bluuebunny/crossref_metadata_2025_split huggingface dataset:
N-acetyl-cysteine in a double-blind randomized placebo-controlled trial: Towards biomarker guided treatment in early psychosis
Authors: Conus P. , Fournier M. , Xin L. , Baumann P. , Ferrari C. , Cousins A. , Alameda L. , Golay P. , Jenni R. , Kashavan M.S. , Eap C.B. , Cuenod M. , Buclin T. , Gruetter R. , Seidman L. , Do K.Q. 
Published: June 2017

PurposeRecent evidence points to a critical role of redox dysregulation induced oxidative stress in the pathophysiology of early phases of schizophrenia. An add-on trial with n-acetyl-cysteine (NAC) led to a reduction in negative symptoms in chronic schizophrenia patients. Aim of this study was to explore impact of addition of NAC to standard treatment in early psychosis (EP) patients.MethodsDouble-blind, randomized, placebo-controlled trial of addition of NAC, 2700 mg daily, to antipsychotic treatment over 6 months. Monthly assessment of PANSS, GAF, SOFAS and antipsychotics treatment; quantification of brain glutathione levels (GSHmPFC) by 1H-magnetic-resonance-spectroscopy and of blood cells glutathione (GSHBC) and glutathione peroxidase activity (GPxBC) as marker of oxidation status at the beginning and end of treatment.ResultsOverall, 63 patients were included. Spectroscopy data showed that GSHmPFC increased by +23% in the NAC group, while it tended to decrease by −5% in the placebo group (P = 0.005). No significant difference between NAC and placebo was observed on global changes in negative symptoms, positive symptoms or functional outcome. However, in patients with high-baseline oxidation status (GPxBC>22.3U/gHb), subgroup explorations revealed an improvement of positive symptoms over time compared to patients with low-baseline GPx (P = 0.02).ConclusionsWhile addition of NAC induced an increase of brain GSH, it had no impact on symptomatic and functional outcome in EP patients. However, in patients with high oxidation status, addition of NAC leads to significantly greater improvement in positive symptoms. Future studies on antioxidant interventions in EP should consider biomarker-guided treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Victimization and perpetration of crime in patients with schizophrenia and related disorders involuntarily admitted
Authors: Fortugno F. 
Published: June 2017

IntroductionIncidence of crime victimization and perpetration is higher in severely mentally ill people than in general population. In the literature, fewer papers investigate the risk of being a victim than the risk of perpetrating violence in psychiatric patients.ObjectivesTo study incidence of self-reported crime victimisation or perpetration in 2 multicentric database of patients suffering from schizophrenia or related psychoses who are admitted involuntarily to hospital.MethodsIncluded involuntarily admitted patients with ICD-10 diagnosis of F20-F29, age 18–65, giving informed consent. Univariable and multivariable logistic regression to estimate odds ratios. Structured interview and BPRS by trained operators.ResultsThree hundred and eighty-three and 543 cases for each database. Victims: 37.8% and 28.0%. Accused: 25.6% and 11.6%. Victims had higher BPRS subscale of Mania, were unemployed and had fewer social contacts. Accused had higher mania in one of the 2 sample. Sociodemographic predictors included unemployment and homelessness, younger age and male gender.DiscussionSociodemographic factors are important predictors of being accused of a crime. Higher symptoms of mania are associated with higher odds of being victim of violence in 2 multicentric samples, after correction for other variables. Rates of both victimisation and perpetration rates are higher than in samples of people from general population or from outpatients settings. Accused and victims have a strong association with consideration on the context of life.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
Help-seeking behavior among patients and their relatives presenting to psychiatric unit in southern Sri Lanka
Authors: Goonawardena K.D.D.R. , Kotalawala S.W. , Ruban R. 
Published: June 2017

