bluuebunny/crossref_metadata_2025 huggingface dataset:
Olfactory reference syndrome
Authors: Sanahuja C. , Espinosa A.
Published: May 2016

Introduction

The term “olfactory reference syndrome” (ORS), introduced by Pryse-Phillips in 1971, is a persistent false belief and preoccupation with body odor accompanied by significant distress and functional impairment. Nowadays, it is not a distinct syndrome and it is currently classified as a delusional or obsessive-compulsive disorder.

Objectives and aims

Review the history of ORSs classification and discuss why it should be considered as a separate diagnostic in the current health care classification systems.

Methods

Description of a clinical case of a 36-year-old man and review the published articles on ORS by using PubMed database with the keywords: “olfactory reference syndrome”, “chronic olfactory paranoid syndrome”, “hallucinations of smell”, “chronic olfactory paranoid syndrome”, “delusions of bromosis” and “taijin kyofusho”.

Results

The published literature on ORS spans more than a century and provides consistent descriptions of its clinical features but nowadays is not explicitly mentioned in current classification systems as Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Statistical Classification of Diseases and Related Health Problems (ICD). ORS is overlap with different diagnostics such as delusional disorder, body dysmorphic disorder, obsessive-compulsive disorder, and hypochondriasis.

Conclusions

Right now, it is not clear how the ORSs should best be classified so we consider interesting to include it as a separate diagnosis in our set classifications, since we understand that an adjusted diagnosis is important in order to help patients and therapists to work on a treatment and to establish a more accurate prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive impairment in patients with epilepsy and effectiveness of overcoming stress behavior
Authors: Korostiy V. , Gerasimov B.
Published: May 2016

Introduction

Today cognitive impairment study epilepsy in children and in people taking anticonvulsants. Unfortunately, we do not know enough about neuropsychological features of mild cognitive impairment in epilepsy, clinical and pathogenetic patterns of their development, role in the development of social exclusion.

Aim

To study the mild cognitive impairment and their relationship with clinical features of epileptic disease forms, socio-psychological characteristics of patients.

Methods

Clinical-psychopathological, psychodiagnostic.

Results

We first used Addenbrooke's cognitive examination (ACE-R) in patients with epilepsy to quantify cognitive disorders in this group. The specified scale detects violations of cognitive function to mild dementia and allows us to differentiate the prevalence of certain disorders of mental processes. We revealed that the reducing the effectiveness of stress overcoming behavior through cognitive disorders in thinking and attention are one of the pathognomonic psychogenic mechanisms of affective disorders in patients with epilepsy. The complex of individual therapeutic measures for patients with epilepsy and MCI is based on the study features of cognitive disorders results. Psychotherapy and psychological correction measures for patients with epilepsy and MCI have to improve the social functioning and quality of life. We also created recommendations for the prevention of cognitive disorders in patients with epilepsy.

Conclusions

The features of cognitive disorders in patients with epilepsy, depending on the clinical form of epilepsy (symptomatic, idiopathic, cryptogenic). It should be used as additional differential diagnostic criteria forms of epilepsy (symptomatic, idiopathic, cryptogenic).

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The effects of alexithymia in the recognition of dynamic emotional faces
Authors: Rocha M. , Soares S. , Silva S. , Madeira N. , Silva C.
Published: May 2016

Introduction

Alexithymia is a multifactorial personality trait observed in several mental disorders, especially those with poor social functioning. Although it has been proposed that difficulties in interpersonal interactions in highly alexithymic individuals may stem from their reduced ability to express and recognize facial expressions, this still remains controversial.

Aim

In everyday life, faces displaying emotions are dynamic, although most studies have relied on static stimuli. The aim of this study was to investigate whether individuals with high levels of alexithymia differed from a control group in the categorization of emotional faces presented in a dynamic way. Given the highly dynamic nature of facial displays in real life, we used morphed videos depicting faces varying 1% from neutral to angry, disgust or happy faces, with a video presentation of 35 seconds.

Method

Sixty participants (27 males and 33 females) were divided into high (HA) and low levels of alexithymia (LA) by using the Toronto Alexithymia Scale (TAS-20). Participants were instructed to watch the face change from neutral to an emotion and to press a keyboard as soon as they could categorize an emotion expressed in the face.

