Although current standard treatment for migraine headache is medication, high levels of psychological comorbidity has led to migraine influencing by cognitive, emotional and environmental factors, as well as biological. Viewing migraine in a biopsychosocial framework introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy (CBT). The aim of this study was to evaluate the efficacy of CBT for chronic migraine.

Thirty-five participants diagnosed as chronic migraine were recruited from Headache Clinic. According to inclusion criteria 14 participants, underwent bi-weekly lasting 30 minutes CBT sessions for 6 months, were administered Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Scale (VAS) and the Migraine Disability Assessment Scale (MİDAS) before and after CBT.

Nine of the participants were female and 5 male. Mean age of group was 34.35 ± 8.17. Duration of illness was 13.07 ± 7.18 and 12 of participants had the history of a psychiatry illness whose diagnoses were depression (7), anxiety disorder (4) and post-traumatic stress disorder (1). Nine of the patients had prophylactic migraine treatment. There were statistically significant difference in Hamilton Depression scores between before CBT (29.07 ± 7.74) and after CBT (14.21 ± 7.7); in Hamilton Anxiety scores before CBT (26.8 ± 11.7) and after CBT (11.7 ± 2.6); in VAS scores before CBT (8.07± 0.91) and after CBT (3.71 ± 1.32); in frequency of migraine attacks between before CBT (10.85 ± 3.50 day) and after CBT (4.92 ± 2.70 day) and in MİDAS before CBT (55.5 ± 20.4) and after CBT (20.12 ± 16.6) (P < 0.05).

CBT might reduce the severity of symptoms in migraine patients especially with the comorbidity of psychiatric illness.

The authors have not supplied their declaration of competing interest.

We present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.

Normal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.

Numerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.

The authors have not supplied their declaration of competing interest.

COPD (chronic obstructive pulmonary disease) is a chronic illness associated with psychological distress. Self-esteem and the associated comorbidities, like depression and anxiety, can influence its evolution.

To analyze how predominant coping styles associated with different levels of self-esteem and mental status in patients with COPD.

To demonstrate that different types of coping-styles have an impact on self-esteem, depression and anxiety.

To a lot consisting of 28 subjects with COPD, was applied the COPE scale to assess the style of coping, to rate anxiety and depression The Hospital Anxiety and Depression Scale (HADS) and for self-esteem the Rosenberg Self-Esteem Scale. According to their higher coping sub-scale score, they were classified to one dominant coping type as follows: patients with problem-focused coping type (n = 9), emotion-focused coping (n = 10), social support-focused coping (n = 6), respectively avoiding coping type (n = 3).

Patients with dominant problem-focused coping had the most elevated self-esteem compared to patients with social-focused coping (22.0 vs. 16.2; P = 0.039), the depression score was the highest in patients with dominant avoidance-type coping and the lowest in patients with dominant problem-focused coping (11.0 vs. 5.6; P = 0.042) respectively anxiety, was the highest in patients with dominant social-focused coping and the lowest in patients with dominant emotion-focused coping (11.6 vs. 5.0; P = 0.006).

In patients with COPD, problem-focused and emotion-focused copings are adaptive, while avoidance and emotion-focused copings are maladaptive on self-esteem and mental status. Such as, the coping represents a psychological dimension with an impact on the evolution of the disease, and the patients with COPD should be assessed and addressed multidisciplinary.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Chronic migraine is commonly regarded as one of the most disabling headache conditions. Although there has been some research indicating the severe impact of this chronic headache, there is little comprehensive evidence of its impact on quality of life, disability and cognitive function.

The aims of this cross-sectional study were to investigate cognition, disability and quality of life in patients with chronic migraine compared to healthy control subjects.

Participants were a convenience sample of 58 adult outpatients admitted to Headache Centre of the Sant’Andrea Hospital in Rome (Italy). Inclusion criteria were a diagnosis of chronic migraine (illness duration >5 years). Fifty-eight age-matched healthy subjects were recruited as controls. Participants were administered the Mini Mental State Examination, the Italian Perceived Disability Scale (IPDQ), the 12-item Short Form Health Survey (SF-12) to assess physical and mental health, and the neurocognitive task Visual Perspective Taking (VPT), as a measure of social cognition.

Patients with chronic migraine showed higher perceived disability and poorer well-being compared with healthy controls. No differences were found in global cognitive function and in the performance of the neurocognitive task.

Addressing the burden associated with subjective state of disability and well-being in migraineurs is important because of its association with a worse prognosis and a worse response to treatment. Findings did not confirm the hypothesis that migraneurs are more impaired in social cognition. Further studies are needed to assess different cognitive dimensions in migraneurs, including various measures of social cognition, to better understand neurocognitive profile of this patients’ population.

The authors have not supplied their declaration of competing interest.

