bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Paternal Depression in Infancy: A Mechanism for the Intergenerational Transmission of Risk
Authors: Sethna V. , Murray L. , Psychogiou L. , Ramchandani P. 
Published: March 2009

The adverse influence of parental psychopathology on child development has been the focus of intense research in recent years, yet we are only beginning to understand the factors that explain this intergenerational transmission. Depressive symptoms in fathers have received relatively little attention when compared to research on the impact of maternal depression on children's emotional and behavioural problems. Recent evidence suggests that paternal depressive symptoms in the postnatal period are associated with an increased risk of toddler behaviour problems, which persist in clinical significance into childhood. This research examines a model of ‘social-environmental transmission’ of paternal psychopathology. We compared patterns of parent-infant interactions among families with depressed and non-depressed fathers to address the following question: Are the early interactions of depressed fathers characterised by maladaptive affect, behaviour and cognitions? This study is part of an on-going longitudinal investigation, The Oxford Fathers Project (OFP) of families who are followed when infants are 3 months to 2 years of age. Paternal behaviours, including verbal comments and interactive behaviour were examined during free-play with their 3-month old infants. Father's behaviour was coded from Fiori-Cowley and Murray's (1996) Global Rating Scale and verbal transcripts were examined for cognitive and mentalizing statements.Preliminary results suggest a higher proportion of infant directed negativity, in the verbal content of depressed fathers. Further analysis will be conducted and presented at the meeting. Discussion emphasises the importance of dysfunctional communication patterns in father-infant interactions that provide important clinical hypotheses as well as targets for identification and early intervention.
Substance Use During Pregnancy, Postpartum Depression and Child Outcomes: A Longitudinal Study
Authors: Imaz M. , Gelabert E. , Navarro P. , Sanjuan J. , Guillamat R. , Gutierrez A. , Gorneman I. , Canellas F. , Gratacós M. , Costa X. , Torrens M. , García-Esteve L. , Martín-Santos R. 
Published: March 2009

Introduction:Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.Method:This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.Results:The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.Conclusions:In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.
Risks of Delirium in Polymedicated Elderly Patients
Authors: Stoppe G. 
Published: March 2009

Delirium is a frequent condition and affects 20-60% of the elderly during hospital stay. It is associated with a worse functional outcome, increased length of hospital stay and mortality. Risk factors have been identified like age, dementia, sensory inhibition, infections, dehydration and polymedication. Prevention programs with multi-faceted interventions are in development.In the German speaking area at least two models deserve further interest because they got a high rate of acceptance in the staffs and were meanwhile implemented into routine care of the respective hospitals. Both models will be presented. One focuses on the continuous individual care through the perioperative process, the other consists of an algorithm with standard assessments of risk-patients by the nurses to identify a beginning delirium just at onset for early interventions.
Depression and Bipolar Disorder: Is Prevention of Mania Possible? Critical Issues on Diagnostic Criteria
Authors: Amedei S. Gorini , Catena M. , Lejeune F. , Duma S. , Scarpato M.A. , Faravelli C. 
Published: March 2009

Diagnostic criteria for bipolar disorder in DSM IV require the occurrence of a manic or hypomanic episode. The scant appropriateness of these criteria compared with Kraepelin"s concept of manic depressive insanity has been repeatedly reported and the concept of bipolar spectrum has been proposed for more than 30 years. The negative consequences of pure adherence to operational diagnostic criteria on clinical needs are presented in terms of community epidemiology results and in terms of clinical evidences and the inadequate treatment of depressive and anxiety episodes and the risk of manic switch with antidepressant drugs are discussed.The epidemiological survey conducted in Sesto Fiorentino showed that depressive episodes in patients with subthreshold mania or hypomania were different from the clinical presentation of pure unipolar depressives episodes confirming not only the numeric impact but also qualitative differences between these groups of patients.Our clinical study where predictors of mania have been prospectively evaluated in a trans nosographic sample of outpatients demonstrated that aspects related to bipolarity predicted manic shift regardless of the diagnosis. DSM IV criteria seem not to be able to detect and describe a group of patients relevant both on epidemiological and on clinical level. These findings underline the need of a careful examination of patients treatment and validate the rule of further research in definition of mood disorders boundaries for prevention strategies.
Subjective well-being Under Neuroleptic Treatment. Relevance for Compliance and Remission
Authors: Naber D. 
Published: March 2009

