Search

Aims and methodWe investigated deliberate and inadvertent off-label prescribing in individuals with recurrent depressive disorder attending a community mental health service.ResultsOff-label prescribing occurred in 87 of 226 people with recurrent depressive disorder (38%) and involved antipsychotic agents (41), maintenance benzodiazepine use (33), antidepressant polypharmacy (28), high-dose antidepressants (19) and use of antidepressants outside of the recommended age range (16). Off-label prescribing was part of a deliberate and documented treatment plan for a half (n= 43) of individuals. Participants receiving off-label prescribing had higher total Health of the Nation Outcome Scale (HoNOS) scores, were attending more frequently and were older and had more chronic illness duration. Inadvertent off-label prescribing was related to higher scores on the behavioural disturbance subscale of the HoNOS.Clinical implicationsOff-label prescribing is a common phenomenon in people with recurrent depressive disorder and relates to greater illness severity and chronicity. Although off-label prescribing is frequently deliberate, in many cases it is undesirable and unplanned.

IntroductionPrevious optimistic assumptions about the prognosis of BAD based on the control of mood symptoms is now challenged as majority of patients continue to have cognitive deficits during the euthymic phase.ObjectivesTo describe cognitive impairment in euthymic BAD and study the association with clinical characteristics.AimsIdentify the prevalence and severity of cognitive impairment (CI); to correlate CI with the first episode, illness duration, number of episodes and predominant polarity.MethodsPatients attending the psychiatry clinic of the National Hospital of Sri Lanka diagnosed with BAD in the remission phase were recruited. An interviewer-administered questionnaire and Montreal Cognitive Assessment test was used to ascertain clinical characteristics and cognitive functions respectively. Scores of 18–26 described as mild, 10–17 moderate and < 10 as severe cognitive impairment.ResultsTotal sample size was 58. Mean age = 48.84 (SD12.5). Fifty-five percent were females. Mean duration of illness was 179.7 months (SD128.5). A mean of 6 episodes were experienced during the course of illness (min = 1, max = 18); 58.6% had depression, 37.9% had manic and 3.4% had mixed as their first episode. The predominant polarity was depressive in 65.5%. No cognitive impairment – 8.6%, mild – 63.8%, moderate – 27.6% and none with severe. There was a significant association between the presence of cognitive impairment and the predominant polarity being depressive (r = 10.886, df = 4, P = 0.028). No significant association was found between illness duration, number of episodes or the type of first episode.ConclusionsPatients with a predominant depressive polarity are more likely to experience cognitive impairment. Cognitive impairment had no association with illness duration, type of episode or number of episodes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patients with eating disorders (EDs) often spontaneously talk about their disorder in terms of a symbolic other (a demon, a voice, a guardian). Further, externalizing exercises where patients are encouraged to separate their true self from their ED self are common in some treatment approaches. Yet, no previous quantitative study has investigated this phenomenon. We examined the patient-ED relationship (using the interpersonal structural analysis of social behavior methodology) and its implications for ED symptoms, illness duration and self-image. Participants were 16–25 year old female patients (N = 150) diagnosed with anorexia nervosa (N = 55), bulimia nervosa (N = 33) or eating disorder not otherwise specified (N = 62). Results suggested that patients had comprehensible and organized relationships with their EDs. EDs were primarily experienced as acting critical and controlling towards patients. Higher ED control was associated with more ED symptoms and longer illness duration, especially when coupled with patient submission. Patients reacting more negatively towards their EDs than their EDs were acting towards them had lower symptom levels and more positive self-images. Externalizing one's ED, relating to it like a symbolic other, seemed to make sense to patients and depending on its quality seemed to influence ED symptoms, illness duration and self-image. We put forward both clinical and theoretical implications based on the assumption that the patient-ED relationship may function in similar ways as real-life interpersonal relationships do.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionBipolar disorder (BD) is associated with an impaired glucose metabolism (IGM) leading to diabetes mellitus Type II (DM). DM influences the medical state of BD individuals and leads to increased mortality. However, there is evidence that IGM is associated with psychiatric symptoms, as well.AimThe study aimed to investigate the association between IGM and number of episodes and their ratio in individuals with BD, separated for gender.MethodsHbA1c levels from fasting blood were measured of 162 individuals (46% females) with BD. Furthermore, clinical parameters e.g. number of depressive and (hypo)manic episodes were gathered.ResultsAfter adjustment for illness duration and BMI there was a positive correlation in male individuals between HbA1c and number of depressive (M = 13.86, SD = 14.67; r = .308, P < 0.05) as well as (hypo)manic episodes (M = 17.23, SD = 24.24; r = 0.263, P < 0.05). There was no association in females as well as between HbA1c levels and ratio of episodes.ConclusionAssociations between HbA1c and number of episodes in male individuals with BD were found. As there are correlations between IGM and somatic comorbidities as well as the course of illness the treatment of glucose metabolism is important in BD. However, number of episodes might have an impact on the glucose metabolism due to inflammation processes, but further investigations have to focus on the direction of the found correlation. As gender differences are known in different pathways, they should be considered in research, diagnosis and therapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Introduction Patients with schizophrenia experience lower quality of life (QOL) than the general population. Improving QOL is both challenging and desirable. Objectives To broaden the understanding of QOL in patients with schizophrenia to facilitate development of treatment strategies. Aims To assess QOL in patients with schizophrenia and to examine the relation of QOL with a) illness duration b) antipsychotic treatment (defined daily doses, ddd), c) body mass index (BMI) and d) smoking. Methods In this naturalistic, cross-sectional study patients were interviewed to obtain smoking habits, they completed a QOL questionnaire (WHOQOL-Bref, composed of a physical, psychological, social and environmental domain) and had height and weight measured. Patients were grouped as first-ever diagnosed or long-term ill. Characteristics were correlated to QOL using multiple regression analysis. Preliminary Results 82 participated. Mean QOL was comparable to prior studies. A number of characteristics were significantly associated with the four QOL domains. The regression coefficients and significance levels are presented in Table I. Conclusion Patients with schizophrenia experienced a low QOL. The following characteristics were significantly associated with lower QOL in a) first-ever diagnosed: high BMI, low ddd and smoking habits and b) long-term ill: high BMI and short illness duration. Changing these might improve QOL in patients with schizophrenia.

