28^th World Congress on Psychiatry, Psychological Syndromes and Therapeutics May 21-22, 2018 New York City, New York, USA

Anna Scandinaro is a third year Medical student at Penn State College of Medicine.

Primary care practitioners are often called upon to differentiate normal from abnormal irritability, but little education is provided to prepare them to do so. Assessing the mental health of a child is a challenging task. This study used appreciative inquiry to answer the question, “How do family medicine practitioners assess and treat irritability in school aged children?” To gain an initial perspective on how practitioners in Family Medicine (FM), Pediatrics (PED), and Psychiatry (PSY) evaluate and treat school-aged children, 17 volunteers participated in in-depth interviews. The participants in primary care expressed frustration over the lack of time and specialized knowledge they had to accurately assess children, even though they were often the first clinician consulted when problems arose. There were clear and sometimes contradictory differences between how practitioners with a general vs. specialized practice assessed mental health status in the clinic setting. In addition, input on treatment approaches revealed that medication prescription was more common in primary care and therapy preferred by the PSY participants. School referrals were common pathways to the FM and PED clinic, where practitioners often focused on assessing functional status to assess normal vs. abnormal irritability. Based on the initial assessment, FM and PED participants often referred the child to more specialized treatment, particularly when complex medication prescription was involved. They were also significantly less confident of their ability to evaluate mental health status, while child and adolescent psychiatry participants were supportive of having more initial triage and possible treatment occur at the primary care level.

Soumen Acharya is working as Consultant at National Institute of Public Cooperation and Child Development New Delhi, India. Previously, he worked as Supervising Officer at All India Institute of Medical Science for 21 years’ and also worked in New Zealand. He published many papers in a leading journal. He is the Life Member of organizations like: Social Psychiatry in India and Fellow of Social Psychiatry of India.

Objective: To evaluate the association between the use of nitric oxide in the pulmonary arterial hypertension (PAH) and the level of aggression in children with acyanotic congenital heart diseases and especially to evaluate the development rates of aggressive behaviors in ICU setting in patients with borderline PAH after correction of congenital heart surgery. Methods: The study was performed with data of 327 patients with acyanotic congenital heart diseases and underwent open heart surgery between January1984-February1995. The design of the study was retrospective and observational. All the patients in this case were given nitric oxide in a controlled manner. The patients were observed before surgery to have aggressive behavior. All patients were evaluated with observational methods. They were classified according to the mean pulmonary artery pressure and level of the surgery. Chi-square, ANOVA tests were used for statistical analysis. Results: The patients were analyzed before coming to ICU before the surgery by observational method. The patients were observed in the field of nitric oxide was detected in 94.8% of patients with PAH and 17.2% of no PAH patients after giving them nitric oxide A negative association was detected between mean pulmonary arterial pressure and body weight for age and z scores of weight (p<0.001 for all). Z scores of weight and height were significantly decreased in patients with PAH in contrast to no PAH group (p<0.001, p<0.01 respectively). There was no statistical difference between no PAH and borderline PAH groups according to this study and relative body weight formula, however z scores of weight in borderline PAH group were decreased compared with no PAH group (p<0.001). The use of nitric oxide in ICU setting finds an important role. The use of nitric oxide showed that the aggression level after the surgery was less as compared before the surgery. Conclusion: A positive association was detected between the use of nitric oxide in ICU setting and the degrees of PAH and level pulmonary hypertension in children with a cyanotic congenital heart disease with open heart surgery. There should be more study in this field and the proper experimental study should be done to further evaluate this study.

Alexandrino-Silva Clóvis Junior is Graduate in Medicine at the Faculty of Medicine of Fundação do ABC, São Paulo, Brazil (2003), and underwent Medical Residency in Psychiatry at the same institution. He got his Doctorate degree from the Department of Psychiatry at the Faculty of Medicine of the University of São Paulo (2012). Currently, he is a Post-doctoral Research Fellow at the Old Age Research Group (PROTER) from the Department of Psychiatry at the Faculty of Medicine of the University of São Paulo. He was also Coordinator of the Psychiatric Emergencies Service of the Santo André Hospital Center, Research Doctor and Collaborator of the Disciplines of Psychiatry and Medical Psychology at the Faculty of Medicine of Fundação do ABC and Medical Researcher at the Faculty of Medicine of the University of São Paulo. He holds a specialist title in Psychiatry and professional competence certificate in psychogeriatric obtained from the Brazilian Association of Psychiatry.

