There is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.

We aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.

A total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).

Our study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.

The authors have not supplied their declaration of competing interest.

Forensic adaptations of assertive community treatment (ACT) remain understudied in Europe, whereas promising results emerge from the United States. There is a need for research into the effectiveness of ForACT outside the United States, as Europe differs greatly in terms of organisation of mental health and judicial system.

Investigating effectiveness of forensic adaptations of ACT in the area of Flanders, Belgium. Outcome measures are divided into forensic, like arrests or incarcerations, and non-forensic, like admissions and length of stay.

Investigating effectiveness of ForACT on forensic and non-forensic outcome measures as well as factors related to outcome. A third outcome is community tenure, which is the actual number of days divided by the potential number of days spent in the community.

A controlled cohort study was designed over with first results at 33 months. The experimental group consists of a new ForACT team in the area of Flanders, Belgium (n = 70). Patients are admitted from prison, psychiatric hospitals or other community-based care. The control group consists of mentally ill offenders in community-based treatment after release from prison (n = 56).

Results on forensic measures and community tenure are promising in favour of the ForACT team. In contrast, clients are often, though shortly, readmitted into psychiatric residential care. Substance use emerges as the main reason for admissions.

A local forensic adaptation of ACT reveals promising results on forensic outcome measures, yet suffers a large number of admissions.

The authors have not supplied their declaration of competing interest.

Psychosocial interventions are an essential part of the treatment of schizophrenia and are aimed at promoting the social, family and occupational functioning of the patient and relapse prevention. They are considered proven clinical measures whenever necessary, however they tend to be underused.

Answer the question on psychosocial therapies available today for schizophrenia.

Review through PubMed by entering the following keywords: psychosocial therapy; schizophrenia; cognitive behavioral therapy, and clinical practice guidelines.

There are several psychosocial therapies used in clinical practice. The main points of approach focus on self-management of the disease, everyday problems, education, crisis intervention, and acquiring insight. The cognitive impairment is an important aspect of schizophrenia to consider. It seems that cognitive remediation therapy has been associated with both neurobiological and cognitive improvement.

The combination of different therapies along with psychopharmacological treatment appears to provide better results in the reduction of negative symptoms, positive symptoms and reduced hospital stay.

The authors have not supplied their declaration of competing interest.

Persistent pondering over negative self-related thoughts is a central feature of depressive psychopathology.

In the present study, we sought to investigate the neural correlates of abnormal negative self-referential processing (SRP) in patients with major depressive disorder (MDD) and its impact on subsequent cognitive control-related neuronal activation.

We hypothesized aberrant activation dynamics during the period of negative and neutral SRP in the rostral anterior cingulate cortex (rACC) and in the amygdala in patients with MDD. We assumed abnormal activation in the fronto-cingulate network during Stroop task execution.

Nineteen depressed patients and 20 healthy controls participated in the study. Using an event-related fMRI design, negative, positive and neutral self-referential statements were displayed for 6.5s and followed by incongruent or congruent Stroop conditions.

In contrast to controls, patients did not exhibit valence-dependent rACC activation differences during SRP. A novel finding was the significant activation of the amygdala and the reward-processing network during presentation of neutral self-referential stimuli relative to baseline and to affective stimuli in patients. The fMRI analysis of the Stroop task revealed a reduced BOLD activation in the right frontoparietal network of patients in the incongruent condition after negative SRP only.

Thus, the inflexible activation in the rACC may correspond to the inability of depressed patients to shift their attention away from negative self-related stimuli. The accompanying negative affect and task-irrelevant emotional processing may compete for neuronal resources with cognitive control processes and lead thereby to deficient cognitive performance associated with decreased frontoparietal activation.

The authors have not supplied their declaration of competing interest.

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.

A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.

Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.

The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.

The authors have not supplied their declaration of competing interest.

Identifying the specific brain pattern characterizing psychiatric disorders could lead us to precise diagnostic process, better treatment plan and outcome prediction. Structural covariance is a graph-analysis method with which disruptions in large scale brain network organization can be observed. More studies, employing this method in psychiatry, are still needed.

The current study aims to investigate how the main psychiatric disorders – schizophrenia, major depressive disorder, bipolar disorder, affect brain circuitry by means of multivariate graph theory, more specifically – structural covariance. We hypothesized that specific abnormalities in the brain circuits would be found in separate diagnostic entities.

