bluuebunny/crossref_metadata_2025 huggingface dataset:
How to choose the best screening instrument for personality disorder for your specific practice
Authors: Germans S. , Van Heck G.L. , Hodiamont P.P.G.
Published: May 2011

Introduction

Personality disorders (PD) are common in psychiatric services and can adversely affect the management and outcome of mental illnesses. Therefore assessment of the personality is an essential part of initial psychiatric examination. To diagnose a PD takes time and competence. A screening instrument in the diagnostic phase can be a solution.

Aim

The goal of the study was to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.

Method

Nine screening instruments were studied in a prospective, observational, test development study with a random sample of Dutch psychiatric outpatients, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality- Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II), three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF)) involved.

Results

The three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.

Conclusion

Before deciding which screening instrument for PD is the best for your practice, you have to consider psychometric values as well as practical circumstances.
Turning Each Borderline Personality Disorder Patient Into Clinical Research Project Through Lifetrack
Authors: Ishizuka Y.
Published: May 2011

Objective

To demonstrate how each BPD patient in therapy can be turned into an on-going research project by tracking progress (or lack thereof) of each patient through daily self-rating on 41 parameters. The author has treated 224 BPD patients, showing that characteristic BPD symptoms (such as high spikes of anxiety, anger, physical symptoms, depression, and psychosis) can be predictably eliminated by transforming personality through ‘Breakthrough Intimacy’ - closeness between committed couples far greater than their previous maximum experience, usually without drugs and often within 6 months.

Method

Lifetrack therapy works with the patient and his/her partner in three-way teamwork, bringing them far closer than ever before, guided by their own daily self-rating on 41 parameters that allow accurate graphic tracking via Internet of subtle changes in their personalities and dynamic mental status during each therapy session. The therapist actively helps the couple to think, feel, and act in such ways that their closeness will increase, provoking and overcoming waves of symptom spikes (defense) until they disappear by exhaustion, as the couples undergo personality transformations.

Results

42% of 224 patients (with or without partners) treated with borderline personality disorder reached a level of adjustment beyond their previous maximum level. Patients with partners (134) did 10 times better (66.4% vs 5.6%) than singles (90). 34% reached Stage-4 (complete transformation far beyond symptom elimination).

Conclusion

BPD should be treated with patients’ partners whenever possible, bringing them far closer than their previous maximum experience, guided by their own daily self-rating graphs.
Identity Disturbance and Substance- Dependency in Patients with Borderline Personality Disorder
Authors: Kheradmand A. , Ghaffari Nejad A. , Toofani K.
Published: May 2011

Introduction

Identity disturbance is one of the DSM- IV criteria for borderline personality disorder, but there has been little attention to its nature. Four subset of identity disturbance (role absorption, painful incoherence, inconsistency, lack of commitment) have been assessed.

Aims

Assess the role of these subsets in patients with borderline personality disorder and examine the relation between identity disturbances with substance- dependency.

Background

This case- control study was conducted on 40 patients with borderline personality disorder referring to Beheshti Hospital in Kerman during 2007-2008; and 40 healthy people who were matched with case group in term of gender, and educational level. Data gathering was done with three questionnaire including a demographic- related questionnaire, disturbance questionnaire (included 35 items), and a questionnaire related to substance- dependency and its related factors. Data analysis was performed using SPSS software (version 11) by mean calculation and t-test and ANOVA.

Methods

Mean score of 33 items of identity disturbance questionnaire were greater with significant difference in case group (p < 0.05). Means differences in two groups in all subsets were statistically significant except for role absorption (p < 0.05). Means differences in all subsets in substance- dependent subjects and substance- independent people in both groups were not statistically significant.

Findings

Identity disturbance is one of the major criteria for borderline personality disorder, but in different societies the role of its subsets are different. Assessing subsets of identity disturbance has no value in assessing substance- dependency in patients with borderline personality disorder.
Health Related Quality of Life in Psychiatric Inpatients and ITS Correlation with the Personality Characteristic of Dispositional Optimism
Authors: Lyrakos G.N. , Karachalios M. , Spinaris B.
Published: May 2011

Introduction

Quality of life (QoL) research has increased during last decates. Psychiatric patients spend many days for their treatment so QoL is something that should be measured for these patients too.

Aims

To examine the relationship between dispositional optimism and Quality of life (QOL) among patients suffering from schizophrenia, schizoaffective disorder, bipolar disorder, depression, and other psychiatric conditions from a psychiatric department and to find out the existing correlations with other measures of personality characteristics.

Objects

To reveal the underlining correlation between QoL and dispositional optimism.

Methods

69 inpatients in a psychiatric ward in Athens-Greece took part in the study.31 (44.9%) of them were males and 38 (55.1%) females. The questionnaires that were used are the Short Form health questionnaire (SF12), the life orientation test-revised (GrLOT-R), the subjective well being scale (SWBC) and the Satisfaction with life Scale(SWLS).

