The Scientific World Journal: Psychiatry The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Development and Reliability of the Basic Skill Assessment Tool for Adolescents with Autism Spectrum Disorder Sun, 22 Jan 2017 09:13:35 +0000 The purpose of this study was to improve upon the first version of the basic work skills assessment tool for adolescents with autism spectrum disorder (ASD) and examine interrater and intrarater reliability using Intraclass Correlation Coefficient (ICC). The modified tool includes 2 components: (1) three tasks measuring work abilities and work attitudes and (2) a form to record the number of verbal and nonverbal prompts. 26 participants were selected by purposive sampling and divided into 3 groups—group 1 (10 subjects, aged 11–13 years), group 2 (10, aged 14–16 years), and group 3 (6, aged 17–19 years). The results show that interrater reliabilities of work abilities and work attitudes were high in all groups except that the work attitude in group 1 was moderate. Intrarater reliabilities of work abilities in group 1 and group 2 were high. Group 3 was moderate. Intrarater reliabilities of work attitudes in group 1 and group 3 were high but not in group 2 in which they were moderate. Nevertheless, interrater and intrarater reliabilities in the total scores of all groups were high, which implies that this tool is applicable for adolescents aged 11–19 years with consideration of relevance for each group. Maethisa Pongsaksri, Suchitporn Lersilp, and Sumana Suchart Copyright © 2017 Maethisa Pongsaksri et al. All rights reserved. Role of Alexithymia, Anxiety, and Depression in Predicting Self-Efficacy in Academic Students Thu, 05 Jan 2017 09:38:15 +0000 Objective. Little research is available on the predictive factors of self-efficacy in college students. The aim of the present study is to examine the role of alexithymia, anxiety, and depression in predicting self-efficacy in academic students. Design. In a cross-sectional study, a total of 133 students at Babol University of Medical Sciences (Medicine, Dentistry, and Paramedicine) participated in the study between 2014 and 2015. All participants completed the Toronto Alexithymia Scale (TAS-20), College Academic Self-Efficacy Scale (CASES), and 14 items on anxiety and depression derived from the 28 items of the General Health Questionnaire (28-GHQ). Results. Pearson correlation coefficients revealed negative significant relationships between alexithymia and the three subscales with student self-efficacy. There was no significant correlation between anxiety/depression symptoms and student self-efficacy. A backward multiple regression analysis revealed that alexithymia was a negative significant predictor of self-efficacy in academic students (, ). The prevalence of alexithymia was 21.8% in students. Multiple backward logistic analysis regression revealed that number of passed semesters, gender, mother’s education, father’s education, and doctoral level did not accurately predict alexithymia in college students. Conclusion. As alexithymia is prevalent in college students and affects self-efficacy and academic functioning, we suggest it should be routinely evaluated by mental physicians at universities. Mahbobeh Faramarzi and Soraya Khafri Copyright © 2017 Mahbobeh Faramarzi and Soraya Khafri. All rights reserved. Reliability and Factorial Structure of the Farsi Version of the Arabic Scale of Death Anxiety in an Iranian Middle-Aged Sample Mon, 28 Nov 2016 09:10:56 +0000 The present study aimed to explore the psychometric properties of the Arabic Scale of Death Anxiety (ASDA) in an Iranian middle-aged sample. A sample of 55 volunteer Iranian persons took part in the study. Cronbach’s alpha of the ASDA was found to be high (0.91) and Spearman-Brown and Guttman Split-Half coefficients were 0.86. The factor analysis of the ASDA items yielded five factors accounting for 72.49% of the total variance and labeled (F1) fear of death and fear of dead people; (F2) fear of postmortem events and fear of tombs; (F3) fear of lethal disease; (F4) preoccupation with after death, and death fear in sleep; and (F5) fear of deprivation of own ones. The ASDA has a good validity and reliability, and it can be used in clinical, educational, and research settings. Mahboubeh Dadfar and Fazel Bahrami Copyright © 2016 Mahboubeh Dadfar and Fazel Bahrami. All rights reserved. Does Quantitative Research in Child Maltreatment Tell the Whole Story? The Need for Mixed-Methods Approaches to Explore the Effects of Maltreatment in Infancy Thu, 11 Aug 2016 16:12:48 +0000 Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children () entering care (age 6–60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms () and between reported domestic violence and decreased DAI inhibited () and disinhibited () attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches. Samuel Glass, Ruchika Gajwani, and Fiona Turner-Halliday Copyright © 2016 Samuel Glass et al. All rights reserved. Current Psychopathological Symptoms in Children and Adolescents Who Suffered Different Forms of Maltreatment Thu, 04 Aug 2016 10:05:06 +0000 The aim of the present study is to evaluate the current psychopathological problems of different forms associated with maltreatment on children’s and adolescents’ mental health. Ninety-five females and ninety males with a mean age of 8.8 years who have suffered in the last six months different forms of abuse (physical, sexual, and emotional) and neglect were included in the study. The current reaction to trauma as directly observed by clinical instruments was examined. Differences in gender, age at the time of medical examination, familial psychiatric disorders, neuropsychiatric status, and type of maltreatment were also taken into account. Results documented that 95.1% of abused children and adolescents developed a psychiatric disorder or a subclinical form of a Posttraumatic Stress Disorder (PTSD). Moreover, our data demonstrate a role for gender, age, and familial psychiatric comorbidity in the current psychopathological problems associated with maltreatment. Overall, our findings can help clinicians make a diagnosis and provide efficient treatment and prevention strategies for child maltreatment and abuse. Paola De Rose, Fortunata Salvaguardia, Paola Bergonzini, Flavia Cirillo, Francesco Demaria, Maria Pia Casini, Deny Menghini, and Stefano Vicari Copyright © 2016 Paola De Rose et al. All rights reserved. Association between Reactive Attachment Disorder/Disinhibited Social Engagement Disorder and Emerging Personality Disorder: A Feasibility Study Mon, 06 Jun 2016 09:15:02 +0000 A systematic review of reactive attachment disorder (RAD)/disinhibited social engagement disorder (DSED) in adolescence highlighted that young people with the disorder had indiscriminate friendliness with difficulties in establishing and maintaining stable relationships. Most reported experiences of rejection. We were struck by similarities between the above and features of emergence of personality disorders (EPD). This feasibility study aimed to determine best ways of recruiting and retaining vulnerable young people and the proportion of participants with RAD/DSED who might have emerging borderline personality disorder (EBPD). Participants were referred to the study by their treating clinicians from local mental health teams. Results showed strong association between RAD/DSED and EBPD. Participant characteristics showed high levels of out of home placements, early termination of school careers, suicide attempts, quasipsychotic symptoms, and multiagency involvements. They experienced the project as an opportunity to talk about relationships and reported that they would like more of this in usual clinical contacts. They all agreed to be contacted for future studies. Previous studies have shown that early detection and treatment of emergent personality traits can alter trajectory. Future research will continue to explore these trajectories, explore detection of vulnerability factors, and evaluate interventions. Khadija Mirza, Gracia Mwimba, Rachel Pritchett, and Claire Davidson Copyright © 2016 Khadija Mirza et al. All rights reserved. Is Early Experience Destiny? Review of Research on Long-Term Outcomes following International Adoption with Special Reference to the British Chinese Adoption Study Tue, 10 May 2016 16:21:12 +0000 The pathway from adverse early experience to adulthood for internationally adopted children is complex in identifying key influences, impacts, and outcomes. This review arose from the authors’ involvement in the British Chinese Adoption Study, a recent outcomes study that explored the links between early orphanage care, adoptive experiences, and midadulthood. It differs from previous reviews in focusing on a greater length of time since adoption. Both quantitative and qualitative studies were included to allow for examination of a fuller range of adult-related outcomes rather than mental health scores alone. The sampling, methods, and results of reviewed articles are summarised and a critical commentary is provided. Despite methodological differences and identified strengths and weaknesses, conclusions are drawn on the basis of the evidence available. Special attention is paid to the interpretation of negative outcomes. Findings identify areas that should be explored further in order to gain a fuller understanding of midlife outcomes of people who experienced a poor start in life followed by international adoption. Such studies help in refining lifespan developmental theories. Margaret Grant, Alan Rushton, and John Simmonds Copyright © 2016 Margaret Grant et al. All rights reserved. Challenges of Assessing Maltreated Children Coming into Foster Care Wed, 06 Jan 2016 14:13:54 +0000 Children who have experienced early adversity have been known to be at risk of developing cognitive, attachment, and mental health problems; therefore, it is crucial that children entering foster care can be properly assessed as early as possible. There are known difficulties in assessing children in foster care, for example, in finding a reliable informant. An ongoing randomised controlled trial in Glasgow, Scotland, recruiting infants entering foster care, provides a unique opportunity to explore some of the issues which need to be considered when assessing these children. The assessment data of 70 infants entering care is described while exploring the reliability of foster carers as informants and the importance of infant engagement with tasks. This group of infants was shown to be having more problems than children from the general population. While correlations were found between a carer’s level of concern about a child and the severity of a child’s problem, there were still a number of children displaying worrying problem scores whom foster carers did not report concern. The child’s engagement in the cognitive task showed associations with the child’s attainment on the task. Findings emphasise the importance of a holistic assessment for these children and all should be considered as potential cases with Maltreatment-Associated Psychiatric Problems (MAPP). Rachel Pritchett, Harriet Hockaday, Beatrice Anderson, Claire Davidson, Christopher Gillberg, and Helen Minnis Copyright © 2016 Rachel Pritchett et al. All rights reserved. Associations between Inadequate Parenting Practices and Behavioral Problems in Children and Adolescents with Attention Deficit Hyperactivity Disorder Wed, 30 Dec 2015 06:29:20 +0000 Children and adolescents with ADHD present behaviors such as impulsiveness, inattention, and difficulties with personal organization that represent an overload for parents. Moreover, it also increases their level of stress and leads them to resort to inadequate educational strategies. The present study verifies associations between inadequate parenting practices and behavioral profiles of children and adolescents with ADHD. The sample was composed of 22 children with ADHD (age range 6–16 years) and their mothers. Spearman correlation analyses were made with the scores of Parenting Style Inventory (PSI) and Child Behavior Checklist for ages 6–18 (CBCL/6–18). Results indicate statistically significant associations between behavioral problems and the use of punishment practices and negligence. When assessing a child with ADHD, it is important to verify the predominant types of parenting practices that can influence both immediate interventions and the prognosis of the disorder. Maria Cristina Triguero Veloz Teixeira, Regina Luisa de Freitas Marino, and Luiz Renato Rodrigues Carreiro Copyright © 2015 Maria Cristina Triguero Veloz Teixeira et al. All rights reserved. Mood Disorders: From Psychopathogenesis to Treatment Sun, 01 Nov 2015 09:34:59 +0000 Ru-Band Lu Copyright © 2015 Ru-Band Lu. All rights reserved. One-Year Follow-Up of the Effectiveness of Cognitive Behavioral Group Therapy for Patients’ Depression: A Randomized, Single-Blinded, Controlled Study Wed, 26 Aug 2015 11:45:46 +0000 The aim of the study was to investigate the long-term (one year) effectiveness of a 12-session weekly cognitive behavior group therapy (CBGT) on patients with depression. This was a single-blind randomized controlled study with a 2-arm parallel group design. Eighty-one subjects were randomly assigned to 12 sessions intervention group (CBGT) or control group (usual outpatient psychiatric care group) and 62 completed the study. The primary outcome was depression measured with Beck Depression Inventory (BDI-II) and Hamilton Rating Scale for Depression (HRSD). The secondary outcomes were automatic thoughts measured by automatic thoughts questionnaire (ATQ). Both groups were evaluated at the pretest (before 2 weeks), posttest (after 12 therapy sessions), and short- (3 months), medium- (6 months), and long-term (12 months) follow-up. After receiving CBGT, the experimental group had a statistically significant reduction in the BDI-II from 40.30 at baseline to 17.82 points at session eight and to 10.17 points at postintervention . Similar effects were seen on the HRSD. ATQ significantly decreased at the 12th session, 6 months after sessions, and 1 year after the sessions ended . We concluded that CBGT is effective for reducing depression and continued to be effective at 1 year of follow-up. Kai-Jo Chiang, Tsai-Hui Chen, Hsiu-Tsu Hsieh, Jui-Chen Tsai, Keng-Liang Ou, and Kuei-Ru Chou Copyright © 2015 Kai-Jo Chiang et al. All rights reserved. The Pathogenesis and Treatment of Emotion Dysregulation in Borderline Personality Disorder Wed, 26 Aug 2015 07:16:28 +0000 Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD). This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author’s own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more parsimonious interpretation of brain imaging findings. In closing, the author draws implications of the proposed theory for clinical practice. He reports an efficacy study for treatment of emotion dysregulation based on that theory. Andreas Laddis Copyright © 2015 Andreas Laddis. All rights reserved. Multivariate Statistical Analysis as a Supplementary Tool for Interpretation of Variations in Salivary Cortisol Level in Women with Major Depressive Disorder Tue, 25 Aug 2015 08:12:54 +0000 Multivariate statistical analysis is widely used in medical studies as a profitable tool facilitating diagnosis of some diseases, for instance, cancer, allergy, pneumonia, or Alzheimer’s and psychiatric diseases. Taking this in consideration, the aim of this study was to use two multivariate techniques, hierarchical cluster analysis (HCA) and principal component analysis (PCA), to disclose the relationship between the drugs used in the therapy of major depressive disorder and the salivary cortisol level and the period of hospitalization. The cortisol contents in saliva of depressed women were quantified by HPLC with UV detection day-to-day during the whole period of hospitalization. A data set with 16 variables (e.g., the patients’ age, multiplicity and period of hospitalization, initial and final cortisol level, highest and lowest hormone level, mean contents, and medians) characterizing 97 subjects was used for HCA and PCA calculations. Multivariate statistical analysis reveals that various groups of antidepressants affect at the varying degree the salivary cortisol level. The SSRIs, SNRIs, and the polypragmasy reduce most effectively the hormone secretion. Thus, both unsupervised pattern recognition methods, HCA and PCA, can be used as complementary tools for interpretation of the results obtained by laboratory diagnostic methods. Ewelina Dziurkowska and Marek Wesolowski Copyright © 2015 Ewelina Dziurkowska and Marek Wesolowski. All rights reserved. Social Anxiety among Chinese People Tue, 25 Aug 2015 08:04:09 +0000 The experience of social anxiety has largely been investigated among Western populations; much less is known about social anxiety in other cultures. Unlike the Western culture, the Chinese emphasize interdependence and harmony with social others. In addition, it is unclear if Western constructed instruments adequately capture culturally conditioned conceptualizations and manifestations of social anxiety that might be specific to the Chinese. The present study employed a sequence of qualitative and quantitative approaches to examine the assessment of social anxiety among the Chinese people. Interviews and focus group discussions with Chinese participants revealed that some items containing the experience of social anxiety among the Chinese are not present in existing Western measures. Factor analysis was employed to examine the factor structure of the more comprehensive scale. This approach revealed an “other concerned anxiety” factor that appears to be specific to the Chinese. Subsequent analysis found that the new factor—other concerned anxiety—functioned the same as other social anxiety factors in their association with risk factors of social anxiety, such as attachment, parenting, behavioral inhibition/activation, and attitude toward group. The implications of these findings for a more culturally sensitive assessment tool of social anxiety among the Chinese were discussed. Qianqian Fan and Weining C. Chang Copyright © 2015 Qianqian Fan and Weining C. Chang. All rights reserved. Evaluation of the Effectiveness of a Psychoeducational Intervention in Treatment-Naïve Patients with Antidepressant Medication in Primary Care: A Randomized Controlled Trial Tue, 25 Aug 2015 08:00:57 +0000 Background. There is evidence supporting the effectiveness of psychoeducation (PE) in patients with symptoms of depression in primary care (PC), but very few studies have assessed this intervention in antidepressant-naïve patients. The aim of this study is to assess the effectiveness of a PE program in these patients, since the use of antidepressant (AD) medication may interfere with the effects of the intervention. Methods. 106 participants were included, 50 from the PE program (12 weekly 1.5-hour sessions) and 56 from the control group (CG) that received the usual care. Patients were assessed at baseline and at 3, 6, and 9 months. The main outcome measures were the Beck Depression Inventory (BDI) and remission based on the BDI. The analysis was carried out on an intention-to-treat basis. Results. The PE program group showed remission of symptoms of 40% () posttreatment and 42% () at 6 months. The analysis only showed significant differences in the BDI score posttreatment (; effect size Cohen’s ). Conclusions. The PE intervention is an effective treatment in the depressive population not treated with AD medication. Before taking an AD, psychoeducational intervention should be considered. R. Casañas, R. Catalán, R. Penadés, J. Real, S. Valero, MA. Muñoz, LL. Lalucat-Jo, and M. Casas Copyright © 2015 R. Casañas et al. All rights reserved. Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders Tue, 25 Aug 2015 07:50:41 +0000 The objective of our study was to examine, discuss, and provide proposals on diagnostic comorbidity of depression in children and adolescents with high functioning autism spectrum disorder (HFASD) in the following aspects. (1) Prevalence. It was concluded that there are an elevated depression rate and the need for longitudinal studies to determine prevalence and incidence based on functioning level, autistic symptoms, gender, age, type of depression, prognosis, duration, and treatment. (2) Explicative Hypotheses and Vulnerability. The factors that present the greatest specific risk are higher cognitive functioning, self-awareness of deficit, capacity for introspection, stressful life events, adolescence, quality of social relationships, and alexithymia. (3) Risk of Suicide. The need for control and detection of suicidal tendencies and bullying is emphasised. (4) Depressive Symptoms. Indicators for early detection are proposed and their overlap with HFASD is analysed, examining the assessment techniques used and arguing that specific adapted tests are needed. Myriam De-la-Iglesia and José-Sixto Olivar Copyright © 2015 Myriam De-la-Iglesia and José-Sixto Olivar. All rights reserved. The State of the Art of the DSM-5 “with Mixed Features” Specifier Tue, 25 Aug 2015 07:10:01 +0000 The new DSM-5 “with mixed features” specifier (MFS) has renewed the interest of the scientific community in mixed states, leading not only to new clinical studies but also to new criticisms of the current nosology. Consequently, in our paper we have reviewed the latest literature, trying to understand the reactions of psychiatrists to the new nosology and its epidemiological, prognostic, and clinical consequences. It seems that the most widespread major criticism is the exclusion from the DSM-5 MFS of overlapping symptoms (such as psychomotor agitation, irritability, and distractibility), with a consequent reduction in diagnostic power. On the other hand, undoubtedly the new DSM-5 classification has helped to identify more patients suffering from a mixed state by broadening the narrow DSM-IV-TR criteria. As for the clinical presentation, the epidemiological data, and the therapeutic outcomes, the latest literature does not point out a univocal point of view and further research is needed to fully assess the implications of the new DSM-5 MFS. It is our view that a diagnostic category should be preferred to a specifier and mixed states should be better considered as a spectrum of states, according to what was stated many years ago by Kraepelin. Norma Verdolini, Mark Agius, Laura Ferranti, Patrizia Moretti, Massimiliano Piselli, and Roberto Quartesan Copyright © 2015 Norma Verdolini et al. All rights reserved. Emotional Intelligence Components in Alcohol Dependent and Mentally Healthy Individuals Sun, 29 Mar 2015 11:38:21 +0000 Objective. Emotional intelligence might play an important role in the onset and persistence of different psychopathologies. This study investigated the relationship between emotional intelligence and alcohol dependence. Methods. In this case-control study, participants included alcohol dependent individuals and mentally healthy inpatients. Each group consisted of 40 individuals (male/female: 1). The diagnosis was based on the criteria of the DSM-IV-TR using the Structured Clinical Interview for DSM-IV (SCID-IV). All the participants completed Bar-On emotional intelligence test. Results. 