bluuebunny/crossref_metadata_2025 huggingface dataset:
1331 – Are Depression And Anxiety Related To Insomnia In Epilepsy Patients?
Authors: Ghahramanyan L. , Gevorgyan D. , Khachatryan S.
Published: July 2013

Introduction

Insomnia is a frequent symptom of depression and vice versa. Both are prevalent in epilepsy and can worsen the course of disease.

Objectives

To assess relationship of insomnia with depression and anxiety in epilepsy.

Methods

Adult patients with all-cause epilepsy diagnoses attending a tertiary epilepsy and sleep centers were interviewed regarding insomnia symptoms. Patients were divided into two groups: with (IG) and without (WIG) insomnia. Depression and anxiety were assessed by Hamilton’s depression (HAMD) and anxiety (HAMA) scales. T-test was used for statistics.

Results

58 patients with epilepsy aged 18-64 (mean age - 33.8, 21 females - 36.2%) were enrolled. Among these patients 31 had insomnia complaints (53.4%). The groups did not differ in terms of mean age: 33.1 for IG and 34.3 for WIG (p>0.05). Mean values for HAMD and HAMA in the groups were as follows: HAMD - 16.3 for IG, 11.04 for WIG; HAMA - 18.3 for IG, 13.4 for WIG. For both scales there was an increase in levels of depression and anxiety for epilepsy patients with insomnia. The difference reached statistical significance for depression (p = 0.004). Anxiety was also numerically more prevalent in IG but this difference was not significant (p = 0.055).

Conclusion

Results of our study show that insomnia is a frequent co-morbidity in epilepsy. We found that depression is more prevalent in patients with concomitant epilepsy and insomnia than in patients without difficulties initiating or maintaining sleep. Anxiety also seems to be more marked in insomniac epilepsy patients but to a lesser degree.
1332 – Radiation Post-traumatic Stress Disorder
Authors: Loganovsky K.N. , Zdanevich N.A.
Published: July 2013

Background

Whether PTSD following radiation emergency has psychopathological, neurocognitive and neurophysiological peculiarities is at issue.

Goal

To explore features and cerebral basis of “radiation” PTSD in the Chernobyl accident survivors.

Subjects and methods

The cross-sectional study included 241 people, 219 of whom have been diagnosed with PTSD according to the DSM-IV criteria, among them 115 clean-up workers [liquidators] of the Chernobyl accident (34 with acute radiation sickness), 76 evacuees from the Chernobyl exclusion zone, 28 veterans of the war in Afghanistan, and 22 healthy unexposed individuals. Psychometric examinations, neurocognitive assessments, computerized electroencephalography, and cerebral vascular Doppler were used.

Results

“Radiation” PTSD includes: “flashforward” phenomenon and anticipating stress (projection of fear and danger to the future); somatoform disorders, depression, trait and state anxiety; neurocognitive deficit (impaired memory and attention, auditory-verbal memory and learning, proactive and retroactive interference; cerebellar and stem symptoms, intellectual changes). The intima-media component thickness of common carotid arteries, and common and left internal carotid arteries stenosis rates are increased in the liquidators. Changes of bioelectrical brain activity as a decrease of beta- and theta-power together with an increase of alpha-power were found in the Chernobyl accident survivors with PTSD.

Conclusions

PTSD following radiation emergency is characterized by comorbidity of psychopathology, neurocognitive deficit, and cerebrovascular pathology with increased risk of cerebral atherosclerosis and stroke. Cerebral basis of this PTSD is proposed to be an abnormal communication between the pyramidal cells of neocortex and hippocampus, and deep brain structures.
1333 – Study On The Incidence Of Depression And Apathy In a Group Of Patients Diagnosed With Parkinson’s Disease
Authors: Dumitru M.M. , Botezatu C. , Andrei R. , Popescu C.D. , Chirita V. , Chirita R.
Published: July 2013

Introduction

Depression and apathy are among the most common psychiatric and behavioral disorders associated with Parkinson’s disease (PD). This two psychiatric disorders are major determinants of quality of life for patients with Parkinson’s disease.

Objectives

The main objective of this study was to establish the prevalence and demographic and clinical correlates of depression and apathy in a sample of inpatients with Parkinson’s disease.

Aims

To identify depression and apathy in a group of patients diagnosed with Parkinson’s disease and to allow appropriate treatment to improve their quality of life.

Methods

A number of 44 inpatients with Parkinson’s disease were investigated with the Starkstein’s Apathy Scale (AS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Hoehn and Yahr staging (HY), the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Mini -Mental State Examination (MMSE).

Results

Apathy coexisted with depression in 34.1% of PD patients, compared with depression without apathy in 4.6%, and apathy without depression in 22.7%. Apathy was associated with higher UPDRS score, lower MMSE score and earlier HY stages. Depression was correlated with more advanced HY stages and younger age of patients with Parkinson’s disease.