164 subjects were included with schizophrenia-SCH (n=17), bipolar disorder-BD(n=25), major depressive disorder–MDD(n=68) and a healthy control group-HC(n=54). Each participant provided a written informed consent and the study protocol was approved by the University’s Ethics Committee. High resolution structural MRI was acquired, and preprocessing was performed using SPM 12 toolbox. The structural covariance method was applied consisting of calculation of the correlation across subjects between the different pairs of regions by using the gray matter average volume. We used the threshold statistic to binarize the covariance matrix and transform it into an adjacency matrix. This allows us to compare psychiatric disorders at a network level by calculating measures such as authorities, hubs and outdegree.

61 statistically significant regions were found for the whole sample. The matrices of the four groups were compared according to their ‘authorities’ ,‘hubs’ and ‘outdegree’ as first, second and third ranking variables, respectively. In the group comparison between HC and BD patients the top five significant regions were Planum temporale (PT), Putamen, Precuneus (PreCu), Calcarine cortex (Calc_cor) and Postcentral gyrus medial segment (PostCGms). The MDD group demonstrated the following regions with most significant difference including Precentral gyrus (PreCG), Entorhinal area (EntA), Amygdala (Amy), Anterior cingulate gyrus (ACC), Anterior insula (AI). While SCH grop was charachterized by ACC, PreCG – medial segment, PostCGms, anterior orbital gyrus, and frontal pole.

The results of our study demonstrated that schizophrenia and mood disorders have specific disturbances in brain network structural organization, affecting hubs of default mode network, salience network, motor, sensory and visual cortex, as well as limbic system. These alterations might elucidate the pathophysiological mechanisms of common symptoms of the disorders under investigation including perceptual, affective and cognitive disturbances.

None Declared

to assess the role of social and psychological factors in manifestation of depression and anxiety, to estimate the prevalence of depression and anxiety symptoms among students.

students of Universities in Lithuania participate in survey: they are assessed with HADS, Beck Depression Inventory and the Symptoms of Anxiety-Depression index containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). The population includes students aged 20 – 22 years. We are assessing students in the first and four years from the various universities. Demographic, environmental data, psychological and social factors are associated with manifestation of depression and anxiety symptoms.

results show, that the prevalence of depressive and anxiety symptoms is rather high. The HADS scale performed better in detecting depressive and anxiety disorders. Patients with anxiety and depressive disorders had adverse social and psychological factors, as financial problems, lack of support from parents, workload, personality features. Personal psychiatric history is related to depression.

These findings underline the importance of screening of depressive and anxiety disorders in young people – students of Universities. Preventive mental health programs should be developed and implemented.

Negative attitudes towards psychiatric patients still exist in our society. Persons suffering from mental illness frequently encounter public stigma and may internalize it leading to self-stigma. Discrimination occurs across many aspects of economic and social existence. It may represent a barrier for patients to receive appropriate care. Many anti-stigma campaigns have been taken to decrease people's prejudice, but its effects are not well documented.

To characterize anti-stigma initiatives and its effects on diminishing negative consequences of stigma.

Bibliographical research using PubMed using the keywords “stigma” and “mental illness”.

Despite several approaches to eradicate stigma, it shows a surprising consistency in population levels. It was expected that focus on education would decrease stigma levels. The same was expected following concentration on the genetic causation of pathology. Most studies have revealed that education has little value and endorsing genetic attributions has led to a greater pessimism on the efficacy of mental health services, sense of permanence and guilty feelings within the family.

Public stigma has had a major impact on many people with mental illness, especially when leading to self-stigma, interfering with various aspects in life, including work, housing, health care, social life and self-esteem. As Goffman elucidated, stigma is fundamentally a social phenomenon rooted in social relationships and shaped by the culture and structure of society. Social inclusion has been pointed as a potential direction of change.

The authors have not supplied their declaration of competing interest.

Although there are very effective treatment approaches for Attention Deficit Hyperactivity Disorder (ADHD) available, the clinical management has its limits making new treatment modalities a necessity. Evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), improves hyperactivity, impulsivity, and attention deficit of individuals with ADHD.

