The National Program of Tobacco Control was recently implemented in the Addictology and Chemical Dependency Ambulatory of UFMG Clinical Hospital. The program is performed with group sessions and it has cognitive behavioral therapy and pharmacological treatment as theoretical basis. The protocol followed was proposed by National Cancer Institute (INCA) and it is set as 4 weekly group sessions, with 10 to 15 people, lasting 90 minutes. All sessions hold 4 steps know as: individual attention, strategies and information, revision and discussion, and at last, home assignments orientations are given. In addition to informative material, some topics are taught, such as techniques to avoid relapses, skill training, stress management, and psychoeducation.

Evaluate qualitatively the efficiency of this program on stopping patient's smoking habits according to criteria's suchs as associated factors with treatment outcome and the grade of patients’ satisfaction.

Transversal and qualitative study, using focal interviews conducted by telephone and a default questionnaire for evaluation of users. Then, patients who completed the program were compared to those who have discontinued.

A low adherence rate to the program was observed in comparison to other anti-smoking groups. In spite of this, the project was very highly rated by patients and well recommended by them. The participants evaluated themselves with low scores of willpower.

However the original approach strategies must be further elaborated on, new strategies need to be considered, and individual stimuli must also be incorporated in order to make this program even more successful.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood, but are recognised as often persistent into adulthood. Impairments in day-to-day functioning associated with ADHD in adults include deficiency in executive function.

Evaluate the effect of lisdexamfetamine dimesylate (LDX) on ADHD symptoms in adults with ADHD and executive function deficit.

This phase 4, randomized, double-blind study enrolled adults (aged 18–55) with baseline ADHD Rating Scale IV with Adult Prompts (ADHD-RSIV- Adult) total score ≥28 and baseline Global Executive Composite T-score ≥65 on the Behaviour Rating Inventory of Executive Function–Adult Version. Patients were randomized 1:1 to receive optimized doses of LDX (30, 50 or 70 mg/day) or placebo for up to 10 weeks. The change from baseline in the investigator-rated ADHD-RS-IV-Adult total score was a secondary efficacy outcome.

The full analysis set comprised 154 patients (LDX, n=79; placebo, n=75). At baseline, mean ADHD-RS-IV-Adult total score was 39.9 in both groups (standard deviation [SD]: LDX, 6.83; placebo, 7.37) and mean changes from baseline to week 10 or early termination were −21.4 (SD, 11.27) and −10.3 (12.70) in the LDX and placebo groups, respectively. Statistical analysis showed a significant difference (LDX minus placebo) in least-squares mean changes of −11.1 (95% confidence interval: −14.9, −7.3), with an effect size of 0.94 in favour of LDX (p<0.0001). Safety outcomes were consistent with previous studies and the known effects of stimulant treatment.

Short-term treatment with LDX markedly reduced ADHD symptoms in adults with ADHD and impaired executive function.

Study funded by Shire.

Alcohol and other substance use problems are common among individuals with schizophrenia. Many of the previous studies have focused on clinical comorbidity, not on longitudinal studies aiming to look for possible causal associations. We aimed to investigate if premorbid or early substance use predicts long-term clinical and social course in schizophrenia.

A systematic review to identify potentially relevant studies was conducted. Only studies with a follow-up period of at least two years were included. We studied following outcomes: negative, positive and total symptoms, clinical remission, hospitalizations, social functioning, employment, and global outcome.

The search identified 9343 unique potentially relevant articles of which 20 studies presenting results from 24 samples met our inclusion criteria. The meta-analysis included 5 to 13 studies in each outcome category. The studied in outcome groups were mainly moderate to high heterogeneous. In meta-analysis, substance use associated modestly with outcome, all the associations (Spearman's r) were non-significant and between −0.05 and 0.10. Non-significant findings are explained by the fact that the original studies found often opposite results, indicating both worse and better long-term outcome for early substance users.

Although comorbid substance use associates with poorer outcome in schizophrenia, the early substance use has only a modest effect as a predictor of long-term outcome. This difference between these two designs may be explained for instance with poorer treatment adherence of dual diagnosed patients.

The diagnosis of psychotic disorders is based on the presence or absence of characteristic symptoms. However the presence of such symptoms varies during the course and treatment of these illness, which raises the question of how stable a diagnosis of psychotic disorder remains over time.

The aim of this study was to assess the 3-year diagnostic stability after first admission for psychotic disorders.

