bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Mental Health and Clinical Psychiatry: Are they Really Two Separate Worlds?
Authors: Priebe S.
Published: June 2017

Public mental health and clinical psychiatry: Are they two separate worlds?

Stefan Priebe, unit for social and community psychiatry, Queen Mary University of London.

Public mental health focuses on health indicators and interventions on population level with an emphasis – although not exclusively–on prevention. In contrast, clinical psychiatry involves treatment of individuals in the setting of a health service and deals with people who usually already have a mental disorder. The theoretical background, the underpinning evidence and the practical approach of public mental health and clinical psychiatry differ from each other and concepts of one of the two cannot easily be transferred to the other.

Nevertheless, the presentation will argue that there are also links between the two. These links may be based on overall applicable values, a common understanding of mental disorders, and social models of overcoming mental distress. These links can have implications for how clinical psychiatrists are engaged in political and societal activities, get involved with local communities, and work in daily practice with their patients.

The public mental health perspective, used in a wide sense of the term, has played a substantial role in the historical development of psychiatry, including its major reforms, and might also open up how clinical psychiatry might be attractive as a career option and relevant as a profession in the future.

Disclosure of interest

The author has not supplied his declaration of competing interest.
What do Clinical Trials Tell us About Antidepressant Delayed Onset of Action?
Authors: Rabinowitz J.
Published: June 2017

Response to antidepressants in major depressive disorder is highly variable and determinants are not well understood. Presentation will provide clinical trial data on time to response and determinants of response to antidepressant treatment. Data is from the Innovative Medicines Initiative funded NEWMEDS collaboration, a large public-private collaboration which assembled the largest dataset of individual patient level information from randomized placebo-controlled trials of antidepressant drugs. Studies were conducted by four large pharmaceutical companies. Dataset includes placebo-controlled trials of citalopram, duloxetine, escitalopram, quetiapine and sertraline in adults with MDD. We examined patient and trial-design-related determinants of outcome as measured by change on Hamilton Depression Scale or Montgomery–Asberg Depression Rating Scale in 34 placebo-controlled trials (drug, n = 8260; placebo, n = 3957). While it is conventional for trials to be 6–8 weeks long, data presented will show that drug-placebo differences were observable at week 4 with nearly the same sensitivity and lower dropout rates. Having any of these attributes was significantly associated with greater drug vs. placebo differences on symptom improvement: female, patients being middle aged, increasing proportion of patients on placebo, excluding all patients from centers with high placebo response regardless of active treatment response, using active run in periods and including self-report measures. Proof of concept trials can be shorter and efficiency improved by selecting enriched populations based on clinical and demographic variables, ensuring adequate balance of placebo patients, and carefully selecting and monitoring centers. In addition to improving drug discovery, patient exposure to placebo and experimental treatments can be reduced.

Disclosure of interest

I have received research grant(s) support and/or travel support and/or speaker fees and/or consultant fees from Takeda, Minerva, Intra-cellular Therapies, Janssen (J&J), Eli Lilly, Pfizer, BiolineRx, Roche, Abraham Pharmaceuticals, Pierre Fabre, Minerva and Amgen.
Treatment of ADHD with Cannabinoids
Authors: Asherson P. , Cooper R.
Published: June 2017

Introduction

Adults with ADHD describe self-medicating with cannabis, with some reporting a preference for cannabis over ADHD medications.

Objectives

The experimental medicine in ADHD-cannabinoids study was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex oromucosal spray, in 30 adults with ADHD.

Methods

The primary outcome was cognitive performance and activity level using QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms.

Results

Thirty participants were randomly assigned to the active (n = 15) or placebo (n = 15) group. For the primary outcome, no significant difference was found in the ITT analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est = -0.17, 95%CI-0.40 to 0.07, P = 0.16, n = 15/11 active/placebo). For secondary outcomes, Sativex was associated with non-significant improvements in hyperactivity/impulsivity (P = 0.03), a cognitive measure of inhibition (P = 0.05), inattention (P = 0.10) and emotional lability. Per-protocol effects were higher.

Conclusion

Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. This provides some preliminary evidence in support of the self-medication theory of cannabis use in ADHD. A larger trial is warranted.

