Day 2 :
Charles B Nemeroff
University of Miami, USA
Keynote: The seminal role of child abuse and neglect in predicting course and treatment response in mood and anxiety disorders: Neurobiology and genetics
Time : 9:30-10:10
Dr. Nemeroff was Professor of Psychiatry and Pharmacology and Chief of the Division of Biological Psychiatry before relocating in 1991 to Emory University School of Medicine in Atlanta, Georgia, where he served as the Reunette W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences until 2008. In 2009 he joined the University of Miami Leonard M. Miller School of Medicine as the Leonard M. Miller Professor and Chairman of the Department of Psychiatry and Behavioral Sciences. 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. He has received numerous honors including the A.E. Bennett Award from the Society of Biological Psychiatry (1979), the Judith Silver Memorial Young Scientist Award from the National Alliance for the Mentally Ill (1989), both the Kempf Award in Psychobiology (1989) and the Samuel Hibbs Award (1990) from the American Psychiatric Association, and the Gold Medal Award and the Research Prize (1996) from the Society of Biological Psychiatry. In 1993 he was awarded the Edward J. Sachar Award from Columbia University and the Edward A. Strecker Award from The Institute of Pennsylvania Hospital. In 1997, he was the recipient of the Gerald Klerman Award from the National Depressive and Manic-Depressive Disorders Association and the Selo Prize from the National Alliance for Research in Schizophrenia and Depression and many more. 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. He has published more than 975 research reports and reviews.
Brain imaging, neuroendocrine and neurotransmitter studies have revealed the many long-term biological consequences of child abuse and neglect. These changes underlie the increased vulnerability to mood and anxiety disorders in adulthood. Our group and others have demonstrated a number of long term neurobiological consequences of child abuse and neglect including structural and functional brain imaging changes, neuroendocrine and immune alterations. In particular, alterations in the hypothalamic-pituitary-adrenal (HPA) axis, the major mediator of the mammalian stress response, contribute to the long standing effects of early life trauma. However, not all exposed individuals demonstrate altered HPA axis physiology, suggesting that genetic variations influence the psychiatric consequences of trauma exposure. Variants in the genes encoding the CRF R1 receptor, FKBP5, PAC1, oxytocin receptor, and others interact with adverse early environmental factors to predict risk for stress-related psychiatric disorders. Epigenetic mechanisms have now been shown to play a seminal role in mediating the effects of early life stress. These studies have suggested new molecular targets for drug development, biological risk factors, and predictors of treatment response. Patients with a history of child abuse and neglect exhibit a more severe disease course in terms of earlier age of onset and symptom severity, and exhibit a poorer treatment response to both psychopharmacological and psychotherapeutic treatments. Recognition of the biological consequences and clinical impact of trauma has critical importance for clinical service delivery, treatment research, and public health policy.
University of Oulu, Finland
Keynote: Long-term associations between use of antipsychotic medication and brain structural changes in Schizophrenia – A systematic review and a meta-analysis
Time : 10:10-10:50
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 150 peer-reviewed publications in field of psychiatry, his research focus has been especially on schizophrenia.
The association between antipsychotic medication and long-term changes in brain structure in schizophrenia is unclear. Our aim was to systematically review longitudinal MRI studies with at least a two-year scan-interval on the relationship between the dose or type of antipsychotic medication and brain changes in schizophrenia. Studies were systematically collected using four databases and we also contacted authors for unpublished data. We calculated correlations between antipsychotic dose and/or type and brain volumetric changes, and used random effect meta-analysis to study correlations by brain area and tissue type. In total 29 publications from 16 different samples fulfilled our inclusion criteria. In meta-analysis higher antipsychotic exposure associated statistically significantly with decrease in parietal lobe volume (studies, n=4; r=-0.14, p=0.013) and with increase in basal ganglia volume (n=4; r=0.10, p=0.044). Most of the reported correlations between brain volume change and antipsychotic dose were statistically non-significant. We did not find any clear differences between typical and atypical exposure and brain volume change. The studies were often small and highly heterogeneous in their methods and seldom focused on antipsychotic medication and brain changes. To conclude, antipsychotic medication may associate with brain structure changes, however more good quality long-term follow-up studies are needed.
- Workshop on Managing
University of Oulu, Finland
Professor, University of Oulu, Finland
Title: Outcomes in Schizophrenia – Systematic Reviews
Time : 11:10-11:40
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.
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
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.
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
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).
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.
Universitat Autonoma de Barcelona, Spain
Title: m-RESIST: Mobile therapeutic attention for patients with treatment resistant schizophrenia
Time : 13:30-14:00
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).
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.
Centre Hospitalier Guillaume Régnier, France
Title: Pharmacological management of treatment resistant schizophrenia
Time : 14:00-14:30
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.
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
Catherine L Clelland
Columbia University, USA
Catherine L Clelland
Columbia University Medical Center, USA
Title: Targeting Proline: Old and New Treatment Approaches for Schizophrenia
Time : 14:40-15:00
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.
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
University Psychiatric Clinic Ljubljana, Slovenia
Title: Effect of tobacco use on symptom severity and medication adherence in Schizophrenia
Time : 15:00-15:20
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.
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.
- Young Researchers Forum
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
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.
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.
University of Montreal, Canada
Title: The role of the lateral habenula in motivation and reward: implication for psychiatric disorders
Time : 15:50-16:10
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.
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.
Neuropsychiatric Hospital, Aro, Nigeria
Title: Violent behaviour tracking format (VBTF): An accurate means of recording patients violent behaviours
Time : 16:30-16:50
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.
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.
Mansoura General Hospital, Egypt
Title: Cognitive Behavior Therapy for childhood OCD
Time : 16:50-17:10
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.
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
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)
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.