bluuebunny/crossref_metadata_2025_split huggingface dataset:
First-episode psychosis intervention – description of our early intervention model
Authors: Melo B. , Pereira C. Alves , Cajão R. , Silva J. Ribeiro , Pereira S. , Monteiro E. 
Published: June 2017

IntroductionThe research about the benefits of early diagnosis and treatment of first-episode psychosis had significantly increased in last decades. There have been several early intervention programs in psychotic disease, implemented worldwide, in order to improve the prognosis of these psychotic patients.ObjectivesTo present a brief description of the first-episode psychosis intervention team of Tondela-Viseu Hospital Centre–Portugal and its model. We aim to further characterize our population and describe its evolution since 2008.AimsWe aim to clarify the benefits of an early intervention in psychosis.MethodsWe conducted a retrospective cohort study of patients being followed by our team from November 2008 to September 2016. Demographic and medical data were collected (such as diagnosis, duration of untreated psychosis, treatments and its clinical effectiveness, relapse rate and hospital admissions) in patient's clinical records. The intervention model protocol of this team was also described and analyzed.ResultsThis multidisciplinary team consists of three psychiatrists, one child Psychiatrist, one psychologist and five reference therapists (areas of nursing, social service and occupational therapy). It includes patients diagnosed with first-episode psychosis, aged 16 to 42 years old, followed for five years. The team followed, since its foundation, 123 patients, mostly male. The most prevalent diagnosis are schizophrenia and schizophreniform psychosis. The team is currently following 51 patients.ConclusionsThis team's intervention have progressively assumed a more relevant importance in the prognosis of patients with first-episode psychosis, by reducing the duration of untreated psychosis, the relapse rate and by promoting social reintegration.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Combination of clozapine and aripiprazole once-monthly in resistant schizophrenia. A review of a clinical case
Authors: Palomo Monge M. , Tascon Guerra M.F. , Calvo Mauri J.F. , Padilla Romero P. , Duque Domínguez A. , Díaz Conde S. , Alcocer Lanza M.F. , Lara de Lucas B. , Ochoa Blanco R. 
Published: June 2017

IntroductionWe report the successful management of a 49-year-old woman with an initial diagnosis of schizoaffective disorder transitioned to resistant schizophrenia. First contact with our psychiatrist service in 2000; referring problems with treatment adherence and occasional toxic abuse, she underwent 15 admissions in acute adult psychiatric hospitalisation units since then (last discharge March, 2015), and a one-year stay (2012–2013) in an adult mid-term mental health unit. She is currently followed-up throughout the major mental-health outpatient visits program.AimsThe patient was prescribed paliperidone 6 mg 2-0-0, oxcarbazepine 600 mg 1-0-1 and clonazepam 0.5 mg 1-0-1 during the last 2 months.MethodsDue to lack of treatment adherence and toxic abuse she suffered a psychotic decompensation in May 2015. She was then prescribed clozapine 200 mg 1-0-2, boosted with aripiprazole 400 mg once monthly. The adjunction of aripiprazole once monthly (AOM) was intended to improve treatment adherence, and to supplement the psychotic control of clozapine without entailing a worsening of therapy tolerability. The patient was monitored during 5 months in our unit.ResultsWe observed a positive psychopathological evolution of the patient, which allowed us to re-evaluate the initial diagnostic, ascribing the previous mood fluctuations to toxic consumption.ConclusionPrevious works have been published about the combination of clozapine and oral aripiprazole for the treatment of resistant schizophrenia, but, as far as we know, this is the first repost of the combined use of clozapine and AOM. Based on our results, this antipsychotic combination resulted in a psychopathological improvement of the patient, with good tolerability.Disclosure of interestThe authors have not supplied their declaration of competing interest.
A case of pharmacologic extrapyramidal syndrome
Authors: Porta Olivares O. , Juncal Ruiz M. , Fernández Abascal Puente B. , Gómez Revuelta M. , Santayana Jenaro G. Pardo de , Sánchez Blanco L. , Landera Rodriguez R. , Pérez Santos A.B. , Revillas Almajano F. Arnaiz de las 
Published: June 2017

