bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weathering the Silver Tsunami: Dementia Community Services in Singapore
Authors: Ting C.H. , Lim W.P. 
Published: May 2016

IntroductionThe prevalence of dementia rises with the rapidly increasing elderly population in developed world. In Singapore, 10% of the elderly population is estimated to have dementia. Other than physical and psychological needs, social welfare should also be addressed with the support of specialised geriatric care sources to improve their quality of life.ObjectiveTo study a case of an elderly with dementia, who was identified and managed through a multi-agency approach and to describe different services involved for dementia care.AimTo highlight the various elderly care organizations available in Singapore to address healthcare and social needs in dementia.MethodThrough a case report of an elderly who presented to hospital for medical issues with dementia, the social needs were identified and multiple agencies were involved to provide holistic care in dementia.ResultA 77-year-old gentleman was brought by a community social worker to hospital as he was found ill during home visit. During admission, the concern for poor self-care and cognition decline was raised by his family. Mini-mental state examination was 16/30. He was diagnosed with vascular dementia with clinical and MRI Brain finding. With active multidisciplinary intervention, his medical issues were addressed, and family and social needs were attended by several voluntary welfare organizations. Access to memory clinic service was also arranged for. This intervention also provided opportunity for his long-term care and welfare.ConclusionMulti-agency approach is crucial in dementia care to identify their unmet needs and plan for long-term care in Singapore.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Evaluation of DBT Manual Adapted for People with Intellectual and Developmental Disabilities (idd): First Results
Authors: Elstner S. 
Published: May 2016

IntroductionIn contrast to psychopharmacological treatment, the current evidence base in psychotherapy for people with IDD is limited. But psychotherapeutic approaches offer an alternative treatment modality in people with IDD.ObjectivesOrientated on the “Dialectic-Behaviour-Therapy” concept, we developed an adapted manual for people with IDD and impulsive behaviour.AimsThis study presents the first results of an evaluation our adapted DBT manual.MethodsThree closed groups with 11 patients in total were prospectively included in a six-week in-patient psychotherapeutic DBT-programme. There was no randomisation or control group. Typical borderline symptoms (BS) were recorded using the “Borderline Symptom List” (BSL) and a short screening version for personality disorders (PSS-K). Impulsivity and behaviour in general were observed with the scale for impulsiveness and emotional deregulation (IES) and the German Developmental Behavioural Checklist (VFE). Special tendencies to self-harm were assessed using the scale for self-harm behaviour (IEFAS). From these scales, the means were observed during the course of our hospital therapy program over 6 weeks.ResultsThere were 19 patients in total in 3 different groups. Eight dropped out for a variety of reasons. The mean scores for the remaining 11 patients in the BSL and PSS-K reduced significantly. The scores for impulsivity and self-harm improved. Overall, there was no significant change in behaviour.ConclusionThis study presents the results of a trial of a DBT manual for people with IDD and BS. In general the BS declined, the impulsivity improved. The study is limited by the small numbers in the patient sample and the absence of a control group.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
Think Fast, Treat Faster – A Case of a Treatable Rapidly Progressive Dementia
Authors: Santo V. Espirito , Figueiredo A.R. , Almendra R. , Almeida A. , Guimaraes P. , Velon A.G. 
Published: May 2016

