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Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
To test the reliability and validity of the DIGS in Spanish population.
Inter-rater and test-retest reliability of the Spanish version of DIGS was tested in 95 inpatients and outpatients. The resultant diagnoses were compared with diagnoses obtained by the LEAD (Longitudinal Expert All Data) procedure as “gold standard”. The kappa statistic was used to measure concordance between blind inter-raters and between the diagnoses obtained by LEAD procedure and through the DIGS.
Overall kappa coefficient for inter-rater reliability was 0.956. The kappa value for individual diagnosis varied from major depression = 0.877 to schizophrenia = 1. Test-retest reliability was 0.926. Kappa for all individual target diagnoses ranged from 0.776 (major depression) to 1. Kappa between LEAD procedure and DIGS ranged from 0.704 (major depression) to 0.825 (bipolar I disorder).
Most of the DSM-IV major psychiatric disorders can be assessed with acceptable to excellent reliability with the Spanish version of the DIGS interview. The Spanish version of DIGS showed an acceptable to excellent concurrent validity. Giving the good reliability and validity of Spanish version of DIGS it should be considered to identify psychiatric phenotypes for genetics studies.
We present the construction of an expert system (ES) for the diagnosis of Obsessive-Compulsive Disorders (OCD). It concerns an artificial intelligence tool, in Lisp language compatible with any personal computer (PC) with a hard disk. The ES asks the user 50 questions in natural language, on the patient or on a clinical history. It is provided with 115 rules of reasoning. Using single or multivaluate variables, the ES reaches the diagnosis of the Obsessive-Compulsive Disorders or the recommendations of differential diagnosis with related patterns or involucred with obsessive pathology: phobic, affective, schizophrenic and Gilles de la Tourette disorders. Finally, the perspectives for the utilisation of the ES in psychopathology are disscussed, in conjunction with the 2 serious problems created, design difficulty and user acceptance.
Depression is associated with high rates of comorbidity with other psychiatric disorders. Adherence to antidepressant medication regimens has been associated to different factors. Few studies have analyzed the influence of comorbid psychiatric disorders and adjunctive pharmacological treatments on antidepressant adherence.
The study evaluates the association of comorbid psychiatric disorder and pharmacological treatments with adherence rates to antidepressants in a large sample of depressive outpatients.
3606 depressive patients were included in a cross-sectional epidemiological study, involving a stratified sample of 750 psychiatrists selected to participate. Patients were included if they met DSM-IV criteria for current single or recurrent non-psychotic major depressive disorder. Simplified Medication Adherence Questionnaire (SMAQ) and Hamilton Depression Rating Scale (HDRS) were used to assess adherence and depression severity.
Adherence rates are lower in depressive patients with psychiatric comorbidity (62.8%) than in patients without comorbidity (69.1%) (Chi-square = 15.9, p < 0.001, OR = 1.6, 1.2–1.8). There are no significant differences in adherence rates between those patients taking or not benzodiacepines.
Psychiatric comorbidity plays a negative role in adherence to antidepressant treatment. Benzodiazepine use has no influence on adherence rates. Special attention should be paid to the symptom overlapping between anxiety and depression and to the benzodiazepine prescription in comorbid depressive patients.
Depression is the most prevalent mental disorder in Primary Care (PC), with 60% of depressed patients receiving treatment in PC Units. Suicide is the most serious consequence of depression. The European Commission funded the European Alliance Against Depression (EAAD), a preventive program on depression and suicide that has been applied in 18 European countries. In Spain, this program has been implemented in Catalonia and the Balearic Islands (Majorca and Menorca).
To present the results obtained in the program implementation in Majorca.
This program was applied in June 2009 within the urban area of Palma (222,100 inhabitants). Phase 1 entailed data collection of suicide, suicide attempts and antidepressant consumption since 2006. Phase 2 implied the development of specific training courses for General Practitioners on suicide prevention in high-risk population, and the launch of a public advertising campaign with the collaboration of mass media.
Based on data collected since 2006, there are nearly 300 suicide attempts in the Balearic Islands every year. Within the area of intervention suicide attempts decreased a 24.8% between 2009 and 2010. Conversely, antidepressant prescription and consumption increased from a frequent 2–3% per year to a 5%.
Obtained results are consistent with findings in other areas where this program has been applied. Data available next years about number of suicides will help to assess the final impact of this program. It is important to continue designing and implementing preventive programs aimed to reduce suicide risk including specific training for health care providers.
The aim of the study was to assess the effect of exposure to selective serotonin reuptake inhibitors (SSRI) in utero on child IQ and psychopathological syndromes.
