bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcultural issues in diagnostic process
Authors: Kastrup M. 
Published: May 2016

Diagnostic systems and methods must respond to patients’ diversity in expressions of mental distress, social and cultural context and the meanings given to illness. Due to increasing migration and globalisation the challenge of considering diagnosis in the context of culture has become increasingly significant in Europe. And globalization has further led to changes in value systems and our awareness of patients with ethnic minority background.Over recent decades, there has been an increasing development of psychiatric diagnosing with nosological categorisation combined with multi-axial schemas. Diagnosis, besides identifying a disorder and distinguishing one disorder from another disorder - differential diagnosis, has also an aim to include an overall understanding of the patient's situation.We witness an upsurge in the attention paid to the cultural limitations to psychiatric diagnostic practice and treatment modalities. Guidelines for the psychiatric profession are in critical focus from a transcultural perspective. Some claim their universality independent of cultural context; others find cultural adaptation useful and necessary.Do the diagnoses and clinical and ethical guidelines give meaning in the cultural setting? Are they compatible with the cultural values of the therapist and those of the patient and the family? Several sources claim the biomedical paradigm for being Western with insufficient consideration of the socio-political context.The cultural formulation developed as part of DSM-IV and now DSM-5 is one model to support a systematic review of culture and context in psychiatric diagnosing.The paper will discuss the advantages and shortcomings of current diagnostic categories and guidelines vis-à-vis the universe of traumatized refugees with other ethnic backgrounds.URL:http://www.mariannekastrup.dk/Disclosure of interestThe author has not supplied his declaration of competing interest.
Introducing PEEP: The psychiatry early experience programme
Authors: Qureshi H. , Holt C. , Mirvis R. , Cross S. , Hussain O. , Hutchings H. , Marshall E. , Turner F. , Wilson Jones C. 
Published: May 2016

At Guy's King's and St Thomas’ School of Medicine, a unique initiative is the Psychiatry Early Experience Programme (PEEP), which allows students to shadow psychiatry trainees at work several times a year. The students’ attitudes towards psychiatry and the scheme are regularly assessed and initial results are already available.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Value-based healthcare delivery in the digital era
Authors: Seara G. , Payá A. , Mayol J. 
Published: May 2016

IntroductionMental disorders are a major cause of disability in Europe [1]. However, organizational structures and information systems are focused on delivery of care, rather than providing value [2]. In the digital era, we have the capacity to change priorities through the analysis of heterogeneous databases that could support patients’ and professionals’ decisions.Objectivesto analyse the contradictions between the design and the theoretical structure of mental health services and the possibilities to evaluate the actual value of the delivered care.AimsTo reflect on changing the trend using a different conceptualization of objectives and evaluating methods.MethodsWe used a tool provided to clinicians by the Madrid's Regional Health Service SERMAS (‘ConsultaWeb’) combining primary care, pharmacy and hospital data (n = 395,073 patients for the catchment area), and a set of hospital-based data (patients attended by psychiatrists at the ER, n = 13,877, and patients admitted to the Psychiatric Inpatient unit n = 3318), to explore some of the present professional information resources.ResultsCurrently used healthcare databases only describe the diagnostic or therapeutic categories of patients and might be used to detect abnormal behaviours. However, they are neither able to show the functional status of patients nor designed to predict their clinical course.ConclusionsA clearer definition of value in patient outcomes is needed. This might help to organize the healthcare delivery and to create a new information system that would allow to asses health outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Motor symptoms and altered connectivity in schizophrenia
Authors: Walther S. , Stegmayer K. , Tobias B. , Federspiel A. 
Published: May 2016

Schizophrenia spectrum disorders are frequently associated with motor abnormalities. Aberrant motor function can be observed in patients throughout the course of the disorder, in subjects at high clinical risk and in unaffected first-degree relatives. Schizophrenia is further characterized by white matter abnormalities in multiple fiber tracts and aberrant resting state cerebral perfusion. In a series of studies, we investigated the association of objectively measured motor behavior in terms of activity levels with white matter microstructure and cerebral perfusion at rest. Patients were less active than controls at the behavioral level. In the associations with neuroimaging techniques, we detected that unlike controls, patients’ activity levels were linked to structure and perfusion of cortical motor areas as well as the connecting white matter. In controls instead, motor activity relied on the association of cortico-subcortical motor loops. Thus, some of the motor signs in schizophrenia may result from ineffective coupling between cortical and subcortical motor areas. Finally, preliminary data from functional connectivity analyses support this notion.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Organizing mental health care in nursing homes: How, by whom and what for?
Authors: de Mendonça Lima C.A. 
Published: May 2016