Conclusions

Apathy and depression are common in patients with Parkinson’s disease. Therefore these two conditions should be screened and considered in the management of patients with Parkinson’s disease.
1342 – Deficits And Biases Of Facial Emotion Recognition In Ultra-high Risk For Psychosis And First-episode Schizophrenia
Authors: Lee S.Y. , Kim K.R. , Park J.Y. , Song Y.Y. , Kang J.I. , Lee E. , An S.K.
Published: July 2013

The purpose of this study was to examine whether people with ultra-high risk for psychosis showed biases as well as deficits in facial emotional recognition which were well-established findings in people with schizophrenia. Forty-five people with ultra- high risk (UHR) for psychosis, 30 people with first-episode (FE) schizophrenia and 40 healthy controls were asked to recognize the emotional category of facial emotional photographs. The stimuli were selected from the standard emotional photographs of Japanese and Caucasian Facial Expressions of Emotion (JACFEE) which depicting the basic emotions of happiness, disgust, sadness, anger, surprise, fear, and contempt. To examine the accurate and biased attribution of facial emotion recognition, unbiased hit rates and misattrbution rates of each emotion were calculated. The common abnormalities observed in the UHR for psychosis and FE schizophrenia group were lower unbiased hit rate for fear faces (UHR< controls: p = 0.027, FE< controls: p = 0.029) and higher contempt misattribution rate to faces (UHR>controls: p = 0.022, FE< controls: p = 0.088) compared with healthy controls. Unbiased hit rates for fear in UHR for psychosis and FE schizophrenia group were correlated with negative symptoms, and these correlations were found in other negative emotions in FE schizophrenia. These findings suggest that the bias as well as deficits of facial emotional recognition may be already present in the (putative) prodromal stages of schizophrenia and could be a possible trait markers for the social cognition.
1347 – Pseudocyesis Study In Brazil
Authors: Caixeta L. , Brasil R. , Vargas C. , Taveira D. , Caixeta M. , Verlaine P. , Caixeta V.
Published: July 2013

Introduction

Pseudocyesis is a rare condition in which a non-pregnant patient believes to bear a child due to psychological or somatic manifestations,or even both.Usually,there is a misinterpretation of body changes associated with emotional aspect of pregnancy or thought disorders(or chronic mental disorders),what makes pseudopregnancy a complex disorder to deal with,starting with its confusing classification in the DSM IV-TR.

Objectives

To document epidemiologic aspects of false pregnancies in a Brazilian population, reporting the most prevalent psychiatric diagnosis and demographic features associated, and compare it to the literature.

Methodology

Retrospective study of 20 patients diagnosed with pseudocyesis over a ten-year period in 3 hospitals of a Brazilian central region.Compare data with studies on sociodemographic, clinic, biological and evolutive correlates of pseudocyesis in PubMed.

Results

The mean age was 33, with the majority between 20–44. The symptomology matches the literature.Of the women, 15 (83%) were in the reproductive age, but 8 (44%) of them were infertil. Two male patients with pseudocyesis had a typical psychiatric presentation. The psychiatric diagnosis were: 9(45%) affective disorders, 9(45%) psychotic disorders, 1 (2,5%) Huntington‘s Disease and 1 (2,5%) epilepsy.

Conclusions

In terms of Brazil, this is an unique study of the subject, with the greatest data collected so far. We found many similarities,including age, socioeconomic status, symptoms, underlying disorders and history. And we notted the frequency of psychiatric disorders in those patients (specially Bipolar Disorder and Schizophrenia)
1351 – Second Hand Smoking (shs) In An Inpatient Psychiatric Unit
Authors: Zografaki A. , Basta M. , Vardavas C. , Tzanakis N. , Girvalaki C. , Koudas V. , Vgontzas A.
Published: July 2013

Introduction

In Greece, current legislation prohibits smoking in hospitals, but not in psychiatric units, that may be associated with significant Second Hand Smoking (SHS) adverse effects on nonsmoking patients/staff.

Objectives

To examine the extent of SHS, and investigate the attitude of the nursing staff regarding smoking in a psychiatric inpatients unit.

Aim

1

To measure objectively indoor air pollution using PM2.5 in the Psychiatric Inpatient Unit of the University General Hospital of Heraklion, Crete (PIU/UOC).

2

To investigate the attitude of the nursing staff towards the smoking permission in psychiatric units.

Methods

Data on smoking were collected for all inpatients between Nov’12-Sept’12. Pollution levels in PIU/UOC due to SHS were recorded by using the TSI Sidepack device. Nursing staff from the psychiatric unit, and medical and surgical units completed a short Questionnaire including demographics, smoking habits and attitude about the existing legislation on smoking.

Results

Among 444 inpatients, 42% were non-smokers. Within the PIU/UOC, indoor pollution attributable to smoking, averaged 318 μgr/m3(range: 82–730 μg/m3). 295 nurses (mean age 39.6 ± 7.5 yrs) completed the questionnaire and only 31.2% disagreed with the existing legislation, whereas 64% responded that they wouldn’t avoid working in a psychiatric unit because of smoking permission.

Conclusions

SHS concentrations within a psychiatric inpatient unit are comparable to those in bars, suggesting a detrimental effect on nonsmoking patients’/employees’ health. These results suggest the need to increase awareness among nursing staff of the adverse effects of SHS and to implement measures to decrease SHS’s impact on other patients/staff, i.e. nicotine patches
1353 – One Thousand Consecutive Attendees Of a Nigerian Psychiatric Emergency Service: Clinical And Socio-demographic Profile
Authors: Adeosun I. , Lawal R. , Ogun O.
Published: July 2013

Introduction

The Psychiatric Emergency service occupies a strategic position where crucial interventions can be initiated and coordinated in linkage with other services in the mental health network. However, there is dearth of information on users of psychiatric emergency in Nigeria and sub-Saharan Africa.

