Day :
- Psychiatric Disorders and Clinical Case Reports
Location: SEGRE
Chair
Thomas Eduard Schlaepfer
University of Bonn, Germany
Co-Chair
Guillem Feixas Viaplana
University of Barcelona, Spain
Session Introduction
Rocco de Fillips
Istituto di Psicopatologia, Italy
Title: Continuous circular cycling in bipolar disorder as a predictor of poor outcome
Time : 11:50-12:10
Biography:
Rocco de Filippis completed his MD and PhD from Catholic University of the Sacred Heart in Rome. Investigator Meeting (Western Europe and North America) per il BRENDA/Studio di fase II farmacologico sul Nalmefene (LUNDBECK - pharmaceutical company). Barcellona (Spagna) . He holds a Master’s degree and he improved respectively in Bipolar Disorders and Addictive behavior in the years 2011/2012. He currently works and at the Institute of Psychopathology - Rome as a Psychiatrist and Addictive Medicine, and up to now presented as scientific coordinator of CME and Master of Addictive Behaviors; he currently publishes on Bipolar Disorders with high specialization on rapid cycling;he is also an official candidate at the Psychoanalytic Italian Society of the First Italian Center of Rome, and member of IPSO (International Psychoanalytic Studies Organization). He had a oral speech at Translational Medicine 2014 in Las Vegas on QTc Prolungation and Psychotropic Drugs.
Abstract:
Objective: This prospective study aims to determine if patients with bipolar disorder with a continuous circular course (CCC) are significantly different in clinical characteristics and response to long- term treatment from those with a non-continuous circular course (N-CCC). CCC was defined as the alternation of depression and (hypo)mania without a completely free well interval, and N-CCC as the presence of symptom- free intervals after the sequence mania-depression or depression-mania. Method: The study sample includes 140 consecutive patients with bipolar I or II disorder according to DSM-IV criteria, aged 18-65 years and receiving prophylactic treatment for ≥1 year. Treatment was based upon international guidelines and clinical experience at the time of patient\\\'s enrollment (from January 1998 to January 2006). Primary outcome was the absence of new episodes during the follow-up. Significance level was set at p<.05
Massimo Cocchi
Paolo Sotgiu Institute for Research in Quantitative & Quantum Psychiatry & Cardiology, Switzerland
Title: Linoleic Acid and Psychopathology
Time : 12:10-12:30
Biography:
Paolo Sotgiu Institute for Research in Quantitative & Quantum Psychiatry & Cardiology, Switzerland
Abstract:
The particularity of our investigation is an almost unique opportunity for groped a hypothesis about the evolutionary aspects of the behavior of brain and consciousness, as represented in the human and animal world, as a result of the evidence that led to the diagnostic classification of mood disorders in humans, in their similarity with some animal species. A logical sequence of considerations about the mood disorder diagnosis, due to unequivocal evidence by the use of mathematical tools that cannot be manipulated, it leads to results that most probably indicate and suggest the existence of a common brain “biochemical house“, in man and animal. This “common house” will become more and more complex, during evolution, from animal to man, respecting the concept of the molecular equilibrium and allowing to each living being the adaptation to their needs and their roles. Small deviations from the biochemical equilibrium of brain fatty acids can manifest pathological behavioral responses, much amplified. Everything seems to be witnessed by the strong classificatory correspondence of the platelets fatty acids which correspond to psycho pathologies, especially for the Linoleic acid, which, to varying percentages, it may correspond to psychopathological phenomena.
Guillem Feixas
University of Barcelona, Spain
Title: Views of self and mental distress: Negative or conflictual?
Time : 12:30-12:50
Biography:
Guillem Feixas, now Professor at the Faculty of Psychology of the University of Barcelona, completed his PhD at this center and hold a postdoc position at the University of Memphis, USA. He is the director of the Master in Cognitive Social Therapy and other postgraduate courses. He has published more than 90 papers in reputed journals and 10 books and led several research projects. His investigations have been focused in interpersonal construing and its role in health (both mental and physical), and in the process of psychotherapy.
Abstract:
Negative self-views have been considered a common trait of many psychiatric disorders (particularly, depression) and for psychological distress in general. However, some lines of research have shown that cognitive conflicts represented by conflicting positive and negative self-perceptions can be vulnerability markers of high significance but often neglected or under-researched. We have conducted a series of studies testing out the relevance of these internal conflicts using the repertory grid technique to carefully assess patients’ constructions of self and others and to explore conflicts between their personal constructs. Our results show that patients with depression, eating disorders and other clinical conditions present a pattern of mixed positive and negative self-descriptions with a high rate of conflict. Regression analyses yielded support to the conflict hypothesis in relation to clinically relevant indicators such as symptom severity, and global functioning. Therefore it would be useful for therapy to focus on conflict resolution, making desirable changes in behaviour and mood compatible with the need for preserving coherence of identity. For example, psychological interventions could target dilemmas as a therapeutic focus and enable therapists to tailor treatment to fit their patient’s own experiences. Finally, several studies using interventions targeted to resolve cognitive conflicts will be examined in terms of available evidence and range of disorders to which they could be implemented. They could also be considered as transdiagnostic interventions.
Gino Serra
Universita di Sassari, Italy
Title: Memantine: A new mood-stabilizer for treatment-resistant Bipolar disorders
Time : 13:40-14:00
Biography:
Gino Serra is a Psychiatrist and Full Professor of Pharmacology at the University of Sassari, Department of Biomedical Science. In 1979 he first suggested that potentiation of dopaminergic transmission in neurons arising in the substantia nigra/ventral-tegmental-area induced by repeated treatment with antidepressants plays an important role in their therapeutic effects Recently, He suggested , and he and his collaborators developed preliminary clinical support for the proposal that memantine may exert beneficial, mood-stabilizing effects. Indeed, they have recently observed in 3 naturalistic clinical studies that memantine, as an augmenting agent, was associated with clinically substantial antimanic and sustained mood-stabilizing effects in otherwise treatment-resistant bipolar disorder patients, with excellent tolerability and safety.
Abstract:
We have recently suggested that blockade of NMDA receptors by memantine could result in an antimanic and mood-stabilizing effect in treatment-resistant Bipolar Disorders (BD). Our group found suggestive evidence of mood-stabilizing actions in 40 BD patients in an unblinded, 12-month trial when added to stable, ongoing but inadequately effective standard treatments. Memantine as a monotherapy also has been reported to show beneficial effects in a few individual BD patients, including after discontinuation of lithium treatment. Finally, we published the results of a three-year naturalistic assessment of adding memantine to 30 treatment-resistant bipolar patients at the LucioBini Mood Disorder Center in Rome. In this unblinded trial, memantine appeared to add substantial long-term benefits, for both depressive and mania-like (mania, hypomania) morbidity, in outpatients who had responded consistently unsatisfactorily to standard treatments for more than 3 years, until memantine (20–30 mg/day) was added clinically to otherwise stable regimens for another 3 years, during which patients improved progressively. Memantine showed marked, statistically significant decreases of duration of illness (total, manic and depressive illness, on average –74.2%), symptom severity scores (CGI-BP; –63.1%), duration of new episodes (–56.3%), and recurrence frequency (episodes/year; –55.8%). These findings indicated impressive improvement in the duration and severity of both affective phases of the disorder, with a greater improvement of depression than mania, and evidence of decreased severity of mania indicated by shifting to hypomania. Subjects with previous rapid- (≥4 episodes/year) or continuous-cycling were particularly improved. The possible mechanism of mood stabilizing effect of memantine will be discussed.
Ivanka Zivcic Becirevic
University of Rijeka, Croatia
Title: Depression and Anxiety in University students
Time : 14:00-14:20
Biography:
Ivanka Zivcic Becirevic is a full Professor of clinical Psychology at Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Croatia. She is the head of a postgraduate specialist program in psychological counseling, head of the University Counseling Center at University of Rijeka and President of Croatian Association for Behavioral and Cognitive Therapies. She has published 44 scientific and professional papers and 6 book chapters.
Abstract:
The psychological problems among students are relatively common, especially symptoms of anxiety and depression, with significant increase in the last two decades. They often interfere with students academic performance through low motivation, poor concentration and general low capacity for work. The results of our 3-years longitudinal study with representative sample of 492 freshmen (60% women) indicate that 52% students have higher level of anxiety and 23% higher level of depressive symptoms when starting college. Based on the cognitive model we have checked the possible moderator role of different cognitive factors contributing to the change in the level of students symptoms, as well as possible protective factors in academic success. Even if depressive symptoms are not as common as anxiety symptoms among students, it seems more important to recognize and alleviate first signs of depression as they have more deleterious effect on academic functioning. Anxious student often feel high stress, but depressed students are at much higher risk for longer attending or dropping out from college. Our results gave strong support for using cognitive-behavioral interventions with depressed students. Cognitive strategies should focus on their negative automatic thoughts during learning and taking exam (especially thoughts related to fear of disappointing parents), expectations and attributions of their success, as well as beliefs about personal control over their achievements. As we have found that better academic adjustment at the beginning of college, better organization and study skills can protect depressed students from dropping out, the behavioral interventions should focus at improving academic skills.
An bang Yu
Institute of Ethnology, Taiwan
Title: The key issue of Clinical Humanities
Time : 14:20-14:40
Biography:
An bang Yu is an associate research fellow at the Institute of Ethnology, Academia Sinica, Taiwan. He received his Ph.D. from National Taiwan University, where he majored in social and personality psychology. His areas of research interest include religious experience, faith healing, self and emotion etc. His indigenous psychological research has focused on Chinese culture and emotion, the body and illness, clinical humanities, and clinical-philosophical practice.
