General Assessment Of Functioning Research Articles

Combined Effects of Physical Activity and Diet on Cancer Patients: A Systematic Review and Meta-Analysis.

The purpose of our systematic review was to examine the effects of any physical activity/exercise intervention combined with any diet/nutrition intervention on any biological/biochemical index, quality of life (QoL), and depression in breast, lung, colon and rectum, prostate, stomach, and liver cancer patients and/or cancer survivors. A systematic review and meta-analysis were undertaken, using PRISMA guidelines and the Cochrane Handbook. The systematic review protocol can be found in the PROSPERO database; registration number: CRD42023481429. We found moderate-quality evidence that a combined intervention of physical activity/exercise and nutrition/diet reduced body mass index, body weight, fat mass, insulin, homeostatic model assessment for insulin resistance, C-reactive protein, triglycerides, and depression, while it increased high-density lipoprotein, the physical component of QoL, and general functional assessment of cancer therapy. We conclude that a combined intervention of physical activity/exercise and diet/nutrition may decrease body weight, fat mass, insulin levels, and inflammation, and improve lipidemic profile, the physical component of QoL, and depression in cancer patients and survivors. These outcomes indicate a lower risk for carcinogenesis; however, their applicability depends on the heterogeneity of the population and interventions, as well as the potential medical treatment of cancer patients and survivors.

Digital-Reported Outcome from Medical Notes of Schizophrenia and Bipolar Patients Using Hierarchical BERT

Patient-reported (PRO) and clinician-reported (CRO) outcomes are assessment instruments that are completed by patients and trained healthcare professionals, respectively. A PRO is a report of the direct experience of the patient with a given disease condition. A CRO is an assessment of the condition of the patient by the healthcare provider. PROs may not be accessible to all patients, especially those suffering from severe disease conditions. CROs are time-consuming and therefore administered infrequently. In the present study, we introduce a new form of assessment, the digital-reported outcome (DRO), which is automatically derived from the medical notes of the patient. DROs have a low overhead and can be generated at each patient’s visit to complement other outcome-assessment instruments and enhance clinical decision support by identifying at-risk patients. In this study, a DRO is developed to evaluate the functional impairment in the daily activities of two cohorts of patients suffering from bipolar disorder and schizophrenia. The input of the DRO is a single medical note from the electronic medical record of the patient. This note is submitted to a hierarchical bidirectional encoder representations from transformers (BERT) model. First, a sentence-level embedding is produced for each sentence in the note using a token-level attention mechanism. Second, an embedding for the entire note is constructed using a sentence-level attention mechanism. Third, the final embedding is classified using a feed-forward neural network. The model is trained to classify patients into moderate or severe functioning impairment levels according to the general assessment of functioning (GAF) scale, a CRO instrument for the assessment of the impact of mental illness on the daily activities of the patient. The DRO is validated using medical notes that were labeled by multiple healthcare providers from different healthcare institutions. The results indicate that a general DRO is able to classify patients from the two cohorts according to the two functioning impairment levels (severe versus moderate) prior to the onset of disease with an AUC of 76%. Disease-specific DROs are only applicable after the onset of the disease and produced AUCs of nearly 85%. The methodology introduced in the present paper is practical and can support the automated monitoring of the severity of the functioning impairment of bipolar and schizophrenia patients. Extending the proposed DRO to other psychiatric conditions and types of impairments is the subject of ongoing research work.

Evaluation of Serum Complement Levels and Factors Affecting Treatment Resistance in Patients with Schizophrenia.