20 males and 20 females were included in each group. Mean age of alcohol dependent participants and controls was 31.28 ± 7.82 and 34.93 ± 9.83 years in that order. The analyses showed that the alcohol dependent individuals had a significant difference compared with the control group and received lower scores in empathy, responsibility, impulse control, self-esteem, optimism, emotional consciousness, stress tolerance, autonomy, problem-solving, and total score of emotional intelligence components. Conclusion. Patients with alcohol dependence have deficits in components of emotional intelligence. Identifying and targeted training of the individuals with lower scores in components of emotional intelligence may be effective in prevention of alcohol dependence. Arash Mohagheghi, Shahrokh Amiri, Seyedreza Mousavi Rizi, and Salman Safikhanlou Copyright © 2015 Arash Mohagheghi et al. All rights reserved. Reliability and Validity of the Thai Version of the Florida Obsessive-Compulsive Inventory Sun, 15 Mar 2015 09:57:03 +0000 This study aimed to examine the reliability and validity of the Thai version of the FOCI (FOCI-T), which is a brief self-report questionnaire to assess the symptoms and severity of obsessive-compulsive disorder (OCD). Forty-seven OCD patients completed the FOCI-T, the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL). They were then interviewed to determine the OCD symptom severity by the Yale-Brown Obsessive-Compulsive Scale-Second Edition (YBOCS-II) and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D), together with the Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity Scales (CGI-S). The result showed that the FOCI-T had satisfactory internal consistency reliability on both the Symptom Checklist (KR-20 = 0.86) and the Severity Scale (). Regarding validity analyses, the FOCI-T Severity Scale had stronger correlations with the YBOCS-II and CGI-S than the FOCI-T Symptom Checklist. This implied the independence between the FOCI-T Symptom Checklist and the Severity Scale and good concurrent validity of the FOCI-T Severity Scale. Our results suggested that the FOCI-T was found to be a reliable and valid self-report measure to assess obsessive-compulsive symptoms and severity. Ratana Saipanish, Thanita Hiranyatheb, and Manote Lotrakul Copyright © 2015 Ratana Saipanish et al. All rights reserved. A Study of Depression and Quality of Life in Patients of Lichen Planus Mon, 23 Feb 2015 08:54:07 +0000 The precise cause of lichen planus is unknown, but the disease seems to be immunologically mediated. It is a psychocutaneous disorder. Due to scarcity of Indian studies in this field, we decided to study in patients of lichen planus the prevalence of depression and quality of life with comparison of the same in both the genders. Patients diagnosed as having lichen planus by consultant dermatologist were enrolled after informed consent and ethics approval. 45 patients were screened, of which 35 who satisfied the criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of dermatology life quality index and Beck’s depression inventory. While 25% were depressed with females being more affected than males, quality of life was impaired in more than 90% patients. Impairment was maximum due to symptoms and illness feelings, disturbed daily activities, or work and time consumption in treatment. There was a strong association between depression and impairment in quality of life in both the genders. This study helps in early identification of psychological problems in lichen planus patients and in planning their future course of management, hence reducing the lack of productivity and improving the prognosis and quality of life. Neena S. Sawant, Nakul A. Vanjari, Uday Khopkar, and Satish Adulkar Copyright © 2015 Neena S. Sawant et al. All rights reserved. Efficacy of Adjunctive Treatments Added to Olanzapine or Clozapine for Weight Control in Patients with Schizophrenia: A Systematic Review and Meta-Analysis Tue, 13 Jan 2015 13:34:09 +0000 Objectives. This study was conducted to review systematically adjunctive treatments for weight reduction in patients with schizophrenia and compare efficacies of clinical trials through meta-analysis, so as to provide effective clinical guideline regarding weight control for patients taking atypical antipsychotics. Methods. Candidate clinical trials were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, and PsycINFO. Fourteen randomized clinical trials were included for systematic review and meta-analysis from 132 potential trials. The Comprehensive Meta-Analysis version 2 was used for meta-analysis. Results. Difference in means and significances from meta-analyses regarding weight control by adjunctive treatments showed that topiramate, aripiprazole, or sibutramine was more effective than metformin or reboxetine. Psychiatric evaluations did not show statistically significant changes between treatment groups and placebo groups except topiramate adjunctive treatments. Adverse effects regarding adjunctive therapies were tolerable and showed statistically no significances compared to control groups. Conclusion. Though having several reports related to exacerbation of psychiatric symptoms, topiramate and aripiprazole are more efficacious than other medications in regard to weight reduction and less burden of critical adverse effects as well as being beneficial for clinical improvement. Yun-Jung Choi Copyright © 2015 Yun-Jung Choi. All rights reserved. Gender Differences in Individuals at High-Risk of Psychosis: A Comprehensive Literature Review Thu, 01 Jan 2015 10:56:00 +0000 Introduction. To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development. Method. Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria. Results. Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women. Conclusions. Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions. Ana Barajas, Susana Ochoa, Jordi E. Obiols, and Lluís Lalucat-Jo Copyright © 2015 Ana Barajas et al. All rights reserved. Cutting a Long Story Short? The Clinical Relevance of Asking Parents, Nurses, and Young Children Themselves to Identify Children’s Mental Health Problems by One or Two Questions Wed, 31 Dec 2014 13:39:03 +0000 Background and Aims. Assessing young children’s mental health is a crucial and challenging task. The aim of the study was to evaluate the clinical relevance of asking parents, nurses, and young children themselves to identify children’s mental health problems by only one or two questions. Methods. In regular health check-ups of 4- to 9-year-old children , parents and public health nurses assessed by one question whether the child had any emotional or behavioral difficulties. The child completed a self-evaluation enquiry on his/her emotional well-being. A stratified proportion of the participating parents were invited to a diagnostic interview. Results. Sensitivities were fairly good for the parents’ (68%), nurses’ (65%), and their combined (79%) one-question screens. Difficulties identified by parents and nurses were major risks (OR 10–14) for any child psychiatric disorders . The child’s self-evaluation was related to 2-fold to 3-fold risks for any psychiatric diagnosis, for any emotional diagnosis, and for negative situational factors. Conclusion. The one-question screen for parents and public health nurses together quite adequately identified the young children with mental health problems. The child’s self-evaluation provided relevant and complementary information on his/her mental health and especially emotional problems. Anne-Mari Borg, Raili Salmelin, Matti Joukamaa, and Tuula Tamminen Copyright © 2014 Anne-Mari Borg et al. All rights reserved. MMPI-2: Cluster Analysis of Personality Profiles in Perinatal Depression—Preliminary Evidence Tue, 09 Dec 2014 07:17:35 +0000 Background. To assess personality characteristics of women who develop perinatal depression. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, to which was administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). A clinical group of subjects with perinatal depression (PND, 55 subjects) was selected; clinical and validity scales of MMPI-2 were used as predictors in hierarchical cluster analysis carried out. Results. The analysis identified three clusters of personality profile: two “clinical” clusters (1 and 3) and an “apparently common” one (cluster 2). The first cluster (39.5%) collects structures of personality with prevalent obsessive or dependent functioning tending to develop a “psychasthenic” depression; the third cluster (13.95%) includes women with prevalent borderline functioning tending to develop “dysphoric” depression; the second cluster (46.5%) shows a normal profile with a “defensive” attitude, probably due to the presence of defense mechanisms or to the fear of stigma. Conclusion. Characteristics of personality have a key role in clinical manifestations of perinatal depression; it is important to detect them to identify mothers at risk and to plan targeted therapeutic interventions. Valentina Meuti, Isabella Marini, Alessandra Grillo, Marco Lauriola, Carlo Leone, Nicoletta Giacchetti, and Franca Aceti Copyright © 2014 Valentina Meuti et al. All rights reserved. Sociodemographic Correlates of Unipolar Major Depression among the Chinese Elderly in Klang Valley, Malaysia: An Epidemiological Study Tue, 02 Dec 2014 07:32:33 +0000 Background. Depression, as one of the most disabling diseases around the world, had caught the global concern with its rising prevalence rate. There is a growing need of detecting depression, particularly in the old age population which is often left being overlooked. Methods. We conducted a cross-sectional community-based study which included 150 Chinese elderly aged 60 and above within Klang Valley area. We obtained the sociodemographic profiles and assessed the status of well-being, depression, and cognitive function of the participants with the help of instruments: WHO Five-Item Well-Being Index, Major (ICD-10) Depression Inventory, and 6-Item Cognitive Impairment Test. Results. We found that the prevalence of depression among the Chinese elderly within Klang Valley region was 10.7%. With multiple logistic regression, decision to consult doctor on depressed mood or memory problem and presence of cognitive impairment were shown to be significantly associated with unipolar major depression, whereas wellbeing status was also found to be statistically correlated with depression in univariate analysis. Conclusion. The prevalence of unipolar depression among Chinese elderly within Klang Valley, Malaysia presented that there was an increased trend compared to the previous studies. Rohit Kumar Verma, Tan Hui Min, Srikumar Chakravarthy, Ankur Barua, and Nilamadhab Kar Copyright © 2014 Rohit Kumar Verma et al. All rights reserved. Causal Attribution and Illness Perception: A Cross-Sectional Study in Mexican Patients with Psychosis Mon, 01 Dec 2014 08:39:10 +0000 Health psychology researchers have begun to focus greater attention on people’s beliefs about health/illness since these beliefs can clearly affect behavior. This cross-sectional study aimed at (1) identifying the most common factors psychotic patients attribute their illness to and (2) assessing the association between causal attribution and illness perception (cognitive, emotional, and comprehensibility dimensions). Sixty-two patients (56.5% females) who had been treated for psychosis at a public psychiatric hospital in Mexico answered the Angermeyer and Klusmann Illness Attribution Scale and the Brief Illness Perception Questionnaire. Results showed that most patients attributed psychosis onset to social factors and that attribution to their personality might have an overwhelmingly negative effect on their lives. Acknowledging psychotic patient attributional beliefs and considering them in clinical practice could improve treatment efficacy and overall recovery success. This is particularly important in psychosis, since symptoms are often severe and/or persistent and require long-term treatment. Lizzette Gómez-de-Regil Copyright © 2014 Lizzette Gómez-de-Regil. All rights reserved. Personality Profile of Parents of Children with Attention Deficit Hyperactivity Disorder Wed, 26 Nov 2014 07:16:02 +0000 Objectives. The present study was carried out aiming to identify the personality profile of parents of children with Attention Deficit Hyperactivity Disorder (ADHD). Methods. This study is of a descriptive, analytic, cross-sectional type in which parents of 6–12-year-old children with ADHD who were referred to the Bozorgmehr Psychiatric Clinic, affiliated with Tabriz University of Medical Sciences, were enrolled. ADHD was diagnosed according to the criteria of DSM-IV-TR and a quasi-structured diagnostic interview (K-SADS-PL). The personality profile of the parents was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Results. According to the findings of this study, the most common personality problems based on the assessment scales in the MCMI-III belonged to the clinical patterns of depressive personality in 43 persons (25.3%), histrionic personality in 34 persons (20%), and compulsive personality in 29 persons (17.1%). According to discriminant analysis, four scales of somatoform, sadistic, dependence, and though disorder were direct and antisocial scale was reverse significant predictors of membership in the women group. Conclusion. According to the findings of this pilot study, personality disorders are prevalent in parents of ADHD children and mothers suffer from personality disorders more than fathers. Hossein Dadashzadeh, Shahrokh Amiri, Ahmad Atapour, Salman Abdi, and Mahan Asadian Copyright © 2014 Hossein Dadashzadeh et al. All rights reserved. Visual Perception during Mirror-Gazing at One’s Own Face in Patients with Depression Thu, 20 Nov 2014 09:13:49 +0000 In normal observers, gazing at one’s own face in the mirror for a few minutes, at a low illumination level, produces the apparition of strange faces. Observers see distortions of their own faces, but they often see hallucinations like monsters, archetypical faces, faces of relatives and deceased, and animals. In this research, patients with depression were compared to healthy controls with respect to strange-face apparitions. The experiment was a 7-minute mirror-gazing test (MGT) under low illumination. When the MGT ended, the experimenter assessed patients and controls with a specifically designed questionnaire and interviewed them, asking them to describe strange-face apparitions. Apparitions of strange faces in the mirror were very reduced in depression patients compared to healthy controls. Depression patients compared to healthy controls showed shorter duration of apparitions; minor number of strange faces; lower self-evaluation rating of apparition strength; lower self-evaluation rating of provoked emotion. These decreases in depression may be produced by deficits of facial expression and facial recognition of emotions, which are involved in the relationship between the patient (or the patient’s ego) and his face image (or the patient’s bodily self) that is reflected in the mirror. Giovanni B. Caputo, Marco Bortolomasi, Roberta Ferrucci, Mario Giacopuzzi, Alberto Priori, and Stefano Zago Copyright © 2014 Giovanni B. Caputo et al. All rights reserved. Lifetime Prevalence of Psychiatric Disorders among Parents of Children with Bipolar I Disorder: Parental Difference Sun, 09 Nov 2014 00:00:00 +0000 Background. Evaluation of family system is an important area in the context of child and adolescent mental health. This study aimed to estimate psychiatric disorders in parents of children and adolescents with bipolar I disorder (BID). Methods and Materials. In this cross-sectional study, during 2012-2013, all of the children and adolescents diagnosed with BID based on Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version were included. All of the parents (both mother and father) were evaluated by Structured Clinical Interview for DSM-IV-TR. Statistical Analysis. Prevalence rates are reported and independent-sample t-test and chi-square test were used when appropriate. Results. A total of 108 families were interviewed. 25% of mothers and 33% of fathers met the criteria for at least one psychiatric disorder, with major depressive disorder, BMD, and cluster B personality disorder being more prevalent. Fathers were more likely to receive a dual psychiatric diagnosis. Cluster B personality disorder and substance dependence were more prevalent among fathers while major depressive disorder was more prevalent among mothers. Conclusion. This study confirmed a higher prevalence of psychiatric disorders in parents of children with BID and emphasizes parental evolution. Shahrokh Amiri, Mohammad Ali Ghoreishizadeh, Yasaman Alavizadeh, and Farnaz Saedi Copyright © 2014 Shahrokh Amiri et al. All rights reserved. Burnout in Medical Residents: A Study Based on the Job Demands-Resources Model Thu, 30 Oct 2014 09:19:49 +0000 Purpose. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. The purpose of our cross-sectional study was to estimate the burnout rates among medical residents in the largest Greek hospital in 2012 and identify factors associated with it, based on the job demands-resources model (JD-R). Method. Job demands were examined via a 17-item questionnaire assessing 4 characteristics (emotional demands, intellectual demands, workload, and home-work demands’ interface) and job resources were measured via a 14-item questionnaire assessing 4 characteristics (autonomy, opportunities for professional development, support from colleagues, and supervisor’s support). The Maslach Burnout Inventory (MBI) was used to measure burnout. Results. Of the 290 eligible residents, 90.7% responded. In total 14.4% of the residents were found to experience burnout. Multiple logistic regression analysis revealed that each increased point in the JD-R questionnaire score regarding home-work interface was associated with an increase in the odds of burnout by 25.5%. Conversely, each increased point for autonomy, opportunities in professional development, and each extra resident per specialist were associated with a decrease in the odds of burnout by 37.1%, 39.4%, and 59.0%, respectively. Conclusions. Burnout among medical residents is associated with home-work interface, autonomy, professional development, and resident to specialist ratio. Panagiotis Zis, Fotios Anagnostopoulos, and Panagiota Sykioti Copyright © 2014 Panagiotis Zis et al. All rights reserved. The Relationship between Alexithymia, Anxiety, Depression, and Internet Addiction Severity in a Sample of Italian High School Students Mon, 20 Oct 2014 12:13:19 +0000 We aimed to assess whether Internet addiction (IA) severity was related to alexithymia scores among high school students, taking into account the role of gender differences and the possible effect of anxiety, depression, and age. Participants in the study were 600 students (ages ranging from 13 to 22; 48.16% girls) recruited from three high schools in two cities from Southern Italy. Participants completed a sociodemographic questionnaire, the Toronto Alexithymia Scale, the Internet Addiction Test, the Hamilton Anxiety Scale, and the Hamilton Depression Scale. The findings of the study showed that IA scores were associated with alexithymia scores, over and above the effect of negative emotions and age. Students with pathological levels of alexithymia reported higher scores on IA severity. In particular, results showed that difficulty in identifying feelings was significantly associated with higher scores on IA severity. No effect of gender was found. Implications for clinicians were discussed. Giuseppe Scimeca, Antonio Bruno, Lucia Cava, Gianluca Pandolfo, Maria Rosaria Anna Muscatello, and Rocco Zoccali Copyright © 2014 Giuseppe Scimeca et al. All rights reserved. The Magnitude and Impact of Bullying among School Pupils in Muscat, Oman: A Cross-Sectional Study Tue, 14 Oct 2014 06:52:39 +0000 Research about bullying among school pupils in the Arab/Muslim population is scarce. This study evaluates the characteristics of bullying and its impact among school pupils in Oman via cross-sectional survey among eighth grade school pupils (n = 1,229) during the academic year 2006-2007. The participants were selected using stratified random selection among 6 administrative divisions of one the governorates in the country. Data were collected using self-completed structured questionnaires. This study found similar percentages of males and females (76%) have experienced one form of bullying, and the majority of the incidents (80%) occurred in the vicinity of the school. In almost half of the cases, the bullying was initiated by a student of the same age or older than the victim. The most common type of bullying encountered in this study was verbal (47.7%), followed by misuse (45.9%), physical (43.9%), and, finally, social isolation/exclusion (22.5%). Although the failure of an academic year was uncommon among victims of bullying, the number of pupils who missed 4–6 and ≥7 school days was higher among bullied pupils. If this study will withstand further research, educational initiatives are needed to mitigate the rate of bullying in Oman. Muna Al-Saadoon, Yahya M. Al-Farsi, Syed Rizvi, Marwan Al-Sharbati, Abdullah Al-Jabri, Sufyan Almamari, Wafaa Al-Baluki, and Samir Al-Adawi Copyright © 2014 Muna Al-Saadoon et al. All rights reserved. Prevalence and Correlates of Video and Internet Gaming Addiction among Hong Kong Adolescents: A Pilot Study Mon, 16 Jun 2014 11:19:10 +0000 This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed. Chong-Wen Wang, Cecilia L. W. Chan, Kwok-Kei Mak, Sai-Yin Ho, Paul W. C. Wong, and Rainbow T. H. Ho Copyright © 2014 Chong-Wen Wang et al. All rights reserved. A Qualitative Study Exploring Facilitators for Improved Health Behaviors and Health Behavior Programs: Mental Health Service Users’ Perspectives Tue, 06 May 2014 13:53:09 +0000 Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population. Candida Graham, Crystal Rollings, Sarah de Leeuw, Lesley Anderson, Brenda Griffiths, and Nansi Long Copyright © 2014 Candida Graham et al. All rights reserved. Effects of Paliperidone Palmitate on Coagulation: An Experimental Study Sun, 09 Feb 2014 11:24:14 +0000 Objective. The aim of the present study was to examine the effects of a new antipsychotic drug paliperidone palmitate on hemogram and coagulation parameters in rats. Materials and Methods. Experiments were performed on 22 female albino Wistar rats (8–12 weeks old). Control group was given drinking water as vehicle (0.3 mL). PAL-1 rats were given 1 mg/kg paliperidone palmitate (in 0.3 mL drinking water) by oral gavage once a day for ten days and PAL-3 rats received 3 mg/kg paliperidone palmitate (in 0.3 mL drinking water) by oral gavage for ten days. Blood samples were drawn from the heart 24 hours after the last drug dose, and hemogram and coagulation parameters were measured with automated analyzers. Results. Hemogram did not change in