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1.
Psychiatr Danub ; 31(Suppl 3): 237-241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488733

RESUMO

BACKGROUND: In a two-year study, we compared the efficacy of noradrenergic and serotonergic antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from major depressive disorder (MDD). In this article we examine the influence of the health locus of control, family relationships and personality traits on the progress of MDD. SUBJECTS AND METHODS: 40 people with MDD (MDD group) were randomly assigned to the different treatment groups. They were followed in parallel with a group of 20 'healthy' subjects (HG). At the beginning of the study, sociodemographic data were collected, and patients were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study subjects were regularly assessed using the Hamilton Depression Scale (HDS), the Short Form Health Survey (SF-12) and the Clinical Global Impression scale (CGI). RESULTS: Regardless of the type of treatment, physical health is the best predictor of variation at two years in the MDD group; 45% of variance is explained by a linear regression model that includes three variables from the MHLC, FACES III and NEO-FFI scales. Similarly, 40% of CGI and 24% of HDS variance is predicted. These explanatory variables are statistically less powerful in the MDD group than the HG group. CONCLUSION: While drug treatment is a determinant in changes on the HDS, CGI and SF12 scales, factors such as family relationships, MHLC or personality are important covariates of these changes. The question remains whether we can influence these covariates to improve the response to antidepressants.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Relações Familiares , Controle Interno-Externo , Humanos , Escalas de Graduação Psiquiátrica
2.
Psychiatr Danub ; 31(Suppl 3): 371-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488754

RESUMO

BACKGROUND: In this paper we focus on adolescents in transition towards young adulthood (ATYA). We know from international studies that the transition process makes adolescents vulnerable to mental illness. However, little is known about Belgian ATYA mental-health status. Nor are risk factors associated with their mental illness understood, in particular with regard to depressive and anxiety disorder. The aim of this study is (1) to discuss evolution in time of prevalence of depressive disorder (DD) and anxiety disorder (AD) among Belgian ATYA and (2), to identify risk factors associated with these disorders among ATYA. SUBJECTS AND METHODS: Data was extracted from the Belgian Health Interview Survey (BHIS), which is a cross-sectional population survey, carried out in 2001, 2004, 2008, and 2013. Information about the population's background characteristics, health services utilization, health behaviours and mental health status were extracted and statistically analyzed. RESULTS: ATYA prevalence of DD and AD was higher in 2013 in comparison with previous years. These changes were significant only for DD (F=4.466, p=0.004). In contrast with younger adolescents, among ATYA odds of DD were 28.2% higher (OR 1.282, 95% CI 0.967-1.698, p=0.084) and, odds of AD were 55.2% higher (OR 1.552, 95% CI 1.137-2.119, p=0.006). For ATYA, a poor quality of social support was the most predictive factor of DD (OR 11.187, 95% CI 5.530-22.629, p<0.0001) and AD (OR 6.238, 95% CI 2.845-13.676, p<0.0001); whereas, having a paid job was the most protective factor with regard to DD (OR 0.282, 95% CI 0.169-0.470, p<0.0001) and AD (OR 0.552, 95% CI 0.330-0.924, p<0.024). CONCLUSION: Prevalence of mental illness among Belgian ATYA appears to worsen in time. In comparison with younger adolescents, ATYA are more vulnerable to anxiety disorders. Adverse and protective risk factors were identified and discussed in a way to improve access, continuity and mental healthcare pathways for Belgian ATYA.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Nível de Saúde , Saúde Mental/estatística & dados numéricos , Adolescente , Bélgica/epidemiologia , Estudos Transversais , Emprego/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Prevalência , Fatores de Risco , Adulto Jovem
3.
Psychiatr Danub ; 31(Suppl 3): 376-380, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488755

RESUMO

BACKGROUND: Mobius syndrome is characterized by a bilateral congenital paralysis of the facial and abducens nerves which leaves the subject with an expressionless "mask-like" face. SUBJECTS AND METHODS: Based on a literature review and a case discussion of an adult patient with Mobius syndrome and obsessive-compulsive disorder, initially undiagnosed and confused with a psychotic disorder, we will discuss the influence of Mobius syndrome in psychiatric evaluations. RESULTS: The lack of facial expressiveness and non-verbal emotional interactions may influence psychiatric evaluations and result in misdiagnosis and the inappropriate prescribing of antipsychotics. In the case analysis, we also observed other associated malformations such as renal atrophy, a bicuspid aortic valve and mitral valve prolapse. CONCLUSION: We feel that educating the patient about the communicative consequences of impaired facial expressions and facial interactions is a necessary prerequisite for any psychiatric or psychological evaluation in subjects with Mobius syndrome. We also recommend using caution when prescribing antipsychotics in patients with Mobius syndrome given the motor side effects secondary to a potentially pre-existing hypotonia.


