Definition, Epidemiology, Clinical Course and Outcomes in Treatment-resistant Schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S67-S67
Author(s):  
J. Seppala ◽  
J. Miettunen ◽  
E. Jääskeläinen ◽  
M. Isohanni ◽  
A. Seppälä ◽  
...  
Keyword(s):  
Brain Structure ◽  
Cognitive Rehabilitation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Behavioral Therapy ◽  
Hospital Treatment ◽  
Younger Age ◽  
Competing Interest ◽  
Definition Of

Based on a systematic review on TRS 285 studies were included regarding definitions of TRS (n = 11), genetics (18), brain structure and functioning (18), cognition (8), other neurobiological studies (16), medication (158), psychotherapy and cognitive rehabilitation (12), electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) (15), prognosis (21), and other miscellaneous studies (8). Definitions of TRS varied notably. TRS was associated with 3 to 11-fold higher healthcare costs than schizophrenia in general. One-fifth to one-third of all patients with schizophrenia were considered to be resistant to treatment. Based on limited evidence of genetics, brain structure and functioning and cognition, TRS may present as a different disorder with different etiology compared to non-TRS. Clozapine, olanzapine, risperidone, ECT and cognitive-behavioral therapy have shown effectiveness, although the number of studies and quality of research on interventions is limited. About 40% to 70% of TRS patients had an unfavorable prognosis. Younger age, living in a rural or less urban area, primary education level, more psychiatric hospital treatment days in the year before first schizophrenia diagnosis, inpatient at first schizophrenia diagnosis, paranoid subtype, comorbid personality disorder and previous suicide attempt may be risk factors associated with TRS.TRS is a poorly defined, studied and understood condition. To create a framework of knowledge for TRS, as a basis to develop innovative studies on treatment, there is a need for a consensus on the definition of TRS. Prospective long-term prognostic and novel treatment intervention studies are needed [1].Disclosure of interestThe authors have not supplied their declaration of competing interest.

A non-smoking program in the psychiatric clinic: Eradicating tobacco from the therapeutic space

2016 ◽  
Vol 33 (S1) ◽  
pp. S633-S633
Author(s):  
J. Jaber ◽  
A. Tomé ◽  
B. Reys
Keyword(s):  
Rio De Janeiro ◽  
Psychiatric Hospitalization ◽  
Behavioral Therapy ◽  
Pharmacological Therapy ◽  
Hospital Treatment ◽  
Psychiatric Clinic ◽  
Moderate Physical Activity ◽  
Therapeutic Space ◽  
Competing Interest

IntroductionThe work describes the well-succeeded experience of the Non-Smoking Program developed in a psychiatric clinic in Rio de Janeiro city, Rio de Janeiro, Brazil.ObjectiveTo treat the tobacco dependence in patients with disorders for the use of substances and other psychiatric disorders. To transform the clinic therapeutic space in a free tobacco environment.AimsTo promote the restoring of the patients’ health integrally, considering the use of tobacco is responsible for a large number of avoidable deaths, in addition to much harm to health.MethodsIn a clinic of hospitalization for diverse mental disorders treatment, especially disorders for the use of substances, in the city of Rio de Janeiro, Rio de Janeiro, Brazil, was simultaneously established a non-smoking treatment program. It was used the pharmacological therapy, associated with cognitive-behavioral therapy, occupational therapy and moderate physical activity. The average time of permanence in the non-smoking program was on average 90 days.ResultsThere was significant acceptance to the proposed program. In the long-term monitoring, over 12 months, it was evidenced that most patients found themselves in tobacco abstinence.ConclusionThe project achieved its objectives, promoting the tobacco abstinence in patients with comorbidities in hospital treatment. The study proved that it is possible to remove tobacco in patients dependent on this substance during a psychiatric hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitive behavioral approaches to coping with suffering and hardship

2016 ◽  
Vol 33 (S1) ◽  
pp. S560-S560
Author(s):  
J. Vyskocilova ◽  
J. Prasko ◽  
M. Ociskova ◽  
Z. Sedlackova ◽  
M. Slepecky ◽  
...  
Keyword(s):  
Behavioral Therapy ◽  
Psychological Disorder ◽  
Cognitive Behavioral ◽  
Permanent Disability ◽  
Acceptance And Commitment ◽  
Compassion Focused Therapy ◽  
Competing Interest ◽  
Cognitive Behavioral Approaches