IntroductionMore than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.MethodsIt is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).ConclusionsThe mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Ekbom syndrome in a visually impaired patient with alcohol abuse and OCD: A case report
Authors: Portilla Fernandez A. , Montes Reula L. , Saiz García H. , Ortigosa Aguilar R. , Rosero Enriquez A.S. , Ballesteros Prados A. 
Published: June 2017

This is a case report of a 63-year-old patient with no previous attentions in mental health. He is referred by his general practitioner because he presents wounds all over his body. He reports that there is a plague of bugs at his place that bite him everywhere. Therefore, he scratches continuously, trying to remove the stingers, and injuring himself all over. The family ensures there are no bugs at all, but the patient threatens to set fire to the house in order to extinguish the plague or even kill himself. An OCD with cleaning compulsive behavior was also present since many years, as well as an alcohol abuse. The patient required hospitalization in the psychiatry service. Organic cause for the disorder was discarded. Long-acting injectable aripiprazol was introduced and the patient stopped drinking. Progressively, the delusional symptoms began to subside. Now he maintains no awareness of illness but he says the bugs are disappearing and, at least, they do not bite him anymore.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Dopamine, glutamate and biotypes in the future of schizophrenia
Authors: Prata-Ribeiro H. , Ponte A. , Luísa G. 
Published: June 2017

IntroductionApproximately a third of patients with schizophrenia show limited response to antipsychotic medication. As several studies have been suggesting new classifications to schizophrenia, our aim is to review different hypothesis and seek a new way of approaching patient's treatment in day-to-day practice.MethodsThe methods we used consisted on reviewing several papers that have recently been published on the area of classification and treatment of schizophrenia, considering an approach to the findings that enables a practical and clinical advantage in the area.DiscussionNew studies suggest that neuroimaging measures of dopamine and glutamate function might provide a means of stratifying patients with psychosis according to their response to treatment. Some of those studies associate treatment response with the anterior cingulate level of glutamate and striatal dopamine synthesis capacity. Other study identified three biotypes with different outcomes to psychosis, reaching a stronger association between biotypes as predictors of illness severity than the DSM-V classification. If a correlation between these studies was found, we would be able, in theory, to predict the response to treatment using simple and affordable neurobiological measures.ConclusionAssociating the anterior cingulate glutamate levels, the striatal dopamine synthesis capacity and biotypes hypothesis in schizophrenia, one can expect to be possible to predict the degree of response to treatment, based on more affordable methods to day-to-day clinicians than the measure of neurotransmitter levels, enabling the regular clinicians to narrow their pharmacological options for patients, achieving better results in the approach to schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Antipsychotics in first-episode psychosis: Patterns of prescription in an inpatient unit
Authors: Monteiro F. , Azevedo P. , Monteiro L. , Machado C. , França G. , Norton A. , Reis A. 
Published: June 2017

IntroductionThe treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.Objectives/aimsTo know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.MethodsWe retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.ResultsA total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.ConclusionsSecond-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Diogene syndrome: About two clinical cases
Authors: Snene H. 
Published: June 2017

IntroductionDiogenes syndrome was first described in 1975 by Clark to characterize the behavioral disorder in the elderly involving neglect of personal and domestic hygiene and a hoarding disorder or hoarding. He is regarded as a psychiatric disorder in its own right in the DSM V and declines criteria compulsive hoarding disorder (“Hoarding Disorder”). The condition is under diagnosed or its prevalence is important from 3.3 to 4, 6%.ObjectiveStudy through two clinical, etiologic and psychopathological diogenes syndrome (DS) and the main diagnostic and therapeutic difficulties.Case no. 1Mrs. L. is 57 years old, without children and with a degree in political science. She was taken back by his partner for behavioral disorder type of pathological accumulation of objects. His home has become inaccessible due to the accumulation of multiple stacks of magazines and other items. The meeting allowed to objectify an incurique presentation, delusional and hallucinatory syndrome.Case no. 2Mrs. BH aged 67, retired, widowed for 17 years. She lives alone after the suicide of his daughter. This would be followed by breast cancer. The patient was admitted following a report of neighbors who discovered that Mrs. BH, isolated for months, sleeping in the garden of her home saw the unhealthy state of the place and the accumulation of waste.ConclusionDiogenes syndrome is heterogeneous, covering multiple medical, psychiatric and social situations. Its pathogenesis remains poorly understood and its management refers to any clinician can examine ethical questions the legitimacy of its actions.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Use of buspirone in selective serotonin reuptake inhibitor-induced sleep bruxism
Authors: Prisco V. , Iannaccone T. , Di Grezia G. 
Published: June 2017