We performed a retrospective study at the Department of Psychiatry of Centro Hospitalar S.João (Porto, Portugal). Patients were admitted in the inpatient unit from 2007 to 2010 (n=59), for a first psychotic episode experience and fulfilled criteria for one of the following diagnosis: Schizophrenia, Schizoaffective Disorder, Bipolar Affective Disorder, Psychotic Disorder due to Substance Use, Acute and Transient Psychotic Disorders and Psychosis NOS (ICD-10). The diagnoses were extracted from clinical records, and reassessed three years after the initial diagnosis. Twenty patients were lost to follow-up and thus excluded from the study.

In our sample, 69.2% of the subjects kept the same diagnosis three years later and 30.8% were given a different diagnosis at follow-up. Schizophrenia and Bipolar Affective Disorder were the most stable diagnoses and Psychosis not otherwise specified and Acute and Transient Psychotic Disorder were more variable.

Diagnosis performed in the first episodes of mental disorders has important therapeutic and prognostic implications. With its characteristic fluctuating symptomatology, first episode psychosis may be more vulnerable to diagnostic change over time.

GXR, a selective α2A-adrenergic agonist, is a non-stimulant treatment for ADHD (approved in the USA for children and adolescents and in Canada for children).

To assess the efficacy (symptoms and function) and safety of dose-optimized GXR compared with placebo in children and adolescents with ADHD.

To evaluate the efficacy (symptom and function) and safety of GXR for the treatment of ADHD. An atomoxetine (ATX) arm was included to provide reference data against placebo (NCT01244490).

Patients (6–17 years) were randomly assigned at baseline to dose-optimized GXR (6–12 years, 1–4 mg/day; 13–17 years, 1–7 mg/day), ATX (10–100mg/day) or placebo for 4 or 7 weeks. The primary efficacy measure is change from baseline in ADHD-Rating Scale-version IV (ADHD-RS-IV). Key secondary measures were defined as Clinical Global Impressions-Improvement (CGI-I) and the Weiss Functional Impairment Rating Scale-Parent (WFIRS-P). Safety assessments included treatment-emergent adverse events (TEAEs), electrocardiograms, and vital signs.

Of 338 patients randomized, 272 (80.5%) completed the study. Placebo-adjusted differences in least squares (LS) mean in ADHD-RS-IV total score, percent improvement versus placebo for CGI-I, placebo-adjusted differences in LS mean change from baseline in WFIRS-P score (family and learning and school domains) are shown in the Table. The most common TEAEs for GXR were somnolence, headache, and fatigue; 8 (7%) TEAEs were severe.

GXR was effective and well tolerated in children and adolescents with ADHD.

While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial.

investigating whether alexithymia is associated with PD regardless of psychopathology severity.

1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction.

167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects.

At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57).

The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.

Treatment in terms of standardised, time restricted, pre-coordinated care packages for anxiety disorders and other non-psychotic disorders has recently been introduced in the public mental health services in Denmark. Currently, the result of the implementation process and its impact on patient outcome and service delivery remains unknown.

To investigate i) the effect of care packages on patient outcome and ii) the implementation and service outcomes of care packages in clinical practice. The care package for anxiety disorders is selected as a case study.

The study is conducted as a quasi-experimental prospective pre-post study in a naturalistic setting. Patients included are aged above 18 years and randomly referred to care package treatment for anxiety disorders (F40-41) at two mental health centres in the capital region. In accordance with Proctor et al [1] outcomes are distinguished at three levels: Implementation, Service and Client. In this study the clinical outcome at client level are measured by the Symptom Check List-90R, Beck Anxiety Inventory, Global Assessment of Functioning and WHO Wellbeing Index. Implementation and services outcomes are measured in terms of time periods for waiting and treatment course and resource spending. An internet-based registration and questionnaire system accessed by patients, administrative personnel and therapists is used for data collection.

Inclusion is closed by December 2013. Implementation outcome results are expected by February 2014.

The basic helix-loop-helix (bHLH) transcription factor TCF4 was confirmed in the combined analysis of several large genomewide association studies (GWAS) as one of the most significant schizophrenia (SZ) susceptibility genes. TCF4 influences verbal learning and memory in humans and modulates sensorimotor gating in SZ patients. We showed recently that transgenic mice overexpressing Tcf4 in forebrain (Tcf4tg) display profound deficits in fear memory and sensorimotor gating.

