was hospitalized with breathelessness that started suddenly two days before. After all diagnostic tests, he was diagnosed with pulmonary embolism and right leg VTE. His medical development was very positive and he must begin with acenocumarol (doses–depend) and support stockings.

Conclusion

As we know, since last 10 years, antipsychotic exposure significantly increases the risk of pulmonary embolism. Due to the lack of risk related factor in this case, it would point that reason. The increase related is about 50% of developing VTE and this increased risk similarly applies to first and second generation antipsychotics drugs. Despite that, there are more cases in olanzapine, clozapine and haloperidol treatments due to antiaggregatory action and antithrombotic effects. We present this case probably closely related with ziprasidone.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Heterogeneous effectiveness patterns of amisulpride in chinese patients with schizophrenia: A cluster analysis of ESCAPE study
Authors: Liang Y. , Yu X.
Published: June 2017

Introduction

Rare research was reported about assessing the effectiveness and safety of amisulpride in Chinese patients with schizophrenia before we performed the ESCAPE, a multicenter, single-arm, phase IV study (NCT01795183). This study is a cluster analysis of ESCAPE study.

Objective

To identify the effectiveness patterns of amisulpride in Chinese patients with schizophrenia.

Aim

To examine baseline characteristics of patients as potential predictors of effectiveness.

Methods

Time-series cluster analysis was performed to identify effectiveness trajectories bases on Positive and Negative Syndrome Scale (PANSS) scores in Chinese patients with schizophrenia received amisulpride for 8 weeks. Baseline characteristics of patients were examined.

Results

Overall, 295 patients were included for efficacy analysis. Four response trajectories based on positive PANSS were identified (Figure 1): (1) rapid response (cluster 1); (2) gradual response (cluster 2); (3) sustained low level (cluster 3); (4) poor response (cluster 4). Age in cluster 4 was significantly higher than that in cluster 1 and cluster 3 (Table 1, P = 0.0025 and 0.0032, respectively). Similarly, four response trajectories based on negative PANSS were generated (Figure 2): (1) rapid response (cluster 1); (2) gradual response (cluster 2); (3) poor response with moderate PANSS (cluster 3); (4) poor response with high PANSS (cluster 4). Male to female ratio in cluster 1 was significantly lower than that in cluster 2 and cluster 3 (Table 2, P = 0.0042 and 0.0208, respectively).

Conclusion

For the first time, we obtained effectiveness patterns of amisulpride-treated Chinese patients. Age and gender may be predictors of effectiveness.

Disclosure of interest

This study is being funded by Sanofi (China) Investment Co., Ltd.
Community based mental health care as an example of good outcomes for young persons with episode of acute and transient psychotic disorders – Case study
Authors: Racetovic G. , Popovic S. , Rosic B. , Grujic-Timarac S.
Published: June 2017

Introduction

The prevalence of acute and transient psychotic disorder (ATPD) varies from 3.9–9.6 per 100,000 population [1]. Even it has clinical course with psychosis, there is no evidence that ATPD is similar with schizophrenia [2].

Objectives

Since in Bosnia and Herzegovina (BH) are not established specialized services for early interventions (EI), community mental health centers (CMHC) are basic services for fast and most efficient interventions in the cases of ATPD among other psychiatric disorders. The mental health reform has planned to establish EI services in the future [3].

Aims and method

To show CMHC as efficient service in the treatment of ATPD without using hospitalisation of young woman with two years follow up (case study)

Results

Full recovery of young female with ATPD using team approach and model of case management. After follow up of two years was any indications that psychotic disorders will develop.

Conclusions

Even we have not EI specialized services in our country, CMHC have capacities to manage ATDP in community settings avoiding hospitalisation of young people.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison of hospitalization rates in schizophrenic patients on first generation versus second generation antipsychotic depots
Authors: Rasool S. , Roy B.
Published: June 2017

Introduction

There is limited data on the efficacy rates between first and second generation antipsychotic depots. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics significantly reduce hospitalizations rates as compared to conventional depots.