Assuntos
Erros de Diagnóstico , Síndrome de Möbius/complicações , Síndrome de Möbius/diagnóstico , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/diagnóstico , Adulto , Antipsicóticos/uso terapêutico , Expressão Facial , Humanos , Síndrome de Möbius/tratamento farmacológico , Síndrome de Möbius/patologia , Comunicação não Verbal , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/patologia
4.
Psychiatr Danub ; 31(Suppl 3): 381-385, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488756

RESUMO

BACKGROUND: Psychiatric disorders may be correlated with a low-grade systemic inflammation but the origin of this inflammatory response remains unclear and both genetics and environmental factors seems to be concerned. Recent researches observed that gut microbiota seems to have an impact on the brain and immune processes. METHOD: We review recent literature to a better understanding of how microbiota interacts with brain, immunity and psychiatric disorders. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords "gastrointestinal microbiota" and "mental disorders" or "psychological stress". RESULTS: We showed links between gut microbiota and brain-gut axis regulation, immune and endocrine system activity, neurophysiological changes, behavior variations and neuropsychiatric disorders. Communications between brain and gut are bidirectional via neural, endocrine and immune pathway. Microbiota dysbiosis and increase gut permeability with subsequent immune challenges seems to be the source of the chronic mild inflammation associated with neuropsychiatric disorders. Repeated immune or stress events early in life may lead to neurodevelopmental disorders or sickness behavior later in life. CONCLUSIONS: Psychological stress impact gut microbiota with subsequent immune activation leading to neurodevelopmental disorders or sickness behavior and altering neurophysiology and reactivity to stress or lifestyle.


Assuntos
Encéfalo/imunologia , Encéfalo/fisiopatologia , Microbioma Gastrointestinal/imunologia , Microbioma Gastrointestinal/fisiologia , Inflamação/imunologia , Inflamação/psicologia , Transtornos Mentais/imunologia , Transtornos Mentais/microbiologia , Disbiose/imunologia , Disbiose/microbiologia , Disbiose/psicologia , Sistema Endócrino/imunologia , Sistema Endócrino/metabolismo , Sistema Endócrino/microbiologia , Humanos , Inflamação/microbiologia , Neuropsiquiatria , Estresse Psicológico/imunologia , Estresse Psicológico/microbiologia
5.
Psychiatr Danub ; 31(Suppl 3): 386-389, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488757

RESUMO

BACKGROUND: Nowadays, anxiety disorders are becoming more and more important in our population. And if there is one category of people more vulnerable to this problem, it is the teenagers. In addition, more and more children and teenagers are diagnosed with an IQ greater than 130, causing all the stress and questions that it generates. In this project, we are comparing two groups of adolescents, one with an IQ over 130, the other with an IQ less than 130. We are wondering if there is any difference between these groups, in terms of phobia and other psychopathologies. SUBJECTS AND METHODS: A sample of 35 teenagers, from 12 to 16 years old, separated in two groups (IQ over 130 and IQ below 130), fulfilled the following questionnaires: the School Rehabilitation Assessment Scale-Revised (SARS-R), the "Family Adaptability and Cohesiveness Evaluation Scale III" (FACES III), and the "Kiddie- SADS-lifetime" (K-SADS-PL), and a social data collection questionnaire. RESULTS: At the end of this study, we can retain the following relevant elements: adolescents with IQs greater than 130 are statistically more likely to be the eldest siblings (Cochran Test F=9.159, p=0.010). They do not develop more phobias, but are more shy (t=4.375, p=0.036) than the control population. These high-potential and shy teenagers have a whole list of commonalities, such as being easily irritable, being easily distracted, ect... They have fewer friends in real life (t=2.255, p=0.033), fewer virtual friends (t=4.346, p=0.000) and fewer virtual relationships (t=2.431, p=0.021). Their families are very cohesive (Test t=0.004). There is no significant role of the socio-professional class of parents playing in the value of the IQ of their children (t=4.667, p=0.323). CONCLUSION: To conclude, being a teenager and having an IQ greater than 130 is not always a pleasure. Our results showed us that the majority of these young people consider themselves as shy, unsure of themselves and claim to have many fears. This is evidence of an increased anxiety component compared to the control sample. It seems important to insist on the need to be able and to know how to identify these young people as soon as possible, in order to propose appropriate therapeutic management.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Testes de Inteligência/estatística & dados numéricos , Inteligência , Psicopatologia , Timidez , Adolescente , Ansiedade/prevenção & controle , Transtornos de Ansiedade/prevenção & controle , Estudos de Casos e Controles , Criança , Medo , Amigos/psicologia , Humanos , Fatores Socioeconômicos , Inquéritos e Questionários
6.
Psychiatr Danub ; 31(Suppl 3): 411-415, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488762

