bluuebunny/crossref_metadata_2025 huggingface dataset:
Punitive Parental Discipline Among Adult Victims of Child Abuse
Authors: Mitkovic M. , Tosevski D. Lecic , Deusic S. Popovic , Milovancevic M. Pejovic
Published: March 2009

Aims:

It has been shown that abusive experiences in childhood may be related to specific behavior patterns manifested in adulthood, especially those that refer to negative parenting practices. The aim of this study was to assess the relationship between the use of punitive parental discipline and the childhood abuse trauma in parents.

Method:

Sixty six parents (30 males, 36 females, age 45.92±8.79 yrs, predominantly urban) completed the socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), and the punitive discipline self-report measure.

Results:

The frequency of use of punitive discipline between parents with and without the history of abuse was not significantly different (t=-1.298; p>0.05). The difference was not found neither among fathers (t=-0.047; p>0.05) nor among mothers (t=-1.951; p>0.05). Emotional abuse was the only type of childhood maltreatment related to the use of punitive discipline (r=0.393; p< 0.01). This relationship was found among both fathers (r=0.428; p< 0.05) and mothers (r=0.371; p< 0.05). In females, the use of punitive discipline was additionally related to the history of emotional neglect (r=0.379; p< 0.05).

Conclusion:

The findings may emphasize the need for identification and modification of the parental discipline strategies in adult victims of child emotional abuse and neglect.
Spanih Validation of TOOL Questionnaire: A New Instrument to Assess Quality of Life in Patients with Schizophrenia and Bipolar Disorder
Authors: Montejo A. , Lauffer J. Correas , Porras F. , Martin T. , Carrasco P. Ruiz , Cordero L. , Diez T. , Maurino J.
Published: March 2009

Objective:

Develop a cross-cultural translation, Swedish to Spanish, of TOOL questionnaire - a previously validated instrument to assess the impact of adverse effects (AE) on the health utilities and health related quality of life (HRQoL) in patients with schizophrenia and bipolar disorder.

Methods:

TOOL questionnaire has 8 attributes and 4 levels per domain: mood (anxiety and depression), function capabilities, and AE frequently associated with antipsychotics (fatigue-weakness, weight gain, stiffness-tremor, physical restlessness, sexual dysfunction, and vertigo-nausea). Firstly, 4 independent translators carried out the forward-backward translations. Next, draft version was reviewed by an experts panel (5 psychiatrists & 1 GP specialized in HRQoL) and tested in 40 stable patients (20 schizophrenic & 20 bipolar). Comprehension and importance (C/I) of each item were evaluated by a Likert scale ranging from 0 (lowest level) to 4 (highest level).

Results:

3 items should be modified to facilitate comprehension: mood, physical restlessness and vertigo-nausea. However, C/I of items mean scores were respectively: mood (3.50/ 2.37); function capabilities (2.58/ 2.03); fatigue-weakness (3.58/ 2.55); weight gain- (3.75/ 2.87); stiffness-tremor (3.65/ 2.61); restlessness (3.37/ 2.62); sexual dysfunction (3.39/ 2.51) and vertigo-nausea (3.56/ 2.44). Only 2 patients (5%) were unable to complete the questionnaire. Internal consistency was high (Cronbach α= 0.87) and neither item ceiling nor floor effects were found.

Conclusions:

The Swedish TOOL questionaire was culturally adapted into Spanish. Psychometric analyses are needed to validate this measure in Spain. A multtiatribute utility fuction should be estimated to evaluate AE by using a patients"centered perspective.
The Attitudes of the Medical Professionals Towards the Psychiatric Patients
Authors: Nastase S. , Ivanovici D. , Mihailescu A. , Dumitrescu I.M.
Published: March 2009

Objective:

The study is assessing the knowledge, attitudes and behaviours of the different categories of medical professionals towards the psychiatric patients.

Method:

The transversal descriptive study was developed in the hospitals from two cities of Romania: Bucharest and Targoviste. We have studied the opinions about patients with mental disorders of 8 groups of medical professionals: psychiatrists, medical doctors, trainees from psychiatry and from other medical specialities, nurses from psychiatry and from other medical specialities, medical students and student nurses. We have conceived an anonymous self-administered questionnaire with 18 items concerning knowledge, attitudes, affects and actions of the medical professionals toward people with a psychiatric disorder.

Results:

From the 450 medical professionals that were asked to complete the questionnaire, 379 returned the questionnaire completed. The comparison between the eight groups of medical professionals showed that the clinical experience is a differentiating factor in the opinions about the cognitions, affects and behaviours towards psychiatric patients. The psychiatric specialists and trainees demonstrated a more tolerant attitude towards the patients with mental disorders. The knowledge about the psychiatric illness had positive correlations with the tolerance in attitude and behavior, apart from the medical category of the respondents.

