bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychopathology, temperament and suicide risk in adolescence: The role of early traumatic experience
Authors: Venturini P. , Fagioli F. , Sapienza L. , Boldrini T. , Bonaccorsi E. , Erbuto D. , Montebovi F. , Girardi P. , Pompili M.
Published: May 2016

Introduction

Previous researches showed that adolescents are at high risk of suicide. Suicide is a trans-nosographic phenomenon regardless of psychiatric diagnosis. Trauma is an important risk factor for suicide and young help-seeking patients usually refer traumatic experiences, especially during childhood.

Objectives

The objective of this study is to assess the relationship between traumatic experience and suicide risk comparing adolescents with suicide risk with adolescents without suicide risk.

Aims

To investigate correlations between trauma, psychopathology and suicide risk in a sample of young help-seeking outpatients.

Methods

We recruited 99 outpatients aged between 14 and 21 years admitted to department for prevention and early intervention in adolescence of Rome. We administered psychometric instruments exploring suicide risk (SHSS, BHS), prodromal (SIPS/SOPS), affective and anxious symptoms (HAM-A, HAM-D,MRS), child abuse (CTQ) and experiences of depersonalization (CDS).

Results

Sample is composed of 31 men and 68 women. A total of 34.3% had mood disorder. A total of 28.3% reported history of emotional neglect, 20.2% emotional abuse, 9.15 sexual abuse, 5.1% physical neglect, 9,1% sexual abuse, 4% physical abuse. More than 30% of patients were at increased suicide risk. Depressive, irritable, anxious and cyclothymic temperament was associated with suicide risk. Patients with suicide risk had higher score at HAM-D (t63 = 2.65; P = 0.01), CDS (t63 = 2.77; P = 0.007), in CTQ (t63 = 3.20; P = 0.002) and BHS (t63 = 3.23; P = 0.002).

Conclusions

Adolescents with suicide risk, compared with those without, reported more frequently early traumatic experiences and psychiatric symptoms. Early traumatic experiences constitute a risk factor for both suicide risk and psychiatric symptoms during adolescence.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Why mental health in young women is more at risk in the 21st century
Authors: Herrman H.
Published: May 2016

The mental health of women and girls is endangered when they experience violence and gender-based discrimination, including poor access to education and lack of autonomy in the family and broader community. The conditions of conflict and poverty that foster violence against women, including systematic sexual violence, are growing across some world regions including parts of Africa and Asia, even while women are becoming more empowered in others. The prevalence of abuse of women at home appears to be high across the regions, and the widespread nature of other forms of violence such as genital mutilation and trafficking is increasingly recognised.

The psychological consequences of violence increase the risk of mental illnesses such as depression and anxiety, including the risk of these conditions in the perinatal period. The services provided for women with mental ill health in primary health care, maternal and child health services, community mental health services or hospital settings do not in many places respond adequately to their needs. The inadequacies in response can reproduce or amplify the difficulties and injustices that women face in their lives, especially maltreatment as girls and intimate partner violence as adults.

The World Psychiatric Association aims to increase awareness of the need for improved mental health of women and girls worldwide, especially in settings of disadvantage, conflict and adversity. It is also aiming to work in partnership with other health and non-health organisations to develop a platform for action to respond to the need – for health promotion, risk reduction and access to prevention and treatment services.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Early psychosis in young women
Authors: Riecher-Rössler A.
Published: May 2016

Introduction

It is well known that young women are at lower risk for schizophrenic psychoses than young men. However, little is known about the peculiarities of emerging psychosis in young women.

Objectives

To describe characteristics of emerging psychosis in women.

Methods

Within the FePsy (Früherkennung von Psychosen = early detection of psychosis) study at the University of Basel Psychiatric Clinics we have examined consecutively all patients with a first episode of psychosis (FEP) or an at-risk mental state (ARMS) referred to us between 2000 and 2015.

Results

Women did not significantly differ from men regarding psychopathology, neither in the ARMS nor in the FEP group. This was true for positive as well as negative symptoms and basic symptoms. Interestingly, women had a higher correlation of self-rating with observer-rating regarding psychotic symptoms. Duration of untreated psychosis was significantly lower in women than in men. Women seek help more quickly than men and their first contact is more often their partner.

Regarding neurocognition women showed a slightly better performance in verbal tasks. They also had higher prolactin levels and larger pituitary volumes, even when drug-naive.

Transition to psychosis occurred as often and as quickly in women as in men.

