2019 Conference Abstracts

Liberation Psychology from an Islamic Perspective

Sarah Mohr

Abstract
Psychology has the potential to reinforce the status quo or radically transform the world. Being clear about working towards a goal of social, and environmental justice brings focus to the work of mental health (Martin-Baro, 1994; Watkins & Shulman, 2008.) In turn, mental health can bring a greater focus to the larger work of humanity to transform and renew our world. (Martin-Baro, 1994; Watkins & Shulman, 2008.)

In the concept of praxis, speech, action, and reflection are inextricably linked (Freire, 2001.) As we work in mental health, theorizing how our work is intentionally aimed towards transforming injustice both on the societal level is critical. Simultaneously, working towards transforming macro level injustice needs to be combined with micro level work that consciously liberates people and facilitates the highest level of mental wellness for all in relationship to oppressive institutions, and paradigms (Martin-Baro, 1994.) This is the work of liberation psychology (Mohr, 2019; Seedat, 1997; Watkins & Shulman, 2008.) Drawing from work by feminists, people of color, Third World peoples, Muslims working in mental health, and Islamic texts and traditions, a possible theoretical framework emerges for the work of mental health for and by Muslims.

Reflecting on Liberation Psychology leads towards approaches that intentionally affirm the full humanity of women, people of color, the poor and the LGBTQ community, the centrality of the work for environmental accountability, healing, transformation and restoration, and the contextualization of violence within the current discourse which decontextualizes and distorts violence by Muslims without reference to colonialism, imperialism, racism, or the war on the poor (Mohr, 2019; Watkins & Shulman, 2008.) This work can contribute to the clear framing of the micro, mezzo and macro work of Muslims in mental health towards a psychology that speaks truth to power with coherent, and systematic clarity of purpose and intent.

References
Freire, Paolo. (2001.) Pedagogy of the Oppressed: 30th Anniversary Edition. New York: Continuum.
Martin-Baro, Ignacio. (1994.) Writings for a liberation psychology. Eds, Aron, A and Corne, S. Cambridge, Massachusetts: Harvard University Press.
Mohr, S. (2019.) Liberation psychology from an Islamic perspective: Some theoretical and practical implications of psychology with a telos of justice. Journal of religion and society. 21.
Seedat, M. (1997) The Quest for Liberatory Psychology. South African Journal of Psychology 27, 4: 261-270.
Watkins, M & Shulman, H. (2008) Toward Psychologies of Liberation. New York, NY: Palgrave Macmillan.

Physical Health Checks in Patients on Antipsychotic Medication

Gloria Lau, Juliette Murphy, Natasha Chaudhury, Mark Agius

Abstract
Schizophrenic patients have traditionally suffered from high rates of cardiovascular disease and early mortality. NICE guidelines suggest that several physical health measures be monitored regularly in these patients, and particularly those on antipsychotic medication, which has a wide side-effect profile that may increase the risk of cardiovascular disease and other comorbidities. This general practice audit aimed to determine the rates of physical health monitoring in primary care in patients on antipsychotic medication for over a year for psychotic symptoms or schizophrenia. The search was conducted in three different general practices in March 2019, yielding 19, 8 and 30 patients respectively, with a total of 57 patients.
This audit aims to record and analyse rates of monitoring of a range of physical health measures recommended by NICE guidelines over the past year. The results demonstrated that physical health monitoring was poor amongst all the practices audited, especially that of prolactin and waist circumference. We recommend that these rates of monitoring be improved, through implementing templates or the delivery of targeted education to general practitioners and nurses.

References
Andor, M., Dehelean, L., Romosan, A.-M., Buda, V., Radu, G., Caruntu, F., Tomescu, M. (2019). A novel approach to cardiovascular disturbances in patients with schizophrenia spectrum disorders treated with long-acting injectable medication. Neuropsychiatric Disease and Treatment, 15, 349–355. https://doi.org/10.2147/NDT.S186892
Bushe, C., Haddad, P., Peveler, R., & Pendlebury, J. (2005). The role of lifestyle interventions and weight management in schizophrenia. Journal of Psychopharmacology (Oxford, England), 19(6 Suppl), 28–35. https://doi.org/10.1177/0269881105058682
Cordes, J., Bechdolf, A., Engelke, C., Kahl, K. G., Balijepalli, C., Lösch, C., … Moebus, S. (2017). Prevalence of metabolic syndrome in female and male patients at risk of psychosis. Schizophrenia Research, 181, 38–42. https://doi.org/10.1016/j.schres.2016.09.012
Eich, P., & Nick, B. (2008). Pharmacotherapy of schizophrenia spectrum disorders: State of the Art. TherUmsch.
Faselis, C., Katsimardou, A., Imprialos, K., Deligkaris, P., Kallistratos, M., &Dimitriadis, K. (2019). Microvascular complications of type 2 diabetes mellitus. Current Vascular Pharmacology. https://doi.org/10.2174/1570161117666190502103733

An Audit of the Reporting of Depression and Anxiety in Elderly COPD Patients in Primary Care

Juliette Murphy, Gloria Lau, Dr Mark Agius

Abstract
Anxiety and depression contribute to a substantial burden of Chronic Obstructive Pulmonary Disease-related morbidity by impairing quality of life and by reducing adherence to treatment. The identification of COPD patients with comorbid depression or anxiety symptoms is vital, as it is estimated that only a third of patients with these co-morbidities are receiving appropriate treatment. The aim of this audit was therefore to identify whether current methods of anxiety and depression screening in elderly patients (over the age of 65) with severe COPD (FEV1 <50% at most recent spirometry reading) are adequate by assessing how frequently anxiety and depression is reported as “discussed with patient” in COPD review appointments across two practices.SystmOne was used to identify a total of 83 patients, and the recording of depression and anxiety discussions in this cohort’s review appointments was analysed and compared with the incidence of QOF-coded depression and anxiety in the patient notes. The results show that both the rate and the quality of depression and anxiety reporting in these review appointments is highly heterogeneous, and has led to ‘missed’ patients suffering from comorbid mental health issues. Additionally, this audit identified a number of patients withdepression or anxiety directly related to their COPD, and it highlighted a trend among this cohort towards more frequent appointments with their General Practitioner, and towards related presentations at the Emergency Department. The results of this audit suggest there is room for amelioration of the current practice, such as the implementation of a structured screening tool into SystemOne’s COPD review appointment template.

References
First 5 references:
Argyropoulou, P., Patakas, D., Koukou, A., Vasiliadis, P., Georgopoulos, D. Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration 1993; 60: 216-220
Cleland, J.A., Lee, A.J., Hall, S. Associations of depression and anxiety with gender, age, health-related quality of life and symptoms in primary care COPD patients. Family Practice 2007; 24(3): 217-223
Ciechanowski, P.S., Katon, W.J., Russo, J.E. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000; 160 (21): 3278-2385
Dalal AA, Shah M, Lunacsek O, et al. Clinical and economic burden of depression/anxiety in chronic obstructive pulmonary disease patients within a managed care population.COPD 2011; 8: 293-299
Eisner, M.D., Blanc, P.D., Yelin, E.H., Katz, P.P., Sanchez, G., Iribarren, C., Omachi, T.A. Influency of anxiety on health outcomes in COPD. Thorax 2009; 65: 229-234

Pharmacological therapies in bipolar disorder: A review of current medications and future management strategies

Amol Joshi, Alex Bow and Mark Agius

Abstract
Background: Bipolar disorder is a mental illness characterised by periods of elevated mood interspersed with periods of depression. Long-term relapse prevention in bipolar disorder is challenging, with a significant number of patients relapsing following successful treatment of an index episode. Initial treatment of the condition is complex and usually occurs in secondary care. Whilst there is no known cure for bipolar disorder, several therapies have been found to be effective in both managing acute episodes and maintaining long-term remission. Common drug classes used for this purpose include atypical antipsychotics, anti-epileptic drugs and lithium.
Aim: This review seeks to outline the most common pharmacological therapies used in the treatment and relapse prevention of this condition and provide insight into future management strategies.
Methods: A MEDLINE search was performed and the available literature was subsequently analysed, including meta-analyses, reviews and original clinical trials.
Results: Management strategies can be subdivided into treating acute presentations of mania and depression and maintaining long-term remission. The extensive side effect profile of the antipsychotics mean that there are certain patient groups for whom they may be intolerable or contraindicated. Special consideration must be given to patients prescribed lithium, as they must be compliant with regular blood tests. Patients prescribed antiepileptics must be informed of the risk of severe cutaneous reactions on the toxic epidermal necrolysis spectrum, which poses a challenge for long-term remission. Combination therapies using pharmacological interventions together with psychological interventions have been proven to be more effective than either alone.
Conclusion: Despite the efficacy of the medications discussed in this article, their underlying mechansims of action remain to be fully elucidated. Overall, there are several therapeutic strategies that are currently employed in this condition. With the advent of personalised medicine, it remains to be seen how novel therapies will shape future clinical practice.

References
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Language reduced resources and trauma stabilisation groups for patients with migration background

S.M. Toparlak, Dr. M. Belz, Dr. I. Özkan, Asklepios Fachklinikum Göttingen

Abstract
Current data shows that global migration is increasing rapidly. In 2016 the proportion of people with a migration background in total German population was 22,5% and it increases successively. There can be multitude of motivations for the migration such as; war, religious or political persecution, natural disasters, bad living conditions.
Studies illustrate the need for care, which should be adapted to the needs of the migrant patient population. (Brandes et al. 2009; Trucks 2004; Whitley et al. 2006)
Since the language barrier often presents an obstacle working with refugees and the use of interpreters is usually not possible or costs for those are not taken over by the health insurances, the need of language-reduced therapy is undeniable. The resource group aiming to strengthen individual means to cope with stress is suitable for all patients dealing with psychological strain. In language reduced trauma stabilisation group, which is specially conceptionalized for traumatised migrants, the patients acquire the opportunity to know and handle their PTSD symptoms. Both group therapies take place in reduced German language, so that the patients with little knowledge of German can also benefit.

References
Sprachreduzierte Ressourcen- und Traumastabilisierungsgruppe- Schattauer- Authors: Dr. M. Belz, Dr. I. Özkan, Asklepios Fachklinikum Göttingen

Eating Disorders and Personality Disorders: the role of mentalising

Angie Cucchi

Abstract
Traditionally, Eating Disorders (ED) have been associated with a number of psychological and medical difficulties [1]. However, more recently, a specific association between eating disorders and personality disorders (PD) has been reported in a meta-analysis of the literature and it is now widely accepted that the two presentations frequently occur together [2]. In particular, it seems that Borderline PD (BPD) is often comorbid with EDs. Whilst until very recently little was known about the relationship between EDs and BPDs, recent studies suggested similar underlying core features for both disorders. More specifically, it was claimed that the characteristic failure to understand one’s own feelings and emotions, the concrete style of thinking, as well as the lack of reference to internal states when explaining behaviour, present in narratives of individuals who presented with EDs and BPD suggested a common lack of a mentalising stance [3, 4]. Mentalising, has been defined as “the mental process by which an individual implicitly and explicitly interprets the actions of himself and others as meaningful on the basis of intentional mental states” [4, p.21]. Empirical evidence supports this hypothesis by confirming that individuals with a diagnosis of BPD, together with individuals diagnosed with eating disorders, score lowest on mentalising [14]. To date, a fragile mentalising capacity, extremely sensitive to social and interpersonal interactions, is believed to be a core feature of BPD and ED. While it can be argued that most mental disorders involve some sort of difficulties with mentalising, recent claims emphasised that impaired mentalising represents an obstacle to treatment in individuals with EDs and PDs. In fact, it has been claimed that traditional psychotherapy takes for granted mentalising capacity, hence limiting this client’s groups’ ability to engage in traditional therapy. Indeed, whilst individuals with EDs and/or PDs might be able to accurately mentalise in neutral situations, this capacity shuts down in the face of intense emotions, particularly emotions linked to the activation of the attachment system. As a result, it appears crucial that clinicians who work with these client groups understand the role of emotions in switching off an individual’s ability to mentalise. Once this is understood, clinicians ought to learn to modulate their clients’ emotional arousal in order to create and/or restore optimal conditions for mentalising.

References
1. Claes, L., Vandereycken, W. & Vertommen, H. (2003). Eating-Disordered Patients with and without Self-Injurious Behaviour: a Comparison of Psychopathological Features. European Eating Disorders Review, 11, 379-396
2. Martinussen, M., Friborg, O., Schmierer, P., Kaiser., S, Øvergård, K., Neunhoeffer, A., Martinsen, E. & Rosenvinge, J. (2017). The comorbidity of personality disorders in eating disorders: a meta-analysis. Eating Weight Disorders, 22(2):201-209
3. Robinson, P., Barrett, B., Bateman, A., Hakeem, A., Hellier, J., Lemonsky, F., Rutterford, C., Schmidt, U., Fonagy, P. (2014). "Study Protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder." BMC Psychiatry 14(1): 51
4. Skarderud, F. (2007). Eating one's words: part III. mentalization-based psychotherapy for anorexia nervosa- an outline for a treatment and training manual. European Eating Disorders Review, 15, 323-339.
5. Bateman, A. & Fonagy P. (2007) Mentalization-Based Treatment for Borderline Personality Disorder. Oxford: University Press

Hypothalamus-Pituitary-Adrenal Axis in Eating Disorders

Dr H P Gaete, Dr Wafaa Gadelkarim, Dr Murali Sekar.

Abstract
The HPA Axis is fundamentally a dynamic system.It is affected by both internal physiological stressors such as cytokines, hypoxia, macromolecules and by external psychological stressors such as fears and anxieties, which threaten the organism homeostasis.
Caroline Lo-Sauro et al (2008),have looked at the literature in the field. They have looked at the relationships between stress, HPA Axis, Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.They found that HPA Axis overactivity is well documented in Anorexia Nervosa and Bulimia Nervosa.
As the patient responds to treatment and improves, the cortisol levels go back towards the normal range.
The HPA Axis alterations can affect other biological systems, like leptin, orexigenic neuropeptide Y, endogenous opioids, growth hormone, thyroid hormone,immune and sympathetic system.
Eating Disorder Patients could be considered as chronically exposed to stress.These patients seem to be in a vicious cycle perpetuated by their psychopathology,their behaviours, and the negative impact of these on social relationships.
Van UUm et al (2011),have done research on hair cortisol estimations and found that it can provide long term measure of cortisol exposure.
Could we use Hair Cortisol estimations to monitor improvement and recovery in these patients?
Could the emerging patterns of cortisol levels be used in bio-feedback?

References
1.Lo-Sauro C. et al "Stress, Hypothalamic-Pituitary-Adrenal Axis and Eating Disorder" (2008), Neuropsychobiology 57, 95-115.
2.Van Uum et al "Hair Cortisol content in patients with adrenal insufficiency on hydrocortisone replacement drugs" Clinical Endocrinol. (Oxf) (2011),74: 687-93.
3.Karlen J et al Cortisol in hair measured in young adults, a biomarker of major life stressors? BMC Clinical Pathology, 2011, 11:12.

Personality Disorders in Black People: less prevalent or the result of healthcare inequalities?

Lucille Mclean, Dr Mark Agius

Abstract
The prevalence of personality disorders (PDs) in black people has consistently been reported as significantly lower than in their white equivalents. If this result is accurate, then it may reveal important clues as to the aetiology of personality disorders, which could provide invaluable insights as to how we should support these patients. However, if this result does not reflect the truth, then important questions must be answered as to why black people with personality disorders are under- represented. There has been limited investigations into what may cause a discrepancy in the PD prevalence between ethnicities. This review aims to determine whether the lower prevalence of PDs in black people is likely to be accurate, and if it isn't, explore some of the potential causes for the difference. This is an important issue to address as may reveal pertinent inequalities in healthcare.

References
Please see paper

The wider effects of Paternal Post Natal Depression: An overview

Ciara Mahon & Mark Agius

Abstract
Paternal Post Natal Depression (PPND), although becoming more prevalent, is still poorly recognised. Unfortunately, its effects and negative outcomes have not been as widely researched as that of maternal postnatal depression. PPND can affect the fathers parenting style and lead to a negative effect on their child’s behaviour and social development. Furthermore, depressed fathers may feel unsupported and this can lead to problems with the marital relationship and be associated with concurrent maternal postnatal depression. Moreover, support services and interventional therapy come at a cost to the health service and therefore treating PPND can impact the economy. Identifying the effects PPND has is important as implementing reliable screening measures and better education may prevent negative outcomes.

References
N/A for abstract

Poor cardiovascular stress recovery after ruminators have been personally criticized

Dedoncker J., De Smet S., Vanderhasselt M.-A., De Witte S., Di Salvo S., Baeken C., De Raedt R

Abstract
Recent literature has demonstrated that being personally criticized might be a risk factor for the (re)occurrence of depression in healthy and remitted depressed individuals (Hooley et al., 2005, 2009). Nonetheless, the possible underlying biological mechanisms in healthy subjects are still poorly understood. Given that post-stress cardiovascular recovery has been associated with somatic and mental health (Thayer and Lane, 2009; Thayer et al., 2012), the present study aimed to investigate if criticism influences cardiovascular recovery thereof and whether this is dependent on the tendency of individuals to ruminate in daily life – a known vulnerability factor for depression (Nolen-Hoeksema, Wisco and Lyubomirsky, 2008). In a randomized between-subject design, healthy individuals with low, moderate or high rumination levels listened to either self-referent criticism or neutral auditory comments. Trait rumination-dependent fluctuations in heart rate variability recovery were assessed while controlling for possible acute cardiovascular reactivity effects during listening to these comments. Our findings suggest that trait rumination influences cardiovascular recovery from being criticized. More specifically, we showed increases in heart rate variability in low trait ruminators during recovery from being criticized. Such a resilient response seems absent in high trait ruminators, who instead showed decreases in heart rate variability during recovery from being criticized. These findings provide a more biologically-oriented framework of how processing of criticism could be especially maladaptive for ruminators – i.e., those individuals more susceptible to develop mood and/or anxiety disorders.

References
Hooley, J.M., Gruber, S.A., Parker, H.A., Guillaumot, J., Rogowska, J., & Yurgelun-Todd, D.A. (2009). Cortico-limbic response to personally challenging emotional stimuli after complete recovery from depression. Psychiatry Research: Neuroimaging, 171(2), 106-119. https://www.doi.org/10.1016/j.pscychresns.2008.04.001.
Hooley, J.M., Gruber, S.A., Scott, L.A., Hiller, J.B., & Yurgelun-Todd, D.A. (2005). Activation in dorsolateral prefrontal cortex in response to maternal criticism and praise in recovered depressed and healthy control participants. Biological Psychiatry, 57(7), 809-812. https://www.doi.org/10.1016/j.biopsych.2005.01.012.
Nolen-Hoeksema, S., Wisco, B.E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424. https://www.doi.org/10.1111/j.1745-6924.2008.00088.x.
Thayer, J.F., Ahs, F., Fredrikson, M., Sollers, J.J., & Wager, T.D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neuroscience & Biobehavioral Reviews, 36(2), 747-756. https://www.doi.org/10.1016/j.neubiorev.2011.11.009.
Thayer, J.F., & Lane, R.D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorder, 61(3), 201-216. https://www.doi.org/10.1016/S0165-0327(00)00338-4.

Inpatient management of GHB/GBL withdrawal

Mirjana Delic

Abstract
BACKGROUND: Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to addiction and the possibility of withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, coma.
AIM: To describe the baseline characteristics, treatment and retention in patients admitted for GHB/GBL withdrawal management.
METHODS: A retrospective review of 4 consecutive cases of patients reporting GHB/GBL addiction who were admitted for inpatient management of withdrawal syndrome.
RESULTS: All patients were using GHB/GBL daily, 1-1.5 ml per hour. One of them was using cannabis additionaly, others were using cocaine and amphetamine type stimulants. Psychiatric comorbidities as personality disorders, depression and bigorexia were recognized. All of them were treated with benzodiazepines, atypical antipsichotics and beta-blockers. Delirium was developed in two patients. One patient completed detoxification and finished the treatment programe. One patient completed detoxification but stopped his treatment earlier, two patients did not completed detoxification.
CONCLUSION: Polysubstance use and psychiatric co-morbidities need consideration in treatment planning. Heavier GHB/GBL use predicts poor treatment retention.

References
1.González A, Nutt D. Gamma hydroxy butyrate abuse and dependency. J Psychopharmacol. 2005;519(2):195–204.
2.Craig K, Gomez HF McManus JL, Bania TC. Severe gammahydroxybutyrate withdrawal: a case report and literature review. J Emerg Med. 2000;18:65–70.
3.Price G. In-patient detoxification after GHB dependence. Br J Psychiatry. 2000;177:181.
4.Abdulrahim D, Bowden-Jones O, on behalf of the NEPTUNE Expert Group. Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances. Novel Psychoactive Treatment UK Network (NEPTUNE). London, 2015.

Depression and dry eye disease: a need for an interdisciplinary approach?

Thomas Weatherby, Pasan Fernando, Mark Agius

Abstract
A recent meta-analysis including data from 22 studies including 2.9 million patients found that anxiety and depression are more prevalent in patients with dry eye disease (DED) than in controls. DED is a common disorder of the tear film which can cause ocular irritation, foreign body sensation and visual disturbance. However there is often a great discrepancy between signs and symptoms of DED, which the symptoms often being more associated with non-ocular disorders such as depression and PTSD than to tear film parameters. In this way it could be considered as more of a psychiatric than ophthalmic complaint.

DED and depression feedback on one another in a synergistic manner. Severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, but also effective management of depression could help alleviate symptoms of DED. Complicating this however is the evidence that SSRIs can exacerbate DED. This makes the management of these comorbidities more difficult, however there are putative therapeutic targets which may be a source of future treatments for DED-associated depression.

In conclusion, it is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients’ lives. Collaboration between psychiatrists and ophthalmologists could be beneficial in the management of those with DED.

References
1. Wan KH, Chen LJ, Young AL. Depression and anxiety in dry eye disease: a systematic review and meta-analysis. Eye (Lond). 2016;30(12):1558-1567.
2. Galor A, Felix ER, Feuer W, et al. Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters. Br J Ophthalmol. 2015;99(8):1126-9.
3. Bitar MS, Olson DJ, Li M, Davis RM. The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study. Cornea. 2019;38(6):684-689.
4. Zhang X, Yin Y, Yue L, Gong L. Selective Serotonin Reuptake Inhibitors Aggravate Depression-Associated Dry Eye Via Activating the NF-κB Pathway. Invest Ophthalmol Vis Sci. 2019;60(1):407-419.
5. Um SB, Yeom H, Kim NH, Kim HC, Lee HK, Suh I. Association between dry eye symptoms and suicidal ideation in a Korean adult population. PLoS ONE. 2018;13(6):e0199131.

Cultural Issues in Neuropsychological Assessment of Dementia in North-Africa

Tarek Bellaj

Abstract
The current vision of the individual as a biopsychosocial entity living in dynamic and various, social, cultural and ecological environments is at the heart of neuropsychological screening and assessment of dementia. Classical neuropsychology assumes that performance interpretation is threefold: lesion factors, test psychometric qualities, and classical non-lesion factors limited to age, gender and level of education.
However, environmental (Williams & Bowman, 2002) and sociocultural factors (Ostrosky, et al. 1985), situational evaluation factors (Ardila, 2005), administration conditions (Cromer, et al., 2015), and personal factors (Perssona & Ørbæk, 2003) are now key elements to draw valid and fair inferences regarding the nature and the severity of cognitive impairments (e.g, Brickman, Cabo & Manly, 2006). These aspects are highly critical for the African Elderly who are mostly illiterate and who embody the traditional values and living style of their societies.
We report experimental and clinical data illustrating the specificities of neuropsychological evaluation of dementia in North Africa with an emphasis on the integration of sociocultural dimensions. We discuss the added value of this integrative approach through the use of more ecological screening and assessment of dementia; and make recommendations for practitioners.

References
Ardila, A. (2005). Cultural values underlying cognitive psychometric test performance. Neuropsychology Review, 15: 185-195.
Ostrosky-Solis, F., Canseco, E., Quintanar, L., Navarro, E., Meneses, S., & Ardila, A. (1985). Sociocultural effects in neuropsychological assessment. International Journal of Neuroscience, 27(1-2): 53-66.
Williams, R. W., & Bowman, M. L. (2002). Current issues in neuropsychological assessment with rural populations. In F. R. Ferraro (Ed.). Minority and crosscultural aspects of neuropsychological assessment. (pp. 265-283). Lisse, Netherlands: Swets & Zeitlinger.

New technologies for art therapy interventions tailored on severe disabilities

Simone Donnari, Valentina Canonico, Giovanni Fatuzzo, Chiara Bedetti, Moreno Marchiafava, Marina Menna, Sandro Elisei

Abstract
Individuals with multiple disabilities can have a wide range of characteristics, depending on the combination and severity of disabilities, such as intellectual disability, mobility issues, sensorial impairment, language issues, brain injury, and more. New technologies can help therapists in targeting an alternative way to engage and interact with clients, by opening a communication window and starting to build the therapeutic relationship.
Digital tools in presence of multiple disabilities have pros and cons. Parents and caregivers regularly report that people with disabilities are attracted by new technology and smart devices. Devising treatments that take advantage of this fascination represents both an opportunity and a challenge. New technologies can be addictive and can be used, especially by people with disabilities, to increase social isolation. Many tools require specific skills and seem actually designed to discourage therapists to adapt them to clinical practice.
Some digital applications seem to aim at teaching the client how to “fit” in the “normal” world without considering his/her specific characteristics and strengths/preferences.
Starting from our experiences in the use of digital tools we will propose selection criteria and show a range of applications in art therapy, where technologies facilitate the development of an interpersonal relationship with the therapist in a safe “third space” which is the screen.
The need to use more customized technological tools lead us to develop Painteraction system, an intuitive tool based on augmented reality that allows clients to be immersed in their own images. Just by moving their bodies they are able to make drawings and receive visual feedbacks of themselves and their therapists, mirrored in the screen.
The use of Painteraction system will be introduced showing clinical experiences.
We will introduce the opportunities for research given by some digital tools and particularly Painteraction, and illustrate a clinical trial design in progress.

References
Pazzagli Chiara, Fatuzzo Giovanni, Donnari Simone, Valentina Canonico, Balboni Giulia, Mazzeschi Claudia, ch. 19, ASSISTIVE TECHNOLOGIES FOR CHILDREN WITH AUTISM SPECTRUM DISORDER in “Assistive Technology Assessment Handbook second edition”, pp. 435-456, © 2018 Edited by CRC Press - Taylor & Frances Group ISBN: 13: 978-1-4987-7411-6
Simone Donnari, Maurizio Peciccia, ch. 2, Psychodynamic art therapy for psychoses: progressive mirror drawing and other sensorial integration techniques in “Art Therapy for Psychosis - Theory and Practice”, Edited by Katherine Killick, pp. 30-69, © 2017 – Routledge, London. ISBN: 9781138792104
Maurizio Peciccia, Ivan Urlić, Simone Donnari, ch. 6, Transference and countertransference features in a psychological approach to patients with psychosis in “Group therapy for psychoses”, Edited by Routledge, pp. 48-60, © 2018 – Routledge, London. ISBN: 978-1-138-69710-2
Ardizzi M, Ambrosecchia M, Buratta L, Ferri F, Peciccia M, Donnari S, Mazzeschi C and Gallese V (2016) Interoception and Positive Symptoms in Schizophrenia. Front. Hum. Neurosci. 10:379. doi: 10.3389/fnhum.2016.00379. PMCID: PMC4961721

Genome-wide methylation patterns in suicide victims: Identification of new candidate genes

Katarina Kouter1, Tomaž Zupanc2, Alja Videtič Paska1

Abstract
1Medical Centre for Molecular Biology, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
2 Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia

Suicide is a major global public health problem with significant impact on society. According to the World Health Organization, every year close to one million people commit suicide, while at the global level suicide accounts for 50 % of all violent deaths among men and for 71 % among women. Slovenia ranks among the countries with the highest suicide rate in the European Union and in the world. Since suicide is a complex phenomenon which cannot be attributed to a single causal factor, but to a combination of simultaneous effects of multiple factors which are expressed in the form of psychological, biological and sociological indicators. Analysis of epigenetic mechanisms (methylation of the DNA, modifications of histone proteins and (networks of) miRNA), which link the interaction between genes and the environment, could importantly contribute to better understanding of suicidal behaviour.
In order to determine, whether DNA methylation patterns could be associated with suicide, we performed global DNA methylation study using next-generation sequencing. The study group consisted of male suicide victims who died by hanging and control group. We analysed cortical region Brodmann area 9 and hippocampus, and determined several differences in methylation level between suicide victims and controls in both brain regions (>25% difference in methylation and q-value < 0.01). The gene ontology analysis showed enrichment for terms associated with cell structural integrity and nervous system regulation, which are both important players in brain plasticity. Additional gene expression analysis identified changes in two potentially regulatory genes, ZNF714 (p-value = 0.002) and NRIP3 (p-value = 0.046). Although our analysis was performed on a rather small sample size and on whole tissue, which is comprised of various cells, our results gave an important contribution revealing new potential candidate genes for suicidal behaviour.