Objectives/aim

To determine the clinical and socio-demographic characteristics, pattern of presentation and disposal of patients attending a Nigerian psychiatric emergency unit.

Methods

One thousand Patients consecutively presenting to the emergency unit of the Federal Neuro-Psychiatric Hospital Yaba, Lagos, Nigeria from January 2012 were prospectively assessed. Following a comprehensive psychiatric evaluation, clinical, socio-demographic and other relevant data regarding their presentation and disposition were recorded into a pro-forma and subjected to statistical analysis.

Results

The majority were females (54.7%), single (65.6%), and unemployed (62.9%), with a mean age of 36.4 (± 14.7) years. Less than two-thirds (62.0%) were new patients. Only 10.8% of the new patients were formally referred to our facility. The most common diagnoses were schizophrenia (34.3%), depression (16.5%) and substance use disorders (11.4%). The patients were predominantly (89.4%) managed as out-patients.

Conclusion

The emergency room is a major port of entry into mental health care and could be prone to over-subscription by patients with non-acute problems, especially when alternatives are not readily accessible. Multipronged interventions, including community based care with relevant linkages, may facilitate appropriate utilization of mental health services and reduce the potential for overcrowding of the psychiatric emergency room.
1363 – Patients And Corticosteroids: Effect On Mood, Quality Of Life And Adherance To Treatment
Authors: Abbes M.
Published: July 2013

Objective

The objective of this study is to investigate the quality of life of patients receiving oral corticosteroids, his impact on the occurance of depressed or hypomanic mood and on the adherence to corticosteroids.

Materials and methods

This descriptive study was held in the department of Internal Medicine, during 04 months (From July to October 2012). We included 50 patients, having corticosteroids with a dose equal or greater than 10 mg of prednisone per day for a period exceeding one month. We used, the HAD scale, the SF-36 to investigate the quality of life of these patients, the ANGST scale of hypomania and Morisky scale for the dherence to treatments.

Results

The average age was 43.43 + / -16.11 years. The age of discovery of the disease was 38.24 + / -14.28 years. An average score of anxiety was 10.6 + / -3.89. An average score of hypomania was 8.43 + / -4.025. We noted that 53.7% of patients belong to level 3 of anxiety, and 40.56% have some level depression by the HAD score. Psychiatric complications were noted in 58.5% of patient with a major depressive state in 12.2%. Patients reported sleep disturbances in 24% with behavioral problems in 9.6% of cases.

The average score of SF36 was 56.55 + / -15.21, and 74% of patients had distorted quality of life, mainly affecting psychic health (92.54%).

Conclusion

Our results suggest the interest of a psychiatric examination before the introduction of corticosteroids, in order to detect patients requiring special supervision.
1365 – Family Functioning, Expressed Emotion And Family Burden In Relatives Of First- Episode And Chronic Patients With Schizophrenia And Bipolar Disorder: Preliminary Findings
Authors: Koutra K. , Basta M. , Roumeliotaki T. , Stefanakis Z. , Triliva S. , Lionis C. , Vgontzas A.N.
Published: July 2013

Introduction

The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP).

Objectives

To investigate possible differences in family environment between FEP and chronic patients with schizophrenia and bipolar disorder.

Aims

To compare family measures between relatives of FEP and chronic psychotic patients.

Methods

Family functioning (FACES-IV), expressed emotion (FQ), family burden (FBS) and psychological well being (GHQ- 28) were assessed in relatives of 30 FEP and 30 chronic patients.

Results

Multivariable linear regression models adjusted for confounders revealed that relatives of chronic patients scored significantly lower in balanced cohesion (β coefficient -4.27, 95% CI: -08.03, -1.71) and balanced flexibility (β coefficient -4.01, 95% CI: -6.91, -1.10), as well as communication (β coefficient -6.61, 95% CI: -11.70, -1.50) and satisfaction scales (β coefficient -7.32, 95% CI: -13.23, -1.41). Relatives caring for a chronic patient had significantly higher scores in critical comments (β coefficient 7.81, 95% CI: 3.95, 11.68) and emotional overinvolvement (β coefficient 3.70, 95% CI: 0.24, 7.16). They, also, reported higher objective (β coefficient 12.23, 95% CI: 3.76, 20.71) and subjective (β coefficient 2.79, 95% CI: 0.45, 5.14) burden, as well as poorer psychological well being (β coefficient 12.23, 95% CI: 3.76, 20.71).

Conclusions

These findings suggest that chronicity adversely affects patients’ family. Early intervention strategies are needed to reduce family burden which in turn may adversely affect the course of the patient’s illness.
1366 – Lupus: Psychosocial Impact, Coping And Mental Health
Authors: Oliveira C.A. , Avelino M.J. , Paixão L.S.M. , Agostinho C.S. , Jara J.M. , Bento A.J.
Published: July 2013

Introduction

Systemic lupus erythematous (SLE) is the paradigm of chronic systemic diseases. It has a strong impact regarding patient’s quality of life and the ability to work, which carries high direct and indirect costs. Intervention strategies promoting appropriate coping seem to have an important positive effect on quality of life. Neuropsychiatric symptoms are common.

Objectives and aims

To review the literature on psychosocial impact of SLE, understand which coping strategies are more often used, and to know what are the most common SLE neuropsychiatric manifestations.

Methods

The authors have conducted an online search in PubMed with the terms “SLE + Psychiatry” and “SLE + Mental health” from 1995 until 2012. From the outcome were collected, analyzed and summarized the articles considered to be relevant.