Disclosure of interest

Kings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech speaker at sponsored events for Shire, Lilly and Novartis.
RNA Sequencing in Bipolar Disorder: From Long Non-coding to Circular rnas
Authors: Luykx J. , Giuliani F. , Veldink J. , Kahn R.
Published: June 2017

Bipolar disorder (BPD) is a highly debilitating psychiatric disorder. The underlying molecular mechanisms of BPD remain largely unknown. Studies targeting postmortem brain tissues of BPD patients have identified very few consistently replicated differences in the expression levels of protein-coding RNAs across different areas of the brain. Since differential expression of the human genome produces a wide spectrum of protein-coding and noncoding RNAs, we hypothesized that major molecular deficits associated with BPD could reflect dysregulation of multiple classes of RNA. To test this hypothesis, we obtained postmortem human medial frontal gyrus tissue from BPD patients and healthy controls (n = 16). To survey the implication of both protein-coding and long non-coding RNAs (lncRNAs) in BPD, we then performed RNA sequencing, PCR validation and replication experiments adopting a case-control design. Thirty-six genes and fifteen lncRNA transcripts not previously implicated in BPD were detected as differentially expressed (FDR < 0.1). Functional analyses identified enrichments of angiogenesis, vascular system development and histone H3-K4 demethylation. In addition, we report extensive alternative splicing defects in the brains of BPD subjects compared to controls. Finally, we describe for the first time a large reservoir of circular RNAs (circRNAs) that populate the medial frontal gyrus and report significantly altered levels of two circular transcripts (cNEBL and cEPHA3) from the NEBL and EPHA3 loci in BPD. Our findings may not only contribute to gain insight into the pathophysiology of BPD but may be tested in the near future as potential biomarkers for diagnostics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Self-regulation of the Dopaminergic Reward System Via Real Time fmri Neurofeedback in Schizophrenia
Authors: Kirschner M.
Published: June 2017

Introduction

Alterations in the mesolimbic dopamine system play a crucial role in the pathophysiology of schizophrenia. However, little is known about potential disturbance in endogenous regulation of neural activity due to cognitive control. Recent research on real-time fMRI (rtfMRI) revealed a novel method to stimulate the substantia nigra and ventral tegmental area (SN/VTA), using positive mental imagery. Importantly, this self-regulation ability could be improved with rtfMRI neurofeedback. For the first time, we applied this innovative method in patients with schizophrenia (SZ) to investigate potential alterations in endogenous regulation of the reward system.

Methods

14 (SZ) and 14 healthy controls (HC) were included in this ongoing study. Participants performed a rtfMRI task with abstract visual feedback of neural activity in the SN/VTA. In the active condition, we instructed participants to voluntary up-regulate SN/VTA activity by recalling rewarding scenes. Neurofeedback learning was correlated with the self-reported negative symptoms.

Results

In contrast to HC, SZ were not able to actively self-regulate SN/VTA activity. Furthermore, they failed to improve self-regulation with rtFMRI neurofeedback. Importantly, impaired neurofeedback learning was associated with negative symptoms, in particular diminished expression.

Discussion

Our preliminary results show that self-regulation of SN/VTA activity is impaired in SZ. Although neurofeedback training improves self-regulation using positive mental imagery in HC, this method might not be suitable as a potential treatment strategy in SZ. The present findings provide new insights to the to the association between negative symptoms and dopaminergic dysfunction and highlight the strengths and limitation for the use of rtfMRI neurofeedback in schizophrenia.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Depression and its Somatic Consequences: Allostatic Load as the Connecting Link
Authors: Penninx B.
Published: June 2017

Stress-related psychiatric disorders, such as depressive and anxiety disorders, have been associated with increased risk of overall mortality as well as with the onset of various aging-related somatic diseases. In addition to unhealthy lifestyles and poorer (self) care, various stress-related physiological processes likely contribute to these detrimental health consequences of psychiatric disorders. Considering the fact that the impact of stress-related disorders is visible on many different somatic health outcomes, it is unlikely that contributing biological systems are very specific. In fact, it is likely that multiple dysregulations of stress systems, including the immune, HPA-axis and autonomic nervous systems, but also various general proteomic or metabolomic pathways are involved. The concept of Allostatic Load (AL) emphasizes the presence of a multi-system physiological dysregulation.

In this talk I will summarize what the evidence is for somatic health consequences of psychiatric conditions, with depression as an important example. Subsequently, I will provide an overview of the various stress systems that are dysregulated in depressed patients. In addition, I will provide empirical data from the Netherlands Study of Depression and Anxiety (n = 2981) that illustrate that there is evidence that depressed patients are especially at risk for a dysregulation in multiple physiological stress systems. I will also illustrate how such a state of AL can impact on basis cellular aging indicators like telomere length and epigenetic age.

In sum, this talk will highlight the current state-of-evidence for an association between depressions with the onset of many adverse somatic health outcomes, and will provide insight into the contributing role of a multisystem physiological dysregulation.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Stay Foolish, Stay Fit: An Excursus on Strategies to Prevent Burnout of Mental Health Professionals
Authors: Ferrari S. , Rioli G.
Published: June 2017

Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives.

Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. Time schedules), infrastructures (eg. Parking places) or dynamics and human interactions, are also essential and effective.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Definition, Epidemiology, Clinical Course and Outcomes in Treatment-resistant Schizophrenia
Authors: Seppala J. , Miettunen J. , Jääskeläinen E. , Isohanni M. , Seppälä A. , Koponen H. ,   M.R.G. M.-Resist Group
Published: June 2017

Based on a systematic review on TRS 285 studies were included regarding definitions of TRS (n = 11), genetics (18), brain structure and functioning (18), cognition (8), other neurobiological studies (16), medication (158), psychotherapy and cognitive rehabilitation (12), electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) (15), prognosis (21), and other miscellaneous studies (8). Definitions of TRS varied notably. TRS was associated with 3 to 11-fold higher healthcare costs than schizophrenia in general. One-fifth to one-third of all patients with schizophrenia were considered to be resistant to treatment. Based on limited evidence of genetics, brain structure and functioning and cognition, TRS may present as a different disorder with different etiology compared to non-TRS. Clozapine, olanzapine, risperidone, ECT and cognitive-behavioral therapy have shown effectiveness, although the number of studies and quality of research on interventions is limited. About 40% to 70% of TRS patients had an unfavorable prognosis. Younger age, living in a rural or less urban area, primary education level, more psychiatric hospital treatment days in the year before first schizophrenia diagnosis, inpatient at first schizophrenia diagnosis, paranoid subtype, comorbid personality disorder and previous suicide attempt may be risk factors associated with TRS.

TRS is a poorly defined, studied and understood condition. To create a framework of knowledge for TRS, as a basis to develop innovative studies on treatment, there is a need for a consensus on the definition of TRS. Prospective long-term prognostic and novel treatment intervention studies are needed [1].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emerging Sensor-based m-health Interventions in the Assessment of Psychotic Symptoms
Authors: Bulgheroni M.
Published: June 2017

This speech aims to overview ongoing research trends on the integration of mobile health and sensors based behavioral analysis in therapeutics programs for subjects with mental health symptoms or disorders. The variety of easily acquirable personal data by smartphones and wearables in a transparent and unobtrusive way, offers the opportunity to describe the person in terms of his/her lifestyle and behavior at physical, cognitive and environmental level. An appropriate management of these data may initiate a new line in healthcare management characterized by tailored and timely interventions. However, despite the huge amount of data that could be acquired, an effective contribution of such information to the improvement of the quality of care in mental-health is still not sufficiently explored. The sensors and data which have been used in studies on mental status include accelerometer, gyroscope, GPS, microphone, calls, messages, screen, apps usage, environmental light, heart rate, skin conductance, and temperature. The primary outcomes build on correlations between sensor data and mental health status/severity of symptoms. These data are provided from studies on bipolar disorders and depression, using validated clinical scales (Patient Health Questionnaire-9; Hamilton Rating Scale for Depression; Young Mania Rating Scale; Center for Epidemiologic Studies Depression Scale; etc.).

m-RESIST consortium is fully aware of the importance to describe behavioral patterns of patients with schizophrenia that could be used to setup remotely based therapeutic tool. m-RESIST is setting up a framework for the creation of a Clinical Decision Support System based on a mobile therapeutic intervention for treatment-resistant schizophrenia.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Cognitive Impairment in Bipolar: Neurodevelopmental or Neuroprogressive?
Authors: Young A.
Published: June 2017

Background

Bipolar Disorders (BD) are common and complex diseases. Recent findings have provided evidence that impairments in cognition are evident in the various sub-groups of Bipolar Disorder and persist after resolution of acute episodes.

Method

An opinion paper based on a narrative review of the field.

Results

Quantifiable cognitive deficits are clearly found in Bipolar 1 and Bipolar 2 Disorders. These persist after recovery from acute episodes. The aetiopathogenesis of these phenomena is likely to be multifactorial. It seems clear that these cognitive impairments are not in general neurodevelopmental and for most are related to repeated episodes of illness [1]. However, the issues of subgroups with differential profiles of impairment and the trajectory of cognitive change remain to be fully established. The effects of putative treatments (e.g., pharmacological, neurostimulation, cognitive remediation) are at an early stage of evaluation.

Conclusions

Future efforts should focus on further integrating the current and emerging research findings into a coherent model, which generates testable hypotheses and allows treatment effects to be tested.