Results

Both Physical (M = 39,9 SD = ±7,2) and Mental (M = 29,4 SD = ±7,8) composite scores are lower than in the greek general population (M = 50 SD = ±6,8). Optimism (M = 14,8 SD = ±4.9) correlates significantly with both mental (p = ,571**) and physical (p = ,438**) health, well being (p = ,427**) and with the days of hospitalization (p = .,261**). Global happiness correlates significantly only with mental health (p = ,493**) and well being (p = ,573**).

Conclusions

Quality of life in mental patients seems to have a mediator and that is Optimism. Optimistic patients seems to have better health related quality of life and well being and stays more days in hospital for treatment needs.
Personality Dimensions and Attitude Towards the Disease: Fibromyalgia
Authors: Pena-Andreu J.M. , Garcia-Masegosa J.F. , Gil-Aguilar V. , Garcia-Ramos M.J. , Fontalba-Navas A.
Published: May 2011

Introduction

There have been numerous studies that reveal attitudes of different social groups in relation to mental illness, but have not been developed none in other chronic diseases such as fibromyalgia.

Our hypothesis is to demonstrate that there are certain beliefs about the disease that determine attitudes, and these beliefs may be related to certain personality patterns.

Objectives

To determine the relationship between personality dimensions and attribution of causes fibromyalgia.

Method

Evaluation of a sample of medical students, which were administered the following tests: demographic data (age, sex, year of study), Zuckerman-Kuhlman's Questionnaire of personality, level of concern about the disease and survey of possible causes in fibromyalgia.

Results

A total of 34 students were interviewed, between 3rd and 6th grade of Medicine, with a mean age of 24.8 years (sd 5.5). 70.6% were women. 20.6% had contact with the disease (which in most cases a family member diagnosed with fibromyalgia), no statistically significant differences with respect to the concern about the disease, compared with the rest. There is a high level of agreement in the sample in the attribution of cause of fibromyalgia to a genetic predisposition, personality or sleep disorders.

In our study, Neuroticism stands between personality dimension. High scores on this dimension are associated with statistically significant differences (t-student), to attribute the cause “attract attention” (p = 0.02) or the “Influence of the mass media” (p = 0,03) in fibromyalgia.

Conclusions

There are dimensions of personality such as neuroticism, which may influence the attribution of causes of the disease Fibromyalgia.
Investigation the Role of Personality Factors that Cause to Stress in University Students
Authors: Pourabdolisardroud M.
Published: May 2011

Introduction & objectives

This study investigated relationship among personality dimensions based on Jungian personality types and stress in university students.

Method

The studied population included 200 students between ages of 19–26 were randomly selected from three universities and Coudron's Stress Inventory (CSI) and Hogan - Champagne's Personal Style Inventory (PSI) were administered on them. PSI assesses eight personality dimensions based on Jungian personality types (introversion-extroversion E/I, intuition- sensing N/S, thinking-feeling T/F, perceiving-judging P/J). The data were analyzed with Pearson correlation coefficient and independent T test.

Results

Findings showed negative correlation between extroversion and stress and positive correlation between introversion and stress. Analysis of personality dimensions showed male are more intuition than female and female are more sensing than male.

Discussion

Based on findings, considering that introverted are quiet, diligent at working alone, and socially reserved, they make decisions somewhat independently and prodding from situations, cultures, people, or things around them, so facing to stress factors interrupt their own world and reduce their function, cause to variability in situation and stress emerge.
Audit and re-audit of patients with PTSD in a community team in bedfordshire UK
Authors: Agius M. , Middleton E. , Zaman R.
Published: May 2011

Introduction

Post-traumatic stress disorder (PTSD) is a disorder which can develop following exposure to one or more severely traumatic events. Symptoms experienced by PTSD suffers include re-experiencing the trauma through intrusive ‘flashbacks’ and recurrent dreams or nightmares, distress when exposed to reminders of the trauma, hyperarousal and emotional blunting. These symptoms can cause significant impairment of function and reduction in quality of life for suffers. Both psychotherapies, including cognitive behavioural therapies (CBTs) and eye movement desensitisation and reprocessing (EMDR), and pharmacotherapy are used in the treatment of PTSD.

Method

We audited patients with PTSD in Bedford East performed in November 2008. A re-audit was performed using data from August 2010 patient database. Demographic information, risk factors, co-morbidities, psychological therapy and pharmacotherapy were compared between these audit and re-audit.

Results

There is increased use of antidepressant augmentation between 2008 and 2010. While no patients in 2008 were on antidepressant augmentations, by 2010, 9 patients were. All 25 patients on anti-psychotics have important identified risk factors. There is no evidence of Psychosis in our PTSD patients except in two cases. There is an increase in Anti-psychotic use in our PTSD Patients. There is an increased use of Mood Stabilisers in our patients with PTSD.

Discussion

PTSD is being identified more frequently in our patients, probably because of greater awareness and more accurate identification.