References
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The effect of Mozart's music in severe epilepsy: functional and morphological features

Chiara Bedetti, Massimo Principi, Massimo Piccirilli, Patrizia D’Alessandro, Domenico Frondizi, Antonella Baglioni, Marina Menna

Abstract
Music is a very important factor in everyday life, involving mood, emotions and memories. The effect of the music on the brain is very debated. Certainly the music activates a complex network of neurones in auditory areas, mesolimbic areas, cerebellum and multisensory areas (Maguire, 2016). In particular, music exerts its effects on the brain and on patients with epilepsy, by a dichotomous influence: whether it be seizure-promoting in musicogenic epilepsy or antiepileptic. Several studies have shown that seizure-prone neural networks may be stimulated by certain periodicities while other frequencies may prevent seizure activity. There are a lot of data in the literature about "Mozart effect" (Rauscher et al,1993). In a previous study we observed that in an institutionalized subject with severe/profound intellectual disability and drug-resistant epilepsy, a systematic music listening protocol reduced the frequency of seizures in about 50% of cases. in this work the case of a patient is reported, affected by intellectual disability and multidrug resistant epilepsy
who underwent six months of listening to Mozart music (Sonata K.448) evaluating both the electroencephalographic and neuroimaging aspects before and after this period

References
Anderson JR, Jones BW, Yang JH, et al. A computational framework for ultrastructural mapping of neural circuitry. PLoS Biol 2009;7:e1000074.
Maguire M. “Epilepsy and music: practical notes”. Pract Neurol. 2017 Apr;17(2):86-95;
Rauscher FH, Shaw GL, Ky KN. “Music and spatial task performance.” Nature 1993; 365:611

Musicotherapy in severe disability: an experience on Serafico Institute

Chiara Bedetti,Beccafichi Anna M, Massimo Piccirilli, Patrizia D’Alessandro, Domenico Frondizi, Antonella Baglioni, Marina Menna

Abstract
Complex disability usually affect communication, cognitive, physical or sensory abilities in any combination. Improved understanding of the care needs of people with complex disabilities has addressed many functional aspects of care (Magee and Bowen, 2008). Previous randomized controlled trials of music interventions for autism spectrum disorder have reported positive effects of music on emotional engagement, social interaction, communication and parent–child relationships
Previous studies that have investigated the effect of music on person with ASD and disability have found that music therapy significantly alleviates autistic symptoms (Boso et al, 2007). Taken together, the literature highlights the effectiveness music to decrease stress and improve both skills and overall well-being in individuals with ID and ASD (Poquérusse et al, 2018).
Serafico Institute receives individuals with complex disability, the most frequently observed diseases are: intellectual disabilities, epilepsies, infantile cerebral palsies, autistic spectrum and intermittent explosive disorders, alone or in association.
The rehabilitative treatment arises from a clinical-functional assessment, which allows to set adequate goals. Based on the characteristics of the patient, it is decided whether to use the technique of receptive music therapy (listening to sound material) or improvisational music therapy (use of musical instruments or the body and voice of the participants).
We will present 4 cases in which a program has been set up based on a direct observation of the individual's interaction with the environment and which communication channels it chooses. Based on this data, an individualized listening and music production program was set up. For patients with hearing loss / deafness, channels of body perception (transosseous transmission, resonance of large hollow organs, presence-absence of sound) were used. This procedure has allowed to improve the social interaction and the harmonization of the self evaluated through sensorial and motor analyzers.

References
Boso M., Emanuele E., Minazzi V., Abbamonte M. & Politi P. (2007) Effect of long-term interactive music therapy on behavior profile and musical skills in young adults with severe autism. The Journal of Alternative and Complementary Medicine 13, 709–12.
Geretsegger, M., Elefant, C., Mössler, K. A. & Gold, C. Music therapy for people with autism spectrum disorder. Cochrane Database Syst. Rev. 6, CD004381 (2014).
Magee WL, Bowen C. Using music in leisure to enhance social relationships with patients with complex disabilities. NeuroRehabilitation. 2008;23(4):305-11.
Poquérusse J., Azhari A., Setoh P., Cainelli S., Ripoli C., Venuti P., Esposito G. Salivary α-amylase as a marker of stress reduction in individuals with intellectual disability and autism in response to occupational and music therapy. J Intellect Disabil Res. 2018 Feb;62(2):156-163. doi: 10.1111/jir.12453.

Sleep related painful erection in a patient with Friedreich's ataxia.

Moreno Marchiafava, Chiara Bedetti, Massimo Piccirilli, Patrizia D'Alessandro, Marilena Gubbiotti, Sandro Elisei

Abstract
Friedreich’s ataxia (FRDA) is an autosomal recessive spinocerebellar ataxia. In the majority of cases the disease is caused by a homozygous GAA triplet repeat expansion in the frataxin (FXN) gene and the shorter repeat expansion length correlates with age at onset and disease severity. Frataxin’s exact physiological function is unknown, but it may be involved in mitochondrial iron homeostasis and/or assembly of iron-sulfur (FeS) proteins and heme synthesis.
FRDA phenotype varies substantially, gait and limb ataxia, dysarthria and loss of lower limb reflexes with deep sensory loss are always detectable. Symptoms tend to present between the ages of 10 and 16, and the mixed ataxia is the result of peripheral sensory neuropathy, spinocerebellar tract degeneration and cerebellar pathology.
Sleep disorders like sleep-disordered breathing (SDB), obstructive sleep apnea (OSA), central sleep apnea (CSA), and nocturnal hypoventilation are often related with FRDA.
We encountered a patient who present sleep related painful erection. During the night, his parents hear him scream and calling for help. When they wake the patient, they notice the erection and, sometimes, they see the eiaculation. In addition, patient is very upset by the conviction to be harrased during the night.

References
Cook and Giunti, British Medical Bulletin, 2017
Corben et al Neurology, 2013

Mathematics anxiety and cognitive performance in adolescent students

Livia Buratta, Massimo Piccirilli, Gianni Lanfaloni, Silvia Ilicini, Sandro Elisei

Abstract
Several studies highlight that many students demonstrate mathematical learning difficulty even in the absence of specific disability; these difficulties are often accompanied by math anxiety (Dowker et al., 2016). The aim of this study was to investigate the relationship between trait and state anxiety as assessed by STAI-Y (Spielberg, 1989), specific mathematic anxiety as assessed by AMAS (Hopko et al., 2003) and mathematical skills assessed through the ABCA tests (Baccaglini et al., 2013) in a sample of 83 adolescent students (78,3% males) without diagnosis of dyscalculia and cognitive disorder attending their first year of secondary school State anxiety was assessed both before and after completion of the math tasks in question. Results showed 40% of students in the sample demonstrated serious difficulties in math, while another 40% of the students demonstrated a high level of math anxiety. Multivariate Analysis of Variance (MANOVA) revealed the differences in specific math anxiety between students with serious, medium and no mathematical difficulty (F = 3.52; p = .034), while no differences were revealed in trait and state anxiety levels (p > .05). The Pearson’s correlation coefficient highlighted a strong negative relationship between mathematics anxiety and mathematics ability, in particular regarding performance in the arithmetical facts test (r = -.394; p < .001). Furthermore, the Repeat Measure Analysis demonstrated a significant increase in state anxiety upon completion of the ABCA tests (F = 6.31; p = .014) regardless of the presence or absence of maths difficulty (F = .078; p > .05). Understanding the relationships between math anxiety and math learning and performance may have relevant implications in clinical, educational and didactic practice.

References
Dowker A, Sarkar A and Looi CY (2016) Mathematics Anxiety: What Have We Learned in 60 Years? Front. Psychol. 7:508. doi: 10.3389/fpsyg.2016.00508
Hopko, D. (2003). Confirmatory factor analysis of the math anxiety rating scale- revised. Educ. Psychol. Meas. 63, 336–351. doi:10.1177/0013164402251041
Spielberger, C.D. (1989). State-Trait Anxiety Inventory: Bibliography, 2nd Edn. Palo Alto, CA: Consulting Psychologists Press
Baccaglini-Frank, A., Perona, M., Bettini, P., Caviola, S. & Lucangeli, D. (2013). Test ABCA 14-16. Prove di abilità di calcolo avanzato per la scuola secondaria di secondo grado. Trento, Italy: Erickson

Neurostimulation in Treating ADHD

Heng Chun Wong, Dr Rashid Zaman

Abstract
Background: Neurostimulation is a potential method of treating ADHD, involving the direct stimulation of brain areas showing abnormal activity in ADHD, and has been associated with benefits that last longer and fewer side effects. This literature review will evaluate the effectiveness of these methods.
Subjects and Methods: A literature search using scientific databases including PubMed and the Cochrane Library, using “ADHD” and “Attention Deficit Hyperactivity Disorder” combined with “Transcranial Magnetic Stimulation”, “TMS”, “Transcranial Direct Current Stimulation”, “tDCS”, “Vagus Nerve Stimulation”, “VNS”, “Trigeminal Nerve Stimulation”, “TNS”, “Deep Brain Stimulation”, “DBS”, “Electroconvulsive Therapy”, “ECT”, “Ultrasound stimulation” as keywords was conducted, yielding 417 references, 30 of which are used in this paper.
Results: Mixed results have been found in the effectiveness of neurostimulatory methods in treating ADHD.
Conclusions: Neurostimulation has potential in treating ADHD, with some studies having positive results. More research using greater sample sizes and standardised outcome measures could be done to verify the results of previous studies.
MeSH: Attention Deficit Hyperactivity Disorder (ADHD), Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS), Trigeminal Nerve Stimulation (TNS)

References
1.

Beyond the disease: "...Am I my brother's keeper?”

Sandro Elisei

Abstract
Today, the concepts of health and illness require a global vision of man; the suffering of the person places the entire environment in great difficulty: health professionals, family, society.
It is important not to simplify the response to a purely health-focused view of the disorder, because fragile people possess a deep need to feel welcomed, listened to, understood and accepted.
Service provision that is respectful of the dignity of the person is an important challenge both for those who are responsible for providing services to individuals and their families as well as for the entire community.
Therefore in providing care the human qualities of the health professional and not only his technical skills come into play: blending together science and humanitarian ethos.
The provision of care therefore "forces" us to broaden our horizons and requires us to face the challenge of responsibility towards the Other, the human condition of being-for.
However, ethical capacity cannot be born solely out of sharing standards or adhering to regulations and respecting prohibitions: it stems from high and unconditional moral values and meanings. The ME-YOU relationship represents the primary ethical factor of the human being: my responsibility towards the Other is unconditional.
In the book of Genesis when the Lord asks Cain: "... where is Abel, your brother?" He responds with another question: "Am I my brother's keeper?"
In this biblical passage Cain kills Abel: the rejection of brotherhood and the care of the other only leads to the death of the Other.
"Where is your brother?"
This question is crucial in today’s day and age and must be taken seriously: it is the decisive question that forces us to decide how to place ourselves in relationship with the other and with the world: do we choose proximity or distance, connection or indifference?

References
Bauman Z.: Life in Fragments: Essays in Postmodern Moralyty. Blackwell Publishers. 1 ed. 1995
Manicardi L.: “Sono forse io il custode di mio fratello?” Eremo della Pace, S. Paolo d’Argon, 2016

Audit of serum Vitamin D and magnesium levels in individuals with psychiatric disorders

G Woodward1, J Wan1, K Viswanath2, R Zaman1,2 1University of Cambridge 2Hertfordshire University Partnership NHS FT

Abstract
Background - Both Vitamin D deficiency and magnesium deficiency have been associated with an increased risk of and increased severity of symptoms in both depression and schizophrenia (Cieslak et al. 2014; Tarleton & Littenberg, 2015). This effect appears more pronounced in younger populations and is often apparent from the time of initial diagnosis and is present with adjustment for confounding factors. Thus, the evidence suggests that Vitamin D and magnesium deficiency reflects not only dietary or somatic aspects of health, but may have a role in the pathophysiology of depression and schizophrenia.
Methods - We carried out a single site audit of serum Vitamin D and magnesium levels in patients at an Acute Day Treatment Unit. Blood tests were performed on admission and analysed in house. Data were collected between April – June 2019 and will be analysed subsequently, as described below (expected sample size n = 40).
Results - First, population characteristics will be characterised. For all patients and each subgroup, analysis of variance (ANOVA) will be used to assess differences in both serum vitamin D and magnesium level with a Type I error rate of 0.05. The vitamin D level of this population will be assessed against the literature for the primary outcome. Secondary outcomes will be assessed by categorising patients based on the following variables: DSM-5 diagnosis, sex, ethnicity, age (by decade). Additionally, the Pearson correlation between serum vitamin D and magnesium will be assessed.
Conclusions - We carried out a single-site audit of serum vitamin D and magnesium levels in a psychiatric day unit population in order to assess the extent of vitamin deficiency in such patients. This analysis may provide insight into the underlying psychopathology of psychiatric disease and provide a basis for further investigation.
Key words - Psychiatry, vitamin deficiency, audit, vitamin D, magnesium

References
Cieslak K, Feingold J, Antonius D, Walsh-Messinger J, Dracxler R, Rosedale M, Aujero N, Keefe D, Goetz D, Goetz R, Malaspina D: Low Vitamin D levels predict clinical features of schizophrenia. Schizophrenia Research 2014; 159(2–3): 543–545.
Tarleton EK. & Littenberg B: Magnesium intake and depression in adults. Journal of the American Board of Family Medicine 2015; 28(2): 249–256

Mobile crisis team in the Brussels region: facts and figures

Liesbeth Santermans, Nathalie Vanderbruggen, Dieter Zeeuws, Frieda Matthys, Cleo Crunelle

Abstract
Background: Since 2011 a reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. These teams can help to reduce the number of hospital admissions and to make care more accessable.
Subjects and methods: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018.
Results: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe.
Conclusion: Many psychiatric crisis situations, including some cases of alcohol withdrawal, can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.

References
1. Allan C, Smith I, Mellin M: Detoxification from alcohol: a comparison of home detoxification and hospital-based day patient care. Alcohol and Alcoholism 2000; Vol 35, No 1: 66-69
2. Cervello S, Pulcini M, Massoubre C, Trombert-Paviot B, Fakra E: Do home-based psychiatric services for patients in medico-social institutions reduce hospitalisations? Pre-post evaluation of a French Psychiatric Mobile Team. Psychiatric Quarterly 2019; 90: 89-100
3. Deschietere G: Mobility in psychiatry, an alternative to forced hospitalisation? Psychiatria Danubina 2018; Vol 30, suppl 7: 495-497
4. Lalevic G, Suhail A, Doyle H: Home-based crisis team in North Cork service description and patient-related outcomes. Ir J Psychol Med 2019 Mar; 36(1): 29-33
5. Nadkarni A et al: Community detoxification for alcohol dependence: a systematic review. Drug and Alcohol Review 2017 May; 36: 389-399
6. Peritogiannis V, Manthopoulou T, Gogou A, Mavreas V: Mental health care delivery in rural Greece: a 10-year account of a Mobile Mental Healt Unit. J Neurosci Rural Pract 2017 Oct-Dec; 8(4): 556-561
7. Sjolie H, Karlsson B, Kim HS: Crisis resolution and home treatment: structure, process and outcome- a literature review. J of Psychiatric and Mental Health Nursing 2010; 17: 881-892
8. Stockwell T, Bolt L, Milner I, Russell G, Bolderston H, Pugh P: Home detoxification from alcohol: its safety and efficacy in comparison with inpatient care. Alcohol and Alcoholism 1991; Vol 26, issue 5-6: 645-650
9. Website: www.psy107.be

Neurodegeneration improved with an antidepressant and antipsychotic: A case report

James J. Sun, Bhathika Perera

Abstract
18-year-old man with moderate intellectual disability (ID) presented with a two-and-a-half-year history of gradual skill regression including loss of speech, social and toileting skills. He developed pseudo-seizure activity, episodes where his body would become stiff and he would shake vigorously.
He was extensively investigated by paediatric neurology and was seen by child and adolescent mental health services. MRI head revealed generalised volume loss in the cerebral and cerebellar hemispheres and the spinal cord appeared thin. Electroencephalography, electromyography and nerve conduction studies were normal. Blood tests were unremarkable. Genetic testing, including for Spinocerebellar Ataxias linked with parkinsonism; and Fragile X syndrome were negative. A microarray showed a microdeletion (1.6 Mb) at 3q29 which is associated with ID, not with neurodegeneration. A diagnosis of neurodegeneration manifesting with regression, parkinsonism and psychiatric features was made.

A detailed history was taken and revealed symptoms of fear, anxiety and possible paranoia around the time of developmental regression which was overlooked due to more neurological nature of the clinical presentation. He was commenced on risperidone and citalopram to treat a possible psychotic depression. Within a few weeks of starting psychotropic medications, the underlying diagnosis started to appear clearer. He started to regain skills he lost which were thought to be neurodegenerative in nature. His mood started to improve with a gradual return to his baseline of functioning.

Mental health problems are common in people with ID1. The diagnosis of mood disorders can be challenging in patients with ID who are less able to verbalise their thoughts and feelings2. The complex interaction of background biological and psychosocial factors are likely to affect the development of mental health disorders in this patient group. This case study highlights the importance of a thorough medical and psychiatric assessment in people with ID, as missed diagnosis leads to missed treatment opportunities.

References
1. Cooper S-A, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry. 2007;190(1):27-35.
2. Hurley AD. Mood disorders in intellectual disability. Curr Opin Psychiatry. 2006;19(5):465-469.

Epilepsy and SUDEP risk in Adults with Intellectual Disability in a Community Psychiatry Service

James J. Sun, Rohit Shankar, Bhathika Perera

Abstract
Intellectual disability (ID) is defined as significant impairment of intellectual function and adaptive behaviour, developing before 18 years of age. The prevalence of epilepsy in the general population is approximately 0.5-1%1. It is widely accepted that there is a higher prevalence of epilepsy in people with ID, around 1 in 5 people with ID have epilepsy2.

There is an increased risk of psychiatric disorders in people with epilepsy and ID, although little data is published on treatment outcomes in this group3. ID is among risk factors for sudden unexpected death in epilepsy (SUDEP)4. The SUDEP and Seizure Safety Checklist is a tool to discuss risk factors influencing seizures and the risk of SUDEP5.

In this cross-sectional study, the management of epilepsy and prevalence of SUDEP risk factors in patients open to a community learning disability service was evaluated. To date, results have been obtained from 50 out of 59 cases that have been examined. There was high co-existence of neurodevelopmental disorders, 24 had autism, 2 had attention deficit hyperactivity disorder (ADHD). 22 had co-existent mental health problems, with depression and anxiety being the most common. Epilepsy in our cohort was associated with increased severity of ID as has been previously found.

Most cases had non-modifiable risk factors for seizures and SUDEP, 60% being male sex, 84% having the diagnosis of epilepsy for more than 15 years and 78% being diagnosed before the age of 16 years. In terms of modifiable risk factors, 23% of those who reported having nocturnal seizures, did not have any surveillance at night.

This study further highlights the risk factors for SUDEP. Modifiable risk factors need to be addressed and necessary steps taken to reduce SUDEP in this patient group. High prevalence of autism and mental illness have implications with regards to assessment and management of epilepsy which needs to be taken into account to further reduce SUDEP risk.

References
1. Sander JW, Shorvon SD. Epidemiology of the epilepsies. Journal of Neurology, Neurosurgery & Psychiatry. 1996;61(5):433.
2. Lhatoo SD, Sander JWAS. The Epidemiology of Epilepsy and Learning Disability. Epilepsia. 2001;42(s1):6-9.
3. Turky A, Felce D, Jones G, Kerr M. A prospective case control study of psychiatric disorders in adults with epilepsy and intellectual disability. Epilepsia. 2011;52(7):1223-1230.
4. Young C, Shankar R, Palmer J, et al. Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk? Seizure. 2015;25:112-116.
5. Shankar R, Cox D, Jalihal V, Brown S, Hanna J, McLean B. Sudden unexpected death in epilepsy (SUDEP): development of a safety checklist. Seizure. 2013;22(10):812-817.

Evaluation of rehabilitation treatment's quality in neurodevelopmental disorder 

Marchiafava, Bedetti, Buratta, Ilicini, Cicuttin, Menna, Piccirilli, D'Alessandro, Baglioni, Gubbiotti, Elisei

Abstract
Complex disability is very difficult to manage. It usually implies a very serious clinical picture, because it affects several body systems, or because it is frequently associated with intellectual disability and behavioral disorders. Affected patients are often unable to communicate their needs. All of these factors combine to make the management of these patients very complex and caregivers are well aware that it is very important to find a way to identify the emotional state and the potential capabilities of these patients.
Developing rehabilitation programs for these patients requires additional effort and clear and objective assessment protocols. In the literature few scales exist capable of evaluating these aspects in patients with complex disabilities, such as the Barthel Index (Mahoney and Barthel, 1965) or the Vineland Adaptive Behavior scale II (Sparrow et al, 2005), and often tend to represent the disease severity data in such a way as to not allow for any rehabilitation program development. As a result of this gap in service provision a concrete need exists to create an instrument capable of identifying the potential of these complex patients and evaluate the effectiveness of the rehabilitation intervention provided by means of an observational grid.
The aim of the study is to evaluate the efficacy of rehabilitative interventions in a group of patients with IQ <32 (determined by the Vineland II scale) using an ad hoc created tool, called D-Rubrics, capable of identifying “micro-differences” between baseline (T0) and T1 (post-rehabilitation) interventions, paving the way for the development of a new assessment tool for patients with complex disabilities, essential for both clinical and the research applications.

References
Mahoney F.I. and Barthel D.W. “Functional evaluation: the Barthel Index” Md State Med J, 1965 Feb; 14:61-5.
Sparrow S. S., Cicchetti, V. D and Balla A. D. (2005). Vineland adaptive behavior scales. 2nd edition. Circles Pines: American Guidance Service.

Emotional condition in patients with lower urinary tract symptoms performing uroflowmetry

Marilena Gubbiotti, Antonella Giannantoni, Sandro Elisei, Matteo Balzarro, Emanuele Rubilotta

Abstract
Aim of the study. The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient’s micturition.
Materials and methods. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics, urological history, International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ-FLUTS questionnaire in females. Anxiety level of patients was evaluated by the General Anxiety Disorder-7 (GAD-7) questionnaire and the questions #4-6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Specific linker-type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort using a threshold score of 60. We measured also post-void urinary residual volume (PVR) by bladder-scan immediately after the examination.
Results. 125 patients (mean±SD age: 65±13 yrs): 85 men (68%) and 40 women (32%). Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjective satisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires. Table 1 shows results according to GAD scores and APAIS modified scores. The relation between GAD- APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Table 2. A low satisfaction/reproducibility of the exam was reported by 31.2% of the pts (39/125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women.
Conclusion. A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the psychological condition of the patients, mostly in women. Anxiety influenced the subjectivity of the patients leading to the sensation of dissatisfaction and unsatisfactory results. Therefore, a proper counseling may lower anxiety levels obtaining more emotional results at UF.

References
1.Hong WS, Ham SY, Kim TW, Seo JS, Yang AK Usefulness of sonographic bladder scan for uroflowmetry and the evaluation of the anxiety level associated with uroflowmetry Korean J Urol 2007,48:633-637;
2.Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008 Mar;46(3):266-74;
3.Buonanno P, Laiola A, Palumbo C, Spinelli G, Terminiello V, Servillo G. Italian validation of the Amsterdam Preoperative Anxiety and Information Scale. Minerva Anestesiol. 2017 Jul;83(7):705-711.

Urinary and bowel dysfunction in Autism Spectrum Disorders

Marilena Gubbiotti, Chiara Bedetti, Moreno Marchiafava, Sandro Elisei, Antonella Giannantoni

Abstract
Aim of the study. Autism spectrum disorder (ASD) is a common neuro-developmental disorder which includes deficits in social communication and interactions. Bladder and bowel dysfunction (BBD) have been recognized in children affected by autism spectrum disorder (ASD), but no consistent information exist in adults with the condition. We evaluated the prevalence and types of BBD and the impact of psychiatric and behavioural profiles in adults affected by ASD.

Materials and Methods. Twenty-two adults and 13 children/teens with ASD and a matched group of typically developing subjects (TD) were prospectively studied. Patients and TD subjects underwent the evaluation of urinary incontinence (UI: diurnal, continuous or intermittent), nocturnal enuresis (NE), and bowel disturbances with the 3-day voiding and bowel diary. In addition, assessment of intellectual disability (ID) and psychiatric and adaptive behaviours with the Neuropsychiatric Inventory Scale (NPI) and the Vineland Adaptive Behaviour Scale 2nd Edition (Vineland-II), was performed.

Results. In adults, any type of incontinence was observed in 81.8% of cases, and NE and intermittent UI in 59.0% and 36.3% of patients, respectively. Faecal incontinence and constipation were detected 36.3% and in 68.1% of cases, respectively. ID was severe in 2 cases and profound in 18; NPI and Vineland-II items most affected were “Irritability/Lability”, “Motor Activity”, and “Agitation”, and IQ-Socialization and IQ-Communication. Significant relationships were identified between intermittent UI and greater ID (p<0.02) and high “anxiety” (p<0.05), and between NE and high “euphoria/elevated mood” (p<0.05). These results were similar to those observed in children/teens.

Conclusions. Adults with ASD, and greater ID and mood disorders, present with a high prevalence of BBD. A shared pathogenetic mechanism could underlie the co-occurrence of ASD, mood disorders and BBD.

References
1. Lever AG, Geurts HM. Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder. J Autism Dev Disord 2016;46:1916-1930
2. Niemczyc J, Wagner C, von Gontard A, et al. Incontinence in autism spectrum disorder: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:1523-1537.

Contrasting vantage points between caregivers and residents on the perception of elder abuse and neglect during long-term care

Neuberg Marijana; Tomislav Meštrović; Rosana Ribić; Irena Canjuga; Goran Kozina

Abstract
INTRODUCTION - Elder abuse and neglect can be defined as refusing or failing to fulfil a caregiver’s obligation to meet the needs of elderly individuals in order to punish or hurt them. We aimed to explore perceptions of elder mistreatment of both caregivers and residents during long-term care, and highlight significant differences in the overall mistreatment perception regarding sociodemographic variables, as well as the type of care facility.

METHODS - The study involved 171 caregivers and 245 elderly individuals in stationary facilities. Two structured questionnaires were used, one for caregivers and the other for institutionalized elderly residents, whose initial validation concerning question and factor selection has been based upon exploratory factor analysis and discriminant validity. Parametric and nonparametric tests were employed in the statistical analysis, and statistical significance was set at p<0.05 (two-sided).

RESULTS - We found significant differences in the perception of elder abuse and neglect between caregivers and elderly residents. More specifically, caregivers tend to recognize unnecessary or inappropriate medical/care procedures as indicators of elder mistreatment, while the elderly residents emphasize the removal of their personal belongings and inappropriate physical contact. According to the care facility, residents reported abuse/neglect more frequently in extended care units (21.4%), compared to the county-owned nursing home (11.4%) and private nursing home (12.1%) (p=0.001). Similarly, caregivers reported abuse/neglect more frequently in extended care units (75.4%), in comparison to county-owned nursing home (24.6%) and private nursing home (0%) (p=0.039). Shift work was also a significant predictor, as the morning nursing staff perceived abuse/neglect more frequently (p=0.011).

CONCLUSION - This study has shown how residents and caregivers have contrasting vantage points in relation to elder abuse/neglect perception, which underlines the need for evidence-based standardization of procedures to prevent any type of elder mistreatment.

References
Neuberg M, Železnik D, Meštrović T, Ribić R, Kozina G. Is the burnout syndrome associated with elder mistreatment in nursing homes: results of a cross-sectional study among nurses. Arh Hig Rada Toksikol. 2017;68(3):190-197. doi: 10.1515/aiht-2017-68-2982
Neuberg M, Kozina G, Meštrović T, Ribić R. The impact of socio-demographic characteristics and health status of older persons on the occurrence of elder abuse and neglect in institutional settings. In: Celec Robert (editor). Challenges of Society. Hamburg: Verlag Dr. Kovač, 2018; pp. 254-293. ISBN number: 978-3-8300-9776-1.
Yon Y, Ramiro-Gonzalez M, Mikton CR, Huber M, Sethi D. The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. Eur J Public Health. 2019;29(1):58-67. doi: 10.1093/eurpub/cky093
Wangmo T, Nordström K, Kressig RW. Preventing elder abuse and neglect in geriatric institutions: Solutions from nursing care providers. Geriatr Nurs. 2017;38(5):385-392. doi: 10.1016/j.gerinurse.2016
Phelan A. Protecting care home residents from mistreatment and abuse: on the need for policy. Risk Manag Healthc Policy. 2015;8:215-223. doi: 10.2147/RMHP.S70191

Patient’s and general practitioner's perspectives regarding disturbed eating.

