bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness, Use and Undesirable Effects of Diagnosis of Mental Disorders
Authors: Steffen S. 
Published: March 2009

In her talk, Sigrid will focus on a number of aspects that arise as a consequence of an individual's diagnosis as suffering from a severe mental disorder, such as schizophrenia, and particularly how a diagnosis affects the wider family unit.From the wider family perspective, the onset of any mental illness is very traumatic and frightening, resulting in total confusion, angst and upset for all members - the sufferer, parents and siblings. So when a diagnosis is finally made, a sense of relief prevails but soon this relief changes when a person realises the real impact of such a diagnosis - in other words, the longer term effects and changes which they will face. A lifetime sentence looms for many.There is a critical need for information to help understand the illness, support and education to help develop one's coping skills, to name just a few issues. Also, a very negative result of someone being diagnosed as suffering with a mental illness is the onset of feelings of stigmatisation, discrimination and isolation. Sigrid will deal with these topics and will explore the efforts which EUFAMI has been employing to counter these.
Methylphenidate Treatment in ADHD/borderline Personality Disorder Adolescent Girls and Smoking Behavior
Authors: Golubchik P. , Sever J. , Shoval G. , Zalsman G. , Weizman A. 
Published: March 2009

Background:Cigarette smoking and nicotine dependence is prevalent among the attention deficit/hyperactivity disorder (ADHD) pediatric population. We assessed the influence of methylphenidate treatment on the smoking behavior of adolescent girls with ADHD/ borderline personality disorder (BPD).Method:Twelve ADHD/BPD female adolescent smokers aged 14-19 years were treated with MPH for an 8 week period. The severity of ADHD was assessed by the ADHD Rating Scale (ADHD-RS) and the smoking behavior was rated by Fagerstorm Test for Nicotine Dependence (FTND).Results:Significant improvement was detected in ADHD symptomathology, (Baseline vs. endpoint: ADHD-RS : 33.1±6.8 vs. 19.9±6.8, t=6.875, df=11, p=0.0001). A decline in the severity of nicotine dependence, as assessed by FTND (baseline vs. endpoint: 4.1±2.6 vs. 2.0±1.9, t = 4.056, df=11, p= 0.0019), was observed. No significant correlation was found between changes in the ADHD-RS and the FTND following methylphenidate treatment (r=0.09935, p=0.7587).Conclusion:Methylphenidate may attenuate smoking behavior in ADHD/BPD female adolescent smokers.
Early Phases of Mental Disorders in adolescence and Young Adulthood
Authors: Wasserman D. 
Published: March 2009

Suicide is one of the leading causes of mortality among adolescent suicides. Data from the WHO European Multicentre study on attempted suicide indicates that rates of attempted suicide and suicide in the young co-vary. The association is strongest and significant for male adolescents and young adults. Furthermore, recent studies have reported a shift to suicide methods with higher lethality for both genders.Suicide prevention strategies are directed at the general population and health care services. Suicide risk is high among adolescents with psychiatric illness, so adequate treatment and detection of psychiatric illnesses in young people is essential. Preventive measures in health care services after a suicide attempt and early recognition of young people at risk in schools are also essential strategies.The emphasis of suicide prevention work needs to shift to an earlier stage of the suicidal process. This question is addressed by the global suicide prevention initiative SUPRE (SUicide PREvention), in the WHO publication Preventing suicide: a resource for teachers and other school staff, which can be adapted to local conditions and inserted in syllabuses for training both pupils and staff.An intervention project called SAYLE: Saving Young lives in Europe is funded by the EU for adolescents in European schools over 12 EU countries. Its main objectives are to lead adolescents to better health through decreased risk taking and suicidal behaviours. Outcomes of preventive programs will be evaluated and culturally adjusted models for promoting health of adolescents in different European countries are planned to be developed.
Therapeutic Drug Monitoring (TDM) During Pregnancy and Breast Feeding
Authors: Conca A. , Bergemann N. , Waschgler R. , Adami P. Steger 
Published: March 2009