IntroductionRapidly progressive dementias (RPD) are conditions that develop over days, weeks or months, which could be treatable if diagnosed in the acute phase.Clinical caseA 62-year-old man with personal history of type 2 diabetes, started complaining of fronto-temporal headache, nausea and sub-febrile temperature. He went to his family doctor who prescribed ciprofloxacin 500 mg bid. Later on, he had difficulty to sleep and referred complex visual hallucinations. His family noted involuntary movements of the left upper limb and that he became more clumsy needing help for daily life activities. He went to our hospital one week later. He was apyretic and hemodynamically stable. On neurological examination, he had executive and visuospecial dysfunction, left limbs bradykinesia and ipsilateral limb ataxia. Involuntary movements of his left upper limb resembled alien limb phenomena. Complete blood count, complete metabolic panel, iron, folic acid, vitamin B12, anti-neuronal antibodies were normal. HIV, hepatitis B and C serologies were negative. Cerebrospinal fluid study showed 4 cells (100% mononuclear), normal glucose and protein levels, negative bacteriological exam but positive Herpes Simplex-1 Virus (HSV) DNA. Brain CT and MRI showed signs of ischemic microangiopathic leukoencephalopathy. He started treatment with acyclovir 30 mg/kg/d IV and quetiapine 100 mg id. His symptoms improved but he remained with a mild mnesic cognitive deficit and bradykinesia that stayed stable 3 years later.ConclusionThis case exemplifies atypical HSV-1 encephalitis, one cause of RPD, that an early recognition is essential to reduce its associated morbidity.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Effectiveness of Cognitive Behavioral Therapy in the Treatment of a Phobic Disorder in a Patient with Down Syndrome and Early Alzheimer's Disease
Authors: Mallet J. , Guillard V. , Huillard O. , Dubertret C. , Limosin F. 
Published: May 2016

IntroductionDown syndrome was clinically described the first time in France by Esquirol (1838) followed by Down (England, 1866), to the identification of a chromosomal abnormality in 1959 (trisomy 21), which is the most common abnormality in neurodevelopmental disorders. Life expectancy increased from 9 years in 1929 to 55 currently. This is a common cause of mental retardation, and few tools are suitable for the care of these patients, including patients with Alzheimer's disease (prevalence of 55% between 50 and 59) or depression (prevalence 30%). No study evaluates the effectiveness of cognitive and behavioral therapy (CBT) in patients with Down syndrome but it is known to be effective in Alzheimer's patients. Some cases have been reported on the efficacy of CBT on phobias in patients with intellectual disability.Objectives and aimsTo evaluate the efficacy of CBT in the treatment of a specific phobia in a patient with Down syndrome and early Alzheimer's disease.MethodLiterature review and clinical case of a 51-year-old patient, hospitalized under constraints for behavioral disorders (agitation, body treatments refusals).ResultsBy adapting CBT techniques to the problem of intellectual disability, treatment against the phobia was effective with clinical improvement, which allowed a return home.ConclusionThe tools provided by CBT are suitable for the treatment of anxiety disorders in patients with intellectual disability, especially in patients with Down syndrome. Psychiatric disorders are under-diagnosed in these patients and under-treated. CBT is an aid to the treatment. It may allow the dismantling of symptoms and reduce behavioral problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Implementation Of Health Of The Nation Outcome Scale (HoNOS) In Outpatient Clinic, Sligo Mental Health Services: Feasibility And Agreement With Global Assessment Of Functioning Scale
Authors: Mulligan O. , Helmi L. , Adamis D. , O’Mahony E. , McCarthy G. , MacDonald A. 
Published: May 2016

IntroductionOutcome measurements in mental health services is beneficial in allowing healthcare providers in determining the effectiveness of their treatment plan. Health of the Nation Outcome Scale (HoNOS) and Global Assessment of Functioning (GAF) are two well-established instruments to measure patients’ outcome.Aims and objectivesTo measure the correlation of these two scales, and the feasibility of HoNOS.MethodsProspective longitudinal study of psychiatric outpatients attending a clinic in Sligo. Patients were assessed using HoNOS and GAF by trained doctors during the consultation. Feedback from doctors using HoNOS during the research was taken as a measure for feasibility.ResultsTotal of 441 HoNOS and 237 GAF completed on 280 patients (53.2% female, mean age 46.23; SD = 14.89). The correlation between HoNOS and GAF was (r = –0.696, P < 0.001). In reassessment, we found significant reduction in HoNOS score when comparing the first assessment with the second (t = 4.590, df = 110, P < 0.01) and the third (t = 2.876, df = 37, P < 0.01). Using a linear mixed-effects model, it was found that patients with diagnosis of schizophrenia, mood affective disorder, neurotic disorder, personality disorder and younger in age are more likely to improve during the follow-up compared to those with organic mental disorders, alcohol related problems and older age.ConclusionsHoNOS is a feasible scale and can be potentially used as an outcome measurement in the mental health services. Can help in deciding better management plan for patient and improvement of the service. HoNOs can also be used for comparison of outcomes between services in national and international level.Disclosure of interestThe authors have not supplied their declaration of competing interest.
A Retrospective Study of the Impact of Antipsychotic Medication on Readmission in Patients Followed by a Domiciliary Care Unit
Authors: Oliveira J. , Sobreira G. , Coelho I. Capeto , Gomes F. , Nobre A. 
Published: May 2016