Abstract:
The real purport of “clinical humanities” is putting oneself in an unexpected (calamity or pain) situation and being unable to understand others’ real situations and; hence, uncovering oneself. Therefore, the so-called “clinical humanities” (a verb) attempts to break the self-recursion in humanities and social sciences and puts humanities and social sciences in a helpless and confused state. Then it can achieve humanistic development in human clinical sites, such as illness, disaster, loss of family member and other calamitous situations, while also forming an on-site humanistic support network. At various clinical sites, on the one hand, the inertia of the humanities and social sciences should be broken, and the voice of suffering should be heard to obtain new self-reflections. On the other hand, through self-reflections, humanities and social sciences can transform and penetrate a suffering situation to extract profound humanistic knowledge. Under this context, “clinical humanities” (a noun, referring to transformed humanities and social sciences) truly participates in human suffering situations and has a professional framework that is different from conventional suffering alleviation. It also has its own unique rhythms. The purpose of my research in recent years is to show the multiplicity of “indigenous/cultural psychology” and “clinical humanities and healing.” My studies try to highlight some of the alternative new meanings of “clinical humanities” and the true manifestation of the encounter between “clinical humanities” and “indigenous/cultural psychology.”
Maria Lidia Gouveia
Ministry of Health, Mozambique
Title: Mental health in Mozambique (1984 – 2009)
Time : 14:40-15:00
Biography:
Maria Lidia Gouveia is renowned scientist presently working with Ministry of Health in Mozambique. His work mainly concentrates on addiction psychiatry and DNA sequencing. Lidia has huge contributions in understanding and development of public mental health in Mozambique.
Abstract:
Several efforts have been made to improve health care for people with mental and behavior disorders in Mozambique. Nevertheless, new steps to a dynamic and innovative era have to be taken in order to guarantee this services quality and expansion with the quality needed. Staring from the First National Mental Health Seminar in 1984, crossing the creation of National Mental Health Program in 1990, running a long way until 2006 when the Second National Mental Health took place, and concluding with the creation of Mental Health Department at Ministry of Health in 2008, the mental health trajectory in Mozambique can be considered historic. The need to expand psychiatry and mental health services and training human resources are some of the main spotlights for developing this huge health area in Mozambique.
- Childhood and Adolescent Psychiatry
Location: SEGRE
Chair
Ivanka Zivcic Becirevic
University of Rijeka, Croatia
Session Introduction
Rivka A. Edery, M.S.W. L.C.S.W.
Psychotherapist, USA
Title: Trauma and Transformation: A 12 Step Guide
Time : 15:10-15:30
Biography:
An experienced psychotherapist, published author on trauma, and radio show co-host addressing issues of adult survivors. I am very passionate about the healing process, and helping people acknowledge their truths, strengths, stumbling blocks, and buried gifts. I am an excellent communicator, understanding that to take the time to speak a person’s language may be the beginning of their healing.
Abstract:
ABSTRACT: The consequences of surviving trauma are complex, making it difficult to formulate a recovery and treatment plan. The most common defense mechanism, and the toughest one to work through, is denial. Throughout human history, lack of knowledge and non-acceptance of the perpetrators misdeeds has placed the suffering of survivors behind an armored wall, perpetuating traumatic effects. No recovery can occur behind this wall of forced silence, ignorance and lack of helpful resources. Over the last two decades, research has revealed the frequency of traumatic events, and their injurious effects on a survivor’s psyche. Mental health professionals have come to understand the connections between unresolved trauma and serious psychological problems. The role of spirituality in trauma recovery is often misunderstood and subsequently minimized. Trauma survivors usually have a difficult time experiencing their vulnerability and the attending feelings of having once been profoundly helpless and alone. The process of unearthing one’s memories and re-experiencing anguish requires the help of skilled, knowledgeable and spiritually grounded professionals who have done healing work on themselves. Interest and research on the healing effects of applying spiritual tools to the multi-layered consequences of trauma survival - including emotional pain, and interpersonal difficulties - has burgeoned. This book, “Trauma and Transformation: A 12-Step Guide”, discusses the efficacy of the 12 Steps of Alcoholics Anonymous to address and heal the root causes and conditions of dysfunctional behaviors, lack of meaning in life, and persistent psychic pain. Results: The primary outcome measure is the client’s self-report on improved affect regulation, reduced depression, decrease in maladaptive behaviors, decreased sense of helplessness and hopelessness, increased sense of personal accountability, meaning and purpose in life, and greater ability to modulate arousal; both physical and emotional.
Wenn Lawson
Private Practitioner, Australia
Title: Autism: Problem behaviours are they due to poor theory of mind or could it be the non-generalization of ‘Object permanence’?
Time : 15:50-16:10
Biography:
Dr. Wenn Lawson is a psychologist (UK) and member of the Australian Psychological Society. Wenn is also a qualified social worker with the ASSW. Specializing in training for autism spectrum conditions for over 20 years, Dr. Lawson is well known in the Northern and Southern hemispheres. As a researcher, an author (of more than 12 books); conference speaker, seminar presenter and university lecturer, Dr. Lawson is passionate about his work. All of Dr. Lawson’s work is research based, practical and accessible. Dr. Lawson is on the editorial board for the Open Access Autism Journal, a teaching fellow with the University of Birmingham’s Distant Ed. Autism Master’s course and involved with The Middleton Centre for Autism in Ireland. As well as presenting and writing on the topic of autism spectrum conditions, Dr. Lawson lectures on Learning Difficulties at Melbourne University, Australia. Dr. Lawson is an autistic adult, a parent of 4 children, the younger one being autistic too and grandparent to three, (including two gorgeous little girls, also on the autism spectrum). All of Dr. Lawson’s work is presented from the insight of living and working with autism.
Abstract:
This presentation concerns children with autism and their understanding of what's 'here, now, permanent, on-going and so on, even when it's out of sight'. For example, one 4 yr. old & one 7yr. old girl with autism know their drinks bottles are in their lunch bag, even when they can't see them, BUT, they don't know that Mummy (or some other person/thing/event) are still available, happening and so on, even though out of sight. How is it they know one concept, but not the other? Could it be connected to lacking in a more generalised understanding of Object Permanence (OP)? If so, maybe this challenges aspects of ‘lacks in theory of mind’ in autism? As in, could failure of theory of mind tasks actually be explained by lacks in object permanence? If so, it explains so much of the fear and possibly subsequent stress support needs we see in these children. So, this presentation explores autism in children and adolescents with regard to problem behaviours often thought to be due to poor theory of mind. But, the author will argue that such behaviours are in fact connected to non-generalization of Object Permanence.
Cigdem Yuksel
Gulhane Military Medical Academy, Turkey
Title: Transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS)
Time : 16:10-16:30
Biography:
Cigdem Yuksel is psychiatrist presently working with Gulhane Military Medical Academy in Turkey. Her expertise includes child and adolescent mental health services, medication in nursing, Proton Magnetic Resonance Spectroscopy in Social Anxiety Disorder, schizophrenia & major depression comorbidity.
Abstract:
Although child and adolescent’s transition from child and adolescent services to adult services has received much attention in the field of physical health, little attention has addressed the transition process in mental health services [1]. Nonetheless children and adolescents often struggle to move between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), and in particular that they are poorly supported. There is a growing evidence-base for interventions with children and adolescents, but transition in mental health settings is still the area where the evidence-base is scant [2]. A number of detailed international clinical guidelines
 has produced to guide intervention in mental health problems occurring in children and adolescent but still there are some differences among between them. It is important to use best practice guidelines to close the gap between current operational practice and the evidence-based practice in transition [3]. The purpose of this paper is to provide a critical review through screening literature for the guidelines released between 01.01.2010-01.03.2015 about transition between child and adolescent mental health services and adult mental health services and to describe the basic steps of effective transition in common. Google database were screened between 27.01.2015 and 01.03.2015 with the key words of ‘national transition guideline, CAMHS, AMHS’ and research restriction “all in text”. As a result of the screening, a total of 36 guidelines were obtained and 11 suitable results were taken into consideration. The results of this review study show that all guidelines define some issues in common. These are a) involving the young individual and the family for transition plans, b) early planning, c) referring the individual to accessible services appropriate to age, d) working in collaboration with other professionals and agencies, e) providing appropriate and accurate information, f) managing the service transition process, g) assessing needs and letting the individual to perform a more central role in deciding his/her care plan, h) assuring continuity of care and follow-up with planning and assessments, i) reviewing and evaluating practice and service models, and include young people, families and careers in the process. Focusing on the whole life of the child and adolescent when assessing needs and planning transition, including their family, friends, housing, school, college and work, as these factors will affect their overall wellbeing. Poor service transitions may cause disengage from mental health services despite continuing is needed which can seriously affect a young person's health and wellbeing, as well as that of their parents, careers and wider family. Adverse outcomes in mental health are associated with difficulties in many aspects of life, including being able to take advantage of education, training and employment opportunities. Proper planning in transition may improve mental health outcomes for child and adolescents
- Symposium on Personalized Medicine in Psychiatry: A Look to the Future
Location: SEGRE
Chair
Charles B Nemeroff
University of Miami, USA
Session Introduction
Charles B Nemeroff
University of Miami, USA
Title: Personalized medicine in Psychiatry
Time : 09:00-09:30
Biography:
Charles B. Nemeroff received his MD and PhD (Neurobiology) from the University of North Carolina at Chapel Hill. His residency training in psychiatry was conducted at both the University of North Carolina and at Duke University, after which he joined the faculty of Duke University. His research has concentrated on the biological basis of the major neuropsychiatric disorders, including affective disorders, schizophrenia, and anxiety disorders. His clinical research is focused on the use of genetic, neuroendocrine, neuroimaging and neurochemical methods to comprehensively understand the pathophysiology of depression. In recent years he has uncovered the neurobiological mechanisms that mediate the increased risk for depression in victims of child abuse. In 2006 he received the American Psychiatric Association Research Mentoring Award and Vestermark Award, and in 2008 The Judson Marmor Award for Research. He is currently a member of the Board of Directors of the American Foundation for Suicide Prevention, and the Anxiety and Depression Association of America. He served as chair of the APA Committee on Research Training. In 2002 he was elected as a member of the Institute of Medicine of the National Academy of Sciences.