Conclusion

New patients being identified represent a group of more difficult to treat patients who represent severe risks. Present psychotherapies offered are not all recommended in present guidelines.
War psychic disorders treatment: Current perspectives
Authors: Colas M.-D. , Calteau M. , Trousselard M. , Canini F. , de Montleau F.
Published: May 2011

Background

The confrontation with extreme events, such as a death threat, may release acute psychiatric troubles named “acute stress disorders” in the DSMIV-TR. Current operational context in Afghanistan is unpredictable and leads military surgeons to support soldiers facing major psychic suffering. Clinical practice confronts them with the difficulty to decrease the symptoms often strong, especially sleep disorders. Circadian rhythm disruption, lack of recovery may be at the origin of somatic and mental exhaustion.

Methods

We propose a debate about the principles of a medico-psychological handling based on the current operational experiences of the French military psychiatry. Special operational circumstances led military psychiatrists to prescribe an antipsychotic, small-dose, in the evening.

Results

Unexpected results are observed on some symptoms like sleep disorders (improvement of sleep disorders, less traumatic nightmares, sensation of restorative night) and hyperarousal.

Conclusions

This clinical discovery leads to a reflection on physiopathological and pharmacological perspectives and to engage an observational study over 30 clinical cases and clinical trial project. Identifying, preventing, and treating operational stress at battlefront can provide the opportunity not only to improve operational performance, but also possibly to improve case by case the mental health.
The impact of a tragic accident on mental health professionals
Authors: Papanikolaou K. , Voura N. , Darai N. , Koukoulas G. , Roboti P. , Angelidis G.F.
Published: May 2011

Objective

To investigate the psychological impact of the tragic accident in Tempi which cost of 21 students’ life (2003), on mental health professionals (MHP).

Material

BDI and Impact of Event Scale-Revised (IES-R) scores of PHPO MHP (psychiatrists/child-psychiatrist/psychologies/social workers) who offered support to victims’families/teachers/rest of the students.

Method/results

The personnel were deployed to the area exposed to witnessing experiences/impressions of the accident. Participants responded to BDI 10 days and IES-R 9–10 months past-accident. There was an IES-R retest 7 years later. The response rate was 100%. All achieved mild depression scores. As for IES-R, common qualities of conscious experience were found among them, though with different personality styles. Two major response sets, intrusion (unbidden thoughts/troubled dreams/waves of feelings/repetitive behavior) and avoidance (denial of the meanings of the event/behavioral inhibition/counterphobic activity/emotional numbness) were abstracted from evaluation.

No sex differences were mentioned as there was only one male in the group.

A correlation of 0.42 (p > 0.0002) between intrusion and avoidance subscale scores indicated that the two subsets were associated, though not measuring identical dimensions.

7 years later the mean score of the personnel on IES-R was 23: Impact Event: may be affected. All achieved a quite high score on the response ‘any reminder brought back feelings about it’.

Conclusion

MHP face additional emotional strain often over extended periods of time. There is a need to develop strategies such as insight oriented training. Research is imperative and an ethical requirement to find ways to protect the health of the carers and so their patients.
Prenatal depression: role of childhood stressors, current stressors and past emotional disorders
Authors: Dayan J. , Creveuil C. , O’Keane V.
Published: May 2011

Background

Very few studies have conducted a multivariate analysis incorporating both the major predictors of depression in women, in accordance with comprehensive developmental models of depression, and specific stressors associated with the biological and psychosocial state of the mother-to-be.

Methodology

We used a cross-sectional cohort design to analyze the associations between prenatal depression and potential risk factors. 693 French-speaking women with singleton pregnancies at 20–28 weeks’ gestation were consecutively recruited. Fifty women with missing values were subsequently excluded from the analysis. Depressive symptoms were assessed on the Edinburgh Postnatal Depression Scale. Risk factors were either extracted from the computerized obstetric records or assessed by means of self-administered questionnaires. The associations between prenatal depression and the potential risk factors were assessed using log-binomial regression models to obtain a direct estimate of relative risk.

Principal findings

The following factors were found to be significant in the multivariate analysis: level of education, past psychiatric history, stress related to the health and viability of the fetus and stress related to severe marital conflicts or to serious difficulties at work. An association was also found with the previous delivery of a child with a major or minor birth defect. Univariate analyses revealed a strong association with childhood adversity (parental rejection and family secrets).

Conclusions

Our study identifies several risk factors that could easily be assessed in clinical practice. It draws attention to the impact of previously delivering a child with a birth defect and to the association with childhood adversity.
Provision of perinatal mental health services in a community setting
Authors: George M.K. , Parashar N.R. , Leek C.
Published: May 2011

Introduction

Psychiatric illness and suicide in particular have been a leading overall cause of maternal mortality in the United Kingdom. Although the most recent Confidential Enquiry into Maternal and Child Health indicated that this is no longer leading causes, mental health problems before and after childbirth have a significant impact on the health of women, family relationships and children's subsequent development.