Dieter Zeeuws, Karolien Cocquereaux, Liesbeth Santermans

Abstract
Objectives: We wanted to investigate the patient’s expectations on the general practitioner’s (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then, we looked for remediation for some of the mentioned shortcomings in family medicine. We also examined if online aid (offered by the non-profit organisation “Eetexpert.be”) is already known and used.
Methods: Anonymous patient questionnaires were gathered at 4 treatment centres for eating disorders or were collected with help of the Flemish patients organisation for eating disorders (Vlaamse Vereniging Anorexia Nervosa en Boulimia Nervosa). Later, online enquiries were sent to Flemish GPs.
Results: Out of 123 patients responding to the questionnaire, 44 found their GP to have had an important supportive role in their healing process. Active listening and targeted referral were among the most appreciated interventions by those patients. 71 GPs replied the online enquiry. Only 1 out of 5 knew about the free online assistance of “Eetexpert.be”. Responders suggested several additional barriers to care
Conclusions: In Flanders there is a contrast between expectations and needs of patients on one hand compared to the services provided by GPs on the other. Reassuringly, all responding physicians were open to more education and support regarding eating disorder treatment.

References
Ansseau M, Dierick M, Buntinkx F, Cnockaert P, De Smedt J, Van Den Haute M et al.: High prevalence of mental disorders in primary care. J Affect Disord 2004, 78(1):49-‐55.
Linville D, Benton A, O’Neil M et al. Medical providers’ screening, training and intervention practices for eating disorders. Eating Disorders 2010, 18:110-‐131.
Eetexpert (2017). Detectie en somatische opvolging van eetstoornissen in de huisartsenpraktijk. Brussels: Eetexpert, with support of the Flemish community, Minstry of welbeing, public health and family. (available at www.eetexpert.be)

Mental disorders/difficulties in the postpartum period

Ivana Zivoder, Sanja Martic –Biocina, Jurica Veronek, Natalija Uršulin- Trstenjak, Melita Sajko, Marija Pauković

Abstract
Mental changes are common in the postpartum period. They can manifest as a milder difficulty, but also as serious disorders who need to be treated in a timely manner. The most common psychological problem is "Baby blues" characterized by relatively short duration without consequences and treatment is largely unnecessary. Postpartum depression is characterized by a sense of sadness, loss of interest, insomnia, discomfort, loss of energy, reduced concentration. Postpartum psychosis as the most serious disorder may have serious consequences for the mother and child. An important role in the postpartum mental problems/difficulties has genetic factors, unwanted pregnancy, a feeling of discomfort for the role of motherhood and sudden hormonal changes.
Methods: One hundred (112) respondents participated in the survey. The survey was conducted from November to December 2017 through a "google docs" application. The survey was placed at different social networks, and the participation in the survey was voluntary and anonymous. A survey of 14 questions with the offered answers was used in the survey.
Results: The results of the surveys have shown that psychological difficulties and disturbances in the postpartum period are common problems encountered by almost 50% of women (44.46%). The most common difficulty is Baby blues, followed by postpartum depression and anxiety disorders. Age and the way of birth do not affect the emergence of changes, while social factors such as family support have a great impact.
Conclusion: The information of the mothers can help, but unchecked information can affect the opposite. The role of health care professionals is important for helping the mother in that period to prevent certain difficulties as well as in identifying and referring mothers to timely seeking help.
Keywords: mental disorders/difficulties, health care professionals, education, prevention

References
1. Gale S & Harlow BL: Postpartum mood disorders: A review of clinical and epidemiological factors, Journal of Psychosomatic Obstetrics & Gynecology 2003; 24:4, 257-266. DOI: 10.3109/01674820309074690
2. Cantwell R & Cox JL: Psychiatric disorders in pregnancy and the puerperium, Current Obstetrics & Gynaecology 2003; 13 (1): 7-13. https://doi.org/10.1054/cuog.2003.0301.
3. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J: Non-psychotic mental disorders in the perinatal period, The Lancet 2014; 384(9956):1775-1788. https://doi.org/10.1016/S0140-6736(14)61276-9.
4. Pearlstein T, Howard M, A Salisbury, Zlotnick C: Postpartum depression Am J Obstet Gynecol. 2009; 200 (4): 357–364.
5. Rai S, Pathak A & Sharma I: Postpartum psychiatric disorders: Early diagnosis and management. Indian journal of psychiatry 2015; 57(2):216–221. doi:10.4103/0019-5545.161481

Innovating in Psychiatry Medical Education: Do Medical Students have a role to play

Anand Krishna, Sagana Thayaparan

Abstract
PsychEDUp is a new, innovative undergraduate psychiatry teaching course, that aims to teach students the ‘hidden curriculum’: skills and knowledge that are not otherwise taught at medical school. The core aims are to improve communication skills, destigmatise mental health and help students feel more comfortable with challenging psychiatric presentations. The course utilises a combination of small group simulation and creative large group presentations.

The teaching was developed and delivered by a multidisciplinary team consisting of doctors, medical students, service users and actors. Experienced medical students played a critical role both in content development and delivery of teaching. They were encouraged to give vital contributions by the flattened hierarchy of the team, and responded by providing unique insights and innovative teaching techniques to improve the quality of delivered teaching. Students also contributed to, and led, research output and evaluation of the course. Contributions were further encouraged by consistent multi-source feedback, with an emphasis on personal development.

Certain limitations exist, such as lack of clinical experience. This supports the conclusion that medical students can play a critical role in innovation in medical education if supported well by multi-disciplinary teams that encourage them to take on leadership and management roles.

References
Quince, T., Abbas, M., Murugesu, S., Crawley, F., Hyde, S., Wood, D. and Benson, J., 2014. Leadership and management in the undergraduate medical curriculum: a qualitative study of students’ attitudes and opinions at one UK medical school. BMJ open, 4(6), p.e005353.
Uhl-Bien, Mary & Riggio, Ronald & Lowe, Kevin & Carsten, Melissa. (2013). Followership theory: A review and research agenda. The Leadership Quarterly. 25. 10.1016/j.leaqua.2013.11.007.

PsychED UP: a course that uses peer assisted learning to positively impact medical students.

Kimberley Wynter, Sarah Arunachalam, Sagana Thayaparan, Imogen Louisa Stables, Sophie Butler, Roxanne Keynejad

Abstract
PsychED UP is a psychiatry-based teaching course covering extra-curricular topics not included on the undergraduate medicine course. The course was designed for third year medical students and focused primarily on complex communication scenarios. The PsychED UP team involved doctors, medical students as peer facilitators (PFs), actors and service users.

The seven week PsychED UP course comprised of two-hour weekly sessions. Each week was structured as a half hour large group teaching session led by a doctor, followed by three half-hour OSCE style role plays carried out in smaller teaching groups. Each small group was led by a team doctor and a PF that were constant for each small group. There was a significant emphasis on high quality, individualised feedback for the medical students, and all members of the PsychED UP team, throughout the duration of the course. The course content was created during a number of development sessions, with all of the team having opportunities to input. Each team member developed skills to produce an engaging, relevant and structured course.

Overall, PsychED UP provided opportunities for students to build confidence in managing challenging encounters and develop techniques to overcome such scenarios. The small group sessions also allowed students to discover strategies to provide meaningful constructive feedback for their peers and to learn from each other.

The progress and outcomes of the course were measured using a survey before and after the seven-week period. The overall feedback was extremely encouraging, with most students reporting positive impacts in a variety of self-reported performance measures. Feedback about how to improve the course was also collected so that the PsychED UP course can continue to improve and help benefit many more medical students.

References
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Suicidal Ideation in Patients with Tinnitus: A Systematic Review

R.E. Thompson1, B.V. Tailor1,2& M. Agius3

Abstract
Background
Tinnitus is a common otological complaint, defined as the perception of sound in the head or ears without a corresponding external acoustic source. Tinnitus is associated with a variety of cognitive, psychosocial and psychiatric disorders(1). Media reports refer to tinnitus as a significant contributor in cases of committed suicide(2). This is usually preceded by suicidal ideation(3). However, the scientific literature concerning the relationship between tinnitus and suicidal ideation is limited compared to reported associations with anxiety and depression(4,5). The aim of this systematic review was to assess the prevalence of suicidal ideation in tinnitus populations.

Subjects & Methods
MEDLINE and CENTRAL databases were searched for studies reporting the prevalence of suicidal ideation among adult populations with tinnitus. Exclusion criteria included a diagnosis of psychotic or personality disorders. Data was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature was performed with narrative data analysis. Included studies were quality assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale.

Results
Five papers met the inclusion criteria. The reported prevalence of suicidal ideation in tinnitus populations varied from 6.9% to 31%. Two studies included a control population and reported a significantly lower prevalence of suicidal ideation in these subjects (p<0.01). The evidence for the quality of included studies was variable, with only two studies utilising a validated psychiatric self-report questionnaire to assess for suicidal ideation.

Conclusions
Despite limited literature, these results suggest an increased risk of suicidal ideation in tinnitus populations. It is therefore important to screen patients for suicidal behaviours and consider referral for formal psychiatric assessment. Additionally, further research is needed into the effect of tinnitus severity on suicidal ideation, which may help psychiatric risk stratification.

References
1. Lynn SG, Bauch CD, Williams DE, Beatty CW, Mellon MW, Weaver AL. 2003. Psychologic profile of tinnitus patients using the SCL-90-R and Tinnitus Handicap Inventory. Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol. 24(6):878–81
2. Pridmore S, Walter G, Friedland P. Tinnitus and suicide: recent cases on the public record give cause for reconsideration. Otolaryngol Head Neck Surg. 2012 Aug;147(2):193-5. doi: 10.1177/0194599812446286. Epub 2012 Apr 24. PubMed PMID: 22535918.
3. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979 Apr;47(2):343-52. PubMed PMID: 469082
4. Gül AI, Özkırış M, Aydin R, Şimşek G, Saydam L. 2015. Coexistence of anxiety sensitivity and psychiatric comorbidities in patients with chronic tinnitus. Neuropsychiatr. Dis. Treat. 11:413–18
5. Malakouti S, Mahmoudian M, Alifattahi N, Salehi M. 2011. Comorbidity of chronic tinnitus and mental disorders. Int. Tinnitus J. 16(2):118–22

Mental disorders/difficulties in the postpartum period

Ivana Zivoder, Sanja Martic –Biocina,Jurica Veronek, Natalija Uršulin- Trstenjak, Melita Sajko, Marija Paukovic

Abstract
Mental difficulties are common in the postpartum period. They can manifest in a mild form, but also as serious disorders which need to be treated in a timely manner. The most common psychological problem is "Baby blues" characterized by relatively short duration without consequences and treatment is largely unnecessary. Postpartum depression is characterized by a sense of sadness, loss of interest, insomnia, discomfort, loss of energy, reduced concentration. Postpartum psychosis as the most serious disorder but also rare and may have serious consequences for the mother and child. An important role in the postpartum mental problems/difficulties have genetic factors, situation of unwanted pregnancy, a feeling of discomfort for the role of motherhood and sudden hormonal changes.
Aim of the study: to investigate the frequency and type of mental problems in the postpartum period, as well as possible type of help needed by the women in postpartum period.
Methods: One hundred (112) respondents participated in the survey. The survey was conducted from November to December 2017 through a "google docs" application. The survey was placed at different social networks, and the participation in the survey was voluntary and anonymous. A survey of 14 questions with the offered answers was used in the survey.
Results: The results of the survey have shown that psychological difficulties and disturbances in the postpartum period have been common problems encountered by almost 50% of women (44.46%). The most common difficulty is Baby blues, followed by postpartum depression and anxiety disorders. Age and the way of birth have not affected the emergence of changes, while social factors such as family support have had a great impact.
Conclusion: The provided information to the mothers can help, but unchecked information can do the opposite. Thus, the role of health care professionals is important for helping mothers in that period to prevent certain difficulties as well as in identifying and referring mothers to timely seeking help.
Keywords: mental disorders/difficulties, health care professionals, education, prevention

Family relationships and health locus of control as covariables in the evolution of major depressive disorder

Zdanowicz Nicolas, Reynaert Christine, Jacques Denis, Lepiece Brice, Dubois Thomas

Abstract
Background: In a two-year study, we compared the efficacy of noradrenergic and serotonergic antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from major depressive disorder (MDD). In this article we examine the influence of the health locus of control, family relationships and personality traits on the progress of MDD. Methods: 40 people with MDD (MDD group) were randomly assigned to the different treatment groups. They were followed in parallel with a group of 20 ‘healthy’ subjects (HG). At the beginning of the study, sociodemographic data were collected, and patients were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study subjects were regularly assessed using the Hamilton Depression Scale (HDS), the Short Form Health Survey (SF-12) and the Clinical Global Impression scale (CGI). Results: Regardless of the type of treatment, physical health is the best predictor of variation at two years in the MDD group; 45% of variance is explained by a linear regression model that includes three variables from the MHLC, FACES III and NEO-FFI scales. Similarly, 40% of CGI and 24% of HDS variance is predicted. These explanatory variables are statistically less powerful in the MDD group than the HG group. Conclusion: While drug treatment is a determinant in changes on the HDS, CGI and SF12 scales, factors such as family relationships, MHLC or personality are important covariates of these changes. The question remains whether we can influence these covariates to improve the response to antidepressants.

References
Zdanowicz N, Jacques D, Reynaert Ch: Comparisons between psychotropics drugs : must the risk of side effects dictate our practices ? Acta Clin Belg 2008; 4: 235-241
Zdanowicz N, Lepiece B, Tordeurs D, Jacques D, Reynaert C: Predictibility of levels of physical and mental health: a 2 years longitudinal study. Psychiatria Danubina 2011 ; 23 : 8-12
Zdanowicz N, Lepiece B, Tordeurs D, Jacques D, Reynaert Ch : Predictibility of levels of physical and mental health in adults and adolescents : a 2 years longitudinal study. Psychatria Danubina 2012; 24: 9-13
Zdanowicz N, Dubois T, Reynaert C, Jacques D, Manceaux P: Comparisons of components of the depression of hospitalized patients admitted trough the emergency dept or consultations Psycha Danub 2016; 28: 159-161
Zdanowicz N, Reynaert C, Jacques D, Lepiece B. Dubois T: Selective serotoninergic (SSRI) versus noradrenergic reuptake inhibitors with and without acteylslicylic acid in major depressive disorder. Pycha Danub 2017 ; 27 : 270-273.

Mobius syndrome and obsessive-compulsive disorder: a case report

Jacques D., Ossemann M., Timmermans J.M., Zdanowicz N., Dubois T.

Abstract
Background: Mobius syndrome is characterized by a bilateral congenital paralysis of the facial and abducens nerves which leaves the subject with an expressionless "mask-like" face
Subjects and Methods: Based on a literature review and a case discussion of an adult patient with Mobius syndrome and obsessive-compulsive disorder, initially undiagnosed and confused with a psychotic disorder, we will discuss the influence of Mobius syndrome in psychiatric evaluations.
Results: The lack of facial expressiveness and non-verbal emotional interactions may influence psychiatric evaluations and result in misdiagnosis and the inappropriate prescribing of antipsychotics. In the case analysis, we also observed other associated malformations such as renal atrophy, a bicuspid aortic valve and mitral valve prolapse.
Conclusion: We feel that educating the patient about the communicative consequences of impaired facial expressions and facial interactions is a necessary prerequisite for any psychiatric or psychological evaluation in subjects with Mobius syndrome. We also recommend using caution when prescribing antipsychotics in patients with Mobius syndrome given the motor side effects secondary to a potentially pre-existing hypotonia.
Key words: Mobius syndrome-OCD-renal atrophy-bicuspid aortic-mitral valve prolapse-BCT-delusions-drug induced dystonia

References
Borbolla Pertierra AM, Acevedo González P, Bosch Canto V, Ordaz Favila JC, Juárez Echenique JC: Eye and systemic manifestation of Mobius syndrome. Pediatr Barc 2014; 5: 297-302.
Briegel W, Heinzel-Gutenbrunner M, Beate Y: Psychological adjustment of young subjects with Möbius sequence and their primary caregivers' strain and life satisfaction: First longitudinal data. Res Dev Disabil 2019; 85: 42-49.
Briegel W: Self-perception of children and adolescents with Möbius sequence. Res Dev Disabil 2012; 33: 54-59.
Briegel W, Schimek M, Kamp-Becker I: Moebius sequence and autism spectrum Disorders less frequently associated than formerly thought. Res Dev Disabil 2010; 6: 1462-6.
Briegel W, Hofmann C, Schwab KO: Behaviour problems of patients with Moebius sequence and parental stress. J Paediatr Child Health 2010; 46: 144-8.

Role of gut microbiota in the interaction between immunity and psychiatry : a literature review.

Dubois T., Reynaert Ch., Jacques D., Lepiece B., Zdanowicz N.

Abstract
Background: psychiatric disorders may be correlated with a low grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut
microbiota seems to have an impact on the brain and immune processes.

Method: we review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords « gastrointestinal microbiota »
and « mental disorders » or « psychological stress ».

Results: we showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders.

Discussions: communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life.

Conclusions: psychological stress impact gut microbiota with subsequent immune activationleading to neurodevelopmental disorders or sickness behavior and altering neurophysiologyand reactivity to stress or lifestyle.

References
Dubois T, Reynaert C, Jacques D, Lepiece B, Patigny P, Zdanowicz N : immunity and psychiatric disorders: variabilities of immunity biomarkers are they specific? Psychiatr Danub. 2018 (Suppl 7):447–51.

Mental health of adolescents in transition to young adulthood.

Lepièce Brice, Zdanowicz Nicolas, Emmanuel de Becker, Philippe de Timary, Vincent Lorant

Abstract
Background: In this paper we focus on adolescents in transition towards young adulthood (ATYA). We know from international studies that the transition process makes adolescents vulnerable to mental illness. However, little is known about Belgian ATYA mental-health status. Nor are risk factors associated with their mental illness understood, in particular with regard to depressive and anxiety disorder. The aim of this study is (1) to discuss evolution in time of prevalence of depressive disorder (DD) and anxiety disorder (AD) among Belgian ATYA and (2), to identify risk factors associated with these disorders among ATYA. Methods: Data was extracted from the Belgian Health Interview Survey (BHIS), which is a cross-sectional population survey, carried out in 2001, 2004, 2008, and 2013. Information about the population’s background characteristics, health services utilization, health behaviours and mental health status were extracted and statistically analyzed. Results: ATYA prevalence of DD and AD was higher in 2013 in comparison with previous years. These changes were significant only for DD (F=4.466, p=0.004). In contrast with younger adolescents, among ATYA odds of DD were 28.2% higher (OR 1.282, 95% CI 0.967-1.698, p=0.084) and, odds of AD were 55.2% higher (OR 1.552, 95% CI 1.137-2.119, p=0.006). For ATYA, a poor quality of social support was the most predictive factor of DD (OR 11.187, 95% CI 5.530-22.629, p<0.0001) and AD (OR 6.238, 95% CI 2.845-13.676, p<0.0001); whereas, having a paid job was the most protective factor with regard to DD (OR 0.282, 95% CI 0.169-0.470, p<0.0001) and AD (OR 0.552, 95% CI 0.330-0.924, p<0.024). Conclusion:
Prevalence of mental illness among Belgian ATYA appears to worsen in time. In comparison with younger adolescents, ATYA are more vulnerable to anxiety disorders. Adverse and protective risk factors were identified and discussed in a way to improve access, continuity and mental healthcare pathways for Belgian ATYA.

References
Beesdo-Baum K & al.: The ‘Early Developmental Stages of Psychopathology (EDSP) study’: a 20-year review of methods and findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50(6): 851-866.
Costello J, Egger H, Angold A: 10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden. J Am Acad Child Adolesc Psychiatry 2005; 44(10): 972-986.
Kessler C, Amminger P, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun B: Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007a; 20(4): 359.
Polanczyk V, Salum A, Sugaya S, Caye A, Rohde A: Annual Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. J. Child Psychol. Psychiatry 2015; 56(3): 345-365.

The relation between emotional intelligence and Internet addiction in Katowice high school students

Szymon Mizera, Karolina Jastrzębska, Tomasz Cyganek, Aleksandra Bąk, Magda Michna, Anna Stelmach, Krzysztof Krysta, Marek Krzyst

Abstract
BACKGROUD: Emotional intelligence (EI) is described as the capacity to be aware of, control, and express one's emotions, and to handle interpersonal relationships judiciously and empathetically. It is considered as one of the most important predictors of success, quality of relationships, and overall happiness. Dynamically changing environment of the youth and young adults in recent years may influence their EI development, affecting their lives significantly. The purpose of this study was to analyse the way how the Internet is used by high school students, to determine the amount of time they spend on the Internet, identify the level of EI and to explore if there is any correlation between those factors.
SUBJECTS AND METHOD: 1450 high school students from Katowice, at the age from 18 to 21 years took part in an anonymous survey consisting of three parts: The Trait Emotional Intelligence Questionnaire – Short Form (TEIQue-SF), Internet Addiction Test and authorial test giving information about the way of spending time online. The questionnaires were collected from May 2018 to January 2019.
RESULTS: 1,03% of the respondents fulfilled the Internet addiction criteria. Students at risk for addiction (33,5%) turned out to be a larger group. A statistically significant correlation between TEIQue-SF and Internet Addiction Test score (P < 0.0001, r= -0,3308) was observed. Another significant correlation was found between TEIQue-SF score and amount of time spend on the Internet ( p < 0,0001, r= -0,162).
CONCLUSION: A significant part of high school students used Internet excessively. Such behaviours were positively correlated with lower EI test results.
KEY WORDS: emotional intelligence, Internet addiction, high school students

References
Siegling AB, Vesely AK, Petrides K V, Saklofske DH.: Incremental Validity of the Trait Emotional Intelligence Questionnaire – Short Form ( TEIQue – SF ). Journal of Personality Assessment 2015; 97: 525-535.
Szczygieł D, Jasielska A, Wytykowska A.: Psychometric properties of the Polish version of the Trait Emotional Intelligence Questionnaire-Short Form. Polish Psychological Bulletin 2015; 46: 447–459.
Tsitsika A, Janikian M, Schoenmakers TM, Tzavela EC, Ólafsson K, Wójcik S, et al.: Internet Addictive Behavior in Adolescence: A Cross-Sectional Study in Seven European Countries. Cyberpsychology, Behav Soc Netw. 2014; 17: 528–535.

Teenage pregnancy in Belgium: protective factors in a migrant population

Lotta Coenen, Pauline Bellekens, Caroline Kadji, Andrew Carlin, Juan Tecco.

Abstract
Background: Teenage pregnancies occur frequently in developing countries and are associated with social issues, including poverty, lower levels of health and educational attainment. Although frequent in European countries in the 20th century today, teenage pregnancies account for only 4% of first children. These pregnancies are usually unplanned and they are considered a vulnerability factor during the pregnancy and the postnatal period, both for the mother and the child. The purpose of our study was to evaluate the evolution of mothers and children of teenage pregnancies, several years after childbirth and to identify factors which may protect or increase the patient’s vulnerability.

Subjects and methods: We conducted a retrospective search in our patient database in order to identify all teenage pregnancies between 2010-2014 at CHU Brugmann Hospital. Outcome date data were obtained from the medical files. Mothers were contacted by phone and asked to complete our questionnaire which focused on maternal and paediatric care; and infant and child development after hospitalization.

Results: Out of the 342 patients identified, 84 patients were contactable and only 72 patients completed the full questionnaire. With only 4 patients originating from Belgium, our population was largely immigrant. Despite this, obstetrical, maternal and paediatric outcomes were remarkably favorable when compared to other published studies.

Conclusion : Our study suggests that some migrant teenage mothers may have a dual advantage in terms of the wealth of a developed country in which have settled and the low social stigma related to their country of origin. More research needs to be done to further investigate this hypothesis.

References
Aslam RW, Hendry M, Booth A, Carter B, Charles M, Craine N, Edwards RT et al. : Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT) : a systematic review of intervention effectiveness ant cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. BMC Medicine 2017 ; 15 :155.
Barton K, Redshaw M, Quigley MA & Carson C: Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role relationship quality and wider social support. BMC Pregnancy Childbirth 2017; 17: 44.
Goossens G, Kadji C, Delvenne V : Teenage pregnancy: a psycholopathological risk for mothers and babies? Psychiatria Danubina 2015 ; 27 Suppl 1 :S499-503.
Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics. 2014;133(1):114–122.
Marthy F, O’Brien Una, Kenny L : The management of teenage pregnancy. BMJ 2014; 349:g5887.

Management of ARFID (Avoidant Restrictive Food intake Disorder) in a 12-year-old on a Pediatric Ward in a General Hospital

Anne-Frederique Naviaux

Abstract
Background: Avoidant Restrictive Food Intake Disorder (ARFID), at the cross roads of eating and feeding disorders, is sometimes called an “umbrella diagnosis” as it covers a certainly large and rather heterogeneous list of eating symptoms. It came with the DSM5 (2013) but still, there are no clear guidelines re diagnosis and treatment.
Purpose: Through this case, we aim to report not only a presentation of ARFID, but also how this relatively new and emerging diagnostic category has been identified and managed on a Pediatric Ward, in a General Hospital.
Subject and Methods: This study reports the case of a 12y old girl Irish girl with ARFID treated by a multi-disciplinary team on a Pediatric Ward in a general hospital. A literature review regarding ARFID was concomitantly carried on, in order to consider the current therapeutic options recommended.
Results: 3 admissions on a pediatric Ward were necessary for this patient with ARFID, who was successfully managed with a partial hospitalization model, Family Based Treatment (FBT) and Mirtazapine.
Conclusions: The dynamic around the management of this condition is the occasion to discuss the other therapeutic options suggested these days, and more specifically the different pharmacological molecules that have also been used in young patients with ARFID and the importance of involving a multi-disciplinary team.

References
Albahari D & Rabie M: Acute food refusal in a seven-year-old hospitalized boy, MOJ Clin Med Case Rep. 2018; 8(6):216-218.
Cooney M, Lieberman M, Guimond T & Katzman D: Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: a descriptive study, Journal of Eating Disorders 2018;6(7).
Gray E, Chen T, Menzel J, Swartz T & Kaye WH: Mirtazapine and weight gain in Avoidant and Restrictive Food Intake Disorder, J AM Acad Child Adolesc Psychiatry 2018 Apr; 57(4): 288-289.
Katzman D, Norris M & Zucker N: Avoidant restrictive food intake disorder, Psychiatr Clin N Am 42 (2019)45-57.
Katzman D, Norris M & Zucker N: Avoidant restrictive food intake disorder: First do no harm, Int J Eat Disord. 2019;52:459-461.

The effects of eating disorders in pregnancy on mother and baby: a review

Ciara Mahon, Hayley Johnson, Charlotte Arnold

Abstract

The psychological and physiological interaction between anorexia and the pregnant state has a large intrapartum and postpartum impact on mother and baby. Current research has attempted to discern the short and long term effects of eating disorders (EDs) on pregnancy as well as mother and baby-related sequelae; however little is understood about which
management strategies are likely to prove most successful in mitigating these risks. The incidence and effect of low pre-pregnancy body mass index (BMI) on obstetric outcomes, and possible health complications in the future child, has attracted widespread attention. Especially concerning is the fact that it has long been known that the incidence of EDs in women of childbearing age is not only the highest out of all age categories but also is on an increasing trajectory.
This paper aims to highlight the recent evidence underpinning the management of pregnant women with EDs in the light of the discussed short and long term effects of the disorders on mother and baby. We shall focus on those women who have a previous diagnosis of an ED prior to being pregnant.
Particular attention will be paid to those studies considering anorexia nervosa. We argue for the use of early intervention strategies for the management of pregnant women with eating disorders, and for the use of a multidisciplinary approach in the treatment of these patients with complex problems.

References
Non required

Attitudes towards a borderline personality disorder unit – a small-scale qualitative survey

Jakub Nagrodzki, Jorge Zimbron

Abstract
Background
Springbank Ward, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, is a Borderline Personality Disorder (BPD) unit employing positive risk-taking, allowing for relevant psychological therapies to be carried out.
The aim of this survey was to identify staff and patient attitudes to Springbank Ward. Previous research has not addressed the question of patient and staff perception of these therapeutic approaches.

Subjects and Methods
We used a qualitative open-ended semi-structured survey of staff and patients
(n=2+4, respectively). We gathered information on the perception of the unit, staff, safety and the positive and negative aspects of the ward. Interview transcripts and participation notes were coded and categorised for emerging themes.

Results
The four main themes were:
1) views on the unit: ‘safe space’, ‘opportunity’, ‘community’;
2) views on the programme: ‘successful’, ‘skills-based’, involving patients in their own recovery;
3) views on staff: important part of the therapeutic process by delivering elements of dialectical behaviour therapy (DBT);
4) views on safety: patients and staff feel safe in the context of positive risk-taking.

Conclusions
1) The long-term therapeutic programme offered at Springbank is perceived positively by both patients and staff.
2) Involving patients actively in their recovery remains a powerful tool.
3) The delivery of DBT by nursing staff contributes significantly to the positive perception of the unit.
4) Positive risk-taking is perceived to be a good and safe strategy.

