bluuebunny/crossref_metadata_2025 huggingface dataset:
“…I Just Wanted to Report Me, I Went Into the Subway Without Paying 9 Times…”
Authors: Canseco Navarro M. , Machado Vera M.M. , Peña Serrano A. , Alonso Guitiérrez S. , Molina López F. , Juan Miguel H.S. , Canccino Botello M.
Published: May 2016

A clinical case is presented. The reason for admission was for behavioral disturbances and agitation piscomotriz episode in the street: she had gone to a library to “denounce” the police for entering the subway without paying several times. The patient was very distraught because she was heavily guarded (someone had tapped her phone, entered her house, changed objects place, she was chased down the street…). In the psychopathological examination revealed the sphere of language, her speech was fluid, with pressured speech, full of details, with loss of thread and highlighted the presence of neologisms and grammatical errors (changes of subject and predicate…) and changes some letters by others in the same word. She often used sayings incorrectly and, when you are exploring about this fact, objectively presenting alteration in abstract thinking. In addition, it presents self-references on television. The diagnostic impression was chronic psychotic process of years of evolution. In this case, it was decided to administer intramuscular antipsychotic treatment because she was not aware of the disease but presenting good tolerability profile because, otherwise, leave the track and also a good social functioning was sought. Currently, she continues in mental health, she has not reported new crisis and a progressive scan objective improvement in the organization of thought and speech, leaving the psychotic symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotion Dysregulation: A Review of the Concept and Implications for Clinical Practice
Authors: D’Agostino A. , Covanti S. , Rossi Monti M. , Starcevic V.
Published: May 2016

Introduction

Over the past decade, emotion dysregulation has become a very popular term in the psychiatric and clinical psychology literature and it has been described as a key component in a range of mental disorders. For this reason, it has been recently called the “hallmark of psychopathology” (Beauchaine et al., 2007). However, many issues make this concept controversial.

Objectives

To explore emotion dysregulation, focusing on problems related to its definition, meanings and role in many psychiatric disorders.

Aims

To clarify the psychopathological core of emotion dysregulation and to discuss potential implications for clinical practice.

Methods

A literature review was carried out by examining articles published in English between January 2003 and June 2015. A search of the databases PubMed, PsycINFO, Science Direct, Medline, EMBASE and Google Scholar was performed to identify the relevant papers.

Results

Although, there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in different proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions.

Conclusions

This review highlights a discrepancy between the widespread clinical use of emotion dysregulation and inadequate conceptual status of this construct. Better understanding of the various dimensions of emotion dysregulation has implications for treatment. Future research needs to address emotion dysregulation in all its multifaceted complexity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Late Onset Psychosis. Review
Authors: Hernández Sánchez J.M. , Canseco Navarro M.Á. , Machado Vera M. , Garay Bravo C. , Peña Serrano D.
Published: May 2016

Introduction

Several risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.

Objectives

To review the medical literature related to late-life psychosis.

Methods

Medline search and ulterior review of the related literature.

Results

Reinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.

Conclusions

Differential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Psychosis In A Blindness Patient: A Case Report
Authors: Marinho M. , Moreira C. , Catarina F.
Published: May 2016

Introduction

Using a clinical case as illustration, the present work engages the different psychopathologic alterations that blindness patients could present.

Methods

The presentation and discussion of a clinical case of psychosis in a blind patient are addressed. The scientific documentation used as support was obtained from PubMed/Medline search engines using as keywords blindness and psychosis.

Results

A 43-years-old male patient, with a medical history of arterial hypertension, heroine dependence (presently with methadone schema) and bilateral blindness caused by a bilateral retinal detachment 20 years ago, was admitted in the psychiatric ward. The patient's historical record includes a previous personality with paranoid characteristics, as well as a hospitalization due to persecutory and auto-reference ideas and kinaesthetic hallucinations with 1 month of evolution, coincident with address changes. Lab tests revealed the following results: haemoglobin 13.8; Leucocytosis 13,400; CRP: 6.2; ALT > AST. Positive results were obtained in the drug tests for cannabinoids, as well as for the anti-HCV antibody (IgG). Finally, the patient was medicated with an antipsychotic and humour stabilizer, achieving a significant improvement after 10 days of hospitalization.