RESUMO

BACKGROUND: Based on our 2012 study and a review of the literature on the therapeutic alliance we asked ourselves different questions: does the alliance exert a real influence on the evolution of depressive affects, the rate of remission and the physical and global health? SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder are randomly assigned to groups that receive a SSRI (escitalopram) or a SNRI (duloxetine), each group receive concomitant ASA (100 mg) or a placebo. Sociodemographic data are recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and Clinical Global Impression (CGI) scale, the Helping Alliance Questionnaire (HAQ) and the Short Form Health Survey (SF-12). RESULTS: There is no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons reveal that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p 0.05) than the escitalopram + placebo (EP) subgroup. Regardless of the treatment arm, the remission rate at 2 years is 50%. Among patients in remission a majority, 65%, have a high level of alliance in opposition to nonresponders who have found mostly a low level of alliance (χ2=6.296, p 0.012). HAQ scores are not correlated with HAD scores, but a correlation is found with remission rates (r=0.316*). At all times, HAQ scores are correlated with physical health. CONCLUSION: Our findings suggest that a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone. A good alliance improves effectiveness of anti-depressant treatment of 1.85 and leads to an improvement of the physical health rather than directly on the depressive feelings.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Nível de Saúde , Inibidores de Captação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Aliança Terapêutica , Citalopram/uso terapêutico , Método Duplo-Cego , Cloridrato de Duloxetina/uso terapêutico , Humanos
7.
Psychiatr Danub ; 30(Suppl 7): 401-404, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439812

RESUMO

BACKGROUND: In a two-year study we compared the efficacy of noradrenergic (duloxetine D) and serotonergic (escitalopram E) antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from a major depressive episode (MDE). The results showed that the D + ASA (DASA) group improved more rapidly than the E + placebo (EP) subgroup. In particular, Hamilton Depression Scale (HDS) scores improved as early as two months, Clinical Global Impression (CGI) scores improved at five months, and remission rates were better. In the course of this study, we also investigated the role of the therapeutic relationship (alliance) on both the progress of the MDE, and patients' mental and physical health. SUBJECTS AND METHODS: 40 people suffering from an MDE were randomly assigned to treatment groups. At the beginning of the study sociodemographic data were collected, and the Helping Alliance Questionnaire (HAQ) was completed. During the study, patients were regularly assessed using the HDS, CGI and the Short Form Health Survey (SF-12). RESULTS: Subgroup comparisons revealed that HAQ scores are not correlated with HAD scores, but a correlation was found with remission rates (r=0.316*). Similarly, at all times, HAQ scores were correlated with physical health (p<0.05), which is in turn correlated with HDS and CGI scores. CONCLUSION: Physical health is linked to the level of depression. While the alliance with the patient is not directly correlated with the intensity of depression, is it correlated with their physical condition and its improvement. For patients, improving their physical health appears to be more important than improving their mental health. These observations must be confirmed.


Assuntos
Antidepressivos , Transtorno Depressivo Maior , Nível de Saúde , Aliança Terapêutica , Antidepressivos/uso terapêutico , Depressão , Método Duplo-Cego , Humanos , Resultado do Tratamento
8.
Psychiatr Danub ; 30(Suppl 7): 409-411, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439814

RESUMO

BACKGROUND: There are medico-psycho-social indications to apprehend the alcohol use disorder (AUD) as a chronic problem for which a continuous care is necessary. The perception of continuity of care is also associated with positive outcomes on the patient's health. Communication between caregivers is essential to maintain a good continual care. In order to put patients back into the center of care, we asked them the question: "why should the psychiatric department (PD) and general physicians (GP) should communicate about AUD patients"? SUBJECTS AND METHODS: After a week of hospitalization for alcoholic withdrawal, we used a qualitative approach with 4 open questions to explore AUD patients' point of view (N=17) about the best way of communication between psychiatrists and GP to improve care continuity. The data collection was carried out in the psychiatric department of the University Hospital of Mont-Godinne, Belgium. RESULTS: AUD patients consider that the GP is the first line actor that will be consulted after hospitalization and have a privileged relationship with him. These arguments justify him being informed. Concerning these patients, communication is useful to have a continuous treatment and project care, for purposes of symptoms' evolution follow-up and so as to help the GP to understand them better to follow the evolution of symptoms and to help the GP to understand them better. CONCLUSION: From AUD patients' point of view, communication between psychiatric department and the GP is useful for a perspective of continuity of care at discharge from the hospital. This communication seems to be at the service of the GP and his patient rather than for the psychiatrist himself. Mainly because of the GP's role as a privileged first-line care, but also thanks to the specific relationship relating him to his patient.