Introduction Lack of insight is often present in patients with schizophrenia. Considering the insight, clinical symptoms and their severity may be important Objective: To establish a level of insight in subjects with schizophrenia and compare it with positive, and negative symptoms of schizophrenia with regard of duration of illness. Methods: A prospective study was conducted on 60 consecutive outpatients with schizophrenia. Two groups were formed regarding the duration of illness (≤2 years, and >3 years). Positive symptoms of SCH were established with 4 item positive symptom ranking scale – PSRS, and negative symptoms with Brief negative symptoms assesment – BNSA. The level of insight was established with Self appraisal of illness questionnaire – SAIQ. Results: There was not significant difference in PSRS score regarding the duration of illnes p=0.197, t-1.30, and small effect size was found. Average score of negative symptoms in the group with shorter duration of illness was 8.37±2.94, and in the group with longer duration 10.73±2.86. Independent Samples Test was significant p=0.003, t-2.367, and therefore difference of scores on BNSA whitin groups was significant. Moderate size effect was found (d 0.69). Total insight score on SAIQ was insignificantly correlated with positve and negative symptoms, regardles of the duration of illness. Conclusion: Longer duration of ilness has moderate effect on negative symptoms severity. Insight level is insignificantly correlated with positive and negative symptoms regardless of illness duration. Symptoms severity has minor impact on insight in patients with schizophrenia.

