bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of an Intervention of Neuro-cognitive Rehabilitation in Treatment Resistant Schizophrenia (TRS) Compared to Schizophrenia Responder Patients
Authors: D’Ambrosio L. , Prinzivalli E. , Oliviero N. , Balletta R. , Callovini G. , Benedetta A. , Formato M.V. , Lattanzio S. , Razzino E. , Avagliano C. , Iasevoli F. , de Bartolomeis A. 
Published: June 2017

IntroductionSchizophrenia is a condition with high impact in terms of disability, also because between 30% and 60% affected individuals do not respond to treatment. It has been proposed that cognitive functioning is strongly impaired in schizophrenia and even more in TRS patients. Cognitive dysfunctions are regarded to worsen psychopathology, psychosocial functioning, and overall course of the illness.ObjectivesTo investigate the impact of Cognitive Remediation (CR) on psychopathology and psychosocial functioning in TRS vs. schizophrenia responder patients.AimsTo determine whether a CR intervention could improve functional outcomes in TRS patients.MethodsWe evaluated proximal and distal effects of CR on approximately 20 schizophrenia responders and 20 TRS patients. Patients in each group were randomized to receive CR or not. Patients were assessed in training task performance, neurocognition, functional capacity, symptoms and psychosocial functioning. Evaluations were conducted at baseline, at the end of the 4-month intervention, and at 6-month, 1 and 2 year-follow-ups. The study is still in active recruitment phase.ResultsBoth TRS and schizophrenia responder patients exposed to CR exhibited a significant improvement in specific neurocognitive domains, and in psychosocial functioning as assessed by either rating scales (SLOF and PSP) and performance-based measures (UPSA) at the 4-month time-point.ConclusionsCR improved psychosocial functioning in both group of patients, however, they were more pronounced in TRS patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Changing the Obesogenic Environment to Improve Cardiometabolic Health in Residential Patients with a Severe Mental Illness: ELIPS, a Randomized Controlled Trial
Authors: Jörg F. , Looijmans A. , Stiekema A. , Van der Meer L. , Schoevers R. , Corpeleijn E. 
Published: June 2017

IntroductionThe life expectancy of severe mentally ill (SMI) patients is shortened up to 30 years, due to cardiometabolic diseases, partly caused by unhealthy lifestyles behaviors. In residential facilities, adopting a healthy lifestyle is hampered by the obesogenic environment; an obesity promoting environment.ObjectiveTo determine, the effectiveness of a 12 month lifestyle intervention addressing the obesogenic environment to improve cardiometabolic health of SMI residential patients.MethodsThe effectiveness of lifestyle interventions in psychiatry (ELIPS) trial is a multi-site, cluster randomized controlled pragmatic trial. Twenty-nine sheltered and long-term clinical care teams serving SMI patients in the Netherlands were randomized into intervention (n = 15) or control (n = 14) arm, including 736 patients (73% psychotic disorder, 63% male, 48 ± 13 years). The intervention aimed to improve the obesogenic environment using a small change approach with a focus on nutrition and physical activity. Primary outcome was waist circumference (WC) after three and twelve month's intervention. Secondary outcomes were BMI and metabolic syndrome.ResultsGeneral linear mixed models adjusted for age, gender, housing facility and antipsychotic medication showed that WC significantly decreased with 1.51 cm (95%CI = −2.99;−0.04, Cohen's d = 0.07) in the intervention group compared to control group after three months and tended to remain lower with 1.28 cm (95%CI = −2.79; 0.23, Cohen's d = 0.06) after twelve months. Metabolic syndrome Z-score decreased after three months with 0.225 SD (95% CI = −0.4038;−0.096, Cohen's d = 0.20), mainly due to lower fasting glucose and WC. No significant effects were found on BMI.ConclusionA small change approach targeting the obesogenic environment of SMI residential patients reduces cardiometabolic risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Elevated C-reactive Protein Levels Associated with Aggressive Behavior in Moroccan Patients with Schizophrenia
Authors: Kachouchi A. , Said D.S. , Imane P.A. , Fatiha P.M. , Fatima P.A. 
Published: June 2017

