Advances in Psychiatry http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Demographic and Clinical Characteristics of Patients with Dementia in Greece Mon, 17 Nov 2014 00:00:00 +0000 http://www.hindawi.com/journals/apsy/2014/636151/ Introduction. Dementia’s prevalence increases due to population aging. The purpose of this study was to determine the demographic profile of Greek patients with dementia and the differences in management between the urban and rural population. Methods. A cross sectional study was carried out including 161 randomly selected specialists from different regions in Greece who filled in a structured questionnaire relating to patients with dementia, regarding various sociodemographic and clinical characteristics. Results. A total of 4580 patients (52% males) with dementia were recorded. Mean age was 73.6 years and 31% lived in rural areas. The Mini Mental Status Examination (MMSE) was used in 87% of cases. In the urban areas the diagnosis of dementia was made in an earlier stage of the disease in comparison to the rural areas . Higher comorbidity and a higher percentage of low education were evident in rural residents , while higher medication usage was observed in urban patients . Conclusions. The results implicate the need for improvement in health care delivery in Greek rural areas and health care professionals’ training to achieve a proper treatment of dementias and increase the quality of life among the elderly habitants of remote areas. Eleni Jelastopulu, Evangelia Giourou, Konstantinos Argyropoulos, Eleftheria Kariori, Eleftherios Moratis, Angeliki Mestousi, and John Kyriopoulos Copyright © 2014 Eleni Jelastopulu et al. All rights reserved. Neuropsychological Profiles and Behavioral Ratings in ADHD Overlap Only in the Dimension of Syndrome Severity Thu, 13 Nov 2014 06:53:58 +0000 http://www.hindawi.com/journals/apsy/2014/502685/ Objectives. The aim of this study was to compare the cognitive neuropsychological and the behavioral rating profiles of attention deficit/hyperactivity disorder (ADHD). Methods. Forty-two children diagnosed with ADHD (  years, ) and 43 typically developing children ( years, ) participated. We measured symptom severity with behavioral rating scales, and we administered neuropsychological tasks to measure inhibitory performance, updating/working memory, and shifting ability. Results. On the basis of the three neuropsychological variables, the hierarchical cluster analytic method yielded a six-cluster structure. The clusters, according to the severity of the impairment, were labeled as follows: none or few symptoms, Moderate inhibition and mild shifting, moderate to severe shifting with moderate updating, moderate updating, severe updating with mild shifting, and severe updating with severe shifting. There were no systematic differences in inattention and hyperactive-impulsive behavior across the clusters. The comorbid learning disorder appeared more likely only in severe neuropsychological forms of ADHD. Conclusion. In sum, our results suggest that behavioral ratings and neuropsychological profiles converge only in the dimension of symptom severity and that atypicalities in executive functions may manifest in nonspecific everyday problems. Ádám Takács, Andrea Kóbor, Zsanett Tárnok, and András Vargha Copyright © 2014 Ádám Takács et al. All rights reserved. Limitations of Randomized Control Designs in Psychotherapy Research Thu, 06 Nov 2014 11:44:51 +0000 http://www.hindawi.com/journals/apsy/2014/561452/ Despite the growing influence of lists of empirically supported therapies (ESTs) there are concerns about the design and conduct of this body of research. These concerns include limitations inherent in the requirements of randomized control trials (RCTs) that favor those psychotherapies that define problems and outcome in terms of uncomplicated symptoms. Additional concerns have to do with criteria for patient selection, lack of integration with research on psychotherapy process and effectiveness studies, limited outcome criteria, and lack of controls for experimenter bias. RCT designs have an important place in outcome research; however it is important to recognize that these designs also place restrictions on what and how psychotherapy can be studied. There is a need for large scale psychotherapy outcome research based on designs that allow for inclusion of process variables and the study of the effects of those idiographic approaches to therapy that do not lend themselves to RCT designs. Interpretative phenomenological analysis may provide a useful method for the evaluation of the effectiveness of idiographic approaches to psychotherapy where outcome is not understood solely in terms of symptom reduction. Glenn Shean Copyright © 2014 Glenn Shean. All rights reserved. Pharmacological