Conclusions

Although studies reveal that mental and behavioural disorders, especially those with symptoms of psychosis and mental retardation, are common among people with congenital blindness, more knowledge of the prevalence and aetiology of mental and behavioural disorders among people suffering from blindness is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Atypical antipsychotic switching versus atypical antipsychotic combination in schizoaffective disorder – A clinical case
Authors: Ballesteros A. , Cortés B. , Petcu A. , Montes L. , Jaimes W. , Inchausti F.
Published: May 2016

Introduction

Recent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.

Objective

We present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.

Aims

To study “oral AAP-LAIA combo” benefits in refractory SAFM cases.

Methods

Our patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.

Results

We maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.

Conclusions

Oral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The practitioner cope with adverse events on atypical antipsychotics: About 63 patients with schizophrenia
Authors: Berrahal I. , Triki R. , Chebbi R. , Ghanjati B. , Ghachem R.
Published: May 2016

Introduction

The propensity of atypical antipsychotics (AAP) for having a therapeutic effect with fewer side effects and the balancing of these supposed benefits with tolerance are the subject of many studies.

Aims and objectives

We focused on adverse drug events (ADEs), occurred under AAP, in a population of patients with schizophrenia to assess the prevalences and describe how the practitioner deal with these ADEs.

Methods

We have used a retrospective and descriptive study of 63 Tunisian patients with schizophrenia, consulting in the adult outpatient of Razi hospital and treated by one type of AAP. The study period was 6 months from the 1st January 2015. We used the Birchwood Insight Scale (BIS), Positive and Negative Syndrome Scale (PANSS) and Udvalg for Kliniske Undersogelser (UKU) to assess the insight, psychotic symptoms and ADEs.

Results

Twenty-four patients were on risperidone, 22 on olanzapine, 8 on amisulpride and 9 on clozapine. Antiparkinsonism drug (15.9%) was associated because of neurological ADEs mainly Parkinsonism. Asthenia had a prevalence of 20.6%. Hypersalivation and palpitation were estimated at 7.9% both. Weight gain's prevalence was 25.4%, including 1 case associated with hypercholesterolemia and 1 case of unbalanced non-insulin-dependent diabetes. The erectile dysfunction's prevalence was 36.3% and decreased libido 27%. There were 2 cases of neutropenia and thrombocytopenia. The management of these ADEs was observed when they moderately began to influence the patient's daily activity.

Conclusion

ADEs must be subject to an appropriate treatment and if necessary resort to a specialist consultation to confirm or deny imputability to AAP.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Tolerability and side effects of an extended-release injectable suspension of aripripazole in a series of inpatients in a dual diagnosis unit
Authors: Farre A. , Palma A. , Mateu G. , Perez de Heredia J.L. , Martinez R. , Castillo C. , Hurtado M.G. , Martí J. , Sanchez R. , Campillo M.T. , Torrens M.
Published: May 2016

Introduction

The integrated care in dual diagnosis units involves selecting pharmacological treatment strategies for both substance use disorder and the non-addictive psychiatric disorder. It is recommended to choose drugs with a favorable balance between efficacy/tolerability, an adequate side effects profile and the minimal drug interactions.

Objectives and aims

To evaluate the tolerability and side effects after first administration-first dose of an extended-release injectable suspension of aripiprazole in a group of patients admitted to an acute dual diagnosis unit.

Methods

The study included a series of patients admitted in our unit from May to August 2015 that received the first dose of the aripiprazole preparation (400 mg). Evaluations included different scales for side effects (SAS, ESRS, UKU) and the clinical global impression scale (CGI).

Results

A total of 9 patients were included and evaluated (all men, mean age: 39-years-old). Diagnoses were: bipolar disorder (5/9), schizophrenia (2/9), schizoaffective disorder (1/9) and delusional disorder (1/9) with concomitant substance use disorder (6 cannabis, 2 alcohol, 1 cocaine). All of them without outpatient control and treatment at admission. The results of the clinical scales conclude that none of them had significant side effects, including extrapyramidal, with an improvement in the ICG scale.

Conclusion

Tolerability of extended-release injectable suspension of aripiprazole was good in all cases. In the future, new cases should be included to extend the sample and to evaluate other aspects such as the craving for substances.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment efficacy with paliperidone palmitate in patients after the first psychotic episode
Authors: Galiano Rus S. , Soler Iborte A. , García Marín S.
Published: May 2016

Objectives

To evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.