Disclosure of interest

Employed by King's College London Honorary Consultant SLaM (NHS UK)

Paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders

No share holdings in pharmaceutical companies

Lead Investigator for Embolden Study (AZ), BCI Neuroplasticity study and Aripiprazole Mania Study

Investigator initiated studies from AZ, Eli Lilly, Lundbeck, Wyeth

Grant funding (past and present): NIMH (USA) CIHR (Canada) NARSAD (USA) Stanley Medical Research Institute (USA) MRC (UK) Wellcome Trust (UK) Royal College of Physicians (Edin) BMA (UK) UBC-VGH Foundation (Canada) WEDC (Canada) CCS Depression Research Fund (Canada) MSFHR (Canada) NIHR (UK).
Possible Involvement of Endogenous Opioids and Nitric Oxide in the Anticonvulsant Effect of Acute Chloroquine Treatment in Mice
Authors: Abkhoo A.
Published: June 2017

Introduction

Chloroquine, a 4-aminoquinoline derivative, has long been used for the treatment of malaria and rheumatological disorders, including rheumatoid arthritis and systemic lupus erythematosus. Accumulating evidence now suggests potential use of chloroquine as a neuroprotectant. Studies have shown that nitric oxide (NO) pathway is involved in the chloroquine actions. Considering the fact that nitrergic neurotransmission plays a crucial role in the central nervous system functioning, in the present study we evaluated whether nitrergic system is involved in the anticonvulsant effects of chloroquine in a model of clonicseizure in mice.

Methods

Clonic seizure threshold was determined by infusion of pentylenetetrazole (PTZ, 0.5%) at a constant rate of 1 mL/min into the tail vein of male Swiss mice (23–29 g). Minimal dose of PTZ (mg/kg of mice weight) needed to induce clonicseizure was considered as an index of seizure threshold.

Results

Chloroquine (5 mg/kg, acutely 30 min before test, intraperitoneally), i.p significantly increased the seizure threshold. Acute co-administration of a non-effective dose of the non-selective NO synthase (NOS) inhibitor, L-NAME (L-NG-Nitro-L-arginine methyl ester hydrochloride,5 mg/kg, i.p.) or the selective inhibitor of neuronal NOS, 7-NI (7-nitroindazole, 40 mg/kg, i.p.) with an effective dose of chloroquine (5 mg/kg) inhibited its anticonvulsant effects. Co-administration of a non-effective dose the selective inducible NOS inhibitor, aminoguanidine (100 mg/kg, i.p.) with chloroquine 5 mg/kg did not alter its anticonvulsant effects.

Conclusion

Chloroquine increases the PTZ-induced clonic seizure threshold in mice. We demonstrated for the first time that nitric oxide signaling probably through neuronal NOS could be involved in the anticonvulsant effects of chloroquine in this model of seizure in mice.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Cognitive Functions Recovery After Traumatic Brain Injury of Mild Severity in Adolescents
Authors: Pervichko S.
Published: June 2017

Introduction

The effect of the traumatic brain injury of mild severity (mTBI) on the cognitive functions influences on the educational activities of adolescents in school and the quality of life in general.

Objectives

To study the violations and to track the dynamics of recovery higher mental functions (HMF), after mTBI in adolescents with neuropsychological syndrome in the range of up to one year.

Materials and methods

The study is based on the original set of techniques designed by A.R. Luria. We focused on assessing the status of various components of the HMF. We also studied of the mental activity in its regulatory and dynamic aspects. Thirty-one patients with mTBI (mean age was 11.5 + 1.3) and 20 healthy subjects (mean age was 12 + 1.5) took part in the study.

Results

Analysis of the results showed that violations of HMF in the acute period were represented by three types of syndromes. The leading place in each syndrome is occupied by deficiency symptoms of non-specific brain structures. Research of dynamics of recovery HMF demonstrated the symptoms related to deficiency of parietal-temporal-occipital area are reducing for the first month, as well as the symptoms of the anterior brain. After six months we observed the decrease all symptoms from cortical structures, but the symptoms persist in the form of fatigue, reduction the rate of mental activity, difficulty in concentration.

Conclusions

Application of neuropsychological approach (Luria school) to the diagnosis and recovery of deficit cognitive function allows to describe the symptoms and to identify their hierarchy in the structure of violations.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Working with Traumatized Immigrants with a ptsd Diagnosis
Authors: Graef-Calliess I.T.
Published: June 2017

Graef-Calliess Iris (Germany).

Germany has always been an important host country for asylum seekers. Although recently an increasing number of investigations about mental health of specific migrant groups have been published in Germany, there is a paucity of research concerning mental health of traumatized asylum seekers. The aim of the presentation is to present study results which describe socio-demographics, types and frequency of traumatic experiences, psychiatric diagnoses, suicidality and time to access to mental health care in traumatized asylum seekers who applied to an outpatient department of a clinical center with high expertise in transcultural psychiatry and psychotherapy in Hannover, Germany. The study shows that most of the traumatized asylum seekers had experienced multiple pre-migratory traumatic events, had unfavorable post-migratory conditions, had PTSD and depressive disorders as diagnoses, and had high suicidality and late access to mental health care. This is indicative of the mental health situation of asylum seekers in Germany in general. Ways of dealing with this challenge for the mental health care system and options for clinical management will be presented.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Late Life Depression, Postural Instability and Dyspnea: The He.s.i.o.d. Study (Hexameter Study in Older Depressed)
Authors: Belvederi Murr M. , Nerozzi E. , Padula N. , Tacconi C. , Coni A. , Chiari L. , Assirelli B. , Toni G. , Chattat R. , Ferdinando T. , Neviani F. , Cremonini A. , Amore M. , Zanetidou S. , Bertakis K.D.
Published: June 2017