the paliperidone treated groups compared to the controls. Factor VIII levels decreased in the PAL-1 and PAL-3 groups; and this decrease was significantly greater in the PAL-3. Factor IX levels decreased in PAL-3 rats, but its levels also increased in PAL-1 rats compared to the control. Discussion. Paliperidone has led to changes in the serum levels of coagulation factors VIII and IX in rats. As a result, paliperidone may be causing thromboembolism or bleeding in a dose-independent manner. Enver Demirel Yılmaz, Sedat Motor, Fatih Sefil, Neslihan Pınar, Hanifi Kokacya, Mustafa Kisa, and Suleyman Oktar Copyright © 2014 Enver Demirel Yılmaz et al. All rights reserved. Suicide Attempts in Malaysia from the Year 1969 to 2011 Mon, 03 Feb 2014 11:03:26 +0000 The aim of this paper is to review the literature on suicide attempts in Malaysia. PsycINFO, PubMed, and Medline databases from 1845 to 2012 and detailed manual search of local official reports from the Ministry of Health and the Malaysian Psychiatric Association and unpublished dissertations from 3 local universities providing postgraduate psychiatric training were included in the current review. A total of 38 studies on suicide attempts in Malaysia were found and reviewed. Twenty-seven (76%) of the studies on suicide attempts were descriptive studies looking at sociodemographic data, psychiatric illnesses, and methods and reasons for suicide attempts. No study has been conducted on treatment and interventions for suicide attempts and the impact of culture was rarely considered. The review showed that in order for researchers, clinicians, and public health policy makers to obtain a better understanding of suicide attempts in Malaysia, more systematic and empirically stringent methodologies and research frameworks need to be used. Aishvarya Sinniah, T. Maniam, Tian Po Oei, and Ponnusamy Subramaniam Copyright © 2014 Aishvarya Sinniah et al. All rights reserved. Sex Dependence of Cognitive Functions in Bipolar Disorder Wed, 29 Jan 2014 14:52:46 +0000 The objective of the present study was to assess the performance of lithium treated euthymic bipolar patients in tests measuring spatial working memory (SWM), planning, and verbal fluency and to delineate the influence of gender on cognitive functioning. Fifty-nine euthymic bipolar patients, treated with lithium carbonate for at least 5 yr, were studied. Patients and controls underwent a neuropsychological assessment. Bipolar patients had significantly worse results than the healthy controls in the spatial memory and planning as well as verbal fluency tests. We detected a gender-related imbalance in the SWM results. Deficits in SWM were observed in male-only comparisons but not in female-only comparisons. The SWM scores were significantly poorer in male patients than in male controls. In female-only comparisons, female patients did not have significantly poorer SWM results in any category than their controls. Bipolar women scored worse in some other tests. The present study points to the different patterns of neuropsychological disturbances in female and male patients and suggests that sex-dependent differences should be taken into account in order to tailor the therapeutic intervention aimed at the improvement of cognitive functions. Aleksandra Suwalska and Dorota Łojko Copyright © 2014 Aleksandra Suwalska and Dorota Łojko. All rights reserved. Medical Students’ Experience of and Reaction to Stress: The Role of Depression and Anxiety Wed, 29 Jan 2014 10:01:15 +0000 Background. Medical school is recognized as a stressful environment that often has a negative effect on students’ academic performance, physical health, and psychosocial well-being. Previous studies have not identified differences between depressed and nondepressed and anxious and nonanxious medical students’ experiences of stress or their reactions to stressors. The present study aimed to identify the prevalence of depression and anxiety among a sample of 358 medical students attending a private university in Malaysia and to examine differences according to participants’ gender, year of study, and stage of training (preclinical and clinical). Additionally, this study examined the extent to which stress predicts depression and anxiety, differences between depressed and nondepressed medical students’ experiences of and reactions to stressors, and differences between anxious and nonanxious medical students’ experiences of and reactions to stressors. Methods. The Student Life Stress Inventory was used to measure stress and reaction to stressors and the Depression, Anxiety, and Stress Scale was used to measure depression and anxiety. Results. The results showed that 44% () of the students were anxious and 34.9% () were depressed. More female students exhibited anxiety compared to male students. Stress is a predictor for depression and anxiety. A significant difference was found between depressed and nondepressed and anxious and nonanxious students’ experience of stressors due to frustration, change, and their emotional reaction to stressors. Conclusion. Overall, depressed and anxious students were found to experience more stress and react differently to stressors compared to nondepressed and nonanxious students. Coumaravelou Saravanan and Ray Wilks Copyright © 2014 Coumaravelou Saravanan and Ray Wilks. All rights reserved. Current State of Evidence for Medication Treatment of Preschool Internalizing Disorders Mon, 27 Jan 2014 18:19:17 +0000 Psychotropic medications are being prescribed off-label by psychiatrists to treat preschool children diagnosed with internalizing disorders. In this review, the current state of evidence is presented for medications used to treat preschool children (ages 2–5 year olds) diagnosed with anxiety and/or depressive disorders. Eleven studies were systematically identified for this review based on a priori criteria. Overall, the available literature revealed that studies addressing the medication treatment of internalizing disorders in preschoolers are extremely limited and represent relatively weak research methodologies. Given the increasing prevalence of the use of psychotropic medications to treat preschool children and the unique challenges associated with working with this population, it is imperative that mental health practitioners are aware of the current, albeit limited, research on this practice to help make informed treatment decisions. Suggestions about how to monitor potential costs and benefits in those unique cases in which psychopharmacological treatments might be considered for young children are given. Moreover, areas of additional research for this population are discussed. Justin A. Barterian, Erin Rappuhn, Erin L. Seif, Gabriel Watson, Hannah Ham, and John S. Carlson Copyright © 2014 Justin A. Barterian et al. All rights reserved. Facebook Enhances Antidepressant Pharmacotherapy Effects Sun, 19 Jan 2014 08:36:46 +0000 Treatment-resistant major depressive disorder (TR-MDD) is a complex condition, with very low remission rates. In recent years some studies have been conducted on the implementation of cognitive behavioral therapy and psychodynamic psychotherapy interventions via the Internet to MDD patients, and results have been promising. However, there have been no studies in patients with TR-MDD nor with the use of Facebook with the psychiatrist as “friend.” 60 TR-MDD patients were randomized to one of three groups: Facebook group with psychiatrist as “friend,” Facebook group without psychiatrist as “friend,” and control group (no Facebook use). Both Facebook groups spent at least 1 hour/day on Facebook, 7 days/week, during the 3 months. All patients maintained their usual pharmacotherapy. All participants were evaluated at baseline and at 1, 2, and 3 months for depressive symptoms using HAD17 and BDI-II. Results show that both Facebook groups had a decrease on HADM17 and BDI-II scores as well as higher remission and response rates than the control group, with better results if the psychiatrist was a “friend” on Facebook. Therefore, in TR-MDD, Facebook can be used as an effective enhancement therapy, adjuvant to pharmacological therapy with regular consultations, especially if the psychiatrist is the patient’s online “friend.” Jorge Mota Pereira Copyright © 2014 Jorge Mota Pereira. All rights reserved. Relationship of Asymmetrical Dimethylarginine, Nitric Oxide, and Sustained Attention during Attack in Patients with Major Depressive Disorder Thu, 16 Jan 2014 15:11:27 +0000 We investigated the relationship of serum nitric oxide (NO) and asymmetrical dimethylarginine (ADMA) levels with cognitive functioning in patients with major depressive disorder (MDD). 41 MDD patients (Beck depression scale scores >16) and 44 controls were included in the study. Rey verbal learning and memory test, auditory consonant trigram test, digit span test, Wisconsin card sorting test, continuous performance task (TOVA), and Stroop test scores were found to be impaired in patients with major depressive disorder when compared to healthy controls. There was no significant difference between patient and control groups in terms of serum NO and ADMA. Serum NO levels were correlated with TOVA test error scores and Stroop test time scores, whereas serum ADMA levels were negatively correlated with TOVA test error scores. Metabolic detriments especially in relation to NO metabolism in frontal cortex and hypothalamus, psychomotor retardation, or loss of motivation may explain these deficits. Serpil Canpolat, İsmet Kırpınar, Erdem Deveci, Hülya Aksoy, Zafer Bayraktutan, İbrahim Eren, Recep Demir, Salih Selek, and Nazan Aydın Copyright © 2014 Serpil Canpolat et al. All rights reserved. Rehabilitation after Amputation: Psychotherapeutic Intervention Module in Indian Scenario Sun, 12 Jan 2014 11:39:21 +0000 Psychological aspects of adjustment to amputation are varied and not addressed in the present treatment regime. There is no research evidence available of psychological intervention and outcome in Indian scenario. One hundred and seventy-three consecutive patients with limb amputations were randomly assigned to psychotherapeutic intervention module (PIM, study group) () and treatment as usual group (TAU, control group) (). Patients with psychotic disorder were excluded from the study. Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Amputees Body Image Scale (ABIS), and Impact of Event Scale (IES) along with specially designed information schedule were administered individually. Structured psychotherapeutic module was developed for the intervention. Patients in PIM group were given six therapy sessions, addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy. Analysis showed that after treatment a significant reduction in scores was noted on CRSD, STAI, ABIS, and IES in the PIM group. On the TAU group a significant reduction was seen only in the ABIS. The psychological intervention module proposed by authors was efficacious in alleviating the psychological distress, depression, and anxiety and thus was vastly superior to the conventional method of management of amputees. Kalpana Srivastava and Suprakash Chaudhury Copyright © 2014 Kalpana Srivastava and Suprakash Chaudhury. All rights reserved. Specific Dysphoric Symptoms Are Predicted by Early Maladaptive Schemas Wed, 08 Jan 2014 11:02:25 +0000 Early maladaptive schemas (EMSs) are cognitive patterns resulting from unmet core emotional needs in childhood that have been linked to the development of psychopathology. As depression is a multifaceted phenomenon, we hypothesized that specific dysphoric symptoms would be predicted by different EMSs. Four hundred and fifty-six participants completed a measure of EMSs (Young Schema Questionnaire) and reported on the severity of the symptoms of criterion A for major depression in DSM-IV during the occurrence of a dysphoric episode in the previous 12 months. A series of stepwise multiple regression analyses were performed to investigate the predictive power of the EMSs for the severity of each specific depressive symptom. When controlling for gender and current levels of depression, specific symptoms were predicted by different EMSs: sadness by Negativity/Pessimism; anhedonia by Failure; self-harm by Emotional Deprivation and Vulnerability to Harm or Illness; worthlessness by Failure and Negativity/Pessimism; psychomotor retardation/restlessness by Vulnerability to Harm or Illness and Entitlement/Grandiosity; and poor concentration by Insufficient Self-Control/Self-Discipline. The more physical symptoms of fatigue, insomnia/hypersomnia, and appetite loss/appetite gain were not predicted by any of the EMSs. Although the cross-sectional design of the study does not allow for conclusions about the direction of effects, results suggest that depression is not a unitary phenomenon and provide a possible explanation for previous inconsistent findings. Roberta Trincas, Cristina Ottaviani, Alessandro Couyoumdjian, Katia Tenore, Grazia Spitoni, and Francesco Mancini Copyright © 2014 Roberta Trincas et al. All rights reserved. Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations Wed, 25 Dec 2013 13:31:02 +0000 Christopher Gillberg, Elisabeth Fernell, and Helen Minnis Copyright © 2013 Christopher Gillberg et al. All rights reserved. Personality Disorders in Obsessive-Compulsive Disorder: A Comparative Study versus Other Anxiety Disorders Sat, 21 Dec 2013 13:56:12 +0000 Objective. The purpose of this paper is to provide evidence for the relationship between personality disorders (PDs), obsessive compulsive disorder (OCD), and other anxiety disorders different from OCD (non-OCD) symptomatology. Method. The sample consisted of a group of 122 individuals divided into three groups (41 OCD; 40 non-OCD, and 41 controls) matched by sex, age, and educational level. All the individuals answered the IPDE questionnaire and were evaluated by means of the SCID-I and SCID-II interviews. Results. Patients with OCD and non-OCD present a higher presence of PD. There was an increase in cluster C diagnoses in both groups, with no statistically significant differences between them. Conclusions. Presenting anxiety disorder seems to cause a specific vulnerability for PD. Most of the PDs that were presented belonged to cluster C. Obsessive Compulsive Personality Disorder (OCPD) is the most common among OCD. However, it does not occur more frequently among OCD patients than among other anxious patients, which does not confirm the continuum between obsessive personality and OCD. Implications for categorical and dimensional diagnoses are discussed. Josep Pena-Garijo, Silvia Edo Villamón, Amanda Meliá de Alba, and M. Ángeles Ruipérez Copyright © 2013 Josep Pena-Garijo et al. All rights reserved. Association, Haplotype, and Gene-Gene Interactions of the HPA Axis Genes with Suicidal Behaviour in Affective Disorders Wed, 27 Nov 2013 16:04:16 +0000 Family twin and adoption studies have noted the heritability of specific biological factors that influence suicidal behaviour. Exposure to stress is one of the factors that strongly contribute to suicide attempts. The biological response to stress involves the hypothalamic-pituitary-adrenal axis (HPA). Therefore, we found it interesting to study polymorphisms of genes involved in the HPA axis (CRHR1, NR3C1, and AVPBR1). The study was performed on 597 patients, 225 of whom had a history of suicide attempts. We did not observe any significant differences in the studied polymorphisms between the group of patients with a history of suicide attempts and the control subjects. Our haplotype analysis of the AVPR1b gene revealed an association between the GCA haplotype and suicide attempts; however, this association was not significant after correcting for multiple testing. We did not observe any other association in haplotype and MDR analysis. We report here a comprehensive analysis of the HPA axis genes and a lack of association for genetic variations regarding the risk of suicide attempts in affective disorder patients. Nonetheless, the inconsistencies with the previously published results indicate the importance of the further investigation of these polymorphisms with respect to the risk of suicide attempts. Anna Leszczyńska-Rodziewicz, Aleksandra Szczepankiewicz, Joanna Pawlak, Monika Dmitrzak-Weglarz, and Joanna Hauser Copyright © 2013 Anna Leszczyńska-Rodziewicz et al. All rights reserved. Overdiagnosis of Bipolar Disorder: A Critical Analysis of the Literature Wed, 20 Nov 2013 08:34:08 +0000 Bipolar disorder (BD) is considered one of the most disabling mental conditions, with high rates of morbidity, disability, and premature death from suicide. Although BD is often misdiagnosed as major depressive disorder, some attention has recently been drawn to the possibility that BD could be overdiagnosed in some settings. The present paper focuses on a critical analysis of the overdiagnosis issue among bipolar patients. It includes a review of the available literature findings, followed by some recommendations aiming at optimizing the diagnosis of BD and increasing its reliability. Amna A. Ghouse, Marsal Sanches, Giovana Zunta-Soares, Alan C. Swann, and Jair C. Soares Copyright © 2013 Amna A. Ghouse et al. All rights reserved. Dimensionality of the Wisconsin Schizotypy Scales-Brief Forms in College Students Mon, 11 Nov 2013 08:54:10 +0000 Wisconsin Schizotypy Scales are one of the most used measuring instruments for the assessment of psychometric risk for psychosis. The main goal of the present study was to analyze the internal structure of the Wisconsin Schizotypy Scales-Brief (WSS-B) forms and the reliability of the scores in a large sample of college students. The final sample was comprised by a total of 1349 students, 288 males, with a mean age of 20.48 years (SD = 2.58). The results indicated that the WSS-B scores presented adequate psychometric properties. Cronbach’s alfa coefficient for total scores in WSS-B ranged from 0.86 to 0.93. Analysis of the internal structure of the WSS-B, through confirmatory factor analysis and exploratory structural equation modeling, yielded a four factor solution (Magical Ideation, Perceptual Aberration, Social Anhedonia, and Physical Anhedonia) as the most adequate. Statistically significant differences in mean scores of WSS-B by sex were found. These results provided new validity evidence of the WSS-B scores in an independent sample of nonclinical young adults. The WSS-B seems to be useful, brief, and easy to administrate for the screening of extended psychosis phenotype in the general population. Eduardo Fonseca-Pedrero, Mercedes Paino, Javier Ortuño-Sierra, Serafín Lemos-Giráldez, and José Muñiz Copyright © 2013 Eduardo Fonseca-Pedrero et al. All rights reserved. Relation of Depression, Anxiety, and Quality of Life with Outcome after Percutaneous Transluminal Coronary Angioplasty Sun, 10 Nov 2013 11:26:19 +0000 Background. Despite, increasing number of percutaneous transluminal coronary angioplasty (PTCA) being performed, there is a paucity of Indian studies on the psychological effects of PTCA. Aim. To study the relation of anxiety, depression, and health related quality of life with outcome after PTCA. Methods. A total of 35 patients undergoing PTCA were included in the present project with their informed consent. All patients filled a specially designed proforma, the Hospital Anxiety and Depression Scale, Coronary Scale, Seattle Angina Questionnaire, and a health related quality of life measure (EQ 5D) one day before undergoing PTCA. Three days after PTCA patients were reassessed with the Hospital anxiety & depression scale, Seattle angina questionnaire and the EQ 5D. Results. Analysis showed that 46% had significant anxiety and 32.1% had significant depression before PTCA. Following successful PTCA, none of the patients had significant anxiety, and only 2 (3.6%) had significant depression. On the Seattle Angina Questionnaire, physical limitation reduced from 67.9 to 48. Disease perception improved from 21.2 to 37.1. On the EQ5D, the health status improved from 42.7 before PTCA to 78.7 after PTCA. Conclusion. Successful PTCA resulted in significant reduction in anxiety, depression, and physical limitation and improvement in disease perception and health status. Suprakash Chaudhury and Kalpana Srivastava Copyright © 2013 Suprakash Chaudhury and Kalpana Srivastava. All rights reserved. Conduct Symptoms and Emotion Recognition in Adolescent Boys with Externalization Problems Mon, 04 Nov 2013 19:11:49 +0000 Background. In adults with antisocial personality disorder, marked alterations in the recognition of facial affect were described. Less consistent data are available on the emotion recognition in adolescents with externalization problems. The aim of the present study was to assess the relation between the recognition of emotions and conduct symptoms in adolescent boys with externalization problems. Methods. Adolescent boys with externalization problems referred to Vadaskert Child Psychiatry Hospital participated in the study after informed consent (, 11–17 years, mean = 13.4). The conduct problems scale of the strengths and difficulties questionnaire (parent and self-report) was used. The performance in a facial emotion recognition test was assessed. Results. Conduct problems score (parent and self-report) was inversely correlated with the overall emotion recognition. In the self-report, conduct problems score was inversely correlated with the recognition of anger, fear, and sadness. Adolescents with high conduct problems scores were significantly worse in the recognition of fear, sadness, and overall recognition than adolescents with low conduct scores, irrespective of age and IQ. Conclusions. Our results suggest that impaired emotion recognition is dimensionally related to conduct problems and might have importance in the development of antisocial behavior. Nikoletta Aspan, Peter Vida, Julia Gadoros, and Jozsef Halasz Copyright © 2013 Nikoletta Aspan et al. All rights reserved. Lifetime Paid Work and Mental Health Problems among Poor Urban 9-to-13-Year-Old Children in Brazil Mon, 04 Nov 2013 16:05:11 +0000 Objective. To verify if emotional/behavioral problems are associated with lifetime paid work in poor urban children, when taking into account other potential correlates. Methods. Cross-sectional study focused on 9-to-13-year-old children (). In a probabilistic sample of clusters of eligible households (women 15–49 years and son/daughter 18 years), one mother-child pair was randomly selected per household (; response rate = 82.4%). CBCL/6-18 identified child emotional/behavioral problems. Potential correlates include child gender and age, socioeconomic status/SES, maternal education, parental working status, and family social isolation, among others. Multivariate analysis examined the relationship between emotional/behavioral problems and lifetime paid work in the presence of significant correlates. Findings. All work activities were non-harmful (e.g., selling fruits, helping parents at their small business, and baby sitting). Children with lower SES and socially isolated were more involved in paid work than less disadvantaged peers. Children ever exposed to paid work were four