Objective: To examine the prevalence of clinically significant depressive symptoms (CES-D≥13) and their correlates in an elderly population-based study in São Paulo, Brazil. Methods: A random sample of 2,673 subjects aged 60 years or more were interviewed, and 2,501 individuals were eligible for the analysis of the frequency of depressive symptoms. The results were presented as absolute and relative frequencies. The odds ratio and 95% confidence intervals values were obtained using univariate logistic regression. Results: We observed a prevalence of clinically significant depressive symptoms in 42.98% of the sample (95% CI=41.05-44.93). The main correlates of clinically significant depressive symptoms were: being female (OR 2.087, CI 1.76-2.47); belonging to the oldest age group (≥80 years) [OR 1.333, CI 1.01-1.74]; being divorced/single (OR 1.607, CI 1.3-1.97) or widowed (OR 1.465, CI=1.21-1.77); and family history of depression (OR 1.82, CI 1.42-2.32). Stroke was the clinical comorbidity that presented the highest odds (OR 2.554, CI 1.9-3.43) for the development of clinically significant depressive symptoms, although other cerebrovascular diseases were also associated with the development of depression. Clinically significant anxiety symptoms (GAI≥13) increased the odds of clinically significant depressive symptoms by almost twenty-fold (OR 19.544, CI 14.75-25.9). Dissatisfaction with the appearance of teeth also associated with clinically significant depressive symptoms (OR 2.147, CI 1.78-2.58). Interestingly, current alcohol consumption was associated with a lower chance of presenting clinically significant depressive symptoms (OR 0.745, CI 0.63-0.87), and this association was maintained for subjects who consumed more than 2 drinks per day (OR 0.484, CI 0.33 -0.7) or more than five drinks per occasion (OR 0.491, CI 0.31-0.77). The elderly who did not practice physical activity were more likely to present clinically significant depressive symptoms (OR 1.663, CI 1.36-2.03), and the higher the weekly frequency of hours practiced, the lower was the chance of presenting depressive symptoms (2-5 hours/week: OR 0.591, CI 0.44-0.79; 6-7 hours/week: OR 0.51, CI 0.31-0.83; and 8 hours or more/week: OR 0.411, CI 0.24-0.7). Conclusions: Sociodemographic characteristics, family history of depression and cerebrovascular diseases were associated with greater odds of presenting clinically significant depressive symptoms. The inverse relationship between alcohol consumption and the presentation of depressive symptoms needs to be better investigated. Physical activity seems to play an important role in preventing depression in the elderly.

Mili Kakadia has been a student of Government Medical College, Bhavnagar, India from August 2011 and graduated in MBBS (Bachelor of Medicine; Bachelor of Surgery) in March 2017. She is now preparing for USMLE step 2 to pursue residency in USA.

Tobacco consumption has been an addiction in India since time immemorial. Bhavnagar is a city with tobacco chewing rates higher than most cities in India. Considering the enormous health complications associated with tobacco use, it is of utmost importance to understand the factors leading to its use and to plan strategies to reduce its intake. Report of this study reviews the tobacco chewing practice in different age groups, reason of starting, any awareness about its health related adverse consequences, any attempt of quitting, total monthly expenditure on tobacco etc. A cross-sectional study was conducted in Vadva, an urban slum settlement in Bhavnagar city (Gujarat, India). The area represents the low socio-economic group and inhabits diverse ethnicities. The information was collected on a pre-tested semi-structured questionnaire determining the frequency of use, knowledge and attitude regarding chewing tobacco. Among the population studied, out of 150 respondents, 108 respondents (72%) were chewing tobacco in some form. Tobacco use in urban slums of Bhavnagar city is almost thrice than the rest of India (25.9%) but higher among lower social economic group. The fact that women are also chewing tobacco is a matter of concern. More than three-fourth of the tobacco chewers started chewing due to peer pressure. More than 95% of the tobacco chewers were aware of the harmful effects due to tobacco chewing. About three-fourth of the tobacco chewers continue to chew tobacco as they are now addicted to it. More than 43% of the tobacco chewers agreed that this habit of theirs puts an economic burden on them pulling them below poverty line. Tobacco control therefore should be a top priority amongst the substance abuses in Bhavnagar.

Meng Zi Jie Aaron is a graduate of Yong Loo Lin School of Medicine from the National University of Singapore. He is currently a Senior Resident of the local Psychiatry Residency Programme and is in his final year of training at Ng Teng Fong General Hospital. He has undergone rotations in most fields of Psychiatry, including Adult General Psychiatry, Child and Adolescent Psychiatry, Psychogeriatric, Addiction Medicine, Consultation and Liason Psychiatry and Forensic Psychiatry.

Olfactory reference syndrome (ORS) is an interesting psychiatric condition which is characterised by a preoccupation that one emits body odour, which is not perceived by others. While anecdotally described as a discrete condition, its phenomenological overlap between anxiety and psychotic disorders poses a challenge in diagnostic classification. We present a case of a 19 year old Chinese Male who was referred through his gastroenterologist for having a fixed persistent belief of having an offensive body odour, which seemingly worsened after his mother had passed away. He was found to have significant anxiety and coped with safety behaviours which had become maladaptive with time. His excessive worries were also associated with psychotic symptoms of referential delusions and olfactory hallucinations related to flatulence. As in our case, the clinical picture of ORS may cross both anxiety and psychotic symptoms and warrants further review in the latest diagnostic classification manual.

