bluuebunny/crossref_metadata_2025 huggingface dataset:
Bipolar spectrum – A helpful concept?
Authors: Cabral Barata P. , Melo J.C. , Maia T.
Published: June 2017

Introduction

Many patients seen in clinical practice have a mood disorder not well described by the existing diagnostic categories. Formally, they would be called “not otherwise specified” but this creates a huge single category for many patients that belies the richness and complexity of their symptoms.

Objectives

Review the existing information regarding the bipolar spectrum concept and reflect about its importance and utility.

Methods

Nonsystematic review of the literature – scientific publications from Pubmed and Psychiatry Textbooks.

Results

The “bipolar spectrum disorder”, designating those patients who fall in the middle of the mood spectrum between the classic unipolar and type I bipolar extremes, would represent recurrent severe depression, but with a family history of bipolar disorder or antidepressant-induced mania or a number of other features of bipolarity in addiction to depressive symptoms, course, or treatment response. The presence of hyperthymic or cyclothymic mood temperaments has also been suggested as part of this bipolar spectrum concept. Several arguments can be found supporting the existence of this spectrum. A validated bipolar spectrum concept will allow a decrease in the diagnostic underestimation of bipolar disease and a more differentiated investigation and treatment model. Bipolar spectrum concepts will help identify those patients to whom antidepressants are not the best therapeutic approach, in relation to mood stabilizers and/or neuroleptics.

Discussion

The bipolar spectrum concept has considerable supporting evidence and utility, theoretical as well as practical. Its development and diagnostic acceptance shall allow new discriminated investigation and better patient outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Safety and efficacy of sildenafil citrate in treating erectile dysfunction in patients with combat-related post-traumatic stress disorder: A double-blind, randomized and placebo-controlled study
Authors: Safarinejad M.R.
Published: June 2017

To evaluate the safety and efficacy of sildenafil citrate for treating erectile dysfunction (ED) in patients with combat related post-traumatic stress disorder (PTSD).

Patients and methods

In all, 266 combat-exposed war veterans with ED (aged 37–59 years) were recruited. They met the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for PTSD according to the Structured Clinical Interview for Patients, Investigator Version. The patients were also evaluated with the Clinician-Administered PTSD Scale, both to establish the diagnosis of PTSD and to measure symptom severity. Only patients with psychogenic ED were included in the study. The patients were randomly divided into a group of 133 who received 100 mg of on-demand sildenafil 0.75–2 h before sexual stimulation, and 133 who received placebo. Patients were asked to use ≥ 16 doses or attempts at home.

Results

Sildenafil did not produce significantly and substantially greater improvement than placebo in each of the primary and secondary outcome measures (P = 0.08). A normal EF domain score (≥ 26) at endpoint was reported by 13 (9.8%), and 11 (8.3%) of patients on the sildenafil and placebo regimens, respectively (P = 0.09). Patients treated with sildenafil had no statistically significantly greater improvement in the five sexual function domains of the IIEF questionnaire than those treated with placebo (P = 0.08). The incidences of treatment-emergent adverse events were significantly greater in the sildenafil arm than in the placebo group (P = 0.01).

Conclusions

Sildenafil is no better than placebo in treating PTSD-emergent ED.

Disclosure of interest

The author has not supplied his declaration of competing interest.
QTc Interval in psychiatric inpatients: A retrospective study
Authors: Brondino N. , Fusar-Poli L. , Rocchetti M. , Besozzi M. , Mori A. , Fasoli F. , Politi P.
Published: June 2017

Introduction

Several psychotropic medications (i.e. antipsychotics, antidepressant) have been recently associated with QTc prolongation. Despite literature data report only mild prolongation of QTc following the use of antidepressants or typical antipsychotics, post-marketing studies have clearly evidenced an increased risk of QTc prolongation and potentially lethal arrhythmias (i.e. torsade de pointes) in psychiatric patients.

Objectives

We aimed to evaluate the prevalence of prolonged QTc and to identify potential predictors influencing QTc in a psychiatric inpatient population.

Methods

Medical records of 200 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.

Results

Prevalence of prolonged QTc at admission was very low (0.1%). No significant differences in QTc interval were observed between patients taking or not antipsychotics (P = 0.66), mood stabilizers (P = 0.36), or antidepressants (P = 0.07). A statistically significant difference was observed between patients on depot formulation and patients who were taking oral antipsychotic (P = 0.02). However, the pharmaceutical class of the medications appeared not significant.

