Psychiatry Journal The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge Sun, 16 Mar 2014 09:08:28 +0000 Introduction. Cerebral blood flow has been well studied in patients with panic disorder, but only few studies analyzed the mechanisms underlying the onset of a panic attack. The aim of the present study was to monitor the cerebral hemodynamics modifications during a panic attack. Materials and Methods. 10 panic disorder patients with recent onset, fully drug naïve, were compared to 13 patients with panic disorder with a previous history of treatment and to 14 controls. A continuous bilateral monitoring of mean flow velocities in right and left middle cerebral arteries was performed by transcranial Doppler. Clomipramine was chosen as challenge. Results. Eight out of 10 patients drug naïve and 6 control subjects out of 13 had a full blown panic attack during the test, whereas none of the patients with a history of treatment panicked. The occurrence of a panic attack was accompanied by a rapid decrease of flow velocities in both right and left middle cerebral arteries. Discussion. The bilateral acute decrease of mean flow velocity during a panic attack suggests the vasoconstriction of the microcirculation of deep brain structures perfused by middle cerebral arteries and involved in the so-called “fear circuitry,” thus suggesting that cerebral homeostatic dysfunctions seem to have a key role in the onset of a panic attack. Francesco Rotella, Marinella Marinoni, Francesca Lejeune, Fabiana Alari, Daniela Depinesi, Fiammetta Cosci, and Carlo Faravelli Copyright © 2014 Francesco Rotella et al. All rights reserved. Organizational Factors Influencing Implementation of Evidence-Based Practices for Integrated Treatment in Behavioral Health Agencies Mon, 03 Mar 2014 08:29:52 +0000 Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities. Caroline A. Bonham, David Sommerfeld, Cathleen Willging, and Gregory A. Aarons Copyright © 2014 Caroline A. Bonham et al. All rights reserved. Disability and Comorbidity: Diagnoses and Symptoms Associated with Disability in a Clinical Population with Panic Disorder Sun, 02 Mar 2014 07:56:27 +0000 Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions. Caroline A. Bonham and Eberhard Uhlenhuth Copyright © 2014 Caroline A. Bonham and Eberhard Uhlenhuth. All rights reserved. Bipolar Disorder in Children Mon, 24 Feb 2014 06:04:15 +0000 Although bipolar disorder historically was thought to only occur rarely in children and adolescents, there has been a significant increase in children and adolescents who are receiving this diagnosis more recently (Carlson, 2005). Nonetheless, the applicability of the current bipolar disorder diagnostic criteria for children, particularly preschool children, remains unclear, even though much work has been focused on this area. As a result, more work needs to be done to further the understanding of bipolar symptoms in children. It is hoped that this paper can assist psychologists and other health service providers in gleaning a snapshot of the literature in this area so that they can gain an understanding of the diagnostic criteria and other behaviors that may be relevant and be informed about potential approaches for assessment and treatment with children who meet bipolar disorder criteria. First, the history of bipolar symptoms and current diagnostic criteria will be discussed. Next, assessment strategies that may prove helpful for identifying bipolar disorder will be discussed. Then, treatments that may have relevance to children and their families will be discussed. Finally, conclusions regarding work with children who may have a bipolar disorder diagnosis will be offered. Kimberly Renk, Rachel White, Brea-Anne Lauer, Meagan McSwiggan, Jayme Puff, and Amanda Lowell Copyright © 2014 Kimberly Renk et al. All rights reserved. First Rank Symptoms and Neurological Soft Signs in Schizophrenia Thu, 13 Feb 2014 12:20:55 +0000 The aim of the study was to compare the neurological soft signs (NSS) in schizophrenia patients with and without first rank symptoms (FRS), their first degree relatives (FDR), and normal controls. The study was conducted on 60 schizophrenia patients diagnosed according to ICD 10 DCR and categorized into groups with and without FRS using Schedules for Clinical Assessment in Neuropsychiatry, 30 FDRs of the study sample, and 30 normal controls matched for age, education, and handedness. All the subjects gave written informed consent. Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were applied to have a comprehensive assessment of the symptoms. NSS were assessed using Extended Standard Neurological Assessment Instrument. The correlations between NSS and clinical symptoms were relatively modest but significant. There was a weak relation between NSS and positive symptom severity. The FDR of schizophrenia patients had significantly lower NSS scores than schizophrenia patients, but only FDR of schizophrenia patients without FRS had significantly higher scores than normal controls. Our results indicate that NSS are more prominent in schizophrenia patients with negative symptoms and support the theory of NSS being a trait marker of schizophrenia particularly in those without FRS. Mahesh Hembram, Jayati Simlai, Suprakash Chaudhury, and Parthasarathi Biswas Copyright © 2014 Mahesh Hembram et al. All rights reserved. The Dutch Social Interaction Anxiety Scale and the Social Phobia Scale: Reliability, Validity, and Clinical Utility Wed, 12 Feb 2014 13:26:05 +0000 The social interaction anxiety scale (SIAS) and the social phobia scale (SPS) assess anxiety in social interactions and fear of scrutiny by others. This study examines the psychometric properties of the Dutch versions of the SIAS and SPS using data from a large group of patients with social phobia and a community-based sample. Confirmatory factor analysis revealed that the SIAS is unidimensional, whereas the SPS is comprised of three subscales. The internal consistency of the scales and subscales was good. The concurrent and discriminant validity was supported and the scales were well able to discriminate between patients and community-based respondents. Cut-off values with excellent sensitivity and specificity are presented. Of all self-report measures included, the SPS was the most sensitive for treatment effects. Normative data are provided which can be used to assess whether clinically significant change has occurred in individual patients. Edwin de Beurs, Deirdre Tielen, and Lisa Wollmann Copyright © 2014 Edwin de Beurs et al. All rights reserved. Service Engagement: Psychopathology, Recovery Style and Treatments Wed, 12 Feb 2014 07:54:21 +0000 The aim of the present study is to evaluate how recovery style, a set of strategies used by patients to interact with services and therapists, and the severity of psychotic symptoms affect the quality/continuity of taking charge of each patient. 156 psychotic patients at different stages of illness were enrolled. Sociodemographic and clinical data were collected and integration/sealing-Over Scale, Recovery Style Questionnaire and Positive and Negative Syndrome Scale were administered. Patients were distinguished into four groups according to the type of treatment received: clinical package, hospital package, day-care package, and residential package. A positive correlation between the cost of psychiatric performance and psychopathological severity (measured with PANSS scores) was identified. No association emerged between ISOS/RSQ total scores and costs. The sanitary expenditure appears to be linked to positive psychotic symptoms while lower performances are given for the treatment of patients with predominant negative symptoms. Recovery style itself has not a direct influence on the quantity/quality of psychiatric services. Simone Vender, Nicola Poloni, Francesca Aletti, Cristiano Bonalumi, and Camilla Callegari Copyright © 2014 Simone Vender et al. All rights reserved. Adverse Effects of Risperidone in Children with Autism Spectrum Disorders in a Naturalistic Clinical Setting at Siriraj Hospital, Thailand Mon, 03 Feb 2014 13:42:37 +0000 A cross-sectional study was conducted to evaluate adverse effects associated with risperidone in 45 children with autism spectrum disorders (ASD), aged 2–15 years, who were treated at Siriraj Hospital, Thailand, between the years 2006 and 2007. Adverse effects were assessed by parent interview, using a semistructure questionnaire, and medical records review. The mean ± SD age of the children at starting risperidone was years. The mean ± SD of risperidone dose was  mg/day and the mean ± SD duration of treatment was months. Adverse effects were reported in 39 children (86.7%). Common adverse effects included increased appetite, somnolence, and rhinorrhea and most of the adverse effects were tolerable. Tardive dyskinesia or other serious adverse events were not found in this study. The child’s mean ± SD weight gain was  kg/year, which exceeded developmentally expected norms. The results from this study suggest that risperidone treatment in children with ASD is associated with frequent mild and tolerable adverse effects. However, excessive weight gain could be found to be a concerning adverse effect and weight monitoring is warranted when risperidone is being prescribed. Vitharon Boon-yasidhi, Pantipa Jearnarongrit, Patnaree Tulayapichitchock, and Jariya Tarugsa Copyright © 2014 Vitharon Boon-yasidhi et al. All rights reserved.