IntroductionLow level of ability to endure discomfort, hardship and distress, which are integral parts of adverse life events, may lead to loss of mental stability and maintenance of psychological disorder.MethodReview of literature and case descriptions.ResultsThe patient often tries to cope with their suffering through avoidance and compensatory behavior which may relieve his suffering immediately; however, in the long term, it leads to the deterioration in the quality of his life and the persistence of suffering. Cognitive behavioral approaches focused on increasing the ability to endure unpleasant and distressful life experiences, allow the patient to better bear the inevitable losses in life, which he is exposed to, endure his anxiety, sadness, and the urge to impulsive action or escape; so the patient have more possibilities to act more freely, functionally and purposefully. Modern cognitive behavioral approaches, such as Dialectic Behavioral Therapy, Mindfulness Based Cognitive Therapy, Acceptance and Commitment Therapy and Compassion Focused Therapy developed and applied therapeutic methods designed to increase the patient's resistance to suffering and his ability to cope it better. These approaches are applied not only in patients with chronic psychiatric disorders, but also in patients with chronic physical illnesses and permanent disability.ConclusionsThe modern CBT strategies can help patients to increase his/her resistance to the distress, discomfort and suffering.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Aripiprazole once-monthly efficacy in patients with schizophrenia. Review

2016 ◽  
Vol 33 (S1) ◽  
pp. S582-S582
Author(s):  
M.F. Molina López ◽  
M.C. Cancino Botello ◽  
A. Peña Serrano ◽  
M.D.L.A. Canseco Navarro
Keyword(s):  
Quality Of Life ◽  
Negative Symptoms ◽  
Partial Agonist ◽  
Emotional Interaction ◽  
Medication Delivery ◽  
Pubmed Database ◽  
Competing Interest ◽  
Long Acting

Introductionlong acting injectable formulations of antipsychotics are a valuable option for patients with schizophrenia, offering continuous medication delivery and stable dosage levels. Aripiprazole once-monthly is the first dopamine partial agonist available in long acting formulation approved in Europe for Schizophrenia with excellent results so far.Aimsto conduct a current review of articles related to the use and efficacy of Aripiprazole once monthly in patients with Schizophrenia.Methodssystematic review of the literature in English using the following keywords: “aripiprazole once-monthly”, “aripiprazole long acting formulation”, “schizophrenia”. PubMed database.ResultsAripiprazole once-monthly (AOM) formulation efficacy has been proven in many studies. The importance of maintaining an oral overlap during 14 days is highlighted in all studies that have been reviewed in order to reach therapeutic level; therefore, it can be used in patients with acute decompensations. Recent studies comparing AOM versus Paliperidone Palmitate once monthly (PP) have shown that patients with AOM had greater clinical improvement and, even though both drugs were well tolerated, when Quality of Life Style Scale was analyzed an important improvement in empathy, sense of purpose, emotional interaction and curiosity in the AOM group was observed.Conclusionslong acting injectable antipsychotics increase long-term adherence treatment and reduce risk of relapse. Because of its unique mechanism of action, Aripiprazole once-monthly improves positive and negative symptoms, giving the patient an opportunity to have a better quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract WP302: Transferring Patients with Primary Intracerebral Hemorrhage to Comprehensive Stroke Centers

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Farhaan Vahidy ◽  
Liang Zhu ◽  
Nancy J Edwards
Keyword(s):  
Intracerebral Hemorrhage ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Stroke Severity ◽  
Long Term Outcomes ◽  
Similar Treatment ◽  
Euroqol 5D ◽  
Transferred Patients

Introduction: The American Heart Association’s updated guidelines for management of patients with primary intracerebral hemorrhage (ICH) recommend monitoring and early care at centers with advanced nursing and neuro-critical care expertise. This entails frequent transfer of ICH patients to certified Comprehensive Stroke Centers (CSC) for higher level of care. We hypothesized that transferred patients (TP) to a CSC will differ from directly admitted patients (DAP) in terms of patient characteristics, treatment factors, and functional and quality of life (QOL) outcomes. Methods: We analyzed data from a prospectively collected ICH registry at our CSC. Patients with traumatic or secondary causes of ICH were excluded. We collected data on demographics, comorbidities, presentation lab values, clinical characteristics, radiological parameters, in-hospital treatment variables, and discharge and long term outcomes. Functional outcomes were captured as modified Rankin Scale (mRS) and EuroQol 5D (EQ-5D) was used to assess QOL indices. Results: Out of a total 192 primary ICH patients, 114 (59.4%) were transferred-in. TP were significantly older, had lower diastolic blood pressure, lower arrival National Institutes of Health Stroke Scale (NIHSS) score, and smaller hematoma volumes as compared to DAP. A higher proportion of TP had a good discharge functional outcome (mRS score 0 - 3) as compared to DAP (29.8% vs. 15.4%, p = 0.02), this trend was also observed for Day-90 mRS (34.2% vs. 24.4%, p = 0.09). TP also reported significantly better QOL indices at Day-90; EQ-5D total median (Q1, Q3) score [10 (6,16) vs. 15 (9.5,18), p = 0.02] and self-reported median (Q1,Q3) score [75 (50,88) vs. 62.5(40,70)], p < 0.01]. Day-90 data are complete for approximately 50% patients. After adjusting for initial stroke severity, the discharge mRS was however not significantly different between TP and DAP. Conclusions: A larger proportion of ICH patients were transferred-in. Our data suggest that TP have lower disease severity, and better discharge and long term outcomes. However, they had similar treatment intensity as DAP at the CSC. We continue to capture day-90, 6 and 12-month functional and QOL data, which will be presented.