Aims

To identify the current practice for management and prevention of perinatal mental illness within a community mental health setting.

To identify the extent to which policy recommendations from NICE “Antenatal and postnatal mental health” been implemented

Methods

The audit included all women who are pregnant, breastfeeding or who are planning to become pregnant and referred to the CMHT between November 2008 to April 2010

20 Cases identified by asking all team members to recall relevant clients.

Results

65% of those referred were in the antenatal period and 25% were in the post natal period. 40% of those referred had a pre existing mental illness and 60% were new onset during antenatal & postnatal period.

The main diagnosis was depression and anxiety disorders.

55% of those referred to the CMHT were on Psychotropic medications. However following the assessment and follow up by CMHT, only 25% of those referred needed to be on the psychotropics.

Good compliance was achieved in the documentation of past psychiatric history and family history, provision of appropriate psychosocial interventions and specific considerations for the use of antidepressant medication during pregnancy and the postnatal period.
Diurnal pattern of cortisol and amylase output in postnatal depression
Authors: Kammerer M. , Taylor A. , Khalife N. , O’Donnell K. , Marks M. , Glover V.
Published: May 2011

Objective

This study investigated the diurnal output of saliva cortisol and saliva amylase in women with symptoms of depression postnatally.

Method

Twenty one depressed and 30 non depressed women at 7.5 weeks postpartum, and 21 non perinatal controls, collected saliva at waking, 30 minutes, and three and twelve hours post waking.

Results

Women who were not depressed postnatally showed a pattern of cortisol secretion over the day similar to non perinatal controls. There was a significant difference in diurnal pattern between postnatally depressed and postnatally non depressed women, due to a difference in the first two time points (waking and +30 mins): compared to the other two groups who each had a significant increase in cortisol levels from waking to +30 minutes, the depressed women had significantly higher cortisol levels at waking and no increase at +30 minutes. Analyses of amylase are underway and will be presented.

Conclusion

The lack of a morning rise in the depressed women is similar to that reported for Post-traumatic Stress Disorder and chronic fatigue syndrome and may reflect a response, in vulnerable women, to the marked cortisol withdrawal that occurs after delivery. Alternatively it could be a trait marker for women at risk of developing postnatal depression.
Menstruation cycle resembles parametric oscillation and subject to exact prediction: Mathematical model explaining hypothalamic behavior in response to stress, multiple pregnancies risk and external stimuli
Authors: Pirkalani K.K. , Rad Z. Talaee
Published: May 2011

Objectives

Reproductive events (cycle length, ovulation) behave regularly in some and chaotic in others. A mathematical model based on empirical data is developed to predict these parameters and hypothalamic oscillations with enough exactness.

Materials and methods

Thirty eight cases were evaluated by autoregressive moving average and laboratory study of a series of hormones.

Results

Cycle to cycle correction with noise is the best model fit to both very regular and very irregular patients. Addition of two hormones (estradiol and GnRH twice) at any time during the cycle can predict the time of the next menstruation with an exactness of 10h and fertility based on the simplified formula: T1 = T0 + k ∫ [Ω(Est-d0GnRH0/GnRH1dt)]

Conclusions

1.

The hormonal armamentarium of the female reproductive systems ensures single ovulation and single pregnancy.

2.

Unlike bone marrow ovaries do not posses a stochastic mechanism and rely solely on suppression of nearby follicles by the dominant follicle.

3.

Hypothalamus senses the risk of MP and adjusts pulsation of GnRH in the consecutive cycle by prolonging the low and postponing the high frequency pulsation. Like electric circuits, external stimuli have a changing strength of 1/4 to 1/15 meaning that they can advance or retard ovulation in this range (percentage of the innate cycle of that person).

4.

The strongest predictor and determining parameter affecting menstruation cycle is sensing the MP risk by the hypothalamus exemplifying itself as frequency of GnRH pulsation (d0GnRH0/GnRH1dt).

5.

Menstruation cycle and fertility can be predicted by mathematical formulas of parametric oscillation.
The relationship between body mass index with nausea and vomiting in the first trimester
Authors: Ranjbar F. , Abbasalizadeh S. , Islamifard H. , Alizadeh A.
Published: May 2011

Introduction

Nausea and vomiting in the first trimester is a common complaint of about 70% of pregnant women and it has a major effect on their quality of life. Its etiology is unknown but there are some risk factors for it.

Aims

The purpose of this study was to obtain the relationship between body mass index (BMI) and nausea and vomiting during pregnancy.

Methods

This case-control study was performed on 300 pregnant women who had referred to outpatient clinics. 150 of these women were suffering from nausea and vomiting while the other 150 didn’t have this problem. We determined BMI in two groups. Then the results were analyzed statistically.