Results

The results revealed an interaction between alexithymia and emotion showing that HA, compared to LA, were more inaccurate at categorizing angry faces.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The association between childhood trauma and facial emotion recognition in patients with stable schizophrenia
Authors: Mrizak J. , Arous A. , Trabelsi R. , Aissa A. , Ben Ammar H. , El Hechmi Z.
Published: May 2016

Introduction

The impairment of facial emotion recognition (FER) among patients with schizophrenia (SCZ) is a significant feature of the illness. Childhood trauma (CT) is reported with a high prevalence in SCZ and is considered one of its risk factors.

Objectives

To investigate the relationship between FER and CT in SCZ.

Methods

Fifty-eight outpatients with stable SCZ completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a newly developed and validated FER task constructed from photographs of the face of a famous Tunisian actress and evaluating the ability to correctly identify Ekman's six basic facial emotions (happiness, sadness, anger, disgust, fear and surprise).

Results

Patients with higher scores of CT performed significantly worse in FER task. Our results suggest that the presence of sexual abuse is specifically correlated to a poor identification of anger (P = 0.02) and disgust (P = 0.03) while the presence of emotional abuse and physical neglect are correlated to a poor identification of happiness and sadness.

Conclusions

CT may represent one of the causes of the FER deficits in schizophrenia. Further studies are necessary to confirm the link between specific kinds of childhood trauma and deficits in the recognition of discrete emotions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional processing in panic disorder and its subtypes: An fMRI study using the emotional faces paradigm
Authors: Pattyn T. , Schmaal L. , Filip V.D.E. , Brenda P. , Bernard S. , Dick V.
Published: May 2016

Introduction

The literature on the neurobiology of emotional processing in panic disorder (PD) remains inconsistent. Clinical heterogeneity could be causing this.

Objective

To investigate differences in brain activity between PD and healthy controls using the emotional faces fMRI paradigm.

Aims

To elucidate neurobiological mechanisms underlying emotional processing in PD and previously identified subtypes (Pattyn et al., 2015).

Methods

The main analysis compared the neural processing of different emotional facial expressions from a large group of PD patients (n = 73) versus healthy controls (n = 58) originating from the Netherlands Study of Depression and Anxiety (NESDA). A second analysis divided the PD group into the three previously identified subgroups: a cognitive-autonomic (n = 22), an autonomic (n = 16) and an aspecific subgroup (n = 35). The fusiform gyrus, the anterior cingulate cortex and the insula were used in a ROI approach.

Results

Comparing PD patients with healthy controls, a decreased activity on angry faces was observed in the left fusiform gyrus. The subgroup analysis showed more activity in the anterior cingulate cortex on neutral faces in the cognitive-autonomic subgroup versus the autonomic subgroup and a decreased activity in the left fusiform gyrus on angry faces compared to the aspecific subgroup. Less activity was observed in the right insula on neutral faces in the autonomic subgroup versus the aspecific subgroup.

Conclusion

Reduced activity in the left fusiform gyrus was differentiating panic disorder patients from healthy controls. In accordance with clinical subtyping, between-subtype differences are an indication that a phenomenological approach could provide more insight in underlying neurobiological mechanisms in emotional processing in PD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cognitive characteristics of unipolar (major depressive disorder) and bipolar depression
Authors: Suciu B. , Paunescu R. , Miclutia I.
Published: May 2016

Introduction

Impairment in cognitive performance is an important characteristic in many psychiatric illnesses, such as Bipolar Disorder and Major Depressive Disorder. Initially, cognitive dysfunctions were considered to be present only in acute depressive episodes and to improve after symptoms recovered. Reports have described persistent cognitive deficits even after significant improvement of depressive symptoms.

Aims/Objectives

We wanted to understand the dimension of cognitive impairment in unipolar and bipolar depression and also to underline the differences between cognitive profiles of patients diagnosed within the two mentioned disorders.

Method

This review examined recent literature about unipolar and bipolar depression.

Results

Both depressed patients presented cognitive deficits in several cognitive domains. Different aspects of attention were altered in both patients but impairment in shifting attention appeared specific to unipolar disorder while impaired sustained attention was particular for bipolar disorder. Both types of patients showed memory deficits that were associated with poor global functioning. Two recent studies described that bipolar depressed subjects were more impaired across all cognitive domains than unipolar depressed subjects on tests assessing verbal memory, verbal fluency, attention and executive functions. The most consistently deficits were displayed on measures of executive functioning – such as tasks requiring problem solving, planning, decision making – suggesting that this cognitive domain is a trait-marker for depression.

