bluuebunny/crossref_metadata_2025 huggingface dataset:
Frontostriatal Dysconnectivity in adolescent Onset Schizophrenia and its Associations with Cognition: An MRI Volumetric and Diffusion Tensor Imaging Study
Authors: James A. , Fernandes H.M. , Mota P. Alves Da , Hough M.
Published: June 2017

Background

Adolescent-onset schizophrenia (AOS) is associated with cognitive impairment and poor clinical outcome. Cognitive dysfunction is thought to reflect functional dysconnectivity between the frontal cortex and the striatum, Previous work [1] has shown frontostriatal dysconnectivity in large WM tracts explain core cognitive deficits, with processing speed, which is affected by alterations in WM connectivity, being an intermediary variable.

Objective

To undertake a follow-up MRI study using whole-brain structural connectomics to track topological changes in the follow-up (1st episode versus follow-up), in order to characterize the early stages (evolution of the first two years) of the disorder.

Design

A follow-up study of 25 AOS subjects and 25 age and sex-matched healthy subjects.

Outcome

Network theory will be applied to identify topological alterations in structural networks, including frontostriatal white matter (WM) tracts in relation to cognition and outcome measures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Impact of the Change Trial on Physical Health in People With Schizophrenia
Authors: Nordentoft M. , Speyer H. , Norgaard H.C.B. , Birk M. , Mors O.
Published: June 2017

Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant. The aim of this trial was to improve the cardiovascular risk profile.

Methods

The CHANGE trial was an investigator-initiated, randomised, parallel-group, superiority, multi-centre trial with blinded outcome assessment. Patients diagnosed with schizophrenia spectrum disorders and increased waist circumference according (>88 cm for women, >102 cm for men), were recruited and centrally randomised 1:1:1 to 12-months of lifestyle coaching plus care coordination versus care coordination alone versus treatment as usual. The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and standardised to age 60, secondary outcomes included cardiorespiratory fitness and physical activity. Clinical.Trials.gov NCT01585493.

Findings

A total of 428 participants were randomly assigned to the CHANGE intervention (n = 138); care coordination (n = 142); or treatment as usual (n = 148). At 12 months, the mean 10 years risk of cardiovascular disease was 8.4% (SD 6.7) in the CHANGE group, 8.5% (SD 7.5) in the care coordination group and 8.0% (SD 6.5) in the treatment as usual group (P = 0.41). We found no intervention effects for any secondary or explorative outcomes, including weight, cardiorespiratory fitness, physical activity, diet or smoking.

Interpretation

The CHANGE trial did not support individual lifestyle coaching or care coordination as superior compared with treatment as usual in reducing the cardiovascular risk in patients with schizophrenia and increased waist circumference.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neurobiological Correlates of Learning and Decision-making in Alcohol Dependence
Authors: Sebold M. , Nebe S. , Garbusow M. , Schad D. , Sommer C. , Rapp M. , Smolka M. , Huys Q. , Schlagenhauf F. , Heinz A.
Published: June 2017

The mesolimbic dopaminergic system has been implicated in two kinds of reward processing, one in reinforcement learning (e.g prediction error) and another in incentive salience attribution (e.g. cue-reactivity). Both functions have been implicated in alcohol dependence with the former contributing to the persistence of chronic alcohol intake despite severe negative consequences and the latter playing a crucial role in cue-induced craving and relapse. The bicentric study “Learning in alcohol dependence (LeAD)” aims to bridge a gap between these processes by investigating reinforcement learning mechanisms and the influence that Pavlovian cues exert over behavior. We here demonstrate that alcohol dependent subjects show alterations in goal-directed, model-based reinforcement learning (Sebold et al., 2014) and demonstrate that prospective relapsing patients show reductions in the medial prefrontal cortex activation during goal-directed control. Moreover we show that in alcohol dependent patients compared to healthy controls, Pavlovian cues exert pronounced control over behavior (Garbusow et al., 2016). Again, prospective relapsing patients showed increased Nucleus accumbens activation during these cue-induced responses. These findings point to an important role of the mesolimbic dopaminergic system as a predictor of treatment outcome in alcohol dependence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental Health and Social Care Providers Facing Requests of Assisted suicide from Elderly in Nursing Homes in Switzerland
Authors: Castelli Dransart D.A. , Voélin S. , Elena S.
Published: June 2017

Introduction

In some Swiss states, right-to-die associations are allowed to assist older people in nursing homes provided that certain requirements are fulfilled.

Objectives

To investigate how health and social care providers and their institutions reacted to and dealt with requests of assisted suicide.

Method

An exploratory qualitative study was carried out in the States of Fribourg and Vaud among 40 professionals working in nursing homes, home care services or social welfare agencies.