Abstract:
Severe psychiatric disorders are, based on recent data from the Global Burden of Disease Study, one of the most significant contributors to disability and disease burden. One of the major factors driving this finding is the absence of reliable laboratory or imaging tests to predict vulnerability, for diagnosis and for response to one or another of the effective treatments for these devastating disorders. This symposium will review the burgeoning findings on personalized medicine in psychiatry with a focus on identifying at risk populations for depression, bipolar disorder and the major anxiety disorders and the evolving data base on matching well defined endophenotypes with specific treatments. Thus, Charles B. Nemeroff (University of Miami) will discuss the long term consequences of child abuse and neglect and how this environmental factor interacts with genetic vulnerability to increase risk for depression and PTSD. The implications of these findings for current treatment as well as novel treatment development will be described. Felix Hausch (Max Planck Institute for Psychiatry, Munich) will describe novel findings on the FKBP5 gene polymorphism, its modification by epigenetic mechanisms and the development of novel small molecules with potential for treatment of PTSD and depression. Giampaolo Perna (Lake Como, Italy and University of Miami) will describe the currently available data on personalized medicine in anxiety disorders with a focus on panic disorder. Thomas Schlaepfer (University of Bonn) will describe how functional brain imaging studies have led to the identification of brain circuitry altered in mood disorders and how these findings have led to the development of deep brain stimulation (DBS) for management of treatment resistant depression. These novel research findings suggest that psychiatry will eventually become much more like oncology and infectious disease in being able to predict optimal treatments for individual patients.
Giampaolo Perna
Hermanas Hospitalarias, Italy
Title: Personalized Medicine in Anxiety Disorders
Time : 09:30-10:00
Biography:
Giampaolo Perna has completed his MD and PhD from Milan State University becoming psychiatrist in the same university. He is the chairman of the department of clinical neurosciences of Hermanas Hospitalarias - Villa San Benedetto Menni near Como Lake. He has published more than 100 papers in impacted journals. He is voluntary professor at Leonard Miller School of Medicine, University of Miami and associate professor at Maastricht University. He is the chair of the WPA section on personalized psychiatry and member of the executive board of the Italian Association for Behavior Analysis and Modification and Cognitive Behavioral Therapy (AIAMC).
Abstract:
In anxiety disorders, pharmacotherapy reports non response rates of 30–60% and relapses rates of 53–80%. Similar data are reported for cognitive behavioral psychotherapy. Causes of treatment-resistance are reported in chronicity of illness, severity of symptomatology, psychiatric comorbidity, physical comorbidity, personality traits and molecular causes. In this context, personalized psychiatry (PP) represents a way to come to the aid of these shortages. To date no one discussed this topic in anxiety disorders and among these panic disorder has the unique characteristic to be quite homogenous in its psychopathologic features, with a strong root in body physiology, and to be variable in responses to panic provocation procedures, to treatment options and in long term prognosis. Physiology of panic patients is different from those of healthy controls in particular for respiratory, cardiovascular and postural systems. Specific abnormal physiological functions might be the premise to the identification of differential diagnostic subgroups of patients. Moreover, in the recent years there are evidences of an association between genetic polymorphisms of serotonin transporter, 5-HT1a receptor, MAO and COMT genes and the response to treatment with drugs and with cognitive behavioral psychotherapy. Less consistent findings have been reported for social phobia and generalized anxiety disorder. The identification of genetic and physiologic markers in their interaction with clinical features might help to find tailored treatments that will ensure the best intervention possible for each patient. Parallel findings, although not yet fully consistent, have been reported for social phobia and generalized anxiety disorder.
Thomas Eduard Schlaepfer
University of Bonn, Germany
Title: Deep Brain Stimulation targets for Depression – On the way to personalized treatment?
Time : 10:00-10:30
Biography:
Schläpfer studied medicine at the University of Bern. After residency training at the University Hospital in Bern, he was there head physician of the psychiatric outpatient clinic. Schläpfer is in the area of translational research on mood disorders active. Particular areas of interest are Transcranial magnetic stimulation, deep brain stimulation, and ethical aspects of interventional procedures in psychiatry. In 1992 he moved as a Fellow to the Johns Hopkins Hospital in Baltimore to the Department of Psychiatry and Behavioral Sciences, where he was appointed Associate Professor 1997th In 2003 he became a university professor at the Department of Psychiatry and Psychotherapy at the Rheinische Friedrich-Wilhelms University of Bonn appointed. Since 2006 he has been Vice Dean for Academic Affairs at the local medical school.
Abstract:
A core symptom of major depression is anhedonia (decreased drive and reward for pleasurable activities) and reduced motivation. The human reward system consists of the neural pathways involved in eliciting rewarding experiences in animals and humans its structures, the striatum (particularly the ventral striatum or nucleus accumbens (NAcc) and the medial forebrain bundle (MFB), are important in emotional memory, and might mediate those symptoms. Antidepressant effects of Deep Brain Stimulation (DBS) to the NAcc and two additional targets have been systematically assessed and results in response in 50-60% of patients studied, albeit only at relatively high stimulation intensities. Using probabilistic diffusion tensor imaging (DTI) we were able to demonstrate that all stimulation sites stimulate fibers of the MFB and hypothesized that DBS to the MFB closer to its origin in the ventral tegmental area might be associated with higher antidepressant efficacy at lower stimulation intensities since the extent of antianhedonic effect might be related to the recruited amount of fibers of the MFB. Recently we demonstrated unexpectedly rapid effects of this procedure.
Felix Hausch
Max Planck Institute for Psychiatry, Germany
Title: FKBP51, a risk factor and potential drug target for stress-related disorders
Time : 10:30-11:00
Biography:
Felix Hausch .He was appointed as Exhibition Group Director in Max Planck Institute for Psychiatry. His Research was in Transitional research in Psychiatry. He done his experiment on GermanyFKBP5, the gene encoding FKBP51, has repeatedly been associated in humans with numerous stress-related end phenotypes and with the risk to develop PTSD. Several animal models confirmed FKBP51 as a key regulator of stress responses. How FKBP51 enhances vulnerability to stress-related disorders or how affects neurobiological pathways to impinge on behavior is unknown. Mood and anxiety disorders, including major depression, panic disorder and post-traumatic stress disorder, have a high life-time prevalence and account for more disability than most other diseases worldwide as they are associated with significant morbidity, mortality and increased medical comorbidities.
Abstract:
FKBP5, the gene encoding FKBP51, has repeatedly been associated in humans with numerous stress-related endophenotypes and with the risk to develop PTSD. Several animal models confirmed FKBP51 as a key regulator of stress responses. How FKBP51 enhances vulnerability to stress-related disorders or how affects neurobiological pathways to impinge on behavior is unknown. Here, I will describe novel mechanistic findings from cellular and animal models on the role of FKBP51 in neurons and in stress-coping behavior. I will present SAFit1 and SAFit2, the first selective FKBP51 inhibitors, and their effects in vivo. Finally, I will discuss the prospect of FKBP51 inhibitors as novel class of antidepressants and possible strategies for patient stratification.
- Post- traumatic Stress Disorder and Neuropsychiatry of Addiction Disorders
Location: SEGRE
Chair
Gabriele Dietze
Humboldt University, Germany
Session Introduction
Gabriele Dietze
Humboldt Universität, Germany
Title: Dada, War and Psychiatry – ‘Active Dynamics of Trauma’
Time : 16:40-17:00
Biography:
Gabriele Dietze is a professor at the Department of European Ethnology Humboldt University of Berlin, Germany. She did her fellowship in the DFG Research Unit "cultures of madness" during summer of 2009 and in 2012 she participated in a part-project "Affective masculinities". She has studied German, philosophy, political science in Frankfurt (Main) and American studies and Cultural Studies at the Free University Berlin. She completed her PhD at the John F. Kennedy Institute for North American Studies, FU (". Hard-Boiled Women Sex Wars in American Mystery Novels"); 2004 Habilitation at the Humboldt University Berlin ("justice negotiate. Competition of Race and Gender in US American emancipation discourse"). She was among others Harris Professor of Gender Studies at Dartmouth; Visiting Fellow at the DuBois Institute at Harvard, NYU and Columbia University; Robert Bosch Guest Professor at the University of Chicago; Visiting Professor of Cultural Studies at the HU and Aigner-Rollett guest professor of gender studies and cultural studies at the University of Graz.
Abstract:
The lecture relates stage performances of dada artists to war neurosis and shell shock as sociocultural phenomena. The leitmotif of this investigation is the notion of simulation, as dada artists were referred to as malingerers (simulators) of madness by the press at the time. I hypothesize that the performers imitate/simulate with drums, shouting and ‘bruitist’ sound poems, the noises of war, staging themselves as war neurotics in a kind of shocking clinical demonstration. Both discourses intersect in the fact that many dadaists try to dodge the draft by simulating madness. The scandalizing anti-art of dada will be understood as contagious anti-pedagogy, trying to vaccinate against the madness of the era.
Hannes Bielas
University of Zurich, Switzerland
Title: Preliminary evidence for a compromised T cell compartment in maltreated children with depression and post-traumatic stress disorder
Time : 17:00-17:20
Biography:
Hannes Biela is a Senior Physician Psychosomatics and Psychiatry presently serving for University of Zurich, Switzerland. His research interest includes Attention deficit hyperactivity disorder (ADHD), Anxiety disorders, Obsessive Compulsive disorders, Autism & Learning and memory in children and youth.