Conclusion:

Based on the fact that the modification of the cognitions influences the attitude and behavior, the stigma-reducing campaigns between medical professionals should have the main objective of informing about the psychiatric illness and patients.
The Picture of Mental Disorders in Czech Printed Media
Authors: Nawková L. , Adámková T. , Vondráčková P. , Nawka A. , Miovský M. , Raboch J.
Published: March 2009

Background and aims:

It's known that media significantly contribute to the stigmatisation of mental disorders themselves, as well as the people suffering from such ailments. The aim of our study is to provide content analysis of media messages covering the topics of mental health and psychiatry.

Methods:

The study sample comprises the media messages pertaining to the topic of mental illness collected by using the database of the Newton IT monitoring system. The articles were chosen from 6 printed most widely read daily periodicals, the period under consideration were 5 separate weeks randomly selected from the year 2007.

Results:

184 articles with mental illness as main content were found, including 110 in broadsheets and 74 in tabloids. Global impression of the message was negative in 76% of articles in tabloids and in 33% in broadsheets. The most represented diagnosis were Substance use disorders that were mentioned in 22% of all articles, on the other hand the representation of Neurotic disorders was quite low - 2% of all articles, Psychotic disorders were mentioned in 7% of articles.

Conclusions:

The results relate to only a short time period, however, suggest that the degree of stigma of mental disorders in the Czech printed media is high and should be further analysed. The main outcome is to formulate the recommendations for media in order to meet anti-stigmatising objectives and thus improve media coverage, minimalize discrimination practises and increase help seeking behavior.
Somatic Symptoms in a Community Sample of Ethiopian Immigrants in Toronto, Canada
Authors: Fenta H. , Hyman I. , Noh S. , Rourke S.
Published: March 2009

Objective:

This study examines the occurrence and correlates of somatization in a sample of adult Ethiopian immigrants and refugees residing n Toronto, Canada.

Methods:

A random sample of 342 adult (≥ 18 years of age) Ethiopian immigrants and refugees in Toronto completed structured face-to-face interviews. The Diagnostic Interview Schedule (DIS) Somatization Disorder Module was used to collect data on somatic symptoms. The Composite International Diagnostic Interview (CIDI) was used to assess major depression and generalized anxiety disorder.

Results:

Nearly two-thirds of the study participants reported having had at least one somatic symptom, and 5% reported experiencing medically unexplained symptoms in the 12 months preceding the interview. Individuals with major depression had significantly increased number of somatic symptoms compared to those without major depressive disorder. In a multivariate linear regression analysis, controlling for major depressive disorder, a higher level of somatization was associated with older age, pre-migration trauma, and post-migration stressful life events, and limited English proficiency.

Conclusion:

The findings of the study suggest that somatic symptoms are prevalent among individuals in cross-cultural transition and symptom level was associated with pre-migration trauma, post-migration stressors and mental disorder, particularly depressive disorder. The data also indicate a need for primary care physicians to routinely screen immigrant minority clients who present with somatic complaints for common and treatable psychiatric conditions, such as depression. In minority immigrant communities, somatic symptoms may reflect psychiatric problems.
A National Evaluation of Mental Health Inpatient Staff Morale in England
Authors: Nolan F. , Johnson S. , Killaspy H. , Wood S. , Osborn D. , Paul M. , Araya R.
Published: March 2009

Introduction:

Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.

Aim:

The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.

Methods:

100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:

1.

A quantitative questionnaire for all staff in participating wards and

2.

A comparison group in 20 community mental health teams and 20 crisis teams.

3.

Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.

4.

Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.

5.

Staff who leave the wards in the course of the first year will be asked their reasons for leaving.

6.

Links between rates of staff sickness and morale will be investigated.

Results:

Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.
Patients’ and Family Attitudes Toward Seclusion and Restraint
Authors: Bilanakis N. , Peritogiannis V.
Published: March 2009

Background and aim:

Coercive physical measures, such as seclusion and restraint are sometimes used in psychiatric inpatient treatment for the management of severely disturbed behaviour of patients. As part of a larger study on the use of restraint and seclusion in a psychiatric unit of a general hospital in Greece we aimed to record the patients’ and their relatives’ attitudes on coercive measures.