Objectives

Comparison of hospitalization rates for patients with schizophrenia on first and second generation antipsychotic depots.

Methods

A retrospective observational study was done by reviewing the records of an antipsychotic depot clinic in Essex, United Kingdom. A list of 47 patients enrolled and receiving depot antipsychotics was obtained. Their records were studied and hospital admission rates calculated.

Results

Of the 47 patients 11 were excluded as they were on depot antipsychotics for non-schizophrenic diagnoses.

Of the 36 patients with schizophrenia, 12 were on second generation and 24 were on first generation depots.

Amongst the 24 patients on first generation depots, 19 were male, 5 female and mean age was 52 years.

Of the 12 patients on second generation depots, 10 were male and 2 female and mean age was 46 years.

When comparing hospital admission rates between the 2 groups, the following data was noted (Table 1).

Conclusions

There is no difference in hospitalization rates between patients on first generation antipsychotic depots as compared to second generation antipsychotic depots.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Staging & profiling in addiction, can we cross the gap from bench to bedside?
Authors: Schellekens A.
Published: June 2017

Addictive behaviours are highly common (prevalence worldwide about 10%), with major impact on the individual and society (contributing to 5% of overall DALYs and mortality) [1,2]. Though a number of evidence-based treatments are available, relapse rates remain high, up to 50% within one year of treatment [3,4]. Staging of addictive behaviors might contribute to improve this prognosis by indicating which patient could benefit most from which treatment modality.

In DSM-5 clinical staging of addictive disorders is limited to grading the severity of the disorder, based on criterion counts [5]. However, addictive disorders are highly heterogeneous, with distinct clinical profiles and neurobiological underpinnings of the disorder. Reward-processing deficits are considered a hallmark of addiction. Several additional neurobiological deficits have been identified in addicted individuals, such as dysfunction of brain stress systems, anterior cingulate cortex and habenula.

These neurobiological deficits may identify clinical subgroups of patients with distinct pathophysiology (profiling), or be related to progression of the disorder (staging). This presentation will focus on clinical staging and profiling of addictive behaviors combining neurobiological findings and clinical practice [6].

Disclosure of interest

The author has not supplied his declaration of competing interest.
Characteristics of pre-morbid functioning in male adolescents who later suffered from psychotic disorders: Case-controlled study
Authors: Rubinstein K. , Bhuknik-Atzil O. , Tuval-Maschiach R. , Fruchter E. , Weiser M.
Published: June 2017

Background

Previous research has shown that people with psychotic disorders have impaired functioning prior to the onset of the illness. The main goal of the proposed study was to deepen understanding of the characteristics of pre-morbid impairment in persons later diagnosed with psychotic disorders.

Methods

We examined unique pre-morbid data from IDF archives, including narrative summaries of pre-induction interviews of 17-year old adolescents (168 male adolescents who were later hospitalized for psychotic disorders, and 168 matched control subjects). The data were analyzed using mixed-method analysis, combining qualitative and quantitative research methods.

Results

Between group comparisons revealed more adaptation difficulties, family problems and dealing with medical conditions in the group of future psychotic disorder patients, while suicidal thoughts and loss of a close person showed trends towards significance. Two factors characterized classification of outcome: adaptation difficulties and family problems. A “high-functioning” factor was significantly higher within the control group, while a “strange” factor was higher among the future psychosis patients. A “high-functioning” factor was identified as a protective factor.

