Psychiatry Journal The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders Sun, 17 Apr 2016 12:21:31 +0000 Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year. Jennifer Downey, Richard C. Friedman, Elizabeth Haase, David Goldenberg, Robinette Bell, and Sidney Edsall Copyright © 2016 Jennifer Downey et al. All rights reserved. Canadian Physicians’ Attitudes towards Accessing Mental Health Resources Sun, 10 Apr 2016 13:24:44 +0000 Despite their rigorous training, studies have shown that physicians experience higher rates of mental illness, substance abuse, and suicide compared to the general population. An online questionnaire was sent to a random sample of physicians across Canada to assess physicians’ knowledge of the incidence of mental illness among physicians and their attitudes towards disclosure and treatment in a hypothetical situation where one developed a mental illness. We received 139 responses reflecting mostly primary care physicians and nonsurgical specialists. The majority of respondents underestimated the incidence of mental illness in physicians. The most important factors influencing respondent’s will to disclose their illness included career implications, professional integrity, and social stigma. Preference for selecting mental health treatment services, as either outpatients or inpatients, was mostly influenced by quality of care and confidentiality, with lower importance of convenience and social stigma. Results from this study suggest that the attitudes of physicians towards becoming mentally ill are complex and may be affected by the individual’s previous diagnosis of mental illness and the presence of a family member with a history of mental illness. Other factors include the individual’s medical specialty and level of experience. As mental illness is common among physicians, one must be conscious of these when offering treatment options. Tariq M. Hassan, M. Selim Asmer, Nadeem Mazhar, Tariq Munshi, Tanya Tran, and Dianne L. Groll Copyright © 2016 Tariq M. Hassan et al. All rights reserved. The Relation between Psychiatric Diagnoses and Constipation in Hospitalized Patients: A Cross-Sectional Study Thu, 10 Mar 2016 12:14:38 +0000 Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of laxatives) and DSM-IV psychiatric diagnosis was studied in a cross-sectional study with “adjustment disorders” as the reference group. The association was analyzed using logistic regression. Results. Of the 4728 patients, 20.3% had constipation. In the stratum of patients older than 60 years, all psychiatric categories except for substance related disorders were significantly associated with a higher prevalence of constipation (odds ratios ranging from 3.38 to 6.52), whereas no significant associations were found in the stratum of patients between 18 and 60 years (odds ratios ranging from 1.00 to 2.03). Conclusion. In the elderly, all measured psychiatric diagnoses are strongly associated with an increased prevalence of constipation. Physicians should be extra alert for constipation in SMI patients, independent of specific psychiatric diagnoses. Janique G. Jessurun, Peter N. van Harten, Toine C. G. Egberts, Ysbrand J. Pijl, Ingeborg Wilting, and Diederik E. Tenback Copyright © 2016 Janique G. Jessurun et al. All rights reserved. Prevalence of Antipsychotic Polypharmacy and Associated Factors among Outpatients with Schizophrenia Attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia Sun, 24 Jan 2016 08:55:23 +0000 Background. Despite recommendations by guidelines to avoid combinations of antipsychotics unless after multiple trials of antipsychotic monotherapy, it is quite a common practice to use combinations. This practice leads to unnecessary expenses and exposes the patient to severe drug adverse effects. Methods. An institution based cross-sectional study was conducted from April to May 2014. Systematic random sampling technique was used to select 423 study subjects. Logistic regression analysis was conducted to identify associated factors of antipsychotic polypharmacy among schizophrenia outpatients. Result. The overall prevalence of antipsychotic polypharmacy was found to be 28.2%. Extra pyramidal side effects (AOR = 2.80; 95% CI: 1.38, 5.71), repeated psychiatric hospitalization (AOR = 2.83; 95% CI: 1.45, 5.50), history of substance use (AOR = 2.82; 95% CI: 1.36, 5.88), longer duration of treatment (AOR = 2.10; 95% CI: 1.14, 3.87), and drug nonadherence (AOR = 1.84; 95% CI: 1.14, 2.98) were found to be significantly associated with antipsychotic polypharmacy. Conclusion. Prevalence of antipsychotic polypharmacy was found to be high among the current study participants. Individuals who had extra pyramidal side effects, admission, substance use, duration of treatment, and drug nonadherence were associated with antipsychotic polypharmacy. Siranesh Tesfaye, Nigussie Debencho, Teresa Kisi, and Minale Tareke Copyright © 2016 Siranesh Tesfaye et al. All rights reserved. Psychometric Validation of the Bangla Version of the