A two cohorts study was designed. A cohort of 40 mother-child pairs with depressive or anxiety disorders (DSM-IV criteria) attended at a Perinatal Psychiatry Program between 2004 and 2006 and exposed in utero to SSRI was compared with a healthy cohort of 40 mother-child pairs, paired by gender and gestational age. The two groups were compared in terms of children's IQ between ages 60 and 72 months, assessed blindly through Kaufman Assessment Battery for Children (K-ABC). The Early Childhood Inventory teachers’ and parents’ versions (ECI-4) were used to assess psychopathological syndromes. Statistical analysis were done with paired t-test, Chi square test, and Fisher's exact test.
There were no differences among the groups in maternal IQ, socioeconomic status and obstetric variables. There were no differences among the groups (exposed vs. non-exposed) in the Mental Processing Composite (101.20 vs. 106.95; p = 0.07), the Sequential Processing Scale (97.78 vs. 103.00; p = 0.11), the Simultaneous Processing Scale (103.90 vs. 109.23; p = 0.13) and the Achievement Scale (98.80 vs. 103.13; p = 0.13). The ECI-4 psychopathological syndromes rates of exposed children were slightly higher than non-exposed children, but these differences were only significant on Adjustment Disorder in parents’ reports (30% vs. 10%; p = 0.04).
Exposure to SSRI during pregnancy does not appear to adversely affect cognitive functioning. Exposed children showed slightly higher rates of psychopathology, especially Adjustment Disorder.
Partial/non-adherence to medication is common amongst patients with schizophrenia. Nurses play an important role in assessing and managing mental health problems and are often involved in helping patients manage and adhere to their medication. As such, the perception of nurses regarding the burden and potential causes of non-adherence is vital in addressing the adherence problem.
The ADHES nurses survey collected opinions of nurses across the EMEA (Europe, Middle East and Africa) region.
To ascertain nurses' perceptions of assessment, potential causes and management of partial/non-adherence to medication in patients with schizophrenia.
The survey was conducted from January-March 2010 in 29 countries across EMEA, comprising 14 questions addressing the issue of partial/non-adherence and the use of long-acting injectable (LAI) antipsychotic medication in patients with schizophrenia.
Results were obtained from 4120 respondents. Nurses estimated high levels of partial/non-adherence (mean 54%) amongst patients with schizophrenia and 85% believed improving medication adherence would have a huge/sizable impact on patient outcomes. 93% believed that continuous medication with an LAI would have long-term benefits for patients with schizophrenia, and that many patients (mean 40%) would prefer LAI medication.
Nurses recognize the issue of partial/non-adherence to medication in patients with schizophrenia. Most nurses believe patients are well informed about LAI antipsychotics, however, approximately a third of nurses believe patients to be poorly informed. There is a need to address the problem of partial/non-adherence in clinical practice with a multidisciplinary approach to avoid suboptimal treatment outcomes in patients with schizophrenia.
Chronic use of alcohol is a known cause of cerebellar atrophy. This finding could be a valuable diagnosis support when there are not other information sources. In this case report, we describe a 65-year-old male patient who was referred from primary care to specialized consultation because a depressive syndrome it was unresponsive to treatment with desvenlafaxine and lorazepam. In psychopathological exploration we found overvalued ideas of suffering some kind of injury and damage by the family, which oriented the diagnostic hypothesis of delusional disorder with secondary mood symptoms, although the clinical suspicion of abuse of alcohol was proposed as a differential diagnosis. The continuing minimization and denial of consumption by the patient as well as their reluctance to incorporate an external informant made that the workup was a key element to elucidate the diagnosis. We found a discrete increase in transaminases, gamma glutamyl transferase and alkaline phosphatase. Magnetic resonance imaging showed cerebellar atrophy (vermian and, in a lesser extent, in both hemispheres). Once the patient was confronted with these results, he agreed to disclose his problem, which fulfilled alcohol dependence criteria. After that, he accepted to initiate treatment and detoxification in a specialized unity.
Although psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Even though the scientific evidence supports the benefits of bariatric surgery, its indications and contraindications must be continually revised in order to avoid psychiatric complications. Substance use is more common in patients subjected to bariatric surgery than in the general population. There are reports of increased incidence of alcohol abuse in patients after bariatric surgery.
To review the available evidence, after treat the case of a 50-year-old man with addiction history whose addictive behaviour worsened after undergoing bariatric surgery, with decreased tolerance to alcohol effect and increase of the intake, as well as changes in the graduation of alcohol used (including antiseptic). As a result, a dangerous revolving door that led him to repeated admissions, including Intensive Care Unit.