There are increasing investigations about the potential role of the complement system in disorders affecting the central nervous system, including schizophrenia. Therefore, we aim to evaluate the levels of complement 3 and complement 4 and the factors affecting treatment resistance in schizophrenia patients. This cross-sectional study was conducted between January 2020 and January 2021 and included schizophrenia patients resistant to treatment or in remission and healthy controls. The Structured Clinical Interview for Diagnostic and Statistical Manual-5 was used to confirm the diagnosis according to Diagnostic and Statistical Manual -5 criteria. We evaluated the patients with some scales and forms. The complement 3 and complement 4 levels were measured from blood samples. In the treatment-resistant schizophrenia group, complement 3 (P = .001) and complement 4 (P = .001) levels were significantly higher compared to schizophrenia patients in remission and healthy controls. While the Brief Psychiatric Rating Scale (P < .001), the Positive and Negative Syndrome Scale-positive (P < .001), the Positive and Negative Syndrome Scale-negative (P < .001), the Positive and Negative Syndrome Scale-psychopathology (P < .001), the Positive and Negative Syndrome Scale-total (P < .001), and the Clinical Global Impression Scale-Severity (P < .001) scores were significantly higher in treatment-resistant schizophrenia patients, the General Assessment of Functioning (P < .001), and Beck Cognitive Insight Scale (P < .001) scores were significantly lower compared to the other groups. In schizophrenia patients, complement 3 levels were positively correlated with the Positive and Negative Syndrome Scale-negative (P = .046), the Positive and Negative Syndrome Scale-psychopathology (P = .001), the Positive and Negative Syndrome Scale -total (P = .025), and Clinical Global Impression Scale-Severity of Disease (P = .004). Also, complement 4 levels were positively correlated with Brief Psychiatric Rating Scale (P = .004), the Positive and Negative Syndrome Scale-positive (P = .003), the Positive and Negative Syndrome Scale -negative (P = .014), the Positive and Negative Syndrome Scale-psychopathology (P < .001), the Positive and Negative Syndrome Scale-total (P = .002), and Clinical Global Impression Scale-Severity of Disease (P = .001) in patients with schizophrenia. It was determined that a higher C4 level increased the risk of treatment resistance (odds ratio: 1.133, 95% CI: 1.012-1.268; P = .030), while a higher Beck Cognitive Insight Scale score decreased the risk of treatment resistance (odds ratio: 0.317, 95% CI: 0.191-0.526; P < .001). In light of the analyses, it can be said that complement concentration increases in certain stages of schizophrenia, and its imbalance may be associated with symptom severity and treatment resistance.

Investigation of the Relationship of Sociodemographic and Clinical Characteristics with Cardiovascular Risk Scores in Patients with Schizophrenia Living in Nursing Homes

Objective: Cardiovascular risk increases in patients with schizophrenia. In our study, it was aimed to predict the 10-year risk of developing cardiovascular disease using the Framingham risk score in schizophrenia patients living in nursing homes&#x0D; Materials and Methods: In our study, the sociodemographic and clinical characteristics of schizophrenia patients living in nursing homes, such as age, gender, educational status, duration of disease, and treatments used, and Framingham risk scoring which included age, gender total cholesterol, HDL, smoking status, systolic blood pressure, and presence of diabetes mellitus. were used in the calculation of cardiovascular risk. Also, the results of the General Assessment of Functioning and Clinical Global Impression disease severity scale were recorded in order to determine the functionality and severity of the disease.&#x0D; Results: 51 patients with schizophrenia were included, and the Framingham risk score of the patients was calculated as 4.65±4.63. While Framingham risk scores were significantly correlated with disease duration (r=0.284, p=0.044), age (r=0363, p=0.01) and length of stay in nursing home (r=0.538, p

Mental distress, quality of life and physical symptoms in Chinese women with ovarian cancer receiving olaparib treatment during the COVID-19 pandemic.

ObjectivesWomen with ovarian cancer (OC) have experienced unprecedented challenges since the novel coronavirus disease-2019 (COVID-19) outbreak in China. We aim to evaluate the experience of psychological status, physical symptoms and quality of life (QoL) and investigate the impact of COVID-19 pandemic on OC patients receiving olaparib.MethodsThe survey was conducted online from April 22 to May 12 in 2020. Demographic and clinical questions were listed to collect general information. The degree of insomnia, depression, anxiety, stress symptoms and QoL were assessed by the Chinese versions of the Insomnia Severity Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised, and the General Functional Assessment of Cancer Therapy, respectively. Multivariate logistic regression analysis was conducted to analyze the risk factors for mental distress and QoL.ResultsA total of 56 respondents coming from 15 various provinces in China participated in the survey. The prevalence of insomnia, depressive, anxiety, stress symptoms and reduced QoL were 37.5, 51.8, 37.5, 30.4, and 51.8%, respectively. Unfavorable disease status, shorter period of olaparib administration, adverse events of olaparib and delay in cancer care were correlated with mental health problems. Reduced QoL was also significantly associated with psychological distress.ConclusionsThis study emphasized that mental health problems and reduced QoL should gain more attention in women with OC who are receiving oral olaparib at home. Appropriate psychological healthcare strategies are necessary for OC patients during the COVID-19 pandemic.

Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study.

Background: Recovery has become a priority in schizophrenia spectrum disorders (SSDs). This study aimed to investigate predictors of objective—general functioning and disability—and subjective—quality of life (QoL)—measures of functional outcomes in SSD. Methods: Sample: n = 77 SSD outpatients (age 18–64, IQ > 70) participating in a randomised controlled trial. Baseline data were used to build three multivariable linear regression models on: (i) general functioning—General Assessment of Functioning (GAF); (ii) disability—the World Health Organization Disability Assessment Schedule (WHODAS-2.0); and (iii) QoL—Satisfaction Life Domains Scale (SLDS). Results: Young age and being employed (R2 change = 0.211; p = 0.001), late adolescence premorbid adjustment (R2 change = 0.049; p = 0.0050), negative symptoms and disorganization (R2 change = 0.087; p = 0.025) and Theory of Mind (R2 change = 0.066, p = 0.053) predicted general functioning. Previous suicidal behaviour (R2 change = 0.068; p = 0.023) and negative and depressive symptoms (R2 change = 0.167; p = 0.001) were linked with disability. Previous suicidal behaviour (R2 change = 0.070, p = 0.026), depressive symptoms (R2 change = 0.157; p < 0.001) and illness recognition (R2 change = 0.046, p = 0.044) predicted QoL. Conclusions: Negative, disorganization and depressive symptoms, older age, unemployment, poor premorbid adjustment, previous suicide attempts and illness awareness appear to underlie a poor global functional outcome in SSD. Achieving recovery in SSD appears to require both symptomatic remission (e.g., through antipsychotics) and measures to improve mastery and relieve low mood.

Specialised early intervention teams for recent-onset psychosis.

Specialised early intervention teams for recent-onset psychosis.

One-year Outcome of First vs. Later Episode Schizophrenia: A Real-world Naturalistic Study

ObjectiveThe aim the study was to calculate remission, recovery and relapse rates in first episode patients with schizophrenia (FES) vs. patients at a later phase (non-FES).MethodsThirty-two FES and 101 non-FES patients took part in the study. The assessment included testing at baseline and at 1 year with the Positive and Negative Syndrome Scale (PANSS), Calgary Depression scale, State-Trait Anxiety Inventory (STAI), Udvalg for Kliniske Undersøgelser (UKU) scale, Simpson Angus, and General Assessment of Functioning (GAF) subscale. The statistical analysis included chi-square test and analysis of covariance.ResultsAt baseline 15.62% FES vs. 10.89% non-FES patients were in remission; none of FES vs. 2.97% non-FES patients were in recovery. At endpoint, the respective figures were 12.50% vs. 25.00% and 3.12% vs. 3.96%. None of the differences in rates was significant between the two groups except from the percentage of patients being under medication (higher in the non-FES group). Baseline PANSS negative subscale (PANSS-N) was the only predictor of the outcome at endpoint.ConclusionThe current study reported very low rates of remission and recovery of patients with schizophrenia without any differences between FES and non-FES patients. One possibility is that the increased antipsychotic treatment compensates for the worsening of the illness with time. An accumulating beneficial effect of antipsychotic treatment suggested that early lack of remission is not prognostic of a poor outcome.