Patient-Doctor Relationship Questionnaire Thu, 21 Jan 2016 13:36:33 +0000 Background. The patient-doctor relationship is an important issue in health care as it is linked to patient satisfaction, treatment adherence, and treatment outcome. The PDRQ-9 is brief instrument which has an excellent overall internal consistency to measure it. Objective. It was aimed at developing a culturally adapted and validated Bangla version of Patient-Doctor Relationship Questionnaire (PDRQ-9). Method. Data were collected during the period of May 2015 to July 2015 from 50 patients by interviewing with the final Bangla version of PDRQ-9 obtained by ideal translation-back translation procedure with nonprobability purposive consecutive sampling and analyzed by Statistical Package of Social Science (SPSS) 16.0 and Microsoft Excel 2007 version software. Result. The internal consistency of Bangla PDRQ-9 was measured by Cronbach’s α which was 0.97. Only one factor was extracted from varimax rotation factor analysis with high commonalities between the items. Conclusion. Bangla version of PDRQ-9 is valid, accepted, and widely applicable in clinical practice, research, public health, and primary health care in Bangladesh. S. M. Yasir Arafat Copyright © 2016 S. M. Yasir Arafat. All rights reserved. Pattern of Presentation and Utilization of Services for Mental and Neurological Disorders in Northeastern Nigeria: A Ten-Year Study Tue, 24 Nov 2015 08:09:05 +0000 Mental and neurological disorders are common in the primary health care settings. The organization of mental health services focuses on a vertical approach. The northeast as other low income regions has weak mental health services with potentially huge mental health burden. The manner of presentations and utilization of these services by the population may assist in determining treatment gap. We investigated the pattern and geographical distribution of presentations with mental disorders and explored the linkages with primary care in northeastern Nigeria over the last decade. A retrospective review of hospital-based records of all the available mental health service units in the region was conducted over a decade spanning between January 2001 and December 2011. A total of 47, 664 patients attended available mental health facilities within the past decade in the northeast. Overwhelming majority (83%, ) attended the region’s tertiary mental health facility. A substantial proportion (30%, ) had primary physical illness, while 18%, , had primary neurologic disorders. The commonest physical comorbidity was hypertension (4%) and diabetes (2%). A significant proportion of the populace with mental disorders appeared not to be accessing mental health care services, even when it is available. Meaningful efforts to improve access to mental health services in the northeast region of Nigeria will require successful integration of mental health into primary and general medical services. Jidda Mohammed Said, Abdulmalik Jibril, Rabbebe Isah, and Omeiza Beida Copyright © 2015 Jidda Mohammed Said et al. All rights reserved. The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals Mon, 23 Nov 2015 12:32:38 +0000 Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. “Physical restraint” is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding) in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients’ and staff’s perspectives. More interventional studies are needed to move the field forward. Rolf Wynn Copyright © 2015 Rolf Wynn. All rights reserved. Acceptance and Avoidance Processes at Different Levels of Psychological Recovery from Enduring Mental Illness Tue, 20 Oct 2015 11:27:36 +0000 Objective. This study examined the use of psychological acceptance and experiential avoidance, two key concepts of Acceptance and Commitment Therapy (ACT), in the psychological recovery process of people with enduring mental illness. Method. Sixty-seven participants were recruited from the metropolitan, regional, and rural areas of New South Wales, Australia. They all presented some form of chronic mental illness (at least 12 months) as reflected in DSM-IV Axis I diagnostic criteria. The Acceptance and Action Questionnaire (AAQ-19) was used to measure the presence of psychological acceptance and experiential avoidance; the Recovery Assessment Scale (RAS) was used to examine the levels of psychological recovery; and the Scales of Psychological Well-Being was used to observe if there are benefits in utilizing psychological acceptance and experiential avoidance in the recovery process. Results. An analysis of objectively quantifiable measures found no clear correlation between the use of psychological acceptance and recovery in mental illness as measured by the RAS. The data, however, showed a relationship between psychological acceptance and some components of recovery, thereby demonstrating its possible value in the recovery process. Conclusion. The major contribution of this research was the emerging correlation that was observed between