Assuntos
Comunicação , Continuidade da Assistência ao Paciente , Clínicos Gerais , Psiquiatria , Bélgica , Humanos , Relações Interprofissionais
9.
Psychiatr Danub ; 30(Suppl 7): 418-421, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439817

RESUMO

BACKGROUND: Denial of pregnancy is an issue that is often discovered a posteriori with sometimes dramatic complications. Denial of pregnancy is considered partial when the woman becomes aware of the pregnancy after the fifth month before delivery. The populations studied were heterogeneous, which made it impossible to establish a standard algorithm of the treatment and support of a discovery of partial denial of pregnancy. SUBJECTS AND METHODS: Based on a literature review and a discussion of partial denial of pregnancy case and the consequential treatment with a five-year follow-up, the global management recommendations need consideration in the case of partial denial of pregnancy. RESULTS: The reported case confirmed the significance of the trauma caused by the discovery of pregnancy in a patient in denial, but also showed that this trauma can extend to caregivers concerned by the treatment. CONCLUSION: Continuous training of all caregivers for denial of pregnancy is essential even if the issue may be considered infrequent. Contraception, prevention of sexually transmitted diseases and the importance of gynecological follow-up must be systematically addressed in a medical consultation. A standard algorithm for the treatment of partial denial is difficult to establish, but the rapid mobilization of a multidisciplinary team or hospitalization is recommended for the announcement of the diagnosis as well as personalized support during ultrasounds. The establishment of a relationship of trust remains the major issue.


Assuntos
Diabetes Mellitus , Complicações na Gravidez , Gravidez , Ideação Suicida , Anticoncepção , Feminino , Humanos , Gravidez/psicologia , Complicações na Gravidez/psicologia
10.
Psychiatr Danub ; 30(Suppl 7): 439-442, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439822

RESUMO

BACKGROUND: The physical and mental health of a population is based, in particular, on its quality of life and its access to health care. Given these determinants, Greece's population has greatly suffered due to the sharp cuts in the budget for social benefits and health care (some measurable evidence is the recent increase in the suicide rate). Starting January, the 1st of 2015, unemployment benefits in Belgium have been eliminated for all recipients who do not have a full-time year of work over the last three years. Therefore, we must ask whether there will be similar psycho-medical consequences for Belgium's population. SUBJECTS AND METHODS: Open study over a year (01/07/14 - 30/06/15) of emergencies admitted to the University Hospital Center of Mont-Godinne including a psychopathological motif. In addition to general socio-demographic data, psychic disorders are measured, as well as different types of crises (familial, professional or couple crisis), familial support and its dynamic (FACES III of Olson) and finally social integration (social isolation scale from the National Social Life, Health, and Aging Project (NSHAP)). These patients are compared with those admitted during the six months preceding the Act modifying the unemployment benefits. RESULTS: Between July the 1st of 2014 and June the 30th of 2015, we saw an increase in the number of admissions to the psychiatric emergency department by 2.5% in six months, despite a decrease in the number of admissions to all-cause emergencies. Our study also shows a degradation of social network quality characterized by a more pronounced social isolation of our patients. At last, an alteration of cohesion in the patient's origin family was highlighted. CONCLUSION: Although we cannot establish a direct causal link between this law and the results of this study, these may suggest a weakening of the population mental health due to difficult socio-economic context. As a result, we are faced not only with a public health problem but also with one concerning health care organization.