Conclusions

We observed a very low rate of QTc prolongation in psychiatric inpatients at admission. Surprisingly we did not find a significant effect of specific medications; however, in our sample intramuscular formulation was associated with lower QTc interval.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Patients with mood disorders and chronic coronary artery disease receiving conservative therapy have a higher risk of death during affective episode
Authors: Lebedeva E.V. , Schastnyy E.D. , Simutkin G.G. , Sergienko T.N. , Nonka T.G. , Repin A.N.
Published: June 2017

The contribution of comorbid with coronary artery disease (CAD) mood disorders (MD) into total mortality is contradictory.

Objective

To study frequency and time until death due to general causes in groups of patients with comorbid MD, and without them as well as interrelationship of these indicators with comorbid MD and therapy with antidepressants.

Methods

Inpatients with chronic CAD (n = 333) under conservative therapy were investigated (31% females (n = 103), 69% males (n = 230), mean age 61.8 ± 9.8 years). Team of cardiologists and psychiatrists followed up patients for 7 years (2008–2014). Survival frequency was evaluated by method of life tables.

Results

Among patients under conservative therapy of CAD the death frequency due to general causes did not differ significantly in presence (n = 80) and absence of MD (n = 253) and was 18.8% and 16.6%, respectively. Correlation of deaths with hypomanic and mixed episodes was revealed (rs = 0.3). The groups differed according to function of immediate risks: patients with MD were at high risk of death during the year after detection of affective symptoms, and in group without MD it increased over the time of observation (Р = 0.0000).

Duration of antidepressant therapy was 5.5 ± 0.5 months. Among patients receiving antidepressants (n = 20), during therapy and after one month after discontinuation there were not deaths. Difference of function of immediate risks in these subgroups was not significant (Р = 0.09).

Conclusions

Patients with affective disorders and chronic CAD under conservative therapy are at high risk of death within affective episode and therapy with antidepressants did not influence change of risk of death.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Tobacco treatment of indigent patients alcoholics rehabilitation in the Association Rauxa
Authors: Marín Puig M.L. , Marín Dra. ML. , Rodríguez D. , Calvo JM. , Acero MJ.
Published: June 2017

Introduction

Smoking is the leading preventable cause of morbidity and mortality in the world and the leading cause of death in alcoholics. The prevalence of smoking among alcohol addicts is very high as among homeless people. Both groups have a higher risk of smoking-related illnesses. It seems that quitting smoking increases the rate of alcohol abstinence. It is therefore crucial to perform treatment of tobacco dependence among this population.

Material and method

Population: homeless alcoholic patients in treatment at the Association Rauxa with dependence criteria DSM-IV-TR and DSM-V, male, over 18 years. Anamnesis, examination, analysis, chest X-ray, addictive history is practiced. Patients are encouraged to start smoking treatment. Once the decision is made.

Tests: motivation, Fagerstrom, fasting weight; weekly and random monitoring of CO in exhaled air. Treatment with decreasing nicotine patches. Weekly smoking therapies. Withdrawal symptoms and relapse, timely or complete, if it occurs, are evaluated. Treatment ends in one year without relapse.

Results

n = 237(2006:n = 19; 2007:n = 26; 2008:n = 24; 2009:n = 33; 2010:n = 31; 2011:n = 25; 2012:n = 33; 2013:n = 25 y 2014:n = 21)

Get high on2006:10/19 (53%); 2007:14/26(54%); 2008:13/24 (54%); 2009:9/33 (27%); 2010:6/31 (19%); 2011:2/25 (8%); 2012:8/33(24%); 2013:9/25 (36%); 2014:11/21 (52%). In 9 years, 82/237 (35%) finishes treatment without relapse.

Discussion

A percentage of 35% is obtained discharge. Different parameters-relapse are correlated to see predictors of relapse.

No correlation is found statistically significant.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Interdisciplinary approach in patients with severe mental disorders
Authors: Garnica V. Martí , Garcia M.D. Ortega , Bernal M.A. Lopez , leon J.R. Russo De , Garcia S. Marin
Published: June 2017

Through the analysis of a case report to analyse the importance of the interdisciplinary approach in people suffering from severe mental disorders for management of an outpatient.

The diagnosis was clear, I wanted to rule out organic pathology was added due to the irregularity in the outpatient monitoring and control (F20. Paranoid schizophrenia)

Community intervention with people suffering from severe mental disorders has some peculiarities. The “in vivo” treatment requires the establishment of the frame, in a space that is constantly changing. It consists of the setting-up of a new working area. Social and community intervention is inter-institutional; include movement between different institutions (health, socio-economic and community). In this new changeable and dynamic, “working area”, the professional is of professional is essential using clinical strategies and social and community coordinating. It is important to highlight the role of community treatment for severe mental disorder. Thus developing social skills is as necessary and also combats social stigma and prejudice to achieve a social integration in community.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Rehabilitation program: Results of a clinic in Lisbon
Authors: Prata-Ribeiro H. , Hanneman S. , Ana C.
Published: June 2017

Introduction

Modern psychiatry includes within its purposes to reintegrate patients into society. Our work's goal is to evaluate in terms of outcome, the current status of patients that underwent the rehabilitation program in a clinic in Centro Hospitalar Psiquiátrio de lisboa, in Lisbon.

