bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spiritual Coping, Communication Training and Problem Solving for Schizophrenia
Authors: Tuchman N. 
Published: March 2009

This speaker will describe literature regarding the adaptive uses of religion and spirituality, such as religious or spiritual coping and making meaning from stressful life events. She will cover the Spiritual Coping module of the Culturally-Informed Therapy for Schizophrenia (CIT-S). In this phase, therapists begin with a detailed spiritual history in order to gauge each family member's beliefs, involvement in spiritual or religious activities and other practices they may have. Therapists assign homework that encourages the family members to explore their religious or spiritual experience in a positive and adaptive light. For clients who do not identify as religious or who are experiencing religious delusions, therapists proceed with this phase of treatment with a more philosophical or existential approach to spirituality and morality. A demonstration of this module will be conducted using volunteers from the audience.This speaker will also describe the final two modules of CIT-S, which are based on the work of Falloon etal. (1984) and Miklowitz and Goldstein (1997). The fourth phase of treatment, Communication Training, attempts to unite concepts and skills learned in the three previous phases through specific attention to communication skills. Family members learn to communicate with and support each other in effective ways. The fifth phase of treatment, Problem-Solving, allows the family to learn and practice problem-solving strategies using relevant examples.
Risk Factors for the Onset of Bipolar Disorder and Factors Influencing Recognition: Results from NEMESIS
Authors: Regeer E.J. , Spijker J. 
Published: March 2009

Aims:Risk factors for the onset of bipolar disorder and factors influencing recognition were examined in a general population sample.Method:In the Netherlands Mental Health Survey and Incidence Study (NEMESIS) symptoms of depression, mania, psychosis and substance use were assessed among 7076 respondents with the Composite International Diagnostic Interview at baseline, after one and after three years. In a reappraisal study among 40 respondents with bipolar disorder confirmed by the Structured Clinical Interview for DSM-IV (SCID) data on illness and treatment history were collected.Results:Predictive values of subclinical depression and (hypo)mania for bipolar disorder ranged from 14.3% to 50%. Cannabis use at baseline increased the risk for manic symptoms during follow-up (OR 2.70, 95%CI:1.54-4.75) (Henquet et al., 2006). Comorbid subclinical psychosis in respondents with subclinical mania had predictive value for future diagnosis of bipolar disorder (positive predictive value of 3% versus 10% respectively) (Kaymaz et al., 2007). The majority of the respondents with a SCID diagnosis bipolar disorder consulted a health professional, only 12.5% received a diagnosis of bipolar disorder and agreed with the diagnosis. Only these respondents used a moodstabilizer and had contact with a psychiatrist. Type of bipolar disorder, number of mood episodes and age of onset did not influence recognition.Conclusion:Subclinical depression and (hypo)mania, and comorbity of subclinical psychosis and mania are predictive for future diagnosis of bipolar disorder. Cannabis use affects the expression of manic symptoms. Self-recognition of bipolar disorder is an important factor in treatment seeking and receiving adequate treatment.
Do Antipsychotics Modify Age and Weight as Risk Factors for Diabetes Mellitus?
Authors: Cohen D. , Burger H. , de Wied C. Gispen , Stolk R. , Grobbee D. 
Published: March 2009

Aims:Study of risk factors of diabetes mellitus from the general population in a schizophrenic population.Method:Measurement of glucose and insuline levels, fasting and 120’ after oral glucose tolerance test (OGTT) and calculating of HOMA-IR and HOMA-B.Results:We studied 167 outpatients, mean age 40.2 years, 90.9% Caucasian, suffering from schizophrenia (83%) or schizoaffective disorder (17%).Age could not be confirmed as a risk factor on any of the glucose or insuline measurements or HOMA in patients with typical or atypical antipsychotics.With bodyweight, patients with typical differed from those with atypical antipsychotics. Weight was not a risk factor on any measurement or model in with typical antipsychotics. In patients with atypical, a significant correlation with levels of plasma glucose (p=0.017), insuline (p= 0.003 resp. p= 0.010) or glucose homeostasis models (p= 0.004 resp. p= 0.016). Fasting plasma glucose (FPG) was the notable exception (p=0.987).Conclusion:Diabetes risk factors age and weight behave differently in schizophrenia or schizoaffective disorder.The finding that age was not a risk factor, suggests that age is not a suitable criterion for the decision of glucose screening in this population.The different effect of weight (a risk factor only in patients treated with atypical, but not with typical antipsychotics) suggests in different pathophysiological pathway.As FPG was the only measurement with no correlation with either risk factors, this suggests that FPG is insufficiently sensitive for detection of disturbed glucosemetabolism in schizophrenia. Additional measurements (fasting insuline, HOMA-IR, HOMA-B, OGTT) seem to be necessary.
What Can be Learned from the Systematic Analysis of Suicides that Occur in the Healthcare System?
Authors: Wasserman D. 
Published: March 2009