Assuntos
Financiamento Pessoal , Transtornos Mentais , Saúde Mental , Bélgica , Emprego , Humanos , Qualidade de Vida
11.
Psychiatr Danub ; 30(Suppl 7): 447-451, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439824

RESUMO

BACKGROUND: In previous studies we showed the interaction between depression and immunity. We observed that psychological stress seems to be important in this association. In this review we try to understand if psychological stress and immunity have similar or specific impact on the other psychiatric disorders. More generally we review literature to understand if specific immune alterations exist between the main psychiatric diagnoses. METHOD: We studied the literature in search of variabilities between the different psychiatric disorders in terms of immunity especially inflammation. We search on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity or inflammation and depression, anxious disorders and schizophrenia. RESULTS: Prevalence of inflammation in psychiatric disorders seems to be between 21 to 42%. Psychiatric disorders are correlated with elevated levels of CRP, pro-inflammatory cytokines (IL-6, IL-1ß and TNFα) and anti-inflammatory factors (TGF ß, IL-10, sIL-2, IL-1RA). IL-6 in childhood were associated with subsequent risk of depression or psychotic disorders in early adulthood and in a dose dependent manner. DISCUSSIONS: We found similar immune processes through the different disorders. Variations in cytokines levels seem paralleling various stages of the illness and treatment. Inflammatory markers are linked with severity and resistance to treatment and with subsequent risk of disorders. CONCLUSIONS: Some inflammatory parameters could be considered as risk factor, severity, resistance, trait or state markers of a psychiatric disorder. Other studies are necessary to a better understanding of clinical implications of this heterogeneity.


Assuntos
Biomarcadores , Transtorno Depressivo , Transtornos Psicóticos , Esquizofrenia , Criança , Citocinas/metabolismo , Transtorno Depressivo/imunologia , Humanos , Transtornos Psicóticos/imunologia , Esquizofrenia/imunologia
12.
Psychiatr Danub ; 30(Suppl 7): 475-478, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439829

RESUMO

BACKGROUND: The links between psychiatry and immune dysfunctions are well known. By contrast, there are few studies that evaluate the link between neuroelectrophysiology and immune system disturbances. SUBJECTS AND METHODS: We retrospectively included 31 patients hospitalized between 2011 and 2012. They completed a sociodemographic questionnaire and were assessed using DSM IV TR on Axis 1. Event-related potentials were performed. Lymphocyte subtypes were quantified using flow cytometry. RESULTS: In terms of P300 latency, there are correlations with the absolute value of leukocytes: for P3a component, we find a correlation in frontal derivation Fz (r=0.405*), in central derivation Cz (r=0.438*), in parietal derivation Pz (r=0.403*) and for P3b component, there is a correlation in Fz (r=0.414*), in Cz (r=0.402*) and in Pz (r=0.425*). In terms of P300 amplitude, for P3b component, there are correlations with CD3 lymphocytes percentage in all derivations (Fz (r=-0.621**); Cz (r=-0.567**); Pz (r=-0.499**)) and with CD19 lymphocytes percentage in all derivations (Fz (r=0.469*); Cz (r=0.466*); Pz (r=0.430*)). For P3a, it is correlated with CD3 percentage (in Fz (r=-0.539**); Cz (r=-0.406*)) and with CD19 percentage (Fz (r=0.364*); Pz (r=0.357*)). With respect to the relationship between mismatch negativity (MMN) amplitude and natural killer (NK) cells percentage, there are correlations in left temporal derivation T3 (r=-0.426*), in Cz (r=-0.401*) and in right temporal derivation T4 (r=-0.427*). A correlation is found between the contingent negative variation (CNV) amplitude and the lymphocytes percentage in Fz (r=-0.471**). CONCLUSIONS: There is a link between lymphocyte-related immunity and electrophysiological disturbances in psychiatric patients. Further studies would be needed to evaluate this relationship more specifically, particularly prospectively and by pathology.


Assuntos
Linfócitos B , Potenciais Evocados , Transtornos Mentais , Linfócitos T , Linfócitos B/imunologia , Eletroencefalografia , Humanos , Imunidade Celular , Células Matadoras Naturais , Transtornos Mentais/imunologia , Estudos Retrospectivos , Linfócitos T/imunologia
13.
Psychiatr Danub ; 30(Suppl 7): 498-501, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439834