Discussion

This study used narrative analysis of interview summaries of adolescents who underwent pre-induction assessments. The current study replicated previously published findings that were obtained as a result of retrospective investigations and comparing numeric scores, using unique pre-morbid data and in-depth qualitative analyses, combined with a quantitative one. The main strengths of the current study are the fact that the subjects were interviewed before the onset of psychosis, as well as the fact that the analyses of the data were performed blinded to outcome.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotic disorder of organic etiology, in the context of sarcoidosis. A case report
Authors: Sánchez Blanco L. , Juncal Ruíz M. , Santayana Jenaro G. Pardo de , Gómez Revuelta M. , Landera Rodríguez R. , Porta Olivares O. , López García E. , Pérez Herrera M. , Núñez Morales N.I.
Published: June 2017

Introduction

Neurosarcoidosis is an uncommon cause of psychosis. It courses with an affectation of the brain, the spinal cord and other areas of the nervous system. It associates both neurological and psychiatric symptoms: cranial mononeuropathy, myelopathy or radiculopathy meningitis, neuroendocrine dysfunction, dementia, delusions, hallucinations.

Objectives

To review in Pub-Med about neuropychiatric manifestarions of neurosarcoidosis.

Methods

We describe the case of 60-year-old woman diagnosed with long evolution schizoaffective disorder with a recent decompensation in the context of a stressful situation. As somatic background to highlight: cognitive impairment (encephalic bilateral and symmetrical frontal atrophy in cranial magnetic resonance) and a probable sarcoidosis with hilia and mediastinal lymph nodes without histologic confirmation. She was hospitalized at the acute care unit because of a descompensation of her schizoaffective disorder. The patient was distressed, with delirious speech, sensoperceptive hallucinations, hypothymia and weigth loss.

Results

Firstly we evaluate the lack of clinical improvement with an anti-psychotic drug in previous hospitalizations. For that reason, we thought in organic mental disorder as an alternative diagnosis. We started treatment with corticosteroids in spite of we did not observe a decompensation of sarcoidosis. In a few days it was remarked a clinical improvement and remission of the delusional and affective clinic.

Conclusions

It is needed to complete the study and continue the monitoring of the patient to see the evolution and drug response. The diagnosis of neurosarcoidosis should be kept in mind for patients with both neurologic and psychiatric symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Moment-to-moment associations between emotional disturbances, aberrant salience and persecutory delusions
Authors: So S.H. , Chau A.K.C. , Peters E. , Swendsen J. , Garety P. , Kapur S.
Published: June 2017

Introduction

Experiences of depression and anxiety are common among patients with persecutory delusions. It has been theorized that emotional disturbances affect the formation and appraisal of persecutory delusions directly and possibly via increasing the sense of aberrant salience.

Objectives

Using a time-lagged analysis of experience sampling data, this study modelled the role of momentary levels of negative emotions and aberrant salience in maintaining persecutory delusions in patients with active delusions.

Methods

Clinically acute participants with at least a mild level of persecutory delusions were assessed using experience sampling method (ESM; 7 entries per day for 14 days) and clinical rating scales. ESM data of participants who completed at least 30 ESM entries were analysed by using multilevel regression modelling.

Results

The final sample consisted of 14 participants, with a total of 1161 momentary observations. Time-lagged analysis revealed that both negative emotions (B = 0.125, P = .009) and aberrant salience (B = 0.267, P< .001) predicted an increase in persecutory delusions in the next moment. Conversely, persecutory delusions did not predict change in negative emotions or change in aberrant salience in the next moment (ps> .05). Negative emotions also predicted an increase in aberrant salience in the next moment (B = 0.087, P = .009).

Conclusions

Our results supported the hypothesis that both negative emotions and aberrant salience exacerbate persecutory delusions, rather than being merely the sequelae of the symptoms. Our results suggested both direct and indirect (via aberrant salience) pathways from negative emotions to persecutory delusions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Differential diagnosis and therapy of cycloid psychoses: A case report
Authors: Uminska-Albert A.M. , Eikmeier G.
Published: June 2017