Epidemiological data indicate that about one third of all pregnant women receive at least one psychotropic drug (Goldberg & Nissim 1994). Women with mental disorders bear a considerable risk of relapse when psychotropic medication is discontinued during pregnancy and the postpartal period.TDM aims to better individualize dosing regimens taking into account relevant pregnancy-induced metabolism returning to baseline activities within 24 hours (Adab 2006).Despite the frequent use of psychotropic drugs in pregnancy, for several psychotropic drugs only few documented cases regarding their influence on organogenesis, delivery complications or long term effects are available. Therefore, one should follow some general guidelines when treating pregnant women (cf. Bergemann & Conca). Furthermore, it is recommended to guide any psychopharmacological therapy by TDM. TDM in pregnant women and/or mothers is recommended to be carried out at least once per trimester and within 24 hours after delivery. For TDM at delivery umbilical cord blood of neonates exposed in utero to psychotropic drugs should be collected, since possible neonatal symptoms has to be differentiated from a withdrawal syndrome versus toxic effects of the substances (cf. Koren 2006, Pakalapati et al. 2006).The use of psychotropic medications during breast-feeding has some implications. All psychotropic medications enter breast milk. However, current data do not support monitoring breast milk levels in attempt to estimate individual infant plasma levels, since the effective drug concentration in the neonate is essentially determined by its own metabolism (Weissman et al. 2004). A systematic monitoring of mother and child including TDM is recommended.
The critical period
Authors: Birchwood M. 
Published: March 2009

Aim:Evidence from long-term follow-up studies of schizophrenia and from the ‘new epidemiology’ of psychoses has forced us to rewrite the textbooks and challenge accepted wisdom. In this paper I aim to review the concept of my ‘Critical Period’ in the long-term trajectory of schizophrenia.Method:I will review long-term follow-up studies of first episode psychosis.Results:Studies suggest that:a.the course of the psychoses is very variable;b.much of this variability is laid down during the ‘prodromal’ and first 3 - 5 years following the first episode;c.the ‘disability’ plateaus quickly, much of it occuring before the positive symptoms develop (the ‘symptom-disability gap’) butd.the psychosocial and ecological risk factors that have now been uncovered, suggest a more protean, malleable process in the development of psychosis, as witnessed, for example by the considerable number of ‘at risk’ individuals with low-level, but disabling psychotic symptoms, who escape psychosis (the misnomer of the ‘false positive’).Conclusion:This picture presents a fresh take on my concept of the ‘critical period’ with implications for public health and prevention.
OPUS -trial: Five-year Follow-up of a RCT of Specialized Treatment for Patients with First Episode Psychosis
Authors: Nordentoft M. , Bertelsen M. , Jeppesen P. , Petersen L. , Thorup A. , Le Quack P. , Krarup G. , Jørgensen P. 
Published: March 2009

Objective:To determine long term effects of intensive early intervention programme (OPUS)for first episode psychotic patients.Design:RCT of two years of intensive early-intervention programme versus standard treatment. Follow-up was two and five years.Patients:547 first-episode psychotic patients were included and interviewed after two years (N=369) and five years (N=301). Registerbased information was available for all patients.Interventions:The intensive early intervention programme OPUS consisted of ACT with family involvement and social skills training.Results:At five-year follow-up, the positive effect of the OPUS treatment seen after two years had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1 to 4.8, P =0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15 to 88,12 P= 0.05) during the five-year period.Conclusions:The OPUS treatment improved clinical outcome after two years, but the effects were not sustainable up to five years after. A difference on supported housing and use of bed days were found after five years in favour of the OPUS treatment.
A Pilot Randomized Controlled Evaluation of “Extended Specialized Early Intervention Service” vs. “Regular Care” for Longterm Management of Early Psychosis
Authors: Malla A. 
Published: March 2009

Introduction:Short term benefits of Specialized Early Intervention (SEI) services for treatment of first episode of psychosis (FEP) are not sustained after transfer to regular care. Optimum length of SEI services remains to be determined.Objective:To carry out a randomized controlled trial (RCT) of extending SEI service for an additional three years compared to “regular” care after both groups have received two years of SEI treatment.Hypothesis:The experimental group (extended SEI) will have better clinical (remission length and proportion) and functional outcomes and be cost effective compared to the control group (regular care).Methods:Remission (length and proportion in remission) are the primary outcomes. We aim to randomize a total of 212 patients following two years of SEI service for their FEP. Outcome evaluations to assess symptoms, functioning and service utilization are carried out at entry and every three months. In this presentation we will report only the method and preliminary results (success of urn randomization, drop out and relapse rates) on the sample recruited thus far.Results:Of the 58 patients approached 50 (86%) agreed to be randomized. Patients were young (mean age 25), mostly male (with a diagnosis of Schizophrenia Spectrum Psychosis (71%). The average length of follow up to date is 13.2 months (s.d. = 5.4). Treatment discontinuation in the experimental and control conditions were 0 and 4 (15%), respectively.Conclusion:The pilot results show the feasibility for carrying out such a study. The methodological challenges of conducting this long term RCT will be discussed.
Do the Benefits of Early Intervention (EI) Treatments for Schizophrenia Persist?
Authors: Gafoor R. , Craig T. , Garety P. , Power P. , McGuire P. 
Published: March 2009