Methods

The methods consisted of retrospective evaluation of the sample of patients that successfully completed the rehabilitation program between 2012 and 2015. Gender, age, provenience, previous and current socio-economic situations were taken into account.

Discussion

Twelve patients concluded the program in the timeframe studied: 64 % males and 36 % between the ages of 36 and 40 and more than half were in homelessness situations. They progressed in increasing levels of autonomy and by the program's end, ten were dismissed and two were still waiting for housing. Ten of the patients are now living with their families or have been integrated in social housing program. Two await conditions to leave the hospital.

Conclusion

The program had a positive impact on the life of all patients that have engaged in it. Only two remain waiting social housing responses. Although the results are satisfactory, the number of patients admitted must improve in coming years.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A Clinical review about differential diagnosis and comorbidities on premenstrual dysphoric disorder
Authors: Sánchez Blanco L. , Juncal Ruíz M. , Santayana Jenaro G. Pardo de , Landera Rodríguez R. , Gómez Revuelta M. , Porta Olivares O. , Núñez Morales N.I.
Published: June 2017

Introduction

Symptoms of premenstrual dysphoric disorder (PMDD) recur during the premenstrual phase of the cycle and disappear to the beginning or after last menstruation. The main symptoms are emotional liability, dysphoria and anxiety.

Objectives

To review PMDD for helping in the differential diagnosis between this disease and classical anxiety disorders.

Methods

It was made a clinical review about differential diagnosis and comorbilities on PMDD in specialized literature and Pub-Med.

Results

PMDD causes significant distress and impairment in social or occupational functioning the first week following menstruation. In relation with differential diagnosis on PMDD, on the one hand, several organic diseases could produce the same symptoms than PMDD: for example gynecological pathology as dysmenorrhea or menopausal transition, endocrinological diseases as hypothyroidism and hyperthyroidism and some hormonal treatment including hormonal contraceptives. In addition, a variety of medical disorders are concomitant pathologies that could be associated with PMDD (eg, migraine; epilepsy, asthma, allergies, systemic exertion intolerance disease, chronic fatigue syndrome; irritable bowel syndrome). These pathologies are exacerbated just before or during menstruation. On the other hand, several psychiatric disorders as bipolar disorder, major depression, dystimia, and anxiety disorders could get worse on the premenstrual phase.

Conclusions

In relation with the diagnosis of PMDD, it seems necessary to consider various differential diagnosis such as psychiatric, gynecological and endocrine disorders because of all of them share like symptoms. For this purpose it is very important to make both a good clinical history and a comprehensive physical examination to offer the most accurate diagnosis and treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of type D personality on the quality of life and on microangiopathic and macroangiopathic complications in outpatients with type 2 diabetes mellitus
Authors: Enatescu V.R. , Papava I. , Romosan R.S. , Grozavu A. , Enatescu V. , Enatescu I. , Diaconu L.
Published: June 2017

Introduction

In 2015, the worldwide point prevalence for diabetes mellitus was 8.8%. Type D personality was found as being more prevalent in type 2 diabetes than in the general population.

Objectives

We aimed to reveal the frequency of type D personality and to analyze the impact of type D personality on both quality of life and angiopathic complications, in patients with type 2 diabetes from our region.

Methods

A cross-sectional research was performed on 79 outpatients that were monitored for diabetes mellitus at Timisoara diabetes, nutrition and metabolic diseases clinic. Type D personality was assessed with the DS-14 scale. Quality of life was quantified by using the Q-LES-Q-SF scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). The angiopathic complications were abstracted from medical records.

Results

Type D personality was present in 38 subjects with diabetes mellitus (48.10%). Compared to those without type D personality, patients with type D personality and diabetes had significant lower mean scores for the following domains of the Q-LES-Q-SF scale: social relationships (P < 0.001), daily life function (P = 0.027), sexual activity (P = 0.005), to get around physically (P < 0.001), work or hobbies (P = 0.008) and raw score (P = 0.003). Type D personality did not make any difference regarding micro and macroangiopathic complications of type 2 diabetes patients.