T21. DEVELOPMENT OF PROTEOMIC PREDICTION MODELS FOR OUTCOMES IN THE CLINICAL HIGH RISK STATE AND PSYCHOTIC EXPERIENCES IN ADOLESCENCE: MACHINE LEARNING ANALYSES IN TWO NESTED CASE-CONTROL STUDIES

BackgroundIndividuals at clinical high risk (CHR) of psychosis have an approximately 20% probability of developing psychosis within 2 years, as well as an associated risk of non-psychotic disorders and functional impairment. People with subclinical psychotic experiences (PEs) are also at risk of future psychotic and non-psychotic disorders and decreased functioning. It is difficult to accurately predict outcomes in individuals at risk of psychosis on the basis of symptoms alone. Biomarkers for accurate prediction of outcomes could inform the clinical management of this group.MethodsWe conducted two nested case-control studies.Study 1, a clinical high-risk (CHR) sample, was nested within the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) cohort study. The sample comprised 133 CHR participants who were followed clinically for up to 6 years, of whom 49 transitioned to psychosis and 84 did not.Study 2, a general population sample, was nested within the Avon Longitudinal Study of Parents and Children (ALSPAC). The sample comprised 121 participants who did not report psychotic experiences (PEs) at age 12, of whom 55 later reported PEs at age 18 and 66 did not.We employed discovery-based proteomic methods to analyse protein expression in baseline plasma samples in EU-GEI and age 12 plasma samples in ALSPAC using liquid chromatography mass spectrometry.Differential expression of quantified proteomic markers was determined by analyses of covariance (with false discovery rate of 5%) comparing expression levels for each marker between those who did not and did not develop psychosis in Study 1 (adjusting for age, gender, body mass index and years in education), and between those who did and did not develop PEs in Study 2 (adjusting for gender, body mass index and maternal social class).Support vector machine algorithms were used to develop models for prediction of transition vs. non-transition (as determined by the Comprehensive Assessment of At Risk Mental States) and poor vs. good functional outcome at 2 years in Study 1 (General Assessment of Functioning: Disability subscale score </=60 vs. >60). Similar algorithms were used to develop a model for prediction of PEs vs. no PEs at age 18 in Study 2 (as determined by the Psychosis Like Symptoms Interview).ResultsIn Study 1, 35 of 166 quantified proteins were significantly differentially expressed between CHR participants who did and did not develop psychosis. Functional enrichment analysis provided evidence for particular implication of the complement and coagulation cascade (false discovery rate-adjusted Fisher’s exact test p=2.23E-21). Using 65 clinical and 166 proteomic features a model demonstrated excellent performance for prediction of transition status (area under the receiver-operating curve [AUC] 0.96, positive predictive value [PPV] 83.0%, negative predictive value [NPV] 93.8%). A model based on the ten most predictive proteins accurately predicted transition status in training (AUC 0.96, PPV 87.5%, NPV 95.8%) and withheld data (AUC 0.92, PPV 88.9%, NPV 91.4%). A model using the same 65 clinical and 166 proteomic features predicted 2-year functional outcome with AUC 0.72 (PPV 67.6%, NPV 47.6%).In Study 2, 5 of 265 quantified proteins were significantly differentially expressed between participants who did and did not report PEs at age 18. A model using 265 proteomic features predicted PEs at age 18 with AUC 0.76 (PPV 69.1%, NPV 74.2%).DiscussionWith external validation, models incorporating proteomic data may contribute to improved prediction of clinical outcomes in individuals at risk of psychosis.

The efficacy of extended metacognitive training for psychosis: A randomized controlled trial

This study investigated the efficacy of 10-module metacognitive training (MCT) among Japanese patients with schizophrenia by conducting a multicenter randomized controlled trial to test the influence of the most recent and extended version of MCT on positive symptoms. A six-center, randomized, assessor-blind, controlled trial between “treatment as usual” (TAU) and TAU + MCT was conducted. Fifty inpatients and outpatients with schizophrenia, schizotypal, and delusional disorders (ICD 10) were enrolled, then randomly assigned to TAU (n = 26) or TAU + MCT (n = 24). Assessments were made at baseline, after six weeks, immediately posttreatment, and 1-month post-treatment. The primary outcome was positive symptom score, as measured by the Positive and Negative Syndrome Scale (PANSS). General assessment of functioning (GAF) and measures of cognitive biases were secondary outcomes. Completion at post-treatment (10 weeks later) and 1-month follow-up was high—TAU + MCT, n = 22 (91.67%) and TAU, n = 23 (88.46%). The severity of PANSS positive symptoms declined significantly in the TAU + MCT treatment group compared with the TAU group. GAF also showed significantly greater improvement in the TAU + MCT group compared with the TAU group. There was also a trend for greater efficacy of MCT on cognitive biases. In conclusion, this study provides support for the efficacy of 10 module MCT concerning positive symptomatology (especially, delusion) and general functioning.