BackgroundRecent studies reported an association between aggression and inflammation. In this study, we examined the association between aggressive behavior and inflammatory markers (serum levels of CRP) in schizophrenia inpatients.MethodsAdult schizophrenia inpatients (n = 145) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 1 mg/dL; n = 45) or normal (CRP < 1 mg/dL; n = 100). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization.ResultsThe results show that patients with elevated CRP levels are more aggressive during hospitalization as detected by statistically significant higher scores of aggressive behavior (PANSS-EC score), and by increased rates of physical restraint during hospitalization. No statistically significant differences in the other clinical features, including suicidal behavior.ConclusionOur results are consistent with previous findings linking schizophrenia to activation of the inflammatory response system.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients
Authors: Malta Vacas S. , Carvalho R. , Heitor M.J. 
Published: June 2017

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Strategies for Managing Psychosis with Small Amounts or no Medication: A Proof of Concept Paper
Authors: Mehl-Madrona L. , Mainguy B. 
Published: June 2017

IntroductionSome patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications.MethodsWe report qualitative and quantitative data on a group of patients as a proof of concept study–that management with minimal or no medication is possible.PatientsA series of 60 adult patients presented with psychosis and engaged with us in dialogical psychotherapy, medication, and lifestyle management over at least six months in an effort to minimize or eliminate medication. An additional 209 patients presented for treatment but did not continue for six months. An anonymous, matched comparison group of 60 patients of the same age, socio-economic status, diagnosis, and severity of illness was generated from the electronic health records at another large clinic where one of us also worked (LMM). We quantifed symptom level using the Brief Psychiatric Rating Scale, the Positive and Negative Syndrome Scale, two depression rating scales, the Clinical Global Inventory, and the Revised Behavior and Symptom Identification Scale. Narrative interviews of all 269 patients generated qualitative data.ResultsThirty-nine patients managed well without medication; 16 managed well on low-dose medication. Four individuals required progressively higher levels of medication and one decompensated. The overall cost-benefit was favorable in creating fewer hospitalization, crises, and diminished suicidality.ConclusionsThe results suggest the need for individualized approaches that are client-centered and build upon the previous successes of the person, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Impact of Environmental Influence and Vulnerability to Stress in the Development of First Psychotic Episode
Authors: Rossini Gajsak L. , Celic Ruzic M. , Koricancic Makar A. , Rojnic Kuzman M. 
Published: June 2017

IntroductionSome findings in patients with first psychotic episode (FEP) could be related to alterations of stress responses. Alterations of stress response are reflected in the alterations of the HPA axis.ObjectiveTo assess the difference in stress response in FEP patients and healthy controls as well as implications of environment to vulnerability to psychosis.AimTo assess endocrine and autonomic responses to acute psychosocial stress, their associations with onset of the first psychotic episode as well as the influence of the environmental factors.MethodsWe have assessed clinical status through clinical psychiatric interviews, standardized psychiatric scales and validated psychological scales, (LEQ, WHOQOL-BREF, PBI, Rosenberg) in 45 subjects with FEP and 50 age and gender matched controls. All participants were then exposed to the Trier Social Stress Test (TSTT).ResultsOur preliminary findings on a sample of 95 participants indicate a differences between patients and controls in salivatory cortisol measured in 5 time points during the TSST. Patients with FEP experience more levels of baseline cortisole, and less changes during the stress test then controls. Baseline stress levels indicated in the salivatory cortisole levels correlate with perceived self-esteem, psychological and social quality of life.ConclusionOur findings support the alterations of stress response, possibly indicating vulnerability to stress in persons with FEP.FundingThis work was funded by the grant of the Croatian Science Foundation No UIP-2014-09-1245 Biomarkers in schizophrenia – integration of complementary methods in longitudinal follow up of first episode psychosis patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Adjunctive Memantine in Clozapine-Treated Refractory Schizophrenia: An Open-Label One-Year Extension Study
Authors: Schulte P. , Veerman S. , Deijen J.B. , De Haan L. 
Published: June 2017