Results

Indirect costs represents 2/3 of the total cost associated with SLE. Inability to work is common (23%) and it is related to multiple factors. Patients with SLE tend to use coping skills that are generally adopted for events perceived as nonmodifiable. The immune system might play a role in the aetiopathogenesis of psychiatric diseases. Neuropsychiatric SLE symptoms are frequent (20-75%), especially depression (10.8-39.6%) and cognitive deficits (>40%).

Conclusions

SLE is a chronic systemic disease with a high psychosocial impact. Using active coping strategies seems to improve patient’s quality of life. Neuropsychiatric manifestations are common. A detailed study on disease impact will probably allow an earlier screening that lead to a more accurate diagnosis and treatment, promoting better mental health and prognosis in SLE patients
1367 – High Incidence Of Vitamin d Deficiency In Patients With Schizophrenia
Authors: Agarwal S.K.
Published: July 2013

Introduction

Neonates born in the winter and those with hypovitaminosis D levels exhibit a higher propensity to develop schizophrenia. Several reports have suggested that adult schizophrenics have lower vitamin D levels.

Objectives

This study was done to evaluate the presence of hypovitaminosis D in institutionalized schizophrenics.

Aims

To compare vitamin D levels in institutionalized patients with schizophrenia.

Methods

We retrospectively reviewed the vitamin D results on all schizophrenic patients seen in our office during a period of six months. Vitamin D was measured as 25-hydroxyvitamin D in the blood and reported as ng/ml. The levels were recorded and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency.

Results

Total of 83 patients, 63 had vitamin D levels measured. 46 (73%) had low Vitamin D levels, while 17 (27%) had normal vitamin D levels. Of the 26 females, 20 (77%) had low vitamin d levels and of the 37 males, 26 (70%) had low vitamin D levels. 10 of the 63 had severe deficiency, 22 of the 63 had moderate deficiency while 14 of the 63 had mild deficiency. No difference was noted between the males and females.

Conclusion

It is estimated that as much as 60% of the adult US population suffers from vitamin D deficiency. Our population of institutionalized schizophrenia patients had a 73% incidence of hypovitaminosis D. It may contribute to the higher morbidity and mortality noted in this population.
1371 – Significant Polypharmacy In Patients With Psychiatric Disorders
Authors: Agarwal S.K.
Published: July 2013

Introduction

Polypharmacy involving prescribed medications in the psychiatric population is increasing. The main psychiatric reason is to gain rapid therapeutic response as well as to bolster medication effectiveness in treating patients with refractory psychotic symptoms, mood symptoms, or behavioral problems. This may also increase the need for additional medications to treat side-effects. Further, these patients have significant co-morbid conditions, requiring additional non-psychiatric medications.

Objectives

To examine polypharmacy amongst psychiatric patients during their visit to an internist's office.

Aims

To confirm the presence of significant polypharmacy in patients with psychiatric diseases.

Methods

All patients seen in our office from residential boarding homes and under care of psychiatrists were included in the study. A list of all medications (antipsychotic and non-psychiatric) were obtained from the boarding home, office charts and pharmacy and tabulations done. Polypharmacy was defined as 5-9 medications and excessive polypharmacy more than 10 medications.

Results

Of the total of 146 patients (92 males, 54 females, aged 24-82 years), 4 (3%) were on one, 6 (4%) on two, 3 (2%) on three, 12 (8%) on four, 9 (6%) one five, 11 (8%) on six,16 (11%) on seven, 14 (10%)on eight, 22 (15%) on nine, 8 (5%) on ten, 41 (28%) on 11 or more medications.

Conclusions

Polypharmacy and excessive polypharmacy is common in psychiatric patients. Monotherapy was extremely rare, with only 4 patients (3%) being on only one drug. Our data suggests that polypharmacy in a residential psychiatric population is more common and more severe than previously reported.
1379 – Living With Urological Cancer: Quality Of Life, Effect On Mood And Neuroticism Level
Authors: Abbes M.
Published: July 2013

Objective

Throughout the course of care, sexuality's patients with urological cancer can be distorded. The aim of the study was to determine the influence of urological cancer on quality of life and the impact of the disease on their psychological state and social lives.

Materials and methods

This is a descriptive study that took place from July until mid-October 2012 in a urology department including 36 male patients with urologic cancer (bladder cancer…)

We used: SF36, HAD scale, Neuroticism scale.

Results

We noticed that the average age of patients; 93.3% were married. The mean age of discovery cancer was 65.9 + / - 11.74 years.

Before starting treatment, erectile dysfunction has increased to 83.3% suggesting the involvement of a psychological effect, especially with the reached the urogenital tract and an unpredictable violation of their sexual life.

After treatment, erectile dysfunction was observed in 86.7% with a decrease in libido 96.7%, with psychological and organic effect.

Anxiety score ranged from 2 to 16; 23.3% of patients had a score above 10 and 40% of them have belong to level 3 of depression.

An average score of neuroticism was 146.53 + /- 20.44 with a maximum of 181.

The average score of SF36 was 61.05 + / -16.42 and we noted that 67.5% of patients had impaired quality of life.