Methods:

Data regarding patients’ and family accounts on coercive measures were collected retrospectively with chart review of all patients who had been admitted to the psychiatric ward of the University Hospital of Ioannina over a six-month period and had been subjected to restraint or seclusion. During hospitalization and after the periods of restraint or seclusion, patients and relatives had been asked whether they considered coercion as justified or not. Patients had been also asked whether they perceived this experience as harmful.

Results:

Thirty one cases of restraint and seclusion from a total of 282 admissions were recorded during the study period. In 6 cases the patients refused to answer or did not have the decision making capacity. Twenty out of 25 (80%) patients considered their coercion to be unjustified and perceived it as traumatic experience. Twenty-five out of 28 (89.3%) relatives considered justified the decision to restrain or seclude the patient.

Conclusions:

Patients and their families have different accounts on coercion, but more research is needed. It is important for care planning to record the patients’ and families’ views and integrate them in mental health policy making.
From Evidence-Based Practice in Suicide Prevention to the Real World: How Long is the Leap?
Authors: Pompili M.
Published: March 2009

This presentation aims to shed light on effective suicide prevention activities that often are missing in the everyday clinical practice. Too often in fact suicidal individuals seek help from mental health professionals that nevertheless fail to recognize suicide risk. For instance, on average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Likewise, the real world often presents challenges that impair proper utilization of the evidence-based practice. Also, the alarming suicide rates around the world points to lack of effective preventive understanding of suicide. This presentation will present key point of the evidence-based practice, how to implement such approach and how to overcome difficulties in the real world. It will deal with the state of the art of preventive measures of suicide, what the missing elements are and how to make the most from personal experience without risking relying on clinician's intuition in management of suicidal individuals.
The Catalan Healthcare Intercultural Mediation Training Project of “la Caixa” Social and Cultural Outreach Projects
Authors: Qureshi A. , Collazos F. , Revollo H.W. , Ramos M. , Delgadillo C. , Harrak J. El , Rubio F. , Lizana T. , Alonso E. , Auquer F. , Muñoz D. , Cabré M. , Blanco P. , Simón M. , Casas M.
Published: March 2009

Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.
Consent to Treatment, Second Opinion Appointed Doctors and Code Compliance - an Audit?
Authors: Qureshi A. , Kirk G.
Published: March 2009

Aim:

Ensuring standards of section 58 documentation and associated communication complies with the code of practice of the Mental Health Act 1983 UK.

Method:

Case note review of detained patients under section 3 of Mental Health Act (MHA) 1983, requiring either a certificate of consent to treatment (form 38) or a certificate of second opinion authorising treatment (form 39), beyond first three months of medication. A standard checklist was devised, based on recommendations of MHA commission and code of practice.

Results:

Form 38 (5 Patients), 100% completion of names, dosage, route of adminstration of medication and proposed number of ECT treatments. Only 60% completion of documentation regarding treatment plan explanation and stating whether clozapine was included excluded.

Form 39 (7 patients) completed correctly in 100% cases with recommendation by second opinion appointed doctor (SOAD) in 85% cases. No documentation by SOAD in case notes and contact with the responsible medical officer (RMO) was only by phone (should have face to face contact). Only in 28% of cases RMO documented the SOAD visit and outcome.

Conclusion:

This audit has highlighted wide range of implications from the medico-legal perspective. The statutory documents, form 38 and 39, were completed correctly in majority of cases except for minor omissions. Adequate documentation was lacking with regards to discussion about the care plan and outcome of the SOAD visit. SOAD contact with the RMO was only on the phone (should only be in emergency) and no documentation of the second opinion in the case notes apart from filling the form 39.
Depression in Chronic Hepatitis C Treated with Interferon: Prevalence and Management
Authors: Scalori A. , Gandossini L. , Santamaria G. , Bellia V. , Bordoni T. , Avolio A. , Parravicini P. , Marin R. , Pioltelli P. , Roffi L.
Published: March 2009

Neuropsychiatric disturbances, from depression to psychosis and attempted or successful suicides are reported during interferon (IFN) therapy for chronic viral hepatitis. IFN schedule and history of psychiatric illness are not enough to predict who will develop symptoms.

Aims:

To assess the prevalence of depression during IFN therapy; to test whether a computerized version of the Minnesota Multiphasic Personality Inventory (MMPI) is a sensitive and reliable test for the early identification of patients at risk of depression before IFN therapy is started; and whether and how the depression can be cured. Patients. 185 patients treated with IFN.

Methods:

Before therapy, all patients underwent an MMPI and a clinical examination for identification of depressive symptoms.