References
1. Birch S, Cole S, Hunt K, Edwards B, Reaney E. Self-harm and the positive risk taking approach. Can being able to think about the possibility of harm reduce the frequency of actual harm? J Ment Heal. 2011;20(3):293-303. doi:10.3109/09638237.2011.570809.
2. Krawitz R, Jackson W, Allen R, et al. Professionally Indicated Short-Term Risk-Taking in the Treatment of Borderline Personality Disorder. Australas Psychiatry. 2004;12(1):11-17. doi:10.1046/j.1039-8562.2003.02052.x.
3. Mullen A. Mental health nurses establishing psychosocial interventions within acute inpatient settings. Int J Ment Heatlh Nurs. 2009;18:83-90. doi:10.1111/j.1447-0349.2008.00578.x.
4. McCann E, Bowers L. Training in cognitive behavioural interventions on acute psychiatric inpatient wards. J Psychiatr Ment Health Nurs. 2005;12:215-222.
5. Caruso R, Biancosino B, Kerr IB, Grassi L. Working With the ‘Difficult’ Patient : The Use of a Contextual Cognitive-Analytic Therapy Based Training in Improving Team Function in a Routine Psychiatry Service Setting. Community Ment Heal J. 2013;49:722-727. doi:10.1007/s10597-012-9579-x.

Bipolar disorders and bipolarity: the notion of the “mixity”.

Giuseppe Tavormina

Abstract
Background -
The dysphoric component of mood (mixed states) is quite frequent among all the subtypes of the bipolar spectrum. Mixed states include approximatively 30% of all mood spectrum disorders.
Clinicians find great difficulties in making a correct diagnosis of the mood disorders which they are assessing, above all when mixed states are present: this is because the patients mainly focus their own symptoms on depressive uneasiness (inducing the clinicians to frequently prescribe antidepressants drugs alone or together with benzodiazepines).

Clinical considerations -
The “mixity” of depressive phases (that are the most insidious symptoms of overlapped depression-restlessness-irritability) can cause increased risk of suicidality: the intensity of these symptoms can be shown using the rating scale for mixed states “GT-MSRS”, an easy rating scale to administer to the patient structured in eleven items (and 7 sub-items), to demonstrate the level of the mixity (a score from 2 to 6 : medium-light level; a score from 7 to 12: medium level; a score from 13 to 19: high level).

Methods -
All the points of mixity symptoms are contained inside the rating scale “GT-MSRS”, structured in eleven items, eight of them subdivided in sub-items.
The prescription of mood stabilisers together with antidepressants in all patients with a diagnosis of mood disorders is crucial for a good treatment.

Final evaluations and conclusions -
The “depression”, is the main issue which the clinician needs to deal with in a patient with mood disorder; this relates to the important notion, that the depressive episode is only one phase of a broader “bipolar spectrum of mood”. In consequence of this, when considering bipolarity the notion of the mixity becomes the conceptual reference point of the diagnostic process.

References
- Tavormina G – Treating the bipolar spectrum mixed states: a new rating scale to diagnose them – Psychiatria Danubina 2014; 26: suppl 1: 6-9.
- Tavormina G - Clinical utilisation of the “G.T. MSRS”, the rating scale for mixed states: 35 cases report – Psychiatria Danubina 2015; 27: suppl 1: 155-59.
- Tavormina G – An approach to treat bipolar disorders mixed states – Psychiatria Danubina 2016; 28: suppl 1: 9-12.
- Tavormina G, et al.- Clinical utilisation and usefullness of the rating scale of mixed states, (GT- MSRS)”: a multicenter study–Psychiatria Danubina2017; 29: supp 3: 365-67.
- Akiskal HS, Pinto O: The evolving bipolar spectrum: Prototypes I, II, III, IV. Psychiatr Clin North Am. 1999; 22:517-534.

THE HUMOR IN THERAPY: THE HEALING POWER OF LAUGHTER

AMICI PATRIZIA

Abstract
Although humour is a key element of human communication, and, for this reason, it is also present in therapeutic contexts, its use in this sense still remains largely untapped. The purpose of this article is to increase curiosity and broaden the reflection on the use of humour in the psychotherapeutic relationship. The first part is dedicated to a short review of the main theories on the origins of laughter. The second part will examine those studies reporting a beneficial effect of humour on physical well-being, while the third part will review those studies describing how humour can help improve psychological well-being. The fourth part will further explore the clinical effects of humour in the therapeutic relationship. Both the positive and negative effects of humour in the therapeutic relationship will be discussed. In addition, some brief examples are included.
Key words - Humour, Psychotherapy, therapeutic alliance

References
Fabian E.: L’importanza dell’Umorismo in psicoterapia. Aracne Editrice, Roma, 2017.
Fry, W.F. :Una dolce follia. L'umorismo ed i suoi paradossi. Raffaello Cortina Editore. Milano 2001.
Chaloult & Blondeau: Perspectives sur l'usage de l'humor en psychoterapie. Santé Mentale au Québec. 2017; 42 (1): 425-433
Scarinci A.( a cura di): Umorismo e psicoterapia. Quando una risata fa bene. Alpes Italia SRL.2018
Franzini L.R. Humor in therapy: The case for training therapists in its uses and risks. The Journal of General Psychology, 128(2): 170-193

THE “IMPERFECT BEAUTY” IN EATING DISORDERS

Maria Rosaria Juli

Abstract
Not only philosophers, but also artists and scientists have always struggled to find a universal definition of beauty. Not even Darwin could find an answer to the question: are there any parameters of beauty that we can apply to every species. Nobody can give a valid definition for the perception of beauty in others. Can a definition in subjective terms be achieved? If I say something is beautiful, it only means that it is beautiful for me, but it does not mean that is necessarily beautiful for everyone else. Beauty is a subjective experience, but it is not only a perceptive experience! There is less and less space for self-acceptance and developing other qualities, whereas we invest more into treatments of various kinds to change our body, considering it as an object we can manipulate, or as a tool to achieve goals. Particularly young people, today, are conditioned by the myth of beauty and by the canons imposed by newspapers,TV and the media, which demands virtual beauty without originality.. Society, the dominant culture, teaches that beauty is thinness, that weight is inversely proportional to self-confidence, and that image and appearance count more than being yourself. An exasperated attention is increasingly developed towards corporeity, to the point that the image seems to become more and more the only channel to express individual identity.
From here we can see the rise of various significant social pathologies and phenomena, ranging from the boom of aesthetic surgery to the pandemic anorexia, and from the endless number of beauty products to the obsession for beauty farms and wellness centers.

References
1.American Psychiatric Association (2013). Manuale diagnostico e statistico dei disturbi mentali, quinta edizione. Raffaello Cortina Editore.
2.Bruch H. (1978). Patologia del comportamento alimentare. Feltrinelli, Milano, 1978
3.Charmet G.P.(2013). La paura di essere brutti. Cortina Raffaello Editore.
4.Juli, M.R. (2017): Perception of body image in early adolescence. An investigation in secondary schools”. Psichiatria Danubina volume 29, Suppl.3, pp 245-482.
5. Juli, M.R. (2018): “The suffering body: manipulation and discomfort in Eating Disorders”. Psichiatria Danubina volume 30, Suppl.7, pp 521-526.

The therapeutic alliance – its impact on antidepressant therapies in major depressive conditions and on the overall health

Sourdeau Aurore and Zdanowicz Nicolas

Abstract
Background: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health?

Subjects and methods: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12).

Results: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2 = 6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health.

Conclusion: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.

References
Berkman LF, Berkman CS, Freeman DH, Leo L, Ostfeld AM, Cornoni J et al: Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epideiol 1986; 124: 372-388.
Zdanowicz N, Lepiece B, Tordeurs D, Jacques D, Reynaert Ch. Predictability of levels of physical and mental health: a 2 years longitudinal study. Psychiatr Danub. 2011; 23(1): 8-12.
Zdanowicz N, Reynaert C, Jacques D, Lepiece B. Dubois T: Selective serotoninergic (SSRI) versus noradrenergic reuptake inhibitors with and without acteylslicylic acid in major depressive disorder. Psycha Danub 2017; 27:270-273.
Zdanowicz N, Reynaert C, Jacques D, Lepiece B, Godenir F, Pivont V. Dubois T: Depression and physical health, the therapeutic alliance and antidepressant. Psychiatria Danubina,2018 ;30 :401-404.
Krupnick J-L, Sotsky S-M, Simmens S, Moyer J, Elkin I, Watkins J. Pilkonis P-A : The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology 1996; 64(3), 532-539.

The therapeutic alliance – its impact on antidepressant therapies in major depressive conditions and on the overall health

Sourdeau Aurore and Zdanowicz Nicolas

IQ over 130 and phobia: correlation, consequences and other psychopathologies

Lacour A-G., Zdanowicz N.

Abstract
Background: Nowadays, anxiety disorders are becoming more and more important in our population. And if there is one category of people more vulnerable to this problem, it is the teenagers. In addition, more and more children and teenagers are diagnosed with an IQ greater than 130, causing all the stress and questions that it generates. In this project, we are comparing two groups of adolescents, one with an IQ over 130, the other with an IQ less than 130. We are wondering if there is any difference between these groups, in terms of phobia and other psychopathologies.

Method: A sample of 35 teenagers, from 12 to 16 years old, separated in two groups (IQ over 130 and IQ below 130), fulfilled the following questionnaires: the School Rehabilitation Assessment Scale-Revised (SARS-R), the "Family Adaptability and Cohesiveness Evaluation Scale III" (FACES III), and the "Kiddie- SADS-lifetime" (K-SADS-PL), and a social data collection questionnaire.

Results: At the end of this study, we can retain the following relevant elements: adolescents with IQs greater than 130 are statistically more likely to be the eldest siblings (Cochran Test F= 9,159, p= 0,010). They do not develop more phobias, but are more shy (t= 4,375, p= 0,036) than the control population. These high-potential and shy teenagers have a whole list of commonalities, such as being easily irritable, being easily distracted, ect… They have fewer friends in real life (t= 2.255, p= 0.033), fewer virtual friends (t= 4.346, p= 0.000) and fewer virtual relationships (t= 2.431, p= 0.021). Their families are very cohesive (Test t= 0.004). There is no significant role of the socio-professional class of parents playing in the value of the IQ of their children (t= 4,667, p= 0,323).

Conclusion: To conclude, being a teenager and having an IQ greater than 130 is not always a pleasure. Our results showed us that the majority of these young people consider themselves as shy, unsure of themselves and claim to have many fears. This is evidence of an increased anxiety component compared to the control sample. It seems important to insist on the need to be able and to know how to identify these young people as soon as possible, in order to propose appropriate therapeutic management.

References
Birmaher B., Ehmann M., Axelson DA., Goldstein BI., Monk K., Kalas C., …, Brent DA. Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) for the Assessment of Preschool Children- A Preliminary Psychometric Study. Journal of Psychiatric Research, 2009, 43 (7), 680–686.

Brandibas G., Jeunier B., Gaspard J. L., Fouraste R. Evaluation des modes de refus de l’école: validation française de la SRAS (School refusal assessment scale) [Evaluation of schoolrefusal modes: French validation of the SRAS (school refusal assessment scale)]. Psychol, 2001, Psychometrie 22 45–58.

Joh JY., Kim S., Park JL., Kim YP. Relationship between Family Adaptability, Cohesion and Adolescent Problem Behaviors: Curvilinearity of Circumplex Model. Korean Journal of Family Medicine, 2013, 34(3), 169–177.

DYSPHORIA DIMENSIONS: A PRELIMINARY INPATIENTS STUDY TO DIFFRENTIATE BORDERLINE PERSONALITY AND BIPOLAR DISORDER SPECTRUM

Massimo C. Bachetti, MD, Francesca Brufani, MD, Giulio Spollon, MD, & Patrizia Moretti, MD

Abstract
Background: Differentiating Borderline Personality Disorder (BPD) from Bipolar Disorder (BD) represents a very difficult challenge for clinicians. Dysphoria could be a possible key to differentiate these disorders. We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them irritability, discontent, interpersonal resentment and surrender prevail. These dimensions can be detected using the Neapen Dysphoria Scale - Italian version (NDS-I). Dysphoria role in BPD has been highlighted by the recent theorization of the Interpersonal Dysphoria Model, according to which dysphoria could represent the “psychopathological organizer” of the BPD. On the other side, dysphoria role in BD has not yet been established. This is simply considered as an aspect, and not fundamental, of the symptomatology characterizing BD, especially in mixed states patients. The phenomenological analysis of the dimensional spectrum of dysphoria within BPD and DB could provide a valuable aid in the differential diagnosis between BPD and BD.
Aims: The aim of this paper is to verify if the dimensional spectrum of dysphoria differs between Borderline Personality Disorder (BPD) and Bipolar Disorder Spectrum (BD) through an observational comparative study
Methods: In this study, 65 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1st 2018 to April 30th 2019. We have formed 2 groups. A BPD group composed of 33 patients (19 Female patients, representing approximately 57,6 % of the sample) and a BD group composed of 32 patients (18 Female patients, representing approximately 56,2% of the sample). Patient’s comorbid with BD and BPD have been excluded from the study. After a preliminary assessment to exclude organic and psychiatric comorbidity, and after at least 72 hours from hospitalization, we administered them the Neapen Dysphoria Scale – Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and their NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender); For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p < 0.05.
Conclusions: This study allowed us to explore and analyze dysphoria dimensions expressions in BPD and BD. Despite the small sample analyzed, the results show a significant different dimensional spectrum expression of the dysphoria between the two disorders. In particular, Surrender and Interpersonal Resentment dimensions show greater interest in BPD than BD spectrum. Further studies with a larger and stratified sample are needed to confirm these results.

References
1. D’Agostino A, et al. Development, cross-cultural adaptation process and preliminary validation
of the Italian version of the Nepean Dysphoria Scale. Journal of Psychopathology 2016;22:149-156
2. Álvaro Frías, Itziar Baltasar and Boris Birmaher, Comorbidity between bipolar disorder and borderline personality disorder: prevalence, explanatory theories, and clinical impact. Journal of Affective Disorders, http://dx.doi.org/10.1016/j.jad.2016.05.048
3. Ghaemi SN, Bipolar vs. borderline – diagnosis is prognosis once again. Acta Psychiatr Scand 2016: 133: 171–173, DOI: 10.1111/acps.12560
4. Moretti P, Bachetti MC, Sciarma T, Tortorella A. Dysphoria as a psychiatric syndrome: a preliminary study for a new transnosographic dimensional approach. Psychiatria Danubina, 2018; Vol.30, suppl, 7, pp 743-505
5. Starcevic V, et al.: Specificity of the Relationships Between Dysphoria and Related Constructs in an Outpatient Sample. Psychiatr Q 2015. DOI 10.1007/s11126-015-9344-6

A DUAL THERAPEUTIC SETTING MODEL EXPERIENCE TO APPROACH A SCHIZOTYPAL INPATIENT WITH PSYCHOTIC BURNING: A CASE REPORT

Massimo C. Bachetti, MD, Federica Cirimbilli, PsyD, Valentina Pierotti, MD, & Patrizia Moretti, MD

References
1. Berembaum et al, Psychological Trauma and Schizotypal Personality Disorder. Journal of Abnormal Psychology 2008, Vol. 117, No. 3, 502–519 DOI: 10.1037/0021-843X.117.3.502
2. Fonagy, P., Target, M. (2006) The mentalization-based approach to self-pathology. Journal of Personality Disorders, 20, 544-576

Strategic Training: The magic world of change

Maria Grazia Spurio

Abstract
"Before convincing the intellectual part of the mind it is necessary to touch and prepare the heart" this aphorism by Blaise Pascal (Vozza, 1995), refering to one of the most important functions of strategic training, not only being successful in making communicative message correctly and rationally understood, but also involving its addressee, above all by making one enter into emotional syntony with the communicative content. To understand the precious wealth of knowledge that has over time brought the necessary skills to do strategic training, it is necessary to find its roots by taking a step back in time.
It is necessary to go as far as the fifth century BC, with Protagoras and its persuasive efficacy, with a rapid historical excursus passing by Aristotle and his Sophistic communication techniques to arrive at about 2000 years later, passing through social psychology, up to the Palo Alto strategic school. Among its various activities, the Genius Academy Center for Research and Psychological Studies has decided to push two strategic training projects aiming to increase the level of well-being perceived by the addressee and encouraging the desired change. One of the two strategic training projects, A "Journey" in A journey, conceived by the writer, started in 2013. The educational and therapeutic value are amplified by optimizing the suggestions and stimuli of the journey.
Another strategic training project for future aeronautical professionals, which gives a great contribution to the traditional technical training, is an innovative psychological program specifically designed to prepare, not only for technical operational challenges, but also for numerous psychological challenges deriving from working in a very particular environment such as the airport.
It is speficically designed to study and improve the travel experience of people in airport transit and aims to raise the level of traveler's well-being, through a series of highly innovative interventions in specifically provided areas also with the use of digital reality in coping and helping with anxiety and fear of flying.

Key words: strategic training, change, academy, airport

References
1. Augé, M., Nonluoghi. Introduzione a un'antropologia della surmodernità, Elèuthera, 2009
2. Augé, M, Che fine ha fatto il futuro?. Dai non luoghi al non tempo, Elèuthera, 2009
3. Bateson, G., Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. University of Chicago Press. 1972, ISBN 0-226-03905-6
4. Buddha, Dhammapada, in Aforismi e discorsi, a cura di Pio Filippani-Ronconi, Tascabili Economici Newton, Roma, 1994. ISBN 88-7983-439-8
5. Clark, W.E., Licklider, J.C.R., On-Line Man-Computer Communication, Year: 1962, Volume: 1, Pages: 113 DOI Bookmark:10.1109/AFIPS.1962.24

King's College London Global Health Society Event discussing Global Mental Health to increase interest in Psychiatry as a Career

Ahmed Hankir, Deyl Djama, Ho Yi Lo, Frederick R. Carrick, Rashid Zaman

Abstract
Introduction: Despite the launching of multiple initiatives to increase recruitment into psychiatry, the profession continues to remain undersubscribed. Studies have shown that teaching on global mental health can improve attitudes toward psychiatry in medical students. To the best of our knowledge, no studies have been published hitherto that evaluate if a brief teaching session (i.e. 60 minutes in duration) on global mental health improves perceptions of psychiatry and increases interest in this specialty as a career.

Methods: We conducted a single-arm, pre- post- comparison study on participants who attended a King’s College London Global Health Society event on Global Mental Health. Participants completed a survey before and after exposure to the event. Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if a brief teaching session on global mental health would increase interest in pursuing psychiatry as a career.

Results: 71 out of 90 participants responded (77.8% response rate). Following exposure to the event, there were statistically significant improvements in the scores for, “Psychiatry is interesting” (pre-event score 4.41, post-event score 4.66 p value <0.001), “I would talk positively about psychiatry to other people” (pre-event score 4.02, post-event score 4.48 p value <0.00001), and, “I would consider psychiatry as a career” (pre-event score 3.24, post-event score 3.72 p value <0.001).

Discussion: The results of our pilot study suggest that a brief lecture on global mental health may improve perceptions of psychiatry and increase interest in this specialty as a career. We recommend that global mental health be introduced into the medical school curriculum since this may help to increase recruitment into psychiatry.

References
[1] Ajaz, A., David, R., Brown, D., Smuk, M. and Korszun, A. (2016). BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students. BJPsych Bulletin, 40(2), pp.97-102.
[2] Chavan, B. and Aneja, J. (2016). Global mental health movement has not helped in reducing global burden of psychiatric disorders. Indian Journal of Social Psychiatry, 32(3), p.261.
[3] Farooq, K., Lydall, G. and Bhugra, D. (2013). What attracts medical students towards psychiatry? A review of factors before and during medical school. International Review of Psychiatry, 25(4), pp.371-377.
[4] Hankir A & Zaman R: Global strategies targeting the recruitment crisis in psychiatry: the Doctors Academy Future Excellence International Medical Summer School. Psychiatr Danub 2015; 27(Suppl 1):S130-5
[5] Jacob, K., Sharan, P., Mirza, I., Garrido-Cumbrera, M., Seedat, S., Mari, J., Sreenivas, V. and Saxena, S. (2007). Mental health systems in countries: where are we now?. The Lancet, 370(9592), pp.1061-1077.

Alpha power in visuospatial working memory reveals possible inhibitory deficit in schizophrenia

Ruben Perellón-Alfonso, Indre Pileckyte, Grega Repovš, Borut Škodlar, Jurij Bon

Abstract
Visuospatial working memory (vsWM) comprises a set of processes for short-term visual information storage and manipulation that is known to be at the core of many higher-level cognitive functions [1]. Deficits observed in schizophrenia (SCZ) patients were more consistently found in vsWM than in other WM modalities [1,2]. Mechanisms of reduced vsWM capacity in SCZ remain unclear. Our previous work [3] indicated that the observed behavioural and electrophysiological indices of WM storage deficit are mostly attributable to the patients’ inability to exclude task-irrelevant distractors. Since oscillatory alpha activity has been reported as being implicated in the suppression of irrelevant information [4], in the present follow-up analysis, we investigated whether the observed deficit is reflected in induced alpha oscillatory power.
15 schizophrenia patients and 15 age-matched controls completed a visual working memory task with 3 conditions (maintain 2 or 4 items, or maintain 2 items/inhibit 2 distractors) while their EEG was recorded. Data were preprocessed and cleaned and then decomposed into the time-frequency domain by performing Morlet-wavelet convolution. We defined 8 regions of interest (ROIs) covering the left and right frontal, central, parietal and occipital regions.
Mixed design ANOVA with a between-subject factor of the group and within-subject factors of condition, hemisphere and ROI, revealed no significant effect of condition, however, there was a significant interaction between group, hemisphere and ROI (F(7, 168) = 2.57, p = 0.0153). The group and hemisphere interaction were checked for each ROI separately. This revealed a significant group and hemisphere interaction in the parietal (F(1, 24) = 4.387, p= 0.047) and parieto-occipital (F(1, 24) = 5.092, p = 0.0334) regions, with the right hemisphere showing the largest group difference.
The results indicate that SCZ patients have a lesser decrease in induced alpha power during early maintenance of a memory set. However, this was present equally in all conditions, which might point to a general inhibitory deficit reflected by alpha induced oscillatory activity.

References
[1] Luck, S. J., & Vogel, E. K. (2013). Visual working memory capacity: from psychophysics and neurobiology to individual differences. Trends in cognitive sciences, 17(8), 391-400.
[2] Johnson, M. K., McMahon, R. P., Robinson, B. M., Harvey, A. N., Hahn, B., Leonard, C. J., ... & Gold, J. M. (2013). The relationship between working memory capacity and broad measures of cognitive ability in healthy adults and people with schizophrenia. Neuropsychology, 27(2), 220.
[3] Bon, J., Repovš, G., Pileckyte, I., & Škodlar, B. (2016). Variable causes of social dysfunction in schizophrenia: The interplay of neurocognitive, personal, and intersubjective factors. Anthropological Notebooks, 22(2).
[4] Sauseng, P., Klimesch, W., Heise, K. F., Gruber, W. R., Holz, E., Karim, A. A., ... & Hummel, F. C. (2009). Brain oscillatory substrates of visual short-term memory capacity. Current Biology, 19(21), 1846-1852.

DYSPHORIA DIMENSIONAL MODEL FOR FEEDING AND EATING DISORDERS: A PRELIMINARY STUDY.

Roberta Lanzi MD, Massimo C. Bachetti MD, Cecilia Giulietti MD, Margherita Rosi, Patrizia Moretti MD, Alfonso Tortorella MD

Abstract
Background: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are severe psychiatric illnesses which represent the main expression of Feeding and Eating Disorders (FED). Clinicians agree that emotional and behavioural dysregulation play a crucial role in FED. Dysphoria could help us to better understand these components. Indeed, we define dysphoria as a generic state of dissatisfaction and emotional instability, without any specific features. Among the multitude of symptoms, we find that irritability, discontent, interpersonal resentment and surrender prevail. These dimensions correspond to the four subscales of Neapean Dysphoria Scale - Italian version (NDS-I). Dysphoria role in FED has not yet been investigated. Using this test, we can characterize dysphoria both in quantitative and qualitative terms. Accordingly, domain evaluation could discriminate these disorders allowing us to assess possible differential phenomenological expressions.
Aims: The aim of this paper is to understand in which way the dimensional spectrum that composes dysphoria differs between Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorders through an observational comparative study.
Methods: The enrolled sample (30 patients) is represented by patients with a history of FED
(AN, BN or BED). Patients were males and females between the ages of 13 and 45 with a good knowledge of Italian language. Patients with severe cognitive impairment (MMSE <19) and civil incapacitation were excluded. Patients were recruited from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), and other residential and semiresidential structures specialized in FED treatment (FED specialized center at Palazzo Francisci in Todi (PG), Nido delle Rondini in Todi (PG), BED (Binge Eating Disorders) center in Città della Pieve (PG) and ambulatory services for FED in Umbertide (PG)). We administered them the Neapen Dysphoria Scale – Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender). For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p < 0.05.
Conclusions: This study allowed us to better understand and characterize the most common Eating Disorders. Beyond that, despite the small sample size, we found in our analysis statistically significant difference in the expression of various dysphoria dimension spectrum inside our 3 groups.

References
1. Barajas-Iglesias B, Jáuregui-Lobera I, Laporta-Herrero I, Santed-Germán MA: Eating disorders during the adolescence: personality characteristics associated
with anorexia and bulimia nervosa. NutrHosp.2017; 34(5):1178-1184
2. Cimbolli P, Quinones A, Ugarte C, De Pascale A. Pilot study on nutritional and eating disorders in children and mood disorders: comorbidity or prodromal traits? Riv Psichiatr. 2017 Jan-Feb; 52(1):32-39
3. D'Agostino et al: Development, cross-cultural adaptation process and preliminary validation of the Italian version of the Nepean Dysphoria Scale. Journal of Psychopathology 2016; 22: 149-156
4. Moretti P, Bachetti MC, Sciarma T and Tortorella A: Dysphoria as a psychiatric syndrome: A preliminary study for a new transonographic dimensional approach. Psychiatria Danubina, 2018; 30(7)
5. Racine SE & Horvath SA: Emotion dysregulation across the spectrum of pathological eating: Comparisons among women with binge eating, overeating, and loss of control eating. Eating Disorders 2018; 26(1):13–25

Circadian rhythms disruptions and eating disorders: clinical impact and possible psychopathological correlates

Giulia Menculini, MD, Francesca Brufani, MD, Valentina Del Bello, MD, Patrizia Moretti, MD, Alfonso Tortorella, MD

Abstract
Background: A link between abnormalities in circadian rhythms and the development of eating disorders was extensively hypothesized, mainly in consideration of the influence of the circadian clock on eating behavior. The present review is aimed at summarizing the evidence about biological rhythms disruptions in eating disorders, possibly clarifying their impact on the psychopathological profile of such patients. Methods: Electronic database MEDLINE/PubMed/Index Medicus was systematically searched for original articles examining the prevalence of circadian rhythms disruptions in eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). Results: Studies included in the review confirmed the hypothesis of a high prevalence of circadian disruptions in eating disorders. The analyzed research mainly focused on sleep-wake cycle, rest-activity abnormalities and hormonal secretion, whilst literature about other circadian rhythms was scanty. Altered biological rhythms presented higher association with specific psychopathological features, but such relationship was assessed in few studies. Conclusions: Circadian rhythms disruptions were confirmed to be relevant aspects in the context of eating disorders. Further research is needed in order to clarify the role of biological rhythms in such illnesses, in the attempt to address adjunctive treatment strategies with the possible focus of circadian abnormalities.

References
Allison KC, Spaeth A, Hopkins CM: Sleep and Eating Disorders. Curr Psychiatry Rep 2016; 18(10): 92.
Asaad Abdou T, Esawy HI, Abdel Razek Mohamed G, Hussein Ahmed H, El-Habiby MM, Khalil SA et al: Sleep profile in anorexia and bulimia nervosa female patients. Sleep Med 2018; 48: 113-6.
Kandeger A, Egilmez U, Sayin AA, Selvi Y: The relationship between night eating symptoms and disordered eating attitudes via insomnia and chronotype differences. Psychiatry Res 2018; 268:354-7.
Mendoza J: Food intake and addictive-like eating behaviors: Time to think about the circadian clock(s). Neurosci Biobehav Rev 2018; S0149-7634(18)30115-5.

CLINICAL UTILIZATION OF THE RATING SCALE OF MIXED STATES (GT-MSRS) IN A PSYCHIATRIC INPATIENT UNIT: A RETROSPECTIVE STUDY

Alba Cervone, Giuseppe Cimmino, Francesco Paolo D’Ostuni, Giulia Esposito, Manlio Russo, Giuseppe Tavormina

Abstract
Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. For this reason, we analyzed retrospectively data from patients admitted in the Psychiatric Hospital from January 1st to April 30th 2019 to identify clinical features of the mixed states by administering the G.T. MSRS scale. Within the 90 subjects of the sample, the large majority (75 %) met criteria for mixed state. Of those only 16 were discharged with a diagnosis of Affective Disorder, however 26 (30.9 %) were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.