Depression and Temporal Lobe Epilepsy: Expression Pattern of Calbindin Immunoreactivity in Hippocampal Dentate Gyrus of Patients Who Underwent Epilepsy Surgery with and without Comorbid Depression.

Purpose Changes in calbindin (CB) expression have been reported in patients with temporal lobe epilepsy (TLE) with controversial implications on hippocampal functions. The aim of this study was to determine the CB immunoreactivity in hippocampal dentate gyrus of patients who underwent epilepsy surgery for drug-resistant TLE with and without comorbid depression and/or memory deficits. Methods Selected hippocampal samples from patients with TLE who underwent epilepsy surgery were included. Clinical and complementary assessment: EEG, video-EEG, MRI, psychiatric assessment (structured clinical interview, DSM-IV), and memory assessment (Rey auditory verbal learning test, RAVLT; Rey-Osterrieth complex figure test, RCFT), were determined before surgery. Hippocampal sections were processed using immunoperoxidase with the anti-calbindin antibody. The semiquantitative analysis of CB immunoreactivity was determined in dentate gyrus by computerized image analysis (ImageJ). Results Hippocampal sections of patients with TLE and HS (n = 24) and postmortem controls (n = 5) were included. A significant reduction of CB+ cells was found in patients with TLE (p < 0.05, Student's t-test). Among TLE cases (n = 24), depression (n = 12) and memory deficit (n = 17) were determined. Depression was associated with a higher % of cells with the CB dendritic expression (CB-sprouted cells) (F(1, 20) = 11.81, p = 0.003, hp2 = 0.37), a higher CB+ area (μm2) (F(1, 20) = 5.33, p = 0.032, hp2 = 0.21), and a higher optical density (F(1, 20) = 15.09, p = 0.001, hp2 = 0.43) (two-way ANOVA). The GAF scale (general assessment of functioning) of DSM-IV inversely correlated with the % of CB-sprouted cells (r = −0.52, p = 0.008) and with the CB+ area (r = −0.46, p = 0.022). Conclusions In this exploratory study, comorbid depression was associated with a differential pattern of CB cell loss in dentate gyrus combined with a higher CB sprouting. These changes may indicate granular cell dysmaturation associated to the epileptic hyperexcitability phenomena. Further investigations should be carried out to confirm these preliminary findings.

F122. CLINICAL CHARACTERISTICS OF LATE-ONSET SCHIZOPHRENIA IN COMPARISON WITH EARLY-ONSET SCHIZOPHRENIA: ONE YEAR FOLLOW-UP STUDY

BackgroundLate-onset schizophrenia (LOS) differs from early-onset schizophrenia (EOS) in several ways including predominance of women, better premorbid social adjustment and lower severity of positive/negative symptoms. However, no studies evaluated the longitudinal course of LOS. This study aimed to investigate the clinical characteristics of LOS in comparison with EOS and the longitudinal course of clinical symptoms and functioning in LOS.MethodsBy reviewing medical records, we assessed demographic data, clinical characteristics, and general functioning of 20 LOS (5 males) and 44 EOS (16 males) who admitted to National Health Insurance Service Ilsan Hospital. LOS and EOS were defined according to age at first onset: ≥40 years (LOS) and <40 years (EOS). The level of clinical symptoms were rated using the Positive and Negative Syndrome Scale (PANSS), and general functioning was evaluated using the General Assessment of Functioning (GAF).ResultsThere was no significant difference in gender between LOS and EOS. The mean ages of onset were 45.4 ± 3.97 (LOS) and 28.4 ± 6.69 (EOS) years. Significantly more LOS patients (90.0%) had a marital history including divorce than EOS (56.8%). There were no differences between LOS and EOS in the positive, negative, and general scores of PANSS measured at admission and 1 year after. LOS patients had significantly higher score of PANSS N2 item (Emotional withdrawal) both at admission (LOS: 4.00 ± 1.34; EOS: 3.43 ± 1.52) and 1 year after (LOS: 3.50 ± 1.00; EOS: 2.91 ± 1.05) than EOS. There were negative correlations between GAF (1 year after) and N2 item score (at admission: r= –0.45, p=0.04; 1 year after: r= –0.85, p<0.001) in the LOS group, but no significant correlation exists in the EOS group.DiscussionConsistent with previous studies, our study suggested that LOS patients had better premorbid social functioning because marital history can be regarded as index of premorbid social adjustment. However, on the contrary to previous findings, LOS patients had more severe emotional withdrawal and it was related to worse functioning. This finding may be due to cultural specificity in Korea; thus, further studies with larger samples are needed for confirmation.