Materials and methods

Two-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.

Results

Average scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.

Conclusion

The results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Effective doses of paliperidone palmitate (PAP): Retrospective analysis from three years of treatment
Authors: Galiano Rus S. , Soler Iborte A. , Quesada González C.
Published: May 2016

Introduction

The use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.

Materials and methods

Two initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.

Results

Average doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.

Conclusions

The data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Discontinuation, read missions and polytherapy with long-acting antipsychotics: An observational study
Authors: García Cabeza I. , Pérez Marín P. , De Diego H.
Published: May 2016

Introduction and aim

Long-acting antipsychotics (LAIs) provide certain advantages over oral medications. The aim of our study is to determine whether there are differences between the various long-acting injectable antipsychotics available in our environment.

Methods

A retrospective observational study with psychotic patients discharged with LAIs was designed. Data on discontinuation, relapses and associated drugs in the discharge and in a year follow-up were collected. Fifty-seven patients were included: 21 risperidone (RLAI), 20 paliperidone palmitate (PP) and 16 first-generation LAIs (FG). Odds ratio was used to compare discontinuation, χ2 test for categorical variables and Kruskal-Wallis test for independent samples.

Results

Discontinuation was lower with PP: ORRLAI/PP = 2.74 and ORFGLAI/PP = 3.09. There were significant differences in readmissions: rehospitalizations (χ2 = 7.072, P = 0.029) and days of stay (χ2 = 8.251; P = 0.016), both lower in the PP group. We found less use of psychoactive drugs with PP, with significant differences in the discharge (χ2 = 11.518; P = 0.003) and in the follow-up (χ2 = 7.097; P = 0.029). There were also significant differences in the use of oral antipsychotics in the discharge (χ2 = 27.049, P = 0.000); anticholinergic drugs in the discharge (χ2 = 7.001, P = 0.03) and in the follow-up (χ2 = 11.699, P = 0.003) and benzodiazepines in the follow-up (χ2 = 8.493, P = 0.014), always lower in the group of patients treated with PP.

Conclusions

Treatment with paliperidone palmitate may be more suitable than other long acting antipsychotics when it starts during the acute episode.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Clinical and socio-demographic characteristics of a sample of outpatients with long-acting injectable antipsychotic treatment
Authors: Moreno Monmany J. , Tinoco Calero I. , Bagué Gomez N. , Samsó Buxareu B. , Chavarria Romero V. , Castillo Magaña S. , Oller Canet S.
Published: May 2016

Introduction

There are relatively few studies of Long-acting injectable antipsychotics (LAI), although poor adherence to treatment is one of the main problems in patients with psychotic disorders.

Objectives

The aim of the study is to describe socio-demographic and clinical characteristics of a sample of outpatients with LAI treatment.

Methods

This is a cross-sectional study. A randomized sampling was performed among the outpatients that were receiving LAI in an outpatient clinic in Barcelona (Spain). For each patient, socio-demographic, clinical and pharmacotherapeutic data were collected through interviews and clinical history.

Results

The sample consisted of 30 subjects (50% men, average age 48 years). Most of the patients in the sample have basic education (50%) and are unemployed, receiving permanent disability pension (39.3%). In addition, 44.8% of the subjects were living with family members and were not married (56.7%). Of the patients, 70% were diagnosed with schizophrenia, 13.3% schizoaffective, 10% bipolar and 6.7% delusional disorder. The main reason to initiate LAI treatment was due to non-compliance of the prescribed oral treatment (85.7%). The 40% of patients were also with oral antipsychotic treatment. Average punctuation in the 3 first items of the Scale to Assess Unawareness of Mental Disorder: 11. Average punctuation in the short version of the Simpson-Angus Scale: 1.68.

Conclusions

In our sample, the outpatients with LAI treatment had a low functioning and disease awareness. Although the main reason to start LAI is the non-compliance, 40% of the patients were concurrently treated with oral antipsychotics. The extrapyramidal side effects are mild.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A comparison of risperidone and olanzapine in the acute treatment of persistent delusional disorder: Data from a retrospective chart review
Authors: Kulkarni K. , Arasappa R. , Prasad K. , Zutshi A. , Chand P. , Muralidharan K. , Murthy P.
Published: May 2016

Introduction

There is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.