IntroductionIn a recent placebo-controlled, double blind crossover trial (n = 52), we found significant beneficial effects on memory (d = 0.30) and negative symptoms (d = 0.29) after 12 weeks memantine augmentation in patients with clozapine-refractory schizophrenia.AimsIn this open-label 1 year extension study, we report the long-term effects and tolerability of memantine add-on therapy to clozapine.MethodsCompleters of the first trial who experienced beneficial effects during 12 weeks of memantine treatment received memantine for one year. Primary endpoints were memory and executive function using the Cambridge neuropsychological test automated battery (CANTAB), the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Severity Scale (CGI-S).ResultsOf 31 RCT completers who experienced beneficial effects from memantine, 24 received memantine for one year. The small improvement in memory found in the memantine condition in the placebo-controlled trial remained stable in the extension study. Executive function did not improve. After 26 weeks of memantine add-on therapy to clozapine, PANSS negative symptoms (r = 0.53), PANSS positive symptoms (r = 0.50), and PANSS total symptoms (r = 0.54) significantly improved. Even further significant improvement in all these measures was observed between 26 weeks and 52 weeks memantine, with effect sizes varying from 0.39 to 0.51. CGI-S showed a non-significant moderate improvement at 26 weeks (r = 0.36) and 52 weeks (r = 0.34). Memantine was well tolerated without serious adverse effects.ConclusionsIn the one-year extension phase, the favorable effect of adjunctive memantine on memory was sustained and we observed further improvement of positive, negative and overall symptoms of schizophrenia.Disclosure of interestP.F.J.S. reports personal fees from H. Lundbeck A/S, outside the submitted work and he is a board member of the Dutch Clozapine Collaboration Group. L.d.H., has received investigator-led research grants or recompense for presenting his research from Eli Lilly, Bristol-Myers Squibb, Janssen-Cilag and AstraZeneca.
Psychological and Psychophysiological Mechanisms of Mental Stress Reaction in Patients with ‘Hypertension at Work’, as Compared with ‘Classical’ Version of Essential Hypertension
Authors: Pervichko E. , Zinchenko Y. , Ostroumova O. 
Published: June 2017

Introduction‘Hypertension at work’ today is found one of the most frequent forms of stress-induced hypertension.ObjectivesTo inquire into the specifics of psychological and psychophysiological mechanisms of stress reaction in patients with ‘hypertension at work’, as compared with ‘classical’ essential hypertension (EH).Materials and methodsThe study developed simulation of emotional stress with the aspiration level (AL) modeling. The level of state anxiety (SA), BP values, urine catecholamine levels and levels of renin and angiotonin I in blood plasma were taken before and after the experiment. Eighty-five patients with ‘hypertension at work’ (mean age was 45.9 ± 2.8) and 85 patients with ‘classical’ EH (mean age was 47.4 ± 4.5 years) took part in the study.ResultsRates of ‘hypertension at work’ patients, when compared with second group patients, revealed a significant increase (Р < 0.001) of systolic BP in response to stress loads (on average, for 16.1 ± 1.9 mmHg and 4.1 ± 0.7 mmHg, respectively). Initially ‘hypertension at work’ patients had significantly lower levels of catecholamines, than the second group, while the levels of renin and angiotensin I were comparable. During the experiment, the patients in the first group showed a significant decrease in all parameters. After the experiment, the patients with ‘HTN at work’ did not show increase of SA, but revealed more frequent inadequacy (69.4%) and instability (56.5%) on the AL. Patients with ‘classical’ EH more often demonstrate adequate AL and lower growth of BP after the experiment.ConclusionsPatients with ‘hypertension at work’ are more prone to repress their emotions. They reveal physiological features of chronic stress and psychophysiological exhaustion, if compared with second group patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Educational Programme in Primary Care is the Basic Way of Decreasing Suicides
Authors: Kornetov N. 
Published: June 2017

IntroductionThe depressive disorder (DD) is a widespread disease described to be a severe burden and to have high suicide risk. Depression is not yet listed in the primary care (PC), Russian specific educational program.ObjectivesTo create educational Recognition of Depressive disorders Program (REDEP) in order to decrease suicides in Tomsk City and Tomsk Area (TA).MethodsEducational Program WPA/PTD on DD (Russian version) was used as a basis of REDEP, comparative analysis of mortality ratio of suicides (MRS) throughout the period of 2004–2015 among the population of the Russian Federation (RF), Siberian Federal Region (SFR) and TA, analysis of suicide decrease in Tomsk City. The Program is based on ideas of collaboration between the Primary Medical Care institutions and the Service of Mental Health Care. Depression and its consequences on people and the economy should be listed as a non-infectious illness.ResultsWe conducted a comparative analysis of suicides in RF, SFR and TA; we also assessed the dynamics of suicides reduction in TA under the influence of educational program on DD. The most prominent MRS decline was in TA: from 38.3 to 12.8 (P < 0.03). During 2008–2015, MRS was being held below 10/100,000 in Tomsk City.ConclusionsSuicide prevention is possible if persistent and continual education of doctors in PC is in place. Such specialists are needed to recognize and manage depression and co-morbid conditions. The Program can be extrapolated to other regions of the country with high MRS.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
Quality Improvement Project: Mentoring, Career Advice and Placement Introduction Session for Year 5 Imperial College Medical Students. Should Induction go Beyond Facts and Numbers?
Authors: Agalioti O. , Nayrouz S. 
Published: June 2017