Conclusions

Cognitive deficits are present in both disorders during a depressive episode but they display slightly different patterns of impairment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuropsychological rehabilitation training in residential mental health services
Authors: Vaccaro A. , Cusmai A.S. , Catania A. , Zoppellaro C. , Manfrin F.
Published: May 2016

The neuropsychological rehabilitation in our mental health service is a central pillar of psychosocial rehabilitation. These interventions are integrated into a more complex program of psychosocial rehabilitation based on cognitive behavioral method.

We devote particular attention to the empowerment of the cognitive functions: attention, memory, language, logical and abstract reasoning.

The aim of this research is to evaluate efficacy of neuropsycological rehabilitation training in cognitive rehabilitation of psychotic patients.

The subjects that took part to the training were psychotics patient, residents in a mental health Community. Patients were both females and males, aged between 18 and 55 years. They were divided in two experimental groups and a control group. The instrument used was a battery of neuropsycological standardized tests. Tests were managed by an eye-tracker specialist.

Preliminary results seem to confirm a certain degree of improvement due to the training. Eye tracking integration during assessment appears to be a powerful tool as well, in order to define more patient-tailored strategies.

The training based on the empowerment of cognitive functions (attention, memory, language, logical and abstract reasoning) seems to change significantly the cognitive functions of the psychotic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depressive symptoms and bone mineral density in menopause and postmenopausal women: A still increasing and neglected problem
Authors: Bener A.
Published: May 2016

Objective

The objective of current study was to investigate whether associaction exist between depression and low BMD during menopausal and post-menopausal period.

Methods

A cross-sectional descriptive study and 1650 women aged 45–65 years were included during 1182 women agreed to participate (71.6%). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes.

Results

A total of 1182 women agreed to participate and responded to the study. The mean age and SD of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Also, the mean and SD of postmenopausal age were 58.55 ± 3.27 depressed and 57.78 ± 3.20 without depressed (P < 0.001). There were statistically significance differences between menopausal stages with regards to number of parity, and place of living. There were statistically significance differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, calcium deficiency and sheesha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in post-menopausal women than in menopausal women (P < 0.001). Similarly, T-score and z-score were lower with depressed menopause and postmenopausal women (P < 0.001).

Conclusion

The multivariate logistic regression analyses revealed that the depression, the mean serum vitamin D deficiency, calcium level deficiency, less physical activity, co-morbidity, number of parity, systolic and diastolic blood pressure and sheesha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Depression, anxiety and stress [DASS21] symptoms in menopausal Arab women: Shedding more light on a complex relationship
Authors: Bener A.
Published: May 2016

Objective

To determine correlation between depression, anxiety and stress in menopausal and post-menopausal women and shedding more light on a complex relationship.

Methods

A cross-sectional descriptive study was used and 1468 women aged 45–65 years were included and 1101 women agreed to participate (75.0%). Depression, anxiety and stress were measured using the Depression Anxiety Stress Scales (DASS-21). Data on body mass index (BMI), clinical and other parameters was used.

Results

A total of 1101 women agreed to participate after informed consent was obtained. The mean age and SD of the menopausal age was 49.55 ± 3.12, the mean and SD of postmenopausal age was 58.08 ± 3.26 (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Also, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, and diseases. Depression and anxiety were more common among post-menopause women. Also, there were no differences between the groups regarding the frequency of certain levels of stress among menopause and post-menopause. Multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were predictor for depression. Meanwhile, diastolic BP, occupation and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation and sheesha smoking habits were considered as the main risk factors associated with stress.

Conclusion

A large number of factors were associated with experiencing menopausal and psychosocial problems which had negative effects on the quality of life among Arabian women.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Most frequent clinic comorbibities in hospitalized patients in a psychiatric clinic
Authors: Jaber J. , Veríssimo J. , Raposo T.T. , Reys B.
Published: May 2016

Introduction

Being hospitalized in a psychiatric clinic, patients present, in addition to the diseases that determine the hospitalization, clinic comorbidities, generally decompensated.

Objectives

To present the most frequent clinic pathologies in a population of hospitalized patients having diverse mental disorders and establish a protocol for investigation and their early treatment.

Aims

To know the most frequent pathologies in a population of hospitalized psychiatric patients and establish a protocol for their assesment, in a way that contributes to the global improvement of the patient health condition.

