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Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
Suicide and attempted suicide are a major public health issue throughout the world, one particularly affecting youth. Its prevalence rates over the past decade have varied from remarkably stable to rising. To understand this phenomenon, researchers turned toward qualitative research, which is more suitable to elicit what links participants' attitudes toward health, individual characteristics and their environment, and what are the facilitators and barriers in the care. The present work is a qualitative metasynthesis of qualitative studies on youth suicide.
A systematic review of 5 web databases (Medline, PsycInfo, Embase, CINAHL, and Social Science Citation Index) retrieve 44 studies from 16 different countries. Thematic synthesis was used to develop categories inductively from the themes identified in the studies.
Three themes organised the results: individual experience, describe the individual burden and suffering related to suicide; relational experience relates the importance of relationships with others; and social and cultural experience, which describes acceptation and rejection from the group.
The violence of the suicidal act and of its message and the fears associated with the representation of death and with the fascination that it might present prevent communication around the suicidal act between the youth, their families, and their healthcare providers, and lead to incomprehension. The physician must play a role as a mediator between young suicide attempters and their families and enable the circulation of representations.
Cranioencephalic trauma and resulting traumatic brain injury are sometimes associated with hard to manage psychiatric symptoms, requiring interpretation from an integrated neuropsychiatric perspective.
We present the case of a 49-year-old man with no known psychiatric history who attempted suicide by gunshot to the head resulting in severe cranioencephalic trauma (GCS=7) and subsequent admission to our hospital's Neurosurgery ward. Brain-CT showed two intracranial projectiles, in left temporal and right occipital topography, as well as multiple haemorragic foci. He was transferred to our Psychiatry ward, as there was no neurosurgical indication and he repeatedly attempted suicide. At admission, he presented with level of consciousness fluctuations, temporospatial disorientation, anosognosia and difficult to assess depressive symptoms. Brief neuropsychological evaluation showed deficits on visual-perceptive abilities, executive functions, logical reasoning, and immediate verbal memory, with a MoCA (Montreal Cognitive Assessment) total score under the normative values. Some language capacities (i.e. naming and repetition) were found to be preserved. Neuroophthalmological evaluation evidenced damage to the anterior left optic tract and a right campimetric defect. The EEG revealed no epileptic activity. At the 34th day of hospitalization, after accidental choking, he began to exhibit delirium with accompanying psychotic symptoms. Presently, two-and-a-half months after admission, we observe remission of delirium, coherent and organized speech, an alexithymic pattern of response, ideative perseverance and no suicidal ideation.
The noteworthiness of this case resides on the scarcity of published reports and on the difficulty it presents in terms of therapeutic and post-discharge management, originating from the hard-to-interpret symptoms and uncertain prognosis.
Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.
Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.
Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.
Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.
Anorexia nervosa (AN) is a severe disease with often chronic courses, relapses and drop-outs. Recently, there has been a growing interest for qualitative research in eating disorders since this methodology gained some recognition as a reliable source of new insights and therapeutic implications. There is indeed an increasing qualitative literature about AN during adolescence but yet difficult to gather and synthesize. Therefore, we decided to perform a metasynthesis, i.e.a review of qualitative studies and a transversal analysis of all the studies, about AN treatment during adolescence. In order to obtain an integrated description of this topic, we included qualitative papers with perspectives from the adolescents, their parents or the healthcare professionals.
This meta-synthesis is based on a procedure adapted from meta-ethnography. From five data base (Medline, PsycINFO, CINAHL, EMBASE, SSCI), we did a systematic review for papers in English published between 1990 and 2014 using solely qualitative methodology and exploring the issue of treatment in adolescent AN. In total, 1140 papers were found and 27 were selected. We used the Critical Appraisal Skill Program – Qualitative research check-list to assess the quality of the studies.
We found three main themes: (1) to cure AN, (2) to care for the adolescent and the family, and (3) the therapeutic alliance as the main treatment challenge. We will discuss the lack of shared representations about treatment and especially the transversal issue concerning the dialectic 'having AN/Being Anorectic”.
The aim of this communication is to show how the phenomenological method, adapted for scientific purposes, can help medical research to improve our understanding and our knowledge about psychiatric disorders during adolescence.