The aim of this case study is to present the effectiveness of rTMS on hyperactivity, impulsivity, and attention deficit of an individual with ADHD.

This is a case study of a 22 year old male diagnosed with ADHD. The protocol applied was 2 weeks of daily rTMS sessions. This involved repetitive TMS to the right dorsomedial prefrontal cortex (10 Hz, 3.000 pulses, 120% motor threshold) to treat attention deficit, hyperactivity and impulsivity. Assessments were conducted using Adult ADHD Questionnaires, the Jasper and Goldberg questionnaire and WHO self- reported scale at baseline, 1 month and up to 3 months follow up.

The patient showed overall improvement in scores in both ADHD scales with scores dropping more than 50 % in both scales from pre treatment to 3 months follow up. No side effects were recorded during therapy

Our findings suggest that the use of rTMS therapy in individuals with ADHD, is an efficacious and safe therapeutic treatment option.

The world is becoming increasingly globalised and this has a major impact on the delivery of healthcare. Issues such as conflict, migration, climate change and technological advances all contribute to this. But are we equipped to deal with the challenges of Global Health?

To discuss the core competencies that health professionals should have in Global Health.

The UK's Global Health Curriculum Group (GHCG), a group of healthcare professionals, was commissioned by the Academy of Medical Royal Colleges to lead a consultation on global health competencies. The consultation took the form of a modified Policy Delphi which involved an online survey and face-to-face and telephone interviews over three rounds. Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world.

This study demonstrated broad agreement that global health competence is essential for postgraduate doctors and other health professionals. It identified five core competencies, relevant to the UK and applicable to other parts of the world: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals.

This framework of five core competencies aims to equip psychiatrists and other doctors with the skills, knowledge and attitudes necessary to practice in a globalised world.

In the workshop we will harness the international nature of the delegates attending the congress to enable a lively debate about the meaning of global mental health and the skills psychiatrists need.

The authors have not supplied their declaration of competing interest.

Akathisia is commonly known for its objective components such as rocking while standing or sitting and lifting feet. However, little is known about its psychiatric impact that can even lead to suicidal attempts.

The aim of this study is to investigate the main psychiatric symptoms associated with akathisia in a Tunisian sample of patients under treatment for Schizophrenia, Schizoaffective or Bipolar Disorder.

Fifteen patients were diagnosed with akathisia using the Barnes Akathisia Scale. Psychiatric symptoms related to akathisia such as mood lability, sadness, anxiety, aggressivity, suicidal ideation, insomnia and social and professional impairment were assessed.

The average age of the sample was 47 years. The average antipsychotic chlorpromazine-equivalent total dosage was 1756 mg. All patients reported at least one psychiatric symptom imputed to akathisia. These were: mood lability (n = 11), inner restlessness (n = 10), anxiety (n = 10), sadness (n = 10), aggressivity (n = 6), and insomnia (n = 12). Eight patients described suicidal ideation and five confessed having committed a suicide attempt. Four and ten said akathisia had professional and social impact respectively. The prevalence of psychiatric symptoms did not differ according to sex, age, diagnosis, illness duration, presence of a comorbid anxiety disorder, the number and types of antipsychotics used, the antipsychotic chlorpromazine-equivalent total dosage or the reported drug compliance.

Psychiatric symptoms resulting from Akathisia remain frequently undetected. Special interest by the clinician is required to elicit these symptoms.

The authors have not supplied their declaration of competing interest.

The purpose of this study was to determine the degree of agreement among parents and teachers with respect to the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF).

A total of 800 randomly selected children (400 boys, 400 girls) aged 7–11 years (mean age 9.28, SD 1.42) were assessed using CBCL and TRF parents completed the Child Behavior Checklist (CBCL) and teachers completed the Teacher's Report Form (TRF). Approximately 98% of the respondents were listed as the mothers and 2% as the fathers. for the TRF, 100% of the respondents were child's teacher. Analyses was included degree of concordance of ratings as a function of informant and child gender. the collected data were analyzed using pearson Coefficient of Correlation.

Coefficient of correlation showed low to moderate agreement among informants (parent-teacher) (r = 0/39). Furthermore the correlation of scores on the externalizing scale were generally significantly higher (p < 0/01) than the scores on the internalizing scale for parent-teacher correlation. There were no significant effects of gender on concordance among Ratings.

