Search

Background: Schizophrenia is a severe psychiatric disorder with periods of remission and relapse. As discontinuation of antipsychotic medication is the most important reason for relapse, long-term maintenance treatment is key. Whether intramuscular long-acting (depot) antipsychotics are more efficacious than oral medication in preventing medication discontinuation is still unresolved. We aimed to compare time to all-cause discontinuation in patients randomly allocated to long-acting injectable (LAI) versus oral medication. Methods: EULAST was a pragmatic, randomised, open-label trial conducted at 50 general hospitals and psychiatric specialty clinics in 15 European countries and Israel. Patients aged 18 years and older, with DSM-IV schizophrenia (as confirmed by the Mini International Neuropsychiatric Interview 5 plus) and having experienced their first psychotic episode from 6 months to 7 years before screening, were randomly allocated (1:1:1:1) using block randomisation to LAI paliperidone, LAI aripiprazole, or the respective oral formulations of these antipsychotics. Randomisation was stratified by country and duration of illness (6 months up to 3 years vs 4 to 7 years). Patients were followed up for up to 19 months. The primary endpoint was discontinuation, regardless of the reason, during 19 months of treatment. We used survival analysis to assess the time until all-cause discontinuation in the intention-to-treat (ITT) group, and per protocol analyses were also done. This trial is registered with ClinicalTrials.gov, NCT02146547, and is complete. Findings: Between Feb 24, 2015, and Dec 15, 2018, 533 individuals were recruited and assessed for eligibility. The ITT population included 511 participants, with 171 (33%) women and 340 (67%) men, and a mean age of 30·5 (SD 9·6) years. 410 (80%) of 511 participants were White, 35 (7%) were Black, 20 (4%) were Asian, and 46 (9%) were other ethnicity. In the combined oral antipsychotics treatment group of 247 patients, 72 (29%) patients completed the study and 175 (71%) met all-cause discontinuation criteria. In the combined LAI treatment arm of 264 patients, 95 (36%) completed the study and 169 (64%) met the all-cause discontinuation criteria. Cox regression analyses showed that treatment discontinuation for any cause did not differ between the two combined treatment groups (hazard ration [HR] 1·16, 95% CI 0·94–1·43, p=0·18). No significant difference was found in the time to all-cause discontinuation between the combined oral and combined LAI treatment groups (log rank test χ 2=1·87 [df 1]; p=0·17). During the study, 121 psychiatric hospitalisations occurred in 103 patients, and one patient from each of the LAI groups died; the death of the patient assigned to paliperidone was assessed to be unrelated to the medication, but the cause of other patient's death was not shared with the study team. 86 (25%) of 350 participants with available data met akathisia criteria and 70 (20%) met parkinsonism criteria at some point during the study. Interpretation: We found no substantial advantage for LAI antipsychotic treatment over oral treatment regarding time to discontinuation in patients with early-phase schizophrenia, indicating that there is no reason to prescribe LAIs instead of oral antipsychotics if the goal is to prevent discontinuation of antipsychotic medication in daily clinical practice. Funding: Lundbeck and Otsuka.

The World Health Organization (WHO) has defined burnout syndrome (BOS) as resulting from chronic workplace stress that hasn't been successfully managed. Until now, BOS has been treated using allopathic drugs and psychotherapy because it has been confused with major depressive syndrome.The aim of the study was to examine the effectiveness of hypnotherapy combined with cognitive-behavioral therapy in changing the personality traits and lifestyles of people in professions vulnerable to stress who have developed BOS.The research team designed a one-group pre-and posttest study.The study was conducted in a private-practice office in Targu Mures, Romania.Participants were 30 patients at the private practice who had been diagnosed with BOS and volunteered to participate in the study.The study alternated hypnotherapy sessions with psychological-counseling sessions, using a general therapeutic plan for all patients and customizing the plan for each participant.The study measured participants' BOS symptomatology and personality dimensions using the Maslach Burnout Inventory (MBI), the DECAS Personality Inventory, the Personality Inventory for DSM-5 (PID5), and the Survey of Work Styles (SWS).Significant changes occurred between baseline an postintervention in the dimensions of extraversion, agreeability, and emotional stability as well as impatience, anger, work involvement, time urgency, job dissatisfaction, and competitiveness. Significant differences existed in almost all personality traits evaluated with the PID-5 (P.05).The combination of hypnotherapy and psychological counseling can treat BOS, increasing patients' quality of life by decreasing negative personality traits. The present study is important because it proposes a new therapeutic approach to BOS.

Background: The challenges that a professional face when working in the field of psychiatry require the development of adequate defensive and coping styles. Our study aimed to explore both the coping strategies and defense mechanisms and their relationship among psychiatry trainees in Romania.Methods: A cross-sectional study was conducted to determine and to evaluate both defensive and coping styles of Romanian psychiatry trainees. DSQ-60 and COPE scales were applied to psychiatry trainees from five training centers in Romania. By applying structural equation modeling, we studied models that presumed the existence of relationships between coping strategies and defensive mechanisms. Results: The results of the study indicate that superior defense mechanisms and task-oriented coping style were the commonly used approach by trainees in psychiatry. Also, our findings show significantly consistent correlations (ranging from 0.2 to 0.5) between adaptive defense mechanisms and coping styles focused on the problem or the emotion. Similarly, the avoidant coping strategies correlated with non-adaptative defense styles (correlations between 0.3 and 0.5). Our model presented good fit indices, X2(34) = 64.324, p < 0.001; GFI = 0.93; RMSE = 0.08. Moreover, the results indicated a weak association, r = 0.07, p < 0.001, between the two types of adaptive processes.Conclusion: Our findings suggest that trainees in psychiatry present a profile based on two independent groups of adaptation processes, namely, adaptive defenses and problem-oriented coping scales, and non-adaptive defenses and avoidant coping scales.

Borderline personality disorder is a complex disease model as it encompasses a diversity of pathological personality traits and psychopathological symptoms. It is not surprising, therefore, that it is often manifested by personality disorders across all three clusters and accompanied by other mental (Axis I) disorders. This melange makes both psychological treatment and pharmacotherapy especially challenging, and this paper describes the case of a particularly complex case of a 33-year-old Romanian patient, who has a history of severe deprivation in childhood, mood and substance use disorder in association with borderline pathology. In the course of treatment from many sources and interventions, it has become clear that dependence is a key component of the pathology and has been rewarded with a degree of success in management. Copyright © 2016 John WileySons, Ltd.

Narcissistic traits interfere in the process of self-determination and the individual motivational strategies of human beings. The grandiose and vulnerable narcissistic personality subtypes have difficulties in their education, interpersonal relationships and quality of life. The latter is also affected by ageing, whose attributes influence, above all, one's self-esteem, especially in women. Though very fearful of suffering and death, narcissists have a powerful desire to overcome them by cultivating their grandiosity, especially through the mystical and paranormal experiences they relate. The spiritual means of transcending one's self, including the components of magical thinking, can prevent the destruction of self-esteem in narcissists in their third-age.