psychological acceptance and positive levels of psychological well-being among individuals with mental illness. Vinicius R. Siqueira and Lindsay G. Oades Copyright © 2015 Vinicius R. Siqueira and Lindsay G. Oades. All rights reserved. The Contribution of Alexithymia to Obsessive-Compulsive Disorder Symptoms Dimensions: An Investigation in a Large Community Sample in Italy Sun, 06 Sep 2015 12:17:44 +0000 Poor attention has been dedicated to the relation between Alexithymia and specific OCD symptoms dimensions. Knowledge about which Alexithymia domains are the most affected ones in OCD dimensions could inform clinical practice, suggesting the need for the introduction of psychotherapeutic interventions targeting Alexithymia deficits. The current study aimed to investigate which OCD symptom dimension correlated with Alexithymia domains. A total of 425 community individuals (mean age = 27.80, SD = 9.89, 60% women) completed measures of Alexithymia, OCD symptoms dimensions, anxiety, and depression. Moderate correlations emerged between Difficulty Identifying Feelings and Hoarding and Checking symptoms and between Difficulty Describing Feelings and Pure Obsessing . Difficulty Identifying Feelings uniquely predicted OCD symptoms , after controlling for anxiety and depression. A main effect emerged of Alexithymia on Ordering and Pure Obsessing symptoms . Psychotherapeutic interventions specifically targeting Alexithymia should be integrated in the treatment of Ordering and Pure Obsessing symptoms. Difficulty Identifying Feelings and Difficulty Describing Feelings should be addressed in the psychotherapeutic treatment of Hoarding, Checking, and Pure Obsessing, respectively. Andrea Pozza, Nicoletta Giaquinta, and Davide Dèttore Copyright © 2015 Andrea Pozza et al. All rights reserved. Prevalence and Factors Associated with Perceived Stigma among Patients with Epilepsy in Ethiopia Sun, 06 Sep 2015 12:16:34 +0000 Background. Epilepsy stigma is considered to be one of the most important factors that have a negative influence on people with epilepsy. Among all types of stigma perceived stigma further exerts stress and restricts normal participation in society. Methods. Hospital based cross-sectional study was conducted from May 1, 2013, to May 30, 2013. All patients with epilepsy in Ethiopia were source population. The sample size was determined using single population proportion formula and 347 subjects were selected by using systematic random sampling method. Data was analyzed by using SPSS version 20. Results. A total of 346 participants with mean age of 29.3 ± 8.5 SD participated with a response rate of 99.7%. The prevalence of perceived stigma was 31.2%. Age range between 18 and 24 [AOR = 2.84, 95%CI: 1.02, 7.92], difficulty to attend follow-up because of stigma [AOR = 3.15, 95%CI: 1.19, 8.34], seizure related injury [AOR = 1.88, 95%CI: 1.12, 3.15], and contagion belief [AOR = 1.88, 95%CI: 1.10, 5.08] were significantly associated with perceived stigma. Conclusions. Perceived stigma was found to be a common problem among patients suffering from epilepsy. The results reinforce the need for creating awareness among patients with epilepsy and addressing misconceptions attached to epilepsy. Tolesa Fanta, Telake Azale, Dawit Assefa, and Mekbit Getachew Copyright © 2015 Tolesa Fanta et al. All rights reserved. Do Panic Symptoms Affect the Quality of Life and Add to the Disability in Patients with Bronchial Asthma? Thu, 03 Sep 2015 14:20:47 +0000 Background. Anxiety and panic are known to be associated with bronchial asthma with variety of impact on clinical presentation, treatment outcome, comorbidities, quality of life, and functional disability in patients with asthma. This study aims to explore the pattern of panic symptoms, prevalence and severity of panic disorder (PD), quality of life, and disability in them. Methods. Sixty consecutive patients of bronchial asthma were interviewed using semistructured proforma, Panic and Agoraphobia scale, WHO Quality of life (QOL) BREF scale, and WHO disability schedule II (WHODAS II). Results. Though 60% of the participants had panic symptoms, only 46.7% had diagnosable panic attacks according to DSM IV TR diagnostic criteria and 33.3% had PD. Most common symptoms were “sensations of shortness of breath or smothering,” “feeling of choking,” and “fear of dying” found in 83.3% of the participants. 73.3% of the participants had poor quality of life which was most impaired in physical and environmental domains. 55% of the participants had disability score more than a mean (18.1). Conclusion. One-third of the participants had panic disorder with significant effect on physical and environmental domains of quality of life. Patients with more severe PD and bronchial asthma had more disability. A. D. Faye, S. Gawande, R. Tadke, V. C. Kirpekar, S. H. Bhave, A. P. Pakhare, and B. Tayade Copyright © 2015 A. D. Faye et al. All rights reserved. Comparative Prevalence of Eating Disorders in Obsessive-Compulsive Disorder and Other Anxiety Disorders Sun, 23 Aug 2015 11:41:11 +0000 Objective. The purpose of this study was to compare the prevalence of comorbid eating disorders in Obsessive-Compulsive Disorder (OCD) and other common anxiety disorders. Method. 