Introduction:Early Intervention (EI) services aim to reduce progression to chronic illness for patients with schizophrenia. The Lambeth Early Onset study (2002) demonstrated reduced hospitalisation at 18 months for patients exposed to EI services. This study assesses the durability of these benefits at 5 years.Methods:Hospital use in the LEO cohort was assessed by case note review.Results:There was no statistically significant difference in terms of ever being admitted at 5 years (OR 1.42; 95% CI 0.550 - 3.68; p=0.468)). Although the mean number of admissions was lower in the EI group: 1.65 (SD = 0.86) versus 1.83 (SD= 0.92), this difference was not significant (coefficient = 0.096; 95% CI -0.550 - 0.742; p=0.770). At 5 years patients assigned to EI used 42.25 days (SD 112.8 days) versus 51.41 days (SD 125 days); coefficient = 6.344; 95% CI -46 - 58.7; p= 0.810. The primary outcome was robust to potentially extreme admission rates for missing subjects on sensitivity analysis.Conclusions:There is no evidence from these data that EI services statistically significantly reduce hospital use at 5 years follow-up (vis a vis care as usual) despite some interim benefits at 18 months. We only considered a limited number of outcomes and more work needs to be done in this area.
Antipsychotics in Anxiety Disorders
Authors: Allgulander C. 
Published: March 2009

In 1970 antipsychotics (haloperidol, levomepromazine, thiothixene) were recommended in Sweden as 1st line treatment of anxiety in organic brain syndromes, psychoasthenia, and substance abuse. The benzodiazepines came to dominate treatment of anxious patients in the 1970s and are still appreciated for their rapid anxiolytic effect, low clinical toxicity and low price. Evidence-based guidelines, however, recommend the SSRIs, venlafaxine, and pregabalin as first line treatment in anxiety disorders.Studies are currently ongoing to assess the utility of new antipsychotics in primary anxiety disorders: quetiapine, risperidone, aripiprazole, ziprazidone, and olanzapine. This is justified in the light of that a large proportion of these patients, about 1/3, do not respond to 1st line treatments or discontinue due to adverse drug effects. Augmentation therapy with antipsychotics may enhance response rates. Primary anxiety disorders may include psychotic symptoms such as dissociation, or severe insomnia, that may be targeted with these medications.Another important patient category are patients with substance use disorders, particularly alcohol, in whom there are few or no controlled studies of conventional anxiolytics. Anxiety is also common among patients with psychoses, bipolar disorder, ADHD or borderline personality disorder, and few controlled studies have addressed that issue.Emerging reports indicate that new antipsychotics may be useful as 1st line therapy, as augmenters, and in patients with anxiety due to psychoses and bipolar disorder. In this educational update, the results regarding symptoms, adverse effects, and functioning of these recent studies will be discussed.
A Pilot Study of at-risk Criteria for Bipolar Disorders in Help Seeking Adolescents and Young Adults
Authors: Bechdolf A. , Nelson B. , Cotton S.M. , Chanen A. , Thompson A. , Conus P. , Yung A.R. , Berk M. , McGorry P.D. 
Published: March 2009

Introduction:We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive and discriminant validity of these criteria were tested in help seeking adolescents and young adults.Method:This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24 years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January.08. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania.Results:The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5 days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n = 5) than in the non-BAR group (0.7%, n = 1) who met conversion criteria (p < .001).Conclusions:These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.
Leadership in New Organisations
Authors: Buwalda V. 
Published: March 2009

In the last decade I served as president of the Dutch Association of Psychiatric Trainees, Secretary General of the European Federation of Psychiatric Trainees and first president ever of the World Association of Young Psychiatrists and Trainees. My ideas were bases on my experience as one of the European leaders of the European Federation of Psychiatric Trainees (EFPT). Psyched and trilled as I was having opportunities faced in the EFPT I thought it would be great to start an world wide association for psychiatric trainees and young psychiatrists. In this presentations I will share my experience as an (new) international leader in Psychiatry and the lessons I learned, the strength, challenges and difference of the World Association of Young Psychiatrists and Trainees (WAYPT) in comparison with the European and Dutch experience.Learning objectives:1.the attendee will learn about the competencies an international leader in Psychiatry needs;2.the attendee will learn about the challenges a international leader faces;3.the attendee will learn to overview different levels of the organization: national, continental and worldwide.
Clinical Research Evidence for the Use of Antipsychotics
Authors: Vieta E. 
Published: March 2009