The Role of Knowledge Management (KM) in Aged Care Informatics

Big Data ◽  
2016 ◽  
pp. 1668-1686
Author(s):  
Margee Hume ◽  
Craig Hume ◽  
Paul Johnston ◽  
Jeffrey Soar ◽  
Jon Whitty
Keyword(s):  
Knowledge Management ◽  
Management Practice ◽  
Aged Care ◽  
Social Infrastructure ◽  
Care Giving ◽  
Aged Care Facilities ◽  
Definition Of

Aged care is projected to be the fastest-growing sector within the health and community care industries (Reynolds, 2009). Strengthening the care-giving workforce, compliance, delivery, and technology is not only vital to our social infrastructure and improving the quality of care, but also has the potential to drive long-term economic growth and contribute to the Gross Domestic Product (GDP). This chapter examines the role of Knowledge Management (KM) in aged care organizations to assist in the delivery of aged care. With limited research related to KM in aged care, this chapter advances knowledge and offers a unique view of KM from the perspective of 22 aged care stakeholders. Using in-depth interviewing, this chapter explores the definition of knowledge in aged care facilities, the importance of knowledge planning, capture, and diffusion for accreditation purposes, and offers recommendations for the development of sustainable knowledge management practice and development.

scholarly journals Implications of Concepts of Consciousness for Understanding Pain Behaviour and the Definitiion of Pain

1997 ◽  
Vol 2 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Kenneth D Craig
Keyword(s):  
Life Experiences ◽  
Tissue Injury ◽  
Conscious Experience ◽  
Self Report ◽  
Older Children ◽  
Explicit Recognition ◽  
Definition Of ◽  
Inherent Quality

Judgements of the nature and severity of pain others may be experiencing are heavily influenced by an observer's preconceptions about the nature of the experience. Our personal sense of conscious experience dictates a search for consciousness characterized by the state of awareness found in competent adults, including constructive memories and thoughts, images and feelings. People incapable of verbally articulating experiences akin to those reported by competent older children and adults are at risk of having other evidence of pain denied, minimized or ignored. Despite substantial behavioural evidence for pain in the neonate and infant, and findings indicating destructive immediate and long term consequences if pain is not controlled, pain in infants and children often continues to be discounted. An alternative perspective on infant consciousness of pain focusing upon sensory and emotional components is presented. The current prominent definition of pain supports the prejudice favouring adult conceptions of consciousness by emphasizing the importance of self-report in assessing pain. Explanatory notes accompanying this definition also perpetrate the misguided belief that the experience of pain emerges as a product of early life experiences. The case for using nonverbal as well as verbal expression in the process of inferring states of pain is presented. As well, the proposition is supported that there should be explicit recognition that the experience of pain is an inherent quality of life present in all viable newborns, with the nature of the experience and its expression changing in the course of maturation and as a result of exposure to life experiences related to tissue injury.

Acetabular Growth Potential in the Dysplastic and Normal Hip. A Long-Term Follow-Up

1994 ◽  
Vol 4 (1) ◽  
pp. 53-58
Author(s):  
F. Specchiulli ◽  
L. Scialpi ◽  
G. Solafino ◽  
L. Battelli ◽  
L. Nitti
Keyword(s):  
Surgical Treatment ◽  
Hip Dislocation ◽  
Normal Subjects ◽  
Growth Potential ◽  
Long Term Follow Up ◽  
Definition Of ◽  
Initial Correction