179 patients from the same geographical area with a diagnosis of OCD or an anxiety disorder were divided into two groups based on their primary diagnosis. The prevalence of a comorbid eating disorder was calculated in both groups. Results. There was no statistically significant difference in the prevalence of comorbid eating disorders between the OCD and other anxiety disorders group. Conclusions. These results suggest that the prevalence of comorbid eating disorders does not differ in anxiety disorders when compared with OCD. However, in both groups, it remains statistically higher than that of the general population. Himanshu Tyagi, Rupal Patel, Fabienne Rughooputh, Hannah Abrahams, Andrew J. Watson, and Lynne Drummond Copyright © 2015 Himanshu Tyagi et al. All rights reserved. Near-Infrared Transcranial Radiation for Major Depressive Disorder: Proof of Concept Study Wed, 19 Aug 2015 11:58:57 +0000 Transcranial near-infrared radiation (NIR) is an innovative treatment for major depressive disorder (MDD), but clinical evidence for its efficacy is limited. Our objective was to investigate the tolerability and efficacy of NIR in patients with MDD. We conducted a proof of concept, prospective, double-blind, randomized study of 6 sessions of NIR versus sham treatment for patients with MDD, using a crossover design. Four patients with MDD with mean age 47 ± 14 (SD) years (1 woman and 3 men) were exposed to irradiance of 700 mW/cm2 and a fluence of 84 J/cm2 for a total NIR energy of 2.40 kJ delivered per session for 6 sessions. Baseline mean HAM-D17 scores decreased from 19.8 ± 4.4 (SD) to 13 ± 5.35 (SD) after treatment (; ; ). Patients tolerated the treatment well without any serious adverse events. These findings confirm and extend the preliminary data on NIR as a novel intervention for patients with MDD, but further clinical trials are needed to better understand the efficacy of this new treatment. This trial is registered with NCT01538199. Paolo Cassano, Cristina Cusin, David Mischoulon, Michael R. Hamblin, Luis De Taboada, Angela Pisoni, Trina Chang, Albert Yeung, Dawn F. Ionescu, Samuel R. Petrie, Andrew A. Nierenberg, Maurizio Fava, and Dan V. Iosifescu Copyright © 2015 Paolo Cassano et al. All rights reserved. Comment on “Some Aspects of Nonbeverage Alcohol Consumption in the Former Soviet Union” Sun, 26 Jul 2015 13:10:16 +0000 Y. E. Razvodovsky Copyright © 2015 Y. E. Razvodovsky. All rights reserved. Evidence for Broadening Criteria for Atypical Depression Which May Define a Reactive Depressive Disorder Tue, 14 Jul 2015 11:23:09 +0000 Objective. Arguing that additional symptoms should be added to the criteria for atypical depression. Method. Published research articles on atypical depression are reviewed. Results. (1) The original studies upon which the criteria for atypical depression were based cited fatigue, insomnia, pain, and loss of weight as characteristic symptoms. (2) Several studies of DSM depressive criteria found patients with atypical depression to exhibit high levels of insomnia, fatigue, and loss of appetite/weight. (3) Several studies have found atypical depression to be comorbid with headaches, bulimia, and body image issues. (4) Most probands who report atypical depression meet criteria for “somatic depression,” defined as depression associated with several of disordered eating, poor body image, headaches, fatigue, and insomnia. The gender difference in prevalence of atypical depression results from its overlap with somatic depression. Somatic depression is associated with psychosocial measures related to gender, linking it with the descriptions of atypical depression as “reactive” appearing in the studies upon which the original criteria for atypical depression were based. Conclusion. Insomnia, disordered eating, poor body image, and aches/pains should be added as criteria for atypical depression matching criteria for somatic depression defining a reactive depressive disorder possibly distinct from endogenous melancholic depression. Brett Silverstein and Jules Angst Copyright © 2015 Brett Silverstein and Jules Angst. All rights reserved. Prevalence of Depressive Symptoms and Related Factors in Japanese Employees: A Comparative Study between Surveys from 2007 and 2010 Mon, 13 Jul 2015 08:14:56 +0000 Aims. The aim of this study was to examine the prevalence of depressive symptoms and their related factors in Japan. The results were analyzed to identify the relationship between high scores on the CES-D, sociodemographic status, and employment-related variables. Methods. Employees in Akita prefecture completed the Center for Epidemiologic Studies Depression Scale (CES-D) during a survey period between November and December 2010. The cutoff point for the CES-D scores was 16 or above (high scorers). Results. Data