BackgroundEarly recognition of the signs and symptoms of psychiatric illnesses is important as the delay would predict worse prognosis.AimsTo study the help-seeking behavior and sociodemographic factors of psychiatric patients presenting to Psychiatric Unit Teaching Hospital, Karapitiya.MethodsA descriptive cross sectional study. Sample drawn from patients presenting for the first time to Psychiatric Unit Teaching Hospital, Karapitiya. An interviewer administered questionnaire was used to collect data.ResultsAge ranged from 13 to 76 years (n = 50). Males 34 (68%). Duration from onset of symptoms to first presentation ranged from 2 days to nine years, mean 2 years. Twenty-five (50%) had symptoms for more than one year. Sixteen (32%) stated to have attributed illness to supernatural courses as the reason to delay seeking medical help. None gave difficulty in accessing a psychiatric unit as reason for the delay. Twenty-six (52%) referred by nonpsychiatric medical professionals. Regarding alternative treatment engaged in prior to presentation to a psychiatric unit, eighteen (36%) tried to dispose of evil spirits with the help of yakaduru or kattadi, seven (14%) sought help from indigenous medical practitioners and twenty (40%) engaged in religious rituals. Thirteen (26%) sought nonpsychiatric medical treatment.ConclusionsA substantial number of patients suffering from psychiatric disorders present to psychiatric units delayed. As the majority were referred by nonpsychiatric medical professionals, alerting them regarding importance of early identification of psychiatric illnesses could help in reducing the delay.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Combined pharmacotherapy involving aripiprazole and clozapine for controlling the positive symptoms refractory to other antipsychotic treatments in a patient with schizophrenia
Authors: Santillan G. Hernandez , Lazo-Chávez K. , Blanco-Prieto M. 
Published: June 2017

IntroductionTreatment resistance is considered a challenging problem of antipsychotic pharmacotherapy in schizophrenia, especially, when it is associated with other factors, such as cultural aspects, diverse clinical presentation, furthermore functional impact. Then, combination approaches are commonly used, for instance, the add-on of aripiprazole to clozapine; which allows increasing of efficacy and safety.ObjectiveAssess the response to clozapine–aripiprazole combination treatment in the management of resistant schizophrenia.AimTreatment of resistant schizophrenia.MethodAnalysis of a clinical case.ResultA 27-year-old male resident in an Iberian country two years ago, is from a Latin American country, lives with his mother, his sister and his nephew. Their parents were separated. Eight years ago, his father died and shortly thereafter, he started impaired behavior, auditory and visual hallucinations, delusions about referentiality, persecution and prejudice, which required a brief hospitalization in their country. Upon arrival, he is included in the network of Mental Health, with positive symptoms, significant behavioral and cognitive disorganization and he needed hospitalization again. Then, treatment is instituted in different lines with risperidone, quetiapine, olanzapine, haloperidol, amisulpride, without results. Then, combined clozapine therapy is initiated up to 400 mg/day, more aripiprazole 20 mg/day, which switch after to pattern injectable depot, with informed consent. Six months after, he presents encapsulated delirium and improvement of disorganization, allowing the patient to retake studies.ConclusionClozapine–aripiprazole combination was associated with 22% reduction of clozapine dose. There was improvement in positive and negative symptoms, social functions and amelioration in their metabolic profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Doses of antipsychotics in maintenance phase compared to doses in acute phase treatment
Authors: Ivanušić J. , Bilić G. Filipović , Koić O. 
Published: June 2017

Maintenance phase treatment with antipsychotic medications is recommended for all patients with schizophrenia. From clinical perspective and based on studies, small proportion of patients after first psychotic episode and far smaller proportion of patients with multiple psychotic episodes do not experience relapse. The use of antipsychotic medications as maintenance treatment reduces relapse rates. The optimal doses of antipsychotics in maintenance phase stay unclear although investigators attempted to identify doses sufficiently high to prevent relapses and at the same time sufficiently low to avoid adverse effects. In maintaining remission, it is usually recommended to use doses of antipsychotic medications that were effective in acute phase treatment as long as they are well-tolerated, but few studies and clinical experience show that lower doses than those usual for the acute phase are sufficient for maintenance treatment. The aim is to investigate doses of antipsychotics used in maintenance phase compared to doses used in acute phase treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Effect in antipsychotic-induced hyperprolactinemia after switching to long-acting injectable aripiprazole: A 1-year study
Authors: Ruiz M. Juncal , Puente B. Fernández-Abascal , Olivares O. Porta , Revuelta M. Gómez , Rodríguez R. Landera , Blanco L. Sánchez , Jenaro G. Pardo de Santayana , Herrera M. Pérez , Son J. Mayoral Van 
Published: June 2017

IntroductionAntipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.AimsTo evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.MethodsThis was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.ResultsIn basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.ConclusionsSeveral studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Influence of clozapine to modified electroconvulsive therapy in the treatment resistant schizophrenia
Authors: Kikuchi Y. , Kanbayashi T. , Shimizu T. 
Published: June 2017

IntroductionClozapine is one of the most effective drugs for the treatment resistant schizophrenia (TRS). It was reported that modified electroconvulsive therapy (mECT) may be an effective clozapine augmentation strategy in TRS.ObjectiveThe objective of this study was to investigate the influence of clozapine to mECT in the TRS.MethodsForty-seven patients were recruited in this study, but eight patients were excluded because clozapine was discontinued by reason of side effects. Ultimately, 39 patients were enrolled.ResultsSeventeen patients received mECT before clozapine therapy. Two patients continued mECT after starting clozapine therapy. There was a significant difference between before–after clozapine therapy (χ2 test, P< 0.01). Intermittent mECT was performed for 3 patients before clozapine and for one patient after starting clozapine.DiscussionThis result suggests that clozapine therapy reduces mECT. In Japan, the first-line treatment for TRS is CLO. mECT is recommended for clozapine resistant schizophrenia patients. Prescription of CLO is limited in the part of medical facility because all physicians who prescribe clozapine must be registered with the clozaril patient monitoring service in Japan. It is considered that mECT is more readily selected than clozapine therapy. Therefore, the number of mECT is not reduced generally.ConclusionClozapine therapy reduces the necessity of mECT.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Can writing be used to study and improve the socio-cognitive functioning of individuals diagnosed with schizophrenia?
Authors: Lucic L. , Khan A. , Daiute C. 
Published: June 2017

Impairments in social and cognitive functioning are some of the most disabling features of the schizophrenia. They result in poorer communication with others, difficulties in maintaining employment status and decrease in community involvement. Recently, cognitive remediation therapy (CRT), which relies on computer-based drill and practice exercises, has emerged as a nonpharmacological intervention that aims to target and improve cognitive and social functions. Given the recent success of CRT based approaches, the question arises: can other nonpharmacological interventions which aim to augment and improve socio-cognitive functions be effective? Building upon Vygotsky's (1934) theorizing, we conducted an 8-week long study involving 19 participants. The study uses the methodology of narrative inquiry to examine participants’ ability to employ varied socio-cognitive functions (affect, causation, perceptive-taking, logical/hypothetical inference, etc.) when writing about everyday activities and attempting to resolve conflicts in narratives. Prompts employed in this study directed participants to write about three different socio-cultural contexts: (1) inpatient; (2) outpatient and (3) a fictional context. The fictional context aimed to examine participant's ability to imagine and express alternative futures/scenarios. Data show significantly higher frequency of occurrence of linguistic devices tied to cognitive functions in (3) fictional narrative context when compared to either (1) inpatient or (2) outpatient context. Use of affect was the only statistically significant difference between contexts (1) and (2). Findings indicate that individuals diagnosed with schizophrenia are able to vary the use of social and cognitive functions across narrative contexts, suggesting that future socio-cognitive interventions can be anchored in mindfully planned narrative activities.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Brain-based psychotherapy for psychosis
Authors: Mehl-Madrona L. , Mainguy B. 
Published: June 2017