Results:

Thirty-one patients developed a psychiatric disorder, 11 of them requiring treatment. Among the 18 patients with MMPI positive tests, 16 developed a psychiatric disorder (sensitivity of 0.58). Among the 154 who did not develop psychiatric side effects, 152 had a negative MMPI (specificity: 0.99). Severe psychiatric disorders (8 patients) were successfully treated with antidepressant drugs.

Conclusions:

Psychiatric side effects are easy to see during IFN therapy. An accurate psychiatric evaluation should be considered on all patients before treatment. However, as this specific examination cannot always be performed because of the lack of psychiatrists in liver units, it is necessary to identify tests, that are easy to carry out, reproducible, self-administered and inexpensive in order to screen all patients. If depression develops, it should be treated aggressively, and selective serotonin re-uptake inhibitors are the anti-depressant of choice.
Gilles De La Tourette Syndrome and Epilepsy: A Case Report
Authors: Silva C. , Nunes C.
Published: March 2009

Introduction:

The association between tics, epilepsy and obsessive-compulsive symptoms, is still little explored in literature.

Case report:

The authors describe case of a male patient, 25 years old, with some obsessive personality traits and with the appearance of simple multiple tics, at 7-8 years old. The tics were vocal and motor, particularly facial and worsen with anxiety. Of the personal history is highlighted the existence of repetitive tonsilitis and in the family history the presence of tics in 3 paternal first cousins. This patient started only consultation of Neurology in 2003 and was medicated with haloperidol 1 mg / day. Already in 2007 it was triggered absence crisis, so that after additional study (EEG and MRI) and detection of focal paroxysmal activity in the left fronto-temporal region, the patient was medicated with levetiracetam 1000 mg / day. Currently holds the following therapy: levetiracetam 1500 mg / day, clonidine 0225 mg / day and buspirone 30 mg / day, with clinical improvement occurred.

Conclusions:

This patient on one hand, presents DSM-IV-TR (2001) diagnostic criteria for Gilles de la Tourette syndrome and on the other hand, criteria for the diagnosis of fronto-temporal epilepsy. It is also relevant the patient"s family history, that is consistent with the high risk of Tourette Syndrome in the first degree relatives.
Evaluation of Suicidal Behaviour in a General Psychiatric Consultation
Authors: Silva C. , Gil I. , Mateus M.A. , Nogueiro Ó.
Published: March 2009

Several studies have been conducted to establish a profile of the suicidal/parasuicidal patient. Also several factors have been identified as possibly influencing the suicidal rates, including the religious practices.

Objectives:

Characterize the profile of suicidal behavior in a sample of patients followed in a general psychiatric consultation.

Methods:

It was done an analytical observational study of a random sample of 100 patients followed in a general psychiatric consultation. A survey was conducted with the collection of socio-economic, religious aspects and clinical data, and it was consulted the patient"s clinical process. Data analysis was done in Excel 2003.

Results:

The sample was consisted mostly by women (74%), being the most representative age group between 40 and 50 years (27%), mostly married (61%), 24% had 2 children and 65% lived in the rural area. The clinical diagnosis (ICD-9) was in 46% of cases, neurotic depression. 52% consider themselves religious not practitioners, being 90% catholics. History of suicide attempts/parasuicide occurred in 32% of patients, in the form of drug intoxication (31%) or with another method (11%). Most of the individuals said to have already thought about suicide at least once in their lifetime (74%). Only 8% had current suicidal ideation. Family history of suicide occurred in 27%, particularly in first degree family members, mainly by drowning (7%) and hanging (7%).

Conclusions:

Our results suggest that exists a high prevalence of suicidal behavior in this patients. For that reason, it should be done a systematic screening for suicidal ideation in this risk population.
Modeling of Selection of Relevant Cues in Rats: Effects of Task Complexity and Lesions of Medial Prefrontal Cortex
Authors: Svoboda J. , Blahna K. , Telensky P. , Bures J. , Stuchlik A.
Published: March 2009

One of key features of cognitive processing in both humans and animals is to select relevant stimuli. Several rodent spatial paradigms proved to be useful in biological psychiatric research. A place avoidance task has been previously used in animal model of cognitive deficits in psychosis.

Here we present modifications of the place avoidance paradigm, assessing the ability of selecting appropriate cues at various levels of task complexity. Moreover, we present a pilot experiment showing an effect of lesion to medial prefrontal cortex (mPFC) on those tasks. Generally, the place avoidance apparatus consists of a circular arena elevated 1m above the floor. Rats are trained to avoid an unmarked forbidden sector, entering which is punished by mild footshocks. The sector can be defined with respect to the room or arena frame, which can be dissociated by arena rotation. Moreover, we studied an ability of rats to avoid the place defined by salient rotating object.

