ISRN Psychiatry The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Empathy in Undergraduate Medical Students of Bangladesh: Psychometric Analysis and Differences by Gender, Academic Year, and Specialty Preferences Mon, 07 Apr 2014 14:08:12 +0000 Empathy is considered to be associated with better patient compliance, satisfaction, and clinical outcomes. The aim of the study is to measure and examine empathy among a sample of undergraduate medical students of Bangladesh. It was a cross-sectional study and all the medical students of first through fifth year enrolled at Chattagram Maa-O-Shishu Hospital Medical College during the study period of 2014 were surveyed. Participants anonymously completed the Jefferson Scale of Empathy Medical Student version translated into Bengali language, a valid and reliable 20-item self-administered questionnaire. Principal component factor analysis with varimax rotation and Cronbach’s alpha coefficient were calculated to check validity and reliability of the scale. ANOVA was used to examine the differences in empathy between gender, academic years, and specialty preferences. The mean empathy score was 110.41 ± 13.59. Cronbach’s alpha coefficient was 0.88. There were significant associations between gender and empathy scores. The level of empathy in medical students gradually increases after clinical training in medical college. A nonsignificant difference was found between empathy scores and specialty preferences. It is suggested that the medical curriculum in Bangladesh should include more extensive program to promote empathy and other humanistic values among the medical students. Asma Mostafa, Rozina Hoque, Mohammad Mostafa, Md. Mashud Rana, and Faisal Mostafa Copyright © 2014 Asma Mostafa et al. All rights reserved. Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine Mon, 07 Apr 2014 14:03:25 +0000 Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course. Natalia Bartolommei, Francesco Casamassima, Laura Pensabene, Federica Luchini, Antonella Benvenuti, Antonello Di Paolo, Luca Cosentino, Mauro Mauri, and Lorenzo Lattanzi Copyright © 2014 Natalia Bartolommei et al. All rights reserved. Clinical Practice Guidelines in Psychiatry: More Confusion Than Clarity? A Critical Review and Recommendation of a Unified Guideline Mon, 31 Mar 2014 08:22:15 +0000 The discipline of psychiatry has a plethora of guidelines, designed to serve the needs of the clinician. Yet, even a cursory glance is enough to discern the differences between the various guidelines. This paper reviews the current standard guidelines being followed across the world and proposes a unified guideline on the backbone of current evidence and practice being followed. The algorithm for pharmacological and psychosocial treatment for bipolar disorder, major depressive disorder, and schizophrenia is formulated after cross-comparison across four different guidelines and recent meta-analytical evidence. For every disorder, guidelines have different suggestions. Hence, based on the current status of evidence, algorithms have been combined to form a unified guideline for management. Clinical practice guidelines form the basis of standard clinical practice for all disciplines of medicine, including psychiatry. Yet, they are often not read or followed because of poor quality or because of barriers to implementation due to either lack of agreement or ambiguity. A unified guideline can go a long way in helping clear some of the confusion that has crept in due to the use of different guidelines across the world. Sahoo Saddichha and Santosh K. Chaturvedi Copyright © 2014 Sahoo Saddichha and Santosh K. Chaturvedi. All rights reserved. The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition Mon, 10 Mar 2014 07:07:19 +0000 Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects () included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes. Sherry Tang, Priyanka Patel, Jagdish Khubchandani, and George T. Grossberg Copyright © 2014 Sherry Tang et al. All rights reserved. Metabotropic Glutamate Receptor 5 Negative Modulation in Phase I Clinical Trial: Potential Impact of Circadian Rhythm on the Neuropsychiatric Adverse Reactions—Do Hallucinations Matter? Tue, 04 Mar 2014 09:10:42 +0000 Metabotropic Glutamate Receptor 5 (mGluR5) negative allosteric modulators (NAMs) may play a role in some psychiatric disorders such as anxiety and depression. The pharmacokinetic profile and pharmacodynamics effects of mGluR5-NAMs have been previously reported. We performed a post hoc analysis of pharmacological and clinical data obtained from 18 young healthy female subjects who received a mGluR5-NAM in the context of a phase I drug-drug interaction study between a mGluR5 NAM and a monophasic oral contraceptive. mGluR5-NAM was administered in an escalating bidaily dose level design. There was no interaction between the OC and mGluR5-NAM. Higher morning mGluR5-NAM plasma concentrations were found compared to evening concentrations. Most of the observed clinically