Abstract:
Objective: Adverse childhood experiences, such as maltreatment, and affective disorders associate with a pro-inflammatory state and/or variably compromised counts in lymphocyte subsets in adults. Animal models of social stress indicate that recent thymic emigrant (RTE) cells, which maintain the T cell compartment, are affected. Methods: We evaluate the link between lymphocyte subsets, depression, and post-traumatic stress disorder (PTSD) among 16 maltreated children (ages 6-17 years) one to three years after the intervention of a child protection team and among 14 healthy age-matched controls. The participants completed psychological assessment and had blood drawn for fluorescent activated cell sorting analysis. Results: Among maltreated children and adolescents, depression was associated with lower counts of RTEs and helper T cells, after controlling for age. We found additional trends and large effect sizes with regard to the percentages of these cells, as well as for related lymphocyte subsets. Similar effects were found for PTSD, associated with lower counts of naïve T cells, also supported by a trend for their percentage. Compared to controls, maltreated participants with a clinical level of depression had decreased percentages of RTEs, with a similar trend for PTSD. Conclusion: These preliminary findings are the first to demonstrate a compromised T cell compartment related to psychiatric symptoms in maltreated children and adolescents. There is a need for further studies, particularly evaluating the role of RTEs.
Marta Vizcaino Rakosnik
Universitat Abat Oliba CEU, Spain
Title: The new technology victims: Sexting and grooming
Time : 17:20-17:40
Biography:
Marta Vizcaino Rakosnik has a Degree in Psychology. She has completed her post graduation in forensic psychological expert and master in legal , forensic and criminological Psychopathology. She is a professor in the Psychology degree at Abat Oliba Ceu University. She has published several papers about domestic violence and sexual abuse.
Abstract:
With Internet, there is a new way of communication. The main characteristic with no precedent is the immediate information exchange with no clear rules. The sexual content has increase during this new digital era, mainly because Internet makes possible to collect and distribute a large number of sexual content in an easiest and fastest way ever. The sexting term is usually use to the sending and receiving of sexual content messages, like photos or images mainly thought smartphones. This is quite a new way used by young kids and teenagers. The sexting attitude can end having very negative consequences for the minors, that can be expose to grooming. Grooming is a major crime, this happens when an adult wins the trust of a minor and by lying the adult gets personal information and images with sexual content from the the minor. From here, the adult can coerce the minor to meet him. The grooming and the sexting can be a vital stress factor with deep psychological consequences for the minor and even in suicide attempt.
- Diagnosis: Psychoactivity and Cognition
Chair
Chantal Martin Soelch
University Fribourg, Switzerland
Co-Chair
Vladimir V Lazarev
Oswaldo Cruz Foundation, Brazil
Session Introduction
Carmen M Sarabia Cobo
Professor, University of Cantabria, Spain
Title: Apathy and leukoaraiosis in mild cognitive impairment and Alzheimer’s disease: Multicenter diagnostic criteria according to the latest studies
Time : 11:30-11:50
Biography:
Carmen M Sarabia Cobo is full Professor in the Nursing Department, at University of Cantabria (Spain). She has completed her PhD at from University Complutense of Madrid (Spain), she is specialist in Neuropsychology, Aging and Dementia. She also has the following degrees: Nurse, Psychologist and Social and Cultural Anthropologist. Her subjects taught are Nursing of Aging. Dementia o neurodegenerative diseases. Skills and Competence through Coaching and Emotional Intelligence. Research interests: aging, dementia, cognitive and emotional processing, emotions, Mild Cognitive Impairment, care in old age, Coaching and Emotional Intelligence.
Abstract:
Aims: The aim is to study the prevalence and possible relationship of apathy and leukoaraiosis in cases of cognitive impairment of varying severity in Spain. Methods: We conducted a cross-sectional, descriptive, multicenter study involving 109 patients with Alzheimer’s disease (AD) and 59 with mild cognitive impairment (MCI). Results: The older group with AD had a higher prevalence of leukoaraiosis and apathy, with significant differences compared to the MCI group. Conclusions: To our knowledge, this is the first multicenter study in our country that jointly analyzes the presence of apathy and leukoaraiosis in the institutionalized elderly with varying degrees of cognitive impairment according to the most recent criteria for detecting apathy in dementia. The term apathy is frequently used in the neuropsychiatric literature, but is not included in the current nosological classifications such as the DSM -IV [21] and ICD -10 [22] as a separate term. Apathy can be defined as a persistent deficit of motivation, a lack or decrease in feelings, emotions or interests that give rise to a significant reduction in self-generated goal-directed behavior [23, 24]. There are several standardized scales with which apathy can be diagnosed; however, they are not unified, so that the percentage of patients suffering from apathy AD varies markedly between 19% and 76% [25, 26]. However, apathy is the most frequent symptom in neuropsychiatric AD [27, 28] and other dementias, and is associated with increased cognitive and functional impairment and a high burden on the caregiver [29, 30]. There is also a growing body of evidence that apathy is a prominent feature of pre-dementia states [31–33]. In fact, there are indications that apathy could be a predictor of progression to dementia [34] to the point that the severity of apathy would be closely related to cognitive function [35]. Robert et al. [36] evaluated patients meeting the criteria of amnestic MCI using the Apathy Inventory (AI), and then checked whether the AD had evolved after a year. The results showed that the cognitive function of patients with MCI who had apathy was higher than those in which apathy was not present. However, given its high prevalence in dementia cases in almost all studies, a 2009 work developed a set of several international associations to establish a consensus on the diagnostic criteria for apathy, mainly in AD cases [33]. Following the new consensus on leukoaraiosis and apathy, especially in cases of dementia, this study was proposed with the intent of establishing the prevalence and possible association of leukoaraiosis and apathy in two clinical groups, one with MCI (prodromal state as possible AD) and another with AD institutionalized in seven residential centers in Spain. To our knowledge, it is the first study of its kind serving the two above factors (leukoaraiosis and apathy) conducted in Spain using the new diagnostic criteria for apathy.
Dexter R Voisin
Professor, The University of Chicago, USA
Title: Examining the relationship between psychotropic medication use and testing positive for chlamydia and gonorrhea among detained adolescents
Time : 11:50-12:10
Biography:
Dexter R. Voisin is a Professor in the School of Social Service Administration at the University of Chicago and and a Faculty Affiliate at the Center for the Study of Race, Culture, and Politics and the Center for Health and the Social Sciences. His fields of special interest include community violence exposure, adolescent sexual risk behaviors, the role of gender in adapting to risks, international HIV prevention, and social work practice. Professor Voisin received his B.A. (psychology, cum laude) from St. Andrews College, M.S.W. (practice) from the University of Michigan, and Ph.D. (advanced practice) from Columbia University School of Social Work.
Abstract:
Objective: Youth with juvenile detention histories have higher rates of psychological problems, especially externalizing symptoms, relative to their peers with no such histories. This study examine whether psychotropic medication (PTM) use was related to testing positive for laboratory confirmed chlamydia and gonorrhea among detained adolescents. Methods A convenience sample of 550 detained adolescents ages 14–18 years were recruited from eight youth detention centers in Georgia. Using A-CASI technology, data were collected on demographic factors such as age, gender, socioeconomic status, use of PTM, and sexual risk behaviors. Chlamydia and gonorrhea diagnoses were assessed by laboratory testing. Results Thirteen percent (13.1%) of adolescents not using PTMs tested positive for STIs compared to only 4.9% of those reporting PTM use. PTM users had a 62% smaller odds ratio for testing positive for Chlamydia or Gonorrhea. Conclusion Findings suggest that use of psychotropic medication, if deemed useful by detained youth, may be a protective factor against engaging in behaviors which may culminate in contracting some sexually transmitted infections. These findings have important practice and psychiatric treatment implications for this population.
Vladimir V Lazarev
Oswaldo Cruz Foundation, Brazil
Title: EEG in psychiatry: Driving Reactions to Intermittent Photic Stimulation Improve the Method’s Sensitivity and Information Value
Time : 12:10-12:30
Biography:
Vladimir V. Lazarev is a full professor of Psychophysiology and Clinical Neurophysiology and Director of Laboratory of Neurobiology and Clinical Neurophysiology at the National Institute of Women, Children and Adolescents Health Fernandes Figueira / Oswaldo Cruz Foundation (Ministry of Health), Rio de Janeiro, Brazil (since 2002). Doctor of Biological sciences in Neurophysiology (National Mental Health Research Center of the Russian Academy of Medical Sciences / Moscow State University, 1991). Ph.D. in Psychophysiology (Institute of Psychology of the USSR Academy of Sciences, Moscow, 1977).
Abstract:
The functional test of intermittent photic stimulation (IPS) induces in the EEG photic driving - a rhythmic response (PDR) time-locked to the stimulus and its harmonics. The IPS can reveal a fuller set of the individual’s potential bioelectrical oscillators of different frequencies including latent ones not present or weak in the resting state and enhanced by resonance-like driving reactions. The frequency and amplitude characteristics of PDRs, together with their topography and coherence, can provide additional information regarding the structure and spatial organization of neurophysiological processes as compared to the spontaneous EEG. In the search for latent EEG signs of the brain development alterations in functional neuropsychiatric disorders, the PDR characteristics of the children and adolescents with partial epilepsy (n=95), autism (n=16) and ADHD (n=30), aged 5 to 18 years, were compared to those of the normally developing subjects (n=120) of the same age. Eleven stimulation runs were presented at fixed frequencies of 3-24 Hz for 20-30 s each. The reduced topographic generalization of PDRs over non-visual cortical areas and the lower level of the driving coherence showed a reducing effect of the antiepileptic drug therapy and a possible delay in brain maturation in partial epilepsy. The latter was also reflected in the increased driving amplitudes at the lower IPS frequencies. In high-functioning autistic patients, the IPS at the fast alpha and beta frequencies revealed a reduction in the right hemisphere activation and in the interhemispheric connectivity together with potential hyperconnectivity in the left hemisphere. In the ADHD patients, some alterations in the PDR topography were also revealed. The results obtained were not observed in the resting spontaneous EEG. This shows that the PDR application improves the sensitivity and information value of EEG and looks very promising for neurophysiological studies and diagnostics of different psychiatric disorders which are not usually evident under traditional examination.