Many European countries have a national suicide preventive programme. In June 2008, a new national programme for suicide prevention was approved by the Swedish Parliament in Sweden. One of the nine strategies in this programme is an assignment called ‘Lex Maria’ - to report all suicides that occur within or 28 days after contact with the healthcare system to The National Board of Health and Welfare (NBHW). Lex Maria guarantees that a systematic evaluation will always occur, providing opportunities to identify components which can be improved when treating suicidal patients. All Lex Maria reports are registered in a separate database at NBHW, allowing systematic analysis at a national level. The methodology used in this analysis will be presented, with examples of individual cases.Analysis of all suicide cases, which occurred in Sweden in 2006 within the health care system, uncovered the following areas which should be improved when working with suicidal people:•Better routines for suicide risk assessment;•Better routines for documentation of suicide risk assessment and changes in patients mood;•Better routines for the transfer of information within the same unit;•Better communication between units to ensure correct transfer of information;•Better routines for collaboration between care givers to ensure a continuity of care.In order to increase the competence of psychiatric health care staff in caring for suicidal patients, an annual 2 day education programme/course is recommended. The government also has an ambition to increase awareness of suicide prevention in the population.
Impact of a Long Asylum Procedure on Health in Iraqi Asylum Seekers in the Netherlands; an Epidemiological Study
Authors: Laban K. 
Published: March 2009

Aim:To investigate the relationship between the length of stay in a western host country and psychiatric disorders among asylum seekers from Iraq.Methods:Two groups of Iraqi asylum seekers, respectively less than 6 months (n=143) and more than 2 years (n=151) in The Netherlands were interviewed The sampling was at random. The health status was measured and evaluated in relation with pre-and post-migration adverse life events. Riskfactor analyses were done and adjusted Odds Ratio's were assessed. Moreover data were collected about physical health, functional disability and quality of life and their relationship with psychopathology as well as with length of stay were assessed.Results:The overall prevalence of psychiatric disorders was 42% in the group that just arrived and 66.2% in the group that stayed more than 2 years in the Netherlands. On logistic regression of all relevant riskfactors, a long asylum procedure showed an odds ratio of 2.16 (CI=1.15-4.08) for psychopathology. Except for female sex, this odds ratio was higher than those from life events in Iraq. Furthermore: the ‘long stay’ group had higher scores on physical complaints and disability and lower scores on quality of life. The post migration living problems were all directly related to psychopathology. Health service use was low and inadequate.Conclusion:A long asylum procedure is a very important risk factor for psychiatric disorders, physical health problems, disability and low quality of life. The risk for common psychiatric problems is higher than the adverse life events in the country of origin.
Cognitive Deficits in First Episode Schizophrenia
Authors: Galderisi S. 
Published: March 2009

Cognitive deficits are increasingly recognized as key features of schizophrenia, important determinants of poor psychosocial outcome and targets for treatment strategies. The huge literature on the topic made it clear that cognitive impairment is present in the majority of subjects with schizophrenia, is not an epiphenomenon of symptoms, is a risk factor for psychotic disorders and seems to contribute to poor functional outcome more than symptoms. However, relationships of cognitive impairment with symptoms, drug treatment and duration of untreated psychosis remain controversial and studies involving large cohorts of first episode schizophrenia patients are highly needed to address these topics adequately. The European First Episode Schizophrenia Trial collected demographic, clinical, psychosocial and cognitive baseline data in 498 first episode patients with schizophrenia, schizophreniform or schizoaffective disorder, with minimal or no prior exposure to antipsychotics, and in 220 healthy subjects, comparable with patients for age, sex, race and education level of parents. Z scores of the examined cognitive abilities (number of standard deviations below the comparison group means) ranged from -0.88 to -1.73. No association was found between the duration of untreated psychosis and cognitive impairment. Psychopathological dimensions were weakly correlated with cognitive impairment both at baseline evaluation and after six months of treatment.According to EUFEST findings, cognitive impairment in patients with first-episode schizophrenia is moderate/severe, has no association with the duration of untreated psychosis, involves several domains of cognition, and is largely independent from psychopathology.
Safety First, Efficacy Second? Fear and Need of Treatment in the Absence of Controlled Data
Authors: Mohr P. , Cermak J. , Hendrychova Y. , Seifertova D. 
Published: March 2009