Within the last decade, success criteria of antipsychotic treatment became more ambitious. The most important change is the long overdue consideration of the patient"s perspective. Among other scales, a self-report instrument has been constructed to evaluate “subjective well-being under neuroleptics” (SWN). Studies indicate:a.schizophrenic patients, if no longer acutely psychotic or suffering from severe cognitive deficits, are able to reliably assess their SWN,b.high SWN is correlated with high compliance,c.atypical antipsychotics increase SWN,d.individual improvements of SWN and of PANSS are not strongly related (r=-.30 - -.40), and e) dopamine D2 receptor blockade is highly correlated to reduced SWN (r = .66 - .76).Several open trials reveal the relevance of early improvement of subjective well-being: In a 12-week trial with 727 patients, 95% of those with early subjective response (within 4 weeks) showed later subjective and/or psychopathological improvement, but only 9% without early subjective response showed later improvement. In another 3-year trial of 2690 patients, again psychopathological response as well as symptomatic and functional remission were mostly related to early (within first 3 months) subjective improvement. Finally, in a first-episode study of 110 patients with a follow-up of 5 years, within the first 6 weeks of antipsychotic treatment only improvement of SWN was related to enduring symptomatic remission (p=.004) while early reduction of PANSS did not predict long-term course. These data indicate the usefulness of self-rating in schizophrenia, insufficient subjective improvement needs to be identified early.
Assessing Social Functioning in Schizophrenia
Authors: Burns T. 
Published: March 2009

Aims:Social functioning has increasingly become recognised as an important outcome in schizophrenia. While measures of symptom status are highly developed and widely used there has been only limited work on developing instruments for measuring social functioning in a reliable and consistent manner. We aimed to review the schizophrenia literature to identify the structured social functioning measures that have been used with any frequency and compare their features (1).Method:A detailed electronic literature search (1990 - 2006) using the key words schizophrenia and social function was carried out and those papers containing details of any structured assessment of social function were used. The most frequently used instruments were identified. A search was also conducted for the use of social function measures in trials of antipsychotics in schizophrenia.Results:301 articles employed 87 potential social function measures and of these only 20 were used 3 or more times. Only 14 RCTs of antipsychotics employed them.Conclusions:There is limited consensus on the definition and measurement of social functioning but two or three scales show promise for regular usage.
Remission in Schizophrenia: A National Survey of Clinical and Psychosocial Aspects
Authors: Aizenberg D. , Barak Y. 
Published: March 2009

Background:Clinical and psychosocial remission amongst schizophrenia patients is nowadays a defined goal of treatment. This necessitates incorporating quantifiable psychosocial variables with traditional symptomatic data as both influence remission.Objective:To assess psychosocial remission in schizophrenia (using the PSRS) along with the quantification of symptomatic remission in a large cohort of community dwelling schizophrenia patients.Method:Psychiatrists, nurses and social workers endorsed the PSRS and the American Psychiatric Association symptomatic remission criteria (APA-SR) for schizophrenia patients they have been treating for 6 months or more. Data as to gender, age and pharmacological treatment of each patient were also collected.Results:Of 445 participants who completed the survey, 268 (60%) were psychiatrists, 161 (36%) nurses and 16 (4%) social workers. Patients mean age was 43.4±13.1 years; 61% were men and 39% were women. Antipsychotic treatments were as follows: Per-os (PO) 243 (55%), IM long-acting typical antipsychotics (LAT) 102 (23%) and IM long-acting risperidone (Consta) 100 (22%). Overall, 37% of patients achieved symptomatic remission and 31% achieved psychosocial remission. Rates of symptomatic remission were significantly higher in patients treated by LAT and Consta compared with PO (51% and 48% vs., 29% respectively, p=0.0003). Rates of psychosocial remission were also significantly higher in patients treated by LAT and Consta compared with PO (43%% and 41% vs., 24% respectively, p=0.003).Conclusion:About a third of schizophrenia patients in Israel were in remission. IM long acting preparations were associated with higher remission rates. Treatment choice may thus influence rates of remission.
Schizophrenia in the Offspring of Antenatally Depressed Mothers and with Familial Risk - the Northern Finland 1966 Birth Cohort
Authors: Mäki P.H. , Riekki T. , Miettunen J. , Isohanni M. , Jones P.B. , Veijola J.M. 
Published: March 2009