Facing a growing number of capacity evaluation requests in the general hospital, physicians increasingly encounter ethical issues and dilemmas that drive them to seek unnecessary psychiatric consultations. This practice raises the expectation that the consultant psychiatrist would be, somehow, the ethicist on board whose role is to bring the most moral solution to their predicament.

Literature review and discussion about ethical questions facing decisional capacity evaluation.

Clinical and literature reviews.

(Case report) This poster presents the case of 92-year-old woman who lives alone with no family support who was brought to the emergency room due to a fall. Consequently, she was diagnosed with small cell lung carcinoma. Instead of the proposed short term rehab to receive radiotherapy, the patient insisted that she be discharged to her home. The psychosomatic team was consulted to evaluate the patient's capacity to make a decision regarding this form of treatment. The psychiatrist who evaluated the patient felt that she lacks capacity. However, palliative care felt strongly that patient's capacity should not be challenged, arguing that she has been living independently, doing well, and is agreeing to treatment.

We will review the most updated guidelines on how to perform a capacity evaluation, how these guidelines are incorporated in residency curriculums, and whether residents from various specialties are being trained on evaluating decisional capacity. We will also explore optimal ways to educate primary care physicians on how to evaluate decisional capacity and when to seek psychiatrists’ expertise for these evaluations.

The authors have not supplied their declaration of competing interest.

Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.

To describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.

To broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.

A 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.

Haloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.

Hyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.

The authors have not supplied their declaration of competing interest.

Clozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.

We describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.

Discuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.

We present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.

At the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)

Diarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.

The authors have not supplied their declaration of competing interest.

Psychiatric morbidity in refractory epilepsy is frequent and has a negative influence on quality of life. Treatment-refractory epileptic patients are at higher risk of developing psychiatric disturbances. The interictal dysphoric disorder (IDD) has been described as a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy. It is characterized by 3/8 symptoms: depressive mood, anergia, pain, insomnia, fear, anxiety, irritability, and euphoric mood.

To provide evidence that psychiatric morbidity is high in refractory epilepsy and to describe associations to IDD.

The present study aims to show that there are typical psychiatric conditions in epilepsy that can be unnoticed.

We cross-sectional analyzed the psychopathologic outcomes of patients with refractory epilepsy. The assessments methods included SCID for DSM-IV and clinical interview for epileptic specific psychiatric conditions.

The sample consists of 153 patients, with a mean age of 37. A total of 42.5% were males. One or more Axis I diagnoses was seen in 38% of the patients. The most common condition was IDD (27.1%), followed by affective and anxiety disorders (22 and 15.3% respectively). Considering patients with IDD, we found differences in locus (P = 0.001) (present in 34.3% of non-stablished locus, 8.6% of extra-temporal locus and 57.1% of temporal locus) but not with hemisphere, sex, type of crises, treatment. We neither found correlation with age, number of crisis or number of treatments.

Psychiatric comorbidities as IDD do not appear in the DSM-IV but are prevalent and could be related with temporal locus.

The authors have not supplied their declaration of competing interest.

Anxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism.

To investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample.

Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.

Fifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04).

Further evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.

The authors have not supplied their declaration of competing interest.

Inflammatory state of the large bowel is a key factor for the development of colorectal cancer (CRC). It has multifactorial aetiology, including psychological determinants. Physical activity may have a protective function against CRC via anti-inflammatory properties; on the contrary, personality traits correlate with an unhealthy and dangerous lifestyle.

To measure the association between personality traits, lifestyle and colonoscopy outcome.

Cross sectional study. Patients undergoing colonoscopy aged 40 or more, with a negative history for cancer or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, smoke, alcohol, physical activity, presence/absence of Metabolic Syndrome, personality traits assessed by the Temperament & Character Inventory (TCI).

In a sample of 53 subjects (females = 24, 45.3%), the mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Twenty patients were smokers (37.74%), 36 (67.92%) drank alcohol at least weekly; approximately 60% reported regular physical activity. At the multivariate regression, the outcome was associated to: TCI Self Transcendence domain (ST) (OR = 1.36, P = 0.04) and physical activity (OR = 0.14, P = 0.03).

People with ST's characteristic personality traits and sedentary life style are more likely to have precancerous colorectal lesions. This confirms the protective role of physical activity, and suggests to further explore the role of personality in cancerogenesis.

The authors have not supplied their declaration of competing interest.

Cerebellar cognitive affective syndrome (CCAS) is a condition that arises from cerebellar lesions. CCAS can easily be overlooked by medical teams; therefore a bibliographic review will facilitate the understanding of symptoms in order to effectively diagnose and provide a holistic early treatment approach.