Objectives and aims

We aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.

Methods

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.

Results

A total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).

Conclusion

Our study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Lithium treatment and thyroid dysfunction – data from an inpatient psychiatric department
Authors: Lázaro M. , Mota A. , Moreira A. , Alves R. , Nobre M.A.
Published: May 2016

Introduction

Lithium is among the most effective therapies for bipolar disorder. Lithium treatment may cause hypothyroidism, goiter or to a lesser extent hyperthyroidism, since it can affect several aspects of thyroid functioning. The prevalence of lithium-associated hypothyroidism varies extensively between studies, reaching up to 47%, and affecting more females than males (5:1).

Objective

Determine the prevalence of thyroid dysfunction in an acute inpatient psychiatric department dedicated to affective disorders and its association with lithium therapy.

Aims

To review the relation between lithium treatment and thyroid dysfunction.

Methods

Observational, descriptive and retrospective study with clinical and laboratorial data concerning all inpatient episodes of 2015 in our Psychiatric Department. A non-systematic literature search was performed in PubMed.

Results

The present study documented a high prevalence of thyroid dysfunction, particularly in women. Most cases were due to either hypothyroidism or subclinical hypothyroidism. Patients treated with lithium were more often under thyroid hormone replacement therapy (levothyroxine).

Conclusions

The evidence that lithium treatment is associated with hypothyroidism is well established and this condition is easily treatable with levothyroxine. This study highlights the importance of baseline screening of thyroid function and regular long-term monitoring in patients treated with lithium.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pro-BNP as a biomarker of asymptomatic clozapine-related heart dysfunction: Possible usefulness for clozapine management
Authors: Prisco V. , Petrosino M. , Fabrazzo M.
Published: May 2016

Cardiovascular clozapine-related side effects such as tachycardia and orthostatic hypotension are well recognized, but are rarely clinically important. However, the increasing number of life-threatening drug-related complications are giving rise to concerns about cardiac adverse reactions (myocarditis, cardiomyopathy, pericarditis and heart failure). The diagnosis is usually made considering patient's symptoms, such as tachycardia, slightly increased body temperature, subjective chest pain, dyspnea. However, this symptomatology is not always present in a clozapine-related pericarditis. Some authors suggest measuring BNP levels to detect early and asymptomatic cardiac dysfunction. We here report the clinical cases of two women, respectively 22 and 28 years old. They both suffered from an early onset resistant schizophrenia. Clozapine was gradually introduced, at a dose of 200 mg/day, in both patients. After about one month in both cases, while the first patient was nearly asymptomatic, apart from the intermittent fever (only PCR and pro-BNP values were elevated, 16.88 mg/dL and 1004 pg/mL, respectively), the second one showed a classic symptomatology suggestive of pericarditis. Clozapine was discontinued in both patients, resulting in progressive resolution of pericarditis. Interestingly, in the patient in which pro-BNP was elevated, after clozapine cessation, the pro-BNP fell down dramatically. Pro-BNP plasma levels appears to be an interesting test in identifying subjects with asymptomatic cardiac impairment. It would be useful to evaluate if early treatment with beta-blockers and ACE-inhibitors may allow the prosecution of clozapine treatment after developing of mild signs of cardiac toxicity in drug resistant schizophrenic patients responsive to clozapine.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mental health transition plans for older adolescents with autistic spectrum disorders – clinical profile of patients from a metropolitan Borough, North West of England
Authors: Olety S.
Published: May 2016

Introduction

The needs of people with Autistic Spectrum Conditions (ASC) are varied and complex. In order to improve outcomes for Adults with Autism, it is important to understand and evaluate the transition planning process and current services for adolescents/young Adults with ASC.

Aims and objectives

Aim was to undertake the needs assessment audit of all young people (ages 16–19) open to a Child and Adolescent Mental Health Service. Objectives was to ensure that transition/discharge plan was in place for all the open cases and also identify any gaps in service provision.

Methods

A retrospective case-note review of all open cases (n = 41) aged 16–19 was undertaken. Data was obtained on diagnosis, co morbid problems, educational status, and transition/discharge plans.