IntroductionFeedback received from previous rotations of year 5 Imperial College medical students in West London Mental Health NHS Trust has consistently shown that medical students feel uncertain about what to expect in their psychiatric placements and are sceptical about psychiatry as a future career option. This prevents them from maximizing the educational benefit and potential in their training.Aims and objectivesTutorial aims to prepare medical students for their psychiatric placements and create the opportunity for informal discussion about psychiatry as future career option. The session aspires to motivate students to be more involved and active participants and invite them to think about their future career option at an early stage.MethodologyA 1-hour tutorial has been added to medical students’ induction in two successive rotations (July–October 2016). Thirty-seven (37) medical students have attended the tutorial so far. Tutorial provides information about psychiatric placements, learning opportunities as well as structural and operational issues. Besides, it encourages discussions about psychiatry as a future career option, informing students about psychiatric sub-specialties, career pathways and NHS operational structure. Feedback questionnaire is handed over at the end.ResultsData were collected and analysed and findings are outlined in the diagram below (Fig. 1).Conclusions and recommendationThe majority of medical students have feedback they found tutorial relevant and useful. Current tutorial formula will be revised based on feedback collated so far.Findings are going to be shared with local Undergraduate Educational Committee and Imperial College medical school board.Disclosure of interestThe authors have not supplied their declaration of competing interest.Fig. 1Imperial College medical students’ feedback.
Transparency and Due Process: A Systematic Approach to Educational Decision-making and Appeals
Authors: Peters A. 
Published: June 2017

IntroductionTransparency and due process are inseparable principles that should underpin any educational and administrative decision made within an organization.ObjectivesIt is considered best practice for organizations to place the processes and structures surrounding reviews of decisions made by their organization at arm's length to the committee or group that made the original decision. This ensures there is and that due process is followed.AimsAn independent appeal process is an integral part of any fair system of assessment and decision making.MethodsThe Royal Australian and New Zealand College of psychiatrists has undertaken several reviews of its current processes to examine its practices as both substantive and procedural issues arise in decisions with regard to the provision of psychiatric training. The reconsideration and appeal policy was developed to set out a clear and fair process for applicants to request decisions of the RANZCP to be reconsidered and appealed. This ensures that an applicant has a fair and reasonable opportunity to challenge the original decision whilst receiving support from the RANZCP to minimize any stress that may be experienced during this process.ResultsThe RANZCP has observed that the three phase process has enabled matters to be resolved at an earlier stage of the appeal cycle and do not require progression to a formal appeal.ConclusionThis presentation will identify best practice methods in educational decision-making and conducting appeals.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
Comparing Learning Outcomes for Mental Health Simulation Training Delivered to Entire Clinical Teams Versus Professionals Not Working Together Clinically
Authors: Valdearenas L. , Attoe C. , Cross S. 
Published: June 2017

IntroductionWorking effectively with colleagues using a multidisciplinary and interprofessional approach is vital in healthcare, particularly mental health, where the interface between physical and mental health is often missed due to involvement with different specialties. Collaborative clinical practice is essential to provide the best clinical care to people experiencing mental and physical health comorbidities. Simulation training encourages experiential learning for human factors (or non-technical) skills, such as teamwork and interprofessional collaboration. This study explored the differences in learning outcomes between team and non-team training for physical and mental health comorbidities.Aims and objectivesThis project aimed to establish differences in human factors learning, confidence and knowledge, following training for teams that work together versus interprofessional groups from various teams. The project hoped to continue improving mental health simulation training and promote and enhance human factor skills that are basic pillars of multi-disciplinary and interprofessional care.MethodsThe human factors skills for healthcare instrument (HFSHI), alongside confidence and knowledge measures were administered to all participants pre and post simulation training on interacting mental and physical health. A post-course evaluation survey with open questions was used to collect qualitative feedback on the impact of the training course.ResultsWith data collection ongoing, preliminary results indicate differences between team and non-team simulation training, with particularly interesting qualitative findings.ConclusionsLearning outcomes may differ for team versus non-team simulation training, evidencing the different value of these two training set-ups.Disclosure of interestThe authors have not supplied their declaration of competing interest.