Prevention of Posttraumatic Stress Disorder: A Systematic Review Sun, 12 Oct 2014 07:31:26 +0000 http://www.hindawi.com/journals/apsy/2014/529562/ Introduction. Various interventions, both psychological and pharmacological, have been studied for their efficacy in preventing posttraumatic stress disorder (PTSD) following trauma exposure. However, the preventive effect of pharmacotherapy has not been systematically assessed. Methodology. A systematic review of all clinical trials of drug therapy to prevent PTSD, available through the PubMed and EMBASE databases, was conducted. This included an assessment of each study’s quality. Results. A total of 13 studies were reviewed. The drugs examined in these papers included propranolol, hydrocortisone, serotonin reuptake inhibitors, gabapentin, omega-3 fatty acids, and benzodiazepines. There was marked heterogeneity across studies in terms of quality, study populations, and methodology. Analysis of the outcomes revealed preliminary evidence for the efficacy of hydrocortisone, particularly in critical care settings. There was no consistent evidence to support the use of other drugs to prevent PTSD. Discussion. There may be a limited role for hydrocortisone in preventing the development of PTSD in specific settings. Results with other drugs are inconsistent. Further large-scale studies should assess the efficacy of these approaches in other contexts, such as natural disasters, and the time frame within which they should be used. Ravi Philip Rajkumar and Balaji Bharadwaj Copyright © 2014 Ravi Philip Rajkumar and Balaji Bharadwaj. All rights reserved. The Concept of Schizophrenia: From Unity to Diversity Mon, 15 Sep 2014 05:29:19 +0000 http://www.hindawi.com/journals/apsy/2014/929434/ After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations. Heinz Häfner Copyright © 2014 Heinz Häfner. All rights reserved. Early Detection and Treatment of Psychosis: The Bern Child and Adolescent Psychiatric Perspective Tue, 09 Sep 2014 11:10:16 +0000 http://www.hindawi.com/journals/apsy/2014/365283/ Commonly conceptualized as neurodevelopmental disorders of yet poorly understood aetiology, schizophrenia and other nonorganic psychoses remain one of the most debilitating illnesses with often poor outcome despite all progress in treatment of the manifest disorder. Drawing on the frequent poor outcome of psychosis and its association with the frequently extended periods of untreated first-episode psychosis (FEP) including its prodrome, an early detection and treatment of both the FEP and the preceding at-risk mental state (ARMS) have been increasingly studied. Thereby both approaches are confronted with different problems, for example, treatment engagement in FEP and predictive accuracy in ARMS. They share, however, the problems related to the lack of understanding of developmental, that is, age-related, peculiarities and of the presentation and natural course of their cardinal symptoms in the community. Most research on early detection and intervention in FEP and ARMS is still related to clinical psychiatric samples, and little is known about symptom presentation and burden and help-seeking in the general population related to these experiences. Furthermore, in particular in the early detection of an ARMS, studies often address adolescents and young adults alike without consideration of developmental characteristics, thereby applying risk criteria that have been developed predominately in adults. Combining our earlier experiences described in this paper in child and adolescent, and general psychiatry as well as in both lines of research, that is, on early psychosis and its treatment and on the early detection of psychosis, in particular in its very early states by subjective disturbances in terms of basic symptoms, age-related developmental and epidemiological aspects have therefore been made the focus of our current studies in Bern, thus making our line of research unique. Frauke Schultze-Lutter and Benno G. Schimmelmann Copyright © 2014 Frauke Schultze-Lutter and Benno G. Schimmelmann. All rights reserved. Temperament and Eating Attitudes in an Adolescent Community Sample: A Brief Report Mon, 08 Sep 2014 09:15:06 +0000 http://www.hindawi.com/journals/apsy/2014/749738/ Objective. Temperament traits like high harm avoidance (HA) have been proposed as putative risk factors for the development of eating disorders (EDs). We aimed at studying the relationship between temperament and eating attitudes on a large community sample of adolescents. Method. We recruited 992 high school students aged 14–18. In addition to measuring body mass index (BMI), participants were asked to complete the temperament and character inventory and the food frequency questionnaire. Results. Sixty-two percent of the sample reported