The case is consistent with the literature that suggests that there is an increased risk of later alcohol-related problems after bariatric surgery. This risk is higher several years post surgery, in patients with previous history of problems related to alcohol, young, men, and Roux-en-Y Gastric Bypass procedure.
The indications for bariatric surgery should thoroughly consider the history of addiction, an adequate assessment of the patient's mental status and psychoeducation about the possible psychiatric side effects, in order to develop preventive strategies.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A case of bilateral posterior vitreous detachment after electroconvulsive therapy (ECT) has been reported previously in the literature. There is not enough evidence about ocular side effects of this treatment. The literature supports a slight increase in intraocular pressure (IOP), although no ocular complications have been reported in normal, glaucomatous or postsurgical eyes. In this case report, we describe a 73-year-old female patient suffering a recurrent depressive disorder, who was admitted to acute psychiatric unit because a treatment-resistant major depressive episode (after an adequate trial of antidepressant drugs and transcranial magnetic stimulation) and clinical suspicion of visual delusions by her reference psychiatrist. The nonpsychiatric history consisted of hypertension, glaucoma and ulcerative colitis in treatment with azathioprine and mesalazine. After a careful examination in the emergency room, we consulted to ophthalmologist because miodesopsias and glaucoma history. The IOP was normal, but a bilateral posterior vitreous detachment (PVD) was identified. Because this entity is not an absolute contraindication for ECT, and there is scarce evidence, we informed the patient and her family. After that, and through informed consent, we decided to undergo ECT. After fourteen sessions, the patient could be discharged because significant clinical benefit and no ocular complications. Outpatient continuation ECT was indicated.
ECT can be a safe treatment choice in cases of PVD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.
To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.
A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12–26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.
Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR=2.26, 95% CI 1.60–3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR=2.21, 95% CI 1.21–4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.
Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
The improvement in porcine embryo preservation and non-surgical embryo transfer (ET) procedures achieved in recent years represents essential progress for the practical use of ET in the pig industry. This study aimed to evaluate the effects of parity, weaning-to-estrus interval (WEI) and season on reproductive and embryonic parameters at day 6 after insemination of donor sows superovulated after weaning. The selection of donor sows was based on their reproductive history, body condition and parity. The effects of parity at weaning (2 to 3, 4 to 5 or 6 to 7 litters), season (fall, winter and spring), and WEI (estrus within 3 to 4 days), and their interactions on the number of corpus luteum, cysts in sows with cysts, number and quality of viable and transferable embryos, embryo developmental stage and recovery and fertilization rates were evaluated using linear mixed effects models. The analyses showed a lack of significant effects of parity, season, WEI or their interactions on any of the reproductive and embryonic parameters examined. In conclusion, these results demonstrate that fertilization rates and numbers of viable and transferable embryos collected at day 6 of the cycle from superovulated donor sows are not affected by their parity, regardless of the time of the year (from fall to spring) and WEI (3 or 4 days).
Increasing plant species diversity has been proposed as a means for enhancing annual pasture productivity and decreasing seasonal variability of pasture production facing more frequent drought scenarios due to climate change. Few studies have examined how botanical complexity of sown swards affects cow performance. A 2-year experiment was conducted to determine how sward botanical complexity, from a monoculture of ryegrass to multi-species swards (MSS) (grasses-legumes-forb), affect pasture chemical composition and nutritive value, pasture dry matter (DM) intake, milk production and milk solids production of grazing dairy cows. Five sward species: perennial ryegrass (L as Lolium), white clover and red clover (both referred to as T as Trifolium because they were always sown together), chicory (C as Cichorium) and tall fescue (F as Festuca) were assigned to four grazing treatments by combining one (L), three (LT), four (LTC) or five (LTCF) species. Hereafter, the LT swards are called mixed swards as a single combination of ryegrass and clovers, whereas LTC and LTCF swards are called MSS as a combination of at least four species from three botanical families. The experimental area (8.7 ha) was divided into four block replicates with a mineral nitrogen fertilisation of 75 kg N/ha per year for each treatment. In total, 13 grazing rotations were carried out by applying the same grazing calendar and the same pasture allowance of 19 kg DM/cow per day above 4 cm for all treatments. Clover represented 20% of DM for mixed and MSS swards; chicory represented 30% of DM for MSS and tall fescue represented 10% of DM for LTCF swards. Higher milk production (+1.1 kg/day) and milk solids production (+0.08 kg/day) were observed for mixed swards than for ryegrass swards. Pasture nutritive value and pasture DM intake were unaffected by the inclusion of clover. Pasture DM, organic matter and NDF concentrations were lower for MSS than for mixed swards. Higher milk production (+0.8 kg/day), milk solids production (+0.04 kg/day) and pasture DM intake (+1.5 kg DM/day) were observed for MSS than for mixed swards. These positive effects of MSS were observed for all seasons, but particularly during summer where chicory proportion was the highest. In conclusion, advantages of grazing MSS on cow performance were due to the cumulative effect of improved pasture nutritive value and increased pasture DM intake that raised milk production and milk solids production.
Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks.
A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression.
Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism.
Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.
Pm-Si:H PIN and NIP solar cells structures grown using plasma enhanced chemical vapor deposition (PECVD) technique were analyzed during 400 hrs of light-soaking exposition. The evolution of the structural and optical properties was observed and characterized by Raman spectroscopy, spectroscopic ellipsometry. The effect observed is related to defects creation due to induced hydrogen diffusion, break of Si-H bonds and the generation of dangling bonds that causes less passivated films. The film microstructure, and therefore the optical properties varied with the exposition time. The crystalline fraction of these structures presents a slight decrease and it is observed to be between 15 to 24% for the PIN and 5 to 10% for the NIP. The optical gap increases from 1.66 to 1.68 eV for the PIN structure while for the NIP no significant change is observed during light-soaking. Hydrogen diffusion during lights soaking generates a decrease on the absorption properties of the films which in turn is expected to reduce the device efficiency during operation. In this work we show that long range motion of hydrogen during light-soaking causes a hydrogen rearrangement on the film and microstructure changes. We determined that there is not an pronounced change on the film structure during prolonged light exposition related to the stability of the pm-Si:H films. The PIN structure properties are more affected during light soaking in comparison to the NIP structure which is expected to cause less degradation of its optoelectronic properties under illumination, and a more stable device during operation.
We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical ‘executive’ tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits.
We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients.
In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient–control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled.
The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.
Aluminum-doped zinc oxide (ZnO:Al) thin films were prepared on glass substrates by radio frequency (RF) magnetron sputtering from a ceramic mixed target ZnO:Al2O3 (1 wt.%) with a power of 250 W. Two series of samples were deposited at room temperature, the first one in pure Ar atmosphere, the second one in Ar/O2 gas mixture. Effects of post-deposition annealing treatments carried out from 400 °C to 500 °C under vacuum and in N2/H2 (5%) atmosphere have been investigated. The influence of these parameters was studied by a detailed microstructural analysis using X-Ray diffraction and Raman spectroscopy. For N2/H2 annealing process, the increase of charge carrier concentration limits the increase of the mobility while after vacuum annealing, an improvement of both electrical and optical properties was observed. The increase of the crystallinity and grain size for ZnO:Al films deposited in Ar/O2 gas mixture could explain their improvements. Resistivity was reduced down to 3.5×10-4 Ω.cm, for a mobility of 49 cm2/V.s with a vacuum annealing at 450 °C for ZnO:Al deposited in Ar/O2 gas mixture.
The present work shows results on elemental distribution analyses in Cu(In,Ga)Se2 thin films for solar cells performed by use of wavelength-dispersive and energy-dispersive X-ray spectrometry (EDX) in a scanning electron microscope, EDX in a transmission electron microscope, X-ray photoelectron, angle-dependent soft X-ray emission, secondary ion-mass (SIMS), time-of-flight SIMS, sputtered neutral mass, glow-discharge optical emission and glow-discharge mass, Auger electron, and Rutherford backscattering spectrometry, by use of scanning Auger electron microscopy, Raman depth profiling, and Raman mapping, as well as by use of elastic recoil detection analysis, grazing-incidence X-ray and electron backscatter diffraction, and grazing-incidence X-ray fluorescence analysis. The Cu(In,Ga)Se2 thin films used for the present comparison were produced during the same identical deposition run and exhibit thicknesses of about 2 μm. The analysis techniques were compared with respect to their spatial and depth resolutions, measuring speeds, availabilities, and detection limits.
One of the primary challenges in the application of hydrogenated microcrystalline silicon (μc-Si:H) to photovoltaic cells is achieving high growth rates while maintaining good material quality over a wide process window. The rapid characterization of the material without generating a complete cell is thus a useful tool to determine said process window. Infrared absorption due to the various vibrational modes of the material has been used as a coarse tool towards this purpose, but the use of FTIR to perform this diagnosis limits the substrates upon which the analysis can be performed. We report on the use of high wave-number (1800-2200 cm-1) Raman scattering to perform a similar role of telltale peak detection directly on solar cells and on substrates suitable for thin-film photovoltaics. We evaluate material grown from SiF4 by RF-PECVD and from SiH4 by Matrix Distributed Electron Cyclotron Resonance (MDECR-) PECVD.