The use of atypical antipsychotics in the treatment of mania has become standard practice as supported by most currently available treatment guidelines. Aripiprazole, asenapine, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone have shown efficacy in placebo-controlled studies in acute mania. Not all these compounds, though, have been tested in maintenance therapy. Aripiprazole, for example, has been evaluated in numerous clinical trials in patients with bipolar disorder. Its efficacy was first established in two 3-week, placebo-controlled trials, and data are now available from a double-blind study of 100 weeks’ duration in manic patients, demonstrating both the effective stabilisation offered by aripiprazole and its superiority over placebo in preventing bipolar recurrence, primarily in preventing recurrence into mania.Furthermore, the addition of aripiprazole to lithium or valproate in patients who are partially non-responsive to these latter agents, can lead to significant improvement in mania symptoms. Several other atypical antipsychotics have also demonstrated adjunctive efficacy in patients with bipolar disorder, including olanzapine, quetiapine and risperidone. Studies comparing different atypical agents have generally shown that efficacy is similar, although the side effect and tolerability profiles differ between agents.In conclusion, atypical antipsychotics such as aripiprazole have proven short-and long-term efficacy as monotherapy or adjunctive treatment for bipolar mania, providing physicians with additional options when selecting the best treatment for their patients.
The Reality of Taking Antipsychotic Medication
Authors: Alptekin K. 
Published: March 2009

Antipsychotic medication provides effective treatment for patients with schizophrenia and bipolar disorder. Patient satisfaction with antipsychotics is positively associated with improvement in psychotic symptoms and treatment adherence. However, some patients, whilst recognising their need for effective intervention, have specific concerns over their management. If these concerns are not adequately addressed the patients remain unsatisfied and may become non-adherent.Health-related attitudes and beliefs of the patients and insights about their illness may affect patients’ decisions on taking medications in the short and long term. Therefore, it is essential for physicians to communicate with their patients about their beliefs regarding their mental and physical health. Careful assessment of the environmental characteristics of the patient relevant to health may also decrease the risk of non-adherence. Improvement of a patient's treatment adherence using specific motivational interview techniques should also be discussed.At the outset patients are often concerned over the possibility of treatment-related adverse events (AEs) such as headache, somnolence and weight gain with antipsychotic treatment. If such AEs do occur, patients have to develop coping strategies and may be tempted to self-manage, which can lead to treatment discontinuation and/or selective adherence.A joint decision-making process between patient and clinician will allow a rational approach to treatment selection and adherence, and the provision of supportive networks will ensure that there is an opportunity for patients to learn about the effects of their medication.
How Art may be a Tool for Understanding Other Cultures and their Perception of Illness
Authors: Kastrup M. 
Published: March 2009

Cultural background has a significant influence upon how we perceive illness, our attitudes to illness and our help-seeking behaviour.But culture is only one of many influences on our health related beliefs and behaviours. Other factors include e.g. individual factors related to age, gender, sociodemographic background, but also environmental factors such as urban or rural setting, pollution, globalization.If we want to understand and assess the impact of culture in a particular clinical case, the use of art may be a valuable tool to facilitate this understanding and serve as a bridge over cultural incongruities.The paper will discuss ways in which the application of artistic elements in the therapeutic process may serve as a useful intervention and ultimately as a vehicle to increase the cultural competence of mental health staff. In an increasingly complex, globalised world with patient populations originating from all parts of the world this may prove to be a profitable instrument.
The Neural Basis of Disorganized Symptoms in Schizophrenia
Authors: Leube D. 
Published: March 2009

Structural brain changes in schizophrenia patients have been reported in many studies. It is still unclear how these changes relate to psychopathological symptom clusters. The aim of the present study was to investigate whether scores of the subscales from a five factorial model of the PANSS correlate with changes of brain morphology.High-resolution magnetic resonance imaging scans from 54 patients with schizophrenia were analyzed with voxel based morphometry, a voxel-wise whole brain morphometric technique. We correlated grey matter density with the subscales of a five factor component analysis of the PANSS score. Additionally we performed a two group comparison with 101 healthy control subjects.Significant negative correlations of the disorganization score with grey matter density were found for clusters of voxels in the right inferior frontal, right insular cortex, left temporal pole and left superior temporal gyrus, as well as cingulate cortex and cerebellum. No morphological correlate was found for the other four subscales. P atients showed significant less grey matter density than control subjects in the left and right insula lobe and superior temporal gyrus, left inferior frontal gyrus, right middle frontal gyrus and left anterior cingulate cortex.The disorganisation syndrome in schizophrenia is linked to particular morphological grey matter reductions in key areas of the disorder. The data support the hypothesis that different symptom clusters in schizophrenia might have different neural substrates.