Methods

For its mission realization, the clinic counts on a multidisciplinary team. The participants were 762 patients, seen in the referred clinic, which presented a minimum period of hospitalization of 10 days and that were submitted to thorough clinic exam and complementary routine exams. The time frame referred to the period of March of 2012 to February of 2014, totalizing 24 months.

Results

In the patients that had medical release after periods of hospitalization of, 90-day average, were obtained, in the totality of the cases, excellent evolution, evidenced by the improvement of the laboratory parameters.

Conclusions

The results were achieved in the hospitalization system with careful medicament administration, differentiated diets established in agreement with the patients, supervised physical activities and psychological and psychiatric support.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The influence of psychopharmacological treatment in the long-term outcome in patients suffering ADH with comorbid drug use
Authors: Núñez Domínguez L.A. , Portilla Fernández A. , Reula L. , Manrique Astiz E. , Arbeo Ruiz O. , García Nicolás M. , Fernández de la Vega O.
Published: May 2016

ADH is one of mental disease with a higher prevalence of alcohol and drug abuse. ADH is a risk factor for drug use, and that's true in the reverse sense. The mutual influence in both disorders is clear and the presence of both disorders together could be a real challenge for a clincial professional.

The main objective of the study is to evaluate the influence of the psychopharmacological treatment in the longterm outcome of this sample, using a measurement drug use, adherence to the treatment and impulsivity.

We make a study that includes a group of patients with both disorders. We select a sample from the Centro de Día Zuría. The patients complete a battery of scales (SCL-90, BArratt, SF-36) before and after the beginning of psychopharmacological treatment.

Our results shows a better prognosis in the patients with a good adherence to treatment, with a decrease in frequency and levels of drug use and a decrease in impulsivity, with a low level of behavioral disorders and violence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Between Scylla and Charybdis: Where does the treatment of Addison's disease in late-life depression go first?
Authors: Petrykiv S. , Arts M. , de Jonge L.
Published: May 2016

Introduction

Older adults with adrenocortical insufficiency, including Addison's disease (AD), are at an increased risk for developing late-life depression. Treatment of AD with glucocorticoid replacement therapy may exacerbate depressive symptoms and may complicate treatment of late-life depression.

Objectives

To present a case with algorithm of decision-making in a particular case of glucocorticoid induced depression in patient with syndrome of Addison.

Aims

To report a case-study, describing treatment of Addison's disease in LLD.

Methods

A case report is presented and discussed, followed by a literature review.

Results

A 77-year-old female, diagnosed with Addison's disease, was referred with persistent fatigue, weakness, weight loss, sleep disturbances, and depressive symptoms over the previous 6 months. She was taken losartan 100 mg/day, zolpidem 10 mg/day, fludrocortisone 100 μg/day, and hydrocortisone 35 mg/day. There was no personal or family history of psychiatric problems. Clinical examination was normal aside from skin hyperpigmentation. After initial minimal dose reduction of glucocorticoids, Addison's disease remained under control. One week later, her depressive symptoms disappeared without administration of antidepressants.

Conclusion

The association between glucocorticoid replacement therapy and late-life depression is not well understood. The current case shows that treatment of glucocorticoid-induced depression in subjects with Addison's disease is achievable by minimal adjustments in glucocorticoid regiment. However, collaboration with endocrinology is of vital importance to prevent an Addison's crisis. Pharmacokinetic dose-finding studies are required to find optimal glucocorticoid adjustment strategy.

Disclosure of interest

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

Introduction

Comorbidity between two or more mental disorders is highly frequent. Depression is one of the diseases that more often accompanies other conditions.

Objectives

The objective of this study is to establish the prevalence of depression in patients with delusional disorder and describe the treatment used in these cases.

Aims

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

Methods

Our results proceed from the Andalusian delusional disorder case register. We reviewed 1927 clinical histories of patients diagnosed of delusional disorder. Upon having verified the diagnosis, following DSM-V criteria, we recollected several data, including sociodemographic factors, depression comorbidity and antidepressive treatment.

Results

One thousand four hundred and fifty-two patients matched DSM-V delusional disorder criteria. 49,8% of our sample were women. Average following period was 9 years and 1 month, with an average of 0,84 hospitalizations. The prevalence of depression in patients with delusional disorders was 31,9%. 67,5% of them received some kind of antidepressive treatment. The antidepressive drugs most frequently used were selective serotonin reuptake inhibitors.