RESUMO

BACKGROUND: Among asylum seekers (AS), mental health conditions are highly prevalent. However this population group has poor access to adequate services and frequently incurs discontinuity of mental healthcare. Many factors explain discontinuity of mental healthcare for asylum seekers. The aim of this study is to evaluate if facilitation of care for AS decreases healthcare provider stereotypes of this population and improves their continuity of care. SUBJECTS AND METHODS: General practitioners (GPs) and mental health professionals (MHPs) were invited to participate in a vignette study, presenting an AS patient manifesting post-traumatic stress symptoms. We randomly manipulated the context of the clinical vignette to create two experimental conditions: facilitated care versus non-facilitated care. In each condition, we measured participants' stereotypes and continuity of care. RESULTS: There was a significant effect of participant's type of stereotypes on continuity of care (F=2.87, p=0.035). However, we found no effect of condition (facilitated vs. non facilitated care) on stereotypes (F=0.11, p=0.95), nor on continuity of care (F=0.35, p=0.55). Furthermore, there was a significant effect of profession (GPs vs MHPs) on continuity of care (F=11.43, p=0.001). Participants' number of consultations per week (F=10.33, p=0.002) and their gender (F=3.69, p=0.030) both have a significant effect on continuity of care. CONCLUSION: Among healthcare providers, we found that "admiration" stereotypes were associated more with continuity of care. Paradoxically, continuity of mental healthcare was better among GPs compared to MHPs. Thus, improvement of continuity of mental healthcare for AS among MHPs should be investigated in further studies.


Assuntos
Continuidade da Assistência ao Paciente , Clínicos Gerais , Transtornos Mentais , Refugiados , Estereotipagem , Humanos , Transtornos Mentais/etnologia , Distribuição Aleatória , Encaminhamento e Consulta , Refugiados/psicologia
14.
Psychiatr Danub ; 30(Suppl 7): 533-536, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439841

RESUMO

BACKGROUND: Anorexia is a frequent pathology; not only does it cause major changes in patients' quality of life, but also the mortality rate is high. This mortality mainly affects young people. However, care remains controversial. The aim of this literature review is, therefore, to review current guidelines. SUBJECTS AND METHODS: A review of the literature published between 2006 and 2017, from articles contained in the Cochrane, PubMed, Scopus and PsychINFO databases. Keywords were 'anorexia nervosa', 'adults' and 'management'. RESULTS: Patient management must be multidisciplinary and prioritise weight gain. For this to happen, outpatient monitoring must include a gradual normalisation of eating habits. This always involves psychotherapy and sometimes prescription medication. However, no specific therapy or psychotropic drug has demonstrated statistical superiority in the management of anorexic patients. Cognitive behavioural therapy remains the most effective therapy in preventing relapse, and family therapies for the treatment of young patients who are still living with their families of origin. Hospitalization is sometimes necessary and must then include gradual and closely monitored refeeding to avoid the potentially fatal refeeding syndrome. CONCLUSIONS: The management of anorexic patients is complex but always involves reaching a normal weight. The best prognosis is found in young patients with the least chronic disease.


Assuntos
Anorexia Nervosa , Terapia Familiar , Psicoterapia , Adolescente , Adulto , Anorexia Nervosa/terapia , Terapia Cognitivo-Comportamental , Humanos , Qualidade de Vida
15.
Psychiatr Danub ; 30(Suppl 7): 537-540, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30439842

RESUMO

BACKGROUND: Many young patients who are cyberbullied maintain communication with their harasser, despite the fact that this behaviour perpetuates the harassment. Numerous studies describe coping strategies adopted by cyberbullied adolescents. None describe what motivates adolescents to continue to communicate with their harassers. METHODS: We conducted a literature review of cyberbullying, taking into account the challenges of adolescence. We used several search engines (Scopus, PsycINFO, Cairn and PubMed), using the following keywords: cyberbullying, teens, behaviour, coping strategies, social network, Facebook, counterpart. Our search returned 526 results, which were subsequently sorted as a function of their relevance. We also consulted reference books on adolescent psychology. RESULTS: The adolescent, whose identity is being rebuilt, seeks a peer group, but also a relationship with a counterpart. This search is replayed on social networks and can lead adolescents to meet a counterpart harasser. Studies show that adolescents who suffer from cyberbullying are more likely than others to be in search of new friendships, and use social networks to make up for a lack or absence of fulfilling social relationships. They have fewer friends, have more difficulty maintaining social ties, and have fewer communication skills. In addition, cyberbullied adolescents have poorer relationships with their parents and teachers than their peers. CONCLUSIONS: Narcissistically fragile adolescents are at greater risk of being unable to stop communicating with their cyberbully. If the adolescent has no other relationships that enable him or her to develop their identity, they will be unable to put an end to this harmful counterpart relationship. It would be interesting to supplement this review with an experimental study, and to consider the development of new, secondary prevention strategies in the adolescent population.