significant neuropsychiatric adverse reactions occurred nocturnally and included visual (pseudo) hallucinations, insomnia accompanied by secondary behavioural disorders, and cognitive dysfunction symptoms of sufficient severity to interfere with daily functioning. Circadian rhythm-related physiological variations in drug absorption and disposition may explain this pharmacokinetics-pharmacodynamics apparently disproportionate relationship. We suggest that clinical trials evaluating basic pharmacokinetic properties of psychiatric medications consider potential drug's chronopharmacokinetics. This may assist with dose optimization and minimize serious neuropsychiatric adverse reactions in the vulnerable psychiatric patient. Khalid Abou Farha, Richard Bruggeman, and Corine Baljé-Volkers Copyright © 2014 Khalid Abou Farha et al. All rights reserved. Different Neural Responses to a Moral Valence Decision Task in Unipolar and Bipolar Depression Tue, 17 Dec 2013 16:43:25 +0000 Objectives. Patients affected by bipolar disorder (BP) and major depressive disorder (UP) share the susceptibility to experience depression and differ in their susceptibility to mania, but clinical studies suggest that the biological substrates of the two disorders could influence the apparently similar depressive phases. The few brain imaging studies available described different brain metabolic and neural correlates of UP and BP. Methods. We studied the BOLD neural response to a moral valence decision task targeting the depressive biases in information processing in 36 subjects (14 BP, 11 UP, and 11 controls). Results. Main differences between UP and controls and between UP and BP were detected in left ventrolateral prefrontal cortex (PFC, BA 47). Neural responses of BP patients differed from those of control subjects in multiple brain areas, including anterior cingulate cortex (ACC) and medial PFC, bilateral dorsolateral PFC, temporal cortex and insula, and parietal and occipital cortex. Conclusions. Our results are in agreement with hypotheses of dysfunctions in corticolimbic circuitries regulating affects and emotions in mood disorders and suggest that specific abnormalities, particularly in ventrolateral PFC, are not the same in UP and BP depression. Daniele Radaelli, Sara Dallaspezia, Sara Poletti, Enrico Smeraldi, Andrea Falini, Cristina Colombo, and Francesco Benedetti Copyright © 2013 Daniele Radaelli et al. All rights reserved. No Association between Depression and Risk of Hepatocellular Carcinoma in Older People in Taiwan Tue, 10 Dec 2013 08:10:04 +0000 Objectives. The objective of this study was to determine whether there is a relationship between depression and risk of hepatocellular carcinoma (HCC) in older people in Taiwan. Methods. A case-control study was conducted to analyze the database from the Taiwan National Health Insurance program. We selected 1815 subjects aged 65 years or older with newly diagnosed HCC as the case group and 7260 subjects without HCC as the comparison group, from 2000 to 2010. Both groups were compared to measure the risk of HCC. Results. After controlling for confounders, the odds ratio of HCC was 0.81 in subjects with depression (95% confidence interval = 0.59, 1.11), as compared with nondepressed subjects. Conclusions. We conclude that no association is detected between depression and risk of hepatocellular carcinoma in older people in Taiwan. Shih-Wei Lai, Cheng-Li Lin, Kuan-Fu Liao, and Wen-Chi Chen Copyright © 2013 Shih-Wei Lai et al. All rights reserved. Individuals Diagnosed with Schizophrenia Assign Emotional Importance to Neutral Stimuli: An fMRI Study Thu, 05 Dec 2013 15:45:43 +0000 The majority of functional neuroimaging studies investigating neural correlates of emotion processing in schizophrenia report a significant deficit in limbic structures activation in patients relative to control participants. Recently it has been suggested that this apparent “deficit” could be due to an enhanced sensitivity of the neutral material in individuals diagnosed with schizophrenia, rather than due to their inefficiency in emotion processing. The purpose of the present study was to test this supposition and verify if the potential effect is present in both men and women diagnosed with schizophrenia. In order to do that we examined the pattern of cerebral activation associated with processing of neutral stimuli in schizophrenia. Thirty-seven schizophrenia patients and 37 healthy controls viewed neutral and emotional images while in a functional magnetic resonance imaging scanner. Schizophrenia patients rated the neutral images as more emotionally salient than controls. Additionally, patients showed significant activation during processing of neutral images in limbic and prefrontal regions; similar areas were underactivated in patients relative to controls during processing of emotional information. Investigation of sex differences revealed that the enhanced responsiveness to the emotionally neutral material was attributed primarily to men with schizophrenia. Nadia Lakis and Adrianna Mendrek Copyright © 2013 Nadia Lakis and Adrianna Mendrek. All rights reserved. Emotional and Cognitive Empathy in First-Year Medical Students Mon, 21 Oct 2013 15:41:11 +0000 Objectives. Doctors’ empathy towards their patients is considered important for treatment outcome. However, during medical school there might be a decline in empathy called “hardening of the heart.” This study evaluated the cognitive and emotional empathy in medical students and investigated the influence of a preference for a specialty and students attachment styles. Methods. 