bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between patients who did not show up for their first visit and the ones who did
Authors: Saenz B. Mata , Fernández L. Nuevo , Aguerri L.M. Asensio , Fernández L. Beato , Cano T. Rodríguez 
Published: June 2017

IntroductionReferrals to psychiatry from primary care has increased in recent years. This can be the result of the global economic situation and represents a problem for specialized care, because patients can’t usually be correctly attended to. On the other hand, patients who don’t come to visits make up other important issues that we must analyze.ObjectivesTo analyze the differences between patients who did not come for their first visit and those who did in order to try to describe variables that could be affecting them.MethodsThis is an epidemiological, analytic, prospective study of patients referred to our department. The following variables were collected: (1) referral protocol, (2) reason, (3) demographic data, (4) attendance to appointment, (5) diagnosis impression and (6) destination of referral. The SPSS 19.0 was used to analyze the data.ResultsWe studied a total of 1.048 patients for 15 months, of which 20.6% did not come to their first visit. A statistically significant relationship between attendance and gender, year of the appointment, adequate demand or not, previous follow-up and diagnosis was found (Chi2). However, if a logistic regression was carried out, only the adequacy of the demand was included in the model.ConclusionsCoordination with general practitioners is essential to improve referrals and, most importantly, the attention to patients. If we can agree on the referral criteria, a better-personalized assistance can be offered to patients who have more difficulties in coming (because of characteristics of illness, place of residence, and other variables).Disclosure of interestThe authors have not supplied their declaration of competing interest.
On purpose of multiple cases: Quaternary prevention on mental health – “Primum non-nocere”
Authors: Lazo Chavez K.L. 
Published: June 2017

IntroductionQuaternary prevention, concept coined by the Belgian Marc Jamoulle, are the actions taken to avoid or mitigate the consequences of unnecessary or excessive intervention of the health system. The concept alludes to actions to avoid the over-diagnoses and over-treatment, trying to reduce the incidence of iatrogeny in patients, which is a serious public health problem and even more in mental health.MethodsSystematic review of bibliography.ObjectivesDo a systematic review of bibliography and through the results invite to the analytic and critic reflection of our professional activities and the current situation of mental health.ResultsThere is not enough studies about quaternary prevention in mental health.–Some studies found that about one-third of diseases of a hospital are iatrogenic, most of them for pharmacological causes.–There is iatrogeny at different levels of the attention of mental health: primary prevention, diagnosis and treatment.–Non-treatment indication avoids in multiple cases iatrogenesis and contributes to the correct distribution of the economic and care resources.ConclusionsSince one of the fundaments of medicine is “primun non nocere” that means “first do no harm” and one of principles of bioethics is “non-maleficence”, quaternary prevention should prevail over any other preventive or curative option.–We should define in a more realistic way the limits, benefits and damages of our interventions in order to not promote a passive and sick role.–Must be recognized the non-treatment intervention as a therapeutic and useful intervention, and one of the best tools of quaternary prevention.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
Multidisciplinary approach in old aged dying patients
Authors: Ogando Portilla N. , Bañon González S.M. , García Jiménez M.G. 
Published: June 2017

IntroductionOver centuries, clinicians have had the responsibility to take care of dying patients. Lately, the withdrawal of life sustaining treatments have assumed a main role in these patients because of ethical aspects. Competent patients have the right to refuse medical care but not always these rights are respected or even explained to them, especially if they are old or they don’t have any close family. A multidisciplinary team should agree on how they think it is best to care for the patient and whether withdrawal of medical interventions is appropriate by using patient's wishes.ObjectivesTo identify the most relevant aspects to deal with in old aged dying patients.MethodsSystematic literature review in Up-to-date and Pubmed.Clinical case 83 years-old-man with a gastric cancer state IV. Married with a woman with Dementia who is waiting for a long stay public residence. No children. No cognitive damage. Fatal prognosis with a need of permanent enteral nutrition, which, he doesn’t want to use and clinicians strongly recommends. Great anxiety and suffering. Decision making capacity. Wish to die.DiscussionPatients with the capacity to make medical decisions can refuse medical care even if this refusal results in their death. Sometimes, a “comfort measures only” can be a better option than trying to keep life. Old people with no family are often less informed and taken in count in making decisions. A symptom management, good patient-clinicians communication, psychosocial, spiritual, and practical support and respecting patient's wishes and decisions is a main goal in any medical care.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Evaluation of elder physical abuse
Authors: Buicu G.E. , Gabos Grecu M. , Salcudean A. , Gabos Grecu I. , Marinescu C. , Nirestean A. , Turliuc S. , Hadareanu V. , Udristoiu I. 
Published: June 2017