Adolescence is a complex process at the interface of many fields of knowledge, such as biology, anthropology, psychology or sociology. Using phenomenology in research enables to explore adolescents ‘personal experience end subjective perception of an object or event without any theoretical preconceptions and presuppositions. Indeed, phenomenological approach involves a detailed exploration of participants’ experiences. Moreover, rather than reducing a phenomenon to a number or an identifiable variable, and controlling the setting in which the phenomenon is studied, phenomenology aims to describe it as faithfully as possible, within the context in which it occurs.
In order to illustrate the role of phenomenology in adolescent psychiatric research, we will present a study about the place of food in family relationships among adolescents with and without anorexia nervosa using phenomenological analysis. The research method was qualitative, and used photo-elicitation – i.e using one or several photographs taken by the participant as the basis of the interview- 14 adolescents and 18 parents were included. Data analysis was performed using Interpretative Phenomenological Analysis (IPA) method. It is an established qualitative methodology that enables to explore how individuals perceive particular situations they are facing, and how they make sense of their personal and social world.
Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression.
Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study.
Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21–88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9–63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire – Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively.
The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.
Cognitive deficits are a core feature of the first psychotic episode patients and could be an obstacle to functional ability. Cognitive stimulation could be a promising method to surpass neuropsychological deficits.
–to implement an online training protocol to stable first psychotic episode outpatients;
–to assess adherence to the intervention;
–to measure neurocognitive, psychopathological and functional outcomes pre- and post-training.
To investigate the feasibility of an online-based resource for cognitive stimulation (COGWEB®) and explore possible benefits in different domains.
Fifteen patients were enrolled from the Early Psychosis Intervention Program (PROFIP) at the Department of Psychiatry of Santa Maria Hospital, Lisbon. The training consisted on 30-40-minute online sessions performed every weekday during 6 months at home. Assessments were performed at baseline and after program completion and included: psychopathological scores; personal and social functioning scores; Clinical Global Impression and a neuropsychological battery.
Every participant had some kind of impairment on baseline. Mean training time was 36 h. Six patients left the program before completion (half of them because they got employed). The program showed overall good feasibility and safety with no reported significant psychiatric occurrences or hospitalizations. Results regarding final neuropsychological, psychopathological and functioning showed a tendency for stability or improvement on an individual case analysis.
Our results show that cognitive training using an online-based stimulation software is a feasible intervention for first-episode psychosis patients with possible benefits for this population. However, results should be analyzed very carefully because of different participant trajectories and of study limitations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Across Europe, school absenteeism is an increasing problem on the crossroad between educational and public-health political matters. This issue underlies socio-economical, sociological and school-related factors as much as it questions individual psychopathology and family functioning. Indeed, school refusal behavior among adolescents has become a very frequent reason to seek for psychiatric consultations. A recent review about this topic has shown that around 90% of these adolescents met the criteria for a psychiatric diagnosis, mostly anxiety disorders . It appears to be a very complex and heterogeneous phenomenon which raises many questions, to date still unsolved: terminology confusions (truancy, school phobia, school refusal), lack of a concise definition, contradictory hypothesis regarding etiology, psychopathology and treatment plan depending on the paradigm the authors would refer to. In this presentation, we will elicit why school refusal can be considered as a new idiom of distress for adolescents in western societies, and we will show how, in clinical practice, these situations can become a genuine Babel tower in which no one, among health-care professionals, teachers, parents and patients, are speaking the same language.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In 1960, the Thomas Jefferson Center of the University of Virginia applied for a “massive” grant from the Ford Foundation. Although Buchanan, Nutter, and Coase had all received grants from Ford, it turned down their proposal because of the Center’s unified “point of view.” The chapter examines correspondence and private discussions of the events. Following the submission of their proposal, Buchanan, Nutter, and then-President of UVA Edgar Shannon met with representatives of the Ford Foundation, Tom Carroll and Kermit Gordon. Buchanan concluded that the “reaction of the Ford representatives must be considered to have been almost wholly negative.” The crux of the matter, in Gordon’s assessment, was the TJC’s supposed “single” and dogmatic “point of view,” an ideological perspective purportedly in line with early 1960s Chicago-style economics. Buchanan and his colleagues attempted to dispel this conclusion, arguing that the program focused on market activity as it reflected social consensus. Coase was particularly incensed by allegations of dogmatic ideological narrowness since he had close ties to the socialist Fabian Society.