Kraepelin already challenged his dichotomy of psychoses, because in clinical practice too many cases were not in line with his pattern. Different terms for these disorders were coined. Leonhard separated cycloid psychoses from other forms of endogenous psychoses. The idealized subtypes (anxiety-beatific, hyperkinetic-akinetic-motility and confusional exited-inhibited) are characterized by a bipolar course with complete recovery. Operationalised criteria were developed by Perris. We report on a 60 year old woman diagnosed as schizophrenic in 1984/1985 and 2006. In August 2015 she was admitted with stupor and mutism and therefore was treated with fluphenazine and lorazepame. Six days later the clinical picture changed, she became confused and very agitated. After change of treatment to benperidole her clinical condition improved within 12 days. After 3 further days she became confused, agitated and euphoric again. The symptoms persisted in spite of a change of treatment to haloperidole. After diagnostic revision therapy was augmented with lithiumcarbonate. Six days later the psychotic symptoms began to improve and were completely remitted after 10 further days. The case report points out that a differential-diagnostic revision of an apparently therapy-resistant schizophrenia should not only be carried out according to ICD 10 criteria but a cycloid psychosis should be taken into account, too. Perris-criteria are contrasted with ICD 10-criteria for schizophrenia and mania with psychotic symptoms. Symptomatology and clinical course in our patient fulfilled exactly the Perris-criteria. We recommend an augmentation trial with lithium in acute phases of cycloid psychoses by all means before ECT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Suicide Risk in Refugees and Asylum Seekers
Authors: Wasserman D.
Published: June 2017

Increasing numbers of individuals forced to leave their home countries in areas of war, conflict, human rights violations and persecution pose a challenge for host countries to meet the mental-health care needs of these individuals. Refugees and asylum-seekers may face unique risk factors for mental disorder before, during, and after their migration leading to suicidality. Experiences of family withdrawal, integration difficulties, and perceived lack of care may contribute to suicide within the refugee populations. Identifying effective treatments and support to minimize the risk especially once the individuals arrive in their new country is key to providing appropriate care. Barriers to mental-health care including lack of knowledge about available resources, communication or language barriers, cultural beliefs about origins and treatment of mental disease, as well as a lack of trust in authority, pose a challenge for health care providers and policy makers.

Research has been inconsistent in the findings for the prevalence of mental disorders, suicidal behaviours, and suicide ideation among refugees and asylum seekers. Thus far, research has been limited to small scale, non-randomised, often qualitative analysis. Several studies have found higher rates of mental disorder, whereas others have found a similar prevalence as in the general population, although, Post-Traumatic Stress Disorder has more consistently been found to have a higher prevalence among migrants. The lack of early and thorough exploration of suicidal intent in this population requires large-scale quantitative studies to evaluate the effectiveness and feasibility of current practices in mental-health care and suicide prevention.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Sexual functioning in male patients suffering from depression and anxiety disorders
Authors: Ciocca G. , Di Lorenzo G. , Comite G. , Limoncin E. , Mollaioli D. , Bianciardi E. , Niolu C. , Jannini E.A. , Siracusano A.
Published: June 2017

Introduction

Sexual dysfunctions are frequent in patients with mental illnesses. In particular, anxious and depressive symptomatology often impacts on sexual functioning.

Objectives

The aim of this study was to evaluate the relationship between sexual function and psychological symptoms in a group of male patients with depression and anxiety disorders.

Methods

From outpatients program, we consecutively recruited a group of 46 males: 28 patients had major depression and 18 anxiety disorders. Then, we administered two self-report psychometric tools to assess male sexuality, depression and anxiety, i.e., international index of erectile function (IIEF-15), and Depression Anxiety Stress Scales (DASS-21). t-tests and Pearson correlations were performed.

Results

We found significantly higher score in terms of desire and general sexual wellness in people with anxiety disorder compared to people with depression. However, we found more significant correlations among depressive/anxious symptomatology and sexual impairment in males with anxiety disorders compared to males with depression.

Conclusions

Our results revealed that males diagnosed with depression show a decrease of sexual desire, as a vast part of literature previously affirmed. On the contrary, the relationship between psychological symptomatology and sexual dysfunction, as the reduction of erectile function, was higher in males with anxiety disorders. This difference is probably due to a major iatrogenic effect of antidepressive treatments in depressed patients, while in anxious patients could be the psychological state, per se, the main cause of sexual dysfunctions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.