A case report of a 72-year-old woman with bilateral cerebellar lesions with high pre-morbid function presented with classic symptoms of CCAS. Multidisciplinary workup included medical, psychiatric, neuropsychological assessment (R-BANS (Form 1), Digit Span, Verbal fluency tests, the Hayling Test, the Delis-Kaplan Executive Function System) as well as other investigations (neuroimaging and blood tests) were conducted on the patient to confirm CCAS and exclude other differential diagnoses.

The results from the medical assessments conducted showed symptoms of cerebellar dysfunction. A psychiatry and neuropsychological review revealed aggression, irritability, disinhibition, deterioration in cognitive function and personality changes. A multidisciplinary team was formed to rehabilitate the patient however patient was non-compliant with therapy. The patient was prescribed Seroquel 50 XR and she responded well to the medication.

This case review illustrates the challenges associated with engaging a CCAS patient in rehabilitation activities due to cognitive and mood disorders. The use of psychotropic medications can be an effective method in improving cognition and mood disorders in CCAS patients. Early psychiatry and psychological intervention can significantly improve the overall outcome of a patient diagnosed with CCAS.

Nil.

The author has not supplied his declaration of competing interest.

Case presentation of a young woman Ms. SH, with neuropsychiatric presentation in a rare Lysosomal Storage Disorder (Fabry's disease).

A 19-year-old female with Fabry's disease (FD) presented initially with symptoms of obsessions of dirt and contamination and compulsions of washing and also with overvalued persecutory ideas of being followed. Since the age of 14, she had suffered from various psychiatric symptoms increasing in frequency and intensity. Routine examinations including cognitive testing, electroencephalography and structural magnetic resonance imaging revealed no pathological findings. During the course of a year, her OC symptoms improved significantly with the use of Fluoxetine 40 mg mane. However, she then became more depressed and psychotic (despite continuing on Fluoxetine). Addition of Risperidone (gradually increased to 2 mg nocte) led to attenuation of her symptoms and she recovered completely over a course of another 6 months.

Mental and behavioural symptoms in Fabry Disease symptoms usually begin during late childhood or adolescence but may not become apparent until the second or third decade of life. Early symptoms include episodes of severe burning pain in the hands and feet and skin lesions. The psychiatric manifestations can be varied, e.g. the index patient, initially presented with what appeared like an Obsessive Compulsive disorder but later as a depressive illness (Muller et al,. 2006) with psychotic symptoms.

To showcase mental and behavioural symptoms associated with a rare disorder like Fabry's disorder and treatment options may be helpful.

The author has not supplied his declaration of competing interest.

There are few studies specifically investigating the acute treatment procedures of patients with schizophrenia in the context of Consultation-liaison psychiatry (CLP).

Describe the main clinical features of the referrals of patients with schizophrenia, attended by a general hospital CLP service.

Longitudinal observational and descriptive study, assessing adult inpatients with schizophrenia (DSM-IV-TR criteria) admitted to non-psychiatric units of Hospital Clínic of Barcelona (Spain), who were consecutively referred to our CLP service over a 10-year period (from January 1, 2005, through December 31, 2014).

During that period, 9.808 psychiatric consultations were requested. 163 of them (1.8%) concerned patients with schizophrenia. These groups of patients were aged 50.9 ± 15.3 years and 65% were male. A 25.9% of patients had history of suicide attempts and 45.6% presented current psychosocial stressors.

Characteristics of referrals Referral sources according to medical specialties are shown in Table 1.

The major medical conditions for referral according to ICD-10 categories were: external causes of morbidity (21.5%), infectious diseases (13.5%) and diseases of the digestive system (10.4%).

The two most frequent reasons for referral were the assessment of psychopharmacological treatment and/or psychopathological state examination (62%) and suicidal risk/attempt assessment (8.6%).

In our sample, only a 1.8% of all patients for whom psychiatric consultation was requested had a diagnosis of schizophrenia. The most common profile of them was: male, 50 years old, coming from general medicine department due external causes of morbidity and referred to the CLP service because of psychiatric state and/or medication review.

The authors have not supplied their declaration of competing interest.

According to the WHO, tropical diseases affect 1/5 of the world population, being increasingly frequent in Europe. Most of these diseases produce mainly physical symptoms, but the appearance of accompanying neuropsychiatric symptoms are not uncommon.

To present a clinical case of mansonellosis with neuropsychiatric symptoms.

Twenty-two-year-old man from Equatorial Guinea, resident in the European Union for 3 years without psychiatric history. His medical history included recurrent malaria, syphilis treated with penicillin and he was HBsAg carrier.

He presented with a 10 month history of headache, pruritus, retrograde amnesia, episodes of anxiety and persecutory delusions. Previously he had gone to the emergency room several times. Cranial CT scan showed no abnormalities. Anxiolytic treatment with benzodiazepines was started, with partial response of the symptoms.