Aims:Schizophrenia is considered to be a neurodevelopmental disorder arising as a result of interactions between genetic vulnerability and environmental risk factors. We studied the association between mothers" antenatal depressed mood and schizophrenia in their adult offspring with special consideration to Familial Risk for psychosis.Method:In the Northern Finland 1966 Birth Cohort mothers of 12,058 children were asked at mid-gestation at the antenatal clinic if they felt depressed. This general population birth cohort of the children was followed up for over 30 years, being record-linked with the Finnish Hospital Discharge Register (FHDR) for detecting psychosis in the subjects. The FHDR was also used for identifying psychosis in the parents. Familial Risk for psychosis was considered as a genetic risk factor and mothers’ depression as an environmental risk factor.Results:Offspring with both Familial Risk of psychosis and depressed mother had the highest cumulative incidence of schizophrenia, 7.4% (adjusted OR 10.3; 4.6-23.0). Of the offspring with only psychotic parent without antenatal depression, 2.3% got schizophrenia (OR 2.6; 1.2-5.4). In the offspring without Familial Risk of psychosis and with maternal depression the risk of developing schizophrenia was not elevated.Conclusion:Mothers’ depressed mood during pregnancy per se is unlikely to increase the risk for schizophrenia in the offspring, but may effect in subjects at risk for psychosis. This finding is an example of a gene x environment interaction in the development of schizophrenia.Acknowledgements:This work was supported by grants from the Signe and Ane Gyllenberg Foundation and the Academy of Finland.
Specificity of Cognitive Deficits in Psychosis; Initial Presentation and Course of Alterations among Different Diagnoses
Authors: Zabala A. , Eguiluz J.I. , Segarra R. , Elizagarate E. , Enjuto S. , Ezcurra J. , Pinto A.M. Gonzalez , Gutiérrez M. 
Published: March 2009

Objective:To describe possible differences in the initial cognitive profile between schizophrenia and non-schizophrenia first episode psychosis patients.Method:We assessed attention, working memory, and executive functioning in 57 first episode psychosis patients at baseline and at a one-year follow-up.Results:No significant differences were detected in the cognitive profile among schizophrenia (n=20) and non-schizophrenia (n=37) patients at baseline or at the one-year follow-up. For the overall group, significant reductions in the percentage of omission and commission errors for the sustained attention task (p< 0.001 and p=0.001 respectively), in the total time to complete the Stroop-I task (p< 0.001), in the percentage of omission errors for the working memory task (p=0.001), and in the percentage of perseverative errors for the WCST (p< 0.001) were detected, as well as a significant increase in the number of categories completed in the WCST (p< 0.001). The other cognitive variables analyzed remained stable (4 of the 10 variables tested). The pattern of change was similar for schizophrenia and non-schizophrenia patients in the areas of attention and working memory. For executive functioning, the non-schizophrenia group showed a more beneficial pattern of change.Conclusions:Our results indicate a lack of specificity of cognitive alterations related to the degree of affectation, at least during the first year after instauration of treatment. The course of cognitive deficits in first episode psychosis showed significant improvements over this period, being the patter of change in executive functioning slightly more beneficial for patients with a non-schizophrenia psychosis.
The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder
Authors: Tournier M. , Cougnard A. , Bégaud B. , Thiébaut A. , Verdoux H. 
Published: March 2009

Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.
Low Bone Mineral Density and Psychosis: A Multifactorial Relation
Authors: Coentre R. , Barrocas D. , Levy P. 
Published: March 2009

Aims:Low bone mineral density (BMD) is a major public health issue leading to fractures, pain and disability. The association between psychosis and low bone density has been suggested in the last years.Method:The authors review the literature in Medline database using the words ‘bone mineral density’, ‘psychosis’, ‘antipsychotic’, ‘schizophrenia’, ‘bipolar disorder’ and ‘psychiatry disorders’.Results:Some studies show elevated prevalence of changes in BMD in patients with psychiatry disorders, namely psychosis. These changes are multifactorial, due to therapeutic factors and/or to the disorder per se. The low BMD induced by some antipsychotic drugs has been attributed mostly to hyperprolactinaemia and its consequences. Lithium, carbamazepine, sodium valproate and the use of thyroid-stimulating hormone-suppressive doses of L-thyroxin used in bipolar disorder also have a negative impact on bone health. Patients with psychosis could be vulnerable to bone abnormalities even without treatment, environmental factors like smoking, sedentary lifestyle, decreased exposure to sunlight, alcoholism, dietary deficiencies and polydipsia are partially responsible for that. Also genetic factors (vitamin D receptor gene, estrogen receptor gene etc.) and biological factors (gender, decreased of peak bone mass, abnormalities in immune-inflammatory mechanisms, hypercortisolemia stress-induced etc.) contribute to the abnormalities in bone dynamics in psychosis.Conclusion:The association between low BMD and psychosis has been demonstrated in literature, understanding all the factors involved in this process will help the development of preventive and treatment strategies. A large study including first psychotic episode patients could be useful to distinguish between disorder and drug induced factors of low BMD in psychosis.
Values and Ethics in Psychiatric Training
Authors: Lindhardt A. 
Published: March 2009