The Effect of Psychosocial Skills Training and Metacognitive Training on Social and Cognitive Functioning in Schizophrenia.

The aim of this study is to investigate the effects of Psychosocial Skills Training (PSST) and Metacognitive Training (MCT) programs on general psychopathology, cognitive functioning, and social functioning in patients with schizophrenia. Twenty patients with schizophrenia who were treated at the Kocaeli University Psychiatry Department outpatient clinic between January and June 2016, accepted to participate in the study and met inclusion criteria were included in this study. Patients were randomized as two groups of 10 people. The management of each group was carried out by a trainer and a co-trainer. The Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression Scale-Severity (CGI-S) to assess psychopathology, the General Assessment of Functioning (GAF) and the Quality of Life Scale in Schizophrenia (QoLS) to assess social functioning, the Cognitive Assessment Interview (CAI) to assess cognitive functioning were used by the clinicians blinding to groups in the first two weeks before and after the intervention. After the training, first and last test scale scores were compared. All patients who participated in the study completed the study (male: 13, female: 7). There was no significant difference in age, gender, marital status, years of education, duration of illness, the age of onset, and the number of hospitalizations in comparison of individual and clinical characteristics of the groups (p>0.05). When the scores were compared of the groups before and after the intervention, there was a significant difference concerning psychopathology, social and cognitive functioning in both groups (p<0.05). There were no significant differences between the groups in terms of effect size. The study showed that both programs aiming to improve psychopathology and functioning in the treatment of schizophrenia have positive results. Improvement in cognitive functioning should also be tested by neurocognitive tests in the large-scale studies with control groups.

Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder

BackgroundCognitive and psychosocial impairment has been associated with increased levels of C-reactive protein (CRP) and homocysteine in bipolar disorder, but gender differences have seldom been studied. MethodsTwo hundred and twenty-four bipolar outpatients were included. Cognitive performance was assessed through the Screen for Cognitive Impairment in Psychiatry (SCIP). Psychosocial functioning was evaluated using the Functioning Assessment Short Test (FAST) and the General Assessment of Functioning (GAF). Homocysteine and CRP levels were determined. Separate analyses were performed by gender. Partial correlations were calculated to test for associations between biomarkers and cognitive and psychosocial functioning. Hierarchical multiple regression was used to assess factors predicting cognitive and psychosocial functioning. Covariates were: age, education, duration of illness, hospital admissions, depressive symptoms, tobacco consumption, and BMI. ResultsA better performance was noted in women in delayed verbal learning (p = 0.010), along with better occupational functioning (p = 0.027) and greater leisure time impairment (p = 0.034). In men, CRP and homocysteine levels were associated with psychosocial dysfunction (interpersonal relationships and financial functioning, respectively). In women, CRP levels correlated with cognitive performance (SCIP total raw score, immediate and delayed verbal learning, and verbal fluency). CRP was a predictor of cognitive performance in women only. LimitationsThe choice of the cognitive scale and covariates and the lack of a control group may be the main limitations. ConclusionsA gender difference was found in biomarker modulation of cognition and psychosocial functioning. A gender-based approach to cognition and real-world functioning should be considered in bipolar disorder to ensure an optimal outcome.