Conclusions

There are only few gender differences in patients with emerging psychosis, which resemble mainly those found in the general population, with women showing a better help-seeking behavior, being more partner-oriented, having a better verbal performance and potentially also a higher stress reactivity [1].

Disclosure of interest

The author has not supplied his declaration of competing interest.
Relevance of brain plasticity to neuroprogression and staging of bipolar disorders – opposing effects of illness burden and lithium treatment
Authors: Hajek T. , Kopecek M. , Alda M.
Published: May 2016

Introduction

Brain changes in bipolar disorders (BD) may represent inherited risk factors or consequences of the illness (brain plasticity). Neuroanatomical changes, which predispose for BD could aid in early diagnosis, whereas the neuronal sequellae of BD could yield biological outcome measures for prevention and treatment.

Methods

To separate neuroanatomical changes into those that increase the risk of BD versus those that result from it, we acquired MRI/clinical data from participants at different stages of BD, including: (1) affected and unaffected offspring of bipolar parents (n = 86); (2) participants with substantial illness burden who had had at least 2 years of current Li treatment (n = 37) or were Li naive (n = 19). We also recruited 99 healthy controls matched to the above-mentioned cohorts by age and sex.

Results

Relative to controls, both the affected and unaffected offpring of bipolar probands showed increased right inferior frontal gyrus (rIFG) volume, but comparable hippocampal volumes and prefrontal N-acetyl aspartate (NAA) levels. Larger rIFG volume was associated with an increased risk of conversion to psychiatric disorders within 4 years following the MRI scanning (hazard ratio = 4.5). In contrast, Li naive patients with substantial illness burden had smaller rIFG, hippocampal volumes and prefrontal NAA levels than controls, who were comparable in these indices to the the Li treated subjects with substantial illness burden.

Conclusions

Brain structural changes in BD may not be static, but may instead result from an interplay between illness burden and compensatory processes. This illness related brain plasticity may be modulated by lithium treatment.

Disclosure of interest

The authors have not supplied his declaration of competing interest.
Implementing the mental health action plan – experiences and challenges
Authors: Muijen M.
Published: May 2016

The WHO European mental health action plan was adopted by all countries in the European region in Izmir in September 2013. Its 6 objectives cover promotion and prevention, human rights, services and partnerships. Since its adoption, the WHO mental health programme is working in some 25 countries, supporting policy development and implementation. Priorities are the introduction of health promotion programmes for vulnerable groups; the competence of primary care to identify, diagnose and treat people with mental disorders; and the implementation of community-based service models sensitive to the culture and resources of countries.

Particularly successful have been countries where a consensus was established between policymakers and professional leaders, and where different levels of government worked together. Obstacles experiences have been funding cuts and lack of incentives. Some examples will be presented.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Nutrition, sleep, physical exercise: Impact on mental health
Authors: Rössler W.
Published: May 2016

Until recently nutrition and various other lifestyle factors were predominantly in the focus of medical disciplines like cardiology, endocrinology or gastroenterology. As mental disorders are multifactorial diseases and as such are complex, emerging evidence suggests that nutrition, exercise and sleep also play an important role in the aetiology, progression and treatment of mental disorders. In this regard research has mostly focused on depression and anxiety, but there is also evidence for other mental disorders like schizophrenia or autism. Some details concerning the relationship between diet and sleep on neuro-transmitter processes, immune-inflammatory pathways or oxidative stress will be demonstrated.

Modifications of life style factors and diet are increasingly recognized as potential therapeutic options. Mostly used are nutrient-based supplements and essential elements in combination. But also healthy diet patterns with a high intake of vegetable, fruits and fish have proven beneficial in the treatment. If we better understand the microbiota-gut-brain axis and its impact on behavior, mood and cognitive processes, diet and lifestyle factors can not only contribute to the treatment but also to the prevention of mental disorders.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The political and social mission of psychiatry
Authors: Priebe S.
Published: May 2016

Psychiatry is based on values and scientific evidence. The presentation will argue that both bases come with a social and political mission.

The values require a commitment to help those in need of support, which cannot be fully achieved without social and political action. The scientific evidence points to the central role of societal factors, such as inequality and poverty, for the development of mental disorders. Influencing these factors requires political decisions.

It will be concluded that taking up the social and political mission is a moral imperative for both psychiatrists as a professional group and individual psychiatrists, and may make the profession more relevant in society, more attractive to medical students, and more effective in helping patients with mental distress.