Conclusions

Type D personality, a highly frequent entity, did not make the difference with respect to diabetic complications; however, it may interfere significantly with several facets of the quality of life of these patients. These results should be taken into account for an interdisciplinary approach to these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The role of alexithymia in non-psychotic mental disorders’ development in patients with primary hypothyroidism
Authors: Pityk O. , Pityk M. , Kuzhda I.
Published: June 2017

In the formation of non-psychotic psychiatric disorders in patients with thyroid pathologies are important neurohumoral mechanisms, and one reason is psychosomatic relationships. The modern concept of relationships includes alexithymia model. The situation of chronic physical illness is regarded by many authors as one that provokes a crisis of mental development (and in fact, identity crisis) and therefore is a traumatic situation, that is a risk factor for the development of mental disorder. The aim of the study was to investigate the alexithymia level in patients with primary hypothyroidism. We used Toronto Alexithymia scale proposed by Taylor G. 50 patients with hypofunction of the thyroid gland were investigated. In a study of 42 patients (84%) had a rate alexithymia more than 74 points, 12% of patients were classified as areas of uncertainty and only 4% of patients according to the method proved non-alexithymic. It was found that patients with an uncertain alexithymia level had difficulties in describing their inner feelings, did not give much attention to the absence of well-being in the emotional sphere, believed that painful symptoms of mental health problems are caused by only thyroid pathologies, even during sighting surveys ignored the presence of emotional stress and conflict experiences that showed a reduced capacity for understanding and expressing their own feelings, low emotional resonance. Thus, psychotherapeutic and psycho-corrective work with such patients should take into consideration alexithymia radical in the personal structure of such patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ethical predicaments in decisional capacity evaluations
Authors: Raai H. , Mateoc A.
Published: June 2017

Introduction

Facing a growing number of capacity evaluation requests in the general hospital, physicians increasingly encounter ethical issues and dilemmas that drive them to seek unnecessary psychiatric consultations. This practice raises the expectation that the consultant psychiatrist would be, somehow, the ethicist on board whose role is to bring the most moral solution to their predicament.

Aims

Literature review and discussion about ethical questions facing decisional capacity evaluation.

Methods

Clinical and literature reviews.

Results

(Case report) This poster presents the case of 92-year-old woman who lives alone with no family support who was brought to the emergency room due to a fall. Consequently, she was diagnosed with small cell lung carcinoma. Instead of the proposed short term rehab to receive radiotherapy, the patient insisted that she be discharged to her home. The psychosomatic team was consulted to evaluate the patient's capacity to make a decision regarding this form of treatment. The psychiatrist who evaluated the patient felt that she lacks capacity. However, palliative care felt strongly that patient's capacity should not be challenged, arguing that she has been living independently, doing well, and is agreeing to treatment.

Conclusion

We will review the most updated guidelines on how to perform a capacity evaluation, how these guidelines are incorporated in residency curriculums, and whether residents from various specialties are being trained on evaluating decisional capacity. We will also explore optimal ways to educate primary care physicians on how to evaluate decisional capacity and when to seek psychiatrists’ expertise for these evaluations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The unnoticed interictal disphoric disorder
Authors: Ramos-Perdigues S. , Bailés E. , Mané A. , Pintor L.
Published: June 2017

Introduction

Psychiatric morbidity in refractory epilepsy is frequent and has a negative influence on quality of life. Treatment-refractory epileptic patients are at higher risk of developing psychiatric disturbances. The interictal dysphoric disorder (IDD) has been described as a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy. It is characterized by 3/8 symptoms: depressive mood, anergia, pain, insomnia, fear, anxiety, irritability, and euphoric mood.

Objectives

To provide evidence that psychiatric morbidity is high in refractory epilepsy and to describe associations to IDD.

Aims

The present study aims to show that there are typical psychiatric conditions in epilepsy that can be unnoticed.

Methods

We cross-sectional analyzed the psychopathologic outcomes of patients with refractory epilepsy. The assessments methods included SCID for DSM-IV and clinical interview for epileptic specific psychiatric conditions.

Results

The sample consists of 153 patients, with a mean age of 37. A total of 42.5% were males. One or more Axis I diagnoses was seen in 38% of the patients. The most common condition was IDD (27.1%), followed by affective and anxiety disorders (22 and 15.3% respectively). Considering patients with IDD, we found differences in locus (P = 0.001) (present in 34.3% of non-stablished locus, 8.6% of extra-temporal locus and 57.1% of temporal locus) but not with hemisphere, sex, type of crises, treatment. We neither found correlation with age, number of crisis or number of treatments.

Conclusions

Psychiatric comorbidities as IDD do not appear in the DSM-IV but are prevalent and could be related with temporal locus.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Culture and mental disorders
Authors: Adrián A. , Canga C. Noval , Rebeca H. , Isabel S. , Sofía G. , Lara R. , Marta G. , Aldara Á. , Pilar D.V.
Published: June 2017

Objectives

Show with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.

Methods and materials

Seventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.