126 first-year medical students were included and completed the Reading the Mind in the Eyes Test revised version (RME-R), the Balanced Emotional Empathy Scale (BEES), and the Experiences in Close Relationships-Revised Adult Attachment Questionnaire (ECR-R). Results. Students identified of 36 photographs in the RME-R test correctly (norm: 26). The female students’ mean BEES total score was and the male students’ ; . The female students’ mean BEES score was significantly () below the female norm of 60. Students who preferred a specialty with continuity of patient care scored significantly higher in the BEES (). A more avoidant attachment style was associated with a lower BEES score (). Conclusion. The students showed low emotional and cognitive empathy scores and an avoidant attachment style. This supports the inclusion of specific training in cognitive and emotional empathy in medical education. Sandra Dehning, Sarah Gasperi, Daniela Krause, Sebastian Meyer, Eva Reiß, Max Burger, Fabian Jacobs, Anna Buchheim, Norbert Müller, and Matthias Siebeck Copyright © 2013 Sandra Dehning et al. All rights reserved. A Novel Model of Schizophrenia Age-of-Onset Data Challenges the Conventional Interpretations of the Discordance in Monozygote Twin Studies Wed, 21 Aug 2013 09:54:09 +0000 The relative importance of genetics and the environment in causing schizophrenia is still being debated. Although the high proportion of monozygote cotwins of schizophrenia patients who are discordant suggests that there may be a significant environmental contribution to the development of schizophrenia, this discordance is predicted by an accumulative multimutation model of schizophrenia onset constructed here implying a genetic origin of schizophrenia. In this model, schizophrenics are viewed as having been born with the genetic susceptibility to develop schizophrenia. As susceptible gene carriers age, they randomly accumulate the necessary mutations to cause schizophrenia, the last needed mutation coinciding with disease onset. The mutation model predicts that the concordance rate in monozygote twin studies will monotonically increase with age, theoretically approaching 100% given sufficient longevity. In dizygote cotwins of schizophrenia patients, the model predicts that at least 71% of cotwins are incapable of developing schizophrenia even though every cotwin and their schizophrenic twin shared a similar early environment. The multimutation model is shown to fit all of the monozygote and dizygote concordance rate data of the principle classical twin studies completed before 1970 considered in this paper. Thus, the genetic hypothesis of schizophrenia can be tested by bringing these studies up to date. Ivan Kramer and L. Elliot Hong Copyright © 2013 Ivan Kramer and L. Elliot Hong. All rights reserved. Dimensions of Hallucinations and Delusions in Affective and Nonaffective Illnesses Tue, 13 Aug 2013 09:12:43 +0000 The aim of the study was to examine the dimensions of hallucinations and delusions in affective (manic episode, bipolar affective disorder, and depressive episode) and nonaffective disorders (schizophrenia, acute and transient psychotic disorders, and unspecified psychosis). Sixty outpatients divided equally into two groups comprising affective and nonaffective disorders were taken up for evaluation after screening, as per inclusion and exclusion criteria. Scores of 3 or above on delusion and hallucinatory behavior subscales of positive and negative syndrome scale were sufficient to warrant rating on the psychotic symptom rating scales with which auditory hallucination and delusion were assessed on various dimensions. Insight was assessed using the Beck cognitive insight scale (BCIS). There were no significant differences between the two groups on age, sex, marital status, education, and economic status. There were significant differences in total score and emotional characteristic subscale, cognitive interpretation subscale, and physical characteristic subscale of auditory hallucination scales in between the two groups. Correlation between BCIS-total and total auditory hallucinations score was negative (Spearman Rho −0.319; ). Hallucinating patients, more in nonaffective group, described a negative impact of hallucinating voices along with emotional consequences on their lives which lead to distress and disruption. Ranju Kumari, Suprakash Chaudhury, and Subodh