times more likely to present anxiety/depression symptoms at a clinical level compared to non-exposed children. Multivariate modeling identified three independent correlates: child pure internalizing problems, social isolation, and low SES. Conclusion. There is an association between lifetime exposure to exclusively non-harmful paid work activities and pure internalizing problems even when considering SES variability and family social isolation. Isabel A. Bordin, Ivens H. Pires, and Cristiane S. Paula Copyright © 2013 Isabel A. Bordin et al. All rights reserved. Are Koreans Prepared for the Rapid Increase of the Single-Household Elderly? Life Satisfaction and Depression of the Single-Household Elderly in Korea Wed, 30 Oct 2013 10:44:13 +0000 Purpose. In Korea, it has been estimated that the number of the single-household elderly increased 45% from 2005 to 2010. This research was conducted to provide empirical resources for development of a community mental health program by an explorative investigation on depression, coping mechanism, and life satisfaction of a single-household elderly population. Design and Methods. This research applied a descriptive survey research design. Participants were 225 single-household elderlies residing in Seoul, Korea. The geriatric depression scale and the satisfaction with life scale were used to check the level of depression and life satisfaction of the participants. Results. Results showed that 46.3 percent of the participants were categorized as having light-to-severe level of depression, and 80.5 percent of the participants responded that they were dissatisfied with their lives. This research demonstrated that the level of depression and life satisfaction of the Korean single-household elderly is statistically significantly related to age and gender as well as coping resources and human resources. Implications. Current public health services in Korea for the single-household elderly are still lacking and require active support, intervention, and research to provide effective programs and services. Case management, counseling, and various programs based on Korean culture including support from family members and community-based assistance are recommended to help the vulnerable population. Mi-Ra Won and Yun-Jung Choi Copyright © 2013 Mi-Ra Won and Yun-Jung Choi. All rights reserved. A Retrospective Chart Review of Treatment Seeking Middle Aged Individuals at a Tertiary Care Substance Use Disorder Treatment Centre in North Part of India over Five Successive Years: Findings from Drug Abuse Monitoring System Sun, 27 Oct 2013 13:47:31 +0000 Adolescents and young adults continue to remain the main focus of attention with regards to substance use related problems. There has been a limited focus on illicit substance use among middle aged and elderly population. The current study explored the changing trends of substance use among treatment seeking middle aged individuals (aged 40–60 years) at a tertiary level drug dependence treatment centre. The questionnaire used to gather information for the study is a 19-item structured questionnaire. It includes information on various sociodemographic variables, “current,” and “ever” use of substance. Information is also collected on variables related to high risk injecting drug use and HIV status of the individuals. There has been consistent increase in the population of treatment seekers over five years. Over the five-year period, the absolute percentage increase in treatment seeking population is approximately 21%. Polysubstance use was found to increase significantly over five-study years (PTrend = 0.007). Yatan Pal Singh Balhara, Ashwani Mishra, Hem Sethi, and Rajat Ray Copyright © 2013 Yatan Pal Singh Balhara et al. All rights reserved. On the Differential Diagnosis of Anxious from Nonanxious Major Depression by means of the Hamilton Scales Sun, 27 Oct 2013 09:14:09 +0000 Objective. Anxious major depressive disorder (A-MDD) is differentially diagnosed from nonanxious MDD (NA-MDD) as MDD with a cut-off score ≥7 on the HAM-D anxiety-somatization factor (ASF). We investigated whether additional HAM-D items discriminate A-MDD from NA-MDD. Moreover, we tested the validity of ASF criterion against HAM-A, gold standard of anxiety severity assessment. Methods. 164 consecutive female middle-aged inpatients, diagnosed as A-MDD () or NA-MDD () by the normative HAM-A score for moderate-to-severe anxiety (≥25), were compared regarding 17-item HAM-D scores. The validity of ASF ≥7 criterion was assessed by receiver-operating characteristics (ROC) analysis. Results. We found medium and large effect size differences between A-MDD and NA-MDD patients in only four out of the six ASF items, as well as in three further HAM-D items, namely, those of agitation, middle insomnia, and delayed insomnia. Furthermore, the ASF cut-off score ≥9 provided the optimal trade-off between sensitivity and specificity for the differential diagnosis between A-MDD and NA-MDD. Conclusion. Additional HAM-D items, beyond those of ASF, discriminate A-MDD from NA-MDD. The ASF ≥7 criterion inflates false positives. A cut-off point ≥9 provides the best trade-off between sensitivity and specificity of the ASF criterion, at least in female middle-aged inpatients. George Konstantakopoulos, Vasilios G. Masdrakis, Manolis Markianos, and Panagiotis Oulis Copyright © 2013 George Konstantakopoulos et al. All rights reserved. Psychopathology and Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Thu, 19 Sep 2013 17:12:33 +0000 Aim. Continuous subcutaneous insulin infusion (CSII) is used as an option in patients with diabetes failing to multiple daily injections (MDI). Psychological factors may play a relevant role in the failure to attain therapeutic goals in patients on MDI. This could lead to an overrepresentation of psychopathology in patients treated with CSII. Methods. A consecutive series of 100 patients with type 1 diabetes was studied, collecting main clinical parameters and assessing psychopathology with the self-reported questionnaire Symptom Checklist 90-revised. Patients on CSII were then compared with those on MDI. Results. Of the 100 enrolled patients, 44 and 56 were on CSII and MDI, respectively. Among men, those on CSII were younger than those on MDI; conversely, no difference in age was observed in women. Women on CSII showed higher scores on most Symptom Checklist 90 subscales than those on MDI, whereas no differences were observed in men. Conclusion. Women with type 1 diabetes treated with CSII display higher levels of psychopathology than those on MDI. This is probably the consequence of the fact that patients selected for CSII are those failing to MDI. Higher levels of psychopathology could represent a limit for the attainment and maintenance of therapeutic goals with CSII. Francesco Rotella, Caterina Lamanna, Ilaria Dicembrini, Carlo Faravelli, Caterina Calasso, and Edoardo Mannucci Copyright © 2013 Francesco Rotella et al. All rights reserved. Autism in Preschoolers: Does Individual Clinician’s First Visit Diagnosis Agree with Final Comprehensive Diagnosis? Wed, 04 Sep 2013 09:47:45 +0000 Comprehensive clinical diagnosis based on all available information is considered the “gold standard” in autism spectrum disorders (ASD). We examined agreement across independent assessments (clinical judgment) of 34 young children (age 24–46 months) with suspected ASD, assessed by a multidisciplinary team, and final comprehensive clinical diagnosis. Agreement across settings and between each clinician’s assessment and final diagnosis was moderate. The poorest fit was found at assessment in connection with psychological evaluation and the best with preschool observation and parent interview. Some individual clinicians had good and others had poor fit with final diagnosis. Disagreement across assessments was pronounced for girls. The findings suggest that multidisciplinary assessments remain important and that comprehensive clinical diagnosis should still be regarded as the gold standard in ASD. Gunilla Westman Andersson, Carmela Miniscalco, and Christopher Gillberg Copyright © 2013 Gunilla Westman Andersson et al. All rights reserved. Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder Thu, 13 Jun 2013 14:35:33 +0000 The peer-reviewed literature investigating the relationship between pain expression and perception of pain in individuals with ASD is sparse. The aim of the present systematic PRIMSA review was twofold: first, to see what evidence there is for the widely held belief that individuals with ASD are insensitive to pain or have a high pain threshold in the peer-reviewed literature and, second, to examine whether individuals with ASD react or express pain differently. Fifteen studies investigating pain in individuals with ASD were identified. The case studies all reported pain insensitivity in individuals with ASD. However, the majority of the ten experimental studies reviewed indicate that the idea that individuals with ASD are pain insensitive needs to be challenged. The findings also highlight the strong possibility that not all children with ASD express their physical discomfort in the same way as a neurotypical child would (i.e., cry, moan, seek comfort, etc.) which may lead caregivers and the medical profession to interpret this as pain insensitivity or incorrectly lead them to believe that the child is in no pain. These results have important implications for the assessment and management of pain in children with ASD. C. S. Allely Copyright © 2013 C. S. Allely. All rights reserved. Autism, Processing Speed, and Adaptive Functioning in Preschool Children Mon, 20 May 2013 17:43:20 +0000 Objectives. To study cognitive test profiles with a focus on processing speed in a representative group of preschool children with autism spectrum disorder (ASD) and relate processing speed to adaptive functioning. Methods. Cognitive assessments were performed in 190 3.6–6.6-year-old children (164 boys and 26 girls) with ASD, using either Griffiths' developmental scales () or the Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) (). Cognitive data were related to adaptive functioning as measured by Vineland Adaptive Behavior Scales (VABS). Results. Cognitive profiles were characterized by low verbal skills. Low processing speed quotients (PSQs) were found in 66 (78%) of the 85 children who were able to participate in the processing speed subtests. Except for Socialization, all VABS domains (Communication, Motor Skills, Daily Living Skills, and Adaptive Behavior Composite scores) correlated significantly with PSQ. Multiple regression analysis showed that PSQ predicted 38%, 35%, 34%, and 37% of the variance for Communication, Daily Living Skills, Motor Skills, and total Adaptive Composite scores, respectively. Conclusion. Preschool children with ASD had uneven cognitive profiles with low verbal skills, and, relatively, even lower PSQs. Except for Socialization, adaptive functioning was predicted to a considerable degree by PSQ. Åsa Hedvall, Elisabeth Fernell, Anette Holm, Jakob Åsberg Johnels, Christopher Gillberg, and Eva Billstedt Copyright © 2013 Åsa Hedvall et al. All rights reserved. S-Adenosyl-L-Methionine Augmentation in Patients with Stage II Treatment-Resistant Major Depressive Disorder: An Open Label, Fixed Dose, Single-Blind Study Sun, 12 May 2013 16:32:51 +0000 We investigated the efficacy of S-Adenosyl-L-Methionine (SAMe) augmentation in patients with treatment-resistant depressive disorder (TRD). Thirty-three outpatients with major depressive episode who failed to respond to at least 8 weeks of treatment with two adequate and stable doses of antidepressants were treated openly with fixed dose of SAMe (800 mg) for 8 weeks, added to existing medication. The primary outcome measure was the change from baseline in total score on Hamilton Rating Scale for Depression (HAM-D). The Clinical Global Impression of Improvement (CGI-I) was rated at the endpoint. Patients with a reduction of 50% or more on HAM-D total score and a CGI-I score of 1 or 2 at endpoint were considered responders; remission was defined as a HAM-D score ≤7. Secondary outcome measures included the Snaith-Hamilton Pleasure Scale (SHAPS) and the Sheehan Disability Scale (SDS). At 8 weeks, a significant decrease in HAM-D score was observed with response achieved by 60% of the patients and remission by 36%. Also a statistically significant reduction in SHAPS and SDS was observed. Our findings indicate that SAMe augmentation may be effective and well tolerated in stage II TRD. However, limitations of the present study must be considered and further placebo-controlled trials are needed. Domenico De Berardis, Stefano Marini, Nicola Serroni, Gabriella Rapini, Felice Iasevoli, Alessandro Valchera, Maria Signorelli, Eugenio Aguglia, Giampaolo Perna, Anatolia Salone, Giuseppe Di Iorio, Giovanni Martinotti, and Massimo Di Giannantonio Copyright © 2013 Domenico De Berardis et al. All rights reserved. Self-Directedness and Cooperativeness, Psychosocial Dysfunction and Suffering in ESSENCE Sun, 28 Apr 2013 11:48:35 +0000 Background. The acronym ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) highlights that children seeking clinical treatment are often multiply impaired, thus requiring treatment from several specialties. The aim was to map and relate, on a population level, ESSENCE to two salient predictors of health and adaptation to adversities, namely, Self-Directedness and Cooperativeness and also to dysfunction and suffering. Methods. Participants were twins aged 9 or 12 whose parents were interviewed with the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC), and the Junior Temperament and Character Inventory (J-TCI). The A-TAC was first used to discern four ESSENCE-related screening diagnoses: autism spectrum disorders, attention deficit hyperactivity disorder, learning disabilities, and developmental coordination disorder; second, to quantify dysfunction and suffering in important social areas. Results. ESSENCE symptoms were continuously and categorically associated with deficiency in Self-Directedness and Cooperativeness and higher ratings of dysfunction and suffering. The impact of ESSENCE symptoms on these measures of mental health was found in a milder form in about 16% of all children and in a severe form in about 2%. Conclusion. Therapeutic interventions focusing on Self-Directedness and Cooperativeness might provide a novel method for child psychiatry in its approach to ESSENCE. Danilo Garcia, Henrik Anckarsäter, and Sebastian Lundström Copyright © 2013 Danilo Garcia et al. All rights reserved. Comment on “Berberine and Its Emerging Benefits in Psychiatric Conditions Especially Alzheimer's Disease” Wed, 24 Apr 2013 19:15:46 +0000 Shailendra Kapoor Copyright © 2013 Shailendra Kapoor. All rights reserved. A Feasibility Randomised Controlled Trial of the New Orleans Intervention for Infant Mental Health: A Study Protocol Tue, 23 Apr 2013 15:53:03 +0000 Child maltreatment is associated with life-long social, physical, and mental health problems. Intervening early to provide maltreated children with safe, nurturing care can improve outcomes. The need for prompt decisions about permanent placement (i.e., regarding adoption or return home) is internationally recognised. However, a recent Glasgow audit showed that many maltreated children “revolve” between birth families and foster carers. This paper describes the protocol of the first exploratory randomised controlled trial of a mental health intervention aimed at improving placement permanency decisions for maltreated children. This trial compares an infant's mental health intervention with the new enhanced service as usual for maltreated children entering care in Glasgow. As both are new services, the trial is being conducted from a position of equipoise. The outcome assessment covers various fields of a child’s neurodevelopment to identify problems in any ESSENCE domain. The feasibility, reliability, and developmental appropriateness of all outcome measures are examined. Additionally, the potential for linkage with routinely collected data on health and social care and, in the future, education is explored. The results will inform a definitive randomised controlled trial that could potentially lead to long lasting benefits for the Scottish population and which may be applicable to other areas of the world. This trial is registered with (NC01485510). Rachel Pritchett, Bridie Fitzpatrick, Nicholas Watson, Richard Cotmore, Philip Wilson, Graham Bryce, Julia Donaldson, Kathleen Boyd, Charles Zeanah, John Norrie, Julie Taylor, Julie Larrieu, Martina Messow, Matt Forde, Fiona Turner, Susan Irving, and Helen Minnis Copyright © 2013 Rachel Pritchett et al. All rights reserved. Coexisting Disorders and Problems in Preschool Children with Autism Spectrum Disorders Tue, 23 Apr 2013 13:56:33 +0000 Objectives. To analyze cooccurring disorders and problems in a representative group of 198 preschool children with autism spectrum disorders (ASD) who had had interventions at a specialized habilitation center. Methods. Parents and children were seen by a research team. Data were based on parental interviews, pediatric assessments, and tests of the child. Information on autistic symptoms, general cognitive function, speech and language, motor function, epilepsy, vision, hearing, activity level, behavior, and sleep was collected. Results. Three ASD categories were used: (1) autistic disorder (AD), (2) autistic-like condition (ALC) or Asperger syndrome, and (3) one group with autistic symptoms/traits but not entirely all its criteria met for ASD. Children with autism had a mean of 3.2 coexisting disorders or problems, the ALC/Asperger group had a mean of 1.6, and children with autistic traits had a mean of 1.6. The most common disorder/problems in the total group pertained to language problems (78%), intellectual disability (ID) (49%), below average motor function (37%), and severe hyperactivity/ADHD (33%). Conclusions. The results accord with the concept of early symptomatic syndromes eliciting neurodevelopmental clinical examination (ESSENCE), and highlight the need of considering ASD in a broad perspective taking also other cooccurring developmental disorders into account. Lotta Höglund Carlsson, Fritjof Norrelgen, Liselotte Kjellmer, Joakim Westerlund, Christopher Gillberg, and Elisabeth Fernell Copyright © 2013 Lotta Höglund Carlsson et al. All rights reserved. Reactive Attachment Disorder in the General Population: A Hidden ESSENCE Disorder Thu, 18 Apr 2013 11:31:34 +0000 Reactive attachment disorder (RAD) is a severe disorder of social functioning. Previous research has shown that children with RAD may have poor cognitive and language abilities; however, findings mainly come from biased, institutionalised samples. This paper describes the characteristics of all children who were given a suspected or likely diagnosis of reactive attachment disorder in an epidemiological study of approximately 1,600 children investigating the prevalence of RAD in the general population. We found that children with RAD are more likely to have multiple comorbidities with other disorders, lower IQs than population norms, more disorganised attachment, more problem behaviours, and poorer social skills than would be found in the general population and therefore have a complex presentation than can be described as ESSENCE. We discuss the clinical and educational implications. Rachel Pritchett, Jennifer Pritchett, Emma Marshall, Claire Davidson, and Helen Minnis Copyright © 2013 Rachel Pritchett et al. All rights reserved. Maltreatment-Associated Psychiatric Problems: An Example of Environmentally Triggered ESSENCE? Wed, 17 Apr 2013 14:59:42 +0000 This paper presents a new concept—maltreatment associated psychiatric problems (MAPP)—a syndrome of overlapping complex neurodevelopmental problems in children who have experienced abuse or neglect in early life. Children with MAPP are a hidden population in the community and, in clinical settings, their problems can seem overwhelming. Individual disorders associated with maltreatment are discussed as well as the overlap between these disorders and their shared environmental and genetic predisposing factors. Because of the complex and overlapping nature of MAPP, with symptoms emerging in early life, I argue that it should be considered an example of ESSENCE. Children presenting with likely MAPP should receive a comprehensive assessment, probing for symptoms of all of the ESSENCE disorders and leading to the use of evidence-based treatments where these are available. Helen Minnis Copyright © 2013 Helen Minnis. All rights reserved. Eating Problems and Overlap with ADHD and Autism Spectrum Disorders in a Nationwide Twin Study of 9- and 12-Year-Old Children Mon, 15 Apr 2013 10:43:57 +0000 Aim. To establish the prevalence of restrictive eating problems, the overlap and association with attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorders (ASD) and to estimate the heritability of eating problems in a general population sample of twins aged 9 and 12. Methods. Parents of all Swedish 9- and 12-year-old twin pairs born between 1993 and 1998 () were interviewed regarding symptoms of ADHD, ASD, and eating problems (EAT-P). Intraclass correlations and structural equation modelling were used for evaluating the influence of genetic and environmental factors. Cross-twin, cross-trait correlations were used to indicate a possible overlap between conditions. Results. The prevalence of eating problems was 0.6% in the study population and was significantly higher in children with ADHD and/or ASD. Among children with eating problems, 40% were screened positive for ADHD and/or ASD. Social interaction problems were strongly associated with EAT-P in girls, and impulsivity and activity problems with EAT-P in boys. The cross-twin, cross-trait correlations suggested low correlations between EAT-P and ADHD or EAT-P and ASD. Genetic effects accounted for 44% of the variation in liability for eating problems. Conclusions. In the group with eating problems, there was a clear overrepresentation of individuals with ADHD and/or ASD symptoms. Maria Råstam, Jakob Täljemark, Armin Tajnia, Sebastian Lundström, Peik Gustafsson, Paul Lichtenstein, Christopher Gillberg, Henrik Anckarsäter, and Nóra Kerekes Copyright © 2013 Maria Råstam et al. All rights reserved. Examining Implicit Attitudes towards Exercisers with a Physical Disability Thu, 04 Apr 2013 14:28:11 +0000 Background. Using measures of explicit attitudes, physical activity status has been established as a factor that reduces the stigma able-bodied people hold towards people with physical disabilities. This phenomenon is called the exerciser stereotype. However, whether the exerciser stereotype exists when using measures of implicit attitudes remains unknown. Objective. The aims of this study were to evaluate the prevalence of negative implicit attitudes towards people with physical disabilities and determine whether implicit attitudes towards people with physical disabilities were influenced by the exerciser stereotype. Methods. One hundred able-bodied participants (82 females, 18 males) completed