Conclusion

Whenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Relationship between pain-coping strategies, catastrophizing to pain and severity of depression
Authors: Batinic B. , Nesvanulica J. , Stankovic I.
Published: June 2017

Introduction

Studies have shown that somatic pain influences the severity of major depressive disorder (MDD), and could be moderated through pain coping strategies and not catastrophizing to pain.

Objectives

The aim of the study was to ascertain the correlation between pain coping strategies, catastrophizing to pain and severity of depression.

Methods

The study sample consisted of 82 patients diagnosed with MDD, aged between 18 and 65 years old (M = 46.21). Assessment instruments included The Beck Depression Inventory-II (BDI-II), The Brief Pain Inventory-Short Form-BPISF (consisting of two subscales: BPI1-intensity of pain, and BPI2-interference with daily functioning), The Vanderbilt Pain Management Inventory-VPMI (consisting of active-VPMIAC and passive pain coping mechanism subscales-VPMIPC) and The Pain Catastrophizing Scale-PCS (consisting of subscales of rumination, exaggeration and helplessness).

Results

The average BDI-II score was 27.21 (SD = 11.53); the average score at BPI1 was 2.99 (SD = 2.83) and 3.35 (SD = 3.26) at BPI2; the average scores on the active coping mechanism subscale was 20.72 (SD = 4.87), and on the passive coping mechanism subscale 34.05 (SD = 7.86); the average catastrophizing scale score was 28.78 (SD = 10.72). Active mechanism of pain coping has shown significant negative correlation with depression (r = –0.227, P > 0.05) while passive mechanism of pain coping has shown significant positive correlation with depression (r = 0.269, P > 0.05). Intensity of depression was significantly positively correlated with intensity of catastrophizing to pain (r = 0.358, P > 0.01) and its derivatives: rumination, exaggeration and helplessness.

Conclusion

Interventions focusing on targeting catastrophizing to pain and pain coping mechanisms should be considered in the treatment of patients with MDD with somatic pain.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Depressive symptomatology and language perception in young women
Authors: Giannouli V. , Syrmos N.
Published: June 2017

Introduction

Depression may have numerous effects on cognition. A little investigated topic is the perception of the grammatical gender.

Objective

The aim of this study is to examine whether there is a different understanding of grammatical gender in Greek-speaking young women with and without depressive symptomatology regarding names of cars that are female or neutral according to the modern Greek language.

Method

Two-hundred fourteen women from Greece (Mean age = 19.59, SD age = 3.60, 18 min–50 max) were examined with the ZUNG Self Rating Depression Scale and a language test that comprised of 38 names of car brands, which were characterized in linguistics either as female or neutral. Half of women scored high in the ZUNG Depression scale.

Results

Results indicated that overall there are no statistically significant differences between women with or without depression in their gender perception of the words (P > .005). In addition to that, there are no statistically significant differences between the names of car brands that are related to large size cars and/or expensive car models.

Conclusions

This research suggests that although there is a tendency to consider the existence of depressive symptomatology as detrimental on cognition, this does not seem to hold true for the perception of the gender of the words as examined by linguistics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Reduced latency to first antidepressant treatment in Italian patients with a more recent onset of major depressive disorder
Authors: Grancini B. , Dell’Osso B. , Cremaschi L. , De Cagna F. , Benatti B. , Camuri G. , Arici C. , Dobrea C. , Oldani L. , Palazzo M.C. , Vismara M. , Altamura A.C.
Published: June 2017

Introduction

Major depressive disorder (MDD) is a prevalent burdensome disease, which frequently remains untreated. The duration of untreated illness (DUI) is modifiable parameter and a valid predictor of outcome. Previous investigation in patients with MDD revealed a DUI of different years, while recent reports have documented a reduction of DUI across time, in patients with different psychiatric disorders.

Objectives/aims

The present study was aimed to investigate potential differences in terms of DUI and related variables in patients with MDD across time.

Methods

An overall sample of 188 patients with MDD was divided in two subgroups on the basis of their epoch of onset (onset before and after year 2000). DUI and other onset-related variables were assessed through a specific questionnaire and compared between the two subgroups.

Results

The whole sample showed a mean DUI of approximately 4.5 years, with a lower value in patients with more recent onset compared to the other subgroup (27.1 ± 42.6 vs. 75.8 ± 105.2 months, P < .05). Moreover, patients with onset after 2000 reported higher rates of onset-related stressful events and lower ones for benzodiazepines prescription (65% vs. 81%; P = 0.02; 47% vs. 30%; P = 0.02).