Chantal Martin Soelch
University Fribourg, Switzerland
Title: Dysfonctions of the neural reward system in psychopathology: Vulnerability factor or consequence?
Time : 13:30-13:50
Biography:
Chantal Martin studied Bilingual study in Clinical Psychology, General Psychology Neurobiology and PhD in Psychology, in University of Fribourg. Her Publication in 2011 is “Habitation” in University of Zurich. Her interests of Research are, treatment and prevention of mental disorders and psychopathologies, the identification of vulnerability factors. she was appointed as Head Psychologist, Head of Research Division, Department of Psychiatry of Psychotherapy, in University Hospital Zurich, Zurich, Switzerland.
Abstract:
Mental health is a major cause of disability worldwide. The major challenges related to this burden are the development of efficient treatment and preventive interventions. For both, treatment and prevention of mental disorders and psychopathologies, the identification of vulnerability factors is essential. The presence and value of rewards, their predictability and accessibility as well as the effort to reach them are crucial in controlling our behavior. Neurophysiological, neurochemical and neuroimaging studies in human and in experimental animals have delineated a network of cortical and subcortical brain regions, including in particular the ventromedial prefrontal cortex (i.e. orbital and medial prefrontal regions), amygdala, striatum and dopaminergic midbrain, that are specifically involved in the processing of reward information. A role of the mesocorticolimbic and mesostriatal dopamine (DA) systems in the processing of reward information was also well documented, although other neurotransmitter systems, such as the opiate system, also seem to play a role in the mediation of reward information. Blunted responses to reward and impaired function of the DA system were observed in several psychopathological conditions including addiction, depression, eating disorders and PTSD. The observed impairments could be associated with the symptoms of anhedonia, apathy and loss of interest observed in these conditions, an hypothesis supported by findings that evidenced an improvement of the blunted response to reward after psychotherapy. This could however also indicate that blunted responses to rewards are a vulnerability factor for the development of psychopathological symptoms. We will present here results from studies investigating the responses to reward in populations vulnerable for developing psychopathological symptoms as well as in remitted patients. We will discuss the role and origin of the blunted responses to rewards as a potential vulnerability factor or as a consequence of psychopathological process with a particular focus on the interaction between the experience of reward and stress. This question is important to understand psychopathological processes, but also to develop targeted preventive strategies.
Carmen M Sarabia Cobo
Professor, University of Cantabria, Spain
Title: Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia
Time : 13:50-14:10
Biography:
Carmen M Sarabia Cobo is full Professor in the Nursing Department, at University of Cantabria (Spain). She has completed her PhD at from University Complutense of Madrid (Spain), she is specialist in Neuropsychology, Aging and Dementia. She also has the following degrees: Nurse, Psychologist and Social and Cultural Anthropologist. Her subjects taught are Nursing of Aging. Dementia o neurodegenerative diseases. Skills and Competence through Coaching and Emotional Intelligence. Research interests: aging, dementia, cognitive and emotional processing, emotions, Mild Cognitive Impairment, care in old age, Coaching and Emotional Intelligence.
Abstract:
We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and non-professional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia. Caregivers of patients with dementia In recent years, an increasing number of studies in stress have been focused on professionals (Knudsen, Ducharme & Roman, 2009). Affected professionals speak of burnout to define a state of emotional and physical exhaustion caused by the stressful demands of their daily work. The equivalent concept in caregivers is the Caregiver Burden (identified by the nursing diagnosis of “Fatigue in the caregiver role”). The study of these two conditions has been developed in areas of high demand for services such as care for people with dementia (Judkins, 2003). As dementia is a progressive, disabling and long-term neurodegenerative disease, the risks of being exposed to chronic stress situations both professional and caregivers is very high (Scott, Hwang & Rogers, 2006; Salmond & Ropis, 2005). Many studies show the consequences of professional stress, both emotional and physical (Chandola, Britton, Brunner, Hemingway, Malik, Kumari et al., 2008), which can cause communication problems in the team and families (Mikels et al., 2008), and affect the general welfare of the person (Salmond & Ropis, 2005). Adopting effective techniques of stress management may require improving the emotional and physical state of the caregiver, and promoting a better working environment and a better relationship with others in both the institutional and home and family environments (Salmond & Ropis, 2005). Improving the ability of caregivers to effectively meet the challenges of the daily work is valuable not only for institutions (having less stressed and healthier workers) but also for people receiving care (Pipe & Bortz, 2009). This is why in recent years, the management of burnout and overload situations has been addressed in areas such as Positive Psychology (Seligman, & Csikszentmihalyi, 2000), which studies resilience and optimism as predictors of effective coping in difficult and demanding situations. In this context, resilience refers to the ability to adapt to changing situations, being able to effectively handle stress or potential stressors in the process (Tugade, Fredrickson & Barrett, 2004). Positive Psychology studies have begun to confirm that chronic stress or certain stressful situations lead to negative emotional states (anxiety, frustration, anger, sadness, etc.), which not only affect caregivers and other professionals themselves, but also have an impact in their performance at work. This suggests that emotional and mental factors play a key role in situations of stress, and maintains that the dimensions of resilience must begin to be taken into account in the study of these groups, as evidenced by recent investigations (Otake, Shimai, Tanaka †Matsumi, Otsui & Fredrickson, 2006).
Mira Jakovcevski
Max Planck Institute of Psychiatry, Germany
Title: Neuronal Kmt2a/Mll1 histone methyltransferase is essential for prefrontal synaptic plasticity, anxiety-like behavior and working memory
Time : 14:10-14:30
Biography:
Mira Jakovcevski is in Postdoc and working in the Department of Stress Max Planck Institute of Psychiatry, Germany. Neurobiology and Neurogenetics, Research Group Deussing. Her research was in Neuronal Kmt2a/Mll1 histone methyltransferase is essential for prefrontal synaptic plasticity, anxiety-like behavior and working memory. She was also done her research in Neurobiology and Neurogenetics.
Abstract:
Neuronal histone H3-lysine 4 methylation landscapes are defined by sharp peaks at gene promoters and other cis-regulatory sequences, but molecular and cellular phenotypes after neuron-specific deletion of H3K4 methyl-regulators remain largely unexplored. We report that neuronal ablation of the H3K4-specific methyltransferase, Kmt2a/Mixed-lineage leukemia 1 (Mll1), in mouse postnatal forebrain and adult prefrontal cortex (PFC) is associated with increased anxiety and robust cognitive deficits without locomotor dysfunction. In contrast, only mild behavioral phenotypes were observed after ablation of the Mll1 ortholog Kmt2b/Mll2 in PFC. Impaired working memory after Kmt2a/Mll1 ablation in PFC neurons was associated with loss of training-induced transient waves of Arc immediate early gene expression critical for synaptic plasticity. Medial prefrontal layer V pyramidal neurons, a major output relay of the cortex, demonstrated severely impaired synaptic facilitation and temporal summation, two forms of short-term plasticity essential for working memory. Chromatin immunoprecipitation followed by deep sequencing in Mll1-deficient cortical neurons revealed downregulated expression and loss of the transcriptional mark, trimethyl-H3K4, at <50 loci, including the homeodomain transcription factor Meis2. Small RNA-mediated Meis2 knockdown in PFC was associated with working memory defects similar to those elicited by Mll1 deletion. Therefore, mature prefrontal neurons critically depend on maintenance of Mll1-regulated H3K4 methylation at a subset of genes with an essential role in cognition and emotion.
- Workshop on Managing
Location: SEGRE
Chair
Jouko Miettunen
University of Oulu, Finland
Session Introduction
Jouko Miettunen
Professor, University of Oulu, Finland
Title: Outcomes in Schizophrenia – Systematic Reviews
Time : 11:10-11:40
Biography:
Jouko Miettunen has university degrees in statistics (MSc 1998; University of Oulu, Finland), epidemiology (MPhil 2003; University of Cambridge, UK), and psychiatry (PhD 2004; University of Oulu, Finland). Since 1997 he has work in various research positions at the University of Oulu, Finland. Currently he holds a position as a Professor in Clinical Epidemiology and he works also as an Academy Research Fellow of the Academy of Finland. He has over 160 peer-reviewed publications in field of psychiatry, his research focus has been especially on schizophrenia.
Abstract:
The aim is to present recent systematic reviews related to outcome of schizophrenia. Included reviews focus different aspects of schizophrenia: proportion of recovery, family history of psychosis as a predictor of functional outcome, and duration of untreated psychosis (DUP) as a predictor of outcome. A comprehensive search strategy was used to identify potential studies, and data were extracted for those original articles that met inclusion criteria. A follow-up of at least two years was required. As a result, the median proportion who met our recovery criteria was 13.5%. Recovery was defined as improvements in both clinical and social domains, and evidence that improvement in at least one of these two domains had persisted for at least two years. Studies from sites in countries with poorer economic status had higher recovery proportions. DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment. The presence of family history of psychosis was associated with poor occupational (r=0.17) and global (r=0.13) outcome. As a conclusion, based on the best available data, approximately one in seven individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased. Both family history of psychosis and longer duration of untreated psychosis associate moderately with poorer long-term outcome in schizophrenia.