Conclusion

A program to improve the care of patient with urological cancer is very important, because the dimensions of sexual health and his effect on quality of social life and psychology.
1381 – Phosphorylation Of Peripheral Glucocorticoid Receptor In The Continuum From Current Depressive Episode To Vulnerability To Depression
Authors: Maric N.P. , Simic I. , Pavlovic Z. , Mitic M. , Soldatovic I. , Andric S. , Mihaljevic M. , Radojcic M. , Adzic M.
Published: July 2013

The impaired glucocorticoid receptor (GR) signaling has long been considered one of cornerstones in understanding the pathophysiology of depression. Phosphorylation of GR is very important for GR function, therefore we investigated: a) whether GR phosphorylation at serine 211 (pGR-S211) and serine 226 (pGR-S226) is altered in patients with episode of major depressive disorder (MDD); b) if neuroticism and negative affective states may be associated with altered GR phosphoisophorms of healthy adults. Phosphorylation at these sites is generally considered to be indicative of receptor activity. We studied leucocytes of :

a)

30 MDD patients and 35 controls, and

b)

37 healthy subjects, to assess the levels of nuclear total GR (tGR), pGR-S211 and pGR-S226 using Western blot technique.

Our results demonstrated increased phosphorylation of GR at S226 and, to a less extent, at S211 in MDD compared to controls. Also, pGR-S226 positively correlated with neuroticism and self report of stress in healthy. In MDD, the pGRS211/ pGR-S226 ratio was decreased (p < 0.05) implying reduced transcriptional activity of GR in patients. In healthy, pGRS211/ pGR-S226 was negatively correlated with self-repored subclinical depression. MDD had higher cortisol levels than others and cortisol concentrations positively correlated with S226 levels from the same blood samples.

We examined whether easily accessible peripheral markers of GR activity and disease status in depression exist. Although we examined leucocytes, we propose that reduced GR transcriptional activity could be one of mechanisms of impaired GR function in the brain, resulting in dysfunction of HPA axis observed as a risk for depression.
1384 – Attitude Of Nigerian Primary School Teachers To Children With Attention Deficit Hyperactivity Disorder
Authors: Adeosun I. , Ogun O. , Fatiregun O. , Adeyemo S.
Published: July 2013

Introduction

Teachers are potential partners in the referral and management of children with Attention Deficit Hyperactivity Disorder (ADHD) especially in resource constrained settings. However, their ability to play this role is a function of their knowledge of ADHD and their attitude towards children with the disorder. There is paucity of information on the attitude of Nigerian school teachers towards children with ADHD.

Objective/aim

This study assessed the attitude of a sample of primary school teachers in Lagos, Nigeria towards children with ADHD.

Method

Primary school teachers (n = 144) recruited from four mainstream schools in Lagos State were presented with vignettes describing school children with ADHD. Thereafter, they completed questionnaires which elicited their knowledge of ADHD and attitudes towards children with the disorder.

Results

The responses of the participants indicated a high level of misperception about ADHD and negative attitudes towards children with the disorder. Only 9.0% and 16.7% of the respondents agreed that ADHD could be successfully managed with medications and psychological interventions respectively. One out of four (25.7%) teachers affirmed that they would avoid relating with a child with ADHD, while 35.4% would be unwilling to accept a student with ADHD in their class.

Conclusion

There is a high level of misperception about ADHD among Primary school teachers in Nigeria. This highlights the need for educational Interventions targeted towards improving the knowledge of teachers about ADHD. Furthermore, mental health literacy could be incorporated into the curriculum of institutions training primary school teachers.
1387 – Psychiatric Background Within Frequent Attenders To The Accident And Emergency Department, a Snap Shot Review
Authors: Mohammed Z. , Gash A. , Adeboye K.
Published: July 2013

Introduction

Frequent attenders to the Accident & Emergency (A&E) can cause a huge burden on the services.

Objectives

To screen this group of patients for any previous existing psychiatric background as well as to identify patients with Medically Unexplained Physical Symptoms (MUPS) in order to sign post them to the appropriate services and to create a joint management plan with the A&E department.

Aims

Not different from the objectives.

Method

The list top 52 frequent attenders to two busy A&E departments in the North East of England for the period between Jan-Jun 2012, was obtained. Their records been verified on PARIS (the local Psychiatric Services Electronic Notes System) looking for at least one previous encounter with the services, if the patient was open to mental health and if the patient was care coordinated during that period. Diagnosis, history of substance misuse and significant alerts as well as housing were recorded. For the MUPS main reason for presentation was recorded. Joint care plan with A&E was also verified.

Results

This group generated 851 attendance to A&E during this period. Mean attendance 16 (12-41). Nearly 80% of the sample had at least one encounter with the psychiatric services. 40% were actively open to the services. 18 patients were care cordinated. 30% had significant alert to harm others. 9 patients in total were classified as homeless.

Conclusion

Significant number of regular patients at the A&E department have psychiatric background. There was limitation in identifying MUPS due to anomalies in coding.
1395 – Quality Of Life And Tnf-a Levels In Mexican Patients With Tuberculosis And Major Depressive Disorder
Authors: Pezoa-Jares R.E. , Alvarez-Sekely A.M. , Lopez-Bago A.L. , Vasquez-Medina J.A. , Cruz-Fuentes C.S. , Lascurain-Ledesma R.
Published: July 2013

Introduction

Tuberculosis (TB) is an infectious disease whose presentation is dependent on host defenses, whereas neuroimmune disregulations are a feature of major depressive disorder (MDD). There are complex interactions between the immune and nervous systems; Tumor Necrosis Factor alpha (TNF-a) has been shown to play a role in the pathophysiology of both TB and MDD. These diseases are prevalent in Mexico, however there is scant research addressing their comorbidity and related immune mechanisms.