Kumar Copyright © 2013 Ranju Kumari et al. All rights reserved. Depression Symptoms Improve after Successful Weight Loss with Emotional Freedom Techniques Sun, 28 Jul 2013 08:14:08 +0000 Ninety-six overweight or obese adults were randomly allocated to a four-week EFT treatment or waitlist condition. Waitlist participants crossed over to the EFT group upon completion of wait period. Degree of food craving, perceived power of food, restraint capabilities, and psychological symptoms were assessed at pretreatment, posttreatment and at 12-month follow-up for combined EFT groups. Significant improvements in weight, body mass index, food cravings, subjective power of food, craving restraint and psychological coping for EFT participants from pretreatment to 12-month follow-up () were reported. The current paper isolates the depression symptom levels of participants, as well as levels of eight other psychological conditions. Significant decreases from pre- to posttreatment were found for depression, interpersonal sensitivity, obsessive-compulsivity, paranoid ideation, and somatization (). Significant decreases from pretreatment to 12-month follow-up were found for depression, interpersonal sensitivity, psychoticism, and hostility. The results point to the role depression, and other mental health conditions may play in the successful maintenance of weight loss. Peta Stapleton, Dawson Church, Terri Sheldon, Brett Porter, and Cassandra Carlopio Copyright © 2013 Peta Stapleton et al. All rights reserved. The Therapeutic Effect of Adding Dextromethorphan to Clonidine for Reducing Symptoms of Opioid Withdrawal: A Randomized Clinical Trial Thu, 20 Jun 2013 18:01:26 +0000 Background. Dextromethorphan is a noncompetitive N-methyl D-aspartate receptor antagonist that is clinically feasible for relieving the opioid withdrawal symptoms. This study compares the efficacy of a combination therapy with dextromethorphan and clonidine to treatment with clonidine alone. Methods and Materials. In this double-blind randomized clinical trial, patients were selected from inpatients of detox and rehabilitation ward of Razi Hospital, Tabriz, Iran. They were randomly allocated to two groups receiving either clonidine (0.4–1.2 mg/day) or clonidine and dextromethorphan (300 mg/day). Withdrawal symptoms were evaluated in the first day of admission and again 24, 48, and 72 hours later. Results. Thirty male patients completed the trial in each group. Withdrawal symptoms began to decrease in the second day in patients receiving dextromethorphan and clonidine while patients receiving clonidine experienced the more severe symptoms in 72 hours. Analysis of variance of the symptom severity score revealed a significant group time interaction (; ), so that patients receiving dextromethorphan plus clonidine had milder symptoms during three days in all of the measurements compared to clonidine group. Conclusion. Combination therapy of dextromethorphan and clonidine would result in milder opioid withdrawal symptoms compared to clonidine alone with a reduction beginning at the second day. Ayyoub Malek, Shahrokh Amiri, and Bohlool Habibi Asl Copyright © 2013 Ayyoub Malek et al. All rights reserved. The Social Attribution Task-Multiple Choice (SAT-MC): A Psychometric and Equivalence Study of an Alternate Form Thu, 20 Jun 2013 13:33:25 +0000 The Social Attribution Task-Multiple Choice (SAT-MC) uses a 64-second video of geometric shapes set in motion to portray themes of social relatedness and intentions. Considered a test of “Theory of Mind,” the SAT-MC assesses implicit social attribution formation while reducing verbal and basic cognitive demands required of other common measures. We present a comparability analysis of the SAT-MC and the new SAT-MC-II, an alternate form created for repeat testing, in a university sample (). Score distributions and patterns of association with external validation measures were nearly identical between the two forms, with convergent and discriminant validity supported by association with affect recognition ability and lack of association with basic visual reasoning. Internal consistency of the SAT-MC-II was superior (alpha = .81) to the SAT-MC (alpha = .56). Results support the use of SAT-MC and new SAT-MC-II as equivalent test forms. Demonstrating relatively higher association to social cognitive than basic cognitive abilities, the SAT-MC may provide enhanced sensitivity as an outcome measure of social cognitive intervention trials. Jason K. Johannesen, Jessica B. Lurie, Joanna M. Fiszdon, and Morris D. Bell Copyright © 2013 Jason K. Johannesen et al. All rights reserved. The Coexistence of Psychiatric Disorders and Intellectual Disability in Children Aged 3–18 Years in the Barwani District, India Tue, 07 May 2013 14:09:02 +0000 Background. The coexistence of psychiatric disorders in people with intellectual disability (ID) is common. This study determined the prevalence of psychiatric disorders in children with ID in Barwani, India. Method. A total of 262 