Clemente Garcia Rizo
Senior Consultant Psychiatrist, Spain
Title: Novel pharmacological treatment for resistant schizophrenia
Time : 11:40-12:10
Biography:
Clemente Garcia Rizo is a senior consultant psychiatrist at the Barcelona Clinic Schizophrenia Unit. He obtained his Medical Degree from the University of Navarra in 2002, completed its training in psychiatry at the Hospital of Sant Pau in 2007. Later he joined the Barcelona Clinic Schizophrenia Unit, first as a research associate and later as a consultant psychiatrist in schizophrenia and afterwards as psychiatrist in charge of the early onset psychosis program, his current position. Doctor of Medicine from the University of Barcelona in 2011 and Graduate Statistics in Health Sciences from the Autonomous University of Barcelona in 2011.
Abstract:
The concept of pharmacological medication in treatment-resistant schizophrenia has been historically related to a unique antipsychotic: clozapine. However, despite its usefulness and in certain cases, diverse pharmacological associations have been studied, not only with dopamine regulators (first or second generation antipsychotics) but other therapeutic groups such as tetracyclines (minocycline) or anticonvulsivants (lamotrigine). The aim of the presentation is to understand the actual pharmacological options of treatment-resistant schizophrenia while delving into the actual novel therapeutic approaches such as glutamatergic agents or nicotine agonists. Non- psychiatric medications and dose reduction strategies in specific treatment-resistant subjects would be also considered.
Eva M Grasa
Universitat Autonoma de Barcelona, Spain
Title: Current and novel cognitive-behavior interventions for resistant schizophrenia
Time : 12:10-12:40
Biography:
Eva M. Grasa has degree in psychologist (University of Barcelona, 1998) and is finishing her PhD research in auditory hallucination phenomena. Since 2001 she has worked in various research positions in the Department of Psychiatry, at Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). Currently she holds a position as a CIBERSAM (Centre of Biomedical Research in Mental Health-Spain) researcher within Schizophrenia Research Group (Hospital Santa Creu i Sant Pau). Her line of research is mainly focused on psychotherapeutic interventions in psychosis (CBT-p, Metacognition Training, Mindfulness), and new therapeutic strategies in treatment resistant schizophrenia (Deep Brain Stimulation, m-Health solutions).
Abstract:
The aim of this presentation is to review the state of the art regarding cognitive-behavior therapies (CBT) in patients with persistent psychotic symptoms. In many people we observed that core schizophrenia symptoms remain resistant to treatment with medication alone. Including targeted treatment with CBT is widely recommended in clinical practice guidelines, particularly for patients with medication-refractory psychotic experiences. But the heterogeneity and multifaceted nature of psychotic symptoms requires a step forward: the development of specific intervention programmes tailored to target profiles of schizophrenia patients. CBT, when considered a variety of therapies that can be applied in several forms to specific problems and circumstances, would be helpful in increasing psychotherapeutic efficacy. The final result should be the development of specific interventions programs, where multifaceted and individualized formulations addressed to a specific patient could be possible. Third-wave approaches in CBT are example of the benefit from incorporating alternative methods of changing relation between patients and their thoughts and feelings. Scientific evidence of the applicability of such CBT approaches to schizophrenia resistant will be reviewed.
Iluminada Corripio
Universitat Autonoma de Barcelona, Spain
Title: m-RESIST: Mobile therapeutic attention for patients with treatment resistant schizophrenia
Time : 13:30-14:00
Biography:
Iluminada Corripio received her MD in 1992 and became a psychiatry specialist in 1998 by the Universitat Autònoma de Barcelona. In 2007 she got her PhD in Neuroscience by the same university. Since 1998 she works as a senior specialist in the Department of Psychiatry at Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). She combines the healthcare activity with the leadership of the Schizophrenia Research Team. Her line of research is focused on: neuroimaging, pharmacogenetics, treatment of negative symptoms, first episode of psychosis and new therapeutic strategies in treatment resistant schizophrenia (Deep Brain Stimulation, m-Health solutions).
Abstract:
The aim of this presentation is to expose the first m-Health program for patient with resistant schizophrenia. In European Union approximately 5 million people suffer from psychotic disorders. Between 30-50% can be considered resistant to treatment, and 10-20% ultra-resistant. These patients present persistent positive symptomatology, require extensive periods of hospital care, and have a greater risk of excess mortality and multi-morbidity. In addition, a high proportion of the total cost for treating schizophrenia is spent on this population. Intervention strategies based on m-Health have demonstrated their ability to support and promote self-management-based strategies. This active role helps to improve adherence to treatment, and to reduce persistent symptoms severity, relapses and hospitalizations. m-RESIST aims to develop an intervention programme based on m-Health to allow patients suffering from resistant schizophrenia to self-manage their condition (resistant schizophrenia and associated comorbidities, e.g. somatic disorders and addictions). This programme could provide a new tool for the psychiatrists and psychologists to work together with other health care professionals. So better monitor of patients, and a personalised and optimised therapeutic process could be achieved. m-RESIST will (1) develop and validate an m-Health solution aimed to reduce the severity of episodes and further complications; (2) involve and promote participation of patients and caregivers in the therapeutic process increasing the awareness of patient and caregiver about the nature of the illness and its consequences, benefits of treatment and needs for healthy habits and promoting an active and collaborative role with the medical team in the treatment decision-making procedure.
Jean-Marie Batail
Centre Hospitalier Guillaume Régnier, France
Title: Pharmacological management of treatment resistant schizophrenia
Time : 14:00-14:30
Biography:
Jean-Marie Batail is a specialist lecturer since 2012. He is in charge of a unit specialized in treating treatment resistant disorders (mainly depression, obsessive and compulsive disorder). This unit have experience in neuromodulations techniques such as rTMS, ECT and DBS. He give consultations on pharmacological management of treatment resistant schizophrenia (TRS).He has worked in the field of high dose antipsychotics in TRS for his MD degree. Currently, his work is focused on clinical and neuroimaging correlates of treatment resistant depression.
Abstract:
Schizophrenia is a debilitating illness with an estimated lifetime prevalence of around 0.7%. In 2001, the World Health Organization described schizophrenia as one of the ten most disabling diseases in the world. It affects nearly all areas of patients\' social, family and professional lives. Its cost for society is high, both directly (hospitalizations, treatment, dysfunctional social skills) and indirectly (loss of productivity). Its course can be marked by resistance to antipsychotic treatment, meaning that therapeutic support is sometimes challenging for the practitioner, with results that are partial and unsatisfactory. Despite the development of a newgeneration ofmolecules, bringing greater efficacy and fewer side effects, some patients still fail to respond to treatment. The rate of treatment-resistant schizophrenia (TRS) is estimated to be between 30 and 60%, depending on which criteria are used. If first-line treatments prove ineffective, there are still many options available, not least the gold standard, clozapine. If this fails, then clozapine augmentation is one possible solution, not to mention the use of alternative antipsychotics, anticonvulsants or nonpharmacological options, including electroconvulsive therapy and transcranial magnetic stimulation for resistant auditory hallucinations. Another therapeutic option is the prescription of atypical antipsychotics at high doses. Since the late 1990s, high-dose olanzapine has become a worthwhile alternative for clozapine-resistant or intolerant patients.
- Schizophrenia: Social Behavioral Disorder
Location: SEGRE
Chair
Catherine L Clelland
Columbia University, USA
Session Introduction
Catherine L Clelland
Columbia University Medical Center, USA
Title: Targeting Proline: Old and New Treatment Approaches for Schizophrenia
Time : 14:40-15:00
Biography:
Catherine Clelland received her PhD in molecular genetics from University College London, and completed her postdoctoral training at Mount Sinai School of Medicine, New York. In 2007, she joined the faculty of the Department of Pathology and the Taub Institute at Columbia University Medical Center. Her work has been funded by the BrightFocus Foundation, the National Institute of Aging, and the National Institute of Mental Health, and she has been the recipient of fellowships from the Charles H Revson Foundation and the Gray Matters at Columbia. She has published more than 15 papers in peer-reviewed journals and she serves as an academic editor for the journal Medicine.
Abstract:
There are multiple genetic links between schizophrenia and a deficit of proline dehydrogenase (PRODH) enzyme activity. There is also evidence that excess proline can disrupt both glutamatergic and dopaminergic signaling, with neurotoxic effects. We have found that over 25% of schizophrenic patients at an acute short-stay psychiatric hospital, have hyperprolinemia (Clelland et al, 2011). Hyperprolinemic patients had a significantly later age of first psychiatric hospitalization, suggestive of later onset, and hospital stays 46% longer than non-hyperprolinemic subjects. Thus hyperprolinemia has implications in the etiology of schizophrenia, and for the clinical management of these patients. Vitamin D deficits have been associated with schizophrenia susceptibility, and in a follow-up study we reported that vitamin D, a potent transcriptional modulator, can upregulate the PRODH gene. Hypothesizing a link between vitamin D insufficiency and schizophrenia risk, via loss of PRODH regulation and proline elevation, we showed that patients with vitamin D insufficiency have three times the odds of being hyperprolinemic and that hyperprolinemia is a significantly mediating phenotype that may explain over one third of the effect of vitamin D insufficiency on schizophrenia risk (Clelland et al, 2014). The aim of this presentation is to discuss both novel and longstanding treatment approaches for schizophrenia that may, directly or indirectly, regulate the PRODH pathway and modulate proline level. We will review the current field, plus will present some new data suggesting that pharmacogenomic methodologies, coupled with treatment approaches that target proline, may yield significant symptom benefit in patients with psychiatric illness. Disclosure: Catherine Clelland is a co-inventor on a US patent application that is related to this work
Barbara Pajk
University Psychiatric Clinic Ljubljana, Slovenia
Title: Effect of tobacco use on symptom severity and medication adherence in Schizophrenia
Time : 15:00-15:20
Biography:
Barbara Pajk has received her Masters Degree in Nursing at the age of 34 years from Faculty of Health Sciences, University of Maribor, Slovenia. She has worked at University Psychiatric Clinic Ljubljana since 2006. She is a lecturer at Slovenian association for help with dementia – Spomincica, Alzheimer Slovenia. She has published articles and proceedings of lectures with peer review in the field of dementia and schizophrenia.