Results

The requests of assisted suicide questioned the professional mission, the quality of accompaniment provided to the older people and both professional and personal values. Health and social care providers were required to ponder over ethical dilemmas or decisions. Several challenges were reported, such as: taking into account and articulating personal freedom or needs with collective functioning or organizational constraints before, during and after the assisted suicide; reconciliating self-determination with protection towards vulnerable people (beneficere, non maleficere).

Conclusions

Assisted suicide challenges and changes professional end-of-life practices. Education and support should be provided to health and social care providers faced with it.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
How long is the interval between the onset and the initial management of bipolar disorder? A meta-analysis
Authors: De Girolamo G. , Signorini G. , Dagani J. , Faustini F.
Published: June 2017

Objective

To evaluate the length of the interval between the onset and the initial management of bipolar disorder (BD).

Method

We conducted a meta-analysis using the preferred reporting items for systematic reviews and meta-analyses guidelines. Systematic searches located studies reporting estimates of the age of onset (AOO) and indicators of the age at initial management of BD. We calculated a pooled estimate of the interval between AOO and age at management. Factors influencing between-study heterogeneity were investigated using sensitivity analyses, meta-regression, and multiple meta–regression.

Results

Twenty-seven studies, reporting 51 samples and a total of 9415 patients, met the inclusion criteria. The pooled estimate for the interval between the onset of BD and its management was 5–8 years (standardized difference, .53; 95% confidence interval, .45 to .62). There was very high between-sample heterogeneity (I2 ¼ 92.6; Q ¼ 672). A longer interval was found in studies that defined the onset according to the first episode (compared to onset of symptoms or illness) and defined management as age at diagnosis (rather than first treatment or first hospitalization). A longer interval was reported among more recently published studies, among studies that used a systematic method to establish the chronology of illness, among studies with a smaller proportion of bipolar I patients, and among studies with an earlier mean AOO.

Conclusions

There is currently little consistency in the way researchers report the AOO and initial management of BD. However, the large interval between onset and management of BD presents an opportunity for earlier intervention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Perfusion SPECT in the Differential Diagnosis of Dementia
Authors: Brigadeiro D. , Nunes J. , Ventura Gil T. , Costa P.
Published: June 2017

Dementia is a syndrome–usually of a chronic or progressive nature–in which there is deterioration in cognitive function beyond what might be expected from normal ageing (WHO). As the world population ages, the number of people afflicted with dementing illnesses will increase. This neurodegenerative disease is one of the major causes of disability and dependency among older people worldwide. Brain single-photon emission computed tomography (SPECT) allows the study of regional cerebral blood flow, providing functional information. Each of the different types of dementia has a distinct blood flow pattern that is revealed with SPECT imaging and which can be used for differential diagnoses. This imaging technique can also be used to differentiate dementia from pseudodementia. The use of SPECT has been recommended in various guidelines to help in differential diagnosis of dementia. The National Institute for Health and Clinical Excellence in the UK recommend the use of SPECT or positron emission tomography (PET) to help differentiate Alzheimer's disease (AD) from frontotemporal dementia and vascular dementia when there is diagnostic doubt (NICE, 2006). The European Federation of the Neurological Societies guidelines for diagnosis also supports the use of FDG-PET (18F fluorodeoxyglucose positron emission tomography) or perfusion SPECT when clarifying a diagnosis of AD. This review describes the utility of perfusion SPECT in differential diagnosis of neurodegenerative dementias.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Association Between Multiple Sclerosis and Depression
Authors: Fornelos A. , Espírito Santo V. , Silva M. , Roque M.
Published: June 2017

Introduction

Multiple Sclerosis (MS) is considered an autoimmune inflammatory disease and it is the most common demyelinating disease of the central nervous system. Although its aetiology remains unknown, it has been considered to be multifactorial. MS tends to be more commonly diagnosed in young Caucasian women. It has been described four clinical courses: relapsing-remitting MS, primary progressive MS, secondary progressive MS and progressive remitting MS based on the temporal sequence in which the symptoms arise. Clinic is also very different because it depends on the sites where the lesions occur. The most frequent signs and symptoms are motor and visual deficits, paraesthesia, gait ataxia, diplopia, dizziness and bladder dysfunction. Depressive symptomatology is also among the most common symptoms of MS.

Objectives

Show the importance of depressive symptomatology in patients with MS.

Aims

Evaluation the connection between MS and depression.

Methods

Search for articles concerning MS and depression on Pubmed and Scielo databases from July 2014 through October 2016.

Results

Psychiatric manifestations, and especially depressive symptoms, affect almost 40% of MS patients in remission, and about 90% of those in a flare-up. This may be due to the diagnosis itself, with its large amount of symptoms and its variable progression, but also due to side effects of therapy. It gives a major contribute to suicidality (7.5%) when compared to the general population.

Conclusion

A combined approach and treatment is in order to diminish the incapacity caused by both these illnesses in every single patient.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuropsychiatric Symptoms in Fahr's Syndrome
Authors: Lopes A. , Trindade R. , Barcelos A.
Published: June 2017

Objectives and methodology

To review the neuropsychiatric symptoms of Fahr's syndrome.