children with ID were evaluated for psychiatric disorders using the diagnostic criteria outlined in the International Classification of Diseases (ICD-10). Results. Psychiatric disorders appeared in study participants at the following rates: attention deficit hyperactivity disorder (ADHD), 6.5%; autism, 4.2%; anxiety, 2.7%; bipolar disorder, 1.1%; delusional disorder, 0.8%; depression, 2.3%; obsessive-compulsive disorder, 0.8%; schizophrenia, 1.9%; enuresis, 10.3%; epilepsy, 23.7%; and behavioral problems, 80.9%. The prevalence of psychiatric disorders was statistically higher in severely intellectually disabled children () than mildly intellectually disabled children (). Conclusions. There is a higher prevalence of psychiatric disorders in children with ID when their compared with ID children whose . Ram Lakhan Copyright © 2013 Ram Lakhan. All rights reserved. SCL-90-R Symptom Profiles and Outcome of Short-Term Psychodynamic Group Therapy Sat, 27 Apr 2013 15:51:42 +0000 Background. Psychodynamic group psychotherapy may not be an optimal treatment for anxiety and agoraphobic symptoms. We explore remission of SCL-90-R Global Severity Index (GSI) and target symptoms in 39 sessions of psychodynamic group therapy. Methods. SCL-90-R “target symptom” profile and GSI remission according to Danish norms were identified in 239 patients and evaluated according to reliable and clinical significant change. Results. Four major groups of target symptom cases (depression, interpersonal sensitivity, anxiety, and phobic anxiety) covered 95.7% of the sample. As opposite to phobic anxiety and anxiety patients, patients with interpersonal sensitivity obtained overall the most optimal outcome. The phobic anxiety scale, social network support, and years of school education were independent predictors of GSI remission, and a low anxiety score and absence of phobic anxiety target symptoms were independent predictors of remission of target symptom pathology. Conclusions. The negative results as associated with the SCL-90-R phobic anxiety scale and the phobic anxiety target symptom group are largely in agreement with recent studies. In contrast, whatever the diagnoses, patients with interpersonal sensitivity target symptom may be especially suited for psychodynamic group therapy. The SCL-90-R subscales may allow for a more complex symptom-related differentiation of patients compared with both diagnoses and GSI symptom load. Hans Henrik Jensen, Erik L. Mortensen, and Martin Lotz Copyright © 2013 Hans Henrik Jensen et al. All rights reserved. Age of Onset of Mood Disorders and Complexity of Personality Traits Tue, 23 Apr 2013 12:34:00 +0000 Objective. The aim of the present study is to evaluate the link between the age of onset of mood disorders and the complexity of the personality traits. Methods. 209 patients with major depressive or manic/hypomanic episodes were assessed using the Structured Clinical Interview for DSM Axis I diagnoses and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Results. 17.2% of the patients had no elevated MCMI-III scores, 45.9% had one peak, and 36.9% had a complex personality disorder with two or more elevated scores. Mood disorders onset of 29 years or less was the variable most related to the complexity of personality disorders as indicated from a recursive partitioning analysis. Conclusions. The relationship between mood disorders and personality traits differ in reference to age of onset of the mood disorder. In younger patients, maladaptive personality traits can evolve both in a mood disorder onset and in a complex personality disorder, while the later development of a severe mood disorder can increase the personality symptomatology. Our results suggest a threshold of mood disorder onset higher compared to previous studies. Maladaptive personality traits should be assessed not only during adolescence but also in young adults to identify and treat potential severe mood disorders. L. Ostacoli, M. Zuffranieri, M. Cavallo, A. Zennaro, I. Rainero, L. Pinessi, M. V. Pacchiana Parravicini, E. Ladisa, P. M. Furlan, and R. L. Picci Copyright © 2013 L. Ostacoli et al. All rights reserved. Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report Tue, 23 Apr 2013 11:55:00 +0000 Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide. Arabinda N. Chowdhury, Sohini Banerjee, Arabinda Brahma, and Mrinal K. Biswas Copyright © 2013 Arabinda N. Chowdhury et al. All rights reserved. Assessment of Behavior Abnormalities of Corticosteroids in Children with Nephrotic Syndrome Tue, 16 Apr 2013 14:06:30 +0000 Introduction. The objective of this work was to define the frequency and severity of steroid related behavioral side effects in children with steroid sensitive idiopathic nephrotic syndrome (SSNS) during Treatment for relapse. Methods. 