Results

Twenty-two percent of the cases had co morbid moderate to severe Intellectual Disability. Transition was not an issue for this group, with entitlement of support from secondary-care-teams. Seventy-eight percent of the cases had diagnosis of Asperger's Syndrome (AS)/high functioning autism (HFA). Seventy-five percent had co-morbid depressive/anxiety disorders, 12% had ADHD and 10% presented with repeated self-harm/suicidal behaviour. Nature of the co-morbid problems/risks did not meet thresholds for Community Adult Secondary Mental Health Services resulting in discharge to Primary Health Care Services.

Conclusions

Better training to equip primary care staff, such as General Practitioners is needed to support the growing numbers of young adults with HFA/Asperger's syndrome being discharged to their care. Costs/benefits of providing specialist adult services for people with HFA and AS to be considered in order to improve outcomes for adults with autism.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.
Public stigma of electroconvulsive therapy (ECT) in the Czech Republic
Authors: Mádlová K. , Kališová L. , Zajícová M.
Published: May 2016

Aims

To find out how the use of ECT in psychiatry is perceived by the public in the Czech Republic.

Method

The questionnaire (8 questions monitoring awareness, knowledge of ECT and its use in modern psychiatry) created for the purpose of this study was shared through internet and also distributed in paper version to public.

Results

The sample consists of 365 respondents – age average 28.9 years, 62% of females, 53% of university graduates, 44% with secondary education, 3% other education, 27% of healthcare professionals outside the field of psychiatry, 20% of medical students before the start of the traineeship at psychiatry, 53% of the public. Among the respondents, 98% have heard about ECT, 7% of them think that ECT is no longer used. Among the respondents, 62% learned about ECT from the media (film, print). Among the respondents, 22% do not believe in the effectiveness of ECT, 30% think that ECT is abused by psychiatrists, 86% believe that ECT has side effects (personality changes, permanent memory disorders, brain damage, epilepsy). Among the respondents, 77% would agree with ECT, if it should be applied to their relative.

Discussion

ECT is an effective method in treating of severe mental disorders. But until now the public view is influenced by media. Due to the negative stereotype of the method many people are afraid of this treatment. The interesting fact is that also health professionals and medical students are influenced by public stigma of ECT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Posterior vitreous detachment and electroconvulsive therapy: Insights from a case
Authors: Pavez F. , Alcántara A. , López N. , García A. , Sánchez M. , Roca M. , Moral E. , Russo J.
Published: May 2016

A case of bilateral posterior vitreous detachment after electroconvulsive therapy (ECT) has been reported previously in the literature. There is not enough evidence about ocular side effects of this treatment. The literature supports a slight increase in intraocular pressure (IOP), although no ocular complications have been reported in normal, glaucomatous or postsurgical eyes. In this case report, we describe a 73-year-old female patient suffering a recurrent depressive disorder, who was admitted to acute psychiatric unit because a treatment-resistant major depressive episode (after an adequate trial of antidepressant drugs and transcranial magnetic stimulation) and clinical suspicion of visual delusions by her reference psychiatrist. The nonpsychiatric history consisted of hypertension, glaucoma and ulcerative colitis in treatment with azathioprine and mesalazine. After a careful examination in the emergency room, we consulted to ophthalmologist because miodesopsias and glaucoma history. The IOP was normal, but a bilateral posterior vitreous detachment (PVD) was identified. Because this entity is not an absolute contraindication for ECT, and there is scarce evidence, we informed the patient and her family. After that, and through informed consent, we decided to undergo ECT. After fourteen sessions, the patient could be discharged because significant clinical benefit and no ocular complications. Outpatient continuation ECT was indicated.

Conclusions

ECT can be a safe treatment choice in cases of PVD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Patient's outgroup socialization in the psychotherapeutic group
Authors: Baños Martín I. , Eaton Itúrbide K. , Guerra Gómez E. , Unzeta Conde B. , Vilariño Besteiro P. , Pérez Bustillo P. , Sanz Mendoza J. , Pérez Franco C. , Lahera Forteza G.
Published: May 2016

Introduction

Patient's outgroup socialization may be a problem in the psychotherapeutic group functioning. Disadvantages – and even benefits – of this common issue in psychotherapy have been described (Vinogradov S., Yalom I.). However, the impact of new social networks – that facilitate other ways of immediate and easy communication – on this phenomenon is still unknown.