two implicit association tests (IATs): the Disability-Attitudes IAT and the Disability-Activity IAT. The Disability-Attitudes IAT measured implicit attitudes towards people who were not disabled relative to disabled; the Disability-Activity IAT measured attitudes towards people with a physical disability who were active relative to inactive. Results. Results revealed that 83.8% of participants had negative implicit attitudes towards people with a disability. Participants held more positive attitudes towards active versus inactive people with a physical disability. Conclusions. The study findings indicate that the exerciser stereotype exists implicitly and may undermine negative attitudes towards people with physical disabilities. Cassandra D. Dionne, Heather L. Gainforth, Deborah A. O’Malley, and Amy E. Latimer-Cheung Copyright © 2013 Cassandra D. Dionne et al. All rights reserved. Mental Health Services Use Predicted by Number of Mental Health Problems and Gender in a Total Population Study Thu, 04 Apr 2013 14:19:24 +0000 We examined the relationship between service use and the number of problem areas as reported by parents and teachers on questionnaires among children aged 7–9 years old in the Bergen Child Study, a total population study including more than 9000 children. A problem area was counted as present if the child scored above the 95th percentile on parent and/or teacher questionnaire. A total number of 13 problem areas were included. Odd ratios (ORs) for contact with child and adolescent mental health services (CAMH), school psychology services (SPS), health visiting nurse/physician, and school support were calculated with gender as covariate. The number of symptom areas was highly predictive of service use, showing a dose-response relationship for all services. Children scoring on ≥4 problem areas had a more than hundredfold risk of being in contact with CAMH services compared to children without problems. The mean number of problem areas for children in CAMH and SPS was 6.1 and 4.4 respectively, strongly supporting the ESSENCE model predicting multisymptomatology in children in specialized services. Even after controlling for number of problem areas, boys were twice as likely as girls to be in contact with CAMH, replicating previous findings of female gender being a strong barrier to mental health services. Maj-Britt Posserud and Astri J. Lundervold Copyright © 2013 Maj-Britt Posserud and Astri J. Lundervold. All rights reserved. Mental Health in Children with Cerebral Palsy: Does Screening Capture the Complexity? Wed, 03 Apr 2013 17:24:48 +0000 Introduction. Children with cerebral palsy (CP), one of the most common childhood neurological disorders, often have associated medical and psychological symptoms. This study assesses mental health problems compared to population controls and the ability of a mental health screening tool to predict psychiatric disorders and to capture the complexity of coexisting symptoms. Methods. Children with CP () were assessed according to DSM-IV criteria using a psychiatric diagnostic instrument (Kiddie-SADS) and a mental health screening questionnaire (SDQ). Participants from the Bergen Child Study, a large epidemiological study, served as controls. Results. Children with CP had significantly higher means on all problem scores including impact scores. Two in three children scored above 90th percentile cutoff on Total Difficulties Score (TDS), and 57% met criteria for a psychiatric disorder, yielding a sensitivity of 0.85 and a specificity of 0.55. Mental health problems coexisted across symptom scales, and peer problems were highly prevalent in all groups of psychiatric disorders. Conclusion. A high prevalence of mental health problems and cooccurrence of symptoms were found in children with CP compared to controls. Screening with SDQ detects mental health problems, but does not predict specific disorders in children with CP. ADHD is common, but difficult to diagnose due to complexity of symptoms. Mental health services integrated in regular followup of children with CP are recommended due to high prevalence and considerable overlap of mental health symptoms. H. M. Bjorgaas, I. Elgen, T. Boe, and M. Hysing Copyright © 2013 H. M. Bjorgaas et al. All rights reserved. Applying an ESSENCE Framework to Understanding Adult Autism Spectrum Disorder and ADHD: Retrospective Parent Reports of Childhood Problems Mon, 25 Mar 2013 08:15:19 +0000 Diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly being made in adulthood. However, assessments can fail to address the diverse range of problems that patients have experienced. The current study applied an early symptomatic syndromes eliciting neurodevelopmental clinical examinations (ESSENCE) framework to explore retrospectively reported childhood developmental and behavioral problems. It examined if adult ASD and ADHD patients would show problems outside those reflected in the respective diagnostic criteria, and also if these patient groups would show more extensive childhood problems than other psychiatric patients. Parents of adults with ADHD (n = 130), ASD (n = 57), coexisting ADHD and ASD (n = 38), and other psychiatric disorders (n = 56) reported on a range of childhood problems. Descriptions of the ADHD, ASD, and ADHD+ASD groups reflected greater impairment than descriptions for patients with other psychiatric disorders in most problem areas. Although differences were observed between ADHD and ASD patients in the core diagnostic areas, these syndromes also shared a number of childhood difficulties. The ESSENCE approach can assist in understanding the symptom history of adult ADHD and ASD patients and can be helpful to distinguish their childhood experiences from other psychiatric patients' experiences. Stephanie Plenty, Dag Heurlin, Christina Arlinde, and Susanne Bejerot Copyright © 2013 Stephanie Plenty et al. All rights reserved. Mental Health, Recovery, and the Community Thu, 21 Mar 2013 14:24:10 +0000 Wouter Vanderplasschen, Richard C. Rapp, Steve Pearce, Stijn Vandevelde, and Eric Broekaert Copyright © 2013 Wouter Vanderplasschen et al. All rights reserved. Language Delay Is Not Predictable from Available Risk Factors Thu, 21 Mar 2013 11:21:00 +0000 Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families. Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed. Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant. Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families. Philip Wilson, Fiona McQuaige, Lucy Thompson, and Alex McConnachie Copyright © 2013 Philip Wilson et al. All rights reserved. The Impact of Drug Treatment Courts on Recovery: A Systematic Review Thu, 21 Mar 2013 10:58:28 +0000 Introduction. Earlier reviews regarding the effectiveness of Drug Treatment Courts (DTCs) reported a reduction in reoffending and substance use. Although substance users suffer from other difficulties than drug use and judicial issues, none of these reviews focused on outcomes or effects of DTCs on drug-related life domains, such as social relationships, employment, or health. Therefor, the present paper aims to review the impact of adult DTCs on substance use and drug-related life domains. Method. Primary studies were systematically searched in Web of Knowledge. Observational and controlled evaluation studies of adult DTCs were considered eligible if substance use and/or drug-related life domains were measured. Results. Moderately positive results were found with respect to within-program substance use. Few studies used drug-related life domains as an outcome measure and most of them yielded no effects. Employment and family relations ameliorated when specific interventions were used. Discussion. DTCs yield beneficial outcomes and effects regarding within-program substance use. However, evidence regarding the impact of DTCs on post-program drug and alcohol use and on other drug-related life domains is scarce. These life domains and thus QoL possibly can be improved by DTCs if specifically targeted. Future research is warranted. Ciska Wittouck, Anne Dekkers, Brice De Ruyver, Wouter Vanderplasschen, and Freya Vander Laenen Copyright © 2013 Ciska Wittouck et al. All rights reserved. Life Cycle and Suicidal Behavior among Women Thu, 28 Feb 2013 10:05:19 +0000 It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide. Pablo Mendez-Bustos, Jorge Lopez-Castroman, Enrique Baca-García, and Antonio Ceverino Copyright © 2013 Pablo Mendez-Bustos et al. All rights reserved. Autism in the Faroe Islands: Diagnostic Stability from Childhood to Early Adult Life Sun, 17 Feb 2013 07:47:52 +0000 Childhood autism or autism spectrum disorder (ASD) has been regarded as one of the most stable diagnostic categories applied to young children with psychiatric/developmental disorders. The stability over time of a diagnosis of ASD is theoretically interesting and important for various diagnostic and clinical reasons. We studied the diagnostic stability of ASD from childhood to early adulthood in the Faroe Islands: a total school age population sample (8–17-year-olds) was screened and diagnostically assessed for AD in 2002 and 2009. This paper compares both independent clinical diagnosis and Diagnostic Interview for Social and Communication Disorders (DISCO) algorithm diagnosis at two time points, separated by seven years. The stability of clinical ASD diagnosis was perfect for AD, good for “atypical autism”/PDD-NOS, and less than perfect for Asperger syndrome (AS). Stability of the DISCO algorithm subcategory diagnoses was more variable but still good for AD. Both systems showed excellent stability over the seven-year period for “any ASD” diagnosis, although a number of clear cases had been missed at the original screening in 2002. The findings support the notion that subcategories of ASD should be collapsed into one overarching diagnostic entity with subgrouping achieved on other “non-autism” variables, such as IQ and language levels and overall adaptive functioning. Eva Kočovská, Eva Billstedt, Asa Ellefsen, Hanna Kampmann, I. Carina Gillberg, Rannvá Biskupstø, Guðrið Andorsdóttir, Tormóður Stóra, Helen Minnis, and Christopher Gillberg Copyright © 2013 Eva Kočovská et al. All rights reserved. Autism in Toddlers: Can Observation in Preschool Yield the Same Information as Autism Assessment in a Specialised Clinic? Thu, 07 Feb 2013 14:03:05 +0000 We wanted to know whether preschool observation of children suspected of suffering from autism can provide the same information about core autism symptoms as the Autism Diagnostic Observation Schedule (ADOS) performed in a clinic. Forty 2–4-year-old children (9 girls, 31 boys), referred for assessment of suspected autism spectrum disorder participated in the study. The symptom areas covered by the ADOS algorithm were scored by an education specialist after free-field observation of each child in the preschool without using the prescribed ADOS materials. The ADOS was then completed in a clinic setting by examiners blind to the preschool results. Excellent agreement across results obtained at the two different types/settings of observations was found. The only significant difference found was with regard to spontaneous initiation of joint attention. The present study does not address the issue of whether or not one of the methods used is superior to the other when it comes to determining the “true” level of “autism problems” in these children. However, it is of interest that free-field preschool observation of children with suspected autism using a structured checklist yields very similar information as that obtained at ADOS assessment performed in a clinic setting. Gunilla Westman Andersson, Carmela Miniscalco, Ulrika Johansson, and Christopher Gillberg Copyright © 2013 Gunilla Westman Andersson et al. All rights reserved. Quality of Life in Persons with Intellectual Disabilities and Mental Health Problems: An Explorative Study Tue, 05 Feb 2013 08:47:02 +0000 The field of intellectual disability (ID) is strongly influenced by the Quality of Life paradigm (QOL). We aimed at investigating whether or not the QOL paradigm also applies to clients with ID and cooccurring mental health problems. This paper aims at stimulating a debate on this topic, by investigating whether or not QOL domains are universal. Focus groups with natural and professional network members were organized to gather qualitative data, in order to answer two questions: (1) Are the QOL dimensions conceptualized in the model of Schalock et al. applicable for persons with ID and mental health problems? (2) What are indicators relating to the above-mentioned dimensions in relation to persons with ID and mental health problems? The results offer some proof for the assumption that the QOL construct seems to have universal properties. With regard to the second question, the study revealed that the natural and professional network members are challenged to look for the most appropriate support strategies, taking specific indicators of QOL into account. When aspects of empowerment and regulation are used in an integrated manner, the application of the QOL paradigm could lead to positive outcomes concerning self-determination, interdependence, social inclusion, and emotional development. Filip Morisse, Eleonore Vandemaele, Claudia Claes, Lien Claes, and Stijn Vandevelde Copyright © 2013 Filip Morisse et al. All rights reserved. Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective Tue, 15 Jan 2013 10:23:11 +0000 Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators. Wouter Vanderplasschen, Kathy Colpaert, Mieke Autrique, Richard Charles Rapp, Steve Pearce, Eric Broekaert, and Stijn Vandevelde Copyright © 2013 Wouter Vanderplasschen et al. All rights reserved. Experience of Wellness Recovery Action Planning in Self-Help and Mutual Support Groups for People with Lived Experience of Mental Health Difficulties Wed, 09 Jan 2013 10:27:19 +0000 The main aim of this research was to assess the relevance and impact of wellness recovery action planning (WRAP) as a tool for self-management and wellness planning by individuals with mental health problems from pre-existing and newly formed groups, where the possibilities for continued mutual support in the development of WRAPs could be explored. Interviews and focus groups were conducted and pre-post recovery outcome measures completed (Recovery Assessment Scale and Warwick Edinburgh Mental Well Being Scale). 21 WRAP group participants took part in the research. The WRAP approach, used in groups and delivered by trained facilitators who could also share their lived experience, was very relevant and appeared to have a positive impact on many of the participants. The impact on participants varied from learning more about recovery and developing improved self-awareness to integrating a WRAP approach into daily life. The apparent positive impact of WRAP delivered in the context of mutual support groups indicates that it should be given serious consideration as a unique and worthwhile option for improving mental health. WRAP groups could make a significant contribution to the range of self-management options that are available for improving mental health and well-being. Rebekah Pratt, Andy MacGregor, Susan Reid, and Lisa Given Copyright © 2013 Rebekah Pratt et al. All rights reserved. “Recovery Came First”: Desistance versus Recovery in the Criminal Careers of Drug-Using Offenders Sun, 30 Dec 2012 16:01:32 +0000 The aim of our paper is to gain insight in the desistance process of drug-using offenders. We explore the components of change in the desistance process of drug-using offenders by using the cognitive transformation theory of Giordano et al. as a theoretical framework. The desistance process of drug-using offenders entails a two-fold process: desistance of criminal offending and recovery. The results however indicate that desistance is subordinate to recovery because of the fact that drug-using offenders especially see themselves as drug users and not as “criminals.” Their first goal was to start recovery from drug use. They were convinced that recovery from drug use would lead them to a stop in their offending. In the discussion, we explore the implications of this result for further research. Charlotte Colman and Freya Vander Laenen Copyright © 2012 Charlotte Colman and Freya Vander Laenen. All rights reserved. Mental Health Recovery: Evaluation of a Recovery-Oriented Training Program Sun, 23 Dec 2012 15:05:20 +0000 Aim. This study investigates the effectiveness of a recovery-oriented training program on knowledge and attitudes of mental health care professionals towards recovery of people with serious mental illness. Methods. Using data from a longitudinal study of recovery, changes in knowledge and attitudes of 210 mental health care professionals towards recovery were explored using the Recovery Attitude Questionnaire and the Recovery Knowledge Inventory. The study uses a two-group multiple intervention interrupted time-series design which is a variant of the stepped-wedge trial design. A total of six measurements occasions took place. Results. This study shows that professionals' attitudes towards recovery from mental illness can improve with training. After two intensive recovery-oriented training sessions, mental health care professionals have a more positive attitude towards recovery in clinical practice. Conclusion. A recovery-oriented training program can change attitudes of mental health care professionals towards recovery of serious mental illness. G. K. M. L. Wilrycx, M. A. Croon, A. H. S. van den Broek, and Ch. van Nieuwenhuizen Copyright © 2012 G. K. M. L. Wilrycx et al. All rights reserved. Rediscovering Recovery: Reconceptualizing Underlying Assumptions of Citizenship and Interrelated Notions of Care and Support Sun, 23 Dec 2012 09:50:36 +0000 Over the last few decades, research, policy, and practice in the field of mental health care and a complementary variety of social work and social service delivery have internationally concentrated on recovery as a promising concept. In this paper, a conceptual distinction is made between an individual approach and a social approach to recovery, and underlying assumptions of citizenship and interrelated notions and features of care and support are identified. It is argued that the conditionality of the individual approach to recovery refers to a conceptualization of citizenship as normative, based on the existence of a norm that operates in every domain of our society. We argue that these assumptions place a burden of self-governance on citizens with mental health problems and risk producing people with mental health problems as nonrecyclable citizens. The social approach to recovery embraces a different conceptualization of citizenship as relational and inclusive and embodies the myriad ways in which the belonging of people with mental health problems can be constructed in practice. As such, we hope to enable social services and professionals in the field to balance their role in the provision of care and support to service users with mental health problems. Caroline Vandekinderen, Griet Roets, Rudi Roose, and Geert Van Hove Copyright © 2012 Caroline Vandekinderen et al. All rights reserved. Recovering from Hallucinations: A Qualitative Study of Coping with Voices Hearing of People with Schizophrenia in Hong Kong Tue, 11 Dec 2012 08:41:36 +0000 Auditory hallucination is a positive symptom of schizophrenia and has significant impacts on the lives of individuals. People with auditory hallucination require considerable assistance from mental health professionals. Apart from medications, they may apply different lay methods to cope with their voice hearing. Results from qualitative interviews showed that people with schizophrenia in the Chinese sociocultural context of Hong Kong were coping with auditory hallucination in different ways, including (a) changing social contacts, (b) manipulating the voices, and (c) changing perception and meaning towards the voices. Implications for recovery from psychiatric illness of individuals with auditory hallucinations are discussed. Petrus Ng, Ricky W. K. Chun, and Angela Tsun Copyright © 2012 Petrus Ng et al. All rights reserved. The Role of Personal Goals in Depressive Reaction to Adverse Life Events: A Cross-Sectional Study Wed, 05 Dec 2012 11:18:00 +0000 Consistent with cognitive views of depression, we aimed to investigate the mediating role of personal goals in the relationship between stressful events and distinct patterns of depressive symptoms in a nonclinical sample. Participants identified a dysphoric episode that occurred in the previous year by reporting the severity of 12 depressive symptoms and their plausible cause. A goal taxonomy was used to determine how much the event interfered with the achievement of a series of personal goals. After controlling for age and current level of depression, the patterns of symptoms differed based on the triggering events. The relationship between sadness and affective losses was partially mediated by the personal goal of lovableness, and success was a partial mediator in the association between an event of failure and symptoms of worthlessness and anhedonia. Although the cross-sectional design of the study does not allow for conclusions on the direction of effects, findings suggest the importance of motivational factors in the development of specific patterns of depressive symptoms to adverse events. Assuming a continuum from low mood to clinical depression, treatment models could benefit from a precise identification of the specific stressors that initiate depressive behaviour and the personal meaning assigned to those events. Alessandro Couyoumdjian, Cristina Ottaviani, Roberta Trincas, Grazia Spitoni, Katia Tenore, and Francesco Mancini Copyright © 2012 Alessandro Couyoumdjian et al. All rights reserved. Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK Mon, 19 Nov 2012 09:27:55 +0000 Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users’ evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents’ and care-workers’ assessments of need differed considerably. Conclusions. Although patients’ housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance. Maria Lambri, Apu Chakraborty, Gerard Leavey, and Michael King Copyright © 2012 Maria Lambri et al. All rights reserved. Strategies to Fight Stigma toward People with Mental Disorders: Perspectives from Different Stakeholders Thu, 11 Oct 2012 09:45:58 +0000 This study aims to provide a more complete and exhaustive perspective on the whole range of potential strategies to fight stigma by considering the perspectives of different stakeholders. Delegates to a Canadian conference were invited to participate in a survey that focused on stigma, from which the responses to the following question were analyzed: tell us briefly what you do to reduce prejudice and stigma toward people with a diagnosis of mental disorder? From 253 participants, 15 categories of strategies to fight stigma were identified from the verbatim (e.g., sharing/encouraging disclosure). These categories fell under six main themes: education, contact, protestation, person centered, working on recovery and social inclusion, and reflexive consciousness. The occurrence of these themes was different among stakeholders (clinical, organizational, and experiential knowledge). For example, people with mental disorders (experiential knowledge) often mentioned contact and person centered strategies, while mental health professionals (clinical knowledge) preferred education and working on recovery and social inclusion strategies. The results from this study highlight the need to pay more attention to the concept of disclosure of mental disorders in the process for de-stigmatization. Future studies are needed to assess the impact of the emerging strategies to fight stigma in the community. Marc Corbière, Esther Samson, Patrizia Villotti, and Jean-François Pelletier Copyright © 2012 Marc Corbière et al. All rights reserved. The Efficacy of Pramipexole, a Dopamine Receptor Agonist, as an Adjunctive Treatment in Treatment-Resistant Depression: An Open-Label Trial Wed, 01 Aug 2012 08:56:39 +0000 Dopaminergic dysfunction is implicated in the pathophysiology of treatment-resistant depression. Although the efficacy of adjunctive pramipexole treatment has been demonstrated in treatment-resistant bipolar depression, such data are scarce for major depressive disorder (MDD). We recruited 17 patients with DSM-IV major depressive episode who have failed to respond to previous treatment with a selective serotonin reuptake inhibitor. Five patients were diagnosed as having bipolar II disorder and 12 as having unipolar MDD. Patients were monitored at an ambulatory care facility every two weeks until 12 weeks. Pramipexole was added to existing medication. Depression severity was assessed with the Hamilton Depression Rating Scale 21-item version (HDRS-21). The mean maximum dosage of pramipexole was 1.6 mg (SD 0.9). The HDRS-21 total score decreased from 19.4 (SD 3.8) at baseline to 7.2 (SD 5.4) at endpoint (𝑃<0.000001). Twelve patients (71%) were responders based on the definition of 50% or more reduction in the HDRS-21 score. Ten patients (59%) remitted (HDRS-21 total score at endpoint <8). These results were almost unchanged when the sample was confined to patients with MDD. No serious adverse events were observed. Our findings indicate that pramipexole augmentation therapy may be effective and well tolerated in refractory depressed patients. Hiroaki Hori and Hiroshi Kunugi Copyright © 2012 Hiroaki Hori and Hiroshi Kunugi. All rights reserved. Exercise and Physical Activity in the Therapy of Substance Use Disorders Thu, 03 May 2012 11:03:51 +0000 Exercise and physical activity are constantly gaining attention as adjuvant treatment for substance use disorders, supplementing classical pharmacological and psychotherapeutic approaches. The present work reviews studies addressing the therapeutic effects of exercise in alcohol abuse/dependence, nicotine abuse/dependence, and illicit drug abuse/dependence. In the field of smoking cessation, evidence is strong for exercise as an effective adjuvant treatment, whereas no generalizable and methodologically strong studies have been published for alcohol and drug treatment so far, allowing only preliminary conclusions about the effectiveness of exercise in these disorders. A couple of potential mechanisms are discussed, by which exercise may act as an effective treatment, as well as future directions for studies investigating exercise as a treatment strategy for substance use disorders. Elisabeth Zschucke, Andreas Heinz, and Andreas Ströhle Copyright © 2012 Elisabeth Zschucke et al. All rights reserved. Psychological Profile in Children and Adolescents with Severe Course Juvenile Idiopathic Arthritis Thu, 03 May 2012 08:14:59 +0000 Objective. Juvenile Idiopathic Arthritis (JIA) is the most common chronic pediatric rheumatic disease. It is recognized that only reliance on clinical signs of disease outcome is inadequate for understanding the impact of illness and its treatment on child’s life and functioning. There is a need for a multidisciplinary and holistic approach to children with arthritis which considers both physical and emotional functioning. This study investigated the psychosocial functioning of children and adolescent with JIA and the disease-related changes in their family. Methods. The sample consisted of 33 hospitalized patients, aged 6–16 years. Both parents and the children were given a number of questionnaire to fill out. Clinical information was extracted from the interviews. Results. Self-reported psychological functioning (depression, anxiety, and behavior) was not different from the normal population; however significant psychological suffering was detected by the clinical interview. Conclusions. Children and adolescents with JIA do not show overt psychopathology by structured assessment; nevertheless a more clinically oriented holistic approach confirms JIA as a disrupting event causing relevant changes in the quality of life of the affected families. Emanuela Russo, E. Trevisi, F. Zulian, M. A. Battaglia, D. Viel, D. Facchin, A. Chiusso, and A. Martinuzzi Copyright © 2012 Emanuela Russo et al. All rights reserved. Frequency and Associated Factors for Anxiety and Depression in Pregnant Women: A Hospital-Based Cross-Sectional Study Wed, 02 May 2012 15:09:08 +0000 Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value=0.073), not having any live birth (P-value=0.036), adverse pregnancy outcome in past including death of a child, stillbirth or abortion (P-value=0.013), participant’s role in household decision making (P-value=0.013), and domestic violence (verbal or physical abuse towards mother or children by any family member) (P-value=0.123). Our study highlights that anxiety and/or depression is quite common among pregnant women. Therefore, there is a need to incorporate screening for anxiety and depression in the existing antenatal programs and development of strategies to provide practical support to those identified. Niloufer S. Ali, Iqbal S. Azam, Badar S. Ali, Ghurnata Tabbusum, and Sana S. Moin Copyright © 2012 Niloufer S. Ali et al. All rights reserved. Age of First Suicide Attempt in Men and Women: An Admixture Analysis Wed, 02 May 2012 13:29:45 +0000 Objectives. To define different subgroups of suicide attempters according to age at onset of suicide attempts. Methods. Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. Results. The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43–50.0). Conclusions. Age at onset of suicide attempts characterizes different subpopulations of suicide attempters. Hilario Blasco-Fontecilla, Analucia A. Alegria, David Delgado-Gomez, Teresa Legido-Gil, Jeronimo Saiz-Ruiz, Maria A. Oquendo, and Enrique Baca-Garcia Copyright © 2012 Hilario Blasco-Fontecilla et al. All rights reserved. Factors Contributing to the Utilization of Adult Mental Health Services in Children and Adolescents Diagnosed with Hyperkinetic Disorder Mon, 30 Apr 2012 14:32:07 +0000 Objectives. To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. Methods. Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. Results. 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. Conclusions. Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS. Hilario Blasco-Fontecilla, Juan J. Carballo, Rebeca Garcia-Nieto, Jorge Lopez-Castroman, Analucia A. Alegria, Ignacio Basurte-Villamor, Juncal Sevilla-Vicente, Rocio Navarro-Jimenez, Teresa Legido-Gil, Consuelo Morant-Ginestar, Miguel Angel Jimenez-Arriero, Jeronimo Saiz-Ruiz, and Enrique Baca-Garcia Copyright © 2012 Hilario Blasco-Fontecilla et al. All rights reserved. Mental Health among Former Child Soldiers and Never-Abducted Children in Northern Uganda Mon, 30 Apr 2012 11:27:32 +0000 The present study aimed to evaluate posttraumatic stress symptoms, psychological distress, and emotional and behavioral problems in former Ugandan child soldiers in comparison with civilian children living in the same conflict setting. Participants included 133 former child soldiers and 101 never-abducted children in northern Uganda, who were interviewed about exposure to traumatic war-related experiences, posttraumatic stress symptoms, psychological distress, and emotional and behavioral problems. Results indicated that former child soldiers had experienced significantly more war-related traumatic events than nonabducted children, with 39.3% of girls having been forced to engage in sexual contact. Total scores on measures of PTSD symptoms, psychological distress, and emotional and behavioral problems were significantly higher among child soldiers compared to their never-abducted peers. Girls reported significantly more emotional and behavioral difficulties than boys. In never-abducted children, more mental health problems were associated with experiencing physical harm, witnessing the killings of other people, and being forced to engage in sexual contact. Ughetta Moscardino, Sara Scrimin, Francesca Cadei, and Gianmarco Altoè Copyright © 2012 Ughetta Moscardino et al. All rights reserved. A Chinese Chan-Based Mind-Body Intervention Improves Sleep on Patients with Depression: A Randomized Controlled Trial Mon, 30 Apr 2012 08:34:25 +0000 Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed Chinese Chan-based intervention, namely Dejian mind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of CBT or DMBI, or placed on a waitlist. Measurements included ratings by psychiatrists who were blinded to the experimental design, and a standardized questionnaire on sleep quantity and quality was obtained before and after the 10-week intervention. Results indicated that both the CBT and DMBI groups demonstrated significantly reduced sleep onset latency and wake time after sleep onset (effect size range = 0.46–1.0, 𝑃≤0.05) as compared to nonsignificant changes in the waitlist group (𝑃>0.1). Furthermore, the DMBI group, but not the CBT or waitlist groups, demonstrated significantly reduced psychiatrist ratings on overall sleep problems (effect size = 1.0, 𝑃=0.00) and improved total sleep time (effect size = 0.8, 𝑃=0.05) after treatment. The present findings suggest that a Chinese Chan-based mind-body intervention has positive effects on improving sleep in individuals with depression. Agnes S. Chan, Queenie Y. Wong, Sophia L. Sze, Patrick P. K. Kwong, Yvonne M. Y. Han, and Mei-chun Cheung Copyright © 2012 Agnes S. Chan et al. All rights reserved. Understanding Autism in Schizophrenia Thu, 26 Apr 2012 15:22:17 +0000 Detachment from external reality, distancing from others, closure into a sort of virtual hermitage, and prevalence of inner fantasies, are the descriptive aspects of autism. However, from an anthropological-phenomenological point of view, in schizophrenia, the autistic mode of life can arise from a person’s being confronted with a pathological crisis in the obviousness of the intersubjective world, essentially a crisis in the intersubjective foundation of human presence. The “condition of possibility” of the autistic way of being is the deficiency of the operation that phenomenology call empathetic-intuitive constitution of the Other, an Other which is the naturalness of evidence of being a subject like me. The theme of the Other, of intersubjectivity, has become so central in the psychopathological analysis of schizophrenic disorders because the modifications of interhuman encounter cannot be seen as the secondary consequences of symptoms but constitute the fundamental disorder of schizophrenic alienation. Revision of the concept of autism from the original definition, centered on the prevalence of inner fantasies, leads to the profound change with the vision of autism as “loss” and “void.” I call attention to possibility of phenomenological research to understand autistic world starting from this “void.” Arnaldo Ballerini Copyright © 2012 Arnaldo Ballerini. All rights reserved. Personal Construction of Cough Medicine among Young Substance Abusers in Hong Kong Thu, 19 Apr 2012 16:17:25 +0000 Although cough medicine abuse is a growing problem in many places, there is no study examining the views of young substance abusers toward cough medicine. The objective of this study was to examine personal constructions of cough medicine abusers via the repertory grid tests (𝑁=11). Several observations are highlighted from the study. First, personal constructions of cough medicine were mixed, including the benefits and harmful effects of its abuse. Second, although the informants perceived cough medicine to be addictive and harmful, they perceived cough medicine to be less addictive and less harmful than did heroin. Third, while the informants construed cough medicine to be similar to ketamine and marijuana, they also perceived cough medicine to possess some characteristics of heroin. Fourth, relative to the construed similarity between heroin and the gateway drugs (cigarette, beer, and liquor), the informants construed cough medicine to be more similar to the gateway drugs. Finally, a higher level of perceived dissimilarity between cough medicine and gateway drugs was related to a higher level of perceived harm of cough medicine abuse. Daniel T. L. Shek Copyright © 2012 Daniel T. L. Shek. All rights reserved. Cognitive-Behavioral Therapy versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review Thu, 19 Apr 2012 13:12:12 +0000 Although war-trauma victims are at a higher risk of developing PTSD, there is no consensus on the effective treatments for this condition among civilians who experienced war/conflict-related trauma. This paper assessed the effectiveness of the various forms of cognitive-behavioral therapy (CBT) at lowering PTSD and depression severity. All published and unpublished randomized controlled trials studying the effectiveness of CBT at reducing PTSD and/or depression severity in the population of interest were searched. Out of 738 trials identified, 33 analysed a form of CBTs effectiveness, and ten were included in the paper. The subgroup analysis shows that cognitive processing therapy (CPT), culturally adapted CPT, and narrative exposure therapy (NET) contribute to the reduction of PTSD and depression severity in the population of interest. The effect size was also significant at a level of 0.01 with the exception of the effect of NET on depression score. The test of subgroup differences was also significant, suggesting CPT is more effective than NET in our population of interest. CPT as well as its culturallyadapted form and NET seem effective in helping war/conflict traumatised civilians cope with their PTSD symptoms. However, more studies are required if one wishes to recommend one of these therapies above the other. N. Inès Dossa and Marie Hatem Copyright © 2012 N. Inès Dossa and Marie Hatem. All rights reserved. Emotional Eating: A Virtually Untreated Risk Factor for Outcome Following Bariatric Surgery Sun, 01 Apr 2012 13:49:36 +0000 Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional eating. Three cases suggest that cognitive behavioral treatment (CBT) might alleviate EE. One describes treatment for distress provoked by loss-of-control eating. The first of two others, associated with negative emotions/life situations, link treatment of a super-super-preoperative obese individual’s reflexive EE with 52% excess BMI (body mass index) loss maintained for the past year, 64 months after surgery. The second relates treatment of conscious/reflexive EE with 84.52% excess BMI loss 53 months after surgery. Implications for research and treatment are discussed. Betty E. Chesler Copyright © 2012 Betty E. Chesler. All rights reserved. Auditing Clinical Outcomes after Introducing Off-Licence Prescribing of Atypical Antipsychotic Melperone for Patients with Treatment Refractory Schizophrenia Sun, 01 Apr 2012 11:14:22 +0000 Aims and Method. To evaluate the practical utility of off-licence prescribing and clinical outcomes of treatment with atypical antipsychotic Melperone. Method: Prospective data collection on patient’s clinical characteristics and outcomes. Results. 17 patients with a diagnosis of refractory schizophrenia were identified as suitable for off-license prescribing of Melperone and commenced treatment (13 were previously treated with Clozapine). Seven of those currently remain on Melperone (41%), and for six patents, the BPRS symptom scores reduced significantly over time (24–61%) additionally patients displayed improvements of their quality of life. Six patients were discontinued due to noncompliance and/or side effects. Melperone was ineffective in the other four patients. Clinical Implications. The example of a small group of patients responding well to a comparably safe and inexpensive atypical antipsychotic with favourable side effect profile should encourage clinicians to use this tool as third-line treatment and to conduct more systematic clinical research. Frank Röhricht, Seema Gadhia, Rinku Alam, and Melissa Willis Copyright © 2012 Frank Röhricht et al. All rights reserved. Eating Disorders and Intrasexual Competition: Testing an Evolutionary Hypothesis among Young Women Sun, 01 Apr 2012 09:26:24 +0000 The sexual competition hypothesis (SCH) contends that intense female intrasexual competition (ISC) is the ultimate cause of eating disorders. The SCH explains the phenomenon of the pursuit of thinness as an adaptation to ISC in the modern environment. It argues that eating disorders are pathological phenomena that arise from the mismatch between the modern environment and the inherited female adaptations for ISC. The present study has two aims. The first is to examine the relationship between disordered eating behavior (DEB) and ISC in a sample of female undergraduates. The second is to establish whether there is any relationship between disordered eating behavior and life history (LH) strategy. Participants completed a battery of questionnaires examining eating-related attitudes and behaviors, ISC, and LH strategy. A group of 206 female undergraduates were recruited. A structural equation model was constructed to analyze the data. ISC for mates was significantly associated with DEB, as predicted by the SCH. DEB was found to be predicted by fast LH strategy, which was only partially mediated by the SCH. The results of this study are supportive of the SCH and justify research on a clinical sample. Riadh Abed, Sunil Mehta, Aurelio José Figueredo, Sarah Aldridge, Hannah Balson, Caroline Meyer, and Robert Palmer Copyright © 2012 Riadh Abed et al. All rights reserved. Self-Harm and Suicidal Behaviors in Hong Kong Adolescents: Prevalence and Psychosocial Correlates Sun, 01 Apr 2012 08:46:12 +0000 The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH) and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed. Daniel T. L. Shek and Lu Yu Copyright © 2012 Daniel T. L. Shek and Lu Yu. All rights reserved. Obesity Is a Marker of Reduction in QoL and Disability Mon, 12 Mar 2012 14:10:41 +0000 The purpose of this paper is to verify the association between outcome measures of health-related quality of life (HRQoL) and disability, BMI, gender, and age. Adult obese patients were clustered using HRQoL (IWQoL-Lite) and disability (WHO-DAS II) scores into three groups: mild, moderate, and high. One-way ANOVA with Bonferroni post hoc test was used to evaluate differences in age and BMI between subjects from different clusters, contingency coefficient to test the relationship between cluster groups and gender. In total, 117 patients were enrolled: subjects with higher disability and HRQoL decrement were older and had higher BMI. Women were more likely to present moderate disability and reduction in HRQoL, while men more likely presented mild disability and HRQoL reduction. Our data further confirm the connection between disability and HRQoL, high BMI and older age. These data obtained with outcomes measures might better address rehabilitation programs. Anna Sirtori, Amelia Brunani, Valentina Villa, Maria Elisa Berselli, Marina Croci, Matilde Leonardi, and Alberto Raggi Copyright © 2012 Anna Sirtori et al. All rights reserved. Homicides and Suicides by Mentally Ill People Mon, 01 Jan 1900 00:00:00 +0000 In 1992, following consultations with the Royal College of Psychiatrists, the confidential inquiry into homicides and suicides by mentally ill people was set up by the United Kingdom Department of Health. The inquiry collects detailed information on contact with secondary mental health services by means of a questionnaire from clinical audit or information departments from these organisations. In Leeds, however, a wider range of available records including Coroner Reports, police, social, educational, and all health records were consulted. This resulted in a series of health/life event histories of suicide cases that had been in contact with psychiatric services. This paper presents an exploratory analysis of these data. The Leeds suicide cases formed less than one-third of all suicide cases in Leeds; the remainder had not come into contact with psychiatric services. This proportion is consistent with the U.K. national figures. Records show that 46% of the sample's first contact with the psychiatric services was through a first failed attempted suicide. Other results include the role of prescribed drugs in repeat suicide attempts, education levels, and employment stability. It is concluded that the link between mental illness and suicide is questionable. Life event history type data on all suicide cases is desperately required to study suicide as a social process. Said Shahtahmasebi Copyright © 2003 Said Shahtahmasebi. All rights reserved. Suicide Behavior in Persons with Intellectual Disability Mon, 01 Jan 1900 00:00:00 +0000 Suicide is today in the Western world one of the leading causes of death and most people have had suicidal ideation at some time during their life. In the population of persons with intellectual disability some researchers have thought that impaired intellectual capacity could act as a buffer to suicidal behavior, but the fact is that the few studies conducted in that population contest this assumption and showed that the characteristics of suicidality in this population are very similar to persons without intellectual disability. This paper reviews the studies conducted and describe the symptomatology in this population. Professionals working with this population should therefore be aware of and assess for this behavior. Sadness or depression are symptoms that could indicate later suicidal behavior. Joav Merrick, Efrat Merrick, Yona Lunsky, and Isack Kandel Copyright © 2005 Joav Merrick et al. All rights reserved. Helicobacter pylori Infection in Persons with Intellectual Disability in Residential Care in Israel Mon, 01 Jan 1900 00:00:00 +0000 Helicobacter pylori (formerly Campylobacter pylori) was identified in 1982 by researchers from Australia as a pathogenic factor in peptic ulcer disease. Due to the few studies on H. pylori infection conducted in the population of persons with intellectual disability it was decided to conduct a clinical study in Israel. The purpose of the study was to determine the occurrence of H. pylori infection in persons who presented with severe dyspeptic symptoms and to monitor clinically the effect of treatment. The Division for Mental