The discussion will address the challenges and practical options for such a mission.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Autism and substance use comorbidity: Screening, identification and treatment
Authors: van Wijngaarden-Cremers P.J.M.
Published: May 2016

Objective

Autism spectrum disorders (ASD) are well-known for high prevalences of comorbid conditions especially anxiety, obsessions, depression, challenging behaviours.

In this presentation, we will consider the evidence for comorbidity between ASD and addiction [substance use disorders (SUD)] and explore the possible underlying explanations.

Methods

A literature study on similarities between addiction and ASD (at a phenotypical and neurobiological level) as well as a case note review on a year cohort of 120 consecutive admissions in an adult addiction psychiatry unit and 120 admissions in an adult ASD unit.

Results

In our addiction psychiatry cohort, 8 (men) on 118 patients were diagnosed with autism spectrum disorder. This is much higher than in the general population (1%). In the ASD cohort, the results are measured at the moment and the results will be presented in the presentation.

Autism spectrum disorders and addiction can both be perceived as developmental disorders in which a genetic predisposition and vulnerability interact with environmental factors. They can be induced by early stress thus affecting the proper functioning of the cortico-striatal dopaminergic regulation systems (and also the HPA axis). In “pure” ADHD this is attributed to a deregulation in the cognitive loops and the “impulsivity” endophenotype. Whereas in cases of ASD without an ADHD component the limbic and sensimotore cortico-striatal regulations loops are also involved.

Conclusions

There are clear indications that a possible comorbidity of substance abuse disorder should be considered in cases of individuals with autism spectrum disorders. This finding is important for clinicians to take into account in assessing patients with addiction problems and ASD.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Transcultural issues in diagnostic process
Authors: Kastrup M.
Published: May 2016

Diagnostic systems and methods must respond to patients’ diversity in expressions of mental distress, social and cultural context and the meanings given to illness. Due to increasing migration and globalisation the challenge of considering diagnosis in the context of culture has become increasingly significant in Europe. And globalization has further led to changes in value systems and our awareness of patients with ethnic minority background.

Over recent decades, there has been an increasing development of psychiatric diagnosing with nosological categorisation combined with multi-axial schemas. Diagnosis, besides identifying a disorder and distinguishing one disorder from another disorder - differential diagnosis, has also an aim to include an overall understanding of the patient's situation.

We witness an upsurge in the attention paid to the cultural limitations to psychiatric diagnostic practice and treatment modalities. Guidelines for the psychiatric profession are in critical focus from a transcultural perspective. Some claim their universality independent of cultural context; others find cultural adaptation useful and necessary.

Do the diagnoses and clinical and ethical guidelines give meaning in the cultural setting? Are they compatible with the cultural values of the therapist and those of the patient and the family? Several sources claim the biomedical paradigm for being Western with insufficient consideration of the socio-political context.

The cultural formulation developed as part of DSM-IV and now DSM-5 is one model to support a systematic review of culture and context in psychiatric diagnosing.

The paper will discuss the advantages and shortcomings of current diagnostic categories and guidelines vis-à-vis the universe of traumatized refugees with other ethnic backgrounds.

URL:http://www.mariannekastrup.dk/

Disclosure of interest

The author has not supplied his declaration of competing interest.
Introducing PEEP: The psychiatry early experience programme
Authors: Qureshi H. , Holt C. , Mirvis R. , Cross S. , Hussain O. , Hutchings H. , Marshall E. , Turner F. , Wilson Jones C.
Published: May 2016

At Guy's King's and St Thomas’ School of Medicine, a unique initiative is the Psychiatry Early Experience Programme (PEEP), which allows students to shadow psychiatry trainees at work several times a year. The students’ attitudes towards psychiatry and the scheme are regularly assessed and initial results are already available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Value-based healthcare delivery in the digital era
Authors: Seara G. , Payá A. , Mayol J.
Published: May 2016

Introduction

Mental disorders are a major cause of disability in Europe [1]. However, organizational structures and information systems are focused on delivery of care, rather than providing value [2]. In the digital era, we have the capacity to change priorities through the analysis of heterogeneous databases that could support patients’ and professionals’ decisions.

Objectives

to analyse the contradictions between the design and the theoretical structure of mental health services and the possibilities to evaluate the actual value of the delivered care.

Aims

To reflect on changing the trend using a different conceptualization of objectives and evaluating methods.