Results

The age average was 24.9 and 26.2 in case and control groups respectively. The BMI average was 26.01 kg/m2 and 26.02 kg/m2 in case and control groups respectively. No significant relationship was observed between two groups regarding the presence of nausea but in case group, women with vomiting had lower BMI (p = 0.026).

Conclusions

It was concluded that BMI is not a risk factor for nausea and vomiting during pregnancy.
Anxiety in pregnant women referred to Sanandaj health centers and that relationship with their personal characteristics in 2009
Authors: Zaheri F. , Hasheminasab L. , Motavalli E.
Published: May 2011

Background and aim

Pregnancy is one of events in women's life that is passed without any physical and psychical complications. But in many cases, predisposing factors can result in problems such as anxiety, depression and other psychical complications in this period. In this research we studied about rate of anxiety in pregnant women referred to Sanandaj health centers.

Methods

This descriptive study was done with 359 pregnant women referred to health centers of Sanandaj city in 2009. Data collection tools was a questionnaire consists of questions about personal characteristics of samples and zung standard anxiety scale. Finally statistics analyze was performed by descriptive and analytic methods with spss16.

Results

According to these results, rate of anxiety was 24.5% totally that 21.4% was related to mild to moderate and 3/1% for moderate to severe anxiety. Also we didn’t find statistic difference between anxiety score and mothers marriage age (P = .229), parity (P = .981), method of previous delivery (P = .270), education (P = .191), job of mother (P = .531), trimester (P = .931). Also there was statistic difference between anxiety score with unwanted pregnancy by women (P = .001) and their husband (P = .001) and have job in husband (P = .008) and their economic status (P = .015).

Discussion

Findings of this research showed that husband's unemployment and unwanted pregnancy by them had a role in degrees of anxiety in pregnant women. Therefore health and care providers can reduce of unwanted pregnancy and psychical complications with promoting the women's acknowledge about methods of family planning and also complications of frequent pregnancy.
Revolving door syndrome: A new meaning for an old concept?
Authors: Garrido P. , Saraiva C.
Published: May 2011

Introduction

“Revolving Door Syndrome” is usually defined as a cyclical pattern of short-term readmissions to the psychiatric units of health care centers, by young adults with chronic psychiatric disorders. Concerning the actual politics in health care sistems, with sucessive budget cuts and reduction of full-time hospital beds, the authors' aim has been to identify the patients that enter into a vicious circle of being admitted to hospital, discharged, and admitted again, as well as the underlying psychosocial reasons.

Objectives

The purpose of this study was to identify factors associated with short-term readmissions to psychiatric acute care services, with statistical significance, and clinical interest, within a portuguese sample.

Material and methods

Retrospective cohort study, in which the medical records of patients admitted to Coimbra University Hospitals two or more times (with short-term readmissions) between January and December of 2009, were analysed for socio-demographic characteristics, psychiatric diagnostic, presence of comorbidities, number of hospital admissions within that year, psychofarmacological treatments and presence of social and familiar support.

Results and conclusions

The authors found that lack of social and familiar support is a strong predictor for “Revolving Door Syndrome”, as well as the presence of a chronic psychiatric disorder.
Alopecia Universalis Causes Serious Personality Derangements: First Report of Negative Impact of a Medical Condition on Personality (279 Patients)
Authors: Pirkalani K.K. , Talaee Rad Z.
Published: May 2011

Objective

To evaluate the reason of major behavioral problems in alopecia universalis patients, we tried to examine by way of MCMI- III whether these signs are transient, developmental or ingrained.

Methods

279 patients with alopecia universalis were studied before and 3 months after treatment with MCMI-III and scheduled psychiatric interview. They were stratified in regard to sex, age, socioeconomic class, age of onset of alopecia (before or after 18yrs) and response. The results were compared with 3000 normal examinees.

Results

There was significant preponderance of personality disorders among patients with early onset (p < 0.003) but not late onset (p = 0.1) alopecia including schizotypal, schizoid, self defeating, borderline and avoidant personalities compared to general population. This was not affected by treatment. (p < 0.004) All patients showed higher scales in axis II disorders including depression, anxiety, drug abuse, alcohol abuse and major thought disorders. (Overall p < 0.02) These were ameliorated with treatment of alopecia. These data were confirmed by scheduled interviews.

Conclusion

This is the first report of severe personality disorder in the context of a medical (dermatological) condition. Childhood onset chronic illnesses can cause serious personality disorders that are stronger predictors than genetics or learned behavior encompassed in previous theories on personality. Alopecia universalis has a more sustained effect due to jeopardizing the development of self image. We recommend that many diseases with their onset during childhood, including type I diabetes, epilepsy, childhood cancers … must not only be treated for concomitant anxiety and depression but for abnormal personality development.
The Importance of Recognition, Validation and Certification of Competences System in Promoting Mental Health
Authors: Sa M. , Ferreira J.
Published: May 2011

In Portugal, Recognition, Validation and Certification of Competences (RVCC) allows adults to achieve recognition of competences acquired by formal and informal learning using a Competences Reference System. By creating a portfolio describing their life story, adults may explore and question their own living experiences.