Introduction

Late life major depression (LLMD) is usually treated within primary care, but still with unsatisfactory outcomes and significant residual symptoms. Moreover, LLMD increases symptoms of anxiety, dyspnea, fear of falling (FOF), and risk of falls. Evidence from non-depressed patients suggests the efficacy of breathing and postural exercises; in particular, rhythmic breathing during poetry recitation was shown to improve cardio-respiratory synchronization. Thus, the aim of the HESIOD study was to test the efficacy of antidepressants plus breathing and postural exercises to improve patients’ anxiety mood, dyspnea, FOF, and postural stability.

Methods

Two non-randomised groups were compared: (1) antidepressant drugs plus weekly sessions of breathing/postural exercises based on the rhythmic recitation of hexameter poetry (intervention); (2) antidepressant drugs plus weekly sessions of group reading (comparator). Patients aged 65 +, with non-psychotic recurrent LLMD were recruited from a psychiatric consultation-liaison program for primary care. The main outcome measure was remission from depression (MADRS score ≤ 10) at 24 weeks. Secondary outcomes will include accelerometer-based measures of postural stability; patient-rated dyspnea, and FOF.

Results

Preliminary data on 34 patients show that patients receiving breathing and postural exercises displayed greater remission rates than those in the reading group (47.1% vs. 11.8%, P = 0.02). Further analyses will examine the effects on postural stability, dyspnea and FOF.

Conclusions

Breathing and postural exercises may exert significant clinical advantage when added to the standard antidepressant drug therapy for LLMD. This study might prompt further research on innovative treatment strategies to improve the outcomes of late life depression in primary care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The Evolution of Mania in the Elderly: A Case Study
Authors: Perez I. Martine. , Sánchez F. García , Gáldamez A.L. Gonzalez , Simo A. Belmar , Acevedo M.D. Piqueras , Briñol C.J. Garcia , Molina B. Perez , Pombo I. Bello , Eugenio A. Lopez
Published: June 2017

Introduction

Bipolar disorder in elderly patients may present as an evolution of the disease initiated in younger stages or as an entity newly emerging. In addition, mania in the elderly, has characteristics that make it different from the adult. These disorders can be correlated with underlying vascular or degenerative disorders [1].

Methods

Review of the relevant literature by searching PUBMED, limited to studies of greater scientific hierarchy.

Results

The existence of changes in the manic phase motivated by the influence of vascular disease, as well as the importance of the changes experienced in therapy at the rate of underlying organic disease described. The useful pharmacotherapeutic approach in this case is discussed.

Conclusion

The most recent research points in the direction of a more organic for mania late age-related substrate. The diverse etiology requires differential diagnosis for addressing the underlying causes [1]. The clinic does not dim with age, but increases the tendency to develop rapid cycling as age progresses. It is also more frequent occurrence of paranoid and aggressive traits, especially in situations of confrontation, along with increased dysphoria [2]. The therapeutic management by neuroleptics require very careful attention, because of the vulnerability of this group to develop adverse effects. Mood stabilizers use has been demonstrated as effective as in young [2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Just Hypochondria or Something Else?
Authors: Perez I. Martine. , Sánchez F. Garcia , Galdamez A.L. Gonzalez , Acevedo M.D. Piqueras , Simo A. Belmar , Eugenio A. Lopez , Quesada M.E. Felices , Briñol C.J. Garcia
Published: June 2017

Introduction

In the older adult hypochondria is one of the most common somatoform disorders, and represents a particular challenge for approach, diagnosis and treatment, since in this age group, non-psychiatric medical comorbidity and concomitant presence of other psychiatric disorders very high. It is therefore very complex differentiate hypochondria disease with a real organic cause [1].

Methods

Review of the relevant literature on the subject by searching PUBMED, limited to studies of greater scientific hierarchy.

Results

Analysis of symptoms present in a hypochondriac patient with comorbid psychiatric disorders and organic pathology, valuing the importance it has in its clinical manifestations and the difficulty of differential diagnosis.

Conclusions

In the elderly, the high frequency of somatic disease conditions the need for a deeper physical and mental examination to avoid subjecting patients to unnecessary scrutiny and risky complementary tests [1].