References
Tavormina G. “Treating the bipolar spectrum mixed states: a new rating scale to diagnose them”. Psychiatria Danubina, 2014; 26: suppl 1: 6-9.
Tavormina G., Clinical utilisation of the "G.T. MSRS", the rating scale for mixed states: 35 cases report. Psychiatr Danub. 2015 Sep; 27: Suppl 1: 155-9.
Tavormina G., An approach to treat bipolar disorders mixed states. Psychiatr Danub 2016; 28: suppl 1:9-12.
Tavormina G, Franza F., Stranieri G , Juli L and Juli MR. Clinical utilisation and usefullness of the rating scale of mixed states, ("GT-MSRS"): a multicenter study. Psychiatria Danubina, 2017; Vol. 29, Suppl. 3, pp 365-367.
Vieta E, Valentí, M. Mixed states in DSM–5: implications for clinical care, education, and research. J Affect Disord. 2013; 148(1): 28–36; Epub ahead of print Apr 2.

The emotional and psychological burden of the “burnout” in families of psychiatric patients

Francesco Franza

Abstract
People, who assist patients with chronic health problems for work, voluntary or family reasons, may be affected by burnout. This is defined as an excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure. A person who assists a suffering person, beyond the professional role, is indicated generally by the term “caregiver”. The definition of Burnout in families is fairly recent, because the psychology of trauma has ignored a large segment of traumatized and disabled subjects (family and other assistants of "suffering people) unwittingly, for a long time. The burnout of secondary stress is due to one’s empathic ability, actions trough disengagement, and a sense of satisfaction from helping to relieve suffering. Figley (1995) claims that being a member of a family or other type of intimate or bonded interpersonal relationship, one feels of the others‘ pain. Closely associated with the suffering of the family caregiver is the concept of compassion fatigue, defined as a state of exhaustion and disfunction-biologically, psychologically, and socially - as a result of prolonged exposure to compassion stress and all that it evokes. In families, this can be the cause of serious conflicts and problems, quarrels, verbal and physical aggression, and broken relationships. The intervention on families requires practice and effectiveness approaches performed by experienced professionals. Some approaches focus more specifically, such as those that adopt a cognitive/behavioral technique with direct exposure, implosion methods, various drug treatments, family group psychotherapy. One of the most common models of intervention is based on the principle that the observation unit for the understanding of the disorder is not the single individual but the relationship between individuals.

References
0825672711

Suicidal behaviour between environmental and genetic factors

Peter Pregelj, Tomaž Zupanc, Alja Videtič Pasha

Abstract
Suicidal behaviour has multiple causes that are broadly divided into hereditary and environmental factors including proximal stressors or triggers such as job loss. Global economic crisis could increase suicidality, with men of working age being at the highest risk. Unemployment seems to be a very strong predictor of suicide rates on a national end regional level, unequal availability of mental health services and quality of depressive disorder treatment may contribute to variations in suicide rates in different regions (1). Beside economic factors climatic effects such as cold climate is associated with variations in suicide rates between countries (2). It seems that environmental factors play stronger role than the economic factors. In Europe suicidality follows the climate/temperature cline from south to north-east (2,3). On the other hand, the pathogenesis of suicidal behaviour predetermined with genetic end epigenetic factors involves altered neural plasticity, resulting in the aberrant stress response of the central nervous system to environmental factors. Although psychiatric disorder is a major contributing factor it seems that genetic risk factors could not be attributed to genetic risk factors for a mental disorder alone. Expression of variety of genes is associated with suicidal behaviour such as neurotrophins including brain-derived neurotrophic factor (BDNF) which are involved in the regulation of structural, synaptic, and morphological plasticity and in the modulation of the strength and number of synaptic connections and neurotransmission in different neuronal systems such as serotoninergic (4). Despite vast knowledge on suicidal behaviour a multifactorial interplay between genetic and environmental factors is poorly understood.

References
1. Fountoulakis KN, Kawohl W, Theodorakis PN, Kerkhof AJ, Navickas A, et al. Relationship of suicide rates to economic variables in Europe: 2000-2011. Br J Psychiatry. 2014;205(6):486-96.
2. Fountoulakis KN, Chatzikosta I, Pastiadis K, Zanis P, Kawohl W et al. Relationship of suicide rates with climate and economic variables in Europe during 2000-2012. Ann Gen Psychiatry. 2016;15:19.
3. Jagodic HK, Agius M, Pregelj P. Inter-regional variations in suicide rates. Psychiatr Danub. 2012 Sep;24 Suppl 1:S82-5. Review.
4. Pregelj P, Nedic G, Paska AV, Zupanc T, Nikolac M, Balažic J, Tomori M, Komel R, Seler DM, Pivac N. The association between brain-derived neurotrophic factor polymorphism (BDNF Val66Met) and suicide. J Affect Disord. 2011;128(3):287-90.

EATING DISORDERS: THE ROLE OF CHILDHOOD TRAUMA AND THE EMOTION DYSREGULATION

1Filippo Brustenghi MD, 1Francesca Alice Fiore Mezzetti MD, 2Cristina Di Sarno, 1Cecilia Giulietti MD, 1Patrizia Moretti MD & 1A

Abstract
Background: The present retrospective case-control study is aimed at evaluating the presence of childhood traumatic factors and the difficulty in regulating emotions, within a sample of patients with eating disorders compared to the group of healthy controls.
Subjects and Methods: We included 65 people assessed for eating disorders, 40 patients and 25 healthy controls, who were given two tests: the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to investigate the presence of traumatic events and the Difficulties in Emotion Regulation Scale (DERS) to assess the emotional regulation.
Results: People with eating disorders showed higher average scores, and therefore greater severity than the control group, in all the domain explored, both considering traumatic experiences and emotional dysregulation. The domain emotional neglect showed the closest correlation with eating disorders (average scoring 15,9 vs 9,9 of healthy controls), followed by emotional abuse (12,2 vs 7,8), physical abuse (8,3 vs 6,6), physical neglect (8,2 vs 6,6) and sexual abuse (7,2 vs 5,6). In the same way, the emotional dysregulation was greater among people with eating disorder than healty controls, concerning every items explored by DERS, as clarity (average scoring 14,8 vs 11,4), awareness (17,1 vs 11,7), goals (16,3 vs 12,9), strategy (22,0 vs 14,7), non acceptance (17,4 vs 12,1) and impulse (16,5 vs 11,4).
Conclusions: Childhood traumatic experiences and emotional dysregulation result significantly higher in people with eating disorders than healthy controls.
Key words: eating disorders-childhood trauma-emotional disregulation

References
Cimbolli P, Quinones A, Ugarte C, De Pascale A. Pilot study on nutritional and eating disorders in children and mood disorders: comorbidity or prodromal traits? Riv Psichiatr. 2017; Jan-Feb;52(1):32-39.
Caslini M, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carrà G.: Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med. 2016 Jan;78(1):79-90

Using Experts by Personal and Professional Experience (EPPE) to increase interest in Psychiatry as a Career at Sixth-Form Level

Ahmed Hankir, Jahangir Mahmood, Nour Houbby, Sabah Ali, Frederick R. Carrick, Rashid Zaman

Abstract
Background: Psychiatrists play a multifaceted and critical role in improving the lives of people with mental illness. However, despite how rewarding, important and thrilling a career in mental health is, there continues to remain a shortage of psychiatrists in Low-, Middle- and High-Income Countries. There has been resurgence in interest in improving the image of psychiatry over recent years and several initiatives have been launched to increase recruitment into the specialty at Sixth Form level in the UK.
Design: We conducted a single-arm, pre-post, comparison study with Sixth Form students at an inner-city school in London. Students were invited to complete a survey before and after exposure to an assembly on mental health that was delivered by an Expert by Personal and Professional Experience (EPPE). Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if there was an increase in interest in pursuing this profession as a career in this group.
Results: 63 out of 123 participants completed the before and after survey (51% response rate). Following exposure to the assembly, there were statistically significant improvements between the pre- and post- intervention means for, “Psychiatry has a positive impact on peoples’ lives” (p value < 0.0001), “People with mental illness can achieve success and be the best at what they do” (p value < 0.0001) and, “I would consider psychiatry as a career” (p value < 0.0001).
Discussion: Notwithstanding the limitations of this pilot study, our findings suggest that an assembly on mental health delivered by an EPPE (i.e. ‘Wounded Healer’) might be effective at increasing interest in psychiatry as a career at Sixth Form level. We suggest that assemblies on mental health and psychiatry be delivered by ‘Wounded Healers’ in schools and colleges nationwide to help drive recruitment into psychiatry.

References
(1) Adekunte O, Owen B, Oliver C. (2016). Before and after: Effect of 4-week psychiatry attachment on medical students’ attitude to psychiatry as a career choice. European Psychiatry. 33: S434-S434
(2) Agyapong VIO, McLoughlin D. (2012). Promoting Psychiatry as a Career option for Ghanaian Medical Students Through Public-Speaking Competition. 36(3): 229-232
(3) Ahmed K, Bennett DM, Halder N, Byrne P. (2015). Medfest: The Effect of a National Medical Film Festival on Attendees’ Attitudes to Psychiatry and Psychiatrists and Medical Students’ Attitudes to a Career in Psychiatry. Academic Psychiatry. 39(3): 335-8
(4) Archer A, Guliani J, Johns F, McCartney E et al. (2017). Effectiveness of a single day induction programme in changing medical students’ attitudes towards the specialty of forensic psychiatry. Australasian Psychiatry. 25(1): 73-77
(5) Beattie S, Lister C, Khan JM, Cornwal PL. (2013). Effectiveness of a summer school in influencing medical students' attitudes towards psychiatry. BJPsych Bulletin. 37(11): 367-371

PSYCHOPATHY IN ADOLESCENCE: CAUSES, TRAITS AND RISK BEHAVIOURS

MARIA VINCENZA MINO'

Abstract
Psychopathy is a personality disorder defined by a specific set of behaviours and personality traits evaluated as negative and socially harmful.
The modern conception of Psychopathy was introduced by Clerckley in "Mask of Sanity" (1941), and refined by Hare with the construction of the PCL (1980, 1991), a gold standard instrument for the evaluation of the disorder. Manipulation, deception, grandeur, emotional superficiality, lack of empathy and remorse, impulsive and irresponsible lifestyle, persistent violation of social norms and expectations (Cleckley, 1976; Hare, 2003) are some behavioural aspects that characterize psychopathic subjects.
With this work we intend to study in depth the causes, the traits, in particular the so-called callous- unemotional and risk factors that lead a teenager to become a psychopathic subject.
The diagnostic tools useful for the assessment and for the possibilities of intervention that can be put into practice will also be described.

References
Clecley, H.M. (1941). The Mask of Sanity. Louis, MO: Mosby.
Frick, P. J., & Ellis, M. (1999). Callous–unemotional traits and subtypes of conduct disorder. Clinical Child and Family Psychology Review, 2, 149–168.
Hare, R. D. (1985). The Psychopathy Checklist. Unpublished manuscript, University of British Columbia, Vancouver, Canada
Hare RD. La psicopatia, valutazione diagnostica e ricerca empirica. Astrolabio,2009.
Sabatello U. (2010). Lo sviluppo antisociale: dal bambino al giovane adulto. Una prospettiva psichiatrico-forense. Raffaello Cortina Editore.

The role of the doctor versus other healthcare professionals in the treatment of serious mental illness in the community

X. Maria Wang, Mark Agius

Abstract
What is the importance of the doctor-patient relationship to patients? Is the specific importance of the relationship relevant only to doctors, or does it actually encompass also any empathetic relationship between any health professional and a patient? This question is of particular interest when considering the development of Community Mental Health Teams, where the ‘Case Manager’ or ‘Care Co-Ordinator’ – usually a community psychiatric nurse or a social worker – takes on the role of the healthcare provider the patient is most regularly in contact with (Department of Health 1990). Similarly, a practice nurse in General Practice may be the healthcare professional a patient is most familiar with. Therefore, for patients with chronic mental illness and receiving long-term care, a doctor is not always the service provider they see most frequently (Laurant 2018). Patients value continuity of care, compassion, and mutual trust and respect: these qualities can all be provided by any trained healthcare professional (Johansson & Eklund 2003).

In the modern era, non-doctor and patient relationships play an increasingly important role in improving the patient experience and contributing to information gathering, shared-decision making, and establishment and adherence of treatment plans (Girard 2017). If therapeutic benefits of the doctor-patient relationship are attainable through patient relationships with other healthcare service providers, could the ‘Care Co-Ordinator’ take over the traditional ‘Doctor’ role in the management of chronic mental illness in the community?

References
Department of Health (DoH) (1990) Caring for People: The care programme approach. for people with a mental illness referred to the specialist, psychiatric services. London: DoH.
Girard, A. et al., 2017. Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study. Journal of Clinical Nursing, 26(9-10), pp.1385–1394.
Johansson, H. & Eklund, M., 2003. Patients’ opinion on what constitutes good psychiatric care. Scandinavian Journal of Caring Sciences, 17(4), pp.339–346.
Laurant, M. et al., 2018. Nurses as substitutes for doctors in primary care. The Cochrane database of systematic reviews, 7(7), p.CD001271.

Language in mild depression: how it is spoken, what it is about and why it is important to listen

Smirnova Daria, Romanov Dmitry, Sloeva Elena, Kuvshinova Natalia, Cumming Paul & Nosachev Gennadii

Abstract
Background: Previous research demonstrated that mild depression (MD) is characterized by patterns of atypical language use such as inverted word order, greater repetition, increased use of reflexive/personal (e.g. myself) or negative/indefinite (e.g. nobody) pronouns, verbs in past tense, and other lexico-grammatical, stylistic and syntactic indicators (how the patient speaks) [1,2,3]. We now investigate the role of semantic features (what the patient speaks about) in diagnosing (why it is important to listen) affective states.
Subjects and methods: 201 written narratives from 124 patients with MD and 77 healthy controls (HC), including 35 cases of normal sadness (NS), were studied using principle component lexis analysis. Statistical data evaluation was performed with SPSS-25 (p<0.05, significant) and included the Cohen's kappa for inter-rater reliability, nonparametric methods to measure between-group differences (Mann-Whitney U-test, Pearson Chi-square test, Kruskal-Wallis, one-way ANOVA) and discriminant analysis for modeling of semantic variables related to affective diagnostic types.
Results: Component lexis analysis revealed an exaggerated usage of semantic categories describing existential and family values in the texts of MD patients compared to HC. However, there were fewer cognitive and altruistic categories presented in patients’ self-reports. The most substantial between-group difference was the decreased semantics of self-realization in MD, as well as the significantly lower ranking of social status’ priorities. Communicative and hedonic values in MD speech displaced and predominated in ranking over the values of social status, versus the opposite relationship in HC speech. The discriminant model revealed a set of semantic indicators significantly distinguishing the MD, HC and NS groups (96.3%; Wilks’λ=0.001, p<0.001, r=0.996).
Conclusions: Linguistic structure and content of patients’ verbalizations may serve as diagnostic markers of MD. Evaluation of psychosocial themes within the content of narratives should enable a better understanding of MD pathogenesis and emphasize the importance of monitoring social difficulties during treatment.

References
1. Bucci W & Freedman N: The language of depression. Bull Menninger Clin 1981; 45: 334–358.
2. Pennebaker JW, Mehl MR, Niederhoffer KG: Psychological aspects of natural language use: our words, our selves. Annu Rev Psychol 2003; 54: 547–577.
3. Smirnova D, Cumming P, Sloeva E, Romanov D, Kuvshinova N, Nosachev G: Language patterns discriminate mild depression from normal sadness and euthymic state. Frontiers in Psychiatry 2018; 10 (9): 105.

Gaming - opportunities and challenges in supporting functioning in patients with schizophrenia

Valimaki M, Tsun Ho Choi W, Kin Sun Yu D, Wong T, LAM YTJ, Lantta T, Pekurinen V, Yang Min, Wai Ming T.

Abstract
Cognitive impairments, a core feature of schizophrenia, is the strongest predictor of functioning and psychosocial outomes and an important factor in determining a patient's ability to engage in daily life and adhere to treatment. Therefore, motivational impairments and deficits in decision making make cognition a good treatment target for patients with schizophrenia. However, prior approaches to improve functional outcomes in schizophrenia are limited in their efficacy and high dropout rates. New types of treatment are needed to promote recovery, optimize rehabilitation and support motivation in patients with schizophrenia. Video gaming has opened new opportunities for patients’ rehabilitation. However, there is still a lack of knowledge how reasonable and realistic it is to design gaming interventions for patients with schizophrenia who often are excluded from the information society. In this presentation, first, a survey result about the habits and attitudes of video gaming and information technology among patients with schizophrenia will be reported. The data have been collected from 110 persons at community-based mental health services in Hong Kong. Second, two small-scale feasibility studies aiming to identify patients’ gaming behavior will be overviewed. These feasibility studies offer important knowledge about practical arrangements for the larger study to be run in the local settings. And third, in the ongoing clinical trial, we are testing the effectiveness of gaming intervention on clinical and neurocognitive outcomes in patients with schizophrenia over a six-month follow-up. If significant positive outcomes of the gaming can be found, the gaming intervention could be used locally and internationally in mental health services.

References
Saboo AV, Deshmukh PS, Deshmukh. SB. Study on non-compliance in patients of schizophrenia. J Evol Med Dent Sci. 2015;4(47):8112-8.
Suenderhauf C, Walter A, Lenz C, Lang UE, Borgwardt S. Counter striking psychosis: commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies. Neurosci Biobehav Rev. 2016;68:20-36.
Desseilles M. Perspectives on games, computers, and mental health: questions about paradoxes, evidences, and challenges. Front Psychiatry. 2016;7:122.

Hajj and the Mental Health of Muslim Pilgrims: A review

Ahmed Hankir, Zavid Chariwala, Usman Siddique, Frederick R. Carrick, Rashid Zaman

Abstract
Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can result in high rates of morbidity and mortality from communicable and non-communicable diseases, ‘accidents’ and, over recent years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj annually, it has been described as, ‘The largest and longest-standing mass gathering event on Earth’. Although Hajj is a spiritual experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims. This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with the mental health of pilgrims.

References
[1] Alnabulsi H, Drury J (2014) Social identification moderates the effect of crowd density on safety at the Hajj. Proc Natl Acad Sci 111(25):9091–9096. https ://doi.org/10.1073/pnas.1404953111
[2] Bakhtiari M,Masjedi Arani A, Karamkhani M, Shokri Khubestani M, Mohammadi H. Investigating the Relationship between Hajj Pilgrimage and Mental Health among Sharif University of Technology Students. J Res Relig Health. 2017; 3(2): 78- 87.
[3] Clingingsmith, David, Asim Ijaz Khwaja, and Michael R. Kremer. 2009. Estimating the impact of the Hajj: Religion and tolerance in Islam's global gathering. Quarterly Journal of Economics 124(3):
[4] Fateh, M., Mousavi, S.A., Sohrabi, M.B. et al. J Relig Health (2019). https://doi.org/10.1007/s10943-019-00825-7
[5] Hankir A, Khalil S, Wadood Q, Madarbukus D, Yunus HA, Bibi S, Carrick FR, Zaman R. The Federation of Student Islamic Societies programme to challenge mental health Stigma in Muslim communities in England: The FOSIS Birmingham study. Psychiatr Danub. 2017 Sep;29(Suppl 3):512-520.

The prevalence of Lyme disease and associated co-infections in people with a chronic post-concussive syndrome

Sergio Azzolino, Ahmed Hankir, Rashid Zaman, Frederick R Carrick

Abstract
Introduction: There is increasing awareness that Lyme borreliosis (LB) and traumatic brain injuries (TB) may cause mental health symptoms. Traumatic brain injuries and Lyme disease compromise the health and activities of millions of patients per year. The chronic symptoms and disability of TBI and Lyme disease share a similar clinical presentation. We have identified an alarming number of individuals suffering from post-concussion syndrome (PCS) that are refractory to care and that have serologically tested positive for Lyme disease.

Methods: A single-center retrospective review of patient charts that were symptomatic a minimum of one year after a TBI that were tested for Lyme disease to ascertain if there was a relationship.

Results: 217 PCS patient records (93 females with a mean age of 34 years, 120 males with a mean age of 40 years and 4 individuals with unknown gender) were included in the review. 38% had a positive Western Blot Igenex IgM. There was a statistically significant relationship of a positive Western Blot Igenex IGM predicting chronic PCS Pearson (1) = 6.8866, P = 0.009, Fisher’s exact score p = 0.015 and an effect size = 0.2813 representing a moderate effect size.

Conclusions: Long term PCS over one year’s duration is associated with undiagnosed Lyme disease. There was statistical and substantive significance between individuals with chronic PCS having a positive Western Blot Igenex IgM. Males were more likely to have a positive Western Blot IgenexIgM than females.

References
1. Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist's Clinical Practice. Healthcare (Basel) 2018;6.
2. Rice SM, Parker AG, Rosenbaum S, Bailey A, Mawren D, Purcell R. Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. Sports Med 2018;48:447-65.
3. Yang MN, Clements-Nolle K, Parrish B, Yang W. Adolescent Concussion and Mental Health Outcomes: A Population-based Study. Am J Health Behav 2019;43:258-65.
4. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation 2007;22:341-53.
5. Younger DS. Epidemiology of Lyme Neuroborreliosis. Neurologic clinics 2016;34:875-86.

Perceived Academic and Psychological Stress among Adolescents in the United Arab Emirates: Role of gender, age, depression, and

NMAlia, NA Nowshada, KM Mansoora, RA Ibnoufa,RM Albehierya , FR Carrick, M Abdulrahman

Abstract
Introduction: Academic learning is the most important source of stress among young students worldwide and appears to be quite severe in eastern countries. We aimed to examine the relationship between academic stress and depression among adolescents.
Methods: A cross-sectional study was conducted among adolescents in United Arab Emirates using the Perceived Stress Scale – 14 (PSS-14) and Educational Stress Scale (ESS) for Adolescents (English and Arabic versions).
Results: The overall PSS was high in 186 (20%) of the respondents, and moderate in 695 (76%). A multiple regression model of predictors of the PSS showed statistically significant correlations between the total PSS-14 scores and age (p<0.0004), gender (p<0.0001), and grade (p<0.001). A multiple regression model of the PSS-14 questionnaire as predictors of the ESSA revealed that Four variables on PSS-14 were statistically significant predictors of the ESSA: history of depression (p<0.0001), content with academic achievement (p<0.0001), high academic expectation of parents (p<0.003), and a believe capable of meeting parental expectations (p<0.0001).
Conclusions: Adolescents with severe academic stress need to be identified early. We suggest that an interdisciplinary team in the schools including student advisors and counselors be developed to further address stressors. In addition, students should be taught different stress management techniques such as cognitive behavioral skills to improve their ability to cope with school demands. The identification of stressors may lead to strategies that might address the quality of teaching and mental health evaluation among adolescents.

References
Aanesen, F., Meland, E. & Torp, S. 2017, "Gender differences in subjective health complaints in adolescence: The roles of self-esteem, stress from schoolwork and body dissatisfaction", Scandinavian Journal of Public Health, vol. 45, no. 4, pp. 389-396.
Aaron, R., Joseph, A., Abraham, S., Abraham, V.J., Muliyil, J., George, K., Prasad, J., Minz, S. & Bose, A. 2004, "Suicides in young people in rural southern India", The Lancet, vol. 363, no. 9415, pp. 1117-1118.
Anderman, E.M. 2002, "School effects on psychological outcomes during adolescence", Journal of Educational Psychology, vol. 94, no. 4, pp. 795-809.
Ang, R. & Huan, V. 2006, "Relationship between Academic Stress and Suicidal Ideation: Testing for Depression as a Mediator Using Multiple Regression", Child Psychiatry and Human Development, vol. 37, no. 2, pp. 133-143.
Ang, R., Huan, V., Li, X. & Chan, W. 2016, "Factor Structure and Invariance of the Reactive and Proactive Aggression Questionnaire in a Large Sample of Young Adolescents in Singapore", Child Psychiatry & Human Development, vol. 47, no. 6, pp. 883-889.

IDENTIFICATION AND EVALUATION OF COGNITIVE DEFICITS IN SCHIZOPHRENIA USING "MACHINE LEARNING"

Vacca Antonella, Longo Roberto, Mencar Corrado, Bertolino Alessandro

Abstract
The study aims to demonstrate how the values detected by specific neurocognitive tests, examined through "Machine Learning" techniques, can be a useful support for the diagnosis and specific rehabilitation treatments of severe mental disorder such as schizophrenia.
The most characteristic cognitive deficits of schizophrenia, already present in the initial phase or before the full-blown disorder, were identified, and, through Machine Learning techniques, a comparison was made among the values of the cognitive variables detected on a sample of 201 subjects divided into two groups: one diagnosed with schizophrenia and the other without a psychiatric pathology diagnosis.
Machine Learning is the scientific study of algorithms and statistical models that computer systems use in order to perform a specific task effectively without using explicit instructions, relying on patterns and inference instead. Having a set of already classified data, we are dealing with supervised learning.
The data were properly prepared, a training set was extracted from the initial sample and appropriately validated, some machine learning algorithms were selected, and, after many simulations, the most performing algorithm was chosen. Finally, this model was applied to the test set and the results were evaluated.
The Machine Learning model can identify the cognitive variables that best discriminate between the two groups and can make predictions with respect to the differentiation between healthy people and those with schizophrenic disorder with an accuracy higher than the 85%.
This model can be an efficient and effective tool to support the diagnosis of schizophrenia due to the greater ease of access to cognitive data obtained through neuropsychological tests, compared to the more complex neuroimaging techniques (PET and fMRI).

References
1) Berthold M. R., Borgelt C., Höppner F., Klawonn F., (2010). Guide to Intelligent Data Analysis, Springer.
2) Bertolino A. et al. (2006). Prefrontal dysfunction in schizophrenia controlling for COMT val158met genotype and working memory performance. Psychiatry Research: Neuroimaging, 147(2-3):221-6.
3) Gold, J. M. (2004). Cognitive deficits as treatment targets in schizophrenia. Schizophr Res 72(1): 21-8.
4) Kelleher Andrew, Kelleher Adam (2019). Machine Learning in Production, Addison Wesley.
5) Zanelli J, Reichenberg A, Morgan K et al (2010). Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations. Am J Psychiatry 167:78-85.

Treatment compliance and suicidal behavior

Sočan V, Faculty of Pharmacy, University of Ljubljana; Kržan M, and Zupanc T, Faculty of Medicine, University of Ljubljana

Abstract
Suicide is one of the leading causes of premature death in Western countries. In Slovenia rate of suicide is still above the European average. Risk for suicide is greater among those who suffer from psychiatric illness, particularly depressive or schizophrenic disorder.

The focus of our study was evaluation of compliance of suicide victims with mental illness, who committed suicide in years 2015-2017, to prescribed antidepressants and/or antipsychotics. Retrospective study included 385 suicide victims from western Slovenia. Demographyc data (age, gender) toxicology findings, alcholometric analysis and other variables were provided by the Institute of Forensic Medicine, Medical Faculty, University of Ljubljana. Data on prescribed medicines with effect on the central nervous system were provided by the National Institute of Public Health. Data analysis disclosed that drug adherence could be assessed in 179 suicide victims who were prescribed antidepressants and/or antipsychotics at least five years before their death. We found out that only 43 (24 %) suicide victims with prescribed antidepressants and/or antipsychotics were compliant to the treatment up to three months before suicide. We found out that the proportion of those who had attempted suicide in the past was greater in the group of suicide victims with prescribed antidepressants and/or antipsychotics compared to to those with no therapy. Treatment of mental illness from one pharmacodynamic group versus treatment with a combination of antidepressants and antipsychotics, i.e. from several pharmacodynamic groups, had no statistically significant effect on compliance. We have also not found a significant relation between frequent therapy modifications and lesser adherence. Frequent and long-term use of anxiolytics, hypnotics, and sedatives was observed in suicide victims with prescribed medication with effect on the central nervous system.

Poor adherence to prescribed therapy for mental illness represents a major impediment in achieving the desired clinical results and greatly increases the risk of suicide. In order to reduce suicidality, monitoring patient adherence among those who suffer from mental illnesses is of great importance.

References
Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and futuredirections. Patient Prefer Adherence. 2012; 6:369–388.
Mulder R, Hamilton A, Irwin L, Boyce P, Morris G, Porter RJ, Malhi GS, Treating depression with adjunctive antipsychotics. Bipolar Disord 2018; 20(2): 17-24.
Martin-Vazquez MJ. Adherence to antidepressants: A review of the literature. Neuropsychiatry; 2016; 6; 236-241.
Youssef NA, Rich CL. Does acute treatment with sedatives/hypnotics for anxiety in depressed patients affect suicide risk? A literature review. Ann Clin Psychiatry. 2008; 20(3):157-69.