Oncological supportive-care unit (OSU): An effective toxicity management model.

e18301 Background: Oncological patients (pts) frequently experience treatment-related toxicities worsening outcome. According to literature data, 23% - 50% emergency department (ED) and/or hospital admissions in this setting could be avoidable and hesitate in higher management costs and worse quality of life (QoL). Cancer treatment adherence rate is 27% - 87%, mostly related to chemotherapy and post-surgical side effects. Since May 2014 we established an OSU to improve clinical outcome and treatment adherence, to reduce ED access/hospital admissions and toxicities management costs. Methods: All OSU data have been recorded in a database which includes daily management costs into an Italian regional regimen called MAC (Complex Ambulatory Macro-activities). ED accesses were recorded by our “First aid ED operative system”. Hospitalizations costs were evaluated according to regional DRG (Diagnosis Related Group) value and Hospital Discharge Register (HDR). All pts admitted to OSU should answer to two validated questionnaires regarding QoL and anxiety: FACT-G (General FunctionalAssessment Cancer Therapy) and HADS (Hospital Anxiety and depression Scale). We compared toxicities management costs 20 months before and 20 months during OSU. Results: From May 2014 to December 2015, 302/719 pts were admitted to OSU for a supportive care therapy. We obtained the reduction of the costs of the ED access/hospital admission to 52%, while the gain in management was 59% (see table). PS ECOG improved in 9 (18%) pts while it was unchanged in 41 (82%) pts. Adherence to oncologic treatment was satisfactory (95%) and the average values of total FACT and HADS in the follow-up phase improved compared to baseline in 63% and 43% of pts respectively. Conclusions: The interim analysis suggests that OSU improves clinical outcome in terms of QoL and treatment adherence. Moreover, our OSU model demonstrated the possibility to reduce toxicity-related ED accesses/hospital admissions and management costs. [Table: see text]

Most common problems across health conditions as described by the International Classification of Functioning, Disability, and Health.

Health conditions are associated with a variety of functional outcomes. Even though functional outcomes are diverse for different health conditions, they can have important commonalities. The aim of this study was to identify the most common problems in functioning across the wide range of health conditions using the International Classification of Functioning (ICF). Existing databases created for the 21 ICF Core Sets studies were descriptively analyzed. These included data collected in 44 countries on 9978 patients with one of 21 health conditions as the main diagnosis. A frequency cutoff of 50% was used to identify the most common problems in functioning when looking at single health conditions and across them. No category was identified as common to all health conditions included in the study. Fifteen most frequent categories were common in 10 to 13 health conditions out of 21. Eleven categories correspond to the list of activities and participation, and four to the list of body functions. These are related to mobility, daily routine, mental functions, intimate relations, employment, and leisure. Some health conditions have more commonalities between each other. The most common problems across health conditions are therefore related to mental functions, mobility, daily life, intimate relations, employment, and leisure. The results contribute toward the identification of the universal set of ICF categories that can be used in clinical practice for the general assessment of functioning.

1468 – Is depression a more frequent comorbid condition in family practice?

Health is defined as the state characterized by a physical, psychological and social wellbeing. In the primary care practice - Individual Medical Practice Popa-Nedelcu Eusebiu MD, 80 patients with various types of depression were identified within 6 months, out of a database of approximately 4000 patients. The aforementioned 80 patients, aged between 35 and 88, were divided into 2 groups: 54 patients with depression and comorbid chronic conditions and 26 patients with depression, without comorbid chronic conditions.Each subject included in the study was assessed with 3 questionnaires: MADRS, M.I.N.I., General Assessment of Functioning (GAF). Results The incidence of the depressive disorder in the studied time frame was 2%, and female gender subjects were more frequently involved. MADRS scores were significantly higher (scores higher than 30) in patients with depression associated with chronic conditions (cardiac, oncological, respiratory). The most frequent condition associated with depression was arterial hypertension (38%). Both MADRS scores, and GAF scores were influenced by antidepressant therapy. Patients under long- term treatment due to medical comorbid condition (74%) have a less satisfactory evolution and prognosis than those without somatic comorbid condition. Conclusions Depression has a too large incidence in primary care. Family physicians need to be familiar with the features and monitoring of antidepressant therapy, as therapeutic compliance is the sine-qua-non prerequisite of remission and relapse prevention in depressive disorder. The severity, prognosis and evolution of patients with depression are more reserved in those with associated medical conditions, than in those without co-occuring conditions.