Methods

We used a tool provided to clinicians by the Madrid's Regional Health Service SERMAS (‘ConsultaWeb’) combining primary care, pharmacy and hospital data (n = 395,073 patients for the catchment area), and a set of hospital-based data (patients attended by psychiatrists at the ER, n = 13,877, and patients admitted to the Psychiatric Inpatient unit n = 3318), to explore some of the present professional information resources.

Results

Currently used healthcare databases only describe the diagnostic or therapeutic categories of patients and might be used to detect abnormal behaviours. However, they are neither able to show the functional status of patients nor designed to predict their clinical course.

Conclusions

A clearer definition of value in patient outcomes is needed. This might help to organize the healthcare delivery and to create a new information system that would allow to asses health outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Motor symptoms and altered connectivity in schizophrenia
Authors: Walther S. , Stegmayer K. , Tobias B. , Federspiel A.
Published: May 2016

Schizophrenia spectrum disorders are frequently associated with motor abnormalities. Aberrant motor function can be observed in patients throughout the course of the disorder, in subjects at high clinical risk and in unaffected first-degree relatives. Schizophrenia is further characterized by white matter abnormalities in multiple fiber tracts and aberrant resting state cerebral perfusion. In a series of studies, we investigated the association of objectively measured motor behavior in terms of activity levels with white matter microstructure and cerebral perfusion at rest. Patients were less active than controls at the behavioral level. In the associations with neuroimaging techniques, we detected that unlike controls, patients’ activity levels were linked to structure and perfusion of cortical motor areas as well as the connecting white matter. In controls instead, motor activity relied on the association of cortico-subcortical motor loops. Thus, some of the motor signs in schizophrenia may result from ineffective coupling between cortical and subcortical motor areas. Finally, preliminary data from functional connectivity analyses support this notion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Organizing mental health care in nursing homes: How, by whom and what for?
Authors: de Mendonça Lima C.A.
Published: May 2016

Though care should be provided in patients’ homes for as long as possible, it must be recognised that care in an alternative residential setting may be the only way of meeting some patients’ needs effectively or avoiding intolerable carer burden. Such care will always be necessary, for people who have no relatives available. The residential care may be useful for respite care including a range of time limited services, to support the carers. Residential care should also be available for those patients whose physical, psychological, and/or social dependencies make living at home no longer possible. This provision includes a range from supported accommodations with low level supervision, medium level care facilities and full nursing facilities. There is a high prevalence of mental disorders in nursing homes and very often the staff is not adequately educated, trained and supported to care these individuals. Psychiatric consultation liaison services should be provided not only for residents but also to support the staff of these facilities. The most recent international documents point out the necessity to offer the best available care [1] for these vulnerable persons in the deep respect of their dignity [2]. It becomes urgent to launch a deep debate on this subject in order to recommend to authorities the best guidelines to support policies to be adopted in this field.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Prisoners with intellectual disability: How to adapt interventions and the environment
Authors: Tort Herrando V.
Published: May 2016

There is an increasing interest in the Spanish prison to give the appropriate care when they are in prison. This situation has a special meaning in inmates with learning disabilities, as they are a vulnerable group inside prison. They are vulnerable in different areas as they have a high prevalence dual diagnosis (both with mental illness and drug misuse), they could suffer from abuse from other inmates, difficulties to understand prison regulations, etc. The prevalence of intellectual disability (ID) in the prison setting has been poorly evaluated. In Spain, despite various approximations or estimates regarding people with intellectual disabilities no reliable data is available.

In our presentation, we will give an overview of the care of this group of patients, presenting some data from an epidemiological study in Spain. The rate of learning disabilities was of 3.77% of the study population has an IQ below 70, and 7, 3% has borderline IQ rate. We also describe a new setting in one of wards of a prison of Barcelona where has a model of therapeutic community for treating offenders with intellectual disabilities. This resource open two years ago and is run between prison services and an organization “Accepta” (specialized in people with learning disability and penal law problems). This is an effort from the prison services to adapt to the needs of inmates and deliver a better service with a good post-release follow-up.

And finally, we present some data about learning disability in penitentiary psychiatric settings (the prevalence as a main diagnose is around 10%).

Disclosure of interest

The author has not supplied his declaration of competing interest.
Clinical pharmacological management of polypharmacy in old age depression
Authors: Baumann P. , Greil W.
Published: May 2016

Polypharmacy is the rule in psychogeriatric patients, as they present frequently comorbidities such as depression, dementia [often including Behavioral and Psychological Symptoms of Dementia (BPSD)] and somatic diseases. Recommended treatments for geriatric depression are antidepressant medications, psychotherapy and psychosocial interventions [1]. Besides antidepressants, other psychotropic drugs are often co-prescribed, but somatic drugs are also needed for the treatment of other concomitant diseases. This situation increases the risk for adverse effects due to pharmacokinetic and pharmacodynamic interactions, especially since the organism of elderly patients displays a lowered homeostatic reserve and a decrease of functions, which allows resisting to xenobiotic influences.