The evolution of hypochondriacs, dragging hypochondria from youth is not good, persisting in his complaint and his need to see a doctor for diagnostic examinations [2]. The therapeutic approach depends on the type of complaint, in which the treatment of the underlying disease as a psychotherapeutic and pharmacological mixed approach may be the right things [2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Fronto-temporal Dementia with Early Onset
Authors: Sabo T. , Bošnjak D. , Jukić V. , Bilić P.
Published: June 2017

Introduction

Even though it is not the most common type of dementia, frontotemporal dementia (FTD) is a major health problem. It affects people younger than 65 with similar frequency as Alzheimer's dementia (AD) and has a progressive course that leads to inevitable deterioration in functioning. Still, FTD is not a unique entity in ICD- 10 classification.

Objectives

To investigate the diagnostic and treatment difficulties in FTD.

Aims

To show very rapid and progressive deterioration in people with early onset FTD.

Methods

We will present a series of cases showing progressive cognitive deterioration and prominent personality changes in patients with FTD hospitalised at University Psychiatric Hospital Vrapce since 2013 to 2015. Collected data included anamnestic and heteroanamnestic information, blood tests and neroimaging.

Results

Our findings showed a significance of early onset FTD, with subtle, untypical symptoms at the beginning, and galloping deterioration during the course of illness.

Conclusions

Presented patients with FTD showed rapid and progressive nature of disease with infaust prognosis. Even though early onset patients make 20% of overall number of patients with FTD, we consider that it is necessary to separate them from late onset patients in future classification systems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Bruxism as a Consequence of Chemotherapy?
Authors: Da Ponte G. , Rato J. , Pinto C. , Lobo M. , Ouakinin S.
Published: June 2017

Introduction

Bruxism is a syndrome with uncertain etiology but with proposed factors: psychosocial, peripheral and central. Treatment is also controversial and one of the options focuses in GABA theory and regularization of ion channels. Xelox (capecitabine + oxaliplatin) and bevacizumad is indicated for metastatic colorectal cancer, being oxaliplatin the most neurotoxic agent (acute syndrome and/or a chronic sensory neuropathy). Acute neurotoxicity is very frequent and it is a sensory and/or a motor toxicity (as tongue tingling or jaw spams). The proposed pathogenesis – neuronal hyperexcitability due to alterations of voltage-gated ion channels – is supported by mechanism of action of some treatments.

Objectives and Aims

Review different causes of bruxism.

Methods

Description of a clinical case.

Results

This is a story of 76-years-old man in treatment for metastatic colon cancer that developed toxicity: nauseas (treated with haloperidol), bruxism and gingival atrophy. He was referred to psycho-oncology by involuntary movements of mouth and trunk. The patient complained of sadness, anhedonia and insomnia since recurrence of cancer and related the movements with CT. At observation he was anxious, tearfulness and agitated. He was treated for a depressive episode, but the doubt remained about involuntary movements: haloperidol was a confounding factor for oxaliplatin acute neurotoxicity, also aggravated by psychic and peripheral factors.

Conclusions

The authors believe that bruxism is linked to CT in a very complex relation that includes psychic, peripheral and central factors. Psychiatrists need to keep attention to the patient as a whole, not being seduced by easy answers like psychosocial factors.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Frontal meningioma and bipolar disorder: Etiopathogenic link or co-morbidity? A case report
Authors: Chaari I. , Ben Ammar H. , Nefzi R. , Mhedhbi N. , Khelifa E. , Aissa A. , El Hechmi Z.
Published: June 2017

Introduction

Frontal meningiomas are benign brain tumours known for their late onset. They may be presented by only psychiatric symptoms. Thus, the diagnosis at early stages can be missed or overlooked until the tumour causes neurological deficit.

Case report

We report the case of a 61-year-old man, receiving a treatment and a follow-up for bipolar disorder for 11 years. He has history of 3 major depressive episodes, 2 suicide attempts and a manic episode. The symptoms were initially well controlled by medication. Since 6 months, the patient started to experience atypical symptoms: he had presented disinhibited and aggressive behaviour, psychomotor instability, pyromania and self-neglect. The patient did not respond to treatment despite repeated adjustments. A frontal syndrome was suspected. Cerebral CT scan revealed an unexpected mass measuring 6.8 cm × 5.6 cm at the right frontal area, suggestive of a giant meningioma (Fig 1).