Introduction Obsessive-compulsive disorder (OCD) symptoms are remarkably diverse, as regards both clinical presentation and severity 1 . Studies are conflicting about whether any specific phenotype of OCD is easier to treat or likely to benefit from a particular treatment. Duration of untreated illness (DUI) represents a modifiable parameter, whose reduction may positively influence the outcome and long-term course of specific psychiatric disorders 2 . The aim of this study was to evaluate possible differences concerning severity, duration of illness (DI) and DUI among OCD subtypes in a sample of OCD patients. Methods 114 OCD outpatients were recruited and assessed using the Y-BOCS. The main OCD phenotypes were identified through the YBOCS- Symptom Checklist. A one-way ANOVA test was performed to compare DUI, DI and Y-BOCS scores in the sample. Results Subjects were categorized into 4 clinical phenotypes,: aggressive/checking (n=31), contamination/cleaning (n=37), simmetry/ordering (n=32) and multiple phenotypes (n=14). DUI, DI and YBOCS scores were found significantly higher in aggressive/checking subgroup, compared to other subgroups (One Way ANOVA: F=3.58 p Conclusions DUI and DI resulted significantly higher in the aggressive/checking subgroup, compared to the other subgroups. YBOCS scores resulted significantly higher in the aggressive/checking subgroup compared to the others, showing that longer DUI and DI may condition a worse clinical outcome in this subgroup. Of note, within the total sample half of the whole DI was spent untreated.

Introduction PERDOVE study is a prospective observational cohort study, which providing follow-up at one year, aims to investigate the socio-demographic and clinical characteristics of patients in in the 23 medium-long term RFs of the St John of God Order. Objectives (1) To describe the sociodemographic, clinical, and treatment-related characteristics of RF-patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at 1-year follow-up; (3) to evaluate clinicians’ predictions about each patient's likelihood of Home Discharge (HD). Methods All patients staying in September 2010 with a primary psychiatric diagnosis received a set of standardized assessment instruments, including a “Patient Schedule”, BPRS, HONOS, PSP, PHI, and SLOF. Detailed socio-demographic and clinical data were also collected. Logistic regression analyses were run to identify independent discharge predictors. Results The study involved 403 patients. 66,7% is male, mean age is 49 (±10). 70.7% is unmarried. The average duration of illness of these patients is 23 years. Primary diagnosis is represented by schizophrenic spectrum disorders (67.5%). At 1 year follow-up, 104 patients (25.8%) were discharged: 13.6% to home, 8.2% to other RFs, 2.2% to supported housing, and 1.5% to prison. Conclusions The main variables associated with a higher likelihood of being discharge to home were: to have an illness duration of less than 15 years and to have an available and effective social support in the last year. Lower severity of psychopathology, and higher working skills were also associated with a significantly higher likelihood to be discharged to home.

Introduction Research indicates a higher risk of somatic problems and cardiovascular and respiratory mortality among patients with non-affective psychotic disorders (NAPD). Data on health care (HC) utilization of this group have revealed ambivalent results pointing at a higher appeal to somatic HC and possible under-consumption. Objective This study focuses on somatic HC utilization in the Netherlands among patients with NAPD, unipolar depression, anxiety or bipolar disorder, compared to matched controls without psychiatric diagnosis. Aims To study possible under-consumption associated with NAPD and its correlates. Methods The HC utilization of 2,392 cases with NAPD registered in the Psychiatric Case Register Middle Netherlands (PCRMN) and above mentioned comparison groups was analyzed by using linked data on prescribed medication, general practitioner (GP) consults and treatment by specialists from insurance company Agis. Results The costs for somatic HC among NAPD patients was on average €1621 per year, marginally higher compared to matched controls (€1441, p=0.079). Among patients with depression and anxiety, much greater differences with their matched controls were found (p 60) and longer duration since diagnosis (>5 years) (OR=0.60, P Conclusion In view of the higher somatic death risk, our data suggest HC under-consumption, which is increasing with a longer illness duration and older age.

Background Some study suggest that unipolar mania could be a separate subtype, while there is no unipolar mania listing in DSM. We compared sociodemographic and clinical data of unipolar and bipolar mania. Methods In an analytical-observation study,through 850 patients with bipolar I disorder, in 10 years of illness duration, 240 patients were included. We evaluated demographic and clinical information and interview with patients and their families consistent with DSM, then we assessment the comorbidities and other clinical conditions and analysed our data by using the mann-witney test, chi-squar test and fisher exact test. Results 22.4% of 219 patients presented a course of illness characterized by unipolar manic episodes without history of major or mild depression. When this group was compared with 170 manic patients with a previous history of depressive episodes, we found significant similarities in most demographic, familial, and clinical characteristics. Just positive family history for MDD was higher in bipolar mania significantly (P Discussion There is no prominent differences between two groups and inform clinical and psychopathological have common characteristics in unipolar and bipolar mania. So, biologic, physiologic and anatomical bases of unipolar and bipolar mania could be similar. Literature on this topic is still insufficient, and it is necessary to ongoing unipolar manic studies in future.