On the other hand, there are also studies which suggest that in hospitalized psychogeriatric patients, the incidence of severe adverse reactions is lower in patients > 60 y than in those < 60 y [2]. This is one of the results of the AMSP-study group, which in German speaking countries has developed a pharmacovigilance program in psychiatric hospitals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Temporality and spatiality of anxious experience
Authors: Doerr-Zegers O.
Published: May 2016

Since the first descriptions of anxiety, it has been related with temporality and in particular with the dimension of future. Thus, we already find anxiety defined as a general feeling of threatening (from the future) in the German mystic Jakob Boehme (1575–1634). He also used the image of “the wheel of anxiety”, with which he refers to its probable origin in a conflict between two forces which tend to separate themselves and are not able to do it, as a result from this centrifugal rotation movement of a wheel. This image also has a temporal character. In Kierkegaard, we read that “anxiety is always related with the future… and when we are disturbed by the past we are basically projecting toward the future…” In Heidegger's masterpiece, “Being and Time”, there is a chapter dedicated to the temporality of Befindlichkeit, and in particular to anxiety. Fear and anxiety have their roots, according to Heidegger, in the past, but their relation with the future makes them different: anxiety arises from the future as possibility, while fear arises from the lost present. In this paper, we try to make a contribution to the phenomenology of temporality (and of spatiality) of anxiety in relation with the analysis of a concrete anxiety experience: flight phobia. The analysis allows us to show both the desolation and narrowing of anxiety space, and with respect to temporality, the disappearance of every plan (the future), of every history (the past), and the reduction of the present to a succession of mere punctualities, behind which there arises, threatening, the nothingness itself.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Adopting and maintaining physical activity behaviour in people with severe mental illness: The importance of autonomous motivation
Authors: Probst M.
Published: May 2016

Background

Physiotherapy can improve the health of people with serious mental illness (SMI) but many are inactive. Adopting theoretically-based evidence considering the motivational processes linked to the adoption and maintenance of an active lifestyle can assist physiotherapists in facilitating lifestyle changes in people with SMI.

Purpose

Within the Self-Determination Theory (SDT) and the Trans-Theoretical Model (TTM) (stages of change) frameworks, we investigated differences in motives for physical activity between different diagnostic SMI groups.

Methods

All participants with SMI from 15 different centers completed the Behavioral Regulation in Exercise Questionnaire 2 (BREQ-2), the International Physical Activity Questionnaire (IPAQ) and the Patient-centered Assessment and Counseling for Exercise (PACE) questionnaire.

Results

Overall 294 persons with SMI (190♀) (43.6 ± 13.6years) agreed to participate. People with affective disorders had higher levels of introjected regulations than people with schizophrenia. No significant differences were found for other motivational regulations. Moreover, no significant differences were found according to gender, setting and educational level. Multivariate analyses showed significantly higher levels of amotivation and external regulations and lower levels of identified and intrinsic regulations in the earlier stages of change. Strongest correlations with the IPAQ were found for motivational regulations towards walking.

Conclusions

Our results suggest that in all people with SMI the level of identified and intrinsic motivation may play an important role in the adoption and maintenance of health promoting behaviours.

Implications

The study provides a platform for future research to investigate the relationships between autonomy support, motivational regulations and physical and mental health variables within physiotherapy interventions for this population.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Classification and clinical issues relating to hypersexuality
Authors: Potenza M. , Shane K. , Rani H.
Published: May 2016

Multiple terms have been used to describe excessive and interfering patterns of non-paraphilic sexual behaviors including sex addiction, compulsive sexual behavior (CSB) and hypersexual disorder (HD). While a field trial was conducted to investigate the reliability and validity of the criteria for HD, the condition was not included in DSM-5, with this decision in part relating to insufficient data on the proposed condition. Currently, CSB is being considered as a diagnostic entity in the category of impulse-control disorders for ICD-11. In this presentation, we will present data relating to HD/CSB. In particular, we will discuss current issues relating to diagnosis and classification, as well as data regarding the assessment and clinical correlates of sexually relevant constructs (e.g., pornography use and craving). Data relating HD/CSB behaviors to sexual risk-taking, sexually transmitted diseases and mental health problems (including suicidality) will be presented. A strategy for addressing HD/CSB in clinical settings will be proposed and discussed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Discontinuation vs. continuation treatment with neuroleptics for a better long-term outcome
Authors: Wunderink L. , Nieboer R. , Nienhuis F. , Sytema S. , Wiersma D.
Published: May 2016