IntroductionDomiciliary care services’ patients have severe psychiatric disorders, challenging social contexts and physical comorbidities. These influence outcome but are difficult to modify. Conversely, antipsychotic medication is changeable and has been shown to be related to number of readmissions and length of stay.ObjectivesTo assess whether injectable or oral and first or second generation antipsychotics (FGAP and SGAP) are associated with readmission and contact with mental health services.AimsTo improve the quality of care in our domiciliary care unit (PreTrarCa) and its efficacy.MethodsActive patients in PreTrarCa in 2015 with schizophrenia, schizoaffective, delusional or bipolar disorders were included (n = 64). Information regarding medication and average number of hospitalizations, appointments and missed appointments per year was retrospectively collected.ResultsPatients were mostly male (37), with mean age of 54, and mean follow-up of 41.20 months; 23 were prescribed injectable antipsychotics alone, 21 oral antipsychotics alone and 20 both; 36 were on injectable FGAP and 7 on SGAP. Oral medication was significantly related with missed appointments per year, but not with number of actual appointments. No other significant relation was found; although patients on SGAP had more hospitalizations (0.9 vs. 0.3 per year) and longer length of stay (21.9 vs. 6.3 days) these differences were not statistically significant.ConclusionType of antipsychotic was not associated with readmission rates or contact with mental health services. Confounding variables and clinical outcome measures were not included and the effect of medication changes during follow up was not addressed.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Seven Years Of Occupational Psychiatry In A Portuguese Universitary Hospital
Authors: Sousa L. , Antunes A. , Bastos L. 
Published: May 2016

IntroductionOccupational psychiatry is the field of psychiatry that focuses on work, its importance in the lives of individuals and work organizations. It gained visibility in the 2000 decade, after the creation of the Academy of Occupational and Organizational Psychiatry. Following that trend, occupational psychiatry outpatient started in 2008 at Hospital de Santa Maria.ObjectiveTo describe the structure and functioning of that project; to characterize the population that has been referred to this subspecialty, as well as the main motives for referral; and to highlight some paradigmatic cases that deserve special attention.AimsCall attention to the importance of occupational psychiatry at the individual and institutional level.MethodsAll the patients ever referred to the occupational psychiatry consultation were considered for the analysis. Clinical information was obtained through medical records and interviews with the patients. Bibliographic research was conducted through the PubMed in the Medline library.ResultsIn our hospital, the prototype patient referred to occupational psychiatry is a middle-aged woman working as a medical assistant. The most frequent motives for referral were related to difficulties in accomplishing job duties and definite psychiatric diagnosis corresponded more often to the common mental disorders (anxiety, depression and adjustment disorders). At the institutional level, the initiative was received with great enthusiasm.ConclusionsAs Freud stated “To Love and work are the cornerstone of our humanness”, in line with that we consider that occupational psychiatry should be taken as a priority in what concerns to mental health policies.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Stigma and Poor Mental Health Literacy As Barriers to Service Use Among Unemployed People With Mental Illness – A Qualitative Study
Authors: Staiger T. , Waldmann T. , Krumm S. , Rüsch N. 
Published: May 2016

Introduction/objectivesMental health problems were shown by different studies to be both: results of and risk factors for unemployment. However, unemployed people with mental health problems often have difficulties in finding and using mental health services and therefore do not benefit from therapies. Because unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to but also facilities for mental health services are poorly understood.AimsThe aim of the study is to identify barriers and facilitators of help seeking and service use, based on experiences of unemployed people with mental health strains.MethodsWe conducted 15 qualitative semi-structured interviews with unemployed individuals, facing self-reported mental health problems or mental illness. Topics included individual experiences with help-seeking and mental health service use, with a focus on barriers and facilitators. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed using qualitative content analysis and major themes were identified.ResultsPatients fear adverse reactions of psychiatric medication. They report to be treated as “different” by their social environment and health professionals, which leads to a lack of self-esteem and inhibits them in their help seeking efforts. Social support and desire for change on the other hand can be strong motivational factors in searching for help.ConclusionPerception of GPs towards mental health issues of their patients, and especially unemployed patients, has to be raised. Stigmatization of mental illnesses and help seeking should be reduced in practical context.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Improving Ghana's Mental Health Care Through Task Shifting – Psychiatrists and Health Policy Directors Views
Authors: Agyapong V. , McAuliffe E. , Farren C. 
Published: May 2016