Conclusions

Depression is a highly prevalent condition among patients with delusional disorder. Most of them are on antidepressive treatment, the most employed of which is based on selective serotonin reuptake inhibitors. Comorbid depression can have an important impact on the course of delusional disorder. A correct diagnosis and treatment should be made to help improve the prognosis and life quality of these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Health-related quality of life in patients with moderate-severe psoriasis: Preliminary results on the role of psychopathology and coping strategies in a cohort of patients
Authors: Fabrazzo M. , De Santis V. , Puca R.V. , Romano F. , Arrigo M. , Cioffi V. , Catapano F. , Schiavo A. Lo
Published: May 2016

Psoriasis is a multisystem inflammatory disease associated to several comorbidities with a significant impact on interpersonal and social life. Depression, anxiety symptoms and suicidal ideation–due to psychological distress–are frequently reported. The aim of the study was to assess whether psychological factors–psychopathology, perceived health status and coping strategies–together with clinical and sociodemographic factors, were independent predictors of Quality of Life (QoL) in adult psoriatic patients on topical and/or systemic pharmacological therapy. A cohort of 87 patients (53 M and 34 F), whose mean age was 46 ± 22 years, was analyzed. Coping responses were assessed by COPE and general psychopathology by Self-Reported-Symptom Inventory Revised (SCL-90), while HAM-D and HAM-A evaluated depressive and anxiety symptoms. In addition, perceived health status and QoL were analyzed by Short-Form-36 (SF-36) while the disease's burden assessed by PSODISK. Univariate analyses were performed for each variable to explore the relationship with QoL. Preliminary results indicated that, although not severe, anxiety and depressive symptoms were the most reported among patients along with somatization and obsessive-compulsivity. Female patients used more frequently mental disengagement, focus on and venting of emotions, use of instrumental social support and religious coping. Physical pain and mental health, instead, greatly affected QoL of subjects in a negative manner. PSODISK data analysis showed that general health, itching, serenity, shame and degree of extension of the disease on the skin were the most compromised areas. Moreover, correlation analysis indicated that a worse perception of patients’ health status was associated to poor QoL.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychogenic stuttering: A case and review
Authors: Almada A. , Simões R. , Constante M. , Casquinha P. , Heitor M.J.
Published: May 2016

Introduction

Stuttering is a speech disorder characterized by involuntary repetition, prolongation or cessation of a sound. This dysfluency may be developmental or acquired. Acquired dysfluency can be classified as neurogenic or psychogenic.

Objectives

This case report aims to describe and discuss a case of psychogenic stuttering, providing an updated review on this disorder.

Methods

In and outpatient interviews were performed by Neurology and Psychiatry. Investigation to exclude organic causes included lab exams, electrocardiogram, electroencephalography, computed tomography scan and magnetic resonance imaging. A literature review in Science Direct database, with the keywords “psychogenic stuttering”, was also conducted.

Results

A 63-year-old man was admitted to the Beatriz Ângelo Hospital with an acute stuttering. Speech was characterized by the repetition of initial or stressed syllables, little affected by reading out loud or singing. Comprehension, syntaxes and semantic were not compromised, as weren’t sensory and motor abilities. During admission, stuttering characteristics changed. Multiple somatic complaints and stress prior to the onset and bizarre secondary behaviors were also detected. Work-up didn’t show an organic etiology for that sudden change. An iatrogenic etiology was considered, as sertraline and topiramate were started for depression 1 month before. However, the stuttering pattern, the negative results, the psychological and the social life events suggested a psychogenic etiology.

Conclusions

Psychogenic stuttering finds its origin in psychological or emotional problems. It is best classified as a conversion reaction. The differential diagnosis between psychogenic and neurological stuttering can be challenging.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dynamics of biochemical changes in anxious-depressed patients under treatment with antidepressants with different mechanisms of action on serotonin reuptake
Authors: Uzbekov M. , Maximova N.
Published: May 2016

Objectives

Pharmacodynamics of serotonergic antidepressants differently influencing on serotonin reuptake receptors is poorly investigated.

Aim

To compare biochemical profiles at patients with anxious depression under treatment with tianeptine–serotonin reuptake enhancer and sertraline–selective serotonin reuptake inhibitor.