overeating, 22.8% reported normal eating, and 15.2% reported under eating. Under and normal eaters had higher BMI than that of over eaters. Harm avoidance was found to be significantly higher in those participants with lower eating intakes whilst novelty seeking was found to be higher in over eaters. Conclusion. An interesting association between temperament (high HA) and food approach (under eating) emerged. Longitudinal studies are needed to evaluate whether these traits represent a risk factor for the development of EDs. Enrica Marzola, Secondo Fassino, Federico Amianto, and Giovanni Abbate-Daga Copyright © 2014 Enrica Marzola et al. All rights reserved. Self-Determination Theory and First-Episode Psychosis: A Replication Mon, 08 Sep 2014 08:31:31 +0000 http://www.hindawi.com/journals/apsy/2014/240125/ Self-determination theory (SDT) posits that human well-being depends on the satisfaction of three basic psychological needs: autonomy, competence, and relatedness. Although many scholars have suggested that SDT may be relevant to psychotic disorders, only one empirical study of SDT in individuals with psychosis has been completed to date by Breitborde and colleagues (2012). This study revealed that individuals with first-episode psychosis reported lower satisfaction of the three basic psychological needs as compared to individuals without psychosis. Moreover, greater satisfaction of basic psychological needs was modestly associated with lower general symptoms (e.g., anxiety and depression), greater social functioning, and better quality of life. Thus, the goal of this project was to replicate Breitborde et al.’s (2012) investigation of basic psychological need satisfaction among individuals with first-episode psychosis. Our results supported the conclusion that individuals with first-episode psychosis report lower autonomy, competence, and relatedness than individuals without psychosis. Moreover, our results comport with the finding that greater need satisfaction was associated with less severe symptomatology and better social functioning and quality of life. In total, the findings lend further credence to the hypothesis that SDT may help to inform the development of improved clinical services for individuals with psychotic disorders. Nicholas J. K. Breitborde, Cindy Woolverton, R. Brock Frost, and Nicole A. Kiewel Copyright © 2014 Nicholas J. K. Breitborde et al. All rights reserved. D-Serine in Neuropsychiatric Disorders: New Advances Thu, 19 Jun 2014 09:30:50 +0000 http://www.hindawi.com/journals/apsy/2014/859735/ D-Serine (DSR) is an endogenous amino acid involved in glia-synapse interactions that has unique neurotransmitter characteristics. DSR acts as obligatory coagonist at the glycine site associated with the N-methyl-D-aspartate subtype of glutamate receptors (NMDAR) and has a cardinal modulatory role in major NMDAR-dependent processes including NMDAR-mediated neurotransmission, neurotoxicity, synaptic plasticity, and cell migration. Since either over- or underfunction of NMDARs may be involved in the pathophysiology of neuropsychiatric disorders; the pharmacological manipulation of DSR signaling represents a major drug development target. A first generation of proof-of-concept animal and clinical studies suggest beneficial DSR effects in treatment-refractory schizophrenia, movement, depression, and anxiety disorders and for the improvement of cognitive performance. A related developing pharmacological strategy is the indirect modification of DSR synaptic levels by use of compounds that alter the function of main enzymes responsible for DSR production and degradation. Accumulating data indicate that, during the next decade, we will witness important advances in the understanding of DSR role that will further contribute to elucidating the causes of neuropsychiatric disorders and will be instrumental in the development of innovative treatments. Andrea R. Durrant and Uriel Heresco-Levy Copyright © 2014 Andrea R. Durrant and Uriel Heresco-Levy. All rights reserved. Missing Motherhood: Jordanian Women's Experiences with Infertility Wed, 04 Jun 2014 11:17:22 +0000 http://www.hindawi.com/journals/apsy/2014/241075/ Aim, Background, and Introduction. Bearing and rearing children are an important part of life in nearly all cultures and are a central role for Jordanian Muslim women. Infertility can create anxiety, stress, and depression for couples who are infertile. Women frequently bear the emotional stigma of a couple’s infertility. There is a paucity of literature focusing on Jordanian Muslim women experiencing infertility and failed assistive reproductive technology. Therefore, this study explored these women’s lived experience. Methods. Qualitative data were collected through interviews with 30 Jordanian Muslim women who experienced