Objectives

Evaluate differences in TNF-a levels and quality of life between subjects with TB and/or MDD.

Methods

Thirty-seven subjects (MDD = 10, TB = 9, TB + MDD = 8, controls = 10) were recruited. Instruments used were the SCID-I, Beck Depression Inventory, Hamilton Depression Scale and the World Health Organization Quality of Life survey. A blood sample was obtained from each subject to assess percentage of mononuclear cells positive for TNF-a, using an intracellular cytokines assay.

Results

Highest mean levels of TNF-a were found in the comorbid TB + MDD group (X = 10.46, DE = 14.59) while the control group had the lowest levels (X = 3.26, DE = 4.93). However, when comparing all groups, no statistically significant differences were found. Mean quality of life scores were lower in the MDD (X = 65.6, DE = 5.4) and TB + MDD (X = 66.2, DE = 14.5) groups. When comparing all groups, there were significant differences between TB vs. MDD (p = 0.013), TB vs. TB + MDD (p = 0.004) and MDD vs. control (p = 0.0002) groups.

Conclusions

No significant differences across groups were found regarding TNF-a levels, while subjects with MDD and TB + MDD showed a worse quality of life.
1401 – High Prevalence Of Treated Comorbid Conditions In Patients With Schizophrenia
Authors: Agarwal S.K. , Agarwal N.K.
Published: July 2013

Introduction

Schizophrenia is a complex and heterogeneous disease. Several psychiatric conditions including depression, obsessive-compulsive disorder, panic attacks, aggressive and violent behavior and substance abuse are frequently associated with schizophrenia. Non-psychiatric comorbid conditions are also common in this population.

Objectives

To evaluate the presence of non-psychiartic comorbid condtions in patients with schizophrenia.

Aims

This study looked at the medication history for non-psychiatric comorbid condtions in patients with schizophrenia.

Methods

Four residential institutions for patients with schizophrenia were chosen for the study. There were a total of 145 patients with schizophrenia. The first had 48 patients, males 30 and females 18, the second had 42 patients; 29 males 13 females, the third had 27 patients; 13 males and 14 females and the fourth had 28 patients; 15 males and 13 females. Medications were reviewed for the following comorbid conditions: hypertension, diabetes mellitus, asthma/COPD, hypercholesterolemia, arthritis, hypothyroidism, osteoporosis and miscellaneous.

Results

Of the 145 institutionalized schizophrenia patients(87 males (60%) and 58 females (40%); aged 28 to 82 years), comorbid conditions being treated were as follows: hypertension: 82(56%); diabetes mellitus:39(27%); lung disease 37(26%); hypercholesterolemia 50(35%); arthritis 28(19%), hypothyroidism 11(6%), osteoporosis 7(5%) and others 50(35%). There were only 24(17%) patients who had no treatment for any comorbid conditions.

Conclusions

The vast majority (83%) of institutionalized patients with schizophrenia are on medications for multiple nonpsychiatric comorbid conditions. Psychiatrists need to be cognizant of this clinical complexity and the resultant polypharmacy in this population. Continuing care should be coordinated with a general medical practitioner.
1404 – Impacts Of Mental Retardation On Inpatient Psychiatric Care Delivery Of Bipolar Disorder - a National-wide Health Insurance Claims Data Analysis
Authors: Liu S.-K. , Wu C.-S.
Published: July 2013

Background

Mental retardation can complicate the clinical course and outcome of bipolar disorder. How mental retardation affects the inpatient care of bipolar disorder warrants further investigation.

Method

Information regarding demographic characteristic, pre-admission use of outpatient services, medical co-morbidities and indices of inpatient health resources use (length of admission, hospitalization expenses and use of psychotrophic medications) of all individuals diagnosed with bipolar disorder and mental retardation first admitted between 2000 and 2010 was extracted from a total population claims database in Taiwan and compared with those admitted during the same period due to bipolar disorder. Confounding factors affecting health utilization, including age, differences in hospital payment standard and medical cormobidity, were controlled by multivariate analysis.

Results

451 and 13,513 bipolar patients with and without mental retardation were identified during the study period. For the index admission, bipolar individuals with mental retardation were younger, had longer hospital stay with higher total expenditures, and tended to be transferred for continual inpatient treatment. They also received smaller dosage of antipsychotics, lithium and benzodiazepines. Although the number of medical co-morbidity did not differ, the prevalence of hypertension and metabolic disturbances was lower among bipolar individuals with mental retardations.

Conclusion

The diagnosis of mental retardation was indeed associated with longer inpatient hospitalization and increased total cost of hospitalization expenses, despite being younger, with less metabolic imbalance and receiving less psychotrophic medications. Implications for the long-term course of bipolar disorder need to be confirmed by longitudinal follow-up studies.
1408 – Effectiveness Of Psychosomatic Rehabilitation Of Depressive Disorders
Authors: Bermejo I. , Löschmann C.
Published: July 2013

Results

64.3 of the patients were women, and were in average 49.1 years old. Most of the patients (46.3%) have an illness duration of one to five years. During the year before rehabilitation treatment 50.6% of the patients were between 3 and 6 month incapable to work and 28.7 more then 6 month. At admission 54.6 were not fit for work. Mean treatment duration was 39.7 (± 10.5) days. 52.0% had a moderate to severe depressive disorder, showing 32.3% comorbid anxiety disorder. After rehabilitation treatment 58.9% had no more depressive symptoms, 15.6% had mild and 25.4% a moderate to severe depression (effect size (ES) .05). During rehabilitation treatment patients improve their psychosocial functioning (GAF) from 59.3 to 70.3 (ES .03) and show a reduction of their physical (1.65 to 1.28; ES .01), psychological (2.32 to 1.54; ES .03) and social stress (2.01 to 1.38; ES .02).