Methods

Platelet monoamine oxidase (MAO) and serum amine oxidase (AO) activities, level of middle mass endotoxic molecules (MMEM) and serum albumin functional properties – effective albumin concentration (EAC) and reserve of albumin binding (RAB) were investigated at 43 patients with anxious depression (F 32.1 and F 33.1). Clinical severity of illness was assessed using Hamilton Depression (21 items) and Hamilton Anxiety Scales. All patients were divided in two groups: group I (21 person) received tianeptine (37, 5 mg/day), group II – sertraline (50 mg/day).

Results

It was established that patients with anxious depression were characterized by significant increase in MAO activity (by 95%) and the level of MMEM (by 86%) and significant decrease in AO activity (by 28%) and EAC and RAB parameters by 43 and 38%, respectively, in comparison with healthy volunteers. Under tianeptine and sertraline treatment, there were revealed contrary directed changes of all investigated parameters.

Conclusion

Results of study show that both tianeptine and sertraline are equally effective in treatment of anxious depression. Present biochemical investigation, however, suggest that underlying biochemical changes are more complete following tianeptine treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Burnout in pediatric oncology healthcare providers: Protection and vulnerability
Authors: Araújo C. , Gonçalves R. , Ferreira J.M.V.D. , Pedroso S. , Pinho C. , Silva S. , Brito M.J.
Published: May 2016

Introduction

Burnout is a condition characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, resulting from the inability to cope with chronic job stress. Healthcare providers at pediatric oncology units, who care for children with life-threatening illnesses, are exposure to high levels of stress, which increases the risk for developing burnout, with consequences in their personal health and quality of patient care.

Objective

To assess the prevalence and sources of burnout on a multidisciplinary team of a pediatric oncology unit.

Methods

Participants were a convenience sample of 16 pediatric oncology professionals, including medical, nursing, and related health staff from a Portuguese pediatric oncology center. Participants completed the Portuguese version of the Copenhagen Burnout Inventory.

Results

All three subscales that compose this Inventory were found to have burnout below normal levels (cut-off ≥ 50 points). However, personal and work-related subscales showed mean values in the superior limit of normality (48 ± 14, 18 points and 49, 48 ± 12, 23 points, respectively). Nevertheless, when analyzed the patient-related subscale, we found low levels of burnout in the majority of responders. These findings are similar to the existing literature, which suggests that patient care and interactions with children are the least stressful aspect of working in this specialty.

Conclusion

Despite the high levels of stress exposure in pediatric oncology units, results suggest that the majority of professionals are not actually in burnout. However, the obtained values advice for the need of prevention and workplace approaches to staff's well-being and stress reduction, in order to avoid burnout development.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder: 5-year retrospective study in one university hospital
Authors: Bahk W.M. , Woo Y.S. , Wang H.R. , Yoon B.H. , Jon D.I. , Kwon Y.J. , Lee K.H. , Min K.J. , Lee S.Y. , Kim M.D.
Published: May 2016

Objectives

The aim of this study was to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder by means of retrospective reviews of medical records.

Methods

The medical records of 250 patients with a diagnosis of major depressive disorder for at least 5 years were retrospectively reviewed for this study. We reviewed DSM-IV diagnosis and detailed clinical information at the index admission with assessments made every year after discharge to determining the cut-off for recurrent depressive episode to predict diagnostic conversion from unipolar depression to bipolar disorder.

Results

Receiver operating characteristic curve analysis indicated cut-off scores for recurrent depressive episode of more than three times (area under curve = 0.647, sensitivity = 0.435, specificity = 0.819, positive predictive value = 0.351, negative predictive value = 0.865).

Conclusions

These findings suggest that it could predict the best diagnostic conversion from unipolar depression to bipolar disorder when depressive episodes are recurrent more than three times. Based on these findings, it will be able to promote the accuracy of diagnosis and the efficiency of treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Acute hypomania in systemic lupus erythematosus, differential diagnosis. A case report
Authors: Ochoa García D.K. , Chauca Chauca G.M. , Carrión Expósito L.
Published: May 2016

Introduction

It is well known that seizures and psychosis are diagnostic criteria for systemic lupus erythematosus (SLE), however, there could be many other neuropsychiatric symptoms. The American College of Rheumatology Nomenclature provides case definitions for 19 neuropsychiatric syndromes seen in SLE (NPSLE), including cognitive impairment, psychosis, mood and anxiety disorders. Lack of specific manifestations difficult diagnosis and treatment.

Objectives

To address the diagnostic difficulties that involve the appearance of hypomanic symptoms in the course of SLE treated with high doses of corticoids in a patient with a depressive episode history.