Obstetric Complications in Adults with ADHD: A Retrospective Cohort Study

Obstetric complications have been associated with a number of mental disorders. In this study, we investigate how obstetric complications relate with clinically significant determinants of adult attention deficit hyperactivity disorder (ADHD), such as gender, age of diagnosis, psychiatric co morbidity, severity of symptomatology and general functioning. Presence of obstetric complications as reported in the psychiatric history of 64 patients in transition from adolescence to adulthood referred to the Yorkshire service for adults with ADHD between June 2009 and October 2010 were recorded. The presence or not of these complications was examined as a factor determining a number of clinically significant variables, such as gender, age at first diagnosis, psychiatric comorbidity, severity of symptomatology (measured with Conners Adult ADHD Rating Scale (CAARS)) and general functioning (measured using the DSM-IV General Assessment of Functioning (GAF) index). Obstetric complications were not associated with any of the variables examined. Adults with ADHD in transition to adult services were highly symptomatic and disabled with a mean Conner’s score (n = 56) of 30.5 (SD = 12.8) and the most common frequency of the GAF score (n = 55) on the 60–51 range. Although it has been reported that environmental factors are associated with ADHD, the presence or absence of obstetric complications in an adult ADHD population was not associated with a number of proxy measures clinically associated with organic aetiology in mental health conditions. Future research on etiology and etiopathology should focus on prenatal and genetic factors instead.

Neurocognitive Impairments and Their Relationship With Psychosocial Functioning in Euthymic Bipolar II Disorder

The aim of this study was to compare neurocognitive functioning between euthymic patients with bipolar I disorder (BDI), bipolar II disorder (BDII), and healthy controls. An additional aim was to estimate the relationship between neurocognitive impairments and psychosocial functioning. Eighty-seven patients with BDI (n = 48) or BDII (n = 39) and 39 healthy controls were included. All subjects completed an extensive neurocognitive battery. Psychosocial functioning was assessed using the General Assessment of Functioning. Patients with BDII performed more poorly than did the controls in measures of psychomotor speed, verbal memory, and executive functioning. Patient groups did not show differences in any of the cognitive measures assessed. The performance in trail-making test B was the only independent predictor of psychosocial functioning in both patient groups. Patients with BDII have cognitive impairments, and this has a negative influence on their functional outcome. Our results bring additional support to the notion that BDII disorder is not a merely mild type of BDI.

P01-165 - The effects of olanzapine in treatment of panic disorder with and without agoraphobia

BackgroundIn this study, we have evaluated the effects of Olanzapine in treatment of panic disorder with and without agoraphobia.Method and materialsPatients whit resistant panic disorder (resistant to tow SSRI agents) who came to psychiatric clinic of Ibn-e-Sina and Ghaem Hospitals-Mashhad during 2004–2005 were enrolled in this study. Low dose Olanzapine (2.5 milligram per day) was administered initially. ALL cases were evaluated by different psychiatric tests such as agoraphobic cognitions questionnaire panic attack and anticipatory anxiety scale, Hamilton depression test and general functional assessment.ResultsIn this study, 30 patients were divided into two groups of panic disorder with agoraphobia (13 cases) and panic disorder without agrophobia (17 cases). Comparing these two groups, all indexes were improved significantly by time but The frequency of panic attacks in the last week minor panic attack duration of panic attacks agoraphobic cognition scale and Hamilton depression indexes were Improved significantly especially in those cases with panic disorder and agoraphobia Although the therapeutic response according to anxiety score, total panic attacks Hamilton depression test and general functional assessment was not showed any Difference.ConclusionOlanzapine augmentation has acceptable effects in the treatment of drug resistant panic disorder with agoraphobia and therapeutic effects were more significant among patients with panic disorder without agoraphobia.