This communication aims at promoting deep consideration on the importance of an RVCC process in promoting adult mental health. It analyses the relation between mental health and the RVCC process, and its benefits to prevention and rehabilitation. Methods include my experience as a psychologist at a Centra de Novas Oportunidades (New Opportunities Centre) and scientific literature on the subject. Adults are involved in activities which contribute to developing their social competences. They increase self-confidence and self-esteem, control over life choices and accountability for their actions. In Portugal, this process also involves patients with mental disorders and offers appropriate Key Competences Reference Systems. Adults suffering from mental disorder and undergoing a RVCC process re-establish their self-confidence, self-esteem, self-efficacy and gain a positive hope for the future. Empowerment leads them to cooperate more actively with mental health professionals in their own treatment and rehabilitation plan.

Despite being highly criticized as a system which only validates competences, such criticisms to this process are clearly reductive.
N-3 Fatty Acid Supplementation Influences Membrane Fatty Acids and Phospholipase A2 Activity in Patients at Risk to Develop Psychosis
Authors: Smesny S. , Milleit B. , Schäfer M. , Milleit C. , Otto M. , Hipler U.-C. , Berger G. , Sauer H. , Amminger P.
Published: May 2011

Introduction

Decreased levels of polyunsaturated membrane fatty acids (PUFA) and increased activity of cytosolic phospholipase A2 (PLA2) enzymes (key regulating enzymes of membrane remodelling and PUFA availability) are supporting pillars of the “membrane phospholipids concept of schizophrenia”. Assuming that membrane PUFA profile and PLA2 activity are altered during the at risk phase of disorder and influenced by fatty acid supplementation, we investigated PUFA profiles and PLA2 activity simultaneously in ultra high-risk (UHR) subjects before and after (n-3) fatty acids supplementation.

Method

In 81 UHR patients (aged between 13 and 25 years) PUFA levels were assessed in erythrocyte membranes using gas chromatography, and cytosolic PLA2 activity was measured in blood serum using a fluorometric HPTLC-based assay. Measurements were performed before and after a 6 month interval of placebo-controlled supplementation with n-3 fatty acids.

Results

At baseline significant associations were found between (n-9) and (n-6)-PUFA levels and psychopathology (especially in negative symptoms) assessed by the PANSS according to PACE criteria. (n-3)-PUFA supplementation caused significant changes in (n-3)- and (n-6)-PUFA levels and a significant decrease of PLA2 activity.

Conclusion

Our results support associations between membrane biochemistry and psychopathology (especially negative symptoms) in people at risk to develop psychosis. Supplementation of n-3 PUFA increases PUFA availability at membrane level and modulates membrane repair and remodelling processes. Assuming that PLA2 activity reflects neuronal damage, PUFA supplementation might unfold neuroprotective effects.
Predictors of Subjective Perception of Quality of Life Among Medical Students
Authors: Stojkovic T. , Ralic T. , Latas M. , Milovanovic S.
Published: May 2011

Introduction

Medical education could contribute to the lower appraisal of quality of life in student population.

Objective

The aim of the study was to estimate the predictors of higher subjective perception of quality of life among medical students, i.e., to identify association between certain sociodemographic and academic characteristics of students and quality of life.

Method

Sample consisted of 310 medical students of Belgrade University. We used sociodemographic questionnaire and Flanagan Quality of Life Scale (QOLS) for assessment of the subjective perception of quality of life across five categories and fifteen scale items.

Results

In medical students’ population, the predictor variable of worse perception of quality of life was a failed year (F = 2,30, p < 0,05). The other features of study participants (gender, age, grade year, average grade, marital status, parenthood and place of living) were not in a correlation with quality of life.

Conclusion

There is a need for maintenance and improvement of quality of life among medical students in order to create competent physicians.
Electroconvulsive Therapy in Treatment-Resistant Schizophrenia: a Case Report
Authors: Barrau V.M. , Salinas M. , Yelmo S. , Santana E. , Montiano F. , Gallego N. , Bello G. , Gracia R.
Published: May 2011

Electroconvulsive therapy (ECT) is born as we know it in the first half of the twentieth century. Although initially introduced as a treatment for schizophrenia, soon proved more effective in affective disorders.

Currently this therapy is second choice in the treatment of schizophrenia, representing only 10–20% of ECT treatments.

We present a 55 years-old-woman diagnosed with Paranoid Schizophrenia in the adolescence, with several hospital admissions who was sent from sub-acute unit to receive ECT, given the null response to several pharmacological trials. The last, 1,200 mg amisulpride, 650 mg clozapine and 1,000 mg valproate per day, and Zuclopenthixol ampoule every 14 days. She verbalizes poorly structured persecutory, megalomaniac and nihilist delusional ideas, as well as auditory hallucinations which she does not clarify, and thought broadcasting phenomena. After withdrawing this medication and starting treatment with 30 mg haloperidol and 550 mg quetiapine, 14 bifrontotemporal ECT sessions were given.