from 1,476 employees indicated that 44.2% had high scores on the CES-D. Sociodemographic and occupation-related factors associated with a high risk of depression were being female, young age, fewer hours of sleep on weekdays, and working over 8 hours per day, whereas drinking alcohol one to two days per week, albeit only in men, was significantly associated with a low risk of depression. The present results were consistent with the results of a previous survey completed in 2007; however, the present results regarding job categories and smoking behavior were not significantly associated with depression and thus were inconsistent with the 2007 survey data. Conclusions. These results can be useful as benchmark values for the CES-D and might help predict depressive disorders. Masahito Fushimi Copyright © 2015 Masahito Fushimi. All rights reserved. Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study Thu, 25 Jun 2015 11:06:40 +0000 Objective. To examine psychiatric patients’ experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients’ experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable. Klas Lanthén, Mikael Rask, and Charlotta Sunnqvist Copyright © 2015 Klas Lanthén et al. All rights reserved. Overcoming Recruitment Barriers in Urban Older Adults Residing in Congregate Living Facilities Wed, 27 May 2015 09:04:42 +0000 Background. Participation of minority older adults in mental health research has been limited by mistrust, transportation difficulties, lack of knowledge, and insufficient community partnership. We describe strategies utilized to overcome these recruitment barriers. Methods. Our target population included 553 public housing residents of older adult high-rise buildings in Rochester, NY. We had a two-stage cross-sectional study: Stage 1 was a health survey for all residents and Stage 2 was a psychiatric interview of English-speaking residents aged 60 years and older. Recruitment occurred through mailings, onsite activities, and resident referrals. Results. Stage 1 had 358 participants (64.7% response) and Stage 2 had 190 (61.6% target population response), with higher participation among African Americans. We found some strategies effective for overcoming recruitment barriers. First, we partnered with a community agency and organized onsite educational activities to improve residents’ trust. Second, the study occurred entirely onsite, which facilitated participation of functionally impaired residents. Third, onsite activities allowed the residents to learn about the study and complete surveys in person. Fourth, we provided immediate incentives that resulted in many study referrals. Conclusions. Although recruitment of minority older adults presents unique challenges, a multifaceted community-tailored approach mitigated several recruitment barriers in this mental health study. Adam Simning, Edwin van Wijngaarden, and Yeates Conwell Copyright © 2015 Adam Simning et al. All rights reserved. Some Aspects of Nonbeverage Alcohol Consumption in the Former Soviet Union Thu, 30 Apr 2015 09:53:01 +0000 Toxicity of some legally sold alcoholic beverages has contributed to enhanced mortality in Russia since 1990. Widespread drunkenness during the early 1990s facilitated privatization of economy: workers and some intelligentsia did not oppose privatizations because of drunkenness and involvement in illegal activities. Apparently, alcohol consumption and heavy binge drinking have been decreasing in Russia since approximately the last decade. Exaggeration of alcohol-related problems tends to veil shortages of the health care system. There are motives to exaggerate consumption of nonbeverage alcohol in order to veil the problem of toxicity of some legally sold beverages. It is essential to distinguish between legally and illegally sold rather than between recorded and unrecorded alcohol because sales of poor-quality alcoholic beverages in legally operating shops and kiosks occurred generally with knowledge of authorities. S. V. Jargin Copyright © 2015 S. V. Jargin. All rights reserved. The Potential Utility of Pharmacogenetic Testing in Psychiatry Wed, 17 Dec 2014 12:31:40 +0000 Over the last decade, pharmacogenetics has become increasingly significant to clinical practice. Psychiatric patients, in particular, may benefit from pharmacogenetic testing as many of the psychotropic medications prescribed in practice lead to varied response rates and a wide range of side effects. The use of pharmacogenetic testing can help tailor psychotropic treatment and inform personalized treatment plans with the highest likelihood of success. Recently, many studies have been published demonstrating improved patient outcomes and decreased healthcare costs for psychiatric patients who utilize genetic testing. This review will describe evidence supporting the clinical utility of genetic testing in psychiatry, present several case studies to demonstrate use in everyday practice, and explore current patient and clinician opinions of genetic