Sleep bruxism is characterized by the involuntary clenching or grinding of the teeth during sleep and can cause severe health problems, including the destruction of tooth structure, temporo-mandibular joint dysfunction, myofascial pain, and severe sleep disturbances. Iatrogenic sleep bruxism may be common during treatment with psychotropic medications, such as anti-psychotics and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). Bruxism is a common movement disorder that affects 8–21% of the population. The majority of bruxism symptoms are mild or moderate, although rare but severe cases may lead to serious periodontal damage, temporo-mandibular dysfunction, sleep disturbances, jaw pain, and stiffness. As a result, such cases must be treated with medication. It has been hypothesized that the mechanism of SSRI-induced bruxism may involve excessive serotonergic action on the meso-cortical neurons arising from the ventral tegmental area. It has been argued that,the addition of buspirone, was necessitated by the high level of residual anxiety. As a result, these symptoms may have been prevented through the use of buspirone alone. Buspirone, is an agonist of the 5-HT1A receptor that increases dopaminergic neuron, firing in the ventral tegmental area and increases the synaptic release of dopamine in the prefrontal cortex. These effects ameliorate drug-induced bruxism. Buspirone can also ameliorate extrapyramidal side effects, such as akathisia and tardive dyskinesia, and this property may be an additional explanation for the bruxism-related effects of the drug. Furthermore, buspirone may be an effective treatment for the bruxism associated with the use of these medications.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Which psychological and socio-demographic dimensions predict amphetamine abuse?
Authors: Farnia V. , Tatari F. , Alikhani M. , Shakeri J. , Ngo V.T. , Sadeghi Bahmani D. , Holsboer-Trachsler E. , Brand S. 
Published: June 2017

IntroductionAmphetamine abuse has become a serious health concern worldwide, and this holds also true for Iran.AimsInvestigating psychological and socio-demographic dimensions to predict amphetamine-abuse.MethodsHundred amphetamine abusers and 100 healthy controls took part in this cross-sectional study. Participants completed questionnaires covering socio-demographic and psychological dimensions.ResultsCompared to healthy controls, amphetamine abusers reported more insecure and ambivalent attachment styles, higher novelty-seeking and risky behaviour, less current social support and stable relationships, and lower emotional competencies. No differences were found for socio-demographic dimensions.ConclusionsResults from this cross-sectional study underscore that amphetamine abuse was related to poor social relationships, poor emotional competencies and higher risky behaviour. The cross-sectional nature of the study, however, does preclude any conclusions about the causal direction of amphetamine abuse and poor interactional behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Audit of near-fatal overdoses (NFOs) in patients on treatment via substance misuse services (SMS)
Authors: Javed U. , Moore R. , McIntosh C. 
Published: June 2017

IntroductionIn the NHS Forth Valley (Central Scotland) substance misuse service (SMS), there is an arrangement whereby the details of individuals administered naloxone for overdose via the ambulance service are passed to the SMS. Each patient has an allocated keyworker (nurse). It is accepted that near fatal overdoses (NFOs) are possible precursors to fatal overdose and drug-related deaths.ObjectivesTo assess:– if the information is being disseminated appropriately;– service response and follow-up for individuals;– patterns which might influence prescribing practice.MethodsA list of NFOs of known patients for the previous two years was acquired from the ambulance service. There was a retrospective review of the SMS prescribing database and clinical casenotes.ResultsPatterns:– 81% male;– 53% aged < 40;– 14% of NFO's involved those in titration phase;– 86% were prescribed methadone. Methadone average dose 57 mg (20–80 mg) and 54% were prescribed > 60 mg/day.Receipts of information:– sixty-one percent of keyworkers were notified.Service response:– in most cases when the keyworkers was informed, there was prompt action to contact and review patients (0–21 days). However, only 21% had a timely review (within 1 month) by a doctor following NFO.ConclusionThere needs to be an improvement in the dissemination of information between the ambulance service, administrative staff and keyworkers. Most NFO patients were prescribed > 60 mg of methadone. There needs to better identification of “harm-reduction” prescribing whereby methadone doses should be reduced at times of ongoing drug use. Fourteen percent of NFO's involved those in titration phase (twice weekly reviews) which provides an opportunity to screen and intervene for potential NFOs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The royal road to the obesity: A case report of food addiction
Authors: Kandeger A. , Bozkurt H. 
Published: June 2017