Retardation in Israel provides service to 6,022 persons in 53 residential care centers and 1 in central Israel was selected for this pilot study. The study has been performed since 1999 and each patient who came to the medical clinic of the institution with severe dyspeptic symptoms was examined clinically and a blood specimen drawn for IgG antibodies to H. pylori (ELISA, Pharmatop Millenia). In case of positive serology, triple drug treatment (amoxycillin, metronidazole, and pantoprazole or omepra-zole) was initiated for 1 week. Since 1999 a total of 43 persons (total population in care was 224) had severe dyspeptic symptoms and 42 persons (98%, 26 males, 16 females, mean age 45 years, mean institutionalization 20 years) had Helicobacter infection. All patients were treated for 1 week, but six patients received an extra month of omeprazole due to persistent symptoms. At follow-up, clinically all patients had improvement and only seven still had minor complaints (83% treatment success). Persons with developmental disability, intellectual disability, or mental retardation in residential care presenting with severe dyspeptic symptoms had a high incidence of H. pylori infection. Therefore, we recommend serology or urea breath investigations in this population presenting with dyspeptic symptoms and triple drug treatment for 1 week in case of positive findings. Joav Merrick, Shoshana Aspler, and Inessa Dubman Copyright © 2001 Joav Merrick et al. All rights reserved. Health Policy for Persons with Intellectual Disability: Experiences from Israel Mon, 01 Jan 1900 00:00:00 +0000 Intellectual disability (ID) is a life-long disability characterized by impaired cognitive and adaptive skills. Over the past few decades, a shift has occurred in the conceptualization and treatment of people with ID and research in health policy and health-care delivery has become increasingly global with a notable disparity between the developed and developing world. This review presents a literature overview of global health policy for ID with the intent to focus specifically on the policy and treatment within Israel. The methodology involved sites visits to care centers, discussions with stakeholders in health policy, and a literature review. We believe that Israel is in a unique position between a developed and developing culture. In particular, the distinct problems faced by the Arab and Bedouin community in terms of ID must be formally accounted for in Israel's future policies. Research from the developing world would be instructive to this end. The global approach in this presentation led to certain policy recommendations that take into account the uniqueness of Israel's position from a social, economic, religious, and demographic perspective. It is the hope that this paper will lead to an increased awareness of the challenges faced by persons with ID and their providers in all sectors of Israeli society and that the necessary policy recommendations will ultimately be adopted. Ilana Halperin, Aliza Shupac, Mohammed Morad, and Joav Merrick Copyright © 2005 Ilana Halperin et al. All rights reserved. Elderly Persons with Intellectual Disability: A Study of Clinical Characteristics, Functional Status, and Sensory Capacity Mon, 01 Jan 1900 00:00:00 +0000 Longer life expectancy is resulting in increasing numbers of elderly adults with intellectual disability (ID). There has been the question whether persons with ID demonstrate early signs of aging before the general population. The aim of this study was to determine if persons with ID (with and without Down syndrome) showed premature aging changes compared with a control group. Elderly persons (n = 24, average age of 61) from one residential care center in Israel and younger adults from another center (n = 37, average age of 45) were compared with elderly residents without ID in an independent living facility. The study considered demographic data, medical data, anthropometric measurements, body fat and body mass index, flexibility, and sensorimotor function tests. The results showed that the persons with ID had basically similar body composition to that of persons without ID, however, the functional performance of elderly adults with ID was more impaired. We postulate that the slower functioning responses may be explained by a less physically active lifestyle, that may accelerate the onset of disease and result in symptoms associated with aging that are detrimental to health. It is therefore important that persons with ID participate in physical activity and exercises in order to promote health and prevent disease. Eli Carmeli, Joav Merrick, Shlomo Kessel, Yossef Masharawi, and Varda Carmeli Copyright © 2003 Eli Carmeli et al. All rights reserved. Clinical Holistic Medicine: Mental Disorders in a Holistic Perspective Mon, 01 Jan 1900 00:00:00 +0000 From a holistic perspective, psychiatric diseases are caused by the patient’s unwillingness to assume responsibility for his life, existence, and personal relations. The loss of responsibility arises from the repression of the fundamental existential dimensions of the patients. Repression of love and purpose causes depersonalization (i.e., a lack of responsibility for being yourself and for the contact with others, loss of direction and purpose in life). Repression of strength in mind and emotions leads to derealization (the breakdown of the reality testing, often with mental delusions and hallucinations). The repression of joy and gender leads to devitalization (emotional emptiness, loss of joy, personal energy, sexuality, and pleasure in life).The losses of existential dimensions are invariably connected to traumas with life-denying decisions. Healing the wounds of the soul by holding and processing will lead to the recovery of the person's character, purpose of life, and existential responsibility. It can be very difficult to help a psychotic patient. The physician must first love his patient unconditionally and then fully understand the patient in order to meet and support the patient to initiate the holistic process of healing. It takes motivation and willingness to suffer on behalf of the patients in order to heal, as the existential and emotional pain of the traumas resulting in insanity is often overwhelming. We believe that most psychiatric diseases can be alleviated or cured by the loving and caring physician who masters the holistic toolbox. Further research is needed to document the effect of holistic medicine in psychiatry. Søren Ventegodt, Niels Jørgen Andersen, Shimshon Neikrug, Isack Kandel, and Joav Merrick Copyright © 2005 Soren Ventegodt et al. All rights reserved. Tackling Adolescent Substance Abuse in Hong Kong: Where We Should and Should Not Go Mon, 01 Jan 1900 00:00:00 +0000 In the 2007 Policy Address, the Chief Executive of the Hong Kong Special Administrative Region, P.R.C. expressed the Administration’s concern about adolescent substance abuse and proposed to form a high-level interdepartmental task force to tackle the problem in a holistic manner. In this paper, the author presents his observations about adolescent substance abuse in Hong Kong, and outlines the risk factors and related strategies based on the ecological perspective that the Government should consider in order to tackle the problem of adolescent substance abuse in Hong Kong. Furthermore, the directions where the Government should and should not go are discussed. Daniel T. L. Shek Copyright © 2007 Daniel T. L. Shek. All rights reserved. Dying To Be Thin: Attachment to Death in Anorexia Nervosa Mon, 01 Jan 1900 00:00:00 +0000 Anorexia Nervosa (AN) usually follows a prolonged course accompanied by significant morbidity and high mortality. AN patients have been found to have elevated and attempted suicide rates, with suicide being the second most common cause of death in AN after the complications of the disorder itself. The suicide risk in AN is similar to that in major depression or conduct disorder and linked mainly to longer duration of illness, lower weight, bingeing and purging, impulsivity-related manifestations, comorbid substance abuse, and affective disorder. This paper reviews suicidal tendency and disturbed body image, death and eating disorders, and attachment and death with clinical implications related to AN. Yael Latzer and Zipora Hochdorf Copyright © 2005 Yael Latzer and Zipora Hochdorf. All rights reserved. In Search of Inner Wisdom: Guided Mindfulness Meditation in the Context of Suicide Mon, 01 Jan 1900 00:00:00 +0000 Spiritual concerns are highly relevant, but often ignored, in psychotherapy in general and in suicide in particular. This article presents Internet data and clinical case material bearing on the topic, and describes an innovative therapeutic intervention administered in a group-workshop format with suicide survivors and mental health professionals. The technique incorporates relaxation and mindfulness meditation, with the addition of guided meditation in search of inner wisdom. Results of the group intervention are described and illustrated. Many participants reported a significant positive experience including connection to knowledge that was highly relevant to them in their current state of life. Whether such insights were experienced as coming from within (a deeper part of the self) or from an external source (a guiding figure or presence), indications are that guided meditation can be a powerful resource for therapists and their clients, suicidal and otherwise. Possible applications in diverse populations and settings, as well as the need for further research, are discussed. Liora Birnbaum and Aiton Birnbaum Copyright © 2004 Liora Birnbaum and Aiton Birnbaum. All rights reserved. Clinical Holistic Medicine (Mindful,Short-Term Psychodynamic Psychotherapy Complemented with Bodywork) in the Treatment of Experienced Mental Illness Mon, 01 Jan 1900 00:00:00 +0000 Short-term psychodynamic psychotherapy (STPP) complemented with bodywork improved 31 of 54 patients (57.4%, 95% CI: 43.21–70.77%) who rated themselves mentally ill before treatment. Calculated from this we find 1.41 < NNT < 2.31; we estimate NNH > 500. Of the 54 patients, 40% had already had traditional treatment that did not help them. Bodywork helped the patients to confront repressed painful feelings from childhood and this seemingly accelerated and improved the therapy. The patients received in average 20 sessions over 14 months at a cost of 1600 EURO. For the treatment responders, all measured aspects of life (on a five point Likert Scale) improved significantly, simultaneously, and radically: somatic health (from 2.9 to 2.3), self-esteem/relationship to self (from 3.5 to 2.3), relationship to partner (from 4.7 to 2.9 [no partner was rated as “6”]), relationship to friends (from 2.5 to 2.0), ability to love (from 3.8 to 2.4), self-assessed sexual ability (from 3.5 to 2.4), self-assessed social ability (from 3.2 to 2.1), self-assessed working ability (from 3.3 to 2.4), and self-assessed quality of life (from 4.0 to 2.3. Quality of life as measured with QOL5 improved (from 3.6 to 2.3 on a scale from 1 to 5; p < 0.001). This general improvement strongly indicated that the patient had healed existentially, i.e., had experienced what Aaron Antonovsky (1923–1994) called “salutogenesis”, defined as the process exactly the opposite of pathogenesis. For the treatment responders, the treatment provided lasting benefits, without the negative side effects of drugs. A lasting, positive effect might also prevent many different types of problems in the future. Søren Ventegodt, Suzette Thegler, Tove Andreasen, Flemming Struve, Lars Enevoldsen, Laila Bassaine, Margrethe Torp, and Joav Merrick Copyright © 2007 Søren Ventegodt et al. All rights reserved. Cocaine and Sleep: Early Abstinence Mon, 01 Jan 1900 00:00:00 +0000 Compulsive cocaine use is associated with a profound dysregulation of sleep. Perhaps the result of chronic use, a significant deterioration in sleep is apparent over the first 3 weeks of abstinence, with no indication of recovery. Interestingly, the diminished sleep is not accompanied by subjective reports of poor or worsening sleep. Rather, subjective reports actually improve over abstinence, while sleep-related cognitive performance declines. A mechanistic understanding of the apparent difference in objective and subjective measures is currently lacking. Here we review the relevant literature on cocaine use and sleep, and discuss the possible relevance of this sleep disturbance in relationship to the underlying disorder and its treatment. Peter T. Morgan and Robert T. Malison Copyright © 2007 Peter T. Morgan and Robert T. Malison. All rights reserved. Quality of Life as Medicine. II. A Pilot Study of a Five-Day �Quality of Life and Health� Cure for Patients with Alcoholism Mon, 01 Jan 1900 00:00:00 +0000 Alcoholism can be understood as a self-treatment for existential pain. A 5-day treatment was designed to relieve this psychological pain and existential anxiety, and thereby diminish the need for self-treatment with alcohol. The basic principle behind the treatment was holistic, restoring the quality of life (QOL) and relationship with self, which according to the life mission theory happens when life-denying views are corrected and inner emotional conflicts are solved. The method in this treatment was a course with teachings in philosophy of life, psychotherapy, and body therapy. The synergy attained was considerable and the outcome demonstrates that in the course of 1 week, people have time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. This was demonstrated by an improved QOL and a decrease in their dependency and need for alcohol abuse. In the week before, after the 5-day course, and again after 1 and 3 months, the 16 participants completed the SEQOL questionnaire on QOL and health. This was a pilot study based on a pre-experimental design, without a control group and without clinical control. Common for the group were a low QOL, numerous health problems, and alcohol dependency in spite of treatment with Antabus� (disulfiram). The study showed an increase in QOL from 57.6% before the course to 69.4% 3 months after the course, or an improvement in QOL of 11.8%. There was a 24.0% improvement in self-perceived mental health, and satisfaction with health in general was improved by 11.1%. The total sum of health symptoms in the group was reduced from 59% of maximum to 33%. It is concluded that for this small and motivated group with alcohol problems, it was possible to improve QOL and health in only 5 days with a holistic treatment that combined philosophy of life, psychotherapy, and body therapy, but the results are not final. Further research is needed. Soren Ventegodt, Joav Merrick, and Niels Jorgen Andersen Copyright © 2003 Soren Ventegodt et al. All rights reserved. Sustained Spatial Attention in Touch: Modality-Specific and Multimodal Mechanisms Mon, 01 Jan 1900 00:00:00 +0000 Sustained attention to a body location results in enhanced processing of tactile stimuli presented at that location compared to another unattended location. In this paper, we review studies investigating the neural correlates of sustained spatial attention in touch. These studies consistently show that activity within modality-specific somatosensory areas (SI and SII) is modulated by sustained tactile-spatial attention. Recent evidence suggests that these somatosensory areas may be recruited as part of a larger cortical network,also including higher-level multimodal regions involved in spatial selection across modalities. We discuss, in turn, the following multimodal effects in sustained tactile-spatial attention tasks. First, cross-modal attentional links between touch and vision, reflected in enhanced processing of task-irrelevant visual stimuli at tactuallyattended locations, are mediated by common (multimodal) representations of external space. Second, vision of the body modulates activity underlying sustained tactile-spatial attention, facilitating attentional modulation of tactile processing in between-hand (when hands are sufficiently far apart) and impairing attentional modulation in within-hand selection tasks. Finally, body posture influences mechanisms of sustained tactile-spatial attention, relying, at least partly, on remapping of tactile stimuli in external, visuallydefined, spatial coordinates. Taken together, the findings reviewed in this paper indicate that sustained spatial attention in touch is subserved by both modality-specific and multimodal mechanisms. The interplay between these mechanisms allows flexible and efficient spatial selection within and across sensory modalities. Chiara F. Sambo and Bettina Forster Copyright © 2011 Chiara F. Sambo and Bettina Forster. All rights reserved. Seasonal Changes in Sleep Duration in African American and African College Students Living In Washington, D.C. Mon, 01 Jan 1900 00:00:00 +0000 Duration of nocturnal melatonin secretion, a marker of “biological night” that relates to sleep duration, is longer in winter than in summer in patients with seasonal affective disorder (SAD), but not in healthy controls. In this study of African and African American college students, we hypothesized that students who met criteria for winter SAD or subsyndromal SAD (S-SAD) would report sleeping longer in winter than in summer. In addition, based on our previous observation that Africans report more “problems” with change in seasons than African Americans, we expected that the seasonal changes in sleep duration would be greater in African students than in African American students. Based on Seasonal Pattern Assessment Questionnaire (SPAQ) responses, African American and African college students in Washington, D.C. (N = 575) were grouped into a winter SAD/S-SAD group or a no winter diagnosis group, and winter and summer sleep length were determined. We conducted a 2 (season) × 2 (sex) × 2 (ethnicity) × 2 (winter diagnosis group) ANCOVA on reported sleep duration, controlling for age. Contrary to our hypothesis, we found that African and African American students with winter SAD/S-SAD report sleeping longer in the summer than in the winter. No differences in seasonality of sleep were found between African and African American students. Students with winter SAD or S-SAD may need to sacrifice sleep duration in the winter, when their academic functioning/efficiency may be impaired by syndromal or subsyndromal depression, in order to meet seasonally increased academic demands. Janna Volkov, Kelly J. Rohan, Samina M. Yousufi, Minh-Chau Nguyen, Michael A. Jackson, Courtney M. Thrower, John W. Stiller, and Teodor T. Postolache Copyright © 2007 Janna Volkov et al. All rights reserved. Suicide from an international perspective Mon, 01 Jan 1900 00:00:00 +0000 Joav Merrick and Gil Zalsman Copyright © 2005 Joav Merrick and Gil Zalsman. All rights reserved. Clinical Holistic Medicine: Psychodynamic Short-Time Therapy Complemented with Bodywork. A Clinical Follow-Up Study of 109 Patients Mon, 01 Jan 1900 00:00:00 +0000 This is a study of 109 patients who attended the Research Clinic for Holistic Medicine in Copenhagen during the 2004–2006 period, grouped according to the symptoms they presented with. Every new patient was asked to answer a 10-question composite questionnaire containing QOL1, QOL5, and four questions on ability to function socially, ability to function sexually, ability to love, and ability to work, rated on a 5-point Likert scale, on initial contact and after 1–3 months, when the patient had received about five treatments, the patient was asked to complete the questionnaire again, and finally again after 1 year. All had been to their general practitioner first with their problems and 30% had been in psychological/psychiatric treatment before. The patients were treated with short-time psychodynamic therapy (less than 40 sessions) including bodywork when necessary. More than half the patients had a bad or very bad self-assessed mental health before treatment, but after treatment only 15% reported a bad or very bad mental health (p < 0.001). Most had a complex of mental, somatic, existential, and sexual problems. Of the patients, 69.72% did the retest after treatment. We conclude that clinical holistic medicine was able to help the majority of these patients, even when patients had not been sufficiently helped by drugs, psychiatry, or psychology before. We found that outcome of therapy was not connected with severity of initial condition, but probably with the former experience of treatment. If psychiatric or psychological treatment had already failed, the patients were more difficult to help. The Square Curve Paradigm was used to document a large, immediate and lasting effect of the therapy. Søren Ventegodt, Suzette Thegler, Tove Andreasen, Flemming Struve, Lars Enevoldsen, Laila Bassaine, Margrethe Torp, and Joav Merrick Copyright © 2006 Sören Ventegodt et al. All rights reserved. A Prospective Longitudinal Study of Seasonality in African Students Living in the Greater Washington, D.C. Metropolitan Area Mon, 01 Jan 1900 00:00:00 +0000 We conducted a prospective, longitudinal study of seasonality in a vulnerable population, i.e., African students who migrated to a temperate climate. Consistent with previous cross-sectional studies, we hypothesized lower mood and energy, and higher appetite and weight, in fall/winter than in spring/summer. Four cohorts of African students attending a year-long nursing school program without vacation in Washington, D.C., were assessed monthly for 1 year. Forty-three subjects (mean age = 33.46 ± 6.25), consisting of predominantly females (76.7%), completed the study. The cohorts began their academic program in different seasons (one each in winter, spring, summer, and fall), inherently minimizing confounding influences on seasonality, such as academic and immigration stress, as well as allowing adjustment for an order effect. At each assessment, students completed three 100-mm visual analog scales for mood, energy, and appetite, and were weighed on a digital scale. For each standardized dependent variable, a repeated measure ANOVA was used and, if a significant effect of month was identified, averages for spring/summer and fall/winter were compared using paired ttests. In addition, a mixed model for repeated measures was applied to raw (nonstandardized) data. Body weight was significantly higher in fall/winter than in spring/summer (p < 0.01). No seasonal differences in mood, energy, or appetite were found. Benefiting from certain unique features of our cohorts allowing adjustment for order effects, this is the first study to identify a seasonal variation in body weight with a peak in winter using longitudinal monthly measurements. Alvaro Guzman, Ryszard Zebrak, Kelly J. Rohan, Irshad A. Sumar, Svetlana Savchenko, John W. Stiller, Adela Valadez-Meltzer, Cara Olsen, Manana Lapidus, Joseph J. Soriano, and Teodor T. Postolache Copyright © 2007 Alvaro Guzman et al. All rights reserved. A Review of Eating Disorders and Suicide Risk in Adolescence Mon, 01 Jan 1900 00:00:00 +0000 This review examines the literature during the past 10 years about suicide risk and suicide during adolescence