testing. Kathryn R. Gardner, Francis X. Brennan, Rachel Scott, and Jay Lombard Copyright © 2014 Kathryn R. Gardner et al. All rights reserved. Sex Differences and Menstrual Cycle Phase-Dependent Modulation of Craving for Cigarette: An fMRI Pilot Study Thu, 13 Nov 2014 08:43:11 +0000 While overall more men than women smoke cigarettes, women and girls take less time to become dependent after initial use and have more difficulties quitting the habit. One of the factors contributing to these differences may be that women crave cigarettes more than men and that their desire to smoke is influenced by hormonal fluctuations across the menstrual cycle. Therefore, the purpose of the present study was twofold: (a) to examine potential sex/gender differences in functional neuroanatomy of craving and to (b) delineate neural correlates of cigarette cravings in women across their menstrual cycle. Fifteen tobacco-smoking men and 19 women underwent a functional MRI during presentation of neutral and smoking-related images, known to elicit craving. Women were tested twice: once during early follicular phase and once during midluteal phase of their menstrual cycle. The analysis did not reveal any significant sex differences in the cerebral activations associated with craving. Nevertheless, the pattern of activations in women varied across their menstrual cycle with significant activations in parts of the frontal, temporal, and parietal lobe, during follicular phase, and only limited activations in the right hippocampus during the luteal phase. Adrianna Mendrek, Laurence Dinh-Williams, Josiane Bourque, and Stéphane Potvin Copyright © 2014 Adrianna Mendrek et al. All rights reserved. Sense of Coherence and Personality Traits Related to Depressive State Thu, 09 Oct 2014 13:36:24 +0000 Aims. The current study aims to examine the influence of job stress, SOC, and personality traits on depressive state. Methods. A self-reported survey was conducted among 347 female nurses in a general hospital. Job stress was measured using the Japanese version of the Brief-Job Stress Questionnaire scale. Depressive state was assessed by the K6 scale. We used 13-item SOC scale. Personality traits were assessed by the Japanese version of Ten-Item Personality Inventory. Multiple liner regression analyses were conducted to examine predictors that significantly affect depressive state. Results. Job and life satisfaction and SOC negatively related to the depressive state (, ; , , resp.) while neuroticism was positively correlated (, ). Also, intrinsic rewards tended to negatively relate (, ). Conclusions. From a practical perspective, the possible influence of SOC and neurotic personality on depressive state should be considered for health care professionals. Yoko Kikuchi, Makoto Nakaya, Miki Ikeda, Shoko Okuzumi, Mihoko Takeda, and Miyoko Nishi Copyright © 2014 Yoko Kikuchi et al. All rights reserved. Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria Mon, 11 Aug 2014 00:00:00 +0000 Objectives. Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria. The aim of this study is to assess psychiatric comorbidities in a group of patients. Methods. Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed through the Persian Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Results. Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders. Conclusion. Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity. Azadeh Mazaheri Meybodi, Ahmad Hajebi, and Atefeh Ghanbari Jolfaei Copyright © 2014 Azadeh Mazaheri Meybodi et al. All rights reserved. Perceived Stigma and Associated Factors among People with Schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Institution Based Study Wed, 21 May 2014 09:33:27 +0000 Background. While effective treatments are available for people with schizophrenia, presence of perceived stigma prevents them from accessing and receiving the help they need to get. Objectives. To assess the prevalence and associated factors of perceived stigma among people with schizophrenia attending the Outpatient Department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Methods. Institution based cross-sectional study design was conducted among 411 subjects using an Amharic version of the perceived devaluation and discrimination scale. Single population proportion formula was used to calculate sample size. Subjects were selected by systematic sampling techniques. Binary logistic regression and odds ratio with 95% confidence interval were used to identify the association factors of outcome variables. Results. A total of 411 subjects participated in the study giving a response rate of 97.4%. The prevalence of perceived stigma was found to be 83.5%. Education status (not able to read and write) (, 95% CI: 1.118, 6.227), difficulties of adherence to antipsychotic drug (, 95% CI: 2.309, 8.732), and duration of illness less than one year (, 95% CI: 2.238, 5.422) were factors associated with perceived stigma. Conclusion. Overall, the prevalence of perceived stigma was found to be