failed assistive reproductive technology for infertility. Perceptions of experiences with failed treatment of infertility were documented and analyzed. Results. Major themes were identified: missing out on motherhood and living with infertility, experiencing marital stressors, feeling social pressure, experiencing depression and disappointment, having treatment associated difficulties, appreciating support from family and friends, using coping strategies, and fear of an unknown future. Discussion, Conclusion, and Implications for Clinical Practice. Being infertile significantly influences the physical, emotional, social, and spiritual health of Jordanian Muslim women as well as their quality of life. Perceived social support and personal coping strategies were used by study participants to mediate failed attempts to conceive. Designing and implementing culturally appropriate interventions for Muslim women globally who are experiencing infertility are essential. Hala Mahmoud Obeidat, Adlah M. Hamlan, and Lynn Clark Callister Copyright © 2014 Hala Mahmoud Obeidat et al. All rights reserved. The Knowledge Concealed in Users’ Narratives, Valuing Clients’ Experiences as Coherent Knowledge in Their Own Right Wed, 28 May 2014 11:51:31 +0000 http://www.hindawi.com/journals/apsy/2014/786138/ Objective. As the history of psychiatry has been written, users have told their stories and often presented pictures incompatible with the professional or official versions. We ask if such a gap still exists and what the ethical as well as epistemological implications may be. Study Design. The design is based on a hermeneutic-phenomenological approach, with a qualitative content analysis of the narratives. Data Sources. The paper draws on user narratives written after the year 2000, describing positive and negative experiences with the mental health services. Extraction Methods. Among 972 users answering a questionnaire, 492 also answered the open questions and wrote one or two stories. We received 715 stories. 610 contained enough information to be included in this narrative analysis. Principal Findings. The stories are coherent, containing traditional narrative plots, but reports about miscommunication, rejection, lack of responsiveness, and humiliation are numerous. Conclusions. The picture drawn from this material has ethical as well as epistemological implications and motivates reflections upon theoretical and practical consequences when users’ experiences do not influence professional knowledge to a larger degree. Ragnfrid Kogstad, Tor-Johan Ekeland, and Jan Kaare Hummelvoll Copyright © 2014 Ragnfrid Kogstad et al. All rights reserved. Screening for Psychiatric Disorders in Bariatric Surgery Candidates with the German Version of the Patient Health Questionnaire Sun, 27 Apr 2014 07:34:11 +0000 http://www.hindawi.com/journals/apsy/2014/165818/ Objective. Obesity has been linked to psychiatric disorders in several studies. Prevalence and severity of psychiatric disorders are high in patients undergoing bariatric surgery. Thus, psychiatric assessment of bariatric surgery candidates has become a standard procedure. However, socially desirable responding leads to biased results in self-reported questionnaires. Here, bariatric surgery candidates were screened with the Patient Health Questionnaire (PHQ-D) additionally to the psychiatric examination. Method. 355 bariatric surgery candidates filled in the PHQ-D before the psychiatric examination as a part of the surgery assessment procedure. PHQ-D results were compared to psychiatric diagnoses and body mass index (BMI). Results. Gender ratio, mean BMI, and age were comparable to earlier studies. Depressive and somatization symptoms did not correlate to BMI. However, females showed higher prevalence of psychiatric disorders with elevated syndrome severity in depressive and somatization disorders, as well as more frequent antidepressant intake. Eating disorders and addiction disorders were rarely reported. Conclusion. The findings suggest a socially desirable responding when filling in the PHQ-D before bariatric surgery. The use of the PHQ-D in this patient sample could be augmented by psychometric tests with internal correction and validation scales. Furthermore, psychiatric examination should be separated from the surgery evaluation process. Ulrich Palm, Wolfgang E. Thasler, Peter Rittler, Ann Natascha Epple, Martin Lieb, Rabee Mokhtari-Nejad, Susanne Rospleszcz, Larissa de la Fontaine, Felix M. Segmiller, and Daniela Eser-Valeri Copyright © 2014 Ulrich Palm et al. All rights reserved. Aggression in Psychoses Wed, 12 Feb 2014 15:07:20 +0000 http://www.hindawi.com/journals/apsy/2014/196281/ Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient. Jan Volavka Copyright © 2014 Jan Volavka. All rights reserved.