and young adulthood of individuals with eating disorders. Epidemiological surveys are summarized, including suicide rates, parasuicidal behaviors, associated risk factors, and comorbid psychopathology. Critical implications for the comprehensive assessment and treatment planning, including safety considerations, are discussed. Two clinical cases of women with long-standing eating disorders are described to highlight both the pragmatic considerations and the complex clinical challenges of working with patients with eating disorders who become suicidal. The potentially life-threatening issues of safety have not received sufficient attention, neither in the medical literature nor by the treating clinicians. All health care professionals who are treating patients with an eating disorder must be keenly aware of the serious risks of suicidal behavior and of suicide in this population. Ida F. Dancyger and Victor M. Fornari Copyright © 2005 Ida F. Dancyger and Victor M. Fornari. All rights reserved. Holistic Health: Does It Really Include Mental Health? Mon, 01 Jan 1900 00:00:00 +0000 Holistic health, incorporating mind and body as equally important and unified components of health, is a concept utilized in some health care arenas in the United States (U.S.) over the past 30 years. However, in the U.S., mental health is not seen as conceptually integral to physical health and, thus, holistic health cannot be realized until the historical concept of mind-body dualism, continuing stigma regarding mental illness, lack of mental health parity in insurance, and inaccurate public perceptions regarding mental illness are adequately addressed and resolved. Until then, mental and physical health will continue to be viewed as disparate entities rather than parts of a unified whole. We conclude that the U.S. currently does not generally incorporate the tenets of holistic health in its view of the mental and physical health of its citizens, and provide some suggestions for changing that viewpoint. Kimberly K. McClanahan, Marlene B. Huff, and Hatim A. Omar Copyright © 2006 Kimberly K. McClanahan et al. All rights reserved. Clinical Holistic Medicine: How to Recover Memory Without “Implanting” Memories in Your Patient Mon, 01 Jan 1900 00:00:00 +0000 Every therapeutic strategy and system teach us the philosophy of the treatment system to the patient, but often this teaching is subliminal and the philosophical impact must be seen as “implanted philosophy”, which gives distorted interpretations of past events called “implanted memories”. Based on the understanding of the connection between “implanted memory” and “implanted philosophy” we have developed a strategy for avoiding implanting memories arising from one of the seven most common causes of implanted memories in psychodynamic therapy: 1) Satisfying own expectancies, 2) pleasing the therapist, 3) transferences and counter transferences, 4) as source of mental and emotional order, 5) as emotional defence, 6) as symbol and 7) from implanted philosophy. Freud taught us that child sexuality is “polymorphously perverted”, meaning that all kinds of sexuality is present at least potentially with the little child; and in dreams consciousness often go back to the earlier stages of development, potentially causing all kinds of sexual dreams and fantasies, which can come up in therapy and look like real memories. The therapist working with psychodynamic psychotherapy, clinical holistic medicine, psychiatry, and emotionally oriented bodywork, should be aware of the danger of implanting philosophy and memories. Implanted memories and implanted philosophy must be carefully handled and de-learned before ending the therapy. In conclusion “clinical holistic medicine” has developed a strategy for avoiding implanting memories. Søren Ventegodt, Isack Kandel, and Joav Merrick Copyright © 2007 Søren Ventegodt et al. All rights reserved. Clinical Holistic Medicine (Mindful Short-Term Psychodynamic Psychotherapy Complimented with Bodywork) in the Treatment of Schizophrenia (ICD10-F20/DSM-IV Code 295) and Other Psychotic Mental Diseases Mon, 01 Jan 1900 00:00:00 +0000 Clinical holistic medicine (CHM) has developed into a system that can also be helpful with mentally ill patients. CHM therapy supports the patient through a series of emotionally challenging, existential, and healing crises. The patient’s sense of coherence and mental health can be recovered through the process of feeling old repressed emotions, understanding life and self, and finally letting go of negative beliefs and delusions. The Bleuler's triple condition of autism, disturbed thoughts, and disturbed emotions that characterizes the schizophrenic patient can be understood as arising from the early defense of splitting, caused by negative learning from painful childhood traumas that made the patient lose sense of coherence and withdraw from social contact. Self-insight gained through the therapy can allow the patients to take their bodily, mental, and spiritual talents into use. At the end of therapy, the patients are once again living a life of quality centered on their life mission and they relate to other people in a way that systematically creates value. There are a number of challenges meeting the therapist who works with schizophrenic and psychotic patients, from the potential risk of experiencing a patient's violence, to the obligation to contain the most difficult and embarrassing of feelings when the emotional and often also sexual content of the patient’s unconsciousness becomes explicit. There is a long, well-established tradition for treating schizophrenia with psychodynamic therapy, and we have found that the combination of bodywork and psychotherapy can enhance and accelerate the therapy and might improve the treatment rate further. Søren Ventegodt, Isack Kandel, and Joav Merrick Copyright © 2007 Søren Ventegodt et al. All rights reserved. Sleep, Circadian Rhythm, and Drug Abuse Mon, 01 Jan 1900 00:00:00 +0000 Hal W. Gordon Copyright © 2007 Hal W. Gordon. All rights reserved. Biomedicine or Holistic Medicine for Treating Mentally Ill Patients? A Philosophical and Economical Analysis Mon, 01 Jan 1900 00:00:00 +0000 Today we have two scientific medical traditions, two schools or treatment systems: holistic medicine and biomedicine. The two traditions are based on two very different philosophical positions: subjectivistic and objectivistic. The philosopher Buber taught us that you can say I-Thou or I-It, holding the other person as a subject or an object. These two fundamentally different attitudes seem to characterize the difference in world view and patient approach in the two schools, one coming from psychoanalysis and the old, holistic tradition of Hippocratic medicine. Holistic medicine during the last decade has developed its philosophical positions and is today an independent, medical system seemingly capable of curing mentally ill patients at the cost of a few thousand Euros with no side effects and with lasting value for the patient. The problem is that very few studies have tested the effect of holistic medicine on mentally ill patients. Another problem is that the effect of holistic medicine must be documented in a way that respects this school's philosophical integrity, allowing for subjective assessment of patient benefit and using the patient as his/her own control, as placebo control cannot be used in placebo-only treatment. As the existing data are strongly in favor of using holistic medicine, which seems to be safer, more efficient, and cheaper, it is recommended that clinical holistic medicine also be used as treatment for mental illness. More research and funding is needed to develop scientific holistic medicine. Søren Ventegodt, Isack Kandel, and Joav Merrick Copyright © 2007 Søren Ventegod et al. All rights reserved. Risk and Protective Factors for Suicide in Patients with Alcoholism Mon, 01 Jan 1900 00:00:00 +0000 Alcoholism is associated with a high risk for suicidal behavior. Up to 40% of persons with alcoholism attempt suicide at some time and 7% end their lives by committing suicide. Risk factors include being male, older than 50 years of age, living alone, being unemployed, poor social support, interpersonal losses, continued drinking, consumption of a greater amount of alcohol when drinking, a recent alcohol binge, previous alcohol treatment, a family history of alcoholism, a history of comorbid substance abuse (especially cocaine), a major depressive episode, serious medical illness, suicidal communication, and prior suicidal behavior. Suicidal behavior is especially frequent in patients with comorbid alcoholism and major depression. However, all patients with alcoholism should be evaluated for suicide risk. Understanding of risk and vulnerability to suicidal behavior in alcoholism still outweighs our knowledge of protective factors and resilience. Knowledge of protective factors for suicide may help to prevent and/or predict suicidal behavior. Protective factors for suicide in alcoholism are quite varied and include an individual's biological and behavioral characteristics, as well as attributes of the environment and culture. Protective factors include effective clinical care for psychiatric (including alcoholism and drug abuse) and physical disorders, easy access to a variety of clinical interventions and support for seeking help, restricted access to highly lethal means of suicide, strong connections to family and community support, skills in problem solving and conflict resolution, cultural and religious beliefs that discourage suicide and support self-preservation. Future studies are necessary to determine which interventions may reduce suicidal behavior in alcoholism. Leo Sher Copyright © 2006 Leo Sher. All rights reserved. Sense of Coherence (SOC) Among Psychotherapists in Austria, Differentiated According to Number of Individually Completed Training Therapy Sessions Mon, 01 Jan 1900 00:00:00 +0000 The sense of coherence (according Aaron Antonovsky, 1923—1994, when a person’s sense that his/her own life and the world are sufficiently comprehensible, manageable, and meaningful) of Austrian psychotherapists was assessed and compared with a standard sample, as well as with the sense of coherence (SOC) of members of other professions. In addition, the question as to whether psychotherapists who had completed more extensive individual training therapy/self-awareness sessions had a higher SOC than do those with fewer, was addressed. Forty psychotherapists who worked in private practices and various psychosocial health care institutions in Styria, Austria took part in the study. The investigation was conducted in the form of a questionnaire assessment. The evaluation showed that the overall SOC value of the professional group in question was significantly higher than that of the standard sample (162.3 vs. 145.7), as well as other samples (physicians: SOC = 153.8; teachers: SOC = 156.1; physiotherapists SOC = 158.1). Concerning whether psychotherapists who had completed more individual training therapy/self-awareness sessions had higher SOC values than did those with fewer, we found no difference in regard to the overall SOC score or SOC scores for individual components. The SOC of psychotherapists did not seem to depend on the number of additional training therapy/self-awareness sessions. Heinz P. Binder, Elke Mesenholl-Strehler, Paul Paß, and P. Christian Endler Copyright © 2006 Heinz P. Binder et al. All rights reserved. Factors Affecting Placement of a Child with Intellectual Disability Mon, 01 Jan 1900 00:00:00 +0000 Parents of disabled children often face the question whether or not to keep the child at home or to place them. The choice between the two alternatives resides with the parents and various factors influence their decision. Several researchers have identified these factors, which include child-related parameters, family and parental attitudes, the influence of the social environment, and the external assistance provided to the family. In a pilot study, we attempted to isolate the main factors involved in the parental decision either to keep the child at home or place the child by examining a sample comprised of 50 parents of children suffering severe intellectual disability studying in a special education school and 48 parents of adults with intellectual disability working in sheltered workshops. Each parent filled out a questionnaire used in a study in the United States and results of the research indicated parental-related factors as the dominant factors that delayed the placement of their child in residential care; guilt feelings were the main factor. Isack Kandel and Joav Merrick Copyright © 2005 Isack Kandel and Joav Merrick. All rights reserved. First Do No Harm: An Analysis of the Risk Aspects and Side Effects of Clinical Holistic Medicine Compared With Standard Psychiatric Biomedical Treatment Mon, 01 Jan 1900 00:00:00 +0000 Clinical holistic medicine (CHM) is short-term psychodynamic psychotherapy (STPP) complemented with bodywork and philosophical exercises, to be more efficient in treating patients with severe mental and physical illness. STPP has already been found superior to psychiatric treatment as usual (TAU) and thus able to compete with psychiatric standard treatment as the treatment of choice for all non-organic mental illnesses; we have found the addition of bodywork and philosophy of life to STPP to accelerate the process of existential healing and recovery (salutogenesis). In this paper we compare the side effects, suicidal risk, problems from implanted memory and implanted philosophy of CHM with psychopharmacological treatment. Method: Qualitative and quantitative comparative review. Results: In all aspects of risks, harmfulness, and side effects, we have been considering, CHM was superior to the standard psychiatric treatment. The old principle of “first do no harm“ is well respected by CHM, but not always by standard psychiatry. CHM seems to be able to heal the patient, while psychopharmacological drugs can turn the patient into a chronic, mentally ill patient for life. Based on the available data CHM seems another alternative to patients with mental illness. There seem to be no documentation at all for CHM being dangerous, harmful, having side effects of putting patients at risk for suicide. As CHM uses spontaneous regression there is no danger for the patient developing psychosis as, according to some experts, has been seen with earlier intensive psychodynamic methods. CHM is an efficient, safe and affordable cure for a broad range of mental illnesses. Søren Ventegodt, Isack Kandel, and Joav Merrick Copyright © 2007 Søren Ventegodt and Joav Merrick. All rights reserved. Mood Sensitivity to Seasonal Changes in African College Students Living in the Greater Washington D.C. Metropolitan Area Mon, 01 Jan 1900 00:00:00 +0000 The purpose of this study was to estimate the degree of seasonality and prevalence of winter- and summer-type seasonal affective disorder (SAD) in African immigrant college students in comparison with African American peers. A convenience sample of 246 African immigrants and 599 African Americans studying in Washington, D.C. completed the Seasonal Pattern Assessment Questionnaire (SPAQ), which was used to calculate a global seasonality score (GSS) and to estimate the prevalence of winter- and summer-type SAD. Degree of seasonality was related to a complex interaction between having general awareness of SAD, ethnicity, and gender. A greater percentage of African students reported experiencing a problem with seasonal changes relative to African American students, and had summer SAD, but the groups did not differ on GSS and winter SAD. African students reported more difficulties with seasonal changes than their African American peers, which could represent a manifestation of incomplete acclimatization to a higher latitude and temperate climate. As Africans also had a greater rate of summer SAD, this argues against acclimatization to heat. Alvaro Guzman, Kelly J. Rohan, Samina M. Yousufi, Minh-Chau Nguyen, Michael A. Jackson, Joseph J. Soriano, and Teodor T. Postolache Copyright © 2007 Alvaro Guzman et al. All rights reserved. Adolescents with Intellectual Disability and Suicidal Behavior Mon, 01 Jan 1900 00:00:00 +0000 It has been assumed that impaired intellectual capacity could act as a buffer to suicidality in the population of children and adolescents with intellectual disability. The few studies that have been conducted contest this assumption, and in fact, the findings showed that the characteristics of suicidality in the population of children and adolescents with intellectual disability are very similar to other adolescents without intellectual disability. This paper reviews the few studies conducted and describe the symptomatology in this population. Joav Merrick, Efrat Merrick, Mohammed Morad, and Isack Kandel Copyright © 2005 Joav Merrick et al. All rights reserved. Changes in Chinese Discharged Chronic Mental Patients Attending a Psychiatric Rehabilitation Program with Holistic Care Elements: A Quasi-Experimental Study Mon, 01 Jan 1900 00:00:00 +0000 This study attempted to examine the changes and related factors in discharged chronic mental patients attending a psychiatric rehabilitation program in Hong Kong adopting a self-help group (SHG) approach with holistic care emphases on the physical, psychological, social, and spiritual functioning of the program participants. A quasi-experimental design involving an experimental group (109 participants attending the program) and a control group (154 patients from a psychiatric outpatient clinic who had never attended any SHG before) was adopted with the participants responding to measures assessing their functioning in the physical, psychological, social, and spiritual domains. Results showed that those who joined the SHG with holistic care elements had more friends and more social satisfaction than the control subjects. Duration of attendance, religious involvement, and group involvement were three key factors related to the outcomes of the program participants. This pioneering study provides support for the effective use of the SHG approach with holistic care elements to help discharged chronic mental patients in the Chinese culture. Andrew L. Luk and Daniel T.L. Shek Copyright © 2006 Andrew L. Luk and Daniel T.L. Shek. All rights reserved. The Theory and Practice of Consultation-Liaison (CL) Psychiatry in Trinidad and Tobago with Reference to Suicidal Behavior Mon, 01 Jan 1900 00:00:00 +0000 Consultation-Liaison Psychiatry (CL Psychiatry) is not a well-established discipline in developing countries. It is a multifaceted area that incorporates clinical, teaching, and research activities both within the hospital and extramurally in community health services. Our purpose was first to define the role of CL Psychiatry, to review essential steps in the process, and to advise on how to set up services. Second, a 1-year retrospective analysis was conducted on all patients referred. A total of 708 persons were referred for psychiatric consultation, of which 41% (291) were referred because of suicidal behavior. Sixty-six percent were female and there was an over-representation of Indo-Trinidadians (67%). Twenty-six percent of all cases of suicidal behavior were diagnosed with clinical depression, 3% were suffering from a psychotic illness (schizophrenia), and 8% (24/291) were under the influence of alcohol. The most vulnerable group was the 25- to 35-year-old age group, accounting for 27% (78/291) of attempters, with the largest number of female attempters. The 36- to 55-year-old males were most likely to attempt suicide (35/99). Ingestion of a toxic substance was the most popular method among all races, genders, and age groups. Of all referrals, 95% originated from medical wards. The most common reason cited for attempts was depressed mood, secondary to a domestic dispute with a family member or significant other. Among Caribbean countries, Trinidad and Tobago has high rates of suicide and suicidal behavior, depression, and alcoholism. CL psychiatrists have a major role to play in the delivery of services to these groups, facilitating the transition of care from admission in the emergency room to discharge and follow-up in the community. Hari D. Maharajh, Petal Abdool, and Rehanna Mohammed-Emamdee Copyright © 2008 Hari D. Maharajh et al. All rights reserved. Changes in Allergy Symptoms and Depression Scores Are Positively Correlated In Patients With Recurrent Mood Disorders Exposed to Seasonal Peaks in Aeroallergens Mon, 01 Jan 1900 00:00:00 +0000 Although growing evidence supports an association between allergy, allergens and depression, it remains unknown if this relationship is between “states” (possible triggers) or “traits” (possible vulnerabilities). We hypothesized that patients with recurrent mood disorders who are sensitized to tree pollen (as determined by allergen specific IgE antibodies), in comparison to those who are not sensitized, would report larger negative changes in mood during exposure to tree pollen in spring. We also hypothesized that differences between high and low tree pollen periods in self reported allergy symptoms would correlate positively with differences in self reported depression scores. We present 1-year preliminary data on the first 51 patients with unipolar or bipolar disorder (age: 19-63 years, 65% female, twelve patients were tree-pollen IgE positive). Ratings of mood and allergic disease status were performed once during the peak airborne pollen counts and once during the period of low airborne pollen counts, as reported by two local pollen counting stations. Linear regression models were developed to examine associations of changes in depression scores (dependent variable) with tree pollen sensitization, changes in the allergy symptom severity score, adjusted for gender and order of testing. We did not confirm the hypothesized relationship between a specific tree pollen sensitization and changes in mood during tree pollen exposure. We did confirm the hypothesized positive relationship between the changes in allergy symptoms and changes in subjects' depression scores (adjusted p<0.05). This result is consistent with previous epidemiological evidence connecting allergy with depression, as well as our recent reports of increased expression of cytokines in the prefrontal cortex in victims of suicide and in experimental animals sensitized and exposed to tree pollen. A relationship between changes in allergy symptom scores and changes in depression scores supports a state-level rather than only trait-level relationship, and thus lends optimism to future causality-testing interventional studies, which might then lead to novel preventative environmental interventions in mood disorders. Teodor T. Postolache, Manana Lapidus, Evan R. Sander, Patricia Langenberg, Robert G. Hamilton, Joseph J. Soriano, Jessica S. McDonald, Nancy Furst, Jie Bai, Debra A. Scrandis, Johanna A. Cabassa, John W. Stiller, Theodora Balis, Alvaro Guzman, Alkis Togias, and Leonardo H. Tonelli Copyright © 2007 Teodor T. Postolache et al. All rights reserved.