Though care should be provided in patients’ homes for as long as possible, it must be recognised that care in an alternative residential setting may be the only way of meeting some patients’ needs effectively or avoiding intolerable carer burden. Such care will always be necessary, for people who have no relatives available. The residential care may be useful for respite care including a range of time limited services, to support the carers. Residential care should also be available for those patients whose physical, psychological, and/or social dependencies make living at home no longer possible. This provision includes a range from supported accommodations with low level supervision, medium level care facilities and full nursing facilities. There is a high prevalence of mental disorders in nursing homes and very often the staff is not adequately educated, trained and supported to care these individuals. Psychiatric consultation liaison services should be provided not only for residents but also to support the staff of these facilities. The most recent international documents point out the necessity to offer the best available care [1] for these vulnerable persons in the deep respect of their dignity [2]. It becomes urgent to launch a deep debate on this subject in order to recommend to authorities the best guidelines to support policies to be adopted in this field.Disclosure of interestThe author has not supplied his declaration of competing interest.
Prisoners with intellectual disability: How to adapt interventions and the environment
Authors: Tort Herrando V. 
Published: May 2016

There is an increasing interest in the Spanish prison to give the appropriate care when they are in prison. This situation has a special meaning in inmates with learning disabilities, as they are a vulnerable group inside prison. They are vulnerable in different areas as they have a high prevalence dual diagnosis (both with mental illness and drug misuse), they could suffer from abuse from other inmates, difficulties to understand prison regulations, etc. The prevalence of intellectual disability (ID) in the prison setting has been poorly evaluated. In Spain, despite various approximations or estimates regarding people with intellectual disabilities no reliable data is available.In our presentation, we will give an overview of the care of this group of patients, presenting some data from an epidemiological study in Spain. The rate of learning disabilities was of 3.77% of the study population has an IQ below 70, and 7, 3% has borderline IQ rate. We also describe a new setting in one of wards of a prison of Barcelona where has a model of therapeutic community for treating offenders with intellectual disabilities. This resource open two years ago and is run between prison services and an organization “Accepta” (specialized in people with learning disability and penal law problems). This is an effort from the prison services to adapt to the needs of inmates and deliver a better service with a good post-release follow-up.And finally, we present some data about learning disability in penitentiary psychiatric settings (the prevalence as a main diagnose is around 10%).Disclosure of interestThe author has not supplied his declaration of competing interest.
Clinical pharmacological management of polypharmacy in old age depression
Authors: Baumann P. , Greil W. 
Published: May 2016

Polypharmacy is the rule in psychogeriatric patients, as they present frequently comorbidities such as depression, dementia [often including Behavioral and Psychological Symptoms of Dementia (BPSD)] and somatic diseases. Recommended treatments for geriatric depression are antidepressant medications, psychotherapy and psychosocial interventions [1]. Besides antidepressants, other psychotropic drugs are often co-prescribed, but somatic drugs are also needed for the treatment of other concomitant diseases. This situation increases the risk for adverse effects due to pharmacokinetic and pharmacodynamic interactions, especially since the organism of elderly patients displays a lowered homeostatic reserve and a decrease of functions, which allows resisting to xenobiotic influences.On the other hand, there are also studies which suggest that in hospitalized psychogeriatric patients, the incidence of severe adverse reactions is lower in patients > 60 y than in those < 60 y [2]. This is one of the results of the AMSP-study group, which in German speaking countries has developed a pharmacovigilance program in psychiatric hospitals.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Temporality and spatiality of anxious experience
Authors: Doerr-Zegers O. 
Published: May 2016

Since the first descriptions of anxiety, it has been related with temporality and in particular with the dimension of future. Thus, we already find anxiety defined as a general feeling of threatening (from the future) in the German mystic Jakob Boehme (1575–1634). He also used the image of “the wheel of anxiety”, with which he refers to its probable origin in a conflict between two forces which tend to separate themselves and are not able to do it, as a result from this centrifugal rotation movement of a wheel. This image also has a temporal character. In Kierkegaard, we read that “anxiety is always related with the future… and when we are disturbed by the past we are basically projecting toward the future…” In Heidegger's masterpiece, “Being and Time”, there is a chapter dedicated to the temporality of Befindlichkeit, and in particular to anxiety. Fear and anxiety have their roots, according to Heidegger, in the past, but their relation with the future makes them different: anxiety arises from the future as possibility, while fear arises from the lost present. In this paper, we try to make a contribution to the phenomenology of temporality (and of spatiality) of anxiety in relation with the analysis of a concrete anxiety experience: flight phobia. The analysis allows us to show both the desolation and narrowing of anxiety space, and with respect to temporality, the disappearance of every plan (the future), of every history (the past), and the reduction of the present to a succession of mere punctualities, behind which there arises, threatening, the nothingness itself.Disclosure of interestThe author has not supplied his declaration of competing interest.
Adopting and maintaining physical activity behaviour in people with severe mental illness: The importance of autonomous motivation
Authors: Probst M. 
Published: May 2016