We investigated the influence of different environmental conditions on the behavior and cognitive performance of Tcf4tg mice by exposing 4 weeks old animals for 4 weeks to single cage housing (SH) or to group housing in enriched environment (EE). In SH, animals were housed under poor conditions without any enrichment. In contrast, EE cages contained two separate compartments: the first with one-way entrance and one-way exit for drinking/feeding, and the second compartment with tubes and a running wheel enabling physical exercise. Animals underwent a profound analysis addressing basic behavior and cognitive performance.

We demonstrated that SH (isolation stress) increases whereas housing in EE (combination of social support with physical exercise) rescues the cognitive impairment of Tcf4tg mice. We provided evidence that the manifestation of the phenotype of Tcf4tg mice depends strongly on environmental factors. This substantiates the importance of G×E interactions in the manifestation of schizophrenic phenotypes.

The observed phenotype of Tcf4tg mice may resemble the situation in patients where symptoms can be elicited by the ‘second hit’ (social stress) and can be ameliorated by social support or physiotherapy.

Knowledge of drug prescription is essential for pharmacovigilance, i. e. for classifying adverse drug reactions (ADR) in clinical routine and for methods of their elimination and prevention.

Since the frequency of ADR is correlated with age, multi-morbidity and polypharmacy, special attention should be given to the medication of elderly or chronically ill patients.

To determine the rate of all kinds of ADR inpatient data (number, gender, age, and psychiatric diagnoses), drug prescriptions and occurrences of ADR were surveyed.

Once in a week for a period of six weeks data from all inpatients of an open station of each of the departments social psychiatry and geriatric psychiatry of the kbo-Inn-Salzach-Klinikum gemeinnützigen GmbH were determined.

The 34 inpatients of geriatric psychiatry were on average 75 years old with on average eight prescribed drugs. Leading diagnosis was recurrent depression’ (17%); leading prescribed agent was sertraline (13%). In 55% of cases ADR occurred, mostly eliminated by medicinal counteractions (34%).

The 54 inpatients of social psychiatry were on average 41 years old with on average four prescribed drugs. Leading diagnosis was paranoid schizophrenia (24%); leading prescribed agent was risperidone (14%). In 36% of cases ADR occurred, mostly eliminated by stopping medication and medicinal counteractions (each 31%).

In general, new drugs were prescribed in a cautious dose-regime. Clozapine was still of high relevance. Drug prescriptions were age specific as was the occurrence of ADR. Although ADR occurrence was high (55% and 36%), severe cardiac and circulatory troubles were relatively rare.

Increasing evidence suggests that clock genes may be implicated in a spectrum of psychiatric diseases, including sleep and mood related disorders as well as schizophrenia. The bHLH transcription factors SHARP1/DEC2/BHLHE41 and SHARP2/DEC1/BHLHE40 are modulators of the circadian system and SHARP1/DEC2/BHLHE40 has been shown to regulate homeostatic sleep drive in humans.

In this study, we characterized Sharp1 and Sharp2 double mutant mice (S1/2-/-) using online EEG recordings in living animals, behavioral assays, global gene expression profiling and bioinformatic modeling. Gene expression in human brains samples was performed with qRT-PCR.

EEG recordings revealed attenuated sleep/wake amplitudes and alterations of theta oscillations. Increased sleep in the dark phase is paralleled by reduced voluntary activity and cortical gene expression signatures reveal associations with psychiatric diseases. S1/2-/- mice display alterations in novelty induced activity, anxiety and curiosity. Moreover, mutant mice exhibit impaired working memory and deficits in prepulse inhibition resembling symptoms of psychiatric diseases. Network modeling indicates a connection between neural plasticity and clock genes, particularly for SHARP1 and PER1, which are also significantly downregulated in the frontal cortex of schizophrenic patients.

Our findings support the hypothesis that abnormal sleep and certain (endo)phenotypes of psychiatric diseases may be caused by common mechanisms involving components of the molecular clock including SHARP1 and SHARP2

Stress has been associated with depression in the past, but large enough, prospective studies to demonstrate this relationship still have to be produced.

To investigate the relationship between stressful life events and depressive symptomatology in a large sample of adolescents, in a prospective setting.

9032 adolescents that participated in all the waves of the SEYLE project were included. Mean age of our study group was 14.84 ± 0.88 years. 56.5% of the participants were females. We used the Beck Depression Inventory (BDI) to assess the depressive symptomatology and Kendler's Life Events Checklist to assess the life events. We build several multivariate linear regression models controlling for age, sex and baseline depressive symptomatology.