30 pediatric patients with steroid sensitive nephrotic syndrome were studied; known as SSNS at complete remission or low dose of Prednisolone and have relapse on follow up. All children in this study were subjected to full history taking, thorough clinical examination, assessment socioeconomic standard, and assessment of pediatric quality of life, a battery of psychometric tests included pediatric anxiety, depression, and aggression scores. Results. Our results revealed that there are highly significant increase in the mean values of anxiety, depression and aggression among cases starts to appear on week one and extends to three, five and seven weeks compared to baseline. In the seventh week of follow up cases show significant positive correlation between prednisone doses and mean values of anxiety and depression scores and aggression. Conclusion. we concluded that all studied children with SSNS often experience significant problems with anxiety, depression, and increased aggression during high dose steroid therapy. Doaa Mohammed Youssef, Mohamed Mohamed Abdelsalam, Ali Mohamed Abozeid, and Usama Mahmoud Youssef Copyright © 2013 Doaa Mohammed Youssef et al. All rights reserved. The Relationship of Affective Temperament and Emotional-Behavioral Difficulties to Internet Addiction in Turkish Teenagers Thu, 28 Mar 2013 13:02:36 +0000 The purpose of this study was to investigate the association of affective temperament profiles and emotional and behavioural characteristics with Internet addiction among high school students. The study sample included 303 high school students. A sociodemographic characteristics data form, internet addiction scale (IAS), the strengths and difficulties questionnaire, and the temperament evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire were used to collect data. Of the sample, 6.6% were found to be addicted to Internet. Having a computer in the home () and using the Internet for more than two years () were found to be related to higher scores on the IAS. The prevalence rate of anxious temperament for Internet addicts was more than that for nonaddicts (). Dysthymic (; ), cyclothymic (; ), hyperthymic (; ), irritable (; ), and anxious (; ) temperaments; conduct problems (; ), hyperactivity-inattention (; ), emotional symptoms (; ), and total difficulties (; ) were found to be correlated with IAS scores. According to these findings, there is a relation between the Internet addiction and affective temperament profiles, especially with anxious temperament. Furthermore, emotional and behavioural problems are more frequent in adolescents who have problematic Internet use. Fatma Ozgun Ozturk, Mine Ekinci, Onder Ozturk, and Fatih Canan Copyright © 2013 Fatma Ozgun Ozturk et al. All rights reserved. A Multiple Case Series Analysis of Six Variants of Attentional Bias Modification for Depression Thu, 21 Mar 2013 14:33:58 +0000 Background. Attention bias modification (ABM) is a new treatment for affective disorders. A meta-analysis of ABM for anxiety disorders showed that the effect size may be large but the number of studies is low. The working mechanism is still unclear, and little is known about the optimal treatment parameters. ABM for depression is much less studied. A few studies claimed positive effects but the sample sizes are low. Furthermore, the treatment parameters varied widely and differed from the anxiety literature. Aim. To select the most promising version of ABM for depression for further evaluation in clinical trials. Methods. Multiple case series design. We tested six versions of ABM that varied on stimulus duration and training direction. Thirty students with mild to moderate symptoms of depression underwent four sessions of ABM. Change of attentional bias was measured during each session. Generalization of treatment effects and the role of awareness of receiving training were also investigated. Results. None of the investigated versions of ABM had a consistent effect on attentional bias. Changes of attentional bias in individual participants the effects did not generalize to untrained stimuli. Conclusion. It is unlikely that any of these ABM versions will have a specific effect on symptoms in controlled studies. Anne-Wil Kruijt, Peter Putman, and Willem Van der Does Copyright © 2013 Anne-Wil Kruijt et al. All rights reserved. Disrupted Central Inhibition after Transcranial Magnetic Stimulation of Motor Cortex in Schizophrenia with Long-Term Antipsychotic Treatment Thu, 14 Mar 2013 15:40:53 +0000 Aims. Schizophrenia is a neuropsychiatric disorder associated with mental and motor disturbances. We aimed to investigate motor control, especially central silent period (CSP) in subjects with schizophrenia () on long-term antipsychotic treatment compared to healthy controls (). Methods. Latency and duration of motor evoked potentials (MEPs) and CSPs were measured with the help of single pulse transcranial magnetic stimulation (TMS) and intramuscular electrodes. After stimulation of the dominant and nondominant motor cortex of abductor digiti minimi (ADM) and tibialis anterior (TA) muscle areas, respective responses were measured on the contralateral side. Results. MEPs did not differ significantly between