BackgroundIn the society we belong to, elders are the target of abuse which is many times generated by the social cultural tendency which promotes different expressions in terms of age, a tendency which also measures capacity in terms of age.ObjectiveTo evaluate elder physical abuse – cases reviewed at the Forensic Institute, Tirgu Mures County, Romania.MethodsAn experimental design was used, focusing on elder physical abuse cases involving victims aged 65 or older, who requested a forensic certificate. All cases were reviewed at the Forensic Institute Tg. Mures, Mures County, Romania between 1st of Jan–31st Dec 2014. Variables included: age, gender, environmental origin, physical abuse, sexual abuse, relationship with the perpetrator (relative, known person/neighbor, unknown person, husband/wife), the required number of days of hospitalization, victim previous psychiatric diagnosis, aggressor previous psychiatric diagnosis.ResultsA total of 5252 forensic medical certificates were issued at request by the Forensic Institute of Tg Mures. One hundred and twenty (2.28%) were related to acknowledgement of the aggression of an elderly peIntroductionrson (≥65 years, with an average age of 69.89 years CI: 68.8903–70.8930). The majority of subjects were males (65%), of rural origin (64.17%). The same address as the aggressor's was identified in most of the cases (41.66%). 35.83% were hurt by neighbours/acquaintances, 22.5% were attacked by strangers.ConclusionWe are aware of that an elder abuse appears to occur most often in domestic home situations, men from rural, more often than women, are involved that victims and may be perpetrated by adult family members, or other persons.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The prevalence of obesity among forensic intellectual disability inpatients
Authors: Denman R. , Chester V. , Watson J. , Nyakunuwa C. , Alexander R. 
Published: June 2017

BackgroundInpatient mental health settings have been described as “obesogenic” environments, due to factors including psychotropic medication, high calorie food, restricted physical activity and sedentary lifestyles. No research has investigated obesity among forensic intellectual disability inpatients, despite this populations’ increased risk. Therefore, this paper aims to evaluate the prevalence and correlates of overweight and obesity on, and during admission.MethodThe weight and body mass index data of 46 inpatients (15 women and 31 men) within a specialist intellectual disability forensic service was examined for the study.ResultsOnly six patients (13%) were a normal weight at admission, whereas 40 (87%) were overweight or obese. During their admission, 28 (61%) gained weight (average 11.8 kg), and one (2%) maintained. However, 17 patients (37%) lost weight (average 6.2 kg), though 16 remained in overweight/obese categories. There was no correlation between length of stay and weight/BMI.ConclusionsThe majority of patients were overweight or obese on admission, and approximately 60% gained weight during their admission. Women appeared at greater risk of obesity. There was no relationship between length of stay and weight. This is potentially due to the high prevalence of obesity on admission and the impact of previous admissions on weight. The results highlight the need for effective weight management interventions with this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Predicting offense recidivism in Schizophrenia patients
Authors: Oueslati B. , Ali M. , Ridha R. 
Published: June 2017

IntroductionSchizophrenia increases the risk of offending. Recidivism rates are significant.AimIdentifying general and violent recidivism risk factors in schizophrenia patients.MethodsWe conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offences’ types as well as to their ages. A multivariate analysis was performed.ResultsWe included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.039; OR = 1.23), having been unemployed (P = 0.047; OR = 1.22) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.032; OR = 1.29) and cannabis use disorders (P = 0.005; OR = 1.34). A hospitalization shorter than 6 months increased the risk by 1.44 (P = 0.039). A combination of conventional antipsychotics (P = 0.003; OR = 1.36) and a poor adherence (P = 0.006; OR = 1.36) were considered as recidivism risk factors too.ConclusionsAll eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Sadistic sexual assault, perversion and schizophrenia: A case report
Authors: Zghal M. , Fekih Romdhane F. , Jmii G. , El Ghali F. , Belkhiria A. , Jouini L. , Ghazeli I. , Ridha R. 
Published: June 2017