Results/discussion

Fahr's Syndrome is a rare degenerative neuropsychiatric condition, characterized by bilateral and symmetrical calcifications of the basal ganglia. It can be associated with several metabolic, infectious or genetic conditions. It is clinically manifested by movement disorders, psychosis, cognitive impairment, mood disorders, personality dysfunction or obsessive-compulsive spectrum disturbances. First presentation can be psychiatric in approximately 40% of the cases. Cognitive dysfunction, mood disorders and psychosis are the most common presentations. In the present case, depression, dementia and movement disorders were the main clinical pictures. This report alerts for the significance of neuropsychiatric symptoms within this diagnosis, considering the multisystemic approach of the illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Differential Effect of Event Rate on Pupil Dilation Patterns Suggests Effort Dysregulation Problems in ADHD
Authors: Metin B. , Sonuga-Barke E. , Wiersema J.R. , Roeyers H. , Vermeir S.
Published: June 2017

Introduction

The state regulation model postulates that ADHD performance difficulties result from failures to regulate activation states in response to changing environmental conditions – producing poor performance under sub-optimal conditions. Behavioral and electrophysiological studies involving the manipulation of event rate (ER) lend support to this idea.

Aim

In this preliminary study, we extended this investigation by comparing pupil dilation, an established marker of cognitive effort allocation, in individuals with ADHD, and controls, in response to varying ERs on a simple cognitive task.

Methods

Nineteen children with ADHD (age range: 8–14 years) and 21 controls (age range: 10–16 years) completed a target detection task under three different ERs (1300, 4000, and 8000 msec). Pupil dilation was monitored using an eye-tracker.

Results

Our results show that for controls, pupil dilation to targets varied as a function of ER according to a “U” function – with fast and slow ERs inducing greater phasic dilation than the moderate ER. However, for children with ADHD the relationship was linear with dilation increasing as ER decreased.

Conclusions

The results provide the first pupillary evidence suggestive of effort allocation dysregulation in ADHD especially under fast event rate conditions. Future studies should explore interventions to overcome effort allocation problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuroretinal Dysfunctions in Regular Cannabis Users: An Impact of Cannabis on Retinal Neurotransmission?
Authors: Schwitzer T. , Schwan R. , Giersch A. , Albuisson E. , Angioi-Duprez K. , Laprevote V.
Published: June 2017

Introduction

Although cannabis is very widespread worldwide, its brain toxicity is poorly understood. The neuroretina is an accessible extension of the brain and could be a relevant site for investigating neurotransmission abnormalities in neuropsychiatric disorders. The retina has a functional endocannabinoid system involved in the regulation of retinal neurotransmission. In animals, the modulation of this system led to retinal dysfunctions measured with the electroretinogram (ERG).

Objectives

To assess whether the regular cannabis use could affect the neuroretinal function.

Aims

Assessments of the neuroretinal function in cannabis users compared with controls.

Methods

Recordings of pattern, flash and on-off ERG were performed in 55 cannabis users and 29 controls. The amplitude and implicit time of the following waves were evaluated: N95 (pattern); a – and b – (flash); a –, b- and d1 – (on-off).

Results

Cannabis users showed a significant increase in implicit time of the waves N95 (P = 0.0001), a- (P = 0.029) and b – (P = 0.002) for the flash ERG and b – (P = 0.016) and d1 – (P = 0.027) for the on-off ERG, compared with controls. No significant difference was found between groups in terms of wave's amplitudes.

Conclusions

These results show a delay in the response of cones, bipolar and ganglion cells of the on and off pathways to constitute a delay of ≈ 6 ms in the transmission of information from the retina to the brain in cannabis users. Cannabis could disrupt the regulatory role of the cannabinoid system and impair retinal glutamatergic neurotransmission. The consequences on visual perception should be explored in future studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Patterns of Eeg Coherence Associated with Emotional Burnout
Authors: Tukaiev S. , Zyma I.
Published: June 2017

One of the main problems is evaluation of the influence of emotiongenic factors in everyday life and interpersonal communication on an individual. Burnout is a mechanism of psychological defense, which is responsible for partial or total loss of emotions in response to stressful situations during interpersonal communication. The changes of functional connectivity between different regions of brain in the rest state depends on the current level of brain activation, which, in turn, depends on the initial emotional state. The development of emotional burnout is characterized by decrease of information capacity of the brain: reduction of spatial synchronization provides delayed and less efficient spread of excitation in the cerebral cortex. The decrease of interhemispheric coherence of low and high-frequency components of EEG may indicate the increase of level of differentiation of neuronal groups. In women, decrease of coherence in theta-subband indicates the influence of burnout on attention concentration, working memory, and emotional processes. In men weakening of the relationship between left frontal and right occipital zones indicates the weakness of informational aggregation, reducing readiness of the neural centers for processing information in the “cognitive axis”. Reduction of the level of coherence of alpha band may indicate problems of psychological adaptation within the experiment in examined groups of men with the Resistance stage of burnout. These EEG features allow us to conclude that participants with Resistance stage were concentrated on negative emotional reactions. Study indicates that men are more vulnerable to stress-induced conditions, which lead to burnout.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Efficacy of CBT Plus Acceptance & Commitment Therapy Versus CBT Alone for Obsessive-compulsive Disorder. Protocol for a Randomised Single-blinded Superiority Trial
Authors: Pozza A. , Domenichetti S. , Giaquinta N. , Davide D.
Published: June 2017