The results indicated that correspondences between parent and teacher ratings of behavioral and emotional problems across home and school settings differ. This difference is at least partly due to the situation specific behavior of children. Externalizing behaviors, in general, are more easily noticeable than internalizing behaviors, which partially explains why there tends to be greater correlation between raters on externalizing behavior. This Results help to gain a greater understanding of how the perception of child behavior varies between raters.

To identify correlates that might constitute risk factors for problematic video game use (PVU) among urban Tunisian secondary school students.

This multivariate cross-sectional study was carried out on 587 secondary school students, aged 14 to 20 years. They were randomly selected from seven secondary schools in the urban area of Sfax. The self-administered Fisher's nine-item questionnaire was used in this survey. To identify an associated problematic internet use video game addiction, Young's eight-item questionnaire was used. A self-administered, anonymous questionnaire covered socio-demographic, individual and family data.

The prevalence of PVU was 14.01%. In multivariate logistic regression analysis, we found that the individual risk factors for problematic video game use were anxiety symptoms (P = 0.034) and an associated problematic Internet use (P < 0.001). Playing sport was a protective factor (P = 0.011). The poor relationships within the family (P = 0.001), the lack of parental supervision of time spent on playing video game (P < 0.001) and mother profession as mid-to upper level manager (P = 0.002), predicted PVU.

The identification of risk factors can help to determine individuals at high risk, and alert mental health providers to be careful to screen these patients for PVU. Total avoidance of the Internet is unrealistic and inadvisable; but a sensibilisation outreach for youth, their families and health professionals may help to limit the onset of PVU among young people.

The authors have not supplied their declaration of competing interest.

One of the current concerns in the research on schizophrenia is the relationship between social functioning and emotion recognition abilities, more specifically of the role that this can have, as a potential pathway for building subsequent psychosocial intervention methods.

To establish the precise role that the ability to recognize emotions has on social functioning in subjects with a diagnosis of Schizophrenia.

To help develop psychotherapeutic intervention programs that will increase social functioning.

This paper analyzed a sample of subjects (N=31) with a diagnosis of Schizophrenia (according to the WHO ICD 10), who were selected based on inclusion/exclusion criteria. The following parameters were assessed: socio-demographic (gender, age of onset, level of education, family and professional status), social functioning (SFS scale) and the ability to identify emotions in the eyes (‘Reading the Mind in the Eyes’ test).

The ability of recognizing the emotion ‘anger’ is directly correlated with the ability to communicate and keep interpersonal relations (Spearman R = 0.310, p <0.05), the ability of independence/performance (Spearman R = 0.471, p <0.05), as well as the ability to relax (Spearman R = 0.456, p <0.05) and to engage in social activities (Spearman R = 0.473, p <0.05).

We noted that ‘anger’ is the only emotion that was correlated with social functioning. Anger must be understood beyond its negative connotation, also as a positive element, in the sense of positioning the individual in the society and of taking action in regard to personal needs.

In many countries suicide is one of the leading causes of death among children and adolescents. Identifying young people at risk and offering effective treatment is a major concern of mental health policies.

To look for the presence of suicidal thinking, plans and attempts in adolescents.

Measure the presence of suicidal tendencies having in mind possible correlation with psychological difficulties (measured by SDQ), level of depression, hopelessness and self-esteem of adolescents in one school sample.

The sample of adolescents at school have been offered to fill out CESD, Hopelessness scale for children, Rosenberg self-esteem scale, SDQ questionnaire and four item adopted questions about suicidal tendencies. All data has been analyzed by SPSS 14.0.

In the sample of 768 adolescents (12-20yr, mean Age=17, 52) 22, 1% of them declared suicidal thinking, 3, 9% planed and 2, 2% attempted. About third of them didn’t find any reason for these tendencies. Females showed more suicidal tendencies but significantly only for thinking. Tobacco, alcohol and marihuana users have significantly more suicidality. Youths who declared more test anxiety have significantly more suicidal thinking. Significantly association is found between suicidal tendencies and psychological difficulties (emotional, conduct, hyperactivity and peers problems). Depression and high hopelessness also have significances. Suicidality is significantly higher in youths with normal self-esteem.

Suicidality is much presented in our sample and showed significantly association with substance use, psychological difficulties, hopelessness, depression and normal self-esteem.