BackgroundPhysiotherapy can improve the health of people with serious mental illness (SMI) but many are inactive. Adopting theoretically-based evidence considering the motivational processes linked to the adoption and maintenance of an active lifestyle can assist physiotherapists in facilitating lifestyle changes in people with SMI.PurposeWithin the Self-Determination Theory (SDT) and the Trans-Theoretical Model (TTM) (stages of change) frameworks, we investigated differences in motives for physical activity between different diagnostic SMI groups.MethodsAll participants with SMI from 15 different centers completed the Behavioral Regulation in Exercise Questionnaire 2 (BREQ-2), the International Physical Activity Questionnaire (IPAQ) and the Patient-centered Assessment and Counseling for Exercise (PACE) questionnaire.ResultsOverall 294 persons with SMI (190♀) (43.6 ± 13.6years) agreed to participate. People with affective disorders had higher levels of introjected regulations than people with schizophrenia. No significant differences were found for other motivational regulations. Moreover, no significant differences were found according to gender, setting and educational level. Multivariate analyses showed significantly higher levels of amotivation and external regulations and lower levels of identified and intrinsic regulations in the earlier stages of change. Strongest correlations with the IPAQ were found for motivational regulations towards walking.ConclusionsOur results suggest that in all people with SMI the level of identified and intrinsic motivation may play an important role in the adoption and maintenance of health promoting behaviours.ImplicationsThe study provides a platform for future research to investigate the relationships between autonomy support, motivational regulations and physical and mental health variables within physiotherapy interventions for this population.Disclosure of interestThe author has not supplied his declaration of competing interest.
Classification and clinical issues relating to hypersexuality
Authors: Potenza M. , Shane K. , Rani H. 
Published: May 2016

Multiple terms have been used to describe excessive and interfering patterns of non-paraphilic sexual behaviors including sex addiction, compulsive sexual behavior (CSB) and hypersexual disorder (HD). While a field trial was conducted to investigate the reliability and validity of the criteria for HD, the condition was not included in DSM-5, with this decision in part relating to insufficient data on the proposed condition. Currently, CSB is being considered as a diagnostic entity in the category of impulse-control disorders for ICD-11. In this presentation, we will present data relating to HD/CSB. In particular, we will discuss current issues relating to diagnosis and classification, as well as data regarding the assessment and clinical correlates of sexually relevant constructs (e.g., pornography use and craving). Data relating HD/CSB behaviors to sexual risk-taking, sexually transmitted diseases and mental health problems (including suicidality) will be presented. A strategy for addressing HD/CSB in clinical settings will be proposed and discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Discontinuation vs. continuation treatment with neuroleptics for a better long-term outcome
Authors: Wunderink L. , Nieboer R. , Nienhuis F. , Sytema S. , Wiersma D. 
Published: May 2016