The results showed that animals with mPFC lesion were capable of avoiding a place defined either by distal of by proximal cues, similarly as controls. However, both control and mPFC-lesioned rats had difficulties to avoid a place surrounding moving salient object. The performance increased whenever the rat was passively rotated with the arena, suggesting that vestibular stimulation enhanced the directed attention to an object. The poster will discuss the present findings and outline the future directions with emphasis on their utilization in animal models of neuropsychiatric disorders.

Supported by GACR grants 309/07/0341 and 309/06/1231.
Comparison of Psychopathology in Type1 and Type2 Diabetic Patients
Authors: Talaei A.
Published: March 2009

Aim:

Psychiatric disorders are from prevalent outcomes of chronic diseases such as diabetes mellitus. In spite of focused attention of prior researchers on psychiatric distresses of diabetes type2, there were not enough researches about psychopathology of diabetes type1. The aim of this study was to compare psychopathology of diabetes type1 with type2, and assess its relationship to demographic factors.

Method:

In this cross-sectional study, all of type1 and type2 diabetic patients who have medical records in "Khorasan Center of Diabetes Researches" matched about age and gender, then assessed their psychopathologies by using SCL-90-R questionnaire. Finally, 66 diabetic patients (33 with type1 and 33 with type2) completed the questionnaires and results processed by SPSS software.

Results:

The most prevalent pathology in SCL-90-R items was related to paranoid ideations (69.7%) and less prevalent item was phobic anxiety (33.3%). Prevalence of psychopathology in diabetic patients was 56.1%, in type1 diabetics more than type2 (66.7%, 45.5%), and in men more than women (63.3%, 50%). Independent t-test did not demonstrate a significant correlation between psychopathology and type of diabetes (P=0.156), but obsessive-compulsive symptoms and hostility in diabetes type1 have seen more than type2 (P< 0.05). ANOVA only could demonstrate relationship of education (P=0.006) and frequency of complications (P=0.011) to psychopathology.

Conclusion:

Great prevalence of psychiatric disorders in diabetic patients, need more attention for early diagnosis and treatment.
Hypochondriasis in Medical Sciences Students of Mashhad, Iran
Authors: Talaei A.
Published: March 2009

Aims:

Hypochondrias is a psychiatric disorder that is recognized with a strong belief and concerns about having a serious illness. Objectives of this study were determination of the frequency of these symptoms in medical sciences fieldsâ€™ students in their relation with age, gender & educational major and degree.

Method:

This study was performed on 500 randomly selected students in Mashhad University of Medical Sciences. Those with a known previous medical or mental disorder or defectiveness were excluded. Assessment was done with the hypochondrias questionnaire that includes 36 items. Data was analyzed with appropriate statistical descriptive and analytic tests such as chi-square, independent t and ANOVA.

Results:

In the present study the prevalence of hypochondrias in medical students were %36.8 at the borderline level and 16% as the disorder level. Out of 70 cases with hypochondriac disorder 57 had mild and 13 had moderate symptoms. This disorder was significantly more prevalent in girls than boys (P=0.000) and it was not related to marital status (P=0.318), However, all the students with moderate disorder were single.

Conclusion:

The present study showed the higher prevalence of hypochondrias in Iranian medical sciences fields’ students compared to those in other countries. In contrast to other studies, the disorder was more prevalent in women in this research. Hypochondriac symptoms in medical sciences fields’ students especially in ones with inaccurate medical information are frequent, in this study also there was a higher prevalence of symptoms in people with bachelor degree than those with other educational levels.
Similar Clinical and Demographic Profile of Immigrant and Native Patients in an Acute Psychiatric Unit
Authors: Magán T. Merino , Diez-Canseco M. Lloret , Sopena L. Laguna , Manteiga A. Tatay , Díez S. Cepeda , Crespo R. Calabuig , Martínez V. Balanzá
Published: March 2009

Aims:

The recent increase of immigrant population in some European countries represents a new social reality demanding an update of psychiatric clinical practice and resources. We aimed to:

1.

compare the clinical and demographic profile of immigrant patients admitted to a Spanish acute psychiatric ward with that of native patients, and

2.

detect changes over the last years regarding both the profile and the occupation of psychiatric beds.

Method:

Demographic and clinical data of immigrant patients admitted to the Doctor Peset University Hospital acute unit during 2005-2007 were retrospectively analyzed. For each case, a non-immigrant patient was assigned as a control. Immigrant subjects hospitalized during 2007 were compared to those admitted during 2000.