In the clinical practice, physicians are routinely asked to make decisions whether to initiate or continue antidepressant treatment in a situation where no safety data are available. As an example can serve pregnancy and breast-feeding, where controlled clinical trials provide little guidance. Females of fertile age are rarely included in the early phases of clinical testing, the Phase IIb and III trials have a standard provision to use a reliable contraception. Pregnancy during drug trial is considered as a ‘serious adverse event’ with subsequent study discontinuation. The reasons are not just ethical and legal but also marketing, the drug manufacturers fear to have their products associated with potentially grave side effects, such as malformations. Drug treatment in pregnancy and lactation thus pose a highly relevant clinical problem that cannot be addressed in controlled trials. Excessive concerns of negative consequences could erroneously result in generalizing recommendation not to get pregnant or to abort existing pregnancy. However, fetus may be already exposed to drugs early in the first trimester during frequently unplanned pregnancies; in addition, recent epidemiological data indicate increasing consumption of psychotropics, including antidepressants, by pregnant women. Psychiatrists have to weigh the known risks of treatment discontinuation versus potential risks for the fetus and infant. They should also consider whether alternative non-pharmacological interventions (psychotherapy, ECT, rTMS) are accessible or effective. The only available safety data on antidepressants come from animal studies, epidemiological trials, drug registries, case series, anecdotal case vignettes and clinical observations.Supported by the research project MZ0PCP2005.
Effects of Smoking, Alcohol and Illicit Drug Misuse on Maternal and Child Outcomes and Acute Management of Treatment
Authors: Havemann-Reinecke U. 
Published: March 2009

Smoking, alcohol and illicit drug misuse during pregnancy lead to toxic harmful consequences for mother and especially for the fetus, neonate or child. In case of misuse of illicit substances pregnant women mostly suffer from polytoxicomania (3 substances and more) and the misuse of illicit substances is often accompanied by severe smoking and drinking of alcohol. Therefore it is often difficult to methodologically differentiate the single toxic effects. Basing on this knowledge in the presentation a view on the single toxic and /or chronic effects of addictive drugs will be given.1.To clarify single toxic effects of the addictive drugs diagnostic procedure about regulary and/ or ecstatical consume and the diagnose of abuse or dependence acc. to DSMIV or ICD 10 and the analysis of relapse behaviour for each substance should be done.2.The toxic effects of the different substances in pregnancy will be reported. Nearly al addictive substances (nicotine (+CO, +tar), alcohol, THC, psychostimulants, heroine) go into placenta and thereby have multiple toxic effects like f.e. decreased perfusion and infarct of the placenta leading f.e. to intrauterine retardation of growth, premature detaching of placenta, premature birth, to deformities, various later heavy postpartal effects (lung and breath diseases, sudden death, fetal alcohol syndrome, neurological dysdevelopment, cardial malformations, learning disturbances, ADHD etc). The toxic effects of the various substances will be differentiated so far it is possible.3.The different therapeutic approach of the various addictive drugs during pregnany (withdrawl treatment, opioid substitution) will be discussed.
Does the First Exposure to Addictive Substances Predict Future Dependence?
Authors: DiFranza J. 
Published: March 2009

Aims:The risk factors for trying a cigarette are well known, however we were interested in the factors that determine which youths become addicted to nicotine once they have tried it.Method:To investigate this we followed a cohort of 1246 students (mean baseline age of 12.2 years) over 4 years. Subjects underwent 11 interviews during which we assessed 45 risk factors, measured diminished autonomy over tobacco with the Hooked On Nicotine Checklist, and evaluated tobacco dependence using the International Classification of Diseases-10th revision. Cox proportional hazards models were used.Results:Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette (adJusted Hazard Ratio (HR)=3.26; 95% CI, 1.95-5.46; P< .001) and depressed mood (HR=1.29; 1.09-1.54; P=.004). Tobacco dependence was predicted by feeling relaxed (HR=2.43; 1.27-4.65; P=.007), familiarity with Joe Camel (HR=2.19; 1.11-4.32; P=.02), novelty seeking (HR=1.56; 1.06-2.29; P=.02), and depressed mood (HR=1.17; 1.04-1.30; P=.007).Conclusion:Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or many other psychosocial factors. These results are discussed in relation to the theory that addiction is initiated by the first dose of nicotine.
Dialectical Behavioral Therapy for Patients with Borderline Features and Posttraumatic Stress Disorder After Childhood Sexual Abuse (DBT-P)
Authors: Bohus M. , Priebe K. , Dyer A. , Steil R. 
Published: March 2009