Evaluation of a destigmatisation program for adolescents

Saša Kocijančič

Abstract
Background:
Medical students started a destigmatisation program called Project In reflection that deals with prevention in the field of mental health. The main purpose is to de-stigmatize and raise mental health awareness among adolescents.
Aims:
The program was evaluated on how it decreases stigmatisation. The interventions were the projects workshops for adolescents, and we compared their attitudes towards mental disorders at different intervals in time to assess the short and long term effectiveness.
Methodology:
Workshops of the project In reflection were performed in 6 different high schools in Slovenia over the course of 6 months. Each workshop had approx. 30 high schoolers aged between 14–19, altogether 539 adolescents. The workshop lasted 2 school hours during which 2 medical students used a peer to peer method of education. A questionnaire (Wolff G.) was given to the participants before and after the workshop, and one year later, without a booster session in between. Standard paired T-test was used, with a value of p<0,05.
Results:
A total of 486 out of 539 high schoolers responded (90% response rate) before and 425 after the workshop (79%). Comparison before and right after the workshop yielded a significant improvement of adolescents attitude (less stigmatising) towards people with mental disorders. 288 adolescents who participated in the workshops and answered the questionnaire 1 year later (53%). Comparison before the workshop and 1 year later showed an improvement - towards less stigmatizing attitude. Comparison between the workshop assessment after and a year later showed also an improvement.
Conclusion:
The destigmatisation program ‘Project In reflection’ with its workshops for adolescents gave results that indicate the persistence of the change in less stigmatising attitude. The change was not only short term, but also long term, without an intervention in between.

References
- Wolff G, Pathare S, Craig T, Leff J. Community knowledge of mental illness and reaction to mentally ill people. The British Journal of Psychiatry. 1996 Feb;168(2):191–198.
- Pinfold V, Toulmin H, Thornicroft G, et al. Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. The British Journal of Psychiatry. 2003 Apr;182(4):342–346.
- Yoshioka K, Reavley NJ, MacKinnon AJ, Jorm AF. Stigmatising attitudes towards people with mental disorders: results from a survey of Japanese high school students. Psychiatry Res. 2014 Jan;215(1):229–36.
- Serra M, Lai A, Buizza C, et al. Beliefs and attitudes among Italian high school students toward people with severe mental disorders. J Nerv Ment Dis. 2013 Apr;201(4):311–8.

Bodymemory, war and conflict: A pilot research project on a non-verbal body-centered approach to support the mental health and a

Dr. phil. Beatrice Schlee, Prof. Dr. Mone Welsche

Abstract
Bodymemory, war and conflict: A pilot research project on a non-verbal body-centered approach to support the mental health and agency of female Muslim refugees in Germany

Since more than two decades, neuroscientific findings have emphasized the close interconnection between the body and the brain, between the physical realm, cognition and emotions (Tschacher & Bergomi 2011). However, body-centered approaches to support the mental health situation of victims of war and conflict are still little known to professionals, international organisations and the wider public. In our interdisciplinary pilot research project we assume that the experiences of conflict, flight and arrival in the host community have left visible traces in the memory of the bodies of Muslim refugees (Fuchs 2012) and impact negatively on their “agent bodies” (Coole 2005). Through a mixed-method approach we are analyzing the impact of our intervention - a Body-Mind Centering® course of 90 min. with weekly sessions during 8 weeks – on the inner state (vitality, intrapsychic equilibrium), body image and body space of eight female refugees from the Middle East. Changes in body image were measured with the body-sculpture test (Stefini & Löwe 2008) and the body image questionnaire (FKB-20) in a pre-post design (Clement & Loewe, 1996) . We were particularly interested in body image as trauma research considering neurophysiology suggests “frozen” and immobile bodies due to traumatizing events (van der Kolk 2015). From our different research instruments, the body-sculpture test emerged to be the most powerful bodily narrative instrument. Even in this short intervention, anatomically incomplete sculptures, tended to get back their missing body parts (legs, arms). Far beyond our expectations, somatic resources particularly within the female Muslim community were easy to be accessed and freed up with positive results regarding the emotional state, vitality, alive presence (versus dissociative states) of the participants. Our embodied research approach revealed not only harm, fatigue and but equally strength, resources and resistance. The core of the method chosen, experiential anatomy, discloses to participants from diverse backgrounds the sameness of humans.

References
Fuchs, T. (2012). The Phenomenology of Body Memory. In: S.C. Koch, T. Fuchs, M, Summa & C. Müller (Eds.). Body memory, metaphor and movement (pp. 9-22). Amsterdam, Philadelphia: John Benjamins P. V
Joraschky, P., & von Arnim, A. (2008). Der Körperbildskulpturtest. In: P. Joraschky, T. Loew & F. Röhricht (Eds). Körpererleben und Körperbild (pp. 183-191). Stuttgart: Schattauer.
Tschacher, W., & Bergomi, C. (2011). Introduction. In: W. Tschacher & C. Bergomi. The implications of embodiment: cognition and communication (pp. VII-X). Exeter: Imprint Academic.
van der Kolk, B. (2015). The body keeps the score: Brain, mind and body in the healing of trauma. New York: Penguin Books.

Inpatient management of GHB/GBL withdrawal

Mirjana Delic

Abstract
BACKGROUND: Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to addiction and the possibility of withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, coma.
AIM: To describe the baseline characteristics, treatment and retention in patients admitted for GHB/GBL withdrawal management.
METHODS: A retrospective review of 4 consecutive cases of patients reporting GHB/GBL addiction who were admitted for inpatient management of withdrawal syndrome.
RESULTS: All patients were using GHB/GBL daily, 1-1.5 ml per hour. One of them was using cannabis additionally, others were using cocaine and amphetamine type stimulants. Psychiatric comorbidities as personality disorders, depression and bigorexia were recognized. All of them were treated with benzodiazepines, atypical antipsychotics and beta-blockers. Delirium was developed in two patients. One patient completed detoxification and finished the treatment programme. One patient completed detoxification but stopped his treatment earlier, two patients did not completed detoxification.
CONCLUSION: Polysubstance use and psychiatric co-morbidities need consideration in treatment planning. Heavier GHB/GBL use predicts poor treatment retention.

References
1.González A, Nutt D. Gamma-hydroxybutyrate abuse and dependency. J Psychopharmacol. 2005;519(2):195–204.
2.Craig K, Gomez HF McManus JL, Bania TC. Severe gamma-hydroxybutyrate withdrawal: a case report and literature review. J Emerg Med. 2000;18:65–70.
3.Price G. In-patient detoxification after GHB dependence. Br J Psychiatry. 2000;177:181.
4.Abdulrahim D, Bowden-Jones O, on behalf of the NEPTUNE Expert Group. Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances Treatment UK Network (NEPTUNE). London, 2015.

Cardiometabolic Risk Prediction Algorithms and Their Suitability for Young People Suffering Psychosis: A Systematic Review

Dr Benjamin I Perry, Mr Owen A Crawford, Miss Claire S Jang, Professor Peter B Jones, Dr Golam M Khandaker

Abstract
Background. Risk prediction algorithms are routinely used in clinical practice to assess, intervene and prevent cardiometabolic disorders in the general population. Young people with psychosis present a particularly high-risk group for the development of cardiometabolic disorders but their risk may not be adequately captured by pre-existing risk algorithms. We aimed to conduct a systematic review to identify and examine cardiometabolic risk prediction algorithms developed for the general or psychiatric populations and assess their suitability for young people with psychosis.

Methods. A systematic literature search was performed following PRISMA guidelines. We searched MedLine, PsychInfo, Web of Science, EMBASE and Google Scholar from inception to April 2019. Studies that reported the development and/or validation of risk prediction algorithms for cardiometabolic disorders in the general or psychiatric populations were included. A narrative synthesis was employed to compare and contrast risk algorithms and assess their suitability for young people with psychosis.

Results. 55 studies were included in the narrative synthesis, of which only one was derived from a sample of psychiatric patients. Two others considered psychiatric predictors such as antipsychotic medication or diagnosis of severe mental illness. The majority of studies were conducted in high-income countries. Mean age across studies was 48.97 (SD 5.31) with roughly even sex distribution. In all studies, algorithms placed significantly greater weight on age than any other risk factor.

Discussion. A large number of cardiometabolic prediction algorithms have been developed. Most have not been adapted for use in clinical practice. From the minority that have, only three incorporate psychiatric risk factors. However, even these studies are unsuitable for young people with psychosis due to the overbearing weighting of age. The significant cardiometabolic risk shouldered by young people with psychosis is therefore likely to be underestimated in all currently existing risk algorithms.

References
Holt RI, Peveler RC, Byrne CD. Schizophrenia, the metabolic syndrome and diabetes. Diabet Med. 2004; 21(6): 515-23.
Perry BI, McIntosh G, Weich S, Singh S, Rees K. The association between first-episode psychosis and abnormal glycaemic control: systematic review and meta-analysis. Lancet Psychiatry. 2016; 3(11): 1049-58.
Berry A, Drake RJ, Webb RT, Ashcroft DM, Carr MJ, Yung AR. Investigating the Agreement Between Cardiovascular Disease Risk Calculators Among People Diagnosed With Schizophrenia. Front Psychiatry. 2018; 9: 685.

Muslims experiences of pregnancy and birth: A metaethnography

Aaliyah Shaikh

Abstract
The topic of exploration is of the space of the womb (rahm in Arabic) and how the place in which we are created is predisposed neurobiologically and psychosocially to a complex architecture of intergenerational experiences and internalisations including traumas that are transmitted unconsciously. The womb is often associated with negativity, taboo, pain and darkness, medicalisation of women’s bodies and a governance of the womb. The way in which we are born into this world and our earliest experiences have a profound impact on our physical and mental health over the life span, our first attachment is rooted in the earliest moments, whether we feel safe or in a state of fear has a significant impact on physiology, our nervous system, our behaviours. It is important to look at the inter play of intergenerational transmission of trauma, adverse childhood experiences and how it manifests through the womb space, how we are created and our early origins as impacting our life span.

With this as a pretext, a literature review and meta-ethnography is conducted of international qualitative research on Muslims’ experiences of pregnancy and birth. Given that Muslims views tend to be underrepresented, and or framed in a negative light, a meta-ethnographic approach was chosen to foreground the emic perspectives of a marginalised community. Given the limited research on this topic, a meta-ethnography was considered apt as it aims to produce new understandings or insights that go beyond a single study. The idea is not just to aggregate studies but produce new interpretations connecting existing studies (France et al., 2015) and to embed the new theoretical insight within evidence. The process allows for the retainment of voices that are often unheard as well as space for bringing new insight. Given that Muslims views tend to be underrepresented, and or “negatively framed” (Ahmed & Matthes, 2016), a meta ethnography offers a worthwhile approach in exploring and understanding a marginalised community.

The PEO (Population, Exposure, Outcome) framework was utilised to construct the research question; ‘What are Muslims experiences of pregnancy and birth?’ Key words searches were combined with Medical Subject Headings (MeSH). A systematic search was performed following the PRISMA guidelines. Through two main database platforms; EBSCOHOST and OVIDONLINE a total of nine specific health related databases were searched for international, qualitative literature in the English language. From 1569 papers identified, after deduplication, titles and abstracts of 438 papers were screened and the full texts of 19 papers were reviewed. Eleven papers met the final inclusion criteria.

An understanding of factors impacting the earliest experiences a baby is born into are crucial for ensuring lifelong wellbeing. The findings identified in this review of factors affecting Muslim men and women’s experiences at the time of pregnancy and birth can be summarised in six themes: mental health and ‘Jinn’ narratives, experiences of healthcare, culture and patriarchy, relationships and family, the role of spirituality, religion, God and morality, and transition to parenthood. This research will be followed by empirical qualitative research on British Muslim men and women’s experiences of pregnancy and birth.

For change to take effect, it is increasingly important to create a platform for discussion and education exploring new and alternative narratives of the womb; the space creation takes form and place in, which all of humanity is invested in, with an understanding of neurobiological, socio-cultural, psychological, religious and intergenerational dynamics that shape the condition of the human.

References
Not clear if this is asking for references to support my submission or for the abstract but if its a academic reference below is one for my mentor. Happy to send others once i receive clarification of the type of references this is referring to.
Professor Rasjid Skinner email arasjid.skinner@gmail.com

Mast cell autocrinicity near cerebral arterial wall „reverse glymphatic flow“ as prime target of electro-magnetic effects.

Gottfried R. S. Treviranus

Abstract
Causal research on neuro-therapeutic electro-magnetic fields (EMF) advances slowly. Immune cells (Gülöksüz), blood vessels, vasomotion (Di Marco) or glymphatic flow (Liu DX) just emerge in research. By combining EFMs with non-canonical migratory routes these areas converge.
Here such routes are attributed to mast cells (MCs), which emerge throughout medicine as hyper-competent actors, focussing on kanban-like migratory and other steps suited to explain early and repeated anti-depressive Electro-Convulsive Therapy (ECT). Hypothetically autocrine signals flushed by external fluidics are integrated into cellular cybernetics and hereby asymmetrically start movement. Furthermore the most rapid glymphatic flow within arterial walls (Cserr 1974) is propulsed by the CIMURAF-mechanism (Treviranus), which manifests itself by the enigmatic (Cole 2019) vasomotion. Since molluscs arterial muscle cells attach to co-axial lamellar tubes separating co-axially twisted compartments. Herein the glymphatic interstitial transport along the basement of arterioles feeds into the layered wall of arteries, which voids into the lymphatics. Hence also arterial segments aligned to cephalic anode to cathode currents (or new meningeo-calvario-myeloid channels) attract most current – as supported by directional effects.
After explaining why MCs are key to EMF-related neuropsychiatry too it is expounded, that induced EFMs could act on autocrine signals of MCs whereby they would be impeded to intrude into the brain as differently as destructive barrier or meningeal MCs. Explanations through MCs in ECT and other EMF-effects are contrasted with standard models from ions to tissues.

Sliding segments are steered neurally upstream, while parallel waves in the VR-spaces accelerate cells (Lyck 2012) against a basic hydraulic flow. Induced therapeutic EFM could modulate the MCs’ migration-steering (dipole-cytokines) and pathogenic molecules or particles.
Conclusion: Accounts centered on MCs for most of the changes (amnesia e.g.) can be plausibly cited even for additional methods or environmental EMFs. The case for MCs in EMF-research seems promising using new single MC-cell-centered methods.

References
Lyck R, Engelhardt B. Going against the tide - how encephalitogenic T cells breach the blood-brain barrier. J. Vasc. Res 2012;49:497-509 / Marino C, et al. Biological effects of electromagnetic fields. Ref Mod Mater Sc Mater Engineer 2016 Oxford: Elsevier; 2016. pp. 1-9. / Pavlov VA, Chavan SS, Tracey KJ. Molecular and functional neuroscience in immunity. Annu Rev Immunol. 2018;36:783-812 / Treviranus GRS. The Co-axial Arterial Wall Engine (CAWE) for depulsation and Cerebral Intramural Reverse Arterial flow via sliding compartments and macro-nano links. Psychoimm. Expert Meeting 2018 , Günzburg. [www.biposuisse.ch/Gbg18]/ Treviranus GRS. Rescue of the appropriative “T-A-M”-space: Anatomy and mast cells generate “mixable” dimensions in language and statistics. Psychiatria danubina. 2018;30 S7:620-9 [www.biposuisse/hd18-1]

Self-disturbances and their neural signatures in schizophrenia.

Yuliya Zaytseva, Eva Kozakova, Pavel Mohr, Filip Spaniel

Abstract
Introduction: The self-disturbances (SDs) concept is considered to be part of the Schneider’s first rank symptoms, i.e., thought-withdrawal, thought-insertion, thought-broadcasting, somatic-passivity experiences, mental/motor automatisms, disrupted unitary self-experience (Mishara et al., 2014). SDs were originally described by W. Mayer-Gross (1920), who observed them in psychotic patients.
Methods: We classified Mayer-Gross’ findings on SDs into the following categories: experience is new/compelling (aberrant salience), reduced access/importance of autobiographical past, cognitions/emotions occur independently from self’s volition, foreign agents have power over self and developed an SDs scale based on these categories and cognitive domains (perception, motor, speech, thinking etc.). Scale is applied as a measure of the frequency of the experiences. In our current study on phenomenology and neurobiology of psychotic symptoms, we administered the scale to a study group of patients with schizophrenia (N=84) and healthy volunteers (N=170). Further, the resting state fMRI was performed and the group was divided into two subgroups with (N=13) and without self-disturbances (N=10) and in healthy individuals (N=39).
Results: We found substantial differences in the frequency of self-disturbances in patients with schizophrenia compared to healthy controls (total score differences, Z=-5.83, p< 0.001). On a neural level, patients with self-disturbances experienced a decreased functional brain connectivity of the default mode and salience networks as compared to the patients without self-disturbances and healthy controls. The differences were mainly explained by the factor ‘’foreign agents’’ and the novelty of the experience.
Conclusions: The scale identifies self-disturbances in schizophrenia and confirms self-related processing in patients with schizophrenia to be associated with altered activation in the cortical midline structures. Supported by the grant projects MH CR AZV 17-32957A and MEYS NPU4NUDZ: LO1611.

References
Mishara A, Bonoldi I, Allen P, et al. (2016). Neurobiological Models of Self-Disorders in Early Schizophrenia. Schizophrenia Bulletin.
42(4):874-880.

The Federation of Student Islamic Societies Programme to Challenge Mental Health Stigma in Muslim communities in Scotland

Ahmed Hankir, Sanah Ghafoor, Rafa Abushaala, Loubna Kraria, Aleema Sardar, Deemah Al-Obaidly, Frederick R. Carrick, Rashid Zaman

Abstract
Introduction: A recent study commissioned by the Scottish Government on the prevalence of mental disorders in Muslims in Scotland revealed that over 50% of the sample met the diagnostic criteria for a mental illness. Stigma is a major barrier to mental health services and despite the availability of effective treatment, many Muslims in Scotland with mental health difficulties continue to suffer in silence. The Federation of Student Islamic Societies (FOSIS) Scotland branch organized a mental health conference in Glasgow to improve Mental Health Literacy and challenge mental health related stigma in the Scottish Muslim community. The conference was comprised of: A counsellor with a background of Islamic psychology, a psychiatrist and an Imam (a Muslim religious leader).

Design: We conducted a single-arm, pre- post- comparison study on Muslims who attended the FOSIS mental health conference in Glasgow, Scotland. Validated psychometric stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviours (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before and immediately after exposure to the programme.

Results: 34 out of the 55 participants who attended the conference responded (response rate 62%). 34/34 (100%) of the respondents were Muslim and the mean age was 22.7 years (Std. Dev. 6.04, min. 18, max. 49). There were no statistically significant changes in stigma across the domains of knowledge, attitude and behaviour in respondents following exposure to the event.

Discussion: Previous FOSIS anti-stigma conferences in England and Ireland featuring an Expert by Lived Experience were associated with statistically significant reductions in mental health related stigma. The results of the FOSIS Glasgow study supports the, ‘Power of contact’ with an Expert by Lived Experience at reducing mental health related stigma in the Muslim community. More robust research in this area is urgently required.

References
[1] Ali, A. (2017) The impact of Islamophobia on the Muslim American community: accounts of psychological suffering, identity negotiation, and collective trauma. Theses, Dissertations, and Projects. Available from: https://scholarworks.smith.edu/cgi/viewcontent.cgi?article=2952&context=theses [Accessed 20 June 2019]
[2] Ahmedani, B. (2011). Mental Health Stigma: Society, Individuals, and the Profession. PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/ [Accessed 19 Jun. 2019].
[3] Angermeyer, M.C., Holzinger, A. and Matschinger, H. (2009). Mental health literacy and attitude towards people with mental illness: a trend analysis based on population surveys in the eastern part of Germany. European Psychiatry, 24(4), pp.225-232.
[3] Choudhury, T.; Fenwick, H. (2011). The impact on counter-terrorism measures on muslim communities. International Review of Law, Computers Technology, 25(3), 151-182.
[4] Ciftci A, Jones N, Corrigan PW. Mental health stigma in the Muslim community. Journal of Muslim Mental Health. 2013; 7(1).
[5] Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric services. 2012; 63:963-73.

Providing psychiatric healthcare to asylum seekers: reflections and challenges

Derlet O., Deschietere G.

Abstract
Abstract
Background: According to the United Nations High Commissioner for Refugees the number of people forced to leave their home as a result of conflict, persecution, violence or human rights violations remains high with 68.5 million forcibly displaced people worldwide. Asylum seekers are vulnerable in terms of mental health but they receive very little specific psychiatric care. The purpose of this literature review is to examine current situation regarding asylum seekers’ psychiatric healthcare. Subjects and methods: This research was conducted using a keyword search on Medline, PubMed and Google Scholar. Results: The literature on the management of the mental health of asylum seekers focuses on the issue of post-traumatic stress disorder. There is little data on other forms of mental illness in this population. The prevalence of post-traumatic stress disorder among asylum seekers is higher than in the general population and its clinical expression is varied and often complex because it involves various vulnerability factors. Guidelines for post-traumatic stress disorder recommend cognitive behavioral therapy with, in some cases, the use of pharmacotherapy. Given the specificities of the asylum seekers’ population, in many cases it is not possible to set up such therapy immediately. Asylum seekers face a number of challenges in accessing mental healthcare. Conclusion: Management of the mental health of asylum seekers requires special attention and guidelines for the general population are not directly applicable to this specific population. The literature focuses on the issue of post-traumatic stress disorder. This review was not able to analyse the state of existing care offer in Belgium for managing the mental health of asylum seekers and the care pathways they take.

References
Beltran RO, Llewellyn GM & Silove D: Clinicians' understanding of International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnostic criteria: F62.0 enduring personality change after catastrophic experience. Comprehensive psychiatry 2008; 49: 593-602.
Crumlish N & O'Rourke K: A systematic review of treatments for post-traumatic stress disorder among refugees and asylum-seekers. The Journal of nervous and mental disease 2010; 198: 237-251.
Fazel M, Wheeler J & Danesh J: Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet 2005; 365: 1309-1314.
Heeren M, Mueller J, Ehlert U, Schnyder U, Copiery N & Maier T: Mental health of asylum seekers: a cross-sectional study of psychiatric disorders. BMC psychiatry 2012; 12: 114.
Kinzie, JD: Immigrants and refugees: the psychiatric perspective. Transcultural psychiatry 2006; 43: 577-591.

Perceived Academic and Psychological Stress among Adolescents in the United Arab Emirates

NM Alia, NA Nowshad, KM Mansoor, RA Ibnouf, RM Albehiery , FR Carrick, M Abdulrahman

An artificial neural network model of visual hallucinations in dementia with Lewy bodies

Vlad-Petru Morozan1, Hiromichi Tsukada2, John O’Brien1, John-Paul Taylor3, Daniel Collerton3, Li Su1

Abstract
Currently, in psychiatry, there is a conceptual and experimental gap between two layers of knowledge: the clinical level, which aims to understand and quantify the symptom and syndromes and the molecular level, which aims to study the interactions between different cellular components to explain the physio-pathological mechanisms of the respective pathology. Hence, how altered molecular pathways lead to a certain symptomology remains largely unresolved. We propose that computational models, aided by deep learning, can narrow this gap and provide the needed intermediate layer.
We took Dementia with Lewy Bodies (DLB) as a first step towards this goal and focused on understanding the neural basis of recurrent complex visual hallucinations (RCVH) – a core feature of DLB present in >80% of all cases. As changes in visual GABA have been related to RCVH in Lewy body diseases [1,2], we developed a multilayered neural network with both biological plausible units and details of neurotransmitters. The layers imitate different brain regions such as prefrontal and inferior temporal cortex.

The model performed accurate object recognition when the parameters were derived from cognitively normal individuals and produced “computational hallucinations” when the parameters were pathologically altered. Computational hallucinations represent a network state, in which the network behaves as it “perceives” an object, despite its absence in the visual scene. In other words, the model could “see” something that is not there.
Using model simulations, we found that reduced ventral visual GABA increased the frequency of hallucinations. This is consistent with previous neuroimaging [2] and postmortem [1] studies. Our model serves as a candidate explanation for the RCVH in DLB, thus, providing insights into the neuro-cognitive mechanisms responsible for this syndrome. We believe that it can lead to future research aimed at improving the diagnosis and treatment of this disease by targeting the GABAergic pathways.

References
Affiliation
1. Department of Psychiatry, University of Cambridge, UK
2. Neural Computation Unit, Okinawa Institute of Science and Technology, Japan
3. Institute of Neuroscience, Newcastle University, UK

Reference:
1. Khundakar AA, Hanson PS, Erskine D, Lax NZ, Roscamp J, Karyka E, Tsefou E, Singh P, Cockell SJ, Gribben A, Ramsay L, Blain PJ, Mosimann UP, Lett DJ, Elstner M, Turnbull DM, Xiang CC, Brownstein MJ, O'Brien JT, Taylor JP, Attems J, Thomas AJ, McKeith IG, Morris CM. Analysis of primary visual cortex in dementia with Lewy bodies indicates GABAergic involvement associated with recurrent complex visual hallucinations. Acta Neuropathologica Communications 2016, 4, 66.
2. Firbank MJ, Parikh J, Murphy N, Killen A, Allan CL, Collerton D, Blamire AM, Taylor JP. Reduced occipital GABA in Parkinson disease with visual hallucinations. Neurology 2018, 91(7), e675-e685.

Contrasting vantage points between caregivers and residents on the perception of elder abuse and neglect during long-term care

Marijana Neuberg, Tomislav Meštrović, Rosana Ribić, Marin Šubarić, Irena Canjuga, Goran Kozina

Abstract
INTRODUCTION - Elder abuse and neglect can be defined as refusing or failing to fulfil a caregiver’s obligation to meet the needs of elderly individuals in order to punish or hurt them. We aimed to explore perceptions of elder mistreatment of both caregivers and residents during long-term care, and highlight significant differences in the overall mistreatment perception regarding sociodemographic variables, as well as the type of care facility.
METHODS - The study involved 171 caregivers and 245 elderly individuals in stationary facilities. Two structured questionnaires were used, one for caregivers and the other for institutionalized elderly residents, whose initial validation concerning question and factor selection has been based upon exploratory factor analysis and discriminant validity. Parametric and nonparametric tests were employed in the statistical analysis, and statistical significance was set at p<0.05 (two-sided).
RESULTS - We found significant differences in the perception of elder abuse and neglect between caregivers and elderly residents. More specifically, caregivers tend to recognize unnecessary or inappropriate medical/care procedures as indicators of elder mistreatment, while the elderly residents emphasize the removal of their personal belongings and inappropriate physical contact. According to the care facility, residents reported abuse/neglect more frequently in extended care units (21.4%), compared to the county-owned nursing home (11.4%) and private nursing home (12.1%) (p=0.001). Similarly, caregivers reported abuse/neglect more frequently in extended care units (75.4%), in comparison to county-owned nursing home (24.6%) and private nursing home (0%) (p=0.039). Shift work was also a significant predictor, as the morning nursing staff perceived abuse/neglect more frequently (p=0.011).
CONCLUSION - This study has shown how residents and caregivers have contrasting vantage points in relation to elder abuse/neglect perception, which underlines the need for evidence-based standardization of procedures to prevent any type of elder mistreatment.

Leveraging Digital Technology to Challenge Mental Health Stigma in West Bengal: A Protocol

Ahmed Hankir, Sharmistha Ghosh, Syed Mustafa Ali, Frederick R. Carrick, Rashid Zaman

Abstract
Mental health related stigma is a pernicious phenomenon that permeates and pervades our world. As stigma continues to evolve so too must our approach to reduce it. This paper outlines a protocol that leverages the power of virtual contact and digital technology to challenge mental health related stigma in West Bengal, India.

References
[1] Abu-Ras, W., Gheith, A., & Cournos, F. (2008). The imam's role in mental health promotion: A study at 22 mosques in New York City's Muslim community. Journal of Muslim Mental Health, (2008) 3(2), 155-176.
[2] Al-Krenawi, A. Mental health practice in Arab countries. Current Opinion in Psychiatry (2005) 18(5), 560-564.
[3] Al-Krenawi A, Graham JR. Culturally sensitive social work practice with Arab clients in mental health settings. Health Soc Work. 2000 Feb;25(1):9-22.
[4] Azhar, M. Z., & Varma, S. L. Mental illness and its treatment in Malaysia. In I. Al-Issa (Ed.), Al-Junūn: Mental illness in the Islamic world (2000) (pp. 163-186). Madison, CT, US: International Universities Press, Inc.
[5] Chowdhury A, Sanyal D, Salil K. Dutta S et al. Stigma and mental illness: Pilot study of laypersons and health care providers with the EMIC in rural West Bengal, India December 2000 International Medical Journal (1994) 7(4):257-260

Metrological Performance of Instruments used in Clinical Evaluation of Balance

Frederick R. Carrick , Ahmed Hankir, Rashid Zaman, Cameron H. G. Wright

Abstract
Clinical assessment of a patient, monitoring the progress of a condition, and/or titration of a therapy is dependent on the metrological characteristics of diagnostic equipment. While metrological performance of instruments is commonly assessed in research, it is not so often done in clinical practice. Physical rehabilitation applications may benefit individuals with mental health concerns and are associated with an accurate analysis of balance and gait. There is a paucity of published data regarding the metrological characteristics of commonly used clinical instruments used in posturographic measurements. We desired to assess the accuracy, trueness, precision and resolution of four posturography systems that we use clinically in practice: a Bertec BP-5050, a Vestibular Technologies CAPS® Professional and a Vestibular Technologies CAPS® Lite three component balance platforms, and a NeuroCom® Balance Manager SMART EquiTest®. Metrological performance by posturography instruments was recommended in 2013 by the International Standardization Committee for Clinical Stabilometry of the International Society for Posture and Gait Research (ISPGR). Clinical and research findings may be erroneous, or at the least misleading, if the instruments used to make clinical decisions are associated with significant error. We suggest that there is a strong need for posturographic instrumentation with appropriate metrological characteristics used in clinical applications. The ISPRG recommendations appear to be reasonable and appropriate, and our results show they are obtainable. Physical measurements and functional testing used to correlate and design mental health and physical based rehabilitation strategies are often dependent upon the accuracy and metrological integrity of diagnostic instruments used in posturography.