Conclusion

Overall, it can be assumed that the rehabilitation of psychological depressive disorders has a high degree of effectiveness and could be an alternative to acute inpatient treatment.
1410 – Structural Brain Changes Associated With Depressive Symptoms In Elderly With And Without Mild Cognitive Impairment
Authors: Lebedeva A. , Westman E. , Lebedev A. , Simmons A. , Aarsland D. ,   The Alzheimer's Disease Neuroimaging Initiative
Published: July 2013

Introduction

Depression is common in the elderly with a significant impact on the quality of life, and increased risk for developing dementia. However, the underlying structural brain changes are not well established.

Objectives

To investigate neuroanatomical correlates of depressive symptoms in elderly people with and without mild cognitive impairment (MCI).

Methods

621 subjects with (n = 395) and without (n = 226) MCI selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were included in the study. Geriatric Depression Scale (GDS-15) with a cut-off point of 6 was used to evaluate depression. All subjects had T1 3D MRI images acquired at multiple ADNI sites using a standardized MRI protocol. Image post-processing included steps for brain segmentation and cortex reconstruction, and was performed using the software Freesurfer. General linear modeling was used to investigate depression-associated brain differences in patients with and without MCI (using age and gender as nuisance covariates).

Results

No depression-associated differences in cortical thickness were observed in subjects without MCI, whereas MCI subjects with depressive symptoms revealed significant thinning in right parahippocampal, middle temporal, left parahippocampal and entorinal gyri compared to non-depressed MCI patients.

Conclusion

We found that depressive symptoms in elderly patients with MCI are associated with more severe atrophy in medial temporal area, suggesting a possible contribution of Alzheimer's pathology in the pathogenesis of depression in this group.
1411 – Integrated Care Of Depression In Germany - The Freiburger Modell
Authors: Bermejo I. , Hölzel L.P. , Voderholzer U. , Tebartz van Elst L. , Berger M.
Published: July 2013

Background

Although in Germany a very well developed healthcare system for mental disorders exists, there is empirical evidence of under diagnosis and under treatment. There is also evidence that a carefully planned integrated care model of inand outpatient treatment is a promising way to achieve improvements in care.

Method

Within the framework of the Freiburger Model of integrated care for depressive disorders a network of psychiatrists, primary care physicians and a university medical center a coordinated treatment for patients was initiated. Complementary to an evidence-based outpatient treatment the department of Psychiatry offers a complex treatment where patients can use different inpatient measures during outpatient treatment. Patients with a chronic depression could use a specific treatment program. To analyze the effects a continuous project evaluation was conducted.

Results

40 physiciansincluded 227 patients. Unipolar depressions constitute the most frequent disorders. Most depression. Most having a recurrent depressive disorder (61.0%) show a moderate depression (57.7%) and 36.3% a severe. Over two thirds (74.9%) are treated exclusively by general practitioners. According to physicians’ ratings, 57.6% of patients were remitted or showed subsyndromal symptoms in the eighth treatment week. After 16 weeks, it raised to 70.3%. According to the PHQ, 58.6% of patients were remitted or showed minimal symptoms.

Conclusion

As a concrete implementation of an intersectorial and interdisciplinary framework concept for an integrated care of depressive disorders the Freiburger Model offers a evidence based model to assure in- and outpatient treatment by improving collaboration care through defined interfaces and clinical pathways.
1422 – Culture Sensitive Analysis Of Psychosomatic Complaints In Migrants In Germany
Authors: Bermejo I. , Kristion L. , Hölzel L.P. , Härter M.
Published: July 2013

Background

To ensure an adequate health care of migrants, differentiated information on the association of cultural background and migration related factors and psychosomatic complaints are necessary.

Method

Cross-sectional questionnaire based survey regarding psychosomatic complaints of migrants from Turkey (n = 77), Italy (n = 95), and Spain (n = 67) and ethnic German resettled from the states of the former Soviet Union (n = 196). Questionnaires distributed by non-health specific counselling agencies of welfare associations.

Results

The cultural background was a relevant factor for psychosomatic complaints, showing Turkish and ethnic German resettled migrants a higher likeliness, also compared to a sample of age corresponding Germans. Whereas Spanish and Italian migrants showed a lower risk for psychosomatic complaints. Also gender, feeling unwell in Germany and fatalism showed a significant association with psychosomatic complaints.

Conclusion

Migrants in Germany do not have per se a higher risk for psychosomatic complaints. A distinct differentiation by cultural background is necessary.
1427 – Dexamethasone Suppression Test And Depressive Symptoms Among Alcoholics Are Connected With Family History Of Alcoholism
Authors: Brykalski J.
Published: July 2013

Clinicians and researchers have long considered stress to play major role in the development and continuation of alcohol use disorders. There are studies which reveal that alcohol dependent individuals manifest dysfunction in hormonal stress response system - the hypothalamic-pituitary-adrenal (HPA) axis. Some data indicate that there is a connection between the HPA axis dysfunction and a family history of alcohol dependence.