Results:

Over the three-year period, 38 immigrant individuals needed 45 hospitalizations (2.9-5.1% of total annual psychiatric admissions). Native patients presented similar demographics and produced a similar number of hospital stays, but had significantly more psychiatric (p=.02) and medical (p=.05) comorbid conditions. Immigrant patients hospitalized during 2007 (n= 12) were comparable to those admitted in 2000 (n=6), although the former accounted for a larger proportion of annual admissions (3.44% vs. 1.93%).

Conclusions:

During the last seven years, the occupation of psychiatric beds by immigrant population has almost doubled but it is still in the low range. The clinical and demographic profiles of patients admitted to this acute ward were similar, regardless of their geographical origin.
Life’s But a Walking Shadow
Authors: Jara J.M. , Tavares J. , Paixão L. , Carriço P.
Published: March 2009

The approach to mental states made in literature even before the sistematization of psichopathology, contributes to the comprehension of mental illness by giving it an almost universal and timeless perspective.

Hamlet walked the stage wearing several masks which succeeded themselfs.

Throught the presentation of a psychiatric story we would like to go through some of the masks present in Shakespear's work. From Othello to Juliet, from Desdemona to Hamlet, to Ophelia.

Following the internment of a 75 year old women, a biography with romanesque and tragic features emerged from her clinical condition: a love story and the Othello syndrom of her Romeo.
Psychosocial Determinants of Quality of Life 6 Months after Transplantation
Authors: Telles-Correia D. , Barbosa A. , Mega I.
Published: March 2009

Objectives:

The study sought to investigate the psychosocial determinants of quality of life 6 months after transplantation.

Methods:

A liver transplant candidates sample (n=60), comprising consecutive patients attending out-patient clinics of a liver transplantation central unit (25% of the patients had Familial Amyloid Polineuropathy (FAP) and the remaining patents had chronic liver diseases), was assessed in the pre-transplantation period by means of Neo FFI personality inventory, HADS, Brief COPE, and SF-36, a quality of life self rating questionnaire. Six months after transplantation these patients were assessed by means of SF-36.

Results:

Psychosocial predictors where found by means of multiple regression. The physical component of quality of life 6 months after transplantation was determined by coping strategies and physical quality of life in the pre transplantation period (this model explained 32% of variance) and that mental component 6 months after transplantation was determined by depression in the pre transplantation period and by clinical diagnosis of patients (FAP patients with lower mental component of quality of life) (explained 25% of the variance).

Conclusions:

Our findings suggest that coping strategies and depression measured in the pre-transplantation period are important determinants of quality of life 6 months after liver transplantation.

Further studies are needed to identify the extent to which early and continued psychotherapeutic interventions can improve not only mental but also physical related quality of life in patients at risk, for example patients with increased scores for depression and for non adaptive coping strategies in the pre transplantation period.
Treatment of Adult ADHD: Is Current Knowledge Useful to Clinicians?
Authors: Torgersen T. , Gjervan B. , Rasmussen K.
Published: March 2009

Psychostimulant drugs have for decades been considered the cornerstone of ADHD treatment. Non-stimulant drugs have also been reported successful. However, many controlled studies exclude patients with comorbidities typical for patients seen in clinical setting. Many patients are also considered non-responders to medication. Current knowledge might not be directly useful to clinicians. The present article reviews the literature on pharmacological and psychotherapeutic treatment in adult ADHD emphasizing comorbidity and other clinically important factors, as well as ADHD specific outcomes. Thirty-three relevant studies of pharmacotherapy and three studies of psychotherapy were included. Most subjects had little current comorbidity, but some studies included subjects with substance use disorder. Significant effect of treatment on ADHD symptoms was found in most studies using pharmacotherapy and all studies of psychotherapy. Both positive and negative effects on comorbid anxiety and depression measures were reported. Pharmacotherapy did not seem to have effect on substance use disorder. Few pharmacotherapy studies conducted any long-term follow-up; two studies that did, found that most subjects had discontinued medication. A clear-cut dose-respons relationship was not substanciated. In conclusion, clinicians have good support for both pharmacological and psychotherapeutic treatment of ADHD in adults, but should take additional measures to deal with comorbidities as well as treatment adherence.
Modelling the Effect of Minor Orthopaedic Day Surgery on Patient Mood at the Early Post-Operative Period: A Prospective Population-Based Study
Authors: Tsapakis E. , Tsiridis E. , Hunter A. , Georgakarakos N. , Thomas P. , Schizas C. , West R.
Published: March 2009

Objective:

The effect of minor orthopaedic day surgery (MiODS) on patient's mood.

Methods:

A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of General Anaesthesia (GA) were included. The Medical Outcomes Study-Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and postoperatively.