The blood tests revealed a WBC count of 62 × 10E9/L leukocytes with 11% eosinophils, IgE 5242 IU/mL and IgG 1740 mg/dL. Given the suspicion of filarial infection, a thick blood film was done, the result being positive for mansonella perstans. He was administered treatment with albendazole 400 mg/12 h for 10 days and ivermectin in single dose. One month after start of treatment the patient was asymptomatic with complete resolution of the neuropsychiatric symptoms and correction of eosinophilia.

The patient's origin, his medical history and the typical symptoms of parasitosis should raise the suspicion of an infectious origin of the neuropsychiatric symptoms.

The patients from tropical regions with neurological and/or psychiatric symptoms should undergo comprehensive diagnostic workup to rule out an infectious disease as a possible cause.

The authors have not supplied their declaration of competing interest.

Consultation-liaison (CL) psychiatry is a branch of psychiatry that study and treat mental health of patients with other medical or surgical conditions. The assistance between hospitals and health services is heterogeneous.

For this reason, the objective of our research is to define the clinical characteristics from our CL service and check out the quality relationship with the applicant service, for improving future assistance.

We made a descriptive analysis of clinical variables from the patients who received assistance during 2 months by the CL service from the hospital del Mar, Barcelona. We got the frequencies and we used the Chi2 test for the comparison between variables: Diagnosis, appearance in the report and treatment in the report.

Total of the sample: 42 patients, 61.9% women. Mean age: 55.1 years. Psychiatric diagnosis was present before the assistance on 57.1% of the patients. The most frequent diagnosis was Adjustment Disorder (47.6%) and more than one diagnosis was made in the 14.3%. Near the half of the patients required only primary care assistance after the discharge from the hospital. In the 68.3% of the reports appeared information about CL assistance and the indicated treatment didn’t appear in all the reports. Statistically significant differences weren’t found in the comparisons.

Adjustment Disorder is supposed to be the most common psychiatric diagnosis in our CL psychiatry service, as we found in the reviewed literature. The results reveal that relationships between services can be improved. More studies must be done for completing information in this issue.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Vitamin D receptor (VDR) is widely distributed in the human brain including areas that are assumed to be involved in the pathophysiology of depression. Vitamin D deficiency may cause physical symptoms like pain.

See if somatic presentation of depression has any correlate with vitamin D deficiency.

To compare prevalence of vitamin D deficiency between depressed and non-depressed subjects and see if somatic presentation of depression has any correlate with vitamin D deficiency.

Sixty diagnosed MDD patients consenting to participate in the study from a large private hospital selected, provided they were non-smoker, 18–65 years, free from chronic illness and not taking anti-depressant control (60 subjects) comprised of close family members of patients. FSC (functional somatic complaints) was assessed using local language version of Bradford Somatic Inventory (BSI), while severity of depression was assessed using HDRS-17. Based on the total score, FSCs are categorized into 3 grades ((>40 ‘high, 26–40 ‘middle, and 0–25‘low’ range).

Vitamin D status (deficiency: insufficiency: sufficiency) was 70: 30.0: 0.0% in depressed, which significantly worse compared to control subjects (55%: 25: 20%). Patients with higher BSI scores (i.e. more somatisation) showed non-significantly lower vitamin D level. These results were more prominent for female subjects.

Vitamin D deficiency is more common in depression subjects, which might thus need to be looked for and treated. However, no significant link between somatisation and vitamin D deficiency could be established.

The authors have not supplied their declaration of competing interest.

In the context of the importance of psychotherapy in mental health care the aim of our study is to highlight the importance of supervision as an integral part thereof.

We analyze the relationship between the assessment of the quality of supervision and the perceived self-efficacy of the psychotherapist as one of the antecedents of decision-making in the psychotherapeutic process. This framework is applied to an empirical study that focuses on psychotherapist's perception of clinical supervision in relationship to professional self-efficacy in the therapeutic process.

The study was operationalized using the Manchester clinical supervision scale (MCSS), containing a demographic questionnaire, counselor self-efficacy scale–modified version. One hundred and twenty-five psychotherapists with supervisory experience participated in the research, including 67 trainees and 58 graduates of psychotherapy training.

The results show a positive relationship between effective supervision and self-efficacy (r = 0.363; sig = 0.000; n = 125). The participants who attributed higher ratings to supervision and supervision work alliance also assigned higher scores to perceived self-efficacy–although there is a significant relationship among the participants of psychotherapeutic training (r = 0.444; sig = 0.000; n = 67), this relation is not significant among the actual graduates. Based on modeling, rapport was discovered to be the most important predictor of supervision effectiveness assessment.

The results support the merits of supervision in the education of psychotherapists and the importance of investing resources in its regular implementation.

The authors have not supplied their declaration of competing interest.