Method

Description of case report and literature revision. We report the case of a 22-year-old woman who presented irritable mood, sexual disinhibition, insomnia and inflated self-esteem. The patient was recently diagnosed with SLE and was on treatment with 50 mg/d prednisone. She had familiar history for bipolar disorder and was taking 20 mg/d paroxetine since the last 6 months after being diagnosed with major depressive episode.

Results

We proposed differential diagnosis between psychiatric symptoms secondary to central nervous system SLE involvement, a comorbid bipolar disorder or prednisone-induced mood symptoms. Fluctuation of hypomanic symptoms during hospitalization, poor relationship with variation in corticosteroid doses, findings on brain MRI compatible with vasculitis and positive antibodies, oriented this case to a neuropsychiatric manifestation of LES.

Conclusions

We should keep in mind that symptoms of neuropsychiatric SLE may vary from more established manifestations of NPSLE to mild diffuses ones. More studies are needed to expand knowledge in the relationship between mood disorders and neuropsychiatric SLE.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
First rank symptoms in mania: An indistinct diagnostic strand
Authors: Channa A. , Aleem S. , Mohsin H.
Published: May 2016

First rank symptoms (FRS) are considered to be pathognomic for schizophrenia. However, FRS is not distinctive feature of schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. Its existence in the first episode of bipolar disorder may be predictor of poor short-term outcome and decompensating course of illness.

Objective

To determine the frequency of first rank symptoms in manic patients.

Method

The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool.

Result

The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. In total, 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a P value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness, 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity, 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception.

Conclusion

The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The old concept of psychogenic psychosis revisited from a transcultural approach: A case series
Authors: Gómez-Arnau J. , Puente-García R. , García-Jorge S. , Benítez-Alonso M. , Dolengevich-Segal H. , Correas-Lauffer J.
Published: May 2016

Introduction

The concept of psychogenic psychosis was introduced by Wimmer in 1916 and subsequently extended by Strömgren in the mid twentieth century. It typically describes a polymorphic psychotic episode of abrupt onset and which follows a trauma or stressful life situation. The duration of the episode is usually brief and remission occurs ad integrum. In recent decades, the notion has fallen into disuse in clinical psychiatry and international classifications. This could be due to a general improvement in living conditions, with less exposure to traumatic situations.

Objective

We intend to study the characteristics of psychogenic psychosis in immigrants. We believe that the condition could be observed better in this population, given their greater vulnerability to trauma. For this purpose, we chose a sample of Romanian patients, who nevertheless have considerable cultural affinity with the Spanish population.

Methods

We collected the clinical and biographical data of four cases of psychogenic psychosis admitted to our clinic between 2012 and 2015.

Results

Four Romanian women aged 25 to 42 were diagnosed with psychogenic psychosis in this period. Mean length of hospitalization was 5, 0 days. All patients reported familiar or occupational stress prior to the onset of symptoms. Psychotic symptoms remitted quickly with low doses of medication, despite being initially intense.

Conclusions

Reported cases fit remarkably well with the original description of Wimmer. The concept of psychogenic psychosis, along with similar brief psychotic entities, could be useful in describing the psychopathology derived from new social models and crises.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Dreaming the memories of our parents: Understanding neurobiology of transgenerational trauma and the capacities for its healing
Authors: Rozentsvit I.
Published: May 2016

Selma Freiberg once said that “trauma demands repetition”. What if actual trauma did not happen in real life of one particular person, but he/she feels that it was real, as it is repeated every night – in every dream? Do children and grandchildren of survivors of holocaust and of the pogroms dream the memories of their parents and grandparents? Does their imagination “make them up” or do they have a transgenerational connection to the traumatic past of their parents and grandparents, even if they were protected from knowing and hearing the horrors of what actually happened to their loved ones sometime one or two generations apart? Are these people born with some specific biological markers (e.g., lower cortisol levels)? Can fear be passed along from parents to children by smell? All these questions can be answered positively (see work of Jacek Debiec, Dias and Ressler, and many others), and can be explained on the level of neurobiology and epigenetics (thanks to contributions of Moshe Szyf and Michael Meaney from McGill University, and others). This presentation will offer some neuro-psychoeducational reflections on the topic of transgenerational trauma, its epigenetic transmission and its neuro-psycho-biological constructs, as well as a very personal touch, a personal story of growing up in a very nurturing and cultured, but very small family, and not knowing of the circumstances of “why small?”