Abstract:
Background: The rate of smoking among the patient with schizophrenia (PS) is at least two to three times higher than in general population. It was found that tobacco use is connected with schizophrenia psychopathology but is often undermined and even tolerated in the psychiatric settings. The aim of this study was to examine the smoking rates in PS and the association between tobacco use and symptom severity in PS and its effect on medication adherence. We also examined the correlations between tobacco use, hospitalization rates and the fist outbreak of the disease in PS.
Method: The study included 91 patients of both genders (18 to 65 years), with a diagnosis of ICD-10 (F20), hospitalized at the University Psychiatric Hospital in Ljubljana in various treatment settings. Clinical symptoms were rated by using the Positive and Negative Syndrome Scale (PANSS). The study was based on a questionnaire that included socio-demographic characteristics of the participants, the data about tobacco use, the medication adherence and some other characteristics of the participants.
Results:The prevalence of smoking was 61.5%, (35.7% females and 64.3% males). Smokers had significantly higher PANSS (total sub score) (97.18 vs. 83.80; p=0.015) and PANSS (general sub score) (48.00 vs. 41.31; p=0.007), G3 (p=0.047), G4 (p=0.008), G5 (p=0.004), G11 (p=0.032), G13 (p=0.000) and G14 (p=0.008). Smokers scored higher on P4 (p=0.020), P7 (p=0,008) and N1 (0,022). Non-adherence rate among smokers was 69.6% vs. non-smokers 30.4%. There is a trend that suggests that smokers have higher number of hospitalizations (M=10.82) compared to non-smokers (M=6.14) (p=0.060).
Conclusion: The findings of this survey suggest that tobacco use might be associated with more severe general and total PANSS sub score, as well as excitement, hostility and blunted affect was more pronounced among smokers. Patients who smoke are less likely to be adherent to antipsychotic medication. Special attention should be paid in patients with schizophrenia who are tobacco users.
- Discrimination and Stigma Related to Mental Health
Location: SEGRE
Chair
Jesus Garcia MartÃnez
University of Seville, Spain
Session Introduction
Jesus Garcia-MartÃnez
University of Seville, Spain
Title: Stigma and victimization: similarities in psychological processes between victims of social violence and psychotic persons
Time : 14:40-15:00
Biography:
Jesús Garcia-Martínez completed his PhD at the University of Valencia in 1992. He works at the University of Seville since 1991 and obtained the place of tenured professor in 2002. He is an accredited therapist and supervisor of the Spanish Association of Cognitive Psychotherapies. His field of research is focused in the treatment of victims and aggressors and in the narratives of change. He has published 15 papers in reputed journals and has presented more than 200 communications in international congress and conferences.
Abstract:
Victims of social violence are characterized by a set of symptoms (low self-esteem, anxiety, in some case post-traumatic manifestations) and too by a set of narrative construction processes (absence of empowerment, fragmentation, low coherence). Therapy is usually oriented to de-construe this kind of discourse and making meaning about his/her skills and capacities in order to get a more personal and empowered narrative. Victimization narratives usually too incorporate a lot of meanings from social forms of control (minus-valuation, believes about the other’s adequacy and a lack of personal sense). This kind of narratives is found too in persons who suffer from psychotic disorders, including when they are in a no-symptomatic or acute phase. Stigma (the self-believe about the own incompetence) is incorporated in the personal narrative in a similar way to victimization process. In this paper, two clinical vignettes are presented to describe the similarities between the two cases and to illustrate similar therapeutic processes to empower both kinds of clients
Sam Warner
Barnardos childrens charity, UK
Title: Maximizing hope and minimizing harm: Researching and working with children and adults who self-harm and self-injure
Time : 15:00-15:20
Biography:
Sam spent 20 years at Manchester Metropolitan University, UK first as a PhD student and then as a research fellow, leaving in 2015 to concentrate on clinical work and strategic development. Sam is a consultant clinical psychologist, qualifying nearly 25 years ago. As an academic and practitioner, Sam has always specialized in child abuse, sexual violence and domestic abuse, and their impact on mental health: from dissociation to self-harm. She has written books, reports and papers on these issues. Sam has worked for the British Department of Health as a national advisor on sexual violence and mental health. Currently Sam provides clinical oversight to Barnardos Safer Futures services, North West, UK.
Abstract:
Children and adults who self-harm and self-injure present a major challenge for social care and mental health services and numerous serious case reviews in the UK and beyond have identified many areas for improvement in respect of children and adults who are at risk of suicide. Such children and adults represent a highly stigmatized, and too often misunderstood and mistreated group. I will argue that clinical research in this area has suffered from a too narrow understanding of what constitutes evidenced-based practice and this has led to an over-reliance on pre-determined outcomes; reductive behavioral goals; and an undue focus on treatment techniques. In this paper, I argue for clinical research that is flexible, user-centered and practice-based. Drawing on theory, research and clinical case studies I demonstrate the utility of triangulating knowledge from multiple data sources in understanding self-harm and self-injury. Using this triangulated knowledge-base, I identify key factors associated with self-harm and self-injury. I build on this analysis to consider what is needed in developing and delivering effective practice with children and adults who use self-harm and self-injury to cope, communicate and/ or as a means to end life. I identify key factors in determining suicide risk. I then contrast harm stopping approaches with positive risk taking and harm reduction strategies, elaborating how and when to use them. Finally, I consider the emotional cost of working with self-harm and self-injury, and the need for policy and research which embeds principles for practice, rather than fetishizes techniques.
P Roberto Bakker
Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands
Title: Public mental health promotion and networks
Time : 15:20-15:40
Biography:
Roberto Bakker works in Psychiatric Centre GGZ Central, Amersfoort, Netherlands. His research mainly focus on function of public mental health (PMH) in medicine is both health promotion and disorder prevention. He added project of his new findings in research field of complex systems in PMH promotion.
Abstract:
The main function of public mental health (PMH) in medicine is both health promotion and disorder prevention. However, in psychiatry public health has been rather neglected, and, therefore, research is warranted. The past decade has seen a rise in (or renewed) interest in complex systems — like biological (e.g. psychiatric), economic, social, internet, and epidemic (ebola) systems— to uncover their pervading hidden laws (http://www.santafe.edu/). In the next few years network architecture will be central in complex system research. These paradigms may encourage new promising public health programs. With this project we hope to add new findings to this important research field of complex systems in PMH promotion.
Nigel Rees
Senior Research Lead at Welsh Ambulance Services NHS Trust
Title: To explore paramedics’ perceptions and experiences of caring for people who Self Harm (SH) in order to inform education and policy
Time : 15:40-16:00
Biography:
Nigel Rees research was on mainly to explore paramedics’ perceptions and experiences of caring for people who Self Harm (SH) in order to inform education and policy. Effect of SH education and training, age of staff, gender, attitudes towards SH, setting, influence of policies and guidelines. Metasynthesis revealed metaphors: Frustration, futility and legitimacy of care. Nigel Rees was appointed as Senior Research Lead at Welsh Ambulance Services NHS Trust.
Abstract:
Background: The U.K. has one of the highest rates of SH in Europe. SH is amongst the five top causes of acute hospital admissions. Paramedics are often the first professionals encountered following SH, yet few have investigated their care Methods: The theoretical perspective draws on Evolved Grounded Theory. Systematic reviews of quantitative and metasynthesis of qualitative literature were conducted. Fifteen paramedics participated semi structured interviews, generating themes by constant comparison, open, axial and selective coding. Results: Systematic review identified themes: Effect of SH education and training, age of staff, gender, attitudes towards SH, setting, influence of policies and guidelines. Metasynthesis revealed metaphors: Frustration, futility and legitimacy of care. First contact in the pre hospital environment: Talking, immediate and lasting implications of the moral agent. Decision making in SH: balancing legislation, risk and autonomy. Paramedics’ perceptions: harnessing professionalism and opportunities to contribute to the care of SH. Paramedicine: Culture and education in transition. Themes emerging from interviews including professionalism, legislation and ethical issues. The theme: Relationships with Police: Procedural, historical practices and evolution of surreptitious strategies. “if you wanted somebody detained then we all know detention under Section 136 needs to take place in a public place. Therefore often the easiest way to do it, to prevent somebody, or to treat somebody with self harm was normally to try to coax them into a public place where a police officer could take action, because they were, obviously, very reluctant to do it in a private property.” (para3) Conclusion: Paramedic care for SH is a complex professional, clinical and social interaction, the developing theory is continuing to evolve our understanding of this encounter, and potential contribution of paramedics to SH care.
- Young Researchers Forum
Location: SEGRE
Session Introduction
Svenja Nina Reinders
Max Planck Institute of Psychiatry, Germany
Title: Azidobupramine a novel chemical tool to enlighten antidepressants mode of action
Time : 15:30-15:50
Biography:
Svenja Nina Reinders is a senior psychiatrist working at Max Planck Institute of Psychiatry in Germany. Her research interest mainly focusses on Depression, Major depression disorders and role of Antidepressants.