References
[1] Webster JG. Medical Instrumentation: Application and Design, 4th Edition. New York: John Wiley & Sons; 2010.
[2] Pagnacco G, Carrick FR, Wright CH, Oggero E. Between-subjects differences of within-subject variability in repeated balance measures: consequences on the minimum detectable change. Gait Posture 2015;41(1):136-40.
[3] Johnson L, Rodrigues J, Teo WP, Walters S, Stell R, Thickbroom G, Mastaglia F. Interactive effects of GPI stimulation and levodopa on postural control in Parkinson's disease. Gait Posture. 2015;41(4):929-34.
[4] Prosperini L, Fortuna D, Gianni C, Leonardi L, Pozzilli C. The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis. Neurorehabil Neural Repair. 2013;27(1):45-52.
[5] Yeh JR, Hsu LC, Lin C, Chang FL, Lo MT. Nonlinear analysis of sensory organization test for subjects with unilateral vestibular dysfunction. PLoS One. 2014;9(3):e91230.

ACCURACY, PRECISION AND CONSISTENCY OF ROBOT AND THERAPIST GENERATED HORIZONTAL HEAD MOTIONS FOR GAZE STABILIZATION REHABILITATI

Frederick R. Carrick, Ahmed Hankir, Rashid Zaman, Matthew M. Antonucci, Pagnacco Guido , Elena Oggero

Abstract
Passive head motions are commonly used in vestibular rehabilitation to improve gaze stability. These motions are typically executed by a trained clinician who sinusoidally repeatedly rotates the patient's head in yaw (no-no) or pitch (yes-yes) by a prescribed amplitude and at a prescribed velocity. Recently a robotic device called “Essential Vestibular Assistant” (EVA) has been developed with the aim of providing the same therapeutic motions in a more accurate, precise and reliable way. It is not clear how the head motion generated by a clinician compares to that generated by a robot in general or the EVA in particular, so the objective of this work was to obtain some preliminary data on this subject. The results indicate that the EVA is superior in terms of motion accuracy, precision and reliability (consistency). The results also indicate that head motion sensors commonly used in vestibular research might not have the metrological performance needed to properly quantify head motions generated by a rob

References
[1] K.E. Cullen , J.E.Roy, “Signal processing in the vestibular system during active versus passive head movements”, J Neurophysiol, vol. 91, pp. 1919-1933, 2004.
[2] A. Dale, K.E. Cullen, “The nucleus prepositus predominantly outputs eye movement-related information during passive and active self-motion”, J Neurophysiol, vol. 109, pp. 1900-1911, 2013.
[3] F.M. Lambert, et al., “Gaze stabilization by efference copy signaling without sensory feedback during vertebrate locomotion”, Curr Biol, vol. 22, pp. 1649-1658, 2012.
[4] J.M. Goldberg, K.E. Cullen, “Vestibular control of the head: possible functions of the vestibulocollic reflex”, Exp Brain Res, vol. 210, pp. 331-345, 2011.
[5] Y. Fang, et al., “Eye-head coordination for visual cognitive processing”, PLoS One, 10:e0121035, 2015.

Cannabinoid hyperemesis syndrome: a review of the literature

Deceuninck E & Jacques D

Abstract
Background: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by cyclic vomiting and compulsive need to take hot showers in the context of chronic cannabis use. Physicians' lack of knowledge of CHS often results in a diagnostic delay of several years. The purpose of this article is to describe CHS in order to enable physicians, and more particularly psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations.

Subjects and methods: Bibliographic search for scientific articles published between 2004 and 2019 in the Cochrane, Medline, PubMed, and Psycinfo databases. Key words used were "hyperemesis", "cannabis", "cannabinoid".

Results: CHS is associated with chronic cannabis use and typically manifests as incoercible cyclical vomiting, diffuse abdominal pain, and relief of symptoms by taking hot showers. Patients suffering from CHS generally visit emergency departments very regularly and undergo numerous additional examinations, both invasive and unnecessary. Since no organic cause can explain these symptoms, these patients are referred to the psychiatry department. The only curative treatment is the complete cessation of cannabis use.

Conclusions: CHS is an under-diagnosed pathology because it is little known to physicians. This syndrome has unique clinical characteristics. Early recognition of CHS avoids repeated visits to the emergency room and unnecessary follow-up examinations.

Key words: hyperemesis, cannabis, cannabinoid.

References
Alipour A, Patel PB, Shabbir Z, Gabrielson S: Review of the many faces of synthetic cannabinoid toxicities. Ment Health Clin 2019; 9(2): 93-99.
Allen JH, de Moore GM, Heddle R, Twartz JC: Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004; 53: 1566-1570.
Bajgoric S, Samra K, Chandrapalan S, Gautam N: Cannabinoid hyperemesis syndrome: a guide for the practising clinician. BMJ Case Rep 2015. doi: 10.1136/bcr-2015-210246.
Blumentrath CG, Dohrmann B, Ewald N: Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment. GMS Ger Med Sci 2017; 15: Doc06.
Chen J & McCarron RM: Cannabinoid Hyperemesis Syndrome: A Result of Chronic, Heavy Cannabis Use: Hot Showers, Marijuana Cessation Relieve Nausea and Vomiting. Current Psychiatry 2013; 12 (10): 48-54.

Review of Anti Cholinergic Burden for patients assessed in Bedford Memory Assessment Services

Boon Leong Aw Yong, Aneeba Anwar, Shevonne Matheiken, Hassan Raza

Abstract
BACKGROUND: This audit identifies population-at-risk in a memory clinic setting and examines current practice in identifying increased anticholinergic burden (ACB).
STANDARDS: The NICE guidance on dementia (CG42) recommends that a diagnosis of dementia should be made only after a comprehensive assessment, including a medication review to identify and minimise use of drugs that may adversely affect cognitive functioning (1). A NHS England dementia diagnosis and management resource for GPs recommends that drugs with strong anticholinergic activity should be stopped if possible or substituted for a drug with less anticholinergic activity (2).
The Department of Health dementia toolkit also recommends considering stopping or reducing anticholinergic drugs.
METHODS: We identified 47 consecutive patients assessed in Bedford Memory Assessment Service in Jan 2019. We reviewed their total ACB scores and identified if any actions were taken by clinicians to minimise anticholinergic burden.
RESULTS/CONCLUSION: There were 20 patients with ACB score of 0 and 12 patients had ACB score 2. (Low Risk). There were 2 patients with ACB score 3 and 5 patients with ACB score 5. (High Risk). Among this group, 3 patients were diagnosed with dementia and 2 were diagnosed with mild cognitive impairment. Both patients with ACB score 3 had their anticholinergic medications reviewed. Whereas those with ACB score 5, only 1 had their anticholinergic medications reviewed while all of them suffered significant memory issues.
RECOMMENDATIONS:
In patients reviewed at memory clinic:
1. Perform a medication review to identify and minimize use of drugs that may adversely affect cognitive function.
2. Avoid prescribing anticholinergics with acetylcholinesterase inhibitors.
3. If there is a suspicion of anticholinergic induced impaired cognition, consider switching or stopping if confirmed and clinically appropriate. Use supportive polypharmacy resources to aid the decision making process.

References
1. https://dementiapartnerships.com/wp-content/uploads/sites/2/nice-cg42.pdf
2.https://www.england.nhs.uk/wp-content/uploads/2015/01/dementia-diag-mng-ab-pt.pdf

Inpatient management of GHB/GBL withdrawal

Mirjana Delic

Abstract
Background: Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone
(GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to addiction and the possibility of withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, coma.
Aim: To describe the baseline characteristics, treatment and retention in patients admitted for GHB/GBL withdrawal management.
Methods: A retrospective review of 4 consecutive cases of patients reporting GHB/GBL addiction who were admitted for inpatient management of withdrawal syndrome.
Results: All patients were using GHB/GBL daily, 1-1.5 ml per hour. One of them was using cannabis additionally, others were using alcohol, cocaine and amphetamine type stimulants. Psychiatric comorbidities as personality disorders, depression, anxiety and bigorexia were recognized. Patients were treated with benzodiazepines and/or clomethiazole, atypical and typical antipsychotics and beta-blockers. Delirium was developed in two patients. One patient completed detoxification and finished the treatment program. One patient completed detoxification but stopped his treatment earlier two patients did not completed detoxification and left the program.
Conclusion: GHB/GBL withdrawal can be severe and retention in program is poor. Polysubstance use, psychiatric co-morbidities and heavier GHB/GBL use as possible predictors of poor treatment outcome need consideration in treatment planning.

References
1. Abdulrahim D & Bowden-Jones O, on behalf of the NEPTUNE Expert Group: Guidance on the Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances Treatment UK Network (NEPTUNE). London 2015.
2. Brorson HB, Arnevik EA, Rand-Hendriksen K & Duckert F: Drop-out from addiction treatment: A systematic review of risk factors. Clinical Psychology Review 2013; 33: 1010-1024.
3. European Monitoring Centre for Drugs and Drug Addiction (2002), Report on the Risk Assessment of GHB in the Framework of the Joint Action on New Synthetic Drugs, Publications Office of the European Union, Luxembourg.
4. European Monitoring Centre for Drugs and Drug Addiction (2019), European Drug Report 2019: Trends and Developments, Publications Office of the European Union, Luxembourg.
5. Gonzalez A & Nutt DJ: Gamma hydroxy butyrate abuse and dependency. J Psychopharmacol 2005; 19(2): 195-204. doi: 10.1177/0269881105049041

EVOLUTION OF RELIGIOUS TOPICS IN SCHIZOPHRENIA IN 80 YEARS PERIOD.

Arkadiusz Dudek, Marek Krzystanek, Krzystof Krysta, Alicja Górna.

Abstract
Background: Environment and culture are shown to be an important factor influencing characteristics of psychotic symptoms. Content of hallucinations and delusions is a projection of internal processes on external world. Religion plays a central to lives of many people, but in schizophrenia religious experience and spirituality is confounded by psychotic symptoms. The aim of this study was to find how content of psychotic symptoms interacts with cultural conditions, that were changing over the decades.
Subjects and Methods: 100 of case histories from 2012 were randomly selected. From the medical record, content of hallucinations and delusion was extracted and categorized. Data from 2012 was compared with previous study by the authors, obtaining in sum 80 years of history in the one hospital.
Results: Religious content of delusions and hallucinations appeared in 26% of patients. Diversity of the religious and spiritual themes in schizophrenia has been gradually decreasing. Many minor religious entities and figures such as “saints” and “angels” disappeared in 2012. Although, occurrence of contact with God and other religious figures was similar as in previous years, number of “visions” abruptly decreased. All of the religious content was culture-specific.
Conclusions: Religious topics express general plasticity over a time, following cultural changes in society.

References
1. Drinnan A & Lavender T. Deconstructing delusions: A qualitative study examining the relationship between religious beliefs and religious delusions. Ment Heal Relig Cult 2006; 9: 317-331.
2. Huguelet P & Mohr S: Religion/spirituality and psychosis. In Huguelet P & Koenig HG (eds.): Religion and Spirituality in Psychiatry, 65-80. Cambridge University Press, 2009.7. Huguelet P & Mohr S: Religion/spirituality and psychosis. In Huguelet P & Koenig HG (eds.): Religion and Spirituality in Psychiatry, 65-80. Cambridge University Press, 2009.
3. Krzystanek M, Krysta K, Klasik A, Krupka-Matuszczyk I: Religious content of hallucinations in paranoid schizophrenia. Psychiatr Danub 2012; 24, Suppl.1: 65-69.
4. Škodlar B, Dernovšek MZ, Kocmur M: Psychopathology of schizophrenia in Ljubljana (Slovenia) from 1881 to 2000: Changes in the content of delusions in schizophrenia patients related to various sociopolitical, technical and scientific changes. Int J Soc Psychiatry 2008; 54:101-111.
5. Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H: Old wine in new bottles? Stability and plasticity of the contents of schizophrenic delusions. Psychopathology 2003; 36:6-12.

Challenges in Mental Healthcare Services: Intergenerational Conflicts in Immigrant and Refugee Families

Lloy Wylie, Vivetha Thambinathan, Ramzan Rana, Aastha Gulati, Hunster Yang

Abstract
With an increasing number of immigrant and refugee populations settling in Canada, various challenges for those working in the mental health care system have emerged. Newcomers of all ages arrive with complex and nuanced mental health histories, traumas, and strenuous migration journeys. Therefore, the resettlement process comes with a multitude of challenges in respect to accessing adequate mental health care services. Research has shown that these barriers in turn have a distinctive impact on the mental health and wellness of children and families. This study explores the factors that influence the intergenerational challenges among immigrant and refugee populations, and how to address these issues through routine practices for mental health care service providers.

The study was part of a larger research project on immigrant and refugee health led by Lloy Wylie, PhD, Western University. This investigation used semi-structured interviews and focus groups with mental health care providers working in London, Ontario. The findings reveal key elements that lead to intergenerational conflicts in mental health care within immigrant and refugee families. In particular, the experiences in cultural conflict, lack of communication between family members, and the stigma surrounding mental health notably influence the intergenerational challenges that newcomer families face. The results suggest the necessity of addressing mental health issues that arise from intergenerational conflicts through the implementation of various methods, such as using a family-based approach practice. The study merits further research for developing strategies in practice and policy to better support immigrant and refugee families in mental health care.

References
Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., Alegría, M. (2007). Use of Mental Health–Related Services Among Immigrant and US-Born Asian Americans: Results From the National Latino and Asian American Study. American Journal of Public Health,97(1), 91-98. doi:10.2105/ajph.2006.098541
Beiser, M., Hou, F., Hyman, I., & Tousignant, M. (2002). Poverty, family process, and the mental health of immigrant children in Canada. American Journal of Public Health, 92(2), 220-227.
Hyman, I., Beiser, M., & Vu, N. (1996). The mental health of refugee children in Canada. Refuge: Canada's Journal on Refugees, 15(5).
Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., Pottie, K. (2010). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal,183(12). doi:10.1503/cmaj.090292

The prevalence of seasonal affective disorder among the blind and patients with serious visual impairment

Bartłomiej Kurczab, Aleksandra Ćwiek, Krzysztof Kramarczyk, Anna Witkowska, Karolina Drzyzga, Krzysztof Kucia

Abstract
Background
Seasonal affective disorder (SAD) is an interesting disorder in which depression should occur at a particular time of a year, each year and it should disappear at a specific time of the year. While the prevalence of SAD among generally healthy individuals is well known, the information about the prevalence of this disorder among the blind and visually impaired patients is very limited. The aim of the study was to investigate the prevalence of SAD among the blind and people with serious visual impairment in polish population.
Subjects and methods
250 blind or seriously visually impaired individuals and 258 healthy controls were assessed with the usage of Seasonal Pattern Assessment Questionnaire (SPAQ). In research group survey was conducted with the Computer Assisted Telephone Interview (CATI) technique. In control group the questionnaire was distributed via Internet. The results were analysed with the usage statistical package - Statistica 13.1.
Results
The results revealed that among people suffering from SAD there is statistically significant difference in SPAQ scores between completely blind and seriously visually impaired people.
The study shows that is the control group age is negatively correlated with score in SPAQ score, while in the study group age is positively correlated with SPAQ score. The data show that there is a difference in occurrence of SAD between men and women.
Conclusion
The study has shown a significant difference in occurrence of SAD between study and control groups. What is more the analysis has indicated major difference in the occurrence of SAD between men and women from the study group. Taking into consideration the fact that this is the second analysis of this type in Europe further investigations are needed.

Key words: seasonal affective disorder, visual impairment, blindness

References
Lam RW, Levitan RD. Pathophysiology of Seasonal Affective Disorder: A Review. Vol 25.; 2000.
2. Zauderer C, Ganzer CA. Seasonal affective disorder: an overview: Cheryl Zauderer and C Anne Ganzer outline the diagnosis, causes and treatment options for people who experience the winter blues. Ment Heal Pract. 2015. doi:10.7748/mhp.18.9.21.e973
3. Roecklein KA, Rohan KJ. Seasonal affective disorder: an overview and update. Psychiatry (Edgmont). 2005;2(1):20-26. http://www.ncbi.nlm.nih.gov/pubmed/21179639. Accessed July 23, 2019.
4. ROSENTHAL NE, GENHART M, JACOBSEN FM, SKWERER RG, WEHR TA. Disturbances of Appetite and Weight Regulation in Seasonal Affective Disorder. Ann N Y Acad Sci. 1987. doi:10.1111/j.1749-6632.1987.tb36213.x
5. Melrose S. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depress Res Treat. 2015. doi:10.1155/2015/178564

Depression and dry eye disease: a need for an interdisciplinary approach?

Thomas Weatherby, Venkat Ram Vasant Raman, Mark Agius

Could problems in the bedroom come from our intestines? A preliminary study of IBS and its impact on female sexuality.

Piotr Sławik, Mateusz Szul, Anna Fuchs, Marek Waluga, Marek Krzystanek

Abstract
INTRODUCTION : Female sexuality may be affected by many somatic and psychological factors. Somatic conditions have impact on psychological well-being. We assumed that chronic disease like Irritable Bowel Syndrome (IBS), when producing the long-term distress, may greatly influence sexual functioning.
AIM: The aim of this study was to determine whether the severity of IBS influences sexual functions of women and take into consideration other factors like Small Intestinal Bacterial Overgrowth (SIBO) comorbidity and duration of IBS.
SUBJECTS AND METHODS: Study patients were recruited by contacting IBS patients at Gastroenterology Ward of Clinical University Centre in Katowice. The survey consisted of 3 parts. The first part were socio-demographic questions. The second part was polish translation of Female Sexuality Functions Index (FSFI) questionnaire. The third part consisted of questions about the patient condition, pharmacotherapy and Irritable Bowel Syndrome Severity Score (IBSSS) questionnaire. 307 women were included in the study and completed the questionnaire. 143 participants were diagnosed with IBS. The mean age of participants was 27 (IQR=23-33). 29% of the patients (n=41) had severe, 47 % (n=68) moderate and 24% (n=34) mild IBS.
RESULTS: The prevalence of sexual dysfunctions was greater in women with IBS (48%) than in healthy control group (23%)(p<0.001). The median of FSFI was: 30.1 (26.3-32.8) for healthy control group, 30 (23.5-32.6) for mild IBS, 26.2 (22.2-31.6) for moderate and 24.4 (20.1-28.9) for severe.
CONCLUSION: IBS decreases all domains of women sexual activity. Severity of sexual dysfunctions relate to intensity of IBS symptoms. All physicians treating IBS-patients should take sexual dysfunctions into their clinical consideration.
Key words: irritable bowel syndrome, sexual dysfunctions, sexual health, gastrointestinal diseases

References
1) Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997 Apr;11(2):395-402.
2) Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208
3) Fass R, Fullerton S & Naliboff B. Sexual dysfunction in patients with irritable bowel syndrome and non-ulcer dyspepsia. Digestion. 1998;59(1):79-85.
4) Whorwell PJ, McCallum M, Creed FH & Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986;27:37-40.
5) Woodman CL, Breen K, Noyes R Jr, Moss C, Fagerholm R, Yagla SJ et al. The relationship between irritable bowel syndrome and psychiatric illness. Psychosomatics. 2016;39:45–54.

The Role of Care Coordinators Versus Doctors In the Management of Chronic Mental Illness in the Community

Xingyue Maria Wang, Mark Agius

Abstract
Paper for supplementary journal - please see attachment

References
Paper for supplementary journal - please see attachment

Role of copper and ketamine in major depressive disorder – an update

Słupski J, Słupska A, Szałach ŁP, Włodarczyk A, Górska N, Szarmach J, Jakuszkowiak-Wojten K, Gałuszko-Węgielnik M, Wilkowska A

Abstract
Major depressive disorder is one of the most important psychiatric issues worldwide, with important prevalence of treatment-resistant depression (TRD). Non-monoaminergic agents are currently in the spotlight. Objective was to explore for information about mechanisms of action of ketamine, its connections with copper and possible importance for TRD treatment. There are at least few possible pathways for ketamine action in depression in which copper and other divalent ions may show a vital role. There is urgent need for more studies to gather information about correlation between ketamine, copper and antidepressive features of these agents.

References
References are included in manuscript file. This paper is to be presented on conference 5-6th September 2019, Cambridge, UK.

Short-term ketamine administration in treatment-resistant depression patients: adverse effects on the central nervous system

Adam Włodarczyk, Wiesław Jerzy Cubała, Joanna Szarmach, Antonina Małyszko, Mariusz S. Wiglusz.

Abstract
Major depressive disorder (MDD) is a recurrent, incapacitating psychiatric illness which will be the second most disabling disease worldwide by the year 2020. There is a rising promise in a N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine, which may be used in the treatment of resistant depression. Many of the studies are in favor of the drug, even in single dose application, with effects appearing in minutes to hours from administration. However, there is a need to evaluate the benefits and risks regarding psychomimetic, psychiatric, neurologic, and cognitive adverse effects of ketamine administration. The most distressing symptoms which appear most frequently during ketamine administration are dissociative symptoms, which can be quantified as a CNS adverse drug reaction. Results generally show that a single infusion of ketamine is efficacious and well-tolerated, while dissociative symptoms tend to abate within 2 hours after ketamine administration. As studies show single doses of ketamine should be definitely considered as an option in TRD patients with/without suicidal thoughts, even though it could not provide remission, or the effect could be temporary, but improving patients’ quality of life by reducing depressive symptomatology should be a major asset while considering this particular procedure, particularly in inpatients.

References
references are included in manuscript file.

paper is to be presented on conference 5-6th september 2019 in Cambridge, UK.

Suicidality in treatment resistant depression: perspective for ketamine use.

Katarzyna Jakuszkowiak-Wojten , Maria Gałuszko-Węgielnik , Alina Wilkowska, Jakub Słupski, Adam Włodarczyk, Krzysztof Krysta

Abstract
Suicidal ideations or attempts in patients with major depressive disorder (MDD) are emergent
conditions that require immediate treatment. Numerous therapeutic interventions to reduce
suicide risk in psychiatric disorders are effective in long-term suicide prevention, but there is
necessity of sufficient, rapid pharmacological treatment of suicidal risk in MDD.
Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been reported to have rapid
antidepressant effect. Depressive symptoms, anxiety, hopelessness, suicidal ideation had
decreased within hours after ketamine infusion. Ketamine’s rapid symptoms relief and
reduction of suicide thoughts has aroused growing interests in psychiatric association.

References
are included in manuscript file.

Paper is to be presented on conference 5-6 September 2019 Cambridge UK

Magnesium and ketamine in the treatment of depression

Górska N, Słupski J, Szałach ŁP, Włodarczyk A, Szarmach J, Jakuszkowiak-Wojten K, Gałuszko-Węgielnik M, Wilkowska A, Wiglusz MS

Abstract
Depression affects over 121 million people annually worldwide. Relatively low remission rates among depressive patients enforce the search for new therapeutic solutions and an urgent need to develop faster-acting antidepressants with a different mechanism of action occurs. The pathomechanism of depression postulated by the monoamine hypothesis is limited. The results of abnormalities in glutamate and γ-aminobutyric acid (GABA) systems in the brains of people with mood disorders allowed to develop new theories regarding pathophysiology of these disorders. Glutamatergic transmission is influenced by magnesium and ketamine through glutamatergic N-methyl-D-aspartate receptor (NMDAR) antagonistic effects.
Magnesium and ketamine have a common mechanism of action in the treatment of depression: an increase in GluN2B (NMDAR subunit) expression is related to the administration of both of the agents, as well as inhibition of phosphorylation of eEF2 (eukaryotic elongation factor 2) in cell culture and increase of the expression of BDNF in the hippocampus. Combination of ketamine and magnesium in a normal magnesium level presents a superadditive effect in depression treatment. Analysed substances affect the GABAergic system and have anti-inflammatory effects, which is correlated with their antidepressant effect.
The synergistic interaction between the pharmacodynamic activity of magnesium and ketamine may be of particular importance for patients with mood disorders. Further research is needed to determine the relationship between magnesium levels and ketamine treatment response mainly in the attempt to establish if the magnesium supplementation can change ketamine treatment response time or present superadditive effect.

References
References are included in manuscript file. The paper is to be presented on conference 5-6th September 2019, Cambridge, UK

Clozapine: promising treatment for suicidality in bipolar disorder

Wilkowska A, Wiglusz MS, Cubała WJ

Abstract
Bipolar disorder is associated with the highest risk of completed suicide of all mental disorders. The suicide mortality of people with bipolar disorder is approximately 25 times higher than the general population. No approved pharmacological strategies for suicidality in bipolar disorder have been introduced so far. There is evidence for anti-suicidal effect of clozapine in schizophrenia. Clozapine with its unique pharmacology, anti-aggressive and anti-impulsive properties is potentially an effective strategy for suicidality in bipolar disorder.

References
Included in manuscript file.
This paper is to be presented at the CMHR conference 5-6 Sept 2019

Anxiety and depression in patients with acute leukaemia treated with hematopoietic stem cell transplantation

Anna Warchala, Irena Krupka-Matuszczyk, Krzysztof Krysta

Abstract
Background
Acute leukemia and hospitalization for hematopoietic stem cell transplantation (HCT) are the great psychological stressors. The aim of this study was to assess anxiety and depression associated with such conditions and their psychophysical predictors before and after HCT. Subject and Method
We conducted a longitudinal study using self-descriptive tools. The questionnaires: LOT-R, AIS, Mini-Mac, CECS, RSCL and HADS were filled by 60 patients with acute leukaemia before and after HCT.
Results
Anxiety and depressive symptoms correlated positively with psychological symptom distress. The correlation with depressive symptoms was weak, however, with anxious symptoms was moderate. In both cases, the higher was a level of psychological symptom distress, the higher level of anxiety and depression was observed in patients. The results indicated the weak, positive correlation between onerousness of physical symptoms and a level of anxiety. The greater was the severity of physical symptoms, the higher was the level of anxiety. The negative predictor of anxious symptoms was control of anxiety but it was weakly associated with a lower level of the explained variable. The negative predictor of anxious symptoms was also dispositional optimism whose high level accompanied the lower severity of the explained variable. However, the positive predictor of anxious symptoms was the variable of onerousness of symptoms whose high level accompanied the higher severity of anxious symptoms in the examined group.
Conclusion Patients with acute leukemia who are hospitalized for HCT require detailed monitoring of their psychological distress to introduce the proper psychological and pharmacological interventions that reduce anxiety as well as boost “dispositional optimism” and mechanisms of control.
Key words: hematopoietic stem cell transplantation, anxiety, depression, dispositional optimism

References
Andrykowski MA. Depression and survival after hematopoietic stem cell transplantation: where do we go from here? J Clin Oncol 2005; 23: 5878-5880.
Braamse AM, Gerrits MM, van Meijel B, Visser O, van Oppen P, Boenink AD et al.: Predictors of health-related quality of life in patients treated with auto- and allo-SCT for hematological malignancies. Bone Marrow Transplant 2012; 47: 757-769.
Coyne JC, Tennen H & Ranchor AV: Positive psychology in cancer care: A story line resistant toevidence. Ann Behav Med 2010; 39: 35-42.
El-Jawahri AR, Traeger LN, Kuzmuk K, Eusebio JR, Vandusen HB, Shin JA et al.: Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer 2015; 121: 951-959.
El-Jawahri AR, Vandusen HB, Traeger LN, Fishbein JN, Keenan T, Gallagher ER et al.: Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer 2016; 122: 806-812.

The immunomodulatory effect of ketamine in depression

Łukasz P. Szałach, Katarzyna A. Lisowska, Wiesław J. Cubała

Abstract
Major depression is one of the most frequent psychiatric conditions. Despite many available treatment methods, more than 30% of patients do not achieve remission, even after trying several antidepressants and augmentation strategies. S-enantiomer of ketamine, well-known anesthetic and analgesic, has been recently approved by Food and Drug Administration in the intranasal form as a new generation antidepressant. However, the mechanism in which ketamine reduces depressive symptoms in treatment-resistant depression patients is still not completely understood. There are several theories explaining how ketamine might reduce depressive symptoms, which have been described in detail; one of them is immunomodulatory effect of ketamine, according to the inflammatory theory of depression. In the review authors present and summarize studies showing ketamine effect on human immune system ex vivo and in vitro, including changes in cytokine levels, number, ratio and activity of various immune cell population and the correlation with clinical improvement in depressive symptoms. Most of the results confirm the anti-inflammatory effect of ketamine. There are only a few studies in the population of patients suffering from depression receiving ketamine, focused on correlation between immunological changes and clinical outcome of the therapy; further studies of that area are neccesary for understanding the immunomodulatory effect of ketamine in depression.