BackgroundCurrently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.AimTo examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.ResultsOnly one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.ConclusionPsychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Transcultural Approach in Early Psychosis Interventions
Authors: Guerrero Jiménez M. , Rodrigo Manzano J.A. , Carrillo de Albornoz Calahorro C.M. , Girela Serrano B.M. 
Published: May 2016

IntroductionThe Early Psychosis Intervention Programme (EPIP) in South Granada serves a population with a first psychotic episode. In 2014, 16 patients entered the program, 6 of whom were North Africans.AimsIt is justified by clinical and health care needs to adapt and contextualize care plans and interventions to the specific necessities of this population: considering its suffering meaning and interpretation.MethodsA descriptive study of the data obtained in this population with the Scale of Positive and Negative Syndrome of Schizophrenia (PANSS) arises.ResultsIn the positive scale, the 6 subjects score in the low range (between 6–25th percentile).On the negative 2 score in the low range and 4 in the middle (between 26–74th percentile).In the compound scale in 3 cases, the predominance of negative symptoms is in the low range scale, the rest is in the middle range.Finally, in general psychopathology scale, 2 subjects scored in the low range, the same who scored in the same range in the negative scale. Two subjects scored in the midrange and 2 in the high.ConclusionsAccording to data, positive symptoms do not stand out among this group of patients. As for negative symptoms, if the range is low, so is the measure of general psychopathology. If the range is average, general psychopathology is medium-high. Also, when the range is average in negative symptoms, means the compound profile reflects predominance of negative syndrome. This reveals the importance of emphasizing a negative symptoms approach and its relationship with general psychopathology.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Psychiatry Trainees in Turkey Considers Leaving the Country
Authors: Kilic O. , Sonmez E. , Guloksuz S. , Pinto da Costa M. 
Published: May 2016

IntroductionThe brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.ObjectiveTo identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.MethodAn online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.ResultsOf 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.ConclusionOverall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.Disclosure of interestThe authors have not supplied their declaration of competing interest.
The Nose – a Case Report of Body Dysmorphic Disorder and a Literature Review
Authors: Agostinho C. , Henriques S. , Coelho I. 
Published: May 2016

IntroductionBody Dysmophic Disorder (BDD) is relatively common disorder. Patients with delusional beliefs seem to show greater morbidity (more suicidal attempts and drug abuse or dependence) and less likelihood of receiving treatment.Objectives and aimsIn this study, we intended to report a case of BDD followed in psychiatric consultation from 2 years ago, and to make a review of the literature, namely presentation, treatment and prognosis of BDD.MethodsWe conducted a description of a BDD case and a research using “Body Dysmorphic Disorder” keywords on Pubmed.ResultsJ.F., 45 years old, unemployed, living with his father, referred to the Psychiatric consultation by his GP. The disorder started in the adolescence with an excessive preoccupation with hair loss and nose length, but in early adulthood these concerns became more important. Around 30 years old he was followed in Psychiatry but abandoned. Years later he underwent nose plastic surgery. He tried underwent other nose surgeries, but was refused. He was advised to look for psychiatric care. From the initial observation I highlight the appearance (thin, with a wig, adhesive tape connecting the tip of the nose to the forehead pulling up the nose), delusional ideas regarding the appearance of the nose, overvalued hypochondriac ideas, and no insight for the disease. The patient was reluctant in taking psychotropic drugs. He was referred to day hospital, which he attended with great irregularity.ConclusionsBDD is a disorder with poor prognosis, especially when delusional variant is present, probably in relation to the lack of insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.