the groups. Multiple CSPs were found predominantly in subjects with schizophrenia, which showed a higher number of CSPs in the dominant ADM and the longest summarized duration of CSPs in the nondominant ADM () compared to controls. Conclusions. There were multiple CSPs predominantly in the upper extremities and in the dominant body side in subjects with schizophrenia. Behind multiple CSPs may lie an impaired regulation of excitatory or inhibitory neurotransmitter systems in central motor pathways. Further research is needed to clarify the role of the intramuscular recording methods and the effect of antipsychotics on the results. Aulikki Ahlgrén-Rimpiläinen, Hannu Lauerma, Seppo Kähkönen, and Ilpo Rimpiläinen Copyright © 2013 Aulikki Ahlgrén-Rimpiläinen et al. All rights reserved. Substance Abusers in an Acute Psychiatric Facility: A Diagnostic and Logistic Challenge Thu, 21 Feb 2013 14:13:51 +0000 Acute resident psychiatric facilities in Norway usually get their patients after referral from a medical doctor. Acute psychiatric wards are the only places accepting persons in need of emergency hospitalisation when emergency units in somatic hospitals do not accept the patient. Resident patients at one random chosen day were scrutinized in an acute psychiatric facility with 36 beds serving a catchment area of 165 000. Twenty-five patients were resident in the facility at that particular day. Eight of 25 resident patients (32.0%) in the acute wards were referred for a substance-induced psychosis (SIP). Another patient may also have had a SIP, but the differential diagnostic work was not finished. A main primary diagnosis of substance use was given in the medical reports in only 12.9% of patients during the last year. Given that the chosen day was representative of the year, a majority of patients with substance abuse problems were given other diagnoses. There seems to be a reluctance to declare the primary reason for an acute stay in a third of resident stays. Lack of specialized emergency detoxification facilities may have contributed to the results. John E. Berg and Asbjørn Restan Copyright © 2013 John E. Berg and Asbjørn Restan. All rights reserved. Chronic Phencyclidine Increases Synapsin-1 and Synaptic Adaptation Proteins in the Medial Prefrontal Cortex Tue, 19 Feb 2013 14:28:39 +0000 Phencyclidine (PCP) mimics many aspects of schizophrenia, yet the underlying mechanism of neurochemical adaptation for PCP is unknown. We therefore used proteomics to study changes in the medial prefrontal cortex in animals with PCP-induced behavioural deficits. Male Wistar rats were injected with saline or 5 mg/kg phencyclidine for 5 days followed by two days of washout. Spontaneous alternation behaviour was tested in a Y-maze and then proteins were extracted from the medial prefrontal cortex. 2D-DIGE analysis followed by spot picking and protein identification with mass spectrometry then provided a list of differentially expressed proteins. Treatment with 5 mg/kg phencyclidine decreased the percentage of correct alternations in the Y-maze compared to saline-treated controls. Proteomics analysis of the medial prefrontal cortex found upregulation of 6 proteins (synapsin-1, Dpysl3, Aco2, Fscn1, Tuba1c, and Mapk1) and downregulation of 11 (Bin1, Dpysl2, Sugt1, ApoE, Psme1, ERp29, Pgam1, Uchl1, Ndufv2, Pcmt1, and Vdac1). A trend to upregulation was observed for Gnb4 and Capza2, while downregulation trends were noted for alpha-enolase and Fh. Many of the hits in this study concur with recent postmortem data from schizophrenic patients and this further validates the use of phencyclidine in preclinical translational research. Chris Pickering, Mia Ericson, and Bo Söderpalm Copyright © 2013 Chris Pickering et al. All rights reserved. The Effect of Methylated Vitamin B Complex on Depressive and Anxiety Symptoms and Quality of Life in Adults with Depression Mon, 21 Jan 2013 14:41:21 +0000 Depression, the most common type of mental illness, is the second leading cause of disability and is increasing among Americans. The effect of improved nutrition, particularly with dietary supplements, on depression may provide an alternative to standard medical treatment. Some studies have shown that certain nutrients (e.g., inositol and S-adenosyl methionine) are effective at improving depressed mood, although the results are not unequivocal. The current study was a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a vitamin B complex nutritional supplement (Max Stress B) for improving depressive and anxiety symptoms according to the Beck Depression and Anxiety Inventories (BDI and BAI) in 60 adults diagnosed with major depression or other forms of depressive disorders. Secondary outcomes included quality of life according to the SF-36. Participants were assessed at baseline and 30- and 60-day followups. Max Stress B showed significant and more continuous improvements in depressive and anxiety symptoms, compared to placebo. Additionally, Max Stress B showed significant improvement