Aims and objectives

To explore the risks of spontaneous “self-help groups” supported by new technologies for the psychotherapeutic group functioning.

Method

Course description of a psychotherapeutic group, composed by patients with eating disorders (bulimia nervosa and binge eating disorder) in the context of a specialized hospital day.

Results

A patient – who has recently had a breakup – asked help to the group through a non-reported whatsapp chat. Gradually, patients used this new channel to express distress and daily interpersonal difficulties, showing less implication in the supervised group sessions. The patient presented a symptomatic relapse with self-harm injuries and severe eating symptoms. Finally, she left the therapy and, in the next weeks, other patients also left the group, due to different reasons, in a “drag phenomenon”. The analysis showed that the formation of this outgroup socialization changed the relationships between members and new roles were taken.

Conclusions

It is necessary to early address the formation of outgroup socialization in the pre-group interview, emphasizing its high risk for the future group functioning. Therapists should consider that out-group communication is common and easy due to new technologies, so the use of specific questionnaires about this issue may prevent or detect pathological events.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treating trauma with EMDR in adults with autism spectrum disorders (ASD) – A literature review
Authors: Sizoo B. , Lobregt E.
Published: May 2016

Introduction

Little is known about trauma or treatment of trauma with Eye Movement Desensitization and Reprocessing (EMDR), in adults with ASD. Neither is it clear on how ASD influences the expression of posttraumatic stress.

Objectives

(1) To increase knowledge about treatment of trauma, and trauma related symptoms in adults with ASD. (2) To provide directionsfor research into the effects of EMDR on the expression of autistic and trauma related symptoms in adults with ASD.

Methods

Review of the literature using Cochrane Collaboration Centre, Embase, Medline, PsychINFO, PubMed and Web of Science.

Results

Clinicians often overlook trauma related symptoms in people with a severe mental illness like ASD, due to diagnostic overshadowing (Grubaugh, Cusack and Zinzow, 2008), caused by the overlap between Post Traumatic Stress Disorder (PTSD) and ASD. In the case of diagnostic overshadowing, symptoms like avoidance, hyperarousal and reduced ability to mentalize (Plana, Lavoie, Battaglia and Achim, 2014) are attributed to ASD, while in actual fact they are manifestations of stress reactions related to perceived traumatic events. However, when symptoms are correctly attributed to negative experiences, clinicians tend to withhold treatment because of fear of aggravating symptoms (Frueh, Cusack, Grubaugh, Sauvageot and Wells, 2006). The literature suggests that trauma in adults with ASD is undertreated.

Conclusion

To our knowledge, the effects of EMDR in adults with ASD have not yet been studied, except at case level. A study protocol will be presented to assess the efficacy of EMDR treatment for trauma related symptoms in adults with ASD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Mutual aid program among adults with mental health illness as part of the treatment in a day hospital
Authors: Guerrero Jiménez M. , Carrillo de Albornoz Calahorro C.M. , Rodrigo Manzano J.A. , Girela Serrano B.M.
Published: May 2016

Introduction/objectives

To supervise agents in a mutual aid experience in Motril Mental Health Day Hospital. To perform a supporting role among the agents involved in a mutual aid program to consolidate its operations autonomously.

Methods

A multidisciplinary working group, which met every two weeks for 4 months was set. Group sessions were planned. We selected mutual aid pairs individually and addressed the difficulties in the process. The experiment was performed with 4 agents setting a maximum of 5 interviews. A success criterion of 80% of the meetings planned was established. In between mutual aid group, success criterion was to maintain a 3-month experience held by 5 members. A qualitative analysis of most important issues amongst coordination meetings were also held.

Results

Three out of 4 pairs reached 80% of the interviews successfully. The support group was developed weekly during 3 months with an average of 8 participants. The trending topics during coordination meetings were toxic consumption, acute crisis, drug intake and issues to be addressed with the psychiatrist.

Conclusions

Mutual aid among users is a way of intervention that needs to be further consolidated. The establishment is still unpretentious and has low weight amongst coordination objectives. The results addressed in number of sessions and satisfaction are favorable, but it is necessary to assess the experience widely and to begin developing specific objectives [1,2].