Patients affected by severe manic episode, often with delusional symptoms, are commonly treated with a combination of mood stabilizers, antipsychotics and other sedatives. The choice of a specific drug, dose and term is still debated.

A naturalistic study on a sample of 84 inpatients affected by acute severe mania treated with a combination therapy.

To compare efficacy and tolerability of haloperidol/risperidone/quetiapine in association with lithium and/or valproate.

Eighty-four bipolar inpatients affected by a manic episode according to DSM-5 criteria. Drugs administered according to our best practice. Clinical course weekly monitored with Young Mania Rating Scale (YMRS) for 4weeks. Extrapiramidal side effects (EPSE) monitored with Saint Hans Rating Scale (SHRS).

Twenty-five men (29.76%) and 59 women (70.24%); mean age 43.37 ± 13.58 years. Mean YMRS score T0 40.27 ± 9.04. Forty-one patients (48.81%) treated with haloperidol (3.4 mg/die); 16 (19.05%) with risperidone (4.3 mg/die); 27 (32.14%) with quetiapine (438 mg/die). The 3 groups showed no difference regarding clinical characteristics and YMRS basal scores. Chi2 analysis confirmed an higher response rate (50% of reduction of YMRS final score compared to T0) with haloperidol (χ2 = 14.88; P = 0.00). The repeated-measures model analysis showed a significant decrease (P < 0.05) in YMRS scores in haloperidol vs. risperidone vs. quetiapine patients for all time points from second week. No statistical difference for EPSE was found.

We suggest that haloperidol could be advisable in the treatment of severe mania, with rapid efficacy, even with low doses. Occurrence of EPSE was not considerable during the acute treatment. Studies with a larger sample size, randomization, fixed doses, double blind design are needed.

The authors have not supplied their declaration of competing interest.

To investigate whether maladaptive strategies to cope with shame feelings were associated with psychopathic traits.

To examine the association between four maladaptive shame coping were positively related with psychopathic traits.

A sample of male offenders incarcerated in Italian jails completed the Self-Report Psychopathy Scale (Paulhus et al., 2015) and the Compass of Shame Scale (Elison et al., 2006).

As hypothesized, maladaptive shame regulation strategies did predict psychopathic traits in the offender sample examined. Specifically, significant and meaningful associations occurred between avoidance and attack other coping styles and psychopathic traits.

The present study is among the first in providing evidence of a possible relationship between maladaptive strategies to cope with shame feelings and psychopathic traits, and such link can be informative to tailor treatment programs for these hard-to-treat patients.

The authors have not supplied their declaration of competing interest.

Obsessive compulsive disorder (OCD) affects 2-3% of the general population. The neurobiology of OCD has been linked to dysfunction of cortico-striatal circuits connecting the orbitofrontal (OFC) to the striatum. Recently, this loop has become an approved target for non-invasive neuromodulatory treatment of OCD.

To explore structural and functional connectivity of the OFC in OCD subjects and healthy controls.

14 OCD patients and 12 age/sex-matched controls underwent magnetic resonance imaging (MRI) (3T-Philips scanner) for diffusion tensor imaging (DTI) and resting state functional connectivity (rsFC). DTI images were brain extracted and corrected for movement and eddy currents. A diffusion tensor model was fitted to each voxel and used to generate Fractional Anisotropy (FA) maps. Voxel-wise statistical analysis of FA was performed using Tract-Based Spatial Statistics. RsFC images were preprocessed and seed-based correlation (SBC) analysis was performed using Data Processing Assistant for Resting-State fMRI.

We found decreased values of FA in the body of the Corpus Callosum bilaterally (MNI_coordinates: x= 16, y= -16, z= 33 and x= -19, y= -16, z= 42) and left superior longitudinal fasciculus in OCD patients (fig 1, left), as well as decreased rsFC of the right superior orbitofrontal seed with the left inferior frontal gyrus and left middle occipital gyrus (fig 2, right).

Using an exploratory multimodal approach we found evidence of abnormal structural and functional long-range connectivity of the OFC in OCD. If confirmed in a larger sample these connectivity abnormalities could be explored as potential predictors of response to OFC-targeted non-invasive neuromodulatory interventions.

No significant relationships.