IntroductionThe suicidal behavior at patients with anhedonia in schizophrenia is one of the burn problems in modern psychiatry.ObjectivesAnhedonia belongs to negative symptoms in schizophrenia. The suicidal activity at patients with it consists from 7% tо 43%. At those patients fixed the suicidal ideas - 40%, suicidal attempts - 23% and complete suicide - 6,4%.AimsStudy the methods of suicidal behavior at those patients.MethodsThe Columbia Suicide severity research scale (C-SSRS).Results157 patients with anhedonia. Selected 49 (31, 21%) patients with suicidal behavior on admission or in the past. 23 women and 26 men with a mean age of 34, 37(±1, 92) and mean illness duration of 7, 72(±1, 42). The anhedonia level was 21, 26(±1, 26). 73,48% were the patients with Schizophrenia among them 44,91% with “postpsychotic depression” (295.60), 28, 57% with paranoid schizophrenia (295.30) and 26,52% - patients with affective disorders (296.3×). All patients wished to die. 79,59% (n = 39) had a suicidal attempts and 20,41% (n = 10) had a suicidal ideas. Active suicidal ideas without the suicide plan had 79, 59% patients. The methods of suicidal attempts were poisoning (38, 52%), cutting (25, 64%), hanging (12, 8%), falls (20, 48%), drowning (2, 56%).ConclusionsAnhedonia in schizophrenia is a risk factor of suicidal behavior. The suicidal behavior declared itself with suicidal attempts much more than suicidal ideas. Suicidal attempts were impulsive and dangerous with risk for life. It point to seriousness and danger results of suicidal behavior.

This prospective study was carried out on 53 in-patients suffering from chronic schizophrenia. Before the Risperidone treatment they were on the convenient antipsychotic therapy - haloperidol average doses 9.6 mg pro die, or Fluphenazine average 4.2 mg pro die.The aim of the study was to follow up therapeutically effects of Risperidone, using PANSS scale for schizophrenia, during two months, by two- weeks visits.ResultsOn average dose of Risperidone 5.1 mg pro die there was found 18.2% reduction on the Positive syndrome scale after two months. Negative syndrome scale showed improvement of 20.5%; General psychopathology scale was reduced for 15.7%. Finally, total PANSS score was reduced 17.2%. Results were also discussed according to sex, age, illness duration and schizophrenia type.ConclusionTherapeutically efficacy of Risperidone has been shown on the positive, as so as the negative schizophrenia symptoms. Better results were in disorganized form of schizophrenia then the paranoid form.

Alcohol- Induced Persisting Dementia (AIPD) can occur because of both the direct effects of alcohol and specific vitamin deficiencies, and the indirect influence of genetic or neurochemical predisposition.Aim of this study was to ascertain the efficiency of the rivastigmine therapy in the treatment of AIPD.Methods:The prospective clinical study included 101 patients diagnosed in accordance with DSM IV criteria for AIPD. Patients were monitored for 3 months in hospital and outpatient conditions, according to specially designed protocol, which included MMSE, BPRS, CGI1-4 scales, and clock drawing test (CDT). Both the control and the experimental groups were treated with conventional therapy and in addition the experimental group treatment was supplemented with rivastigmine (3-12 mg/24 h).Results:The participants were in the same age range, predominantly male, with an similar average illness duration. Average daily rivastigmine dose was 9.76±2.014 mg. An average pretrial MMSE score was around 19, BPRS score was around 50, CGI1 score was around 4.6, and CDT score around 5. Statistically significant differences among the C and E group begin to show after 14th (in BPRS scores)and 28th day of therapy(in MMSE,CDT,and CGI1 scores) (p>0.1) and to become more apparently significant after two and three months of treatment (p>0.5).Conclusion:MMSE and CDT scores are significantly higher, and BPRS, CGI1-3 scores significantly lower in rivastigmine group from 14th and 28thday of treatment. Rivastigmine has statistically significant effect in treatment of AIPD.