IntroductionIn some forms of sexual perversion, sexual satisfaction is achieved only by treating one's partner violently (sadism) or conversely, by suffering pain (masochism).Objective and methodThe objectives of our study were to understand the complex relationship between psychotic and perverse structures, and discuss the importance of some criminal risk factors for psychotics who have sexually perverse behaviors, through clinical observation and review literature.Case reportMr AB was 35-year-old, single and unemployed. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of emasculation on a child aged 5 years without sexual abuse. In his biography we have objectified cruelty to animals, charged judicial history (imprisonment for theft, murder and escape from prison, hetero aggressive acts) and substance use.The patient explained with indifference that he heard voices making fun of his “sexual impotence and loss of his manhood”. The day of the forensic act, he got an uncontrollable urge to emasculate the first man he met on his way at the behest of this hearing hallucinatory activity. Psychiatric experts retained the diagnosis of psychosis with perverse arrangements. Under neuroleptic treatment, psychotic symptoms disappeared but the patient's sadistic problems remained present and active throughout his hospitalization.ConclusionThe following case illustrates the issue of dangerousness and responsibility in a perverse psychotic author assault of a sexual nature. Given their clinical history, the path between perversion and psychosis shows that perverse manifestations are prior to the first psychotic symptoms and the perverse constitution is developed parallel to the psychotic illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Family-based association study between the brain derived neurotrophic factor (bdnf) gene and the attention deficit hyperactivity disorder in a Mexican population
Authors: de la Cruz J.P. Sánchez , López López A. , Tovilla Zárate C.A. , Molina Sólis R. , Valencia Hernández A. , Gómez Valencia L. , Rivera Angles M.M. , López Narváez M.L. , Bermúdez Ocaña D.Y. 
Published: June 2017

The attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disease in infancy and adolescence, its world prevalence in the general population is high 3.4%. There is genetic evidence that consistently supports the polygenic nature of ADHD with a heritability estimated between 75% and 91%; literature proposes that the brain derived neurotrophic factor (BDNF) is a candidate gene that participates in the ADHA pathogenesis. One of the most studied polymorphisms is the Val66Met. The aim of this study was to determine a family-based an association between the rs6265, rs122,733,63 and rs110,301,19 polymorphisms of the BDNF gene and the ADHD in a Mexican population. The ADHD diagnose was performed by a pedopsychiatrist utilizing the diagnostic and statistical manual of mental disorders (DSM-V) who selected 35 patients; along with the biological parents, a total of 105 individuals grouped in family-trios (mother, father and ADHD patient) were studied. Of the 35 probands, 32 were men and 3 were women (average age 7.7 years; age range 4–14 years). Subsequently, no statistically significant association was observed between the BDNF gene polymorphisms and the ADHD etiology in Mexican families: rs6265 (χ2 = 1.33; P = 0.24); rs122,733,63 (χ2 = 1.33; P = 0.24); rs110,301;19 (χ2 = 0.66; P = 0.41). Furthermore, no preference of transmission was observed for any of the haplotypes. In conclusion, it was not possible to prove any association between the BDNF gene polymorphic variants and ADHD in a Mexican population. Future studies comprising larger samples are necessary to determine the potential role of the BDNF gene in ADHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Kleefstra syndrome: Considerations about treatment strategy in 2 patients with a causative Ehmt1 mutation and apathy
Authors: Verhoeven W.M.A. , Egger J. , De Leeuw N. , Kleefstra T. 
Published: June 2017

IntroductionKleefstra syndrome [OMIM: 610253] is caused by a 9q34.3 micro-deletion or an intragenic mutation in the EHMT1 gene. Its core phenotype comprises intellectual disability, childhood hypotonia and distinct dysmorphisms. The syndrome can be associated with congenital anomalies, epilepsy, cardiac arrhythmias and a typical sleep pattern. Starting from adult age, a regressive phenotype may develop.ObjectivesFurther delineation of the neuropsychiatric phenotype.AimsFormulating a comprehensive treatment approach.MethodsDetailed examination of two patients with EHMT1 mutation.ResultsPatient 1, male aged 34 years, showed recurrent behavioral problems with aggression and self-injuries as well as obstipation. Elsewhere, a diagnosis of autism was established. Aged 24, he suffered from some epileptic seizures. Recently, paroxysmal atrial fibrillation was diagnosed. Neither treatment with pipamperone and risperidone nor with valproate was effective for behavioral control. Array analysis and metabolic screening did not reveal abnormalities. Whole exome sequencing revealed an intragenic EHMT1 mutation. Patient 2, female aged 53 years, was known with childhood epilepsy and developed gradual decline of general functioning with motor slowing from her third decade. In her thirties, a mood/anxiety disorder was suspected for which several antidepressants were given without any effect. Array analysis was normal. A pathogenic nucleotide deletion was identified resulting in a frame-shift in exon 21 of the EHMT1 gene. In both patients marked apathy was observed (AES = 62 and 64, respectively).ConclusionsApathy syndrome in Kleefstra syndrome should be differentiated from depression and autism. Apart from treatment with selected psychotropics, individually targeted contextual measures should always be implemented.Disclosure of interestThe authors have not supplied their declaration of competing interest.
A qualitative study of attitude towards people with mental illness among nurses in Saudi Arabia
Authors: Alshowkan A. 
Published: June 2017