References
1. Abdallah CG, Adams TG, Kelmendi B, Esterlis I, Sanacora G, Krystal JH: Ketamine’s mechanism of action: a path to rapid-acting antidepressants. Depress Anxiety. 2016;33:689-97.
2. Albensi BC, Mattson MP: Evidence for the involvement of TNF and NF-kappaB in hippocampal synaptic plasticity. Synapse. 2000;35:151-9.
3. Belujon P, Grace AA. Restoring mood balance in depression: ketamine reverses deficit in dopamine-dependent synaptic plasticity. Biol Psychiatry. 201415;76:927-36.
4. Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, et al.: Antidepressant effects of ketamine in depressed patients. Biol Psychiatry. 2000 Feb 15;47(4):351-4.
5. Braun S, Gaza N, Werdehausen R, Hermanns H, Bauer I, Durieux ME et al.: Ketamine induces apoptosis via the mitochondrial pathway in human lymphocytes and neuronal cells. British Journal of Anaesthesia 2010;105:347-54.

and 39 more

Risk factors for noncompliance with antipsychotic medication in long-term treated chronic schizophrenia patients

Marek Krzystanek, Krzysztof Krysta, Małgorzata Janas-Kozik, Ewa Martyniak, Janusz Rybakowski

Abstract
Background:
The attitudes of schizophrenic patients toward medications directly impact the treatment compliance. Although noncompliance represents a serious concern in long-term schizophrenia treatment, a detailed information on the factors that impair compliance is still limited. The present study aims to assess the factors related to noncompliance with antipsychotics agents, in long-term treated chronic paranoid schizophrenia patients.
Subjects and Methods
Two groups of such patients (total number n=162) were analyzed and compared: 1). patients with symptomatic remission on haloperidol (n=32), clozapine (n=40) or olanzapine (n=45), and 2). drug resistant patients (n=45). The mean duration of the disease was 19.3 years.
Results
Altogether, in our patient sample, a better drug attitude was found in the olanzapine and clozapine groups. Our findings have also revealed that worse attitude toward antipsychotics correlated with an earlier onset of schizophrenia, younger patient age, shorter duration of the disease, higher burden of symptoms, treatment with a typical antipsychotics, and higher severity of akathisia.
Conclusion
Our results suggest that detecting factors that influence the patient’s attitude toward medications might be helpful for designing targeted educational strategies in chronic schizophrenia patients (particularly those with the high risk of noncompliance), and further trials are warranted to explore this topic.

References
1. Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR & Weinberger DR: Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162:441–449.
2. Brain C, Allerby K, Sameby B, Quinlan P, Joas E, Karilampi U et al.: Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS(®)) in the Swedish COAST-study. Eur. Neuropsychopharmacol 2013; 23:1754–1762.
3. Chandra IS, Kumar KL, Reddy MP & Reddy CM: Attitudes toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia. Indian J Psychol Med 2014; 36:294–298.
4. Dassa D, Boyer L, Benoit M, Bourcet S, Raymondet P & Bottai T: Factors associated with medication non-adherence in patients suffering from schizophrenia: a cross-sectional study in a universal coverage health-care system. Aust NZJ Psychiatry 2010; 44:921–928.
5. Gaebel W, Riesbeck M, von Wilmsdorff M, Burns T, Derks EM, Kahn RS et al., WW; EUFEST Study Group: Drug attitude as predictor for effectiveness in first-episode schizophrenia: Results of an open randomized trial (EUFEST). Eur Neuropsychopharmacol 2010; 20:310–316.

Efficacy of Ketamine in bipolar depression: focus on anhedonia.

Maria Gałuszko-Węgielnik1, Mariusz Stanisław Wiglusz1, Jakub Słupski1, Łukasz Szałach1, Adam Włodarczk1, Natalia Górska1, Joanna

Abstract
Bipolar depression (BD) is among the most severe psychiatric disorders. A significant number of patients do not achieve an entirely symptom-free state and experience residual sub-syndromal depression. Most of the treatment options approved for bipolar depression give no rapid symptom improvement. Ketamine is an anaesthetic medication that acts as an antagonist of the NMDA receptor and has antidepressant potential. Due to its unique way of action, ketamine seems to be crucial for the treatment of anhedonia. This review paper aims to provide an overview of the efficacy of ketamine infusions in bipolar depression with a focus on anhedonia Literature suggests that intravenous ketamine 0.5mg/kg over 40min weekly could be useful in the treatment of bipolar depression with prominent anhedonia, but there is still a small number of studies that examine the efficacy of ketamine infusions in BD. In conclusion, ketamine should be considered as a valuable treatment option for patients with BD and anhedonia.

References
are included in manuscript file.

Short-term ketamine administration in treatment-resistant depression: focus on cardiovascular safety.

Joanna Szarmach, Wiesław Jerzy Cubała, Adam Włodarczyk, Mariusz S. Wiglusz

Abstract
Ketamine is an anaesthetic and analgesic agent that demonstrates the antidepressive effect in major depression. Several administrations routes, dosing schemas and esketamine are investigated in basic and clinical research with particular focus on treatment-resistant depression (TRD) where drug demonstrates its efficacy where very limited alternatives are available. The majority of ketamine studies in TRD treatment reported no serious adverse events regardless the administration route or regimen. However, the most commonly observed adverse events following ketamine administration in antidepressive doses include general, psychotomimetic, dissociative and hemodynamic ones. The side effects are mild or moderate, well-tolerated and transient.
This paper discusses the risks regarding cardiovascular safety in MDD patients in short-term ketamine administration with particular focus on the effect on blood pressure and adverse drug reactions mitigation measures.
The increase in systolic (SBP) and diastolic (DBP) blood pressure is dose-dependent and begins shortly after administration peaking at around 30 to 50 minutes with SBP and DBP rise from 10% to 50% above predose values and resolving at approximately 2 to 4 hours after the dose administration. These changes generally are primarily asymptomatic. The elevations in SBP and DBP are observed on each dosing day with multiple administration schema.
The treatment with ketamine and esketamine is contradicted in subjects at risk of an increase in blood pressure or intracranial pressure. The current evidence indicates the blood pressure should be assessed prior to dosing with ketamine and hypertensive individuals shall receive effective lifestyle/pharmacologic management prior to treatment. Blood pressure should be monitored after dose administration until blood pressure returns to acceptable levels. If blood pressure remains elevated acute blood pressure management shall be delivered. In patients experiencing symptoms of hypertensive crisis immediate emergency care must be provided.
The unmet need for improved pharmacotherapies for TRD means the use of ketamine and esketamine is warranted therapeutic option in patients who fail to achieve a sustained remission of depressive symptoms with drugs with monoamine-based mechanisms of action. Adequate safety measures must be applied when using ketamine/esketamine in TRD subjects with particular focus on somatic comorbidities as the transient drug effect on cardiovascular system is demonstrated and of clinical significance.

References
all REFERENCES are included in manuscript file

this manuscirpt is to be presented on 5-6th september 2019 Cambridge, UK conference.

QEEG prefrontal theta cordance and alpha asymmetry in the prediction of response to antidepressants treatment

Martin Brunovsky, Martin Bares, Tomas Novak, Miloslav Kopecek, Jiri Horacek

Abstract
Objective: Previous studies demonstrated the efficacy of reduction of QEEG prefrontal theta cordance (RC) after the first week of treatment in the prediction of antidepressant response[1-3]. Our study aimed to compare the ability of RC in the prediction of response to various antidepressants.
Methods: 142 inpatients with MDD were treated with various antidepressants for ≥4 weeks. The primary efficacy measure was MADRS score, assessed at baseline, weeks-1,-2,-4, and at the end of study. EEG prefrontal theta cordance[4], was calculated as an average from 3 prefrontal electrodes (Fp1,Fp2,Fz) in theta (4-8 Hz) band at baseline and after 1-week of treatment.
Results: Logistic regression identified RC as a predictor of response to SSRI, SNRI and NDRI. Predictive parameters of RC for response were as follows: For SSRI(N=58), the AUC of ROC analysis yielded value of 0.77, positive predictive value(PPV) of RC at week-1 was 0.81, negative predictive values(NPV) of RC at week-1 was 0.73 and the accuracy of prediction reached value of 0.78.For SNRI(N=47), the AUC of ROC analysis yielded value of 0.77, PPV of RC at week-1 was 0.72, NPV of RC at week-1 was 0.84 and the accuracy yielded value of 0.77. For NDRI(N=22), the AUC of ROC analysis yielded value of 0.87, PPV of RC at week-1 was 0.91, NPV of RC at week-1 was 0.82 and the accuracy yielded value of 0.86. AUC of ROC analysis of RC for response prediction weren’t significantly different among antidepressant classes.
Conclusion: Prefrontal QEEG cordance is a promising tool predicting the response to various antidepressants. In this study, the predictive efficacy of 1-week reduction of QEEG prefrontal theta cordance for response to SSRI, SNRI and NDRI was comparable[5].
This work was supported by MHCR grants 15-29900A, NV18-04-00260 and project PROGRES Q35 of the 3rd Faculty of Medicine, Charles University in Prague.

References
[1] Bares M, Brunovsky M, Kopecek M, Stopkova P, Novak T, Kozeny J, et al. Changes in QEEG prefrontal cordance as a predictor of response to antidepressants in patients with treatment resistant depressive disorder: a pilot study. J Psychiatr Res. 2007;41(3-4):319-25.
[2] Bares M, Brunovsky M, Novak T, Kopecek M, Stopkova P, Sos P, et al. The change of prefrontal QEEG theta cordance as a predictor of response to bupropion treatment in patients who had failed to respond to previous antidepressant treatments. European Neuropsychopharmacology. 2010;20(7):459-66.
[3] Bares M, Novak T, Brunovsky M, Kopecek M, Hoschl C. The comparison of effectiveness of various potential predictors of response to treatment with SSRIs in patients with depressive disorder. J Nerv Ment Dis. 2017;205(8):618-26.
[4] Cook IA, Leuchter AF, Morgan M, Witte E, Stubbeman WF, Abrams M, et al. Early changes in prefrontal activity characterize clinical responders to antidepressants. Neuropsychopharmacology. 2002;27(1):120-31.
[5] Bares M, Novak T, Kopecek M, Brunovsky M, Stopkova P, Hoschl C. The effectiveness of prefrontal theta cordance and early reduction of depressive symptoms in the prediction of antidepressant treatment outcome in patients with resistant depression: analysis of naturalistic data. Eur Arch Psychiatry Clin Neurosci. 2015;265(1):73-82.

The effect of daytime psilocybin administration on sleep

Jana Koprivova, Daniela Dudysova, Jitka Buskova, Martin Brunovsky, Tomas Palenicek, Jiri Horacek

Abstract
Objective: Psilocybin is a psychedelic drug currently investigated for its potential antidepressant properties. The aim of this study was to evaluate changes in subjective and objective sleep characteristics associated with psilocybin administration.
Methods: Twenty healthy volunteers (10 women, mean age 36±8.1 years) were enrolled in the sleep experiment as part of a larger ongoing study (EudraCT No. 2012-004579-37). All participants underwent an adaptation night and a whole-night sleep recording after both, placebo and psilocybin session, approximately 12 hrs after the placebo/psilocybin ingestion. After each night subjective and objective sleep characteristics were evaluated. Sleep macrostructure, first sleep cycle slow-wave activity (SWA) and EEG spectral power were compared between the experimental nights.
Results: No significant changes in subjective total sleep time or sleep quality were observed. However, subjects perceived times to fall asleep as longer (10.5min on average, p=0.028) during the night after psilocybin administration compared to placebo condition. Objective sleep analysis revealed prolonged REM sleep latency after psilocybin administration (p=0.048) and an overall tendency to REM sleep suppression. SWA in the first sleep cycle was found to be significantly reduced after psilocybin administration in comparison to placebo condition.
Conclusion: The changes of REM sleep observed after psilocybin administration correspond with the acute effect of antidepressants and are congruent with evidence for antidepressant properties of psilocybin. Contrary to our expectations, our data did not provide evidence for sleep-related neuroplastic changes. This might be due to longer pharmacological dynamics of psilocybin compared to other psychedelic drugs promoting SWA, e.g. ketamine or ayahuyasca. Possibly, sleep-related markers of neuroplastic changes might be observed at a longer time interval after drug ingestion.
This work was supported by Ministry of Health of the Czech Republic, grants NV18-07-00272, Ministry of the Interior VI20172020056 and by project “Progres Q35” of the 3rd Faculty of Medicine, Charles University in Prague.

References
Barbanoj MJ, Riba J, Clos S, Gimenez S, Grasa E, Romero S: Daytime Ayahuasca administration modulates REM and slow-wave sleep in healthy volunteers. Psychopharmacology (Berl) 2008; 196; 315-26.
Bravermanova A, Viktorinova M, Tyls F, Novak T, Androvicova R, Korcak J, et al.: Psilocybin disrupts sensory and higher order cognitive processing but not pre-attentive cognitive processing-study on P300 and mismatch negativity in healthy volunteers. Psychopharmacology (Berl) 2018; 235; 491-503.
Carhart-Harris RL, Bolstridge M, Rucker J, Day CM, Erritzoe D, Kaelen M, et al.: Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3; 619-27.
Kay DC & Martin WR: LSD and tryptamine effects on sleep/wakefulness and electrocorticogram patterns in intact cats. Psychopharmacology (Berl) 1978; 58; 223-8.
Tyls F, Palenicek T & Horacek J: Psilocybin - summary of knowledge and new perspectives. Eur Neuropsychopharmacol 2014; 24; 342-56.

Possible Applications of Virtual Reality in Neuroscience Research of Mental Disorders

Iveta Fajnerová, Lukáš Hejtmánek, Adéla Plechatá, Ivana Oravcová, David Tomeček, David Greguš, Jaroslav Hlinka, Jiří Horáček

Abstract
There is an increasing trend in application of new technologies, such as virtual reality (VR) in the mental health care. One of the main applications of virtual technology is the assessment of complex human behavior and cognitive abilities. Two of the main advantages of VR over the standard paper-and-pencil tests are detailed recording of the human reactions in complex environments and situations, and ecological validity - similarity to real life situations. The lecture will introduce an example of the application of virtual tasks in assessment of episodic memory and spatial navigation in complex environments, ranging from mazes to complex cities, performed during functional brain imaging combined with eye movement monitoring. This approach is used to study functional connectivity (FC) within large-scale brain networks, specifically frontotemporal connectivity during active movement in virtual environment. The task is currently tested in schizophrenia patients in order to address alterations of FC between hippocampus and prefrontal cortex in context of behavioral episodes specific for spatial memory retrieval and spatial orientation. Presented results are funded by the Ministry of Health CR grant No. 17-30833A and by the European Regional Development Fund-Projects "PharmaBrain" No. CZ.02.1.01/0.0/0.0/16_025/0007444 and Charles University Grant Agency projects No. 238217 and 1832218.

References
Fajnerová I, Greguš D, Hlinka J, Nekovářová T, Škoch A, Zítka T, Romportl J, Žáčková E, Horáček J. Could Prolonged Usage of GPS Navigation Implemented in Augmented Reality Smart Glasses Affect Hippocampal Functional Connectivity? Biomed Res Int. 2018 Jun 13;2018:2716134. doi: 10.1155/2018/2716134. eCollection 2018.
HEJTMÁNEK, L., ORAVCOVÁ, I., MOTÝL, J., HORÁČEK, J., FAJNEROVÁ, I. Spatial knowledge impairment after GPS guided navigation: Eye-tracking study in a virtual town. International Journal of Human-Computer Studies. 2018, 116(August), 15-24. ISSN 1071-5819. DOI: 10.1016/j.ijhcs.2018.04.006. IF 2.006.
Plechatá A, Sahula V, Fayette D, Fajnerová I. Age-Related Differences With Immersive and Non-immersive Virtual Reality in Memory Assessment. Front Psychol. 2019 Jun 11;10:1330. doi: 10.3389/fpsyg.2019.01330. eCollection 2019.
Krajcovic B, Fajnerova I, Horacek J, Kelemen E, Kubik S, Svoboda J, Stuchlik A. Neural and neuronal discoordination in schizophrenia: From ensembles through networks to symptoms. Acta Physiol (Oxf). 2019 Aug;226(4):e13282. doi: 10.1111/apha.13282. Epub 2019 May 22. Review.

Mental disorders/difficulties in the postpartum period

Ivana Zivoder, Sanja Martic –Biocina, Jurica Veronek, Natalija Ursulin- Trstenjak, Melita Sajko, Marija Paukovic

Abstract
Mental difficulties are common in the postpartum period. They can manifest in a mild form, but also as serious disorders which need to be treated in a timely manner. The most common psychological problem is "Baby blues" characterized by relatively short duration without consequences and treatment is largely unnecessary. Postpartum depression is characterized by a sense of sadness, loss of interest, insomnia, discomfort, loss of energy, reduced concentration. Postpartum psychosis is the most serious disorder but is also rare and may have serious consequences for the mother and child. Important factors in the postpartum mental problems/difficulties are genetic factors, situation of unwanted pregnancy, a feeling of discomfort with the role of motherhood and sudden hormonal changes.
Aim of the study: to investigate the frequency and type of mental problems in postpartum period, as well as possible type of help needed by the women in postpartum period.
Methods: One hundred (112) respondents participated in the survey. The survey was conducted from November to December 2017 through a "google docs" application. The survey was placed on different social networks, and the participation in the survey was voluntary and anonymous. A series of 14 questions with the offered answers was used in the survey.
Results: The results of the survey have shown that psychological difficulties and disturbances in the postpartum period to be common problems encountered by almost 50% of women (44.46%). The most common difficulty is Baby blues, followed by postpartum depression and anxiety disorders. Age and the mode of birth did not affect the emergence of changes, while social factors such as family support had a great impact.
Conclusion: The provision of information to the mothers can help, but inaccurate information can do the opposite. Thus, the role of health care professionals is important for helping mothers in that period to prevent certain difficulties as well as in identifying and referring mothers to seek help in a timely fashion.
Keywords: mental disorders/difficulties, health care professionals, education, prevention

References
1. Fiala A, Švancara J, Klánová J and Kašpárek T: Mindful with Your Baby: Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study. BMC Psychiatry 2017; 17:104.
2. Gingnell M, Toffoletto S, Wikström J, Engman J, Bannbers E, Comasco E & Sundström-Poromaa I: Emotional anticipation after delivery – a longitudinal neuroimaging study of the postpartum period. Scientific Reports 2017;| 7: 114.
3. Ohashi Y, Kitamura T, Sakanashi K and Tanaka T: Postpartum Bonding Disorder: Factor Structure, Validity, Reliability and a Model Comparison of the Postnatal Bonding Questionnaire in Japanese Mothers of Infants. Healthcare 2016; (4):50.
4. Olaoluwa S. Agbaje, Joy I. Anyanwu, Prince I. C. Umoke, Tochi E. Iwuagwu, Cylia N. Iweama, Eyuche L. Ozoemena and Ijeoma R. Nnaji: Depressive and anxiety symptoms and associated factors among postnatal women in Enugu-North Senatorial District, South-East Nigeria: a cross-sectional study. Archives of Public Health 2019; 77:1.
5. Saligheh M, Rooney RM, McNamara B & Kane RT: The relationship between postnatal depression, socio demographic factors, levels of partner support, and levels of physical activity. Frontiers in Psychology | Psychology for Clinical Settings 2014; Article597 (5): 1-8.

Clinical and experimental potentials of psychedelics

Jiri Horacek, MD, Ph.D., FCMA; Tomáš Páleníček, MD, PhD.

Abstract
The knowledge of therapeutic properties of natural psychedelic medicines have been preserved continuously till these days by native people. The active substances contained in these medicines, so called psychedelics, hallucinogens or entheogens, are powerful substances that in modern language alter one´s perception, thinking, emotional and cognitive processing and can also induce strong long-term neurobiological effects. After almost 40 years of restriction these substances found a way back to the modern human clinical research and nowadays we are witnesses of the renaissance of clinical studies focusing on their therapeutic potential.
After isolated case reports and open label studies, controlled double blind phase II and III clinical studies are emerging, showing substantial therapeutic potential of psychedelics in affective disorders, anxiety, addiction and some other disorders. In my talk I will summarize the results from our ongoing psilocybin trial in healthy volunteers and the recent evidence of the clinical potential of psychedelics in relation to their effects on the brain neuronal activity and neuronal plasticity.

Acknowledgment: This work was supported by projects AZV no. 17-30833A, 16-29857A and NV18-04-00260, and GACR no.: 17-23718S and 17-04047S.

References
A. Bravermanova, M. Viktorinova, F. Tyls, T. Novak, R. Androvicova, J. Korcak, J. Horacek, et al. Psilocybin disrupts sensory and higher order cognitive processing but not pre-attentive cognitive processing-study on P300 and mismatch negativity in healthy volunteers, Psychopharmacology (Berl), 235 (2018) 491-503.
J. Horacek, M. Brunovsky, T. Novak, B. Tislerova, T. Palenicek, et al. Subanesthetic dose of ketamine decreases prefrontal theta cordance in healthy volunteers: implications for antidepressant effect, Psychol Med, 40 (2010) 1443-1451.
P. Sos, M. Klirova, T. Novak, B. Kohutova, J. Horacek, T. Palenicek. Relationship of ketamine's antidepressant and psychotomimetic effects in unipolar depression, Neuro Endocrinol Lett, 34 (2013) 287-293.
F. Tyls, T. Palenicek, J. Horacek, Psilocybin--summary of knowledge and new perspectives, Eur Neuropsychopharmacol, 24 (2014) 342-356.

Deaf psychiatry: a review of the difficulties and the effect of an inquiry on current practice

Shentong Wang

Abstract
Communication is a huge difficulty in researching Deafness in psychiatry and in practically assessing and treating deaf patients. This paper aims to review the difficulties surrounding the assessment and treatment of deaf patients, using a review of the current literature on audio-visual hallucinations as an example. It will also include a summary of the published inquiry into the care and treatment of Daniel Joseph (a profoundly Deaf man), and a review of the Department of Health consultation document and NHS England responses to that inquiry as evidence of why these difficulties have relevance in everyday practice. In structuring the paper in this manner, the author hopes to review the current state of healthcare provided for Deaf individuals within psychiatry, and what still needs to be done.

References
Anglemyer E, Crespi C. Misinterpretation of Psychiatric Illness in Deaf Patients: Two Case Reports. Case reports in psychiatry. 2018 :3285153.
Atkinson JR. The perceptual characteristics of voice-hallucinations in deaf people: insights into the nature of subvocal thought and sensory feedback loops. Schizophrenia bulletin. 2006 ;32:701-8.
Atkinson JR, Gleeson K, Cromwell J, O'Rourke S. Exploring the perceptual characteristics of voice-hallucinations in deaf people. Cognitive neuropsychiatry. 2007 ;12:339-61.
Britain G. A Sign of the Times: Modernising Mental Health Services for People who are Deaf. Department of Health; 2002. Department of Health. Mental Health and Deafness. Towards Equity and Access. 2005
DuFeu M, McKenna PJ. Prelingually profoundly deaf schizophrenic patients who hear voices: a phenomenological analysis. Acta PsychiatricaScandinavica. 1999 ; 99 : 453-9.
Glickman N. Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation. In Cognitive-Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges 2008 ; 77-108. Routledge.
Landsberger SA, Diaz DR. Identifying and assessing psychosis in deaf psychiatric patients. Current psychiatry reports. 2011 ;13:198-202.
Merton Sutton and Wandsworth Health Authority and Lambeth Southwark & Lewisham Health Authority. Report of the independent inquiry team into the care and treatment of Daniel Joseph. 2000
Perrone-Bertolotti M, Rapin L, Lachaux JP, Baciu M, Lœvenbruck H. What is that little voice inside my head? Inner speech phenomenology, its role in cognitive performance, and its relation to self-monitoring. Behavioural brain research. 2014 ;261:220-39.
Ram D, Kumar V, Rao TS. Issues in acute psychosis of an illiterate hearing impaired with minimal speech output: A psychiatrist perspective. Indian journal of psychiatry. 2015 ;57:99.

PHARMACOLOGICAL THERAPIES IN BIPOLAR DISORDER: A REVIEW OF CURRENT TREATMENT OPTIONS

Amol Joshi, Alexander Bow and Mark Agius

Abstract
BACKGROUND: Bipolar disorder is a mental illness characterised by periods of elevated mood alternating with periods of depression. Long-term relapse prevention in bipolar disorder is challenging, with a significant number of patients relapsing following the initial stabilisation of mood. Initial treatment of the condition is complex and usually occurs in secondary care. Whilst there is no known cure for bipolar disorder, several therapies have been found to be effective in both managing acute episodes and sustaining long-term remission. The key pharmacological therapies in bipolar disorder are lithium salts, antiepileptics and antipsychotics and these will be the focus of this review.

AIM: This review seeks to outline the key common pharmacological therapies used in the treatment and relapse prevention of this condition.

METHODS: A MEDLINE search was performed, and the available literature was subsequently analysed, including meta-analyses, reviews and original clinical trials.

RESULTS: Management strategies can be subdivided into treating acute presentations of mania and depression and maintaining long-term remission. The extensive side effect profile of several antipsychotics means that there are certain patient groups for whom they may be intolerable or contraindicated. Lithium emerges as a highly efficacious maintenance therapy but retains the burden of therapeutic drug monitoring. Antiepileptics play a crucial role in maintaining remission but are linked to serious, albeit rare, side effects.

CONCLUSION: Despite the efficacy of the medications discussed in this article, their underlying mechanisms of action remain to be fully elucidated. Nonetheless, these key therapies continue to be essential tools in the management of bipolar disorder.

References
See paper

Cardiovascular side effects of clozapine therapy in patients with schizophrenia

Anna McKeever

Abstract
Mortality due to physical diseases is higher in patients with mental illness than the general population, and a large proportion of early deaths are due to cardiovascular diseases (CVD). Treatment with antipsychotics increases patients’ risk of CVD, and in some cases may augment an already high background risk. Clozapine is a second-generation anti-psychotic with unique efficacy in reducing symptoms, rehospitalisation and treatment failure in patients with schizophrenia who have failed to respond to other treatments. However, clozapine is associated with several adverse cardiovascular side effects, including myocarditis, cardiomyopathy and other CVD occurring in the context of metabolic syndrome. Despite our long-standing awareness of early mortality in patients with schizophrenia and the implementation of physical health monitoring in patients prescribed clozapine, there has been no reduction in deaths. In fact, the mortality gap may be increasing. We will review the adverse cardiovascular side effects of clozapine therapy and the current monitoring for drug-related cardiovascular complications. Clinicians must weigh up the unknown risks of inadequately treated psychosis vs early mortality due to CVD. Risk stratification, monitoring and primary prevention should increase the safety of this highly efficacious treatment for patients with treatment resistant schizophrenia.

References
1. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The Lancet Psychiatry Commission : a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry [Internet]. 2019 Aug [cited 2019 Jul 19];6(19):1–39. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2215036619301324
2. McEvoy J, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, et al. Effectiveness of Clozapine Versus Olanzapine, Quetiapine, and Risperidone in Patients With Chronic Schizophrenia Who Did Not Respond to Prior Atypical Antipsychotic Treatment. Am J Psychiatry [Internet]. 2006 Apr 1 [cited 2019 Jul 31];163(4):600. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16585434
3. Tiihonen J, Mittendorfer-Rutz E, Majak M, Mehtälä J, Hoti F, Jedenius E, et al. Real-World Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of 29 823 Patients With Schizophrenia. JAMA Psychiatry [Internet]. 2017 Jul 1 [cited 2019 Jul 31];74(7):686. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28593216
4. Merrill DB, Dec GW, Goff DC. Adverse cardiac effects associated with clozapine. J Clin Psychopharmacol [Internet]. 2005 Feb [cited 2019 Jul 11];25(1):32–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15643098
5. De Hert M, Correll CU, Cohen D. Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study. Schizophr Res [Internet]. 2010 Mar [cited 2019 Jul 29];117(1):68–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20060684

LIFESTYLE MEDICINE – A HOLISTIC APPROACH TO MENTAL HEALTH – CASE SERIES

DR TAMARA KARNI COHEN

Abstract
A growing number of medical professionals believe that existing conventional treatment approaches such as prescription medications and therapy do not fully address the health needs of people (1). The importance of lifestyle medicine as an effective and complimentary approach to treatment of health issues is increasingly recognised, particularly concerning treatment of mental health issues. Lifestyle medicine includes a range of treatments focusing on physical, emotional, nutritional and community needs of each patient.

The method adopted within the primary care setting involved applying lifestyle medicine in combination with conventional treatments. This holistic approach can be viewed as the concerted application of the triad of therapy, medication and lifestyle medicine (TML triad). The effectiveness of this holistic approach is demonstrated by this case series.

In all three cases outlined, therapy and prescription medicine were complemented by a variety of lifestyle modifications, including mindfulness, nutritional changes, movement, routine, new hobbies and emotional release. In all cases, involvement of the family and social support was a key constituent of the lifestyle modification, creating a better and more supportive community.

The outcomes for the patients were far superior to previous treatments they had undergone that had only focused on prescription medicine or therapy, demonstrating the effectiveness of a holistic approach such as the TML triad.

References
1. http://www.theintegrativementalhealthsolution.com

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2019 Conference Abstracts