Introduction

Cognitive behavioural therapy (CBT) is the first-line psychological treatment for Obsessive-Compulsive Disorder (OCD). However, 30% of individuals have a null or partial response. Preliminary evidence suggested that Acceptance & Commitment Therapy (ACT) may be effective. No study investigated whether the association of CBT with ACT may improve outcomes of CBT alone.

Objectives

This paper presents the protocol of a trial where individuals with OCD will be randomly assigned to CBT alone or CBT plus ACT. Primary endpoints will be the number of individuals meeting OCD diagnostic criteria at post-treatment and follow-up. Secondary endpoints will be self-reported depression, anxiety, disgust and guilt, and obsessive beliefs. It is hypothesized that CBT plus ACT is associated to fewer individuals meeting OCD criteria and greater reductions in secondary endpoints.

Methods

A single-blinded superiority randomised design will be used. Primary/secondary outcomes will be administered at baseline, post-treatment and 6-month follow-up. Treatment duration will be 25 weekly sessions in both conditions. Individuals (age ≥ 18 years) with OCD diagnosis will be recruited at mental health services in a 60.000 inhabitants area in Italy. Chi squared will be computed to test group differences on OCD diagnosis. ANCOVAs will be calculated entering baseline scores as covariates, group allocation as random factor and primary/secondary outcomes as dependent variables.

Results

To obtain a medium effect size, 80% power and 0.05 significance, a priori power analysis suggests inclusion for at least 34 individuals as total sample.

Conclusions

A description of the protocol will be provided. Strengths and potential limitations will be addressed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Diagnostic Accuracy of the Overlapping Infinity Loops, Wire Cube, Clock Drawing Tests and their Combined Score for Cognitive Impairment in Mild Cognitive Impairment and Dementia
Authors: Charernboon T.
Published: June 2017

Objectives

To investigate the diagnostic accuracy of the overlapping infinity loops, wire cube, clock drawing tests (CDT) and the combined score in the detection of mild cognitive impairment (MCI) and dementia.

Methods

The participants were 60 normal controls (NC), 35 patients with MCI, and 47 patients with dementia. For the overlapping infinity loops and wire cube tests, the participants were told to copy the figures from the examples. For the CDT, the participants were asked to draw a clock face with numbers on it with the hands at ten past five.

Results

The results illustrate that infinity loops, cube, or CDT alone, or combined score, were not able to discriminate between NC and MCI groups. In dementia detection, the CDT had the highest diagnostic accuracy (sensitivity 76.6% and specificity 87.4%) followed by infinity loops (sensitivity 83.7% and specificity 78.9%) and cube (sensitivity 93.6% and specificity 46.3%). Additionally, when the three tests were combined, better diagnostic accuracy was demonstrated with a sensitivity of 87.2% and specificity 86.3%.

Conclusion

This study demonstrates that the three drawing tests are sensitive detectors of dementia but not MCI. The combination of these three drawing tests is a brief tool of good diagnostic accuracy for dementia screening.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Prescribing Tricyclic Antidepressants in the Elderly
Authors: Oueslati B. , Oumaya M. , Bouzid R.
Published: June 2017

Introduction

Although not recommended as a first-line treatment for old patients with depressive, anxiety or somatic symptom disorders, we continue seeing tricyclic antidepressants being frequently prescribed.

Objectives

To estimate the prevalence and to assess the implementation of safety measures related to the prescription of such molecules in the elderly. To explain their choice as a first-line treatment.

Methods

We included all new patients aged 65 years or over between 1st January 2011 and 31st December 2015 whom, were prescribed an antidepressant. Recommendations of the Canadian coalition for seniors’ mental health, of the world federation of societies of biological psychiatry and of the national institute for health and care excellence were our evaluation tools. We compared tricyclic receivers to those having newer antidepressants to try to understand the choice of tricyclics as a first-line treatment.

Results

Eighty patients were included. Mean age was of 75 years. 46% were prescribed a tricyclic as a first line treatment. Depressive disorders were the most diagnosed ones (79%) followed by anxiety disorders (14%) and somatic symptom disorders (7%). An electrocardiogram was not performed to all patients prior to the initiation of the tricyclic nor at anytime later. 11% continued being prescribed tricyclics in spite of contraindications. Only a low economic level was significantly related to their choice as a first-line treatment (P = 0.001).