IntroductionNurses are the most important contributor of care during patients’ hospitalization and have become an important source in the delivery of mental health care. However, the attitudes and ability of many nurses in providing this care have been shown to be deprived, and this may have a negative effect on providing patients’ care. There is a little is known about the attitude of nurses toward people with mental illness in Saudi Arabia.ObjectiveThis study has a qualitative research design. The main aim of this study is to explore the attitude of nurses toward people with mental illness in Saudi Arabia.MethodData were collected through semi-structured fact to face interviews with nurses. Thematic analysis was used for data analysis.ResultsData analysis identified three main themes that affect nurses’ attitude toward people with mental illness. The identified themes are: 1) personal factors, 2) social factors, and 3) factors related to the view of mental illness.ConclusionThis study concluded that there are a number of factors that affect nurses’ attitude toward people with mental illness. Several recommendations were discussed related to nurses’ education, continuous mental health training courses, public education about mental health and mental health nursing, and mental health care and resources.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
A Proposal of an innovative program for informal caregivers of patients with mood disorders
Authors: Cabral J. , Carvalho C. Barreto , Freitas P. Castilho , Pato C. 
Published: June 2017

IntroductionIntervention with informal caregivers (IC) of psychiatric patients is internationally recognized as relevant and a priority. However, the existing responses in this area are still insufficient, especially regarding caregivers of individuals with mood disorders (MD). Mindfulness and compassion focused therapy have proven to be an effective approach in stress reduction and in improving emotional and social well-being of caregivers of patients with other conditions. However, no studies testing these new approaches in IC of patients with MD have been carried out. The objective of this work is to present a research project that aims to develop, implement and empirically test the effectiveness of an innovative group program to help informal caregivers of individuals with mood disorders to cope with the negative impact of the disease and reduce caregiver burdens.MethodsThe design of this experimental study to test the program's efficacy is a non-randomised controlled trial (nrct) with 12 months follow-up, with a mixed assessment methodology (quantitative and qualitative analysis). A sample of 60 informal caregivers of individuals with chronic MD will be constituted (n = 30 Control group; n= 30 Experimental group).ResultsWe expect the program to promote significant changes in participants in terms of several emotional variables (eg: burden, stress, resilience, compassion and quality of life).ConclusionsFurther efforts to continue studying the impact of interventions in caregivers should be carried out, as a way to improve the quality of life of caregivers and their ability to provide informal care to MD patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Burnout of Caregivers in Geriatric Institution: “Coping” Strategies
Authors: ammar H. Ben , Hamdi G. , hechmi Z. El 
Published: June 2017

IntroductionThe health sector has long been recognized to be a very stressful work environment for teams that can lead to “burnout”. Geriatric institutions are no exception to this observation; this state has deleterious effects on health care as on the quality of care.ObjectivesMeasure the burnout rate among caregivers in geriatric institutions and identify associated factors and coping strategies specific to this population in order to provide the necessary preventive measures.Subjects and method A cross-sectional study, conducted among caregivers exercising at the shelter for aged subjects of Manouba, Tunisia. We used a pre-survey exploring the socio-demographic data associated with two validated scales: the Maslach Burnout Inventory assessing the level of burnout and the Brief COPE assessing coping strategies.ResultsThirty-one subjects were recruited. The prevalence of burnout was 45.16%. Respectively 32.26%, 25.80% and 45.16% of the respondents had high scores in dimensions emotional exhaustion, depersonalization and personal accomplishment at work. The analytical study revealed that seniority in work increased the risk of burnout. The coping strategies of caregivers in geriatric institution facing burnout were mainly centered on emotion. The number of years of experience has been associated with burnout in our study.ConclusionThis work reaffirms that the population of caregivers in geriatric institution is at risk of burnout and allows to identify predictors. The establishment of individual and collective measures is essential for appropriate treatment references (In the body text, a publication should be referred to by a consecutive number between bracket)Disclosure of interestThe authors have not supplied their declaration of competing interest.