IntroductionPsychotherapy methods are evolving for patients with psychosis.MethodsWe present a psychotherapy of psychosis that is brain-based, along with results of working with patients using these methods. Patients with psychosis are known to have decreased connectivity of the elements of the default mode network, also known as the story-making brain. These patients are known to tell narratives that lack coherence, of both excessive elements and inadequate elements. These stories are rigid and either cacophonous or rigidly monologic. The key brain area of the precuneus shows diminished connectivity to other brain areas. We present a narrative approach in which patients are assisted through rehearsal and modeling to tell more coherent stories about their life experiences. We work toward achieving a future orientation in which a sequence of actions leads toward an achievement of a future goal. The protagonist encounters obstacles and learns how to overcome them. Through iterative rehearsals, the story achieves more vivid mental imagery and emotional connectivity. Delusions and voices are accepted and incorporated into those stories in ways that provide the patient with improved capacity to cope with their delusions and voices.ResultsWe present the results of 59 patients who worked with these techniques and compare them to a matched cohort of patients treated conventionally. The treated patients show statistically significant improvement in positive and negative symptoms and in quality of life.DiscussionBrain-based narrative psychotherapy approaches can improve the quality of life and reduce symptoms.ConclusionThese techniques are worthy of further exploration.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Functional Connectivity of Reward Circuits in Eating Disorders
Authors: Favaro A. , Santonastaso P. 
Published: June 2017

ObjectiveAnorexia nervosa display alterations of reward systems and some authors hypothesize the presence of a “starvation addiction”. The aim of the study is to explore the resting-state functional connectivity of dorsal and ventral striatal nuclei.Method51 subjects with lifetime anorexia nervosa (AN) (35 acute and 16 recovered) and 34 healthy controls underwent high resolution and resting-state functional magnetic resonance imaging.ResultsThe AN group showed a reduced functional connectivity of the putamen in comparison to healthy women and this reduction appeared to be stronger in patients with lifetime binge eating or purging. Both acute and recovered AN groups showed larger left accumbens area in comparison to healthy women. Moreover, the functional connectivity of bilateral nucleus accumbens and putamen showed significant negative correlations with the number of obstetric complications in the AN group.Discussionthe present study supports the hypothesis that AN is associated with structural and functional alterations of striatal networks and unveils a possible role of obstetric complications in the pathogenesis of striatal dysfunction.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Sexual and mental health of patients with cardiovascular disease: A review
Authors: Szczegielniak A.R. , Krzystanek M. 
Published: June 2017

More than 4,000,000 people die from cardiovascular diseases in Europe every year. Even though a significant reduction in mortality of patients suffering from heart and blood vessels disorders can be observed across the continent, a number of hospitalizations in this group constantly increase. Large disparities in the assessment of population's health awareness, prevention activities and the availability of specialized treatment between different regions of Europe are still recognized with the highest incidence rates in Central Europe, Eastern Europe and the countries of the former Soviet Union. Both researchers and clinicians pay increasingly more attention to the cardiac patients’ quality of life. It determines not only the daily physical, mental and social functioning, but also a general response to the further treatment conducted in outpatients clinic. Sexuality is an integral part of the human personality. Disorders appearing in the area make it difficult to fully achieve the comprehensive well-being from the individual, interpersonal and social dimension. Reduction of satisfaction and decrease in sexual activity are commonly observed in cardiac patients and frequently associated with depression and anxiety disorders. Older age, pharmacological treatment, and variety of cardiovascular risk factors (diabetes, hypertension, dyslipidemia, physical inactivity, smoking) also negatively influence sexual functioning. Thus, cardiac rehabilitation programs must be designed in a way to include recommendations regarding clinical management of sexual dysfunction, improving functional capacity, quality of life, morbidity and mortality of the patients with cardiovascular disease across Europe. Psychiatric assessment and general psychological well-being appraisal seem to be inseparable in these regards.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Insomnia and sleep state misperception: Clinical features, diagnosis, management and implications
Authors: Isaac J. , Santos C. , Matos Pires A. 
Published: June 2017

BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.ObjectivesDescribe the main differences between primary insomnia WSM and wSM regarding:– clinical features;– diagnosis;– management;– implications.MethodsWe conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.ResultsThe prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.ConclusionsThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.Disclosure of interestThe authors have not supplied their declaration of competing interest.