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Emotional management training in residential mental health services
Authors: Vaccaro A. , Fusco V. , Manfrin F. , Forte E. , Petagine G.
Published: May 2016

A core element for the treatment of psychiatric patients in mental health services is the Psychosocial Rehabilitation. In this work we mainly refer to a training whose targets are fundamental components of the Emotional Intelligence (EI), which is, according to the original Salovey and Mayer's definition (1990), “a set of skills hypothesized to contribute to the accurate appraisal and expression of emotion in oneself and in others, the effective regulation of emotion in self and others, and the use of feelings to motivate, plan, and achieve in one's life”.

The purpose of this study is to evaluate the efficacy of Emotional Management Training and to compare our emotional management assessment to standardized emotional intelligence assessment instruments.

Twenty adult inpatients (from 18 to 55 years of age) were enrolled: ten subjects were assigned to a one year lasting emotional management training (clinical target group) and ten subjects were assigned to a clinical control group; furthermore twenty subjects were selected and assigned to a non-clinical control group. Outcome measures were: emotional management assessment, Schutte Emotional Intelligence Scale (SEIS) and Toronto Alexithymia Scale (TAS-20).

Emotional management assessment outcomes confirm the efficacy of emotional management training. Preliminary results also confirm the effectiveness of the assessment compared to standardized emotional intelligence scales.

Emotional management training improves psychiatric patient competence in terms of: emotions definition and acknowledgement, self-emotion identification, self-emotion sharing, management of stressing situation and intense emotions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Facets Mindfulness Questionnaire-10 – A shorter Portuguese version to evaluate mindfulness dimensions in pregnant women
Authors: Azevedo J. , Bento E. , Xavier S. , Marques M. , Freitas V. , Soares M.J. , Pinto A.M. , Oliveira A. , Macedo A. , Pereira A.T.
Published: May 2016

Introduction

Mindfulness refers to the capacity of being present and aware, without feeling the need to react or judge that experience (Kabat Zinn, 1990). This ability is associated with mental health and stress reduction (Baer, 2014; Teasdale et al., 2014). Five Facet Mindfulness Questionnaire (FFMQ) is widely used to measure mindfulness and its relation to psychopathology (Gregorio and Gouveia, 2011).

Objective

To analyze the psychometric properties of the Portuguese 15 items FFMQ (Baer; Gregório et al., authors’ manuscript) in a Portuguese sample of pregnant women.

Methods

A total of 427 pregnant women (Mean age: 32.56 ± 4.785 years) in their second trimester of pregnancy (17.34 ± 4.790 weeks of gestation) completed the Portuguese version of FFMQ-15.

Results

The FFMQ-15 Cronbach's alpha was unsatisfactory (α = 0.62) and five items presented low (< 0.20) correlations and had the effect of increasing Cronbach alpha if removed. Without these items, α increased to a satisfactory level (0.72) and all the ten items contributed to internal consistency. The factorial analysis of these ten items resulted in a three factors solution, which explained variance (EV) was of 53.9%. Based on items content, the meaningful three factors were denominated as follows: F1 Nonjudging of experience (EV 27.69%; α = 0.77), F2 Acting with awareness (18.00%; α = 0.77) and F3 Observing and describing (8.21%; α = 0.73).

Conclusions

Although the FFMQ-15 has shown good psychometric properties in other samples, in this sample of pregnant women a 10-items FMQ (Facets of Mindfulness Questionnaire) version performed better, presenting good reliability and validity in evaluating three mindfulness facets.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Population pharmacokinetic modeling and simulations of dopamine Dd2 receptor occupancy of long-acting intramuscular risperidone-ISM
Authors: Llaudó J. , Anta L. , Ayani I. , Martínez-González J. , Gutierro I. , Faelens R. , Winkler J. , Snoeck E.
Published: May 2016

Introduction

Risperidone-ISM is a new long-acting intramuscular formulation intended to achieve sustained plasma concentrations over 4 weeks without oral supplementation. The clinical efficacy to risperidone has been associated with 65–80% occupancy of dopamine D2 receptor (D2RO) and a mean Cmax between 7.5 ng/mL and 80 ng/mL.