Conclusions

The comparison of groups with different epochs of onset showed a significant reduction in terms of DUI and benzodiazepines prescription, and a higher rate of onset-related stressful events in patients with a more recent onset. Reported findings are of epidemiologic and clinical relevance in order to evaluate progress and developments in the diagnostic and therapeutic pathways of MDD in Italian and other countries.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Cerebral correlates of emotional interference processing in the elderly with subthreshold depression: A functional fMRI study
Authors: Li J. , Zhou H.
Published: June 2017

Introduction

Compared to healthy controls, adults with major depressive disorder (MDD) showed stronger activation in dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) in resolving emotional conflict. Whether subthreshold depression (StD) at an advanced age is also accompanied by similar changes in brain activation in coping with emotional conflict remained unknown.

Objectives

By using face-word Stroop task, the current study explored the neural correlates of emotional interference processing in old adults with StD.

Methods

Participants were 19 community-dwelling older adults with StD assessed by the Center for Epidemiologic Studies Depression scale (CES-D) scores. We collected magnetic resonance images of their brain compared to images of 18 healthy aged-matched adults. We used SPM to analyze differences in brain activations in emotional interference processing between the two groups.

Results

Results showed that elderly individuals with StD have stronger activation in DLPFC, ACC, default mode network (DMN) and visual extrastriate cortex compared to healthy controls. Furthermore, the brain activations of the DLPFC, DMN and visual extrastriate cortex were significantly associated with participants’ behavioral interference effect in StD.

Conclusions

Stronger brain activation in DLPFC, ACC, DMN and extrastriate cortex in old adults with StD suggests that the working efficiency of their brain is quite low and their cognitive control is impaired to some extent.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Comparison between patients with depressive disorders and healthy controls in resilience and coping skills
Authors: Molino C. , Camera P. , Girardi L. , Gattoni E. , Feggi A. , Gramaglia C.M. , Zeppegno P.
Published: June 2017

Introduction

Resilience in the psychiatric field, it is defined as the ability to recover from perceived adverse or changing situations through a dynamic process of adaptation. This process is influenced by personal characteristics, family and social resources and is expressed by positive coping skills. It is well known that resilience has an inverse relation with depression, however, the specific role of resilience in disorders like depression, personality disorders and psychosis is not fully understood.

Objectives

Compare differences in resilience and coping skills in a sample of patients with depressive disorder in acute phase versus healthy controls.

Methods

We are conducting a cohort study to the date we recruited 82 inpatients admitted in our psychiatric ward. The data have been gathered from the 1st December 2014 and they will continue to be collected until the 1st December 2016, the healthy controls are represented by 67 subjects with similar socio-demographic features.

Inclusion criteria are: diagnosis of depressive disorders or dysthymia according to DSM-IV-TR diagnostic criteria, age > 18 years, proper understanding of Italian language, willingness to give written informed consent. We compared them with healthy controls with similar socio-demographic features.

Patients’ assessment includes the following tests:

– Resilience Scale for Adults (RSA);

– Brief-COPE Scale (Brief-COPE);

– Statistical analysis will be performed using SPSS for Windows, 21.0 (Armonk, NY: IBM Corporation).

Results

Data collection is still ongoing.

Conclusions

From a preliminary analysis of data, we assume that the levels of resilience and coping of our patients is reduced compared with controls, however the recruitment during the acute phase could significantly influence final results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The impact of depression on the human personality
Authors: Petrović M.
Published: June 2017

Depression is a common experience. We have all felt “depressed” about a friend's cold shoulder, misunderstandings in our marriage, tussles with teenage children, sometimes we feel “down” for no reason at all. However, depression can become an illness when:

– the mood state is severe;

– it lasts for 2 weeks or more and;

– it interferes with our ability to function at home or at work.

Signs of a depression includes:

– lowered self-esteem (or self-worth);

– change in sleep patterns, that is, insomnia or broken sleep;

– changes in appetite or weight;

– less ability to control emotions such as pessimism, anger, guilt, irritability and anxiety;

– varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses;

– reduces capacity to experience pleasure: you cannot enjoy what's happening now, nor look forward to anything with pleasure;

– hobbies and interests drop off;

– reduces pain tolerance: you are less able to tolerate aches and pains and may have a host of new ailments;

– changes sex drive: absent or reduced;

– poor concentration and memory: some people are so impaired that they think that they are becoming demented;

– reduces motivation; it does not seem worth the effort to do anything, things seem meaningless;

– lowers energy levels.

At the Institute, we believe that personality and temperament contribute to depression, particularly non-melancholic depression. Certain personality types are more at risk of developing depression than others.

Generally speaking, someone who is depressed would: have a low mood, be pessimistic, have lowered self-esteem and feel hopeless and helpless.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Cognitive symptoms in mayor depression: A study with vortioxetina
Authors: Porta Olivares O. , Juncal Ruiz M. , Fernández Abascal Puente B. , Gómez Revuelta M. , Pérez Herrera M. , Santayana Jenaro G. Pardo de , Sánchez Blanco L. , Pérez Santos A.B. , Revillas Almajano F. Arnaiz de las , Martín Gutiérrez R. , Landera Rodríguez R.
Published: June 2017

Introduction

The major depression is associated with decreased cognitive functions in a range of areas, including attention, memory and executive functions. The cognitive symptoms of depression can have a profound effect on the ability of patients to keep out the tasks of daily living, and are significant factors that affect the ability to function both interpersonal and occupational level.