Assuntos
Adaptação Psicológica , Bullying , Internet , Rede Social , Adolescente , Feminino , Humanos , Masculino , Grupo Associado , Estresse Psicológico
16.
Psychiatr Danub ; 29(Suppl 3): 219-221, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953766

RESUMO

BACKGROUND: Delusional parasitosis (DP) is an uncommon psychiatric disorder. Patients suffering from this disorder have the fixed false belief of being infested by a parasite. Because of this condition, patients mainly consult with dermatologists or general practitioners. They are often reluctant to see a psychiatrist and to take treatment with antipsychotics because of their belief. The following describes the case of a woman who has the particularity that the DP started a few days after sertraline interruption. This situation raises the question of the impact of the sertraline interruption on pruritus and its role as a trigger of DP. SUBJECTS AND METHODS: Case report description and research on medline, pubmed with the keyword: delusional parasitosis, Ekbom syndrome, pruritus, SSRI. RESULTS: Any other pathology that could explain the patient's symptomatology was excluded which allows us to diagnose this patient with DP. The disappearance of the symptoms was obtained with 200 mg of sertraline and 2 mg of risperidone. It appears that pruritus can be favored by cutaneous dryness due to age and anxiety. Symptoms of discontinuation of SSRIs may include anxiety and paresthesia. CONCLUSIONS: The main hypothesis explaining the onset of DP would be the raise of paresthesia followed by the interruption of sertraline (discontinuation symptom) on a favorable field, which means an elderly woman of an anxious nature and having cutaneous dryness. It therefore seems necessary to discuss the discontinuation symptoms at the initiation of a treatment for this kind of patient to avoid false interpretations of skin symptoms such as paresthesia or itching.


Assuntos
Antipsicóticos , Delírio de Parasitose , Idoso , Antipsicóticos/uso terapêutico , Delírio de Parasitose/tratamento farmacológico , Feminino , Humanos , Risperidona/uso terapêutico , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico
17.
Psychiatr Danub ; 29(Suppl 3): 254-258, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953772

RESUMO

BACKGROUND: A large amount of evidence has already shown associations between depression and immunity, a bi-directional relationship seems to be increasingly evident. We showed in several precedent studies that family dynamics (Dubois et al. 2016, Zdanowicz et al. 2015), some coping skills (Manceaux et al. 2016) or gender (Fagniart et al. 2016) are correlated with depression and/or immunity and change the way depression and immunity interact together. METHOD: The objective of this review is to study the literature in search of older and recent evidence about how immunity and depression interact and which determinants influence this relationship. We searched on PubMed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity and depression and with coping, gender and family. RESULTS AND DISCUSSIONS: Surprisingly we observed in the literature that depression is mostly correlated with both inflammatory and impaired immunity mainly for cell-mediated immunity. Recent studies showed that gender differences in immunity seems to explain in part some variabilities concerning depression and acute/chronic stress among men and women. There is evidence for a sexual dimorphism of the immune system. Coping style, perceived control or personality impact the immune system. There is evidence that childhood maltreatment or stress occurring early in life can exert persistent effects over a long period of time like a "biological scar". CONCLUSIONS: There seems to be an individual and biological heterogeneity behind the label of major depressive disorder. We demonstrated the role of several modulators on immunity and depression such as gender, coping, personality, early-life stress or relationships. Many other modulators could exist and should be considered for further investigations.


Assuntos
Depressão , Transtorno Depressivo Maior , Sistema Imunitário , Adaptação Psicológica , Criança , Maus-Tratos Infantis , Depressão/imunologia , Depressão/terapia , Transtorno Depressivo Maior/imunologia , Transtorno Depressivo Maior/terapia , Feminino , Humanos , Sistema Imunitário/fisiologia , Masculino , Modelos Imunológicos , Estresse Psicológico
18.
Psychiatr Danub ; 29(Suppl 3): 262-266, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953774

RESUMO

BACKGROUND: Since 2010, the Belgian mental healthcare system has been involved in a structural reform: the main objective of this reorganisation is to foster the reintegration in the community of patients suffering from a mental health disorder. In parallel, the role of mental health professionals has evolved these last years: from a strictly clinical role, to the preoccupation with the rehabilitation of social competencies such as enhancing patients' abilities to return to work. The aim of this paper is to explore, specifically for patients hospitalized for a common mental health disorder, the predictive variables of returning to work within 6 months after hospitalization (RTW6). SUBJECTS AND METHODS: Our sample was extracted from routinely collected data during the patients' hospital stay (10 days) at the Psychosomatic Rehabilitation Day Centre of CHU Godinne. A sample of 134 patients participated in our study. Those patients were contacted 6 months after their hospitalization to assess resumption of work. RESULTS: We found that a patient's sociodemographicand socioeconomic variables, and depressive symptoms at the beginning of hospitalization were not predictive of return to work within 6 months (RTW6). On the other hand, duration of absence from work before hospitalization and the diagnosis of a major depression in particular were negatively associated with RTW6, whereas improvement of depressive symptoms during hospitalization stay was positively associated to RTW6. CONCLUSION: Our study identified the diagnosis of major depression and the duration of absence from work before hospitalization as two important risk factors impeding a fast return to work for patients hospitalised for a common mental health disorder. As the preoccupation with patients' abilities to return to work is now on the agenda of mental health professionals, special support and supervision should be dedicated to the more vulnerable patients.