Disclosure of interest

The author has not supplied his declaration of competing interest.
Associations among immune activation, the clinical characteristics, and the current severity of the “with anxious distress” specifier in patients with depressive disorders
Authors: Bahk W.M. , Shim I.H. , Woo Y.S. , Lee S.Y. , Kwon Y.J. , Jon D.I. , Seo H.J. , Nam B.W. , Seo J.S.
Published: May 2016

Introduction

This study assessed the levels of immune factors, demographic and clinical characteristics, and pharmacological treatments of patients with depressive disorders and compared them between patients with mild-to-moderate and moderate/severe-to-severe anxiety.

Methods

This study included 177 patients diagnosed with a depressive disorder who were hospitalized between March 2012 and April 2015. The patients were categorized into mild-to-moderate anxious distress and moderate/severe-to-severe anxious distress groups, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) based on the “with anxious distress” specifier. The current severity of symptoms was determined using the Hamilton Depression Rating Scale (HAM-D) scores on the Agitation and Anxiety-Psychic subscales. The charts of the patients were reviewed to evaluate immune factors, including C-reactive protein (CRP) and white blood cell (WBC) levels, confounding factors, such as smoking, other general medical disorders, and body mass index (BMI), and demographic and clinical characteristics.

Results

The moderate–severe to severe anxious distress group tended to have higher CRP and monocyte levels compared with the mild to moderate anxious distress group. However, after adjusting for the total HAM-D scores, there was a significant difference only in monocyte levels. After this adjustment, patients with moderate–severe to severe anxious distress had a significantly greater trend toward significance for suicidality and a higher rate of antipsychotic use.

Conclusions

High levels of anxiety symptoms may influence various underlying pathophysiological factors and modulate the inflammatory response and course of illness, affecting treatment planning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Facing depression with botulinum toxin: Literature review
Authors: Cátia Alves M. , Sobreira G. , Aleixo M.A. , Oliveira J.M.
Published: May 2016

Introduction

Affecting over 120 million people, major depressive disorder (MDD) is characterized by low mood, lack of interest and a cluster of other vegetative and cognitive symptoms causing significant distress of functioning. It has a relapsing and recurring course and frequently becomes chronic. Thus, there is a need to further develop therapeutic techniques to improve the course and the prognosis of depressive disorders. Recent clinical trials suggest that botulinum toxin (BTX) treatment may also have an antidepressant effect.

Objective

The authors aim to conduct a non-systematic review in order to understand the relationship between MDD and BTX treatment.

Aims

To assess whether current evidence supports the BTX to treat major depressive patients.

Methods

A non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “botulinum toxin” and “depression”.

Results

There is a small but growing body of evidence suggesting that botulinum toxin may be useful for the treatment of depression. The main hypothesis for the proposed beneficial effects of botulinum toxin is through the facial feedback. Low mood and depression are often associated with a sad facial expression. Injecting botulinum toxin and improving facial expression would lead to the improvement of depression symptoms.

Conclusions

Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin. It supports the concept that the facial musculature not only expresses, but also regulates mood states.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Computer-based cognitive training for patients with unipolar depression
Authors: Elliott A. , Munk-Jørgensen P. , Sheldrick-Michel A. , Hell M.D. , Nielsen B.
Published: May 2016

Introduction

Unipolar depression is a public health problem and is the most common psychiatric disorder among people with long-term sick leave in Denmark. Patients with unipolar depression are often associated with deficits in cognitive function long after the affective symptoms have disappeared. This could explain the long-term sick leave among patients suffering from unipolar depression. Computer-based cognitive training has been used to increase cognitive function in other patient groups.

Objectives

It is unknown whether cognitive functions are improved in patients with depression by help of a cognitive computer program. Further we investigate whether this intervention shortens sick leave.

Aims

To investigate whether a computer-based cognitive training group present a higher score in cognitive function after training and return to their employment earlier compared to the control group.

Methods

The study includes patients who have been admitted because of depression, but are finished with their treatment. When the patients are discharged, they will be randomizes into two groups and evaluated on their cognitive function. Only one of the two groups will receive computer-based cognitive training. After 12 week the two groups’ cognitive function will be compared. Furthermore there is a six-month follow up, to show if or when the participants have returned to work.

Results

The results will be presented at the EPA March 2016 in Madrid.

Conclusion

Based on the results of study it is our intention to conclude whether or not to implement computer-based cognitive training in treatment of patients with depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.