Conclusions

Tricyclics’ prescribing rate was high. Safety measures were not applied for all patients. Regular availability of newer antidepressants in public health structures and a better awareness of antidepressants prescribing guidelines in the elderly are mandatory.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Medical Staff's Social Representation on Elderly with Psychiatric Disorder: Impacts About the Life Project
Authors: Salime S. , Clesse C. , Prudent C. , Dumand I. , Batt M.
Published: June 2017

Today, the questioning about the life project of elderly with mental disorders seems not to be a priority of research and politics. Many studies shows that social representation of this specific population are mostly negative. They impact the place of these subjects on their social and community integration into the society. The purpose of our research work is to identify the nature of health professional's social representation involved in the accompaniment of these subjects. In that case, the authors aim to identify it impact on their life project. Consequently, the authors interviewed 715 professionals (doctors, psychologists and nurses) with the free association method of Abric. A prototypical and categorical analysis was conducted with the help of IRAMUTEQ software. Then a factorial analysis was performed in order to identify which factors could be possibly linked with some dimensions of the social representation we isolated (age, sex, profession and study level). Results shows that social representation of health professionals is really close to the social representation of the rest of population. To conclude, the authors will discuss about the influence and impact of this social representation on the decision process concerning the life project developed by the medical staff in psychiatry

Disclosure of interest

The authors have not supplied their declaration of competing interest.
I was not so
Authors: Gordillo Montaño M.J. , Ramos Perdigues S. , Guillén Guillén E. , Lopez Berastegui O. , Guisado Rico M. , Boned Torres S.V. , De Amuedo Rincon M. , Merino del Villar C. , Latorre S.
Published: June 2017

Introduction

The frontal lobes are the brain structures of latest development and evolution in the human brain. It is considered that the frontal lobes represent the “executive center of the brain”. The frontal tumors represent 16% of all supratentorial tumors. Symptoms are easily confused as psychiatric rather than neurological.

Objectives

Can see the alterations of the executive functions in a case of frontal affectation, for future cases know where to focus our attention and develop concepts associated with frontal lobe.

Method

Thirty-year-old patient without relevant medical history. Go to the emergency department with major episode of agitation. After performing cranial CT abnormality, it is detected in the front area. Sign up study. It presents amnesia episode before admission, whereupon shown stunned and worried. The patient describes a change in your life 12 months ago, when it begins to be more nervous, increasing their impulsiveness, she has episodes of binge eating, purging behavior with subsequent occasional alcohol abuse. Jealousy. The patient is informed as much as your family of the possible impact of the injury on the behavioral sphere and impulse control when it is still unknown origin.

Conclusions

From a neuropsychological point of view the frontal lobes represent a system of planning, regulation and control of psychological processes; coordination and allow selection of multiple processes and various behavioral options and strategies available to the human being. Tumour research is important as it provides enough information we cognitive impairment. These patients exhibit symptoms that are easily confused as psychiatric rather than neurological.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pregabalin Pain and Anxiety Treatment in Oncological Patient–Case Report
Authors: Popovic D. , Pavicevic D.
Published: June 2017

Severe side effects of chemotherapy during treatment of malignant disease significantly disrupt patient's mental and physical state. Seventy five-years-old female patient was treated for breast cancer by protocol (operation, radiotherapy, chemotherapy-paclitaxel (CHT-PX) every tree weeks) and for dysthymia and generalized anxiety disorder with escitalopram (ESC). Tramadol (TRA) and clonazepam (KLO) given by oncologist due to severe side effects of CHT-PX: muscle cramps, lower back pain, walking difficulties, had partial results, increased anxiety and drug abuse (TRA doses increase from 100 to 300 mg/day and KLO from 4 to 6 mg/day). Efficiency of pregabalin (PG) in pain and anxiety control during CHT-PX application. The assessment was made by 100 mm visual analogue scale (VAS), which assessed physical symptom severity and Hamilton Anxiety Rating Scale (HAMA) on the first day after CHT-PX application, on the 7th, 14th and 21th day. Effective PG dose was 300 mg/day with EST, KLO and TRA previously taken. On the first day after CHT-PX, patient rated pain level as 9 according to VAS. During TRA and KLO treatment, pain level on VAS was 6 from the 7th till 14th day after CHT-PX, on 21th day deceased to 2. HAMA score was 49. After PG augmentation, according to VAS, pain level was 3 on the 7th day and 0 on 14th day. HAMA score was 20. Tapering off the dose of TRA and KLO started till discontinuation of both medications. Pregabalin efficiency in pain and anxiety control increase compliance of oncological patient and reduce harm of drug abuse.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Disadvantage of Social Sensitivity: Interaction of Oxytocin Receptor Genotype and Child Maltreatment on Brain Structure
Authors: Dannlowski U.
Published: June 2017

Background

Oxytocin has received much attention as a pro-social and anxiolytic neuropeptide. In human studies, the G-allele of a common variant (rs53576) in the oxytocin receptor gene (OXTR) has been associated with protective properties such as reduced stress response and higher receptiveness for social support. In contrast, recent studies suggest a detrimental role of the rs53576 G-allele in the context of childhood maltreatment. To further elucidate the role of OXTR, gene by maltreatment (GxE) interactions on brain structure and function were investigated.