Aims

Vortioxetina have a multimodal action acting on various serotonin receptors in addition to inhibiting serotonin reuptake. Vortioxetina, is a new therapeutic tool seems to have shown efficacy in the treatment of cognitive symptoms of depression.

Methods

To evaluate this action we have evaluated the cognitive decline in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. For that, we’ve used the Verbal Hearing Test King (RAVLT), which evaluates the auditory verbal short-term memory, the learning rate, the retention of information, and the differences between learning and recovery, and testing Digit substitution by symbols (DSST) that perform quick detection of brain dysfunctions by a conventional task.

Results

The results of this study are still under analysis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Vortioxetine versus citalopram in treating major depressive disorder (MDD)
Authors: Rossi A. , Di Tullio E. , Prosperini P. , Feggi A. , Gramaglia C. , Zeppegno P.
Published: June 2017

Introduction

Citalopram is a widely used antidepressant (AD), indicated for the treatment of Major Depressive Disorder (MDD), with a high and Selective Serotonin Reuptake Inhibitory action (SSRI), good efficacy and safety profile. Vortioxetine is a novel multimodal antidepressant compound, with a mixed action on Serotonin (both 5-HT agonism and antagonism). Its clinical efficacy has been established in several short and long term trials; furthermore it proved effective at mitigating cognitive dysfunction, which is addressed to as one of the main causes of social impairment in MMD patients.

Objectives

To evaluate the relative efficacy and safety of Vortioxetine versus Citalopram, in patients suffering from MDD.

Aims

To assess whether Vortioxetine effectiveness and tolerability are comparable to those observed for previous antidepressants.

Methods

The main outcomes were efficacy (variance from baseline to 1 month) in the Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Depression (HAM-D) and tolerability (adverse events). Changes in cognitive performance were assessed using the following specifics tools: Digit symbol substitution test (DSST), Trail Making Test A (TMT-A) and Hopkins Verbal Learning Test-Revised (HVLT-R).

Results

Data collection is ongoing. According to Literature we expect to find a significant number of MDD patients on Vortioxetine to achieve a reduction in depressive symptoms from baseline, to report poor adverse events and to increase their cognitive performance.

Conclusion

As shown by recent literature, Vortioxetine might be an effective option in treating MMD with particular focus on cognitive dysfunction.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effect of yoga and meditation on accelerated cellular aging in major depressive disorder patients
Authors: Madhuri T. , Dada R. , Sagar R.
Published: June 2017

Introduction

Accelerated aging is associated with major depressive disorder (MDD) and studies of yoga and meditation based lifestyle intervention (YMLI) on biomarkers of cellular aging are lacking.

Aim and objectives

To investigate the peripheral blood biomarkers of cellular aging in MDD patients after short term YMLI. Biomarkers include DNA damage, oxidative stress (OS), telomere attrition, and nutrition sensing assessed respectively by 8-hydroxy 2’- deoxyguanosine (8-OHdG); reactive oxygen species (ROS) and total antioxidant capacity (TAC); telomere length and telomerase activity; and sirtuin-1.

Methods

We consecutively enrolled 33 MDD patients and 40 healthy subjects; 30 MDD patients were followed up with 12- week YMLI. Biomarkers of cellular aging in peripheral blood were measured with assay kits. All patients were evaluated by examining the correlation between cellular aging markers and Montgomery–Asberg Depression Rating Scale (MADRS) scores.

Results

The levels of DNA damage, OS, and telomere attrition in MDD patients were significantly higher than healthy subjects (all P = 0.005). The MADRS scores had a significantly positive association with 8-OHdG and ROS levels and negative association with TAC, telomerase and sirtuin-1 levels (all P < 0.01).

Conclusions

Peripheral blood biomarker levels in our results suggest significant cellular aging in MDD patients compared to healthy subjects. There was strong correlation between the changes in biomarkers of cellular aging and clinical improvement in MDD. Our study is the first to show significant increase in sirtuin-1 levels in MDD patients after yoga and meditation. Therefore, biomarkers of cellular aging might be indicators of MDD severity and clinical remission after YMLI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Ghrelin response to hedonic eating in underweight and short-term weight restored patients with anorexia nervosa
Authors: Fico G. , Monteleone A.M. , Nigro M. , Patriciello G. , Volpe U. , Monteleone P.
Published: June 2017

Introduction

Recently, anorexia nervosa (AN) has been conceptualized as a reward-related disorder, and brain imaging studies have shown functional and structural abnormalities in areas of the brain involved in reward processes in both acute and recovered AN patients. However, the role of endogenous biochemical mediators, such as Ghrelin, in the modulation of reward processes has been poorly investigated in this eating disorder.