Aim

Investigation of the relationship between the HPA axis function, depression and family history of alcohol problem (FHA).

Method

40 abstinent, alcohol dependent patients (9 females and 31 males) of inpatient treatment program were tested during the hospitalization with questionnaires (including family history of alcohol problem (FHA) and depressive symptoms measured by Beck Depression Inventory (BDI)) and with dexamethasone (DEX) suppression test.

Results

22,5% of subjects had abnormal results of DEX test.

There was significant (p < 0,05) correlation between DEX test and depressive symptoms among alcohol dependent subjects with positive FHA. There was no such correlation in negative FHA group. Abnormal DEX test was connected with higher scores in BDI.

Conclusions

There are correlations between depression, HPA-axis function and family history of alcohol problem.
1443 – Impaired Multisensory Integration And Disruption Of Spatial References In Anorexia Nervosa
Authors: Carey A. , Luyat M. , Cottencin O. , Thomas P. , Guardia D.
Published: July 2013

In anorexia nervosa (AN), body distortions have been associated with right parietal cortex (PC) dysfunction. The PC is the anatomical substrate for a supramodal reference framework involved in spatial orientation constancy. Our aim was to evaluate spatial orientation constancy and the perception of body posture in AN patients.

In this case control study, the population consisted of 25 AN patients and 25 healthy controls. We investigated the effect of passive lateral body inclination on the visual and tactile subjective vertical (SV) and body Z-axis perception in each group. Subjects performed visual- and tactile- spatial judgments of axis orientations in an upright position and tilted 90° ckwise or counterclockwise.

We observed a significant deviation of the tactile and visual SV towards the body (an A-effect) under tilted conditions, suggesting a multisensory spatial orientation deficit. Significant deviation of the Z-axis in the direction of the tilt was also observed in the AN group. The greatest A-effect in AN patients could reflect reduced interoceptive awareness and thus inadequate consideration of gravitational inflow. Furthermore, marked body weight loss could decrease the somatosensory inputs involved for spatial orientation.

Our study results strengthen the role of PC in AN. These suggest that spatial references are impaired in AN, which could be due to disrupted multisensory integration in the PC such as visual, tactile, vestibular and somatosensory information.
1450 – Acute And Transient Psychotic Disorders: Clinical Features After Ten Years Of Evolution
Authors: Bredicean C. , Papava I. , Romosan R. , Romosan F. , Cristanovici M. , Vladut M. , Ienciu M.
Published: July 2013

Introduction

There currently are only a few clinical studies found in literature that assess acute psychosis in terms of its longitudinal clinical course, meaning whether it totally recovers, reappears later on or other types of psychotic episodes will appear.

Objectives

To assess the clinical features of acute and transient psychosis after 10 years of evolution.

Aim

To emphasize the clinical stability of an onset diagnosis of acute psychotic disorder.

Method

A sample of 40 subjects was assessed prospectively. They were admitted for the first time in Timisoara Psychiatric Clinic between 1999 and 2001 and have been diagnosed according to ICD 10 with acute and transient psychotic disorder (F23). The evaluation was performed at onset and after 10 years of evolution. Following parameters were analyzed: socio- demographic (age at onset, gender, educational, professional and familial status) and clinical (onset and current diagnosis).

Results

After 10 years of evolution 67.5% of the subjects have experienced also other types of psychotic episodes and changed diagnosis during the illness course. 32.5% of the subjects followed a 1 to 2 years treatment and did not relapse so far.

Conclusions

Acute psychosis represent a heterogeneous group which can evolve to any other psychotic disorder.
1451 – Somatiforms Disorders And Parasuicidal Behaviour
Authors: Novakovic M.P. , Nasković Z. , Savković D. , Maksimović Z. , Novaković R. , Mitrić M.
Published: July 2013

Objective

Object of the study is self-destructive behaviour of young people in Bosnia and Herzegovina (B&H) in the period 2001- 2010. g. The aim of the study is exploration of the forms of self-destructive behaviour of young people in relation to poverty, adaptability and adolescence. Special aim is the analysis of self-destructive personalities.

Method

Two adolescent groups from (B&H) were statistically processed. The test group consisted of n=125 subjects who had parasuicide before they were of legal age, and control group consisted of n=125 persons with somatic symptoms and parasuicidal behaviour. The design of the study is longitudinal. Statistical processing was done with: GDL, EPQ, HAMD, PIE, and the study is prospective, stratified by quality (number of attempts) of parasuicide.

Results

Parasuicide has a growing trend of seriousness of self-destruction in the first group and increased somatization of anxiety and depression in control group. Parasuicidal destruction is reflected in suicide (7.7%), mental disorders (15.5%), social segregation (12.5%) and cases of good maturation (65%). Somatiform disorders are proven on Hamilton’s scale: body anxiety: t-test=0.78593, general body symptoms: t-test=0.73369, genital symptoms: t-test=0.8268, which are confirmed by Pluchic’s test.

Conclusions

Demonstrations of parasuicidal behaviour are found in both groups of respondents. Strong manifestations of self-destruction are clear in the test group, and in the control group they are expressed as masked forms of self-destruction. Both kinds of expression of the parasuicide are results of poverty, adaptability (PTSD), and personal difficulties in adolescence.