Given the disappearance of persecutory delusional ideas, and the decrease of auditory hallucinations, which she criticizes, the patient was discharged. After 4 months, she is still psychopathologically stable, and receiving maintenance ECT biweekly.

ECT, either alone or in combination with conventional antipsychotic drugs, has been shown effective in a certain percentage of patients with acute schizophrenia, particularly in the catatonic subtype and also in schizoaffective disorder. The use and efficacy of ECT in chronic schizophrenia is a more controversial topic.

Research should also focus on the determination of optimal number of ECT, the predictors of response and the efficacy of continuation and maintenance ECT.
Treatment of Primary Insomnia: Effect of Repetitive Transcranial Magnetic Stimulation with and Without Field Modulation Based on the Normal Sleep EEG
Authors: He M. , Wang X. , Shi H.
Published: May 2011

Background and objective

Aside from medications, no effective physical methods of treatment for insomnia have been reported. The purpose of this study is to evaluate the effect on primary insomnia of sleep electroencephalogram modulated repetitive transcranial-magnetic stimulation (SEM-rTMS) compared with the effect of routine repetitive transcranial magnetic stimulation (R-rTMS).

Methods

The 126 patients who volunteered for this study were diagnosed by DSM-IV criteria. Patients were divided randomly into an SEM-rTMS group (44 cases), an R-rTMS group (42 cases), and a sham therapy group (40 cases). Each case was treated for 10d with consecutive rTMS for 30 min once a day with both patient and therapist being blind to conditions. The Krakow sleep score, electroencephalogram, and blood pressure were recorded before treatment, after the 10d treatment, and 30 days after treatment.

Results

During therapy with rTMS, a portion of the patients felt sleepy and their EEG pattern showed signs of sleep. The efficiency of producing sleep signs in the SEM-rTMS group was 79.5% and in the R-rTMS group was 45.2%, with the former being significantly higher (c2 = 9.4065, P = 0.0022). At 30d after completion of therapy, the efficiency of sleep production in the SEM-rTMS group was still higher than in the R-rTMS group (c2 = 16.7998, P = 0.0000). No obvious side effects were observed in any of the three groups during the observation period.

Conclusion

SEM-rTMS therapy for insomnia appears to be more effective and more stable than routine rTMS therapy and appears to be a safe treatment for primary insomnia.
Double dissociation of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral
Authors: Oulis P. , Kalogerakou S. , Papakosta V.-M. , Kontis D. , Theochari E. , Koutroumpi M. , Anyfandi E. , Michopoulos I. , Poulopoulou C. , Tsaltas E.
Published: May 2011

Introduction

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses.

Method

Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and nonpsychiatric Controls (matched groups, n = 15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

Results

ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p = 0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p < 0.03 ; Control/NECT p < 0.01) and the Spatial Recognition Memory (SRM) task (p < 0.05 ; Controls/NECTs p < 0.05) ; ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p < 0.01 ; Controls/ECTs p < 0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H = 11, p < 0.01) but ECTs who completed SOC performed comparably to the other two groups.

Conclusions

A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT dépressives.
Brain-derived neurotrophic factor and electroconvulsive therapy in a schizoaffective patient with treatment-resistant paranoid-hallucinatory symptoms
Authors: Martinotti G. , Ricci V. , Di Nicola M. , Caltagirone C. , Bria P. , Martinotti A. , Angelucci F.
Published: May 2011

It has been proposed that deficits in the production and the utilization of brain-derived neurotrophic factor (BDNF) may contribute to the pathogenesis of schizophrenia. At the same time, electroconvulsive therapy (ECT) has been shown to induce a robust increase of BDNF protein in animal models. These findings suggest that one putative mechanism of action of ECT is the regulation of BDNF and/or related neurotrophins. In this case report a 54-year-old man with severe treatment-resistant schizophrenic symptoms was treated with ECT. In order to evaluate the effect of ECT on BDNF serum levels, we collected a blood sample before each ECT session. During the course of ECT treatment the paranoid and hallucinatory symptoms gradually improved while BDNF levels increased over time. In addition, there was a general improvement of its positive and negative schizophrenic symptoms and depressive state.

In conclusion, this case report further validates the therapeutic efficacy of ECT in schizophrenic patients with inadequate or poor response to traditional treatments. Moreover, ECT therapeutic effect is associated with an increase in BDNF serum levels. Further studies are needed to characterize the relationship between BDNF and ECT in patients with schizophrenia symptoms.
Transcranial direct current stimulation (TDCS) of the prefrontal cortex in therapy-resistant depression: A double-blind, placebo-controlled study
Authors: Palm U. , Schiller C. , Fintescu Z. , Obermeier M. , Keeser D. , Reisinger E. , Pogarell O. , Nitsche M. , Möller H.-J. , Padberg F.
Published: May 2011

Background

TDCS for modulating neurophysiology is known since the 1960s. tDCS trials in patients with depression showed promising results.