Total number of life events occurred in the previous 12 months seems to be significantly related to the intensity of the depressive symptomatology. Personal life events seem more closely related to depressive symptomatology than network life events. Out of the personal life events, the ones in the Interpersonal, Work (School), Marriage (Intimate relationship), and Financial categories seem to be the most important for this relationship.

Our study supports the hypothesis that life events can lead to depression in adolescents and draws attention on the most important categories of life events for this relationship.

Family disintegration due to workforce migration is a relatively new phenomenon affecting quite a large number of families in developing countries around the world that raised a lot of concerns regarding the mental health of children and adolescents left behind.

To investigate weather family disintegration is associated with suicide risk in adolescents.

The 12395 adolescents from the SEYLE baseline evaluation were included. Mean age in this group was 14.91 ± 0.90. 55.2% of the participants were females. We used the direct questions in the SEYLE baseline questionnaire to assess for families in which at least one parent was working abroad and for suicide attempt history. A binary logistic regression model was used to test this hypothesis, controlling for significant depressive symptomatology (assessed using the Beck Depression Inventory), substance misuse, the presence of a physical disability or chronic illness and the number of life events.

Our data revealed that parental migration, along with depressive symptomatology, substance misuse and the total number of life events reported in the previous 6 months were the items most closely associated with suicide attempt history.

Family disintegration due to workforce migration is associated with a higher risk for suicide in adolescents.

Disturbed body image perception and personality features and the way they influence eating disorders have been frequently studied in patients with eating disorders, but not in children's non clinical samples.

To analyze the influence of body image perception and personality features on eating disturbances in a non clinical sample of children

Longitudinal study. The sample was composed of 100 children, who were assessed at eleven and thirteen. Emotional, cognitive and behavioral aspects of the body image were evaluated using BPSS, BSQ, DST, BIAQ and body mass index (BMI). To assess personality features the EPQ was used and to assess eating disorders three scale of EDI-2 (drive for thinness, bulimia and body dissatisfaction) were used. For the statistic analysis, stepwise regression was used.

In the boys’ group, introversion ate 11 positively correlated with drive for thinness at 13. Neuroticism predicted higher bulimia score and body mass index predicted body dissatisfaction. In the girls’ group, neuroticism predicted drive for thinness, psychoticism predicted higher bulimia and higher BMI predict body dissatisfaction.

Personality features and BMI seem to predict at eleven the eating disturbances that will be detected later, at thirteen.

The incidence of different psychiatric diagnoses in Danish Psychiatric Hospitals are characterized by fluctuations. This phonemena could be due to changes in true incidence, changes in the entry into the health care system, changes in the diagnostic practices and the possibilities of treatment for a given disease, or due to changes in the attention towards the disease within the population, the profesionals or the medias.

Nowadays there is a notable increase of the number of new ADHD diagnoses among children and adults.

There is a need for epidemiological measures in ADHD in The Danish Psychiatric Health Care System.

To investige treated incidence in ADHD in adults in Denmark through the period of 1995–2012, and to investigate psychiatric comorbidity, latency from the first contact to the ADHD diagnosis and mortality.

From The Danish Psychiatric Central Research Register all patients with following diagnoses given for the first time ever after their 18th birthday were identified: ICD-10: F.90.0, F90.1, F90.8, F90.9, F98.8.

These data are used to make an age standardized incidence rate throughout the period differentiated with gender and possible existence of previous childhood psychiatric diagnosis. We will also analyze for psychiatric comorbidity after their primary ADHD diagnosis.

The statistical analysis are still in progress.

There is a marked increase in treated incidence in adult ADHD from the introduction of ICD-10 to 2012. Further results about psychiatric comorbidity and mortality will be presented.

The first goal of schizophrenia treatment in the past was to reduce positive symptoms, because it is thought that due to psychopathology and poor awareness, patients were unable to assess themselves and their needs. Recently, the goal of the treatment is improvement of social life and emphasizes the assessment of quality of life and life satisfaction as a priority of the service providers.

Quality of life and life satisfaction assessment in schizophrenia, evidence of anxiety and depression in schizophrenia and connection between the above variables.

Exploration of quality of life and life satisfaction in patients suffering from schizophrenia.

Subjects were120 outpatients diagnosed with schizophrenia by psychiatrists. Data were obtained using: Quality of Life Questionnaire, Hopkins Questionnaire for Depression and Anxiety, Life Satisfaction Questionnaire and The McGill Illness Narrative Interview.