Methods

n = 309 healthy participants genotyped for OXTR rs53576 underwent structural as well as functional MRI during a common emotional face-matching task. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ). Gray matter volumes were investigated by means of voxel-based morphometry (VBM) across the entire brain.

Results

Structural MRI data revealed a strong interaction of rs53576 genotype and CTQ-scores, mapping specifically to the bilateral ventral striatum. GG homozygotes but not A-allele carriers showed strong gray matter reduction with increasing CTQ-scores. In turn, lower ventral striatum gray matter volumes were associated with lower reward dependence, a pro-social trait. Furthermore, the G-allele was associated with increased amygdala responsiveness to emotional facial expressions.

Conclusions

The findings suggest that the G-allele constitutes a vulnerability factor for specific alterations of limbic brain structure in individuals with adverse childhood experiences, complemented by increased limbic responsiveness to emotional interpersonal stimuli. While oxytocinergic signalling facilitates attachment and bonding in supportive social environments, this attunement for social cues may turn disadvantageous under early adverse conditions.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Health screening audit – south Barnet PCMH pilot
Authors: Rahmanian H.
Published: June 2017

Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement.

Aims

The aim of this project was to improve the physical health monitoring for patients with mental health illness. The patients group was under the care of south Barnet primary care mental health pilot (SB PCMH Pilot). SB PCMH pilot is a multidisciplinary team that includes: consultant psychiatrist mental health nurse and psychologist.

Results

Between November to December 2014, 60 patients were discharged from SB PCMHT and the electronic case notes of 38 of them who had an assessment/intervention by the service were reviewed. Results showed that 82% of the records verified that discussion and screening of physical health, smoking, drugs and alcohol had been completed. The data was discussed in team meetings with all team members. After thorough team discussions and brainstorming; the team agreed that an improvement in the process of monitoring was needed to work towards ensuring these matters are discussed with 100% patients and that this is accurately recorded. It was agreed to re-audit in 3 months.

Re-audit

A re-audit completed between January to April 2015 confirmed an improvement as 98% of patients seen for an assessment by SB PCMH pilot have had their annual health checks and appropriate health screenings discussed and recorded routinely.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The NYMPHA-MD Project: Next Generation Mobile Platforms for Health, in Mental Disorders
Authors: Faurholt-Jepsen M.
Published: June 2017

Bipolar Disorder is a common and complex mental disorder with a prevalence of 1-2% and accounts as one of the most important causes of disability at age 15-44 years worldwide.

Electronic versions of self-monitoring tools and symptom registration using computers, personal digital assistants (PDAs), text messages, and web interfaces have been described in the literature and a large number of commercial Smartphone applications for patients with bipolar disorder are available.

The Next Generation Mobile Platforms for Health, in Mental Disorders project (the NYMPHA-MD project), funded by the European Union's Seventh Framework program for research, technological development and demonstration, focuses on the implementation of a Pre-Commercial Procurement of mobile e-health service for supporting physicians and patients in the treatment of bipolar disorder through continuous patients monitoring in order to dynamically support illness management and potentially identify early warning signs.

The NYMPHA-MD project will define the framework of a Pre-Commercial Procurement for the provisioning of next generation services advocated for mental health treatment with a special focus on bipolar disorder based on the use of new technologies, open standards and open platforms.

The NYMPHA-MD project will focus on identifying requirements involved in the structuring of mental health services with a focus on bipolar disorder treatment including medical, technological, patients, legal, ethical, policy, risk management and business-orientation needs in order to construct a reference model of service provisioning useful in different European contexts.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Cognitive emotional regulation in Romanian general medicine students
Authors: Romosan R.S. , Romosan A.M. , Enatescu V.R. , Papava I. , Giurgi-Oncu C.
Published: June 2017

Introduction

During medical school, students experience significant amounts of stress. Since certain emotion regulatory strategies are known to be maladaptive, the way in which students are capable to regulate their emotions becomes very important, because it can affect their physical and mental welfare.

Objectives

The purpose of this study was to assess cognitive emotion regulation strategies in Romanian general medicine (GM) students.

Methods

The study was conducted between 2015–2016 on 86 sixth-year Romanian GM undergraduates from the Timisoara “Victor Babes” university of medicine and pharmacy. In order to identify the cognitive emotion regulation strategies (or cognitive coping strategies) that students use after experiencing negative situations or life events we used the Romanian version of the cognitive emotion regulation questionnaire (CERQ).