Increasing prevalence of obesity in the world and increasing role of processed foods in daily life has led to become the focal point of food addiction. In recent years, the animal studies and human brain imaging studies demonstrated the neurobiological and behavioral similarities between drug addiction and food addiction. Here, we aim to present a 13-year-old, female, adolescent who applied with complaints of anger and irritability and shows serious addictive behaviors of chocolate. Our patient with increasing chocolate consumption in the last two years was using atomoxetine 60 mg/day with attention deficit hyperactivity disorder (ADHD). She gradually needs more chocolate to be satisfied. She has complained of nervousness, irritability and serious chocolate-seeking behavior during chocolate deprivation. She gained weight in proportion to the increase in chocolate consumption. Her daily diet was increasingly deteriorated. We used behavioral approach and sertraline in her treatment and were observed that partially benefit from treatment. Combined data from retrospective accounts of adults and prospective observations of youth indicates that juveniles with ADHD are at increased risk for cigarette smoking and substance abuse and behavioral addiction such as Internet addiction, gambling and sex addiction during adolescence. Recognition of the food addiction is important to fight against obesity, strengthening the treatment of choice in the food addiction and take political measures against food addiction are becoming inevitable.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Identifying the relationship between marital adjustment and, sex roles and burnout rather than dependence features of the patient in wives of the patients with AUD
Authors: Kokurcan A. , Nazan K. , İlhan İ.Ö. 
Published: June 2017

ObjectiveTo identify the relationship between marital adjustment and, sex roles and burnout rather than dependence features of the patient in wives of the patients with AUD.MethodThe study sample consisted of 33 wives of AUD patients (according to DSM-IV-TR criteria) who were applied to a University Hospital Alcohol Dependence Clinic to leave alcohol use. Sociodemographic questionnaire, Marital Adjustment Scale (MAS), Maslach Burnout Inventory (MBI), Bem Sex Role Inventory-Short Form (BSRI) and, Beck Depression Inventory (BDI) were applied to the wives of ADD patients.ResultsMean MAS score was under cut-off score (29.63 ± 10.33) and it shows that marital adjustment is lower in wives of ADD patients. It was shown that marriages longer than ten years, and higher emotional exhaustion scores were associated with lower marital adjustment in our study. Masculinity scores were higher in wives who perceived their income status higher. In contrast to previous studies, which examined marital adjustment, masculinity role was found to be associated with higher marital adjustment in our study.DiscussionEmotional exhaustion and depression are common in spouses of the patients with ADD in our study. There may be a distortion in expected roles of the spouses which cause a disequilibrium on the family relationship. Lower income status, having increased number of children was associated with severe depression in wives which found to reduce marital adjustment scores. Finally, most of the wives of ADD patients will need psychotherapeutic treatments during addiction period. So incorporating spouses into treatment of ADD patients is a necessity to improve marital adjustment and burnout.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Absent substance use disorder and survival of extraordinarily high blood alcohol concentration
Authors: Gahr M. , Graf H. , Malejko K. 
Published: June 2017

IntroductionIntoxications with alcohol are very frequent in clinical psychiatry and may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors as liver function, tolerance, comedication, etc. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation are occasionally necessary.Objectives/aimsTo illustrate the broad range of clinical outcomes of alcohol intoxications and their adequate therapy.MethodsWe present the case of a 58-year female patient with depression who demonstrated a very high BAC of 8.68 g/L (representing the highest survived BAC in literature) due to ingestion of large amounts of alcohol with suicidal intent.ResultsIntubation and ventilation were lifesaving and the patient did not develop any physical or mental consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent tolerance could be ruled out.ConclusionsThis case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large inter-individual differences regarding ethanol susceptibility.Disclosure of interestThe authors have not supplied their declaration of competing interest.