Aims:To present reflections on the importance on teaching a method to work with values in psychiatric trainingMethod:Based on 6 years of teaching at training courses in values and ethics the papers presented by the trainees on values will be discussed and case exampels be presentend for discussionResults:Ethical reflection in psychiatry is influencing many aspects of everyday practise and decision making. the papers presentend by the trainees showed a great variety in capability to reflect abstract ethiocal issues and relate them to practical clinical work. One especially interesting aspect was the confrontation on how different cultural backgrounds amongst the trainees reflect the values with which they practise psychiatryConclusion:A training course involving discussion of ethics and values is essential to raise awareness of ethical reflection and providing tools to do so
Treating Schizophrenia in Mediterranean Region; do we need Reform? State of Art in Italy after 30 Years of Psychiatric Reform
Authors: Nicolo G. 
Published: March 2009

In Italy 30 years ago a very radical psychiatric reform has been carried out. All psychiatric hospitals have been closed by law. This reform received very strong political support but was not scientific or evidence based. After 30 years it is necessary to evaluate the Italian reform scientifically.Basaglia's law was oriented, first to create a net of community care, and then to close Psychiatric Hospitals. The challenge was to improve the quality of life of patients that had spent their life in an Asylum. The patients admitted to psychiatric hospitals, normally had a diagnosis of Chronic Psychosis, Chronic bipolar disorder, mental retardation, but not other more prevalent psychiatric, sometimes more prevalent, diseases. The hypothesis was that psychiatric illness would improve further if the medical interventions were less specialised, thus the psychiatric intervention have to be very generic and supportive, specialization or pharmacologic treatment was perceived as bad practice. Many psychiatric illnesses did not receive specific treatment (panic attacks, personality disorders e.g)After 30 years this model shows some evidence of efficacy. We must consider weather we can really can apply this model in community treatment or whether we need a scientific based reform in which we can apply algorithms of treatment, early detection of disease and integrated and specialist treatment for severe psychopathology. Data from national health service will be presented and also some specific proposals in a European perspective.
Cross-cultural Psychiatry, Liaison Psychiatry and other Major Challenges for Modern Psychiatrists
Authors: Ferrari S. , Silva V. Barbanti , Forghieri M. , Rigatelli M. 
Published: March 2009

Beyond the awareness that psychiatry and contemporary medicine have undergone a dramatic change in recent years, walking the first steps as recently-qualified consultants in psychiatry is a major challenge. As a consequence of changes in society, technological progress and restricted funding availability, modern psychiatrists have to face problems that are new, and difficult to be faced, but also representing an opportunity to grow and contribute massively to medicine.This is particularly true in two specific fields, cross-cultural psychiatry and consultation-liaison psychiatry. The former is defined as psychiatry of disorders influenced by the cultural background; the latter is defined as the care of psychiatric disturbances in the medically ill. Though generic, these definitions highlight what is challenging in these branches of psychiatry: the disposition towards an inter-disciplinary approach to human illnesses. Both deepen their roots in the bio-psycho-social paradigm of George Engel and were in fact frequently mentioned in Engel's writings as the future of psychiatry. Training and clinical experience in cross-cultural and consultation-liaison psychiatry are to be major components of the curriculum of psychiatric trainees.Therefore, the role of psychiatrists and psychiatrists-to-be in the contemporary scientific community and society must be a strong one: on the side of scientific knowledge, by marking the complex, systemic nature of physiopathology and therapy; on the side of epistemology, by marking the paradoxes of bio-medicine; on the side of organization of health care, by promoting the need for a person-oriented approach to illness; and finally on the side of culture, society and ethics.