Abstract:
Antidepressants were discovered in the 1950s but their underlying molecular mechanisms are still incompletely understood. Revealing the identity of additional targets may contribute to a better understanding of the antidepressants` mode of action. The aim of this study was to develop a chemically modified antidepressant enabling the identification of alternative direct drug targets. For this purpose, azidobupramine, a structurally related analogue of imipramine, was synthesized featuring two additional chemical groups, one for photoaffinity labeling (PAL) and the other for copper(I) catalyzed azide alkyne cycloaddition (CuAAC). Using the serotonin transporter as model target, we demonstrate that azidobupramine is characterized by equilibrium dissociation constants (Ki) equivalent to those of clinically active substances. Furthermore, we show that azidobupramine forms chemical bonds with the transporter after UV light exposure in living cells. Thus, azidobupramine represents a promising and versatile tool for the discovery of novel direct antidepressant target sites in living systems.
Marc Fakhoury
University of Montreal, Canada
Title: The role of the lateral habenula in motivation and reward: implication for psychiatric disorders
Time : 15:50-16:10
Biography:
Marc Fakhoury has completed his B.S (Biochemistry) and M.Eng (Biomedical Engineering) from McGill University. He is currently doing a PhD in Neuroscience at the University of Montreal. He is interested in the identification of the neural substrate involved in motivation and reward, and their relevance to psychiatric disorders such as substance abuse and major depression. He has published more than 20 papers in reputed journals and has participated in several local and international conferences.
Abstract:
A dysfunction of the lateral habenula (LHb) is implicated in several psychiatric disorders including drug abuse, bipolar disorder, alcohol dependence and schizophrenia. Previous work with psychophysically-based studies suggests that electrolytic lesion of the LHb, which lies in the dorsal diencephalic conduction system, degrades the intracranial self-stimulation (ICSS). This experiment was aimed at studying the importance of the LHb in brain reward stimulation, and its connection with other areas that support operant responding for ICSS. For this purpose, rats were trained to receive an electrical stimulation at the lateral hypothalamus (LH), a region in the brain implicated in reward and motivation. The change in reward was measured daily for two weeks, and Fos-like immunoreactivity was quantified at the end of the experiment. The expression of c-fos was measured in several forebrain and midbrain regions in order to visualize the neurons that were activated by the stimulation. The same experiment was done in rats that received a stimulation at the LH following an electrolytic lesion at the LHb. Results show that a lesion at the LHb produced a large and long-lasting attenuation of reward, which was generally associated with reduced c-fos expression. Since an alteration in reward is an important characteristic of several psychiatric disorders, identifying the role of the LHb in the brain reward circuitry will constitute an important step towards a better understanding of the neurobiological bases of these disorders.
Francis Itua
Neuropsychiatric Hospital, Aro, Nigeria
Title: Violent behaviour tracking format (VBTF): An accurate means of recording patients violent behaviours
Time : 16:30-16:50
Biography:
Francis Itua is a high rank Psychiatrist at Neuropsychiatric Hospital, Aro in Nigeria. His research interests mainly include people and consequences related to patients with Anger, emotions and behavioural disorders. He has huge contributions in mental health treatments.
Abstract:
Violence is an expression of anger, fear or despair through an extreme and forceful delivery of actions and emotions, inflicting harmful or damaging effects. Violence could take the form of actual physical assault on a target, intense verbal or written threats and/or damage to property. Aggression/Violence may represent the lowest incidence of all the broad risk indicators, but it holds the potential to attract most attention through its ability to tap into personal and collective fear of assault. Such fear certainly has a great deal of effect on staff’s performance and effectiveness and the need to keep accurate record of such behaviours that has the capacity to create enormous fear among clinicians cannot be overemphasised. Clinical violence risk assessment and management with the aid of structured instrument has become an integral part of mental health nursing practice. It is therefore needful to also keep an accurate record of clinical violent behaviour with the aid of a structured format. Before now, nurses and other members of the health team gave verbal reports of violent attacks in the course of their practice. And it has never been easy getting accurate figures out of these reports. Hence, there is a pressing need to give scientific approach to whatever we do, especially in the management of violent behaviours and be able to substantiate reports of violence in our day to day practice with the aid of accurate figures (statistics). Since the introduction of Aro Clinical Risk Assessment Tool (ACRAT); a multi-risk assessment tool to the mainstream of clinical practice in NPH, Aro, the author have always seen the need to keep clear and accurate records of these risks (including violence) and the way they are managed. Hence, the creation of Violent Behaviour Tracking Format (VBTF) by the author is a timely undertaken. This format is the result of experience, observations and extensive literature search. The need to understand clinical violence risk: The pattern, frequency, management methods and the efficacy of such methods underscore the importance of this format.
Dalia Asfour
Mansoura General Hospital, Egypt
Title: Cognitive Behavior Therapy for childhood OCD
Time : 16:50-17:10
Biography:
Dalia Asfour is presently working at Mansoura General Hospital in Egypt. Her contributions in diagnosis & treatment of Obsessive-compulsive disorder, anticipatory anxiety & comorbid emotional and behavioral problems are highly remarkable. Her research mainly focusses on childhood disorders.
Abstract:
Obsessive-compulsive disorder (OCD) is more common in children and adolescents with a lifetime prevalence estimated at 2% to 3%. All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can’t stop worrying, no matter how much they want to. Childhood OCD is often associated with severe disruption in social and academic functioning, comorbid emotional and behavioral problems. Children may keep their OCD a secret and be ashamed of, thus parents may be unaware of the presence or severity or OCD. The presenting symptoms of irritability, agitation, aggression, withdrawal, or decline in school functioning may mask the real obsessionals thoughts and fears to be mistaken for depression, other anxiety disorders, or attention deficit hyperactivity disorders. Although OCD presentation in children is quite similar in presentation to OCD in adults, developmental differences between children and adults arising from age, maturity, ability for abstract thinking, language development, and inability to delay gratification and handling anxiety. All these reasons may complicate the application of CBT for children. An important difference as well is that childhood OCD is considered a family illness, parents are an integral part of children lives, they commonly involve family members in their OCD through participation in rituals, provision of reassurance, and assistance in avoiding fear triggers. So therapy as well as illness must involve parents as active team members in the treatment plan. Despite these reasons, cognitive behavior therapy for children that is modulated to correspond to these differences is well established therapy for childhood OCD the following lecture will illustrate different methods in conducting basic cognitive behavioral therapy schema for OCD (cognitive errors, exposure, habituation, and anticipatory anxiety, as well as the ability to tolerate anxiety during Exposure and response prevention) in away the child with OCD is motivated by and compliant to.
Ibrahem Mohammed Hamdey
Mansoura General Hospital, Egypt
Title: Psychiatric disorders among prisoners: An egyptian study
Time : 17:10-17:30
Biography:
Mohamed Hamdy Ibrahim graduated from Faculty of Medicine, Ain Shams University, Cairo, Egypt. He joined the neuropsychiatry residency at Ain Shams University Cairo, Egypt from 2001 till 2003. He finished his MD in Neurology and got his Doctorate by 2008. He has been assigned as Lecturer of Neurology and his main concern was in the field of Neurovascular Interventional Radiology. He finished his fellowship in interventional neurology at Zurich University, Switzerland as F.I.N.R. by 2013. Currently he is an Assistant Clinical Professor of Neurology, GMU University, Ajman, United Arab of Emirates (UAE) since 2010. He has published many journals as Open Journal of Medical Imaging (OJMI), The Egyptian Journal of Radiology and Nuclear Medicine, The European Journal of Neurology, Neurology of India. In addition he is now a member of World Federation of Interventional and therapeutic Neuroradiology (WFITN), Member of ESMINT (European Society of Minimal Invasive Neurological Therapy) & Member of European Society of Neuroradiology Diagnostic and Interventional (ESNR)
Abstract:
Introduction: In Egypt, a few small scale studies were conducted to study the real state of the mental health of the prisoners, the data about the situation of the mentally ill offenders in Egypt still not clear, especially with the increasing number of prisons, prisoners and with the multiplicity of penalties and crimes. This research hypothesize that the prevalence of psychiatrically ill Egyptian prisoners is higher than the prevalence of psychiatrically ill population outside the prison. Also, this research hypothesize that there are multiple factors which affect psychiatric disorders among prisoners.
The practical part: This is a cross- sectional study on adult prisoners of both sexes with different crimes and different penalties, from age of 18 years old to 65 years old that have spent at least one year in the prison. This study was done in 16 prisons all over Egypt, during a period of 2 years from the 1st of March 2012 to end of February 2014. The target sample size is 1350 prisoners, in a ratio of 50 prisoners for each thousand. Sampling Technique was stratified proportional sample. The interview with prisoners had two parts: the first part was for measuring different factors associated with psychiatric disorders inside the prison: sex, age, education, work and visits inside the prison, types of crime, duration of sentence and times of arrest inside the prison, feeling of prejudice, feeling of shame, affection of home responsibility and effect of organic disorders and substance abuse inside and outside the prison. The second part was applying standardized psychiatric assessment.
Results: Overall point Prevalence of psychiatric disorders among studied prisoners is 22.4%. The highest Prevalence of personality disorder between prisoners all over Egypt was 12.3% for antisocial type. Psychiatric disorders between prisoners are statistically significant regarding age groups, work inside the prison, family visits, officers and prisoners’ maltreatment, admission times, different types of crimes, substance abuse outside the prison, past History of psychiatric disorders outside and inside the prison.
Conclusions: Work inside the prison and family visits are protective from psychiatric disorders in prisoners, while substance abuse outside the prison and past history of psychiatric disorders inside the prison are risk factors for psychiatric disorders. Admission times and multiple types of crimes are statistically protective from psychiatric disorders but this is may be explained by prisoners personality traits and their capability to break the law which make them less vulnerable to stress and psychiatric disorders. A lot of Egyptian prisoners are incarcerated due to social, environmental and financial rationales; there is no excuse for any person to break the law and regulations, but bad bringing up of some families for their kids, not to grow them on values, manners and religion make them risky to acquire different forms of corruption which was disseminated in the Egyptian society all over the past 60 years.