Background

Long-term functional outcome of dose-reduction/discontinuation strategies in first-episode psychosis (FEP) has not been studied before. The present study compared 7-year outcome of an early antipsychotic dose-reduction/discontinuation (DR) strategy with maintenance treatment (MT). Primary outcome was (symptomatic and functional) recovery; relapse rates, functional and symptomatic remission were secondary outcomes.

Methods

FEP patients (n = 128) symptomatically remitted for 6 m during their first treatment year who completed an 18 months trial comparing MT and DR were followed-up at 7 years. Symptomatic remission criteria were adopted from Andreasen et al., functional remission criteria were based on a functioning scale. Recovery was defined as meeting both criteria sets. MT or DR strategy, and baseline parameters were entered in a logistic regression analysis with symptom and functional remission and recovery at 7-years follow-up as dependent variables.

Results

One hundred and three patients consented to participate. DR-patients showed twice the recovery-rate of MT-patients (40% against 18%), odds ratio 3.5 (P = .014). Symptomatic remission-rates were equal (69% and 67%). Better DR recovery-rates were attributable to higher functional remission-rates (46% vs. 20%) in DR. Predictors of recovery were DR, baseline living together and less severe negative symptoms. During the last 2 years of follow-up the mean daily dose in haloperidol equivalents was 2.20 mg in DR vs. 3.60 mg in MT (P = .031).

Relapse rates were initially higher in DR but leveled at 3 years; 61.5% relapsed in DR and 68.6% in MT in 7 years.

Conclusion

DR of antipsychotics during early stages of remitted FEP significantly improved 7-years outcome in terms of recovery and functional remission compared to maintenance treatment. Though initially relapse rates in GD were higher, these equalled those in MT from 3 years to the end of the study. While the necessity of immediate antipsychotic treatment in FEP and positive symptoms relapse is robustly demonstrated in a great number of studies, this study suggests that we are faced with a dilemma concerning the drawbacks of long-term maintenance antipsychotic treatment on functional capacity. Though antipsychotic discontinuation appears only feasible without relapse in a substantial minority of patients, guided dose-reduction as far as positive symptoms remain subsided and allow it, appears a feasible strategy in view of functional recovery, doing justice to both sides of the dilemma.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional instability and borderline personality disorder
Authors: Ebner-Priemer U. , Santangelo P. , Bohus M.
Published: May 2016

Affective instability is widely regarded as being the core problem in patients with borderline personality disorder (BPD) and the driving force behind the severe clinical manifestations of BPD symptoms. In ICD-10, BPD is even labelled as emotionally unstable personality disorder. In the last years, the advent of electronic diaries, in combination with sophisticated statistical analyses, enabled studying affective instability in everyday life. Surprisingly, most recent studies using state-of-the-art methodology to assess and model affective instability in BPD failed to show any specificity, supporting the idea of a transdiagnostic construct. In addition, dysfunctional emotion regulation strategies revealed results contradictory to current clinical beliefs. Using multiple data sets and multilevel modelling, we will demonstrate that to understand affective instability it is important:

– to statically model basic subcomponents of affective dynamics simultaneously;

– in combination with dysfunctional regulation strategies;

– cognitive processes in everyday life.

Altogether, current research suggests that the dynamics of affective states and their intentional regulation are even more important to psychological health and maladjustment, than the affective states itself. Current initiatives to fundamentally improve psychopathological research are looking at basic physiological processes spanning across disorders. However, these approaches do fall short in understanding human behaviours as dynamical processes that unfold in the broadest setting imaginable – everyday life. Only the combination of basic physiological processes and methods assessing dynamical affective mechanisms in everyday life will enhance our understanding how dysregulations and dysfunctions of fundamental aspects of behaviour cut across traditional disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The age of onset of anxiety disorders in samples from the general population: A meta-analysis
Authors: de Lijster J. , Dierckx B. , Utens E. , Verhulst F. , Zieldorff C. , Dieleman G. , Legerstee J.
Published: May 2016

Workshop

Age of onset of mental disorders: etiopathogenetic and treatment implications.