Aim

Use a population PK/PD model to predict the PK and the D2RO for Risperidone-ISM in schizophrenic patients and to characterize the relationship among doses, in order to guide dose selection for a future Phase-III trial.

Methods

A population PK/PD analysis for Risperidone-ISM using Monolix software was conducted based on 6641 plasma samples from two Phase-I studies (17 healthy subjects and 31 schizophrenic subjects, respectively) and 1 Phase-II study (60 schizophrenic subjects). Simulations were subsequently undertaken predicting the steady state PK and D2RO after multiple Risperidone-ISM doses administered every 28 days for 12 weeks.

Results

Doses of 75 and 100 mg, administered either in gluteal or deltoid muscle, were predicted to result in median Cmax and Ctrough that stayed between 7.5 ng/mL and 80 ng/mL. At steady state 75 mg and 100 mg dose (gluteal) achieved a D2RO average [min–max] of 70.8% [61.4–80.4] and 74.3% [66.2–82.1], respectively; a 75-mg and 100-mg dose (deltoid) achieved a D2RO average [min–max] of 69.3% [56.5–80.3] and 73.0% [61.8–82.1], respectively. The model estimated that the 65% D2RO occurs within first 8 h after treatment.

Conclusions

Simulations were carried out supporting doses of 75 mg and 100 mg Risperidone-ISM to show the greatest efficacy and safety potential to be assessed in the future Phase-III trial.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Treatment of schizophrenia with aripiprazole may contribute to improved functions
Authors: Björner A. , Erixon-Lindroth N. , Öberg Jansdotter S. , Flatla A.
Published: May 2016

Introduction

The goals with modern treatment of schizophrenia are to achieve remission of clinical symptoms, prevent relapse, and to restore the patients’ functions.

Objectives/aims

The objective of this study was to investigate the impact of treatment with the partial dopamine agonist aripiprazole on functions, measured as time spent for work or studies, in patients with schizophrenia or schizoaffective disorder.

Methods

Retrospective data on employment and study activities were collected for all patients between 18–65 years with schizophrenia or schizoaffective disorder at an open care psychosis clinic in Sweden (n = 104). Possible impact of treatment with aripiprazole and of other variables, such as age, gender, and disease severity, was analysed.

Results

Among patients who worked or studied at Day of admission (n = 36), the probability of maintaining or increasing time for work or studies was significantly higher in patients treated with aripiprazole compared with patients who were not (88% versus 53%; P = 0.020). This difference remained significant after controlling for severity of symptoms, age and sex. A secondary analysis, including all patients (independent of work or study status at Day of admission) also showed a significant difference in favour of aripiprazole (53% versus 26%, P = 0.005).

Conclusions

The results indicate that patients treated with aripiprazole (monotherapy or add-on) have higher probability of maintaining functional capacity. A plausible explanation might be aripiprazole's favourable effect on cognitive functions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Specifics of communication with schizophrenic patient
Authors: Manojlovic S. , Nikolic-Popovic J.
Published: May 2016

The precondition of communication with schizophrenics is knowing and understanding of their fragmented and chaotic world. Communication with the schizophrenics should respect their fear of fusion and disintegration, as well as the fear of abandoning. In communication with the schizophrenic two facts are important: the real support is accepting the bizarre existence of the patient, and the other side of the support is the capacity of the psychiatrist to understand and withstand the patient. This capacity is determined through the consistency of therapist's behavior, possibility to accept the patient's right on regression, but also the ability to offer the constancy of himself, too. The therapist is the representative of the reality whose consequence and constant presence enables him to grow up from the internal mixture of the mental presentations into an authentic, independent person, dedicated to the patient. The therapist is expected to tolerate the patient's alienation due to the fears from fusion or disintegration. A constant activity of reestablishing of contact and respect of a specific cognitive style are needed. Communication with the schizophrenics implies an explicit calling to a verbal communication that has to be understandable, and searching for the conceptual framework, which provides understanding. Basic characteristics of the adequate communication are persistence, consequence and simplicity of instructions with the norm of behavior control, as well as the clarity of the “here-and-now” situation. The therapist's understanding of the schizophrenics justifies his actions and allows taking the psychotherapeutic attitude.

Disclosure of interest

The authors have not supplied their declaration of competing interest.