Results

The sample consisted of 30 (34.9%) males and 56 (65.1%) females, with ages ranging between 24 and 31 years (mean age = 24.97 years, SD = 1.74). Compared to female students, males obtained significantly lower mean scores in “umination” (t = -2.84, P = 0.005, 95% CI = -1.64; -0.29), “positive refocusing” (t = -2.09, P = 0.037, 95% CI = -1.42; -0.04) and “catastrophizing” (t = -3.17, P = 0.002, 95% CI = -1.31; -0.3). Both male and female GM students had significantly higher mean scores in “blaming others” than their respectively gender-related general population.

Conclusions

Results of this study suggest that GM students, when facing stressful or negative events, are more inclined in using “blaming others” as a coping strategy. Female students seem to be more inclined than males to use “rumination”, “catastrophizing” and “positive refocusing” as cognitive coping mechanisms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Neuroacanthocytosis syndromes and neuropsychiatry symptoms associated
Authors: Saiz Garcia H. , Montes Reula L. , Portilla Fernandez A. , Pereira Sanchez V. , Lopez N. Olmo , Heredero E. Mancha , Enriquez A.S. Rosero
Published: June 2017

Introduction

Neuroacanthocytosis is an infrequent cause of both neurological and psychiatric manifestations, and acanthocytes, which are a special form of spiculated red blood cells. Clinically significant psychopathology, ranging from behavioural disturbance to frank psychiatric illness, has been reported to occur in up to 60% of ChAc patients.

Methods

A review was conducted aiming to clarify the physiopathology of this illness and its clinical features in order to distinguish neuroacanthocytosis from other neurological or psychiatric diseases. The literature search was conducted in PubMed data reviewing articles dating between 2010 and 2016.

Results

– Neuroacanthocytosis autosomal recessive disorder associated with mutations or deletions in the VPS13A gene on chromosome 9q, which codes for the membrane protein chorein. Chorein is strongly expressed in the brain. Chorein loss particularly affects the basal ganglia, especially the caudate nucleus and putamen;

– Dysexecutive syndromes, OCD, depression and possibly psychosis, which may precede the frank motor and cognitive impairment;

– The most recently developed treatment for neuroacanthocytoses is the use of deep-brain stimulation (DBS), with stimulation of the globus pallidus internus.

Conclusions

While conducting a neurological exam, secondary causes of psychosis have to be included in the differential diagnosis. It is important to notice the possible confusion between tardive dyskinesia and a primary movement disorder. It should be necessary to investigate all de novo movement disorders in psychotic patients in order to eliminate etiologies other than iatrogenic ones.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Magnitude of resource and reputational concern impact generosity and deception in children
Authors: Shayesteh Far M.
Published: June 2017

Introduction

In a bargaining process, there are factors impacting the outcome (i.e. gain versus loss). Of the important factors is the informational asymmetries between bargainers which could provide a more powerful position for whom has information that the other partner has not as well as magnitude of resource.

Objectives

Thus, in a modified two-round, 4 trials (different magnitudes) bargaining paradigm, we investigated deception in children when there is no chance of deception revelation (first round) and when there is a chance of deception revelation (second round).

Methods

One hundred and forty one healthy schoolchildren (90 boys and 51 girls) between age of 7 and 12 participated in the current study. We designed a modified version of the bargaining paradigm based on the experimental design by members of the junior faculty workshop in the conflict management division at the 1995 academy of management meetings in Vancouver, BC. Variables included earning amount, deception frequency, real generosity and pretend generosity.

Results

Using paired-samples T-test we showed that there were significant differences between two rounds in earning amount, deception frequency and real generosity. We administered separate one-way ANOVA with repeated measure on 4 different conditions (bank amounts. We found that, the main effect of condition was significant for real generosity (in both round), for pretend generosity (in first round) and for deception amount (in both round).

Conclusions

We found that revelation (reputation concerns) decreases deception and increases generosity. Moreover, lesser magnitudes increase generosity and decrease deception and vice versa.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Personality and Defence Mechanisms in Takotsubo Cardiomyopathy
Authors: Ferrara R. , Renda N.
Published: June 2017

Introduction

Takotsubo cardiomyopathy (TC) is an acute cardiologic syndrome, characterized by specific symptoms and ECG, echocardiographic and enzymatic abnormalities, similar to an acute myocardial infarction, with no hemodynamically significant stenosis at coronary-ventriculography.

Objective

To assess personality in TC patients in order to find common psychopathological elements.

Methods

A series of consecutive patients suffering from TC hospitalized at the Cardiology Unit of “Ingrassia” Hospital in Palermo in 2013–2014, were included in the study. We used Structured Clinical Interview for Axis I and II, according to DSM-IV TR criteria. Further, the Defense Mechanisms Inventory (DMI), used in order to explore defensive strategies: turning against self (TAS), projection (PRO), principalization (PRN), turning against object (TAO), and reversal (REV).