high. Education status (not able to read and write), difficulties of adherence to antipsychotic medication, and duration of illness were factors associated with perceived stigma. Adherence to antipsychotic medication particularly during the early stage of the illness and strengthening the educational status of the participants were suggested in the clinical care setting. Berhanu Boru Bifftu and Berihun Assefa Dachew Copyright © 2014 Berhanu Boru Bifftu and Berihun Assefa Dachew. All rights reserved. Unipolar Mania: Recent Updates and Review of the Literature Wed, 30 Apr 2014 00:00:00 +0000 Introduction. Unipolar mania (UM) has received less than the expected attention, when compared to its contemporary mood disorders, unipolar depression (UD) and bipolar disorder (BD). Method. The literature search included PUBMED and PSYCINFO databases. Cross-searches of key references were made to identify other articles of importance. Results. There seems to be a bipolar subgroup with a stable, unipolar recurrent manic course. Although UM does not have significant differences from bipolar mania in terms of sociodemographic variables, there are certain significant differences in clinical features. UM is reported to have more grandiosity, psychotic symptoms, and premorbid hyperthymic temperament, but less rapid cycling, suicidality, seasonality, and comorbid anxiety disorders. It seems to have a better course of illness with better social and professional adjustment. However, its response to lithium prophylaxis is found to be poor as compared to classical BD and valproate could be a better choice in this case. Conclusion. The available literature suggests that UM has certain differences from classical BD. The evidence, however, is insufficient to categorize it as separate diagnostic entity. However, considering UM as a course specifier of BD would be a reasonable step. Shubham Mehta Copyright © 2014 Shubham Mehta. All rights reserved. Road Rage: Prevalence Pattern and Web Based Survey Feasibility Wed, 23 Apr 2014 09:00:23 +0000 Introduction. Incidents of road rage are on a rise in India, but the literature is lacking in the aspect. There is an increasing realization of possibility of effective web based interventions to deliver public health related messages. Objective. The aim was to quantitatively evaluate risk factors among motor vehicle drivers using an internet based survey. Methods. Facebook users were evaluated using Life Orientation Test-Revised (LOT-R) and Driving Anger Scale (DAS). Results. An adequate response rate of 65.9% and satisfactory reliability with sizable correlation were obtained for both scales. Age was found to be positively correlated to LOT-R scores (; ) and negatively correlated to DAS scores (; ). Years of education were correlated to LOT-R scores (; ) but not DAS scores (; ). LOT-R scores did not correlate to DAS scores. Conclusion. There is high prevalence of anger amongst drivers in India particularly among younger males. A short web survey formatted in easy to use question language can result in a feasible conduction of an online survey. Shaily Mina, Rohit Verma, Yatan Pal Singh Balhara, and Shiraz Ul-Hasan Copyright © 2014 Shaily Mina et al. All rights reserved. Where Lies the Risk? An Ecological Approach to Understanding Child Mental Health Risk and Vulnerabilities in Sub-Saharan Africa Wed, 16 Apr 2014 07:01:59 +0000 Efforts at improving child-health and development initiatives in sub-Saharan Africa had focused on the physical health of children due to the neglect of child and adolescent mental health (CAMH) policy initiatives. A thorough and broad-based understanding of the prevalent child mental-health risk and vulnerability factors is needed to successfully articulate CAMH policies. In this discourse, we present a narrative on the child mental-health risk and vulnerability factors in sub-Saharan Africa. Through an ecological point of view, we identified widespread family poverty, poor availability and uptake of childcare resources, inadequate community and institutional childcare systems, and inadequate framework for social protection for vulnerable children as among the risk and vulnerability factors for CAMH in the region. Others are poor workplace policy/practice that does not support work-family life balance, poor legislative framework for child protection, and some harmful traditional practices. We conclude that an ecological approach shows that child mental-health risks are diverse and cut across different layers of the care environment. The approach also provides a broad and holistic template from which appropriate CAMH policy direction in sub-Saharan Africa can be understood. Olayinka Atilola Copyright © 2014 Olayinka Atilola. All rights reserved. Suicide Risk Assessment in Australian Emergency Departments: Assessing Clinicians’ Disposition Decisions Mon, 07 Apr 2014 06:40:23 +0000 Objective. To determine (1) the uniformity of disposition decisions made by clinicians working in Australian emergency departments (EDs) using vignettes describing patients presenting with deliberate self-harm or suicide risk; (2) factors associated with these decisions; (3) factors associated with confidence in these decisions. Methodology. We validated and distributed by email an online survey tool to Australian emergency clinicians via their colleges. Participants were presented with five vignettes and asked to rate the level of risk and protective factors for suicide, the patient’s disposition (admit/discharge/review), factors influencing this decision, their confidence in the decision, and factors that would have improved their confidence. Results. Percentages of participants choosing the modal disposition decision for each scenario ranged from 58.6% (136/232) to 92.4% (220/238), demonstrating uniformity in clinicians’ disposition decisions. Predictors of disposition were consistently level of risk factors perceived and, infrequently, clinician factors including age and years experience. Confidence in disposition decisions was high across scenarios. Clinicians reported patient, clinician, contextual and decision support factors relevant to an Australian emergency context affected their disposition decisions and confidence in decisions. Conclusion. Emergency clinicians are uniform and confident in their disposition decisions for patient vignettes where there is risk of suicide or self harm. T. J. Weiland, A. Cotter, G. A. Jelinek, and G. Phillips Copyright © 2014 T. J. Weiland et al. All rights reserved. Impact of Substance Use Disorder on Presentation and Short-Term Course of Schizophrenia Wed, 02 Apr 2014 09:13:30 +0000 The aim of the present study was to compare a cohort of schizophrenia patients with substance use disorder (SUD) with a similar cohort of schizophrenia patients without SUD with regard to sociodemographic variables, clinical variables, psychopathology, anxiety symptoms, depressive symptoms, treatment outcome, and side effect profile of drugs. A total of 143 consecutive inpatients with ICD-10 DCR diagnosis of schizophrenia were included after obtaining informed consent. Patients were evaluated by a semistructured data sheet and Maudsley Addiction Profile. They were then rated by Positive and Negative Symptoms Scale, Calgary Depression Scale, Hamilton Anxiety Rating Scale, and Brief Psychiatric Rating Scale at presentation, three weeks, and six weeks. At three weeks and six weeks, they were also evaluated by UKU Side Effect Rating Scale. Substance abuse was detected in 63.6% schizophrenia patients. Nicotine was the commonest substance followed by cannabis and alcohol. Substance users had longer untreated illness and more depressive symptoms at presentation and six-week follow-up. Dual diagnosis patients had difficulty in abstraction at three and six weeks but not at presentation. Schizophrenia patients with SUD had more depressive symptoms. SUD appeared to mask abstraction difficulties at presentation. Schizophrenia patients with SUD should be carefully assessed for presence of depression. Rudraprosad Chakraborty, Arunima Chatterjee, and Suprakash Chaudhury Copyright © 2014 Rudraprosad Chakraborty et al. All rights reserved. The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?” Thu, 27 Mar 2014 11:49:26 +0000 There is little disagreement in the substance use treatment literature regarding the conceptualization of substance dependence as a cyclic, chronic condition consisting of alternating episodes of treatment and subsequent relapse. Likewise, substance use treatment efforts are increasingly being contextualized within a similar disease management framework, much like that of other chronic medical conditions (diabetes, hypertension, etc.). As such, substance use treatment has generally been viewed as a process comprised of two phases. Theoretically, the incorporation of some form of lower intensity continuing care services delivered in the context of outpatient treatment after the primary treatment phase (e.g., residential) appears to be a likely requisite if all stakeholders aspire to successful long-term clinical outcomes. Thus, the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse. Given the extant treatment literature clearly supports the contention that treatment is superior to no treatment, and longer lengths of stay is associated with a variety of positive outcomes, the more prudent question appears to be not whether treatment works, but rather what are the specific programmatic elements (e.g., duration, intensity) that comprise an adequate continuing care model. Generally speaking, it appears that the duration of continuing care should extend for a minimum of 3 to 6 months. However, continuing care over a protracted period of up to 12 months appears to be essential if a reasonable expectation of robust recovery is desired. Limitations of prior work and implications for routine clinical practice are also discussed. Steven L. Proctor and Philip L. Herschman Copyright © 2014 Steven L. Proctor and Philip L. Herschman. All rights reserved.