Results:

The mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n = 148, p = 0.51, 95%CI = (-1.03 -1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient, r = 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with χ2 (df = 1) = 0.86 for which p = 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.

Conclusions:

MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.
Discussing First Aid Training Issues of Psychiatric Emergencies
Authors: Tsopelas C. , Kapsali F. , Tsetsou S. , Kardaras K. , Oikonomou D. , Sardis A.
Published: March 2009

Aims:

Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.

Methods:

Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.

Results:

There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.

Conclusions:

Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.
Dhat Syndrome: A Systematic Review
Authors: Udina M. , Foulon H. , Corcoles D. , Rodriguez L. , Battacharyya S. , Martín-Santos R.
Published: March 2009

Background:

Dhat syndrome is a widely recognized clinical condition from the Indian subcontinent characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. This condition has been considered to be a culture-bound syndrome, and may be considered to be a culturally manifestation of depression or anxiety.

Aims:

The purpose of this paper was to perform a systematic review of published literature on Dhat syndrome.

Methods:

A review of the literature on Dhat syndrome until July 2008, without any language restriction was conducted by a search of the MEDLINE and PsycLIT indexing services using the following key words:Dhat syndrome, semen loss anxiety and loss of semen syndrome. Inclusion criteria were any case-control or cross-over study.

Results:

Twenty-three studies were identified, of which 10 met the inclusion criteria. There were 8 cross-over and 2 case-control studies. The reviewed studies included a total number of 680 cases and 93 controls. Patients included in these studies were mostly unmarried, young males (25.4 years old;18-45 years) from a poor socio-economic status. Majority of the studies involved patients from the Indian subcontinent. Some studies reported concomitant depressive symptoms (50%), anxiety (40%), fatigue (30%) and sexual problems (40%). Only 4 studies reported information about treatment (psychotherapy and pharmacotherapy).

Conclusions:

There was a high degree of heterogeneity among the studies reviewed. In conclusion, Dhat syndrome appears to be commonly associated with depression, anxiety and somatic symptoms. More studies are warranted related to the various treatment approaches for this condition.
Kynurenine Involvement in Pathogenesis of Hyperkinetic Children Syndrome
Authors: Uzbekov M.
Published: March 2009

Objectives:

The aim of the study was to evaluate the response of different monoaminergic systems to psychostimulant treatment in children with mild form of hyperkinetic syndrome (HKS).

Methods:

The levels of N-methylnicotinamide (end product of kynurenine pathway of tryptophan metabolism), 5-hydroxyindoleacetic (product of serotonin pathway of tryptophan metabolism), homovanillic and vanillylmandelic acids were measured in daily (3 days) urine samples of children (30 patients, 7-11 years old) with mild HKS with normal intellect or borderline mental insufficience. Biochemical measurements were performed before and 3 weeks after sydnocarb medication (5-15 mg sydnocarb daily). (Sydnocarb is a psychostimulant introduced into the clinical practice in the Soviet Union in the 70th of XX century).

Results:

After 3 weeks of sydnocarb therapy there were found the improvement of children's clinical status in both groups. It was followed by a significant decrease in the excretion of homovanillic (by 45 %), vanillylmandelic (by 35 %) and 5-hydroxyindoleacetic (by 50 %) acids but by a significant increase in N-methylnicotinamide excretion (by 30%).

Conclusions:

Psychostimulant medication has revealed the involvement of kynurenine and serotonin in HKS pathogenetic mechanisms. There were found a reciprocal relationship between serotonergic and kynurenine systems. It is proposed the kynurenine hypothesis of pathogenesis of HKS. It is characterized by the decreased activity of kynurenine system in HKS children. Clinical improvement of HKS children under psychostimulant medication is connected with activation of kynurenine system along with the decrease of serotonergic activity.
A Model for the Management of Suicidal Behaviour in Primary Care [P02-304]
Authors: Voros V. , Osvath P. , Fekete S.
Published: March 2009

Introduction:

Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.

Aims and methods:

Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.

Results:

We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.

Conclusion:

In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.
Medicating Malingerers: A Case Study of Feigned Sickle Cell Disease
Authors: Welch A. , Sachdeva S. , Chung C. , Alao A.
Published: March 2009

Speculation exists that bone pain crises among sickle cell disease (SCD) patients are not adequately treated. We counter this assertion with the case of a 17 year-old African American woman receiving narcotics while malingering SCD.

There are various complications of SCD with the most common resulting from ischemia of the bone marrow. While depression, anxiety, and post-traumatic stress disorder have been described, psychiatric complications are not well documented in SCD.