Results

Eight women (mean age + SD: 57 ± 5 years) have been included in the study. A common element of them was a stressful event immediately preceding the onset of TC, in particular bereavement (4), armed robbery (1), infarction of a family member (1), estrangement of a family member (1), and separation from a partner (1). Although the patients did not fulfill any diagnostic criteria for Axis I or Axis II disorders of DSM-IV-TR, they showed scores at the SCID-II close to the limit values for avoidant and dependent personality .DMI showed, unequivocally, the common use of TAS-type defence style.

Conclusions

Although the sample size was too small for complex statistical analyses, nevertheless our initial findings would indicate the presence of a common, defensive style in TC patients, and how this syndrome may be related to stressful life events.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Shame and Guilt Inducing Drugs
Authors: DiPetta G.
Published: June 2017

The Author in this presentation examines the role of two complex human experiences, the Guilt and the Shame, in the field of the substances addiction. The population of abuser can be divided between users of sedatives and users of stimulants. Sedative drugs and stimulant drug belong to two different way of being-in-the-world. Sedative drugs are able to medicate the internal pain, which is constitutive of the guilt. Stimulant drugs are able to medicate the dysphoria, which is constitutive of the shame. In the realm of psychopathology Tellenbach with the concept of premelancholic personality in the guilty man and Kohut with the concept of narcissism in the tragic man have put the bases for a different typification. In both cases, the common final result, from a psychopathological point of view, is a severe crisis of the temporalization.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Goodbye Eros. Hello Narciso
Authors: Hernandez Anton R. , Gomez Sanchez S. , Alvarez Astorga A. , Cepedello Perez S. , Rybak Koite E. , Garcia Cantalapiedra M.J. , Rodriguez Andres L. , Segura Rodriguez A.I. , Uribe L.D.C. , Isidro Garcia G.
Published: June 2017

Introduction

Love has been one of the topics most discussed by philosophy, literature, anthropology, religion, psychology and medicine. “The feelings of love and hate are present in the background of all psychiatric disorders; love has been associated, in one way or another, in all patients that I have had” Dr. Perez Lanzac Trujillo.

Objectives

(1) Analyze the possible relationship between psychotic symptoms and breakup (stressor). (2) Review the neurotransmitters involved in psychotic episodes and in love. (3) Postmodern culture and sexuality (agony of Eros and liquid love).

Methodology

A 17-years-old female patient, who presented psychotic symptoms without psychiatric history. We hypothesize that the affair was the symptom and the stressful event was the breakup. We believe that early bond with the mother is a decisive factor in shaping the psychic structure of every human being factor. In this case, it seems that there is an insecure attachment: absent parent + overprotective mother.

True love draws three triangles: records (demand, drive and desire); dimensions (beliefs, significant and encounter) and emotions (pride, hope and desire).

Results

Most psychiatric disorders are especially alterations in the way of experiencing emotions. Some neurotransmitters involved in her psychosis and addiction are key players in the neurobiology of love.

Conclusions

True love is the neurotic experience closer to psychosis.

Overexcitement in today's society is a trauma for the psychic apparatus and it has consequences on the internal world, psychosexuality and loving bond.

The crisis of art and literature can be attributed to the disappearance of the other, to the agony of Eros.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pieces of Me: A Story of Trauma and Dissociation
Authors: Garcia Ayala L. , Gómez Revuelta M. , Martin Requena C. , Juncal Ruiz M. , Porta Olivares O. , García de Acilu E. Saez de Adana , Aranzabal Itoiz A. , González Hernández B. , Laborde Zufiaurre M. , Zubia Martín M. , Núñez Morales N. , López Peña M.P. , González-Pinto Arrillaga A.M.
Published: June 2017

Introduction

Traumatic event related disorders (ASD, PTSD and dissociative disorders) could share a common dissociative psychobiological origin. Patients diagnosed with dissociative identity disorder present a high sexual abuse rate (85–90%), way above the rest of the traumatic spectrum disorders.

Objectives

The goal of this study is to analyse the existing relation between different types of trauma, especially sexual abuse, and the onset and continuity of dissociative disorders.

Materials and methods

We report the case of a 37 years old woman with a long sexual abuse history. The symptoms appear by age 30, in the form of flashbacks, ushering a persistent identity fragmentation in individual differentiated opposed components, shaping a dissociative personality disorder, which was present for years taking a fluctuating and invalidating nature.

Discussion

When a traumatic event occurs, acute dissociative reactions frequently appear, usually briefly, disappearing spontaneously afterwards. In this case, we can discern the persistence of the dissociative symptoms and the repercussion they had in the patient's functionality.

Conclusion

The existence of a correlation between the duration of a chronic traumatic event and the persistence of dissociative symptoms in the evolution of a dissociative personality disorder is possible.

Disclosure of interest

The authors have not supplied their declaration of competing interest.