Assuntos
Transtorno Depressivo Maior , Hospitalização , Transtornos Mentais , Retorno ao Trabalho , Cognição , Depressão , Transtorno Depressivo Maior/reabilitação , Humanos , Saúde Mental
19.
Psychiatr Danub ; 29(Suppl 3): 259-261, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953773

RESUMO

BACKGROUND: It is important to perform psychiatric assessments of adult patients who are candidates for cochlear implants both to screen them for psychiatric disorders and to assess their understanding and compliance with the procedure. Deafness is a factor of difficulty for conducting in-depth psychiatric interviews, but concomitant blindness may make it impossible. SUBJECTS AND METHOD: After a description of Norrie disease, a rare disease in which blindness and deafness may occur together, we propose a case report of a patient suffering from the disease and who consulted in view of a cochlear implant. RESULTS: Early information on cochlear implants appears to be necessary before total deafness occurs in patients suffering from Norrie disease. An inventory of digital communication tools that can be used by the patient is also highly valuable. CONCLUSIONS: Research should be supported for a more systematic use of psychiatric assessments prior to cochlear implants. In the special case of Norrie disease, we recommend early screening for mental retardation and related psychotic disorders and, depending on the patient's level of understanding, preventive information on the benefits and limits of cochlear implants before total deafness occurs.


Assuntos
Cegueira/congênito , Implantes Cocleares , Surdez , Doenças Genéticas Ligadas ao Cromossomo X , Doenças do Sistema Nervoso , Transtornos Psicóticos , Degeneração Retiniana , Espasmos Infantis , Adulto , Cegueira/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Humanos , Doenças do Sistema Nervoso/diagnóstico , Transtornos Psicóticos/diagnóstico , Degeneração Retiniana/diagnóstico , Espasmos Infantis/diagnóstico
20.
Psychiatr Danub ; 29(Suppl 3): 270-273, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28953776

RESUMO

BACKGROUND: Antidepressant medication efficacy remains a major research challenge. Here, we explored four questions: whether noradrenergic antidepressants are more effective than serotonergic antidepressants; whether the addition of 100 mg acetylsalicylic acid (ASA) changes antidepressant efficacy; whether the long-term efficacy differs depending on the antidepressant and the addition of ASA; and whether serum levels of brain-derived neurotrophic factor (BDNF) are clinically informative. SUBJECTS AND METHODS: In a two-year study, forty people with major depressive disorder were randomly assigned to groups that received an SSRI (escitalopram) or an SNRI (duloxetine), each group received concomitant ASA (100 mg) or a placebo. Sociodemographic data were recorded and patients under went regular assessments with the Hamilton depression scale (HDS) and clinical global impression (CGI) scale. Serum levels of BDNF were measured four times per year. RESULTS: There was no significant difference in efficacy between the two antidepressants or between antidepressant treatment with and without ASA. However, subgroup comparisons revealed that the duloxetine + ASA (DASA) subgroup showed a more rapid improvement in HDS score as early as 2 months (t=-3.114, p=0.01), in CGI score at 5 months (t=-2.119, p=0.05), and a better remission rate (χ2=6.296, p 0.012) than the escitalopram + placebo (EP) subgroup. Serum BDNF before treatment was also higher in the DASA subgroup than in the EP subgroup (t=3.713; p=0.002). CONCLUSION: This suggest two hypotheses: either a noradrenergic agent combined with ASA is more effective in treating depression than a serotonergic agent alone, or the level of serum BDNF before treatment is a precursor marker of the response to antidepressants. Further research is needed to test these hypotheses.


Assuntos
Antidepressivos , Aspirina , Inibidores de Ciclo-Oxigenase , Transtorno Depressivo Maior , Antidepressivos/uso terapêutico , Aspirina/uso terapêutico , Citalopram/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Cloridrato de Duloxetina/uso terapêutico , Humanos , Inibidores de Captação de Serotonina/uso terapêutico
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