Methods

22 patients with therapy resistant major depression (DSM-IV criteria) were included in a four week cross-over trial, 10 received 1 mA tDCS, 12 received 2 mA tDCS, 2 dropped out. Patients received add-on tDCS under a stable antidepressant treatment over 3 weeks and were randomized to active or sham tDCS treatment. The sham condition was evaluated in 10 healthy volunteers and was indistinguishable.Both, active (1 mA resp. 2 mA) and placebo tDCS were applied for 20 min per day and for two weeks and then switched to the other condition. The anode was positioned over F3 and the cathode over the contralateral supraorbital region. For placebo tDCS a novel sham device (neuroConn, llmenau, Germany) was used which is indistinguishable for the applying person. Severity of depression was assessed by HAMD, BDI, CGI and CORE scales and raters were blind to treatment conditions.

Results

Mean HAMD decreased by 25% in the whole population after four weeks of tDCS. Active tDCS performed significantly better (p = 0.0492) than the control treatment. However this positive association was restricted to the first study phase as there was also a significant (p = 0.0271) influence of the study phase in the cross-over design and an almost significant (p = 0.0864) interaction between treatment and study phase.

Conclusion

Though active tDCS was not superior to sham treatment, we observed hangover effects in weeks 3 and 4 depending on the first condition.
Analysis of treatment results in the electroconvulsive therapy unit of centro hospitalar psiquiatrico de lisboa (CHPL)
Authors: Silva-Carvalho F. , Moutinho A. , Mendonça L. , Cunha I.
Published: May 2011

Introduction

Electroconvulsive therapy is widely used for treatment-resistant psychiatric patients, with remission rates close to 50% and response rates between 60–70%. Post ictal suppression index (PISI) has been positively correlated with clinical outcome.

Objectives

Characterize the treatment results of the electroconvulsive therapy unit of CHPL; find a correlation between improvement on HAM-D, PANSS and PSAS and PISI.

Methods

The patient data was collected and divided according to ICD-10 diagnosis. Evaluation scales were applied at the beginning and end of treatment: depressed patients (F31.3–5; F33; F20.4; F25.1) - HAM-D; schizophrenic/ schizoaffective/ bipolar-manic or mixed patients (F20.X, F25.X, F31.0, F31.6) - PANSS; with any of these diagnosis - PSAS. A correlation between the points of improvement on each scale and PISI was investigated using the Pearson product-moment correlation coefficient.

Results

Of 101 depressed patients, 33,7% showed remission and 49,5% showed response, over 11 sessions (average). The reduction on HAM-D score was significantly greater for patients with initial HAM-D score > 18 versus HAM-D ≤ 18 (52,9% versus 37,75%). Patients with unipolar depression (N = 72) and bipolar depression (N = 22) showed comparable results (response:47,2% versus 52,4%; remission: 30,6% versus 40,1%). Schizophrenic patients (N = 43) had higher response rates: 88%. No correlation was found between PISI and HAM-D, PANSS or PSAS improvement (r = -0,1;-0,01;-0,07).

Conclusion

Response and remission rates in depressed patients were inferior to other ECT studies, except in patients with higher severity. Those rates were comparable for schizophrenic patients. PISI did not correlate with clinical outcome.
Study on organic hallucinosis: The charles-bonet syndrome
Authors: Campos Mangas M.C. , Ruiz Feliu M.A.
Published: May 2011

Introduction

In 1890 Ball defined hallucinations as perceptions without real object with sharp features and embodiment of that approach actual sensory perceptions.

Objective and methods

We present the case of an elderly woman with cataract. Previously we maked a review of the literature and its controversies.

Results

An 82 year old woman was referred to psychiatry for primary care physician for evaluation of visual hallucinations of 3 ½ months of evolution. Among somatic background are collected: arterial hypertension, cataracts and increased intraocular tension.

The detection of the picture is casual, for the comments that the patient makes to his daughter. She says that she sees her husband died 6 years ago, on the stairs. Reported to have a house full of people describing in detail the number of people and the characteristics of them. She claims that under the bed see rats and dogs.

She was conscious and oriented. No significant objective emotional impact of visual hallucinations. Is euthymic and without anxiety clinic. Complex visual hallucinations are objectified. The content of thought has developed a delusional elaboration of hallucinations with partial insight.

The primary care physician began treatment with haloperidol, the patient presenting extrapyramidal symptoms, so it was discontinued and olanzapine was started up to 10 mg. The clinical picture resolved completely within a few days.

Conclusions

Charles Bonnet described in the 1760s. Morsier is the first called the Charles Bonnet syndrome as a persistent or recurrent visual hallucinosis in older people with serious visual impairment and psychically healthy.