A 17 year old African American female entered the emergency room (ER) with right tibia and fibula fractures. She admitted to having SCD with bone pain crises previously treated with Ketorolac and Meperidine.

On this occasion, radiological studies did not confirm sickle cell changes. A subsequent immunoglobulin electrophoresis came back hemoglobin AA. After the patient received notification she did not have SCD, she attempted to leave against medical advice. Her fractures were treated and she was discharged.

DSM IV defines malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms”. One previous report of malingering sickle cell crises exists.1 This case demonstrates that the motivation to gain narcotic analgesics is a determining factor for malingering vis-à-vis factitious disorder, in which the primary goal is to assume the sick role.1

Clinicians may assume the validity of a self-reported SCD history. In this case, ER physicians prescribed narcotics without objective evidence of SCD pathology. We suggest verification of SCD diagnosis in order to prevent unnecessary prescription of narcotics.
Help Seeking Behaviour of Chinese Living in Belfast, Northern Ireland
Authors: Yeung Y.-W.
Published: March 2009

Aims:

British Chinese have a low uptake of mental health servcies. Poor symptom recognition, language difficulty and mental illness stigma are the key barriers to accessing services. This study aims to explore their help seeking behaviours when they experience mental illness.

Methods:

About 96% of Chinese in Northern Ireland worked in catering business. Questionnaires (both in Chinese and English) were sent to ninety-one addresses occupied by catering businesses in Belfast. A bilingual covering letter was enclosed to encourage recipients to ask their families and friends to return the questionnaires.

Results:

Twenty-four questionnaires were returned. 66.6% reported that they visited their GP within the year prior to the study. Only one person visited the GP becasue of a mental / psychological problem. All others visited their GP for their physical illness. Racism (58.3%), physical ill health (50%) and lack of social support (41.7%) were the key stressors. 21% would visit their GP if they had a mental health problem and 45.8% would contact the GP if someone they knew became mentally unwell. Poor recognition of mental illness (41.7%) and mental illness stigma (25%) were the reasons for not seeking medical advice.

Conclusion:

Findings revealed that the Chinese do seek help from their GP. However, little evidence suggests that the community will approach their GP when they or someone they know actually become mentally unwell. Further investigation is needed to explore diifferent ways to provide information about mental illness symptoms and mental health services for the community.
Prevalence of Metabolic Syndrome and Coronary Heart Disease Risk in Patients with Schizoaffective Disorder: Clamors Study
Authors: Arango C. , Bobes J. , Aranda P. , Carmena R. , Garcia-Garcia M. , Rejas J.
Published: March 2009

Aims:

To assess the prevalence of metabolic syndrome (MS) and the coronary heart disease (CHD) risk in patients with schizoaffective disorder treated with antipsychotics.

Methods:

Schizoaffective patients from a multicentre cross-sectional study, in which 117 psychiatrists recruited consecutive outpatients meeting DSM-IV criteria for schizophrenia, schizophreniform or schizoaffective disorder and receiving antipsychotic treatment in monotherapy for at least 12 weeks. MS was defined as fulfilment of at least 3 of the following components (NCEP-ATP-III definition): waist circumference >102(men)/>88(women) cm; triglycerides >=150mg/dL; HDL-cholesterol < 40mg/dL(men)/< 50mg/dL(women); blood pressure >=130/85; fasting glucose >=110mg/dL. CHD risk was assessed by SCORE (10-year CV death) and Framingham (10-year all CV events) functions.

Results:

268 valuable patients with schizoaffective disorder (127 men, 48.1%), 41.9±12.3 years (mean±SD) were examined. MS was presented in 26.5% (95%CI:21.2-31.8) of subjects [26.8% in men (19.1-34.5), 27.0% (19.6-34.4) in women (p=0.966)]. the overall 10-year CV risks (CV death or any event) were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. the 8.4% (95%CI:5.0-11.8) and 20.1% (95%CI:15.2-24.9) of patients showed high/very-high risk according to SCORE (≥3%) and Framingham (≥10%), respectively. A high/very-high risk of any CV event (Framingham≥10%) was associated with age above 40(men)/45(women) years [OR: 32.44 (9.59-109.71, p< 0.001)], and CGI-S=3-4; [OR: 4.32 (1.15-16.26, p=0.03)]. Women showed lower risk of any CV event [OR: 0.30 (0.14-0.65, p=0.002)].

Conclusions:

MS prevalence and CHD risk were high among patients with schizoaffective disorder treated with antipsychotics. Gender, age and poor disease control could be associated with CHD risk.

*On behalf of the CLAMORS Collaborative Group.