Objectives

Hedonic eating, that is the consumption of food exclusively for pleasure and not to maintain energy homeostasis, is a useful paradigm to investigate the physiology of food-related reward.

Aims

We assessed the Ghrelin response to food-related reward in symptomatic AN women in order to further explore the modulation of reward processes in this severe and debilitating disorder.

Methods

Plasma levels of Ghrelin were measured in 7 underweight and 7 recently weight-restored satiated AN patients before and after the ingestion of a favorite (hedonic eating) and non-favorite (non-hedonic eating) food. Ghrelin responses were compared it that of previously studied healthy controls.

Results

We found that in satiated underweight patients with AN plasma Ghrelin levels progressively decreased after the exposure and the consumption of both the favorite and non-favorite food whereas in satiated weight-restored AN patients and satiated healthy controls plasma Ghrelin concentrations significantly increased after the exposure to the favorite food and after eating it, but decreased after the non-favorite food.

Conclusions

These results suggest a derangement in the Ghrelin modulation of food-related pleasurable and rewarding feelings, which might sustain the reduced motivation toward food intake of acute AN patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Anorexia nervosa and attachment
Authors: Red Gallego H. De la , Alonso Sánchez A. , Álvarez Astorga A. , Gómez Sánchez S. , Rodríguez Andrés L. , Cepedello Pérez S. , De Lorenzo Calzón M. , De Uribe Viloria N. , Gómez García M. , Rodríguez Campos A. , Ladrón de Cegama F. De Uribe
Published: June 2017

Introduction

Attachment is an innate programming whereby a child seeks for security. There is scientific and empirical evidence that insecure attachment is usual in eating disorder patients [1].

Objectives

To highlight the relevance of attachment between child and caregivers, as well as its significance in therapeutic approach.

Methods

A 17-year-old girl hospitalized after attending to emergency department due to fainting. BMI: 12.89. She reports restrictive behavior since age 11 that her mother regards as “child issues”. Divorced parents, she grew up with her mother, diagnosed of hypochondria, who mentions not understanding why she is not the one who is hospitalized.

Results

During hospitalization, she turned 18-years-old. Guardianship of her younger siblings was removed to her mother. She had a secure relationship with her 24-year-old sister, so she decided to move in with her. Later on, she had a positive progress, maintaining the gained weight and mood stability, although cognitive distortions persist.

Conclusions

Among developmental and maintaining factors of eating disorders, impaired attachment is becoming increasingly interesting. Even though the main goal of treatment is weight restoration, exploring attachment patterns can facilitate to achieve that aim. This clinical case emphasizes the importance of attachment in eating disorders among child and young adults.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Immunity and eating disorders. Clinical description of a case
Authors: Gallego M.D.H. , Álvarez Astorga A. , Alonso Sánchez A. , Hernández Antón R. , Mayor Toranzo E. , Sevillano Benito I. , Hernández García M.S. , Geijo Uribe M.S. , Ladrón de Cegama F. De Uribe
Published: June 2017

Introduction

Recently, there is an increasing interest in the link between anorexia nervosa and autoimmune diseases. Studies show significant association between anorexia nervosa, diabetes mellitus, autoimmune thyroid disease and Crohn's disease [1]. The findings of significantly elevated autoantibodies (anti α-MSH, anti ACTH) and cytokines (IL-1, IL-6, IFN-γ, TNF-α) support this relationship.

Objectives

To illustrate with a clinical case the connection between eating disorders and Crohn's disease.

Methods

Fourteen years-old boy with moderate depression syndrome after his grandfather's decease. Since overweight diagnosis by his pediatrician, he begins to restrict food intake with an important weight loss (19 kg in 9 months) and over exercising. Blood test reveals microcytic and hypochromic anaemia, rest of the examination shows no other disorder. Psychometric assessment EDI-3 suggests Anorexia Nervosa restricting type.

Results

Two months after clinical stabilization, he is hospitalized due to abdominal pain. Exploration including blood test, serology, coproculture, sonography and colonoscopy reveals severe Crohn's disease.

Conclusions

This case is about a patient diagnosed of moderate depressive syndrome, who develops anorexia nervosa and Crohn's disease during his follow up. It exemplifies the link between stress, immunity and eating disorders. Recent findings suggest that immune diseases are involved in onset and maintenance of eating disorders. More studies are required in order to inference its consequences in evaluation, prognostic, treatment and identification of subgroups of patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.