on the mental health scale of the SF-36 compared to placebo. Thus, we showed modest utility of Max Stress B to improve mood symptoms and mental health quality of life in adults with depression. John E. Lewis, Eduard Tiozzo, Angelica B. Melillo, Susanna Leonard, Lawrence Chen, Armando Mendez, Judi M. Woolger, and Janet Konefal Copyright © 2013 John E. Lewis et al. All rights reserved. Complementary and Alternative Therapies for Pediatric Attention Deficit Hyperactivity Disorder: A Descriptive Review Wed, 26 Dec 2012 11:55:26 +0000 Attention deficit hyperactivity disorder (AD/HD), characterized by impulsivity, distractibility, and inattention, has an estimated pediatric population prevalence of 6–8%. Family physicians and pediatricians evaluate and treat the majority of children with this condition. The evidence-based treatment of choice for ADHD, stimulant medication, continues to be a source of public controversy. Surveys suggest that among parents of children with ADHD, there is considerable interest in complementary and alternative medicine (CAM). These therapies include herbal preparations, mineral supplements, sugar restriction, and polyunsaturated fatty acids. Other AD/HD therapies include neuro-feedback, cognitive training, mindfulness meditation, and exposure to “green space.” In order to assist physicians and mental health professionals in responding to patient and parent queries, this paper briefly describes these CAM therapies and current research regarding their effectiveness. While investigations in this area are hampered by research design issues such as sample size and the absence of double-blind placebo-controlled trials, there is some evidence that omega three fatty acids, zinc supplements, and neuro-feedback may have some efficacy. H. Russell Searight, Kayla Robertson, Todd Smith, Scott Perkins, and Barbara K. Searight Copyright © 2012 H. Russell Searight et al. All rights reserved. The Relationships between Cholesterol and Suicide: An Update Sun, 23 Dec 2012 12:23:24 +0000 Cholesterol is a core component of the central nervous system, essential for the cell membrane stability and the correct functioning of neurotransmission. It has been observed that cholesterol may be somewhat associated with suicidal behaviours. Therefore, the aim of this paper was to elucidate current facts and views about the role of cholesterol levels in mood disorders. The majority of the studies reviewed in the present paper suggest an interesting relationship between cholesterol (especially lower levels) and suicidality. On the other hand, particularly during the last years, relationships between serum cholesterol and suicidality were doubted on the basis of some recent studies that have not found any correlation. However, the debate on relationships between cholesterol and suicide is open and longitudinal studies on a larger sample of patients are needed to further clarify this important issue. Domenico De Berardis, Stefano Marini, Monica Piersanti, Marilde Cavuto, Giampaolo Perna, Alessandro Valchera, Monica Mazza, Michele Fornaro, Felice Iasevoli, Giovanni Martinotti, and Massimo Di Giannantonio Copyright © 2012 Domenico De Berardis et al. All rights reserved. Religion, Spirituality, and Health: The Research and Clinical Implications Sun, 16 Dec 2012 11:11:52 +0000 This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard. Harold G. Koenig Copyright © 2012 Harold G. Koenig. All rights reserved. Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence Wed, 14 Nov 2012 09:52:43 +0000 Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes. Linda E. Carlson Copyright © 2012 Linda E. Carlson. All rights reserved. Frequency Distribution of COMT Polymorphisms in Greek Patients with Schizophrenia and Controls: A Study of SNPs rs737865, rs4680, and rs165599 Thu, 01 Nov 2012 10:07:45 +0000 Schizophrenia, a severe psychiatric condition, is characterized by disturbances of cognition, emotion, and social functioning. The disease affects almost 1% of world population. Recent studies evaluating the role of catechol-O-methyltransferase enzyme (COMT) polymorphisms in the pathogenesis of schizophrenia have resulted in ambiguous findings. The current study examined the association of schizophrenia with three COMT polymorphisms, namely, rs737865, rs4680, and rs165599 in a Greek population. There was no significant association between schizophrenia and any of the three SNPs examined. However, haplotype analysis showed that cases have higher frequency of the T-A-A haplotype, and participants with that haplotype were at increased risk for developing schizophrenia (OR = 1.52; CL : 1.12–2.08; ). Furthermore, patients with schizophrenia displayed an excess of TC/AA/AA and the TT/AA/GA genotypes. Similarly a protective effect of TT/GG/GG and TT/GA/GG was suggested by our results. Kotrotsou Maria, Touloumis Charalampos, Dido Vassilakopoulou, Syriou Stavroula, Kalampoki Vasiliki, and Drakoulis Nikolaos Copyright © 2012 Kotrotsou Maria et al. All rights reserved.