Conclusions

Generally, once diagnosed, psychiatric disorders are rarely revised. Consequently, “silent” tumours such as frontal meningiomas can be overlooked. Neuroimaging should be considered in case of new-onset psychiatric symptoms, atypical or change in clinical presentation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
CADASIL case report: Psychiatric symptoms as first manifestation of a neurological process
Authors: De Uribe-viloria N. , De Lera Alfonso M. , Gomez Garcia M. , De Lorenzo Calzon M. , Alonso Sanchez A. , Red Gallego H. De La , Medina Ojeda G. , Ladron De Cegama F. De Uribe
Published: June 2017

Introduction

CADASIL (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), the most common form of hereditary stroke disorder, is characterized by headaches, transient ischemic attacks and psychiatric symptoms which include mood changes, behaviour disorders and variable levels of dementia.

Objectives and aims

To emphasize the necessity of discarding somatic and neurological processes before a psychiatric diagnosis is reached.

Methods

We present a case initially followed in psychiatry and derived to neurology, and compare it with articles no older than ten years, found in a bibliographic search in Medline (PubMed), fitting the next keywords: CADASIL, autosomal dominant encephalopathy, psychiatric symptoms.

Results

The most frequent manifestation of CADASIL is the early age onset of cerebrovascular ischemic attacks, nonetheless, a fair percentage of patients debut with insidious psychiatric symptoms, especially mood changes, behavioural disorders and even mutism. Independently of the age of onset, these symptoms are present at some point of the illness in most cases.

Conclusions

Psychiatric symptoms can be found in a vast number of somatic and neurological disorders, even being the first manifestation of such processes. This challenges diagnosis, and given than the line between brain and mind is blurred and not always clear, cooperation among different specialities is of utmost importance in order to correctly treat the illness as a whole, and not just the sum of the parts.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychiatric picture of encephalitis: Stigmatisation of psychiatric patient
Authors: Hrnjica A. , Pekic I. Lokmic. , Bise S. , Kurtovic B.
Published: June 2017

Background

Psychiatric symptoms/disorders in brain diseases are not specific and may have the same clinical presentations as functional psychiatric disorders, so they can compromise early diagnosing of disease.

Objective

This paper's objective is to show (negative) influence of stigma in a diagnostic process of patients with predominantly psychiatric symptoms in their clinical pictures.

Materials and methods

The subject is a 46 year-old female patient with no history of psychiatric disease. Her symptoms includes: confusion, disorientation, perseveration, visual and auditory hallucination, lack of motivation, inability to understand questions, developed following a 10-day long period of febricity. During the outpatient care, she has been examined by a neurologist, a specialist of urgent and internal medicine, and a psychiatrist. As the CT scan made in that stage was interpreted as normal, the patient was hospitalised in a psychiatric hospital. She was treated both with typical and atypical antipsychotics but no therapeutic effects have been reached. Thinking of organic etiology, advanced diagnostics have been made (MR, LP). MR scan showed lesion that is a characteristic for herpetic meningitis, which is also confirmed with positive serological tests.

Conclusion

In patients with a sudden onset of psychiatric symptoms, patients with unexpected changes in mental status or suddenly developed headaches, as in the therapy- resistant psychiatric disorders, it is important to keep in mind the possibility of the coexistence of brain disease. Removing the stigma from psychiatric patients is important in order to be able to give every patient the chance of getting the correct diagnose on time.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The investigation of nurses’ sociotropic-autonomic personality features levels in the context of emotional habitus
Authors: Malak Akgun B.
Published: June 2017

Introduction

Researchers who plan to debate the nursing practice habits and nurses’ professional-individual self and identity can study out nurse habitus. Habitus affects how the nurses understand care needs of patients. Also, sociotropy-autonomy is important for both the personal and professional development of nurses. According to researchers, professional criteria are autonomy, commitment to the profession and unity consciousness.

Objectives

The study was designed to investigate of nurses’ sociotropic-autonomic personality features levels in the context of emotional habitus.

Methods

Information form, sociotropy-autonomy scale were applied to 10 nurses. Also, semi-structured thorough individual interviews were made with them.

Results

Seven nurses have voluntarily chosen their profession and the others are not. Nurses’ sociotropy levels were 59.2 ± 22. Sixteen and autonomy levels were 83.9 ± 22.41. According to the results of the MWU test (U = .0 P < .05), anxiety about disapproval of eight undergraduate nurse (MR = 4.5) is lower than two graduated from health school nurse (MR = 9.5). Five nurses stated that nursing is appropriate for their personal character. Six nurses stated that nursing influenced the positive development of personal character. With content analysis, similarities and differences between nursing identity and social identity, optimal behaviour in expressing feelings of nurses and emotional habitus themes were reached.

Conclusions

Nurse habitus is developed by both of individual and structural factors which are complex and diversity. So, it affects nurses’ career and motivation to provide services. That the researcher assesses them from this aspect affects positively the quality of care.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Association between child asthma control and maternal mental health in Alagoas, Brazil
Authors: Miranda C. , Costa A.D. , Dos Santos L.M. , Coelho J.A.P.M. , Medeiros M.L.
Published: June 2017

Introduction

Maternal mental health is very important to manage children with chronic health problems.