Data collected were analyzed with SPSS 17. Description of the results includes descriptive data, cross table for nominal data and ANOVA and T test for averages. Average age was 41.6, range 21–67. Average of education was 10.1, range 4-19. The average age of diagnosis was 25.1, range 15–39.

Frequent changes of therapy have resulted in more anxiety and depression symptoms in patients suffering from schizophrenia. Individuals with more symptoms of anxiety and depression were found to have less life satisfaction. Quality of life was found to be the highest reported in individuals treated with atypical antipsychotics.

Publication of scientific research papers is important for professionals working in academic medical centres. Quantitative measures of scientific output determine status and prestige, and serve to rank universities as well as individuals. The pressure to generate maximum scientific output is high, and quantitative aspects may tend to dominate over qualitative ones. How this pressure influences professionals’ perception of science and their personal well-being is unknown.

We performed an online survey inviting all medical professors (n=1206) of the 8 academic medical centres in The Netherlands to participate. They were asked to fill out 2 questionnaires; a validated Publication Pressure Questionnaire and the Maslach Burnout Inventory.

In total, 437 professors completed the questionnaires. among them, 54% judge that publication pressure ‘has become excessive’, 39% believe that publication pressure ‘affects the credibility of medical research’ and 26% judge that publication pressure has a ‘sickening effect on medical science’. The burn out questionnaire indicates that 24% of medical professors has signs of burn out. The number of years of professorship was significantly related with experiencing less publication pressure. Significant and strong associations between burn out symptoms and the level of perceived publication pressure were found. The main limitation is the possibility of response bias.

A substantial proportion of medical professors believe that publication pressure has become excessive, and have a cynical view on the validity of medical science. These perceptions are statistically correlated to burn out symptoms. Further research should address the effects of publication pressure in more detail and identify alternative ways to stimulate the quality of medical science

Negative attitudes towards mental illness or the psychiatrist's role have repeatedly been reported in the literature among pregraduate medical students. Although a clerkship may improve the student's attitudes, negative perceptions regarding mental illness remained unchanged in about one-third of the students. When recovery is being assumed as a central concept of care, the presence of stigma among students represents an ethical challenge that the medical schools cannot avoid.

to implement a programme aiming i. to assess the stigma towards mental illness among pregraduate medical students, and ii. to tackle negative attitudes regarding mental illness and psychiatry.

The authors, targeting the 6th year medical students, have developed a one half-day program to be held before the 4-weeks psychiatric clerkship. The program offers sequentially an initial overview about the concept of stigma, several examples from experiences reported by patients, videos and role-playing exercises. Attitudes towards mental illness were assessed by the Kassam‘s et al Mental Illness: Clinicians’ Attitudes Scale MICA-2’ self-reported questionnaire.

106 students were evaluated. The acceptance was very good, with no refusals to participate in the program. After the clerkship, perceptions about patients’ dangerousness, the need for social protection, the assets and the role of psychiatry were significantly improved.

The good acceptance from the students and the preliminary results were very encouraging, suggesting that this program could change attitudes towards mental illness favorably. Given we’ve just evaluated a time span of one month, further studies are needed to assess the temporal stability of the changes.

International literature indicates that migrants have highest incidence of mental disorders compared to natives, especially for psychotic disorders. Few studies about mental health of migrants in Italy have been published, although net migration rate grew in the last twenty years.

to describe socio-demographic and clinical characteristics of migrants attending Community Mental Health Centre (CMHCs) of Borgomanero (Piedmont, Italy) and to evaluate differences in psychiatric diagnoses and pathway to care among different ethnic groups.

Migrants attending CMHCs between 1st January 2012 and 31 August 2013 were included in the study. Data were gathered retrospectively from clinical data sets.

97 Migrants attended the CMHCs. The most represented ethnicity is East European (36%), the less one is Asian (4%). Most frequent diagnosis is adjustment disorder (33%). In most cases, access to the service follows the family doctor's referral (46%), except for patients with schizophrenia, whose access is most frequently direct (they are usually brought to the service by family members) (33%). The majority of those migrating for working reasons suffers from adjustment disorder, schizophrenia or anxiety. Pathway to care and diagnosis seem to be statistically related (p-value 0,00052), as well as migration reason and diagnosis (p-value 0,0452). Lack of regular residence permit seems to be related to non-medical pathways.

Pathways to CHMCs are complex and influenced by many factors. Most of the sample received a diagnosis of adjustment reaction. More attention should be paid to developing psychiatric consultation liaison models that encompass the physician and social services.