Several randomised clinical trials (RCT) have demonstrated the efficacy of cognitive behavioral therapy in the treatment of Posttraumatic Stress Disorder (PTSD). However, the external validity of these studies is limited with regard to PTSD related to childhood sexual abuse which often results in severe and complex sympomatology accompanied by a variety of concurrent disorders or symptoms, for example self-mutilation, suicidal ideation, or severe dissociation. Nearly 30% of patients with PTSD have a co-occuring borderline personality disorder (BPD). The prevalence rates of PTSD in patients with BPD vary between 40% and 60%.Several RCTs have shown the efficacy of Dialectical Behavioral Therapy (DBT) in the treatment of borderline patients, who exaggerate severe behavioural dyscontrol. However specific treatment for co-occuring PTSD has been lucking.Clinical lore suggests that exposure to trauma-relevant memories can potentially aggravate dysfunctional behaviour in patients with BPD. Empirical research however reports discrepant results with two studies documenting deleterious effects of comorbid BPD on treatment outcome, whereas one study did not find an impact.DBT-P was specifically tailored to treat patients with PTSD after sexual abuse during childhood. DBT-P includes training in emotion regulation and mindfulness, cognitive interventions and exposure elements, usually in combination with the use of skills. To evaluate the efficacy of DBT-P as compared to a wait list control group a RCT is currently carried out. Preliminary data, which will be presented, revealed large between effect sizes for the primary outcome measures (PDS, CAPS).
What will be the Consequences from the Changes in ICD-11/DSM-V for Decision Making in Clinical Psychopharmacotherapy?
Authors: Bitter I. 
Published: March 2009

The preparations of DSM V/ICD-11 are in progress. The frustrations and limitations engendered by the categorical model in psychiatry led to the suggestion of alternative dimensional models of classification, e.g. to the suggestions for a dimensional view of psychosis. However there are strong arguments for keeping the categorical classification maybe with inclusion of new criteria, such as neurocognitive impairment for schizophrenia and even there are suggestions for new categories such as nonaffective remitting acute psychosis.Therapeutic indications of drugs are developed by the industry and are approved by regulatory agencies (FDA, EMEA). Indications are linked to diagnostic categories as defined by DSM-IV/ICD-11, e.g. one antipsychotic is indicated for the treatment of both schizophrenia and bipolar disorder, while another is only indicated for the treatment of schizophrenia. These indications are used by the insurance industry to manage financing of drug treatment.Changes in the criteria of a diagnostic category will result in a revision of approval which may include the obligation for new studies. Generic companies are now an important part of the major pharmaceutical markets, however many of them do not have the capacity to launch clinical studies, which may lead to the withdrawal of marketing authorization of important drugs. Clinical studies seem to be unavoidable for licensing recently available drugs for the new diagnostic categories of DSM V/ICD 11. The introduction of diagnostic categories by a dimensional approach may lead to “double book keeping”: a dimensional diagnosis used for the medical practice and a categorical one for the insurance.
Therapeutic Drug Monitoring and Pharmacogenetic Tests in Pharmacovigilance - When and What?
Authors: Sirot E. Jaquenoud , Baumann P. 
Published: March 2009

More than 80% of all adverse drug reactions are Type A reactions and dependent on drug concentrations. Therapeutic Drug Monitoring (TDM), Drug Interaction checking programs and pharmacogenetic tests are valuable instruments in elucidating or preventing Type A reactions. It stands for Quality Assurance in clinical practice. The TDMplus algorithm (Jaquenoud Sirot E et al 2006) is helpful in clinical practice and prevents unnecessary testing. This decision tree leads in several “stop/go” steps from the clinical situation of inefficacy or adverse reaction to measuring and interpreting plasma levels, checking for pharmacokinetic interactions and finally, if indicated, to pharmacogenetic tests with gentoyping and/or phenotyping. Genetic results are noted on a personal “pharmacogenetic card” for the patient's future treatments.The interplay of genetics, drug interactions, life style and other personal vulnerabilities like comorbidity make prediction of drug response very complex. The use of TDMplus has proven useful guiding the clinicians in difficult clinical situations and helping elucidating the causality of adverse drug reactions. Its practical benefit has been shown with pharmacovigilance cases from the AMSP program (Arzneimittelsicherheit in der Psychiatrie = Drug Safety in Psychiatry).
How to Examine a Patient with Movement Disorders?
Authors: Hoek H.W. , van Harten P.N. 
Published: March 2009

Patients with movement disorders do not always complain about their ‘troubles with muscles’ spontaneously, and sometimes, often out of shame, they try to hide their involuntary movements. E.g. a hand tremor can be temporarily suppressed by pushing the hand against the body or sitting on it. To reveal these movement disorders, a systematic investigation of the patient is required. This investigation consists of a (hetero) anamnesis and a physical examination. The anamnesis demands knowledge of sensitive questions such as: ‘Do you notice any movements that are not under your control? Do you feel restless: an inability to keep the legs still? Do you tremble, are you slower than usual?’ Next, a physical examination is required. The investigator lets the patient execute several movements such as stretching the arms, opening the mouth and walking.In this workshop you will learn and practice this highly sensitive examination. In clinical practice this investigation takes less than 5 minutes and will reveal all drug induced movement disorders.