Objective

To evaluate the role of maternal common mental disorders (CMD) in the control of asthma in children by taking the maternal stressful life events (SLE) into account.

Aims

To improve the management of childhood asthma by using a psychosocial approach.

Methods

Cross-sectional study involving mother-asthmatic child dyads assisted in paediatric pulmonology outpatient clinics. To characterize maternal CMD, the Self-report questionnaire (SRQ–20) with cut-off 7/8 was used. The global initiative for asthma control (GINA) questionnaire was used to define controlled and uncontrolled patients. The SLE questionnaire was also used.

Results

Table 1 suggests association between uncontrolled asthma with asthma severity and SLE, and a borderline association between uncontrolled asthma and maternal CMD. Table 2 indicates that, considering all independent variables simultaneously, asthma severity is the only variable statistically significant. It is also possible that with a larger sample size, maternal CMD and SLE would also become statistically significant.

Conclusions

The frequency of uncontrolled asthma is associated with asthma severity and tended to be higher in children whose mothers had CMD and were exposed to SLE.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Table 1

Crude odd ratios (OR) for the association between asthma control in children, and selected variables (n = 272).

Table 2

Simultaneous effect of maternal CMD and selected risk factors on asthma control through logistic regression (n = 272).
Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials
Authors: MoghaddamHossein V. , Nazarzadeh M. , Jahanfar S.
Published: June 2017

Introduction

Fear of childbirth (FOC) is a problematic mental health issue during pregnancy and postpartum period. It is essential to identify the most effective approaches to reduce the problem.

Objective

Using meta-analyses, we aimed to examine the most effective intervention for reduction of FOC.

Method

We searched the Cochran central register of controlled trials, PubMed, Embase and PsycINFO databases since inception till January 2016 without any language restriction. The reference lists of all included studies were checked for additional published reports and citations of unpublished research. We included randomised control trials and quasi-randomised control trials comparing interventions for treatment of FOC. Two review authors independently assessed trial quality and extracted data. The standardized mean differences (SMD) were pooled using random and fixed effect model. The heterogeneity was determined using the Cochran's test and I2 index and was further explored in meta-regression model and subgroup analyses. Egger's regression and funnel plot were used for assessing publication bias.

Results

Ten studies totalling 3984 participants were included from two quasi-experimental and eight randomised clinical trials. Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled SMD of FOC for the education intervention and hypnosis group in comparison with control group were -0.46 (95% CI-0.73 to -0.19) and -0.22 (95% CI-0.34 to -0.10), respectively.

Conclusion

Interventions were effective on reducing FOC; however educational interventions reduced FOC twice as high as hypnosis. This result highlights the roll of antenatal education in enhancing childbirth expectations and experiences to enhance maternal and neonatal well-being.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Procrastination as a Personal Factor in Young Patients with Mental Disorders
Authors: Zvereva M.
Published: June 2017

Introduction

Many of contemporary studies of procrastination were conducted with healthy students. Only a few investigators analyzed procrastination's connection with personal features (self-esteem), socio-psychological parameters (aggression, well-being). Researchers do not consider procrastination as a personal factor in patients with different mental disorders. Most of procrastination's researches are related to affective spectrum disorders (depression), often found in the student's environment.

Objectives

Male and female students (aged 18–25). Normal group–61. Experimental group - 54 patients of psychiatric clinic, divided to diagnosis: schizophrenia F20.01, bipolar disorder F31 and personality disorder F60.

Aims

Study of procrastination combined with personal characteristics (self-esteem, aggression) on young people: normal and with endogenous pathology.

Methods

Procrastination assessment scale-students (PASS) by L.J. Solomon, E.D. Rothblum; Rosenzweig Picture Frustration Test; E. Wagner's The Hand Test; Warwick-Edinburgh Mental Well-being Scale; Rosenberg Self-Esteem Scale; Self-esteem by Dembo-Rubinstein. Multiple linear regressions were used as method of data assessment.

Results

Assessment of obtained data allowed to distinguish some different models of connections parameters of PASS and other tests. These models differ in comparing groups. Healthy students: multidimensional model of communication procrastination and personality parameters harmoniously combined personal and socio-psychological parameters. Schizophrenia: fewer models, mostly one-dimensional structure (identified only communication based on personal parameters). Bipolar disorder: one or two dimensional model (include mainly characteristics of aggression and self-rated health). Personality disorders: some mono and multi-dimensional models, their structure and content are very close to normative sample.

Conclusions

Procrastination is consider as common phenomenon at young people.

Connections PASS and personal features differ according to disease.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.