Background

Age of onset (AOO) of anxiety disorders could serve as a vital statistic in the formulation of mental health policy. Previous reviews have reported on the AOO of anxiety disorders in the general population. However, these review studies did not systematically estimate the AOO of different anxiety disorder subtypes, and did not examine factors that might have influenced reported AOO.

Objective

The aims of the present study were (1) to estimate the AOO for all anxiety disorders and for specific subtypes, (2) to examine gender differences in AOO of anxiety disorders, and (3) to examine the influence of study characteristics on reported AOO.

Method

Seven electronic databases were searched with keywords representing anxiety disorder subtypes, AOO and study design. The inclusion criteria were studies using a general population sample that provided data on AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV or ICD-10 criteria. Meta-analysis was used to estimate AOO and gender differences, while meta-regression was used to examine the influence of study characteristics.

Results

A total of 1028 titles were examined, which yielded 24 studies meeting the inclusion criteria. Meta-analysis found an average AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to 25.07). Separation anxiety disorder, specific phobia and social phobia had their mean onset before the age of 15 years, whereas AOO of agoraphobia, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder and generalized anxiety disorder began on average between 21.1 and 34.9 years. Anxiety disorder is more common in women, but meta-analysis revealed no difference in AOO between genders. Prospective study design and higher developmental level of the study country were associated with earlier AOO.

Conclusion

Results from this meta-analysis indicate that anxiety disorder subtypes differ in mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards the factors associated with the development of subtypes of anxiety disorder in the age groups with the greatest vulnerability for developing those disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Novel research on transition from child to adult mental health services in Europe: The MILESTONE project
Authors: Tuomainen H. , Singh S.P. ,   The MILESTONE Consortium
Published: May 2016

Introduction

Current service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.

Objectives

The overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.

Aims

To improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.

Methods

Data will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.

Results

First results are expected in 2016 with further major findings following in 2019.

Conclusions

The MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychotherapeutic interventions in consultation-liaison psychiatry implications for psychiatric trainees
Authors: Koelkebeck K.
Published: May 2016

In clinical reality, psychiatric trainees working in consultation and liaison psychiatry (CLP) face a lot of obstacles to gain satisfactory results from their work on somatic wards. Specifically, the deliverance of psychotherapeutic interventions in every-day CLP is a topic of discussion. The talk will present a case of a young anorectic patient that will exemplify the difficulties in delivering psychotherapeutic treatment in every-day clinical work and will outline common difficulties, specifically in relation to interactions with staff of somatic units. The presentation will be wrapped-up by suggestions on how to deal with the most common problems.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The new neuroscience based nomenclature of neuropsychotropic drugs: A chance for a better understanding and teaching of clinical psychopharmacology
Authors: Möller H.J.
Published: May 2016

Traditional psychopharmacological terminology is based on historical grounds and under different aspects not systematic and rational. It even tends to confuse patients by prescribing a drug that does not reflect their identified diagnosis, prescribing “antipsychotics” to depression. Four major colleges of neuropsychopharmacology (ECNP, ACNP, Asian CNP, an CINP) proposed a new multi-axial pharmacologically-driven nomenclature. The template has five axes: 1- class (primary pharmacological target and relevant mechanism); 2- family (reflecting the relevant neurotransmitter and mechanism); 3- neurobiological activities; 4- efficacy and major side effects; and 5- approved indications. The results of the surveys suggest that the clinicians found the available indication-based nomenclature system dissatisfactory, non-intuitive, confusing, and doubt-inducing for them and the patients. The proposed five-axis template seeks to upend current usage bay placing pharmacology rather than indication as the primary axes. With the proposed nomenclature relating primarily to Axis 1 – the class, and usage of the other axes would largely depend the extent to which the clinician seeks to deepen the scientific and clinical base of his involvement.