In CHD (Congenital Hip Dislocation), the elements which determine the degree and quality of acetabular growth are not clear. This has caused a great deal of controversy on the capability of development of the cotyloid cavity, hence on the indications to reconstructive surgical treatment. In order to study the behavior of che cotyloid cavity, two groups of patients were taken into consideration: normal subjects and subjects with CHD. In normal subjects the median value of the Hingelreiner angle was 19°–4'± 1° (normal limit), at 1 year old. The acetabular index decreases rapidly until becoming stable at adult values at the age of 8-10 years of age. The distinctive characteristics of the hip with spontaneous recovery from cotyloid dysplasia could be defined as follows: a) the higher critical value on average is reached after 24 months of treatment; b) once the borderline is reached, the dislocated hip evolves in the same way as the healthy hip; c) the earlier treatment is started, the sooner correction of the H angle is obtained; d) the cotyloid cavity continues to develop even after 5 years from reduction. In CHD with terminal residual dysplasia, an initial correction of the H angle is followed by a sudden interruption in acetabular development, which remains inadequate and will never reach normal values. These data allow not only the definition of the acetabular growth potential, but also the establishment of more precise indications for reconstructive surgical treatment.

Long Term Effect of Cognitive Behavioral Therapy in Patients with Health Anxiety

2017 ◽  
Vol 41 (S1) ◽  
pp. S111-S112
Author(s):  
K.E. Veddegjaerde
Keyword(s):  
Quality Of Life ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Health Anxiety ◽  
Term Effect ◽  
Cognitive Behavioral ◽  
Long Term Effect

IntroductionCognitive-behavioral therapy (CBT) has been found to be an effective treatment of excessive health anxiety (HA), but the long-term effect over 18months has not been examined.ObjectivesSeveral studies have shown effect of CBT for HA-patients. However, these effects have been short or immediate after therapy. To our knowledge no studies have examined long-term effect of CBT for HA over 18 months.AimsTo investigate the long-term effect of CBT on HA, focusing on level of HA, quality of life, subjective health complaints and general anxiety. Follow-up time was at least 10 years. Our hypothesis was that the effect was sustained.MethodsPatients with HA received 16 sessions of CBT over a period of 12–18 months, and were followed up over at least 10 years. All patients fulfilled criteria for F45.2, hypochondriacal disorder according to ICD-10.The patients answered several questionnaires, exploring areas such as HA, Quality of life, somatization, and mental health problems. Questionnaires were answered before CBT, after CBT and at follow up. Mixed model analysis was performed in SPSS 23.0 for all questionnaires.ResultsAll scores were found to be significant in the Pre-CBT–Post-CBT and Pre-CBT–FU (0.034– < 0.001), and none were found to be significant in the Post-CBT–FU.ConclusionsOur findings suggest that for the majority of patients with HA, CBT has a significant and lasting long-term effect. This effect lasts up to ten years post therapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Long-Term Outcomes in Patients with Stroke after in-Hospital Treatment—Study Protocol of the Prospective Stroke Cohort Augsburg (SCHANA Study)

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 280
Author(s):  
Michael Ertl ◽  
Christa Meisinger ◽  
Jakob Linseisen ◽  
Sebastian-Edgar Baumeister ◽  
Philipp Zickler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Recurrent Events ◽  
Cox Regression ◽  
University Hospital ◽  
Hospital Treatment ◽  
Invasive Treatment ◽  
Cox Regression Analysis ◽  
Relative Risks

Introduction: In Germany, stroke is the third leading cause of death, with more than 60,000 fatalities out of approximately 260,000 cases (first-ever and recurrent strokes) each year. So far, there are only a few long-term studies investigating determinants of the natural course of the disease, especially in the era of mechanical thrombectomy. Materials and Methods: The prospective single-center stroke cohort Augsburg (SCHANA) study will include about 1000 patients treated for stroke in the University Hospital of Augsburg. Patients aged 18 years or older with a confirmed diagnosis of ischemic or hemorrhagic stroke are included in the study. Information on demographic characteristics, onset of symptoms, etiologic factors, comorbidities, quality of life, invasive and non-invasive treatment, complications, and laboratory parameters are collected during a personal interview conducted during the patients’ hospital stay and via a medical chart review. About 30 mL of blood is collected from each patient, and after processing and aliquoting, all blood specimens are frozen at −80° C. The study participants will be followed-up via postal questionnaires at three and 12 months after discharge from the hospital. Furthermore, mortality follow-ups will be conducted. Cox-regression analysis will be used to estimate relative risks. Conclusion: The SCHANA study will generate comprehensive data on the long-term course of the disease. In addition to the main outcomes, recurrent events and survival, patient-oriented outcomes such as health-related quality of life and depression are the focus of the study.

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