BackgroundLong-term functional outcome of dose-reduction/discontinuation strategies in first-episode psychosis (FEP) has not been studied before. The present study compared 7-year outcome of an early antipsychotic dose-reduction/discontinuation (DR) strategy with maintenance treatment (MT). Primary outcome was (symptomatic and functional) recovery; relapse rates, functional and symptomatic remission were secondary outcomes.MethodsFEP patients (n = 128) symptomatically remitted for 6 m during their first treatment year who completed an 18 months trial comparing MT and DR were followed-up at 7 years. Symptomatic remission criteria were adopted from Andreasen et al., functional remission criteria were based on a functioning scale. Recovery was defined as meeting both criteria sets. MT or DR strategy, and baseline parameters were entered in a logistic regression analysis with symptom and functional remission and recovery at 7-years follow-up as dependent variables.ResultsOne hundred and three patients consented to participate. DR-patients showed twice the recovery-rate of MT-patients (40% against 18%), odds ratio 3.5 (P = .014). Symptomatic remission-rates were equal (69% and 67%). Better DR recovery-rates were attributable to higher functional remission-rates (46% vs. 20%) in DR. Predictors of recovery were DR, baseline living together and less severe negative symptoms. During the last 2 years of follow-up the mean daily dose in haloperidol equivalents was 2.20 mg in DR vs. 3.60 mg in MT (P = .031).Relapse rates were initially higher in DR but leveled at 3 years; 61.5% relapsed in DR and 68.6% in MT in 7 years.ConclusionDR of antipsychotics during early stages of remitted FEP significantly improved 7-years outcome in terms of recovery and functional remission compared to maintenance treatment. Though initially relapse rates in GD were higher, these equalled those in MT from 3 years to the end of the study. While the necessity of immediate antipsychotic treatment in FEP and positive symptoms relapse is robustly demonstrated in a great number of studies, this study suggests that we are faced with a dilemma concerning the drawbacks of long-term maintenance antipsychotic treatment on functional capacity. Though antipsychotic discontinuation appears only feasible without relapse in a substantial minority of patients, guided dose-reduction as far as positive symptoms remain subsided and allow it, appears a feasible strategy in view of functional recovery, doing justice to both sides of the dilemma.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Emotional instability and borderline personality disorder
Authors: Ebner-Priemer U. , Santangelo P. , Bohus M. 
Published: May 2016

Affective instability is widely regarded as being the core problem in patients with borderline personality disorder (BPD) and the driving force behind the severe clinical manifestations of BPD symptoms. In ICD-10, BPD is even labelled as emotionally unstable personality disorder. In the last years, the advent of electronic diaries, in combination with sophisticated statistical analyses, enabled studying affective instability in everyday life. Surprisingly, most recent studies using state-of-the-art methodology to assess and model affective instability in BPD failed to show any specificity, supporting the idea of a transdiagnostic construct. In addition, dysfunctional emotion regulation strategies revealed results contradictory to current clinical beliefs. Using multiple data sets and multilevel modelling, we will demonstrate that to understand affective instability it is important:– to statically model basic subcomponents of affective dynamics simultaneously;– in combination with dysfunctional regulation strategies;– cognitive processes in everyday life.Altogether, current research suggests that the dynamics of affective states and their intentional regulation are even more important to psychological health and maladjustment, than the affective states itself. Current initiatives to fundamentally improve psychopathological research are looking at basic physiological processes spanning across disorders. However, these approaches do fall short in understanding human behaviours as dynamical processes that unfold in the broadest setting imaginable – everyday life. Only the combination of basic physiological processes and methods assessing dynamical affective mechanisms in everyday life will enhance our understanding how dysregulations and dysfunctions of fundamental aspects of behaviour cut across traditional disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The age of onset of anxiety disorders in samples from the general population: A meta-analysis
Authors: de Lijster J. , Dierckx B. , Utens E. , Verhulst F. , Zieldorff C. , Dieleman G. , Legerstee J. 
Published: May 2016

WorkshopAge of onset of mental disorders: etiopathogenetic and treatment implications.BackgroundAge of onset (AOO) of anxiety disorders could serve as a vital statistic in the formulation of mental health policy. Previous reviews have reported on the AOO of anxiety disorders in the general population. However, these review studies did not systematically estimate the AOO of different anxiety disorder subtypes, and did not examine factors that might have influenced reported AOO.ObjectiveThe aims of the present study were (1) to estimate the AOO for all anxiety disorders and for specific subtypes, (2) to examine gender differences in AOO of anxiety disorders, and (3) to examine the influence of study characteristics on reported AOO.MethodSeven electronic databases were searched with keywords representing anxiety disorder subtypes, AOO and study design. The inclusion criteria were studies using a general population sample that provided data on AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV or ICD-10 criteria. Meta-analysis was used to estimate AOO and gender differences, while meta-regression was used to examine the influence of study characteristics.ResultsA total of 1028 titles were examined, which yielded 24 studies meeting the inclusion criteria. Meta-analysis found an average AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to 25.07). Separation anxiety disorder, specific phobia and social phobia had their mean onset before the age of 15 years, whereas AOO of agoraphobia, obsessive compulsive disorder, post-traumatic stress disorder, panic disorder and generalized anxiety disorder began on average between 21.1 and 34.9 years. Anxiety disorder is more common in women, but meta-analysis revealed no difference in AOO between genders. Prospective study design and higher developmental level of the study country were associated with earlier AOO.ConclusionResults from this meta-analysis indicate that anxiety disorder subtypes differ in mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards the factors associated with the development of subtypes of anxiety disorder in the age groups with the greatest vulnerability for developing those disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.