Disclosure of interest

The author has not supplied his declaration of competing interest.
The negative image of psychiatry in the medical community
Authors: van der Gaag R.J.
Published: May 2016

It is a very unfortunate matter of fact that mental problems and diseases are matter to societal stigmatization. In the slipstream psychiatry has a negative image in the public eye. Fighting stigma should be at the core of all professionals involved in mental health care. Self-reflection should be a primary reaction of any psychiatrist when confronted with a sensitive issue like stigmatization and negative image. It is painful to realize that the negative image of psychiatry is also present to the community to which psychiatrists belong, namely the medical community. This is strange and hurting. Psychiatrists (then closely linked to neurology) have, worldwide strongly contributed to the birth and strengthening of medical associations. Yet psychiatrists have estranged themselves from the medical community, thus, in my view, contributing themselves to stigma on patients with mental conditions and the negative image of psychiatry. So time for action, starting by self-awareness of psychiatrists that they are medical specialist, urging oneself as a psychiatrist to behave as a medical specialist by relating to colleagues in a helpful way and keeping one's own medical knowledge and skills up to standards. Psychiatrists have so much to offer in helping their colleagues in somatic medicine.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Training in old age psychiatry: The 30 countries’ perspective
Authors: Orrell M.
Published: May 2016

To improve the care of older people with mental health problems it is necessary to have a highly skilled workforce who is very well-trained in the diagnosis and management of the range of the psychiatric problems affecting older people including the dementias. Key to this is the need to have an adequate number of specialists in geriatric psychiatry and a wider recognition of geriatric psychiatry training across Europe including a broad agreement on training requirements. In 2012 the European Association of Geriatric Psychiatry (Toot et al.) published the results of a Europe wide survey on geriatric psychiatry training to scope current practice and develop recommendations to begin a debate on harmonization. Representatives from 30 out of 38 (79%) representatives responded including many from countries where old age psychiatry was not formally a specialty. Training programs and duration varied between countries. Eleven countries reported that they had geriatric psychiatry training programs and most of these required geriatric psychiatry trainees to complete mandatory training for two years within old age psychiatry. Representatives from ten countries reported having specific Continuing Professional Development (CPD) for old age psychiatrists at consultant level.

The recognition of geriatric psychiatry as a specialist discipline in Europe is on the rise. The training procedures and processes in place vary considerably between and sometimes within countries. There are several options for harmonizing old age psychiatry training across Europe with advantages to each. However, support is required from national old age psychiatry bodies across Europe and an agreement needs to be reached on a training strategy that encompasses supervision, development, and appraisal of the knowledge and skills sets of old age psychiatrists. This workshop will look at options for harmonization and take first steps towards a consensus.

Disclosure of interest

The author has not supplied his declaration of competing interest.
Old and new reasons for specialization
Authors: Stoppe G.
Published: May 2016

Mental illness is one of the largest areas of activity in the health service, with mental disorders of the elderly an important part of it. This substantial ageing of the population is a new phenomenon, occurring over the last century. It has given prominence to mental illness in old age. There is a growing interest in making decisions about how many and which services to provide to the older community.

The expertise of old age psychiatry services lies in the care and treatment of people with complex mixtures of psychological, cognitive, functional, behavioral, physical and social problems usually relating to ageing. Current evidence suggests specialist old age services are best equipped to diagnose and treat mental illness in our ageing population. However, the specialists should be integrated optimally into a service system to the benefit of the elderly. It will be crucial to improve access of older patients to the services. The service system and the partners in the system differ to those for younger adult psychiatric patients. Thus, not only knowledge and skills underline the necessity of specialization but also the increasingly complex health service structures of modern societies.

Disclosure of interest

The author has not supplied his declaration of competing interest.
21st century house call home tele-behavioral medicine
Authors: Schwagar H.A.
Published: May 2016

Objective

This presentation will focus on and demonstrate the effective, secure, cost effective delivery of Tele-Behavioral Medicine services to patients in the privacy or their own home.

Method

Today's use of internet technology brings with it “cost effectiveness” for Tele-behavioral medicine applications. Today, with a relatively current laptop computer, a web-cam or iPad, broadband connectivity (256 kB or faster), and a downloadable, free, secure video conference application, makes this technology available literally and virtually everywhere, anywhere, in the world at any time.

Results

Medical History clearly supports the value of the “house call” as a means of getting to “see the entire picture”. Chronically ill patients are frequently visited by home health nurses and or “in home” medical monitoring programs. Psychiatrically ill patients may now receive their medication management and behavioral intervention and assessment right in the privacy of their own home. Psychiatrists and psychologists merely schedule “in home” appointments with their patients in the same manner as they would if the patient were being seen in their office.

Conclusion

Chronically ill patients favored treatment rendered in “their private space” as well as providers tended to learn much more about their patients when the provider is the “guest” in the patients home versus the patient as the “customer” in the providers office. The convenience and cost savings for both provider and patient is significant. Availability of spouses, parents etc. was a valuable addition to the Tele-Home-Behavioral Medicine model.

Disclosure of interest

The author has not supplied his declaration of competing interest.