Despoina Drivakou is a Psychologist, trained in Systemic Approach Psychotherapy. She earned her MSc from the Medical School of Thessaloniki in Epidemiology and Public Health and continued her studies as a PhD candidate in Psychology of Health. She is a Psychologist and has private practice in Thessaloniki, working with couples, families and individuals. She is an academic staff member of QMU- Department in Thessaloniki and is Instructor of “Health and Welfare” and “Public Health Practices”. She treats people with dementia in a care home for elderly people. The areas of trauma, PTSD, ADHD and quality of life for elderly people are her scientific and clinical interests. She is a member of the Systemic Company of Northern Greece and ELPSE. She is the Founder and President of the NGO EP7A that aims to provide awareness on health education to people.

Objective: The aim of this study was to investigate the relation of 25(OH) D levels with anxiety and depression symptoms in elderly individuals. Depression and anxiety are common in elderly individuals. Vitamin D insufficiency/deficiency is common in the elderly. However, a limited number of studies has analysed the association between vitamin D levels and anxiety/depression prevalence in elderly population. Methods: Data were collected from 130 elderly individuals (N=130, 60-98 years) attending the Κ.Α.P.I of East Prefecture of Thessaloniki, from October 2015 to November 2017. Blood samples were collected during the winter periods and vitamin D levels were measured. The psychological state of the participants was assessed with the STAI, which comprises two scales: S-Anxiety and T-Anxiety. Furthermore, symptoms of depression were assessed with the CES-D scale, a useful tool for detection of this clinical entity independent of the psychological wellness. The indicated value index for the presence of depression in Greek population is greater than 9.03. The statistical data processing was carried out using the SPSS. Results: Data from 130 individuals were analysed. They were classified as vitamin D sufficient (25(OH) D >30 ng/ml), insufficient (25(OH) D: 21-29 ng/ml), deficient (25(OH) D < 20 ng/ml) and severely deficient (25(OH) D <10 ng/ml). 67.7% of the participants (n=88) were either insufficient or deficient and 5.4% of the participants (n=7) were found to suffer from severe vitamin D deficiency. 80% (n=71 of participants) of the insufficient/deficient cohort were suffering from anxiety or depression while either anxiety or depression symptoms was present in half of the participants that were vitamin D sufficient. All individuals (n=7) that suffered from both anxiety and depression were vitamin D severely deficient. Conclusions: Both anxiety and depression are common in elderly individuals. Vitamin D deficiency or insufficiency may be an additional factor that promotes these conditions.

Esheref Haxhiu is a PhD candidate in Psychology at The University of Warsaw, Poland. He has completed his Master’s in Counseling Psychology at Sheffield University. He has completed his Bachelor’s at The University of Pristina. Previously, he has worked as a high school Teacher of Psychology in Kosovo.

Background & Aim: The Difficulties in Emotional Regulation Scale (DERS) is a 36-item self-report scale, designed to assess multiple aspects of emotional dysregulation. These aspects include: an acceptance of emotional responses, difficulties engaging in goals-directed behavior, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and the lack of emotional clarity. The DERS is a new and promising scale, and the previous findings suggest that it has good psychometric properties. The purpose of the present study is to make the Albanian population adapt the DERS scale. Methods: Two independent professional translators have translated the scale from the English version into Albanian, and then the back translation was done from another third translator. After completing the translation process, a sample of 340 high school students (n=340), age 18-19, fulfilled the questionnaire twice in a two-week period. Results: The results reveal that the Albanian version of DERS has good psychometric properties. The internal consistency of the scale in both study phases was shown to be high (α ≥0.85), as well the test-retest reliability (r=0.85). Conclusions: The Albanian version of DERS is a reliable scale for measuring the difficulties in emotional regulation for the respective population.

Vijaya Padma Kotapati has completed her Medical School from Meenakshi Medical College in India. After completing her degree she cleared her USMLE with flying colors. She has a keen interest in research and wants to pursue Psychiatry residency and will be applying in the upcoming March. Currently, she is working at Manhattan Psychiatric Center as a Research Intern.

Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRI) are the first pharmacological choice for this condition due to mild adverse effect profile. This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children. Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline CY-BOCS, end-treatment CY-BOCS with respective SD and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane RevMan software was used for meta-analyses, providing Forest plots where applicable. SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over CBT alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and Sertraline appear to be superior to Fluvoxamine. The results of current systematic review and meta-analysis support the existing NICE guidelines for choosing CBT as the first line of treatment and substituting it with SSRI depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders, but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness and their relative efficacy remains to be investigated.