Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a non-invasive technique that allows monitoring of cerebral hemodynamics during cognitive performance with a high temporal resolution. There is ample evidence that age impacts on performance and cerebral hemodynamics. This study investigated those associations between a sample of young adult healthy subjects performing the Trail Making Test (TMT), a means of selective attention and complex cognitive functioning.

We examined cerebral hemodynamic parameters in the middle cerebral arteries (MCA) using fTCD while healthy subjects (mean age 31.5 years) simultaneously performed the TMT.

There was a significant slowing with older age (age 30 years or older) for both selective attention and complex cognitive functioning, and older age was associated with significantly lower mean cerebral blood flow velocity (MFV) in males during complex functioning. Young age (younger than 30 years) was associated with initially bilateral and then significantly left sided lateralization, and older age with a bilateral pattern.

These novel results suggest that, in a relatively young age continuum sample, older age results in slowing and decreased brain perfusion, though in a diverse manner. Younger age is associated with alternating pattern of lateralization implying a diverse cognitive style with age as covariate. It adds to the notion that fTCD is a substantial tool to significantly link age related modulation of performance with dedicated parameters of brain perfusion.

The scarcity of human resources is a factor that hampered the improvement of mental health (MH) services in Portugal. MH teams continue to rely on a small number of psychologists, nurses, social workers, occupational therapists and other non-medical professionals, with most teams maintaining traditional models care delivery. Nevertheless teams continue to evolve to ameliorate MH care considering present patients needs and effective treatments.

This study aims to describe services and workforce profiles in Portuguese MH services.

The study was carried out at public and private MH services in mainland Portugal. Profiles were assessed by survey method related with two dimensions: 1 - services characteristics and 2 - workforce profile.

Assessment of services showed: liaison with primary health care (56%), routine use of guidelines (57%), use of individual care plans (46%), inservice research (25%). Regarding workforce, 19% of the teams still rely on 2 professional groups (Psychiatrist and Nurse), 88% do regular training, 60% reported use of case management models, but only 16% had formal training on the model.

Despite the incremental inclusion of MH care essential components associated with services modernisation, Portuguese mental health teams still struggle to provide integrated care with the contribution of multiple professional groups in a multidisciplinary framework. This is specially true in the interior and rural areas of the country. Training programmes need to be maintained as a special priority by national and regional authorities to assure effective delivery of care.

The identification of factors that may facilitate or hinder the implementation of evidence based practices and subsequent innovation in mental health (MH) settings is an area of recent development. Studies regarding organisational culture of services are widespread in economical and managerial areas but very few evaluate MH care contexts. Most of these studies aim to help in the management of human resources.

Assess the organisational culture and leadership profiles in the Portuguese MH services.

Cross-sectional study, made in public mental health services. Evaluation was made by means of the competing values framework tool (Quinn, 1990) (Portuguese version - MJ Felício, 2007), which includes dimensions such as organizational culture and leadership profiles in the framework of more open or closed systems and with more control or flexibility strategies.

The leadership profile clearly outstanding in the Portuguese MH services was the Mentor profile (45.6%), followed by the Broker and Producer profiles (12.8%). Innovation profile, linked with the ability to cope and manage change, had the lowest score (3.5%).

Further studies are critical to develop a clearer view regarding the influence of organisational culture and leadership profiles in the organisation of MH services. Low scores on innovation components may influence the way evidence based practices are welcomed and implemented in services. Organisational culture may have an important role in the implementation of best practices, namely for the design of programmes that aim to translate evidence into everyday care.

Official reports indicate that the overall prevalence of lifetime childhood maltreatment has been estimated to be 30% in population-based samples and the association between childhood trauma, suicide behaviors and psychiatric disorders was previously shown.

The objective of the current study was to assess the presence and severity of ‘male’ depressive symptoms and suicidal behaviors in psychiatric patients who reported history of child abuse and neglect on the Childhood Trauma Questionnaire (CTQ)

To study the association between childhood trauma, suicidal behaviors and non-typical depressive symptoms.

163 adult inpatients were enrolled in the current study and completed the Mini International Neuropsychiatric Interview, Gotland Scale of Male Depression, the Childhood Trauma Questionnaire and the Suicidal History Self-Rating Screening Scale.

The group with no or minimal history of child abuse and neglect (N = 98) was characterized by lower scores on all the dimensions of the CTQ and higher scores on minimization/denial than the group with moderate to severe history of child abuse and neglect (N = 64). Furthermore patients with moderate to severe history of child abuse and neglect were more often females (62.5%), reported more severe ‘male’ depressive symptoms (20.82±10.12, t160 = −3.675, p-value < 0.001) and higher SHSS scores (6.90±4.49, t160 = −2.68, p-value 0.01).

Our data highlight the association between several childhood trauma and ‘male’ depression in both male and female patients. Furthermore Childhood trauma may be a risk factor for suicide attempts. Further researches are needed to clarify this issue.

Primary and secondary care communication is the cornerstone of patient's care. Proper dialogue should be established. The shared care protocol was an attempt to try to fill gaps and build bridges.

A special form was designed to collect information about psychiatrists’ opinion on GPs’ referral letter to psychiatric services. It contained 14 items, each item was marked as essential, can be included or irrelevant. This form was sent electronically to psychiatrists in Southessex University NHS Trust. They are 98 in total. It was input on Excel data sheet and was analysed.

43 psychiatrists responded

All respondents agreed that reason for referral is essential.

Concise description of the condition, risks and current medication were rated as essential in more than 90 %.

Past medical history, past psychiatric history and current physical health were essential in 79 %.

All professionals involved should participate in evaluating and refining communication. Psychiatrists’ opinion in GPs letters is paramount as they are the recipients and their assessments and future management plan should be geared to address the GP's concerns. This is shown clearly by the psychiatrists agreeing that reason for referral should be included in all letters, followed by what the GP has already done and what risks the patient presents.

Improving communication between health professional, improve patient's care, saves time and money, in addition to prevent duplication of investigation and procedures.

Worldwide, trends in life expectancy and ageing-related diseases as Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) are increasing, having a rising impact on patients’ quality of life, on caregivers’ distress and on economic burden.

The purpose of this study was to review the use of modern technologies in medicine, usually known as Tele-Medicine, to improve quality of life of MCI and AD patients and their caregivers

–A systematic literature review was conducted of all published studies examining the relationship between Tele-Medicine and Alzheimer or MCI listed in the PubMed databases from January 1995 to December 2012. The inclusion criteria were the use of technological instruments and a Mild Cognitive Impairment or Alzheimer's diagnosis by a standardized diagnostic procedure.

A total of 69 articles met inclusion criteria. Overall, 21 suggested how to make a remote (10) or earlier (11) diagnosis; 31 described different type of patient's support during the stages of the disease; 9 described how to support patients’ caregivers and 8 showed multiple scopes.

The rising use of Tele-Medicine could actively improve conditions of AD and MCI patients and their caregivers, and could offer good instruments to make early diagnosis and screening even if patients live in remote places.

An international group developed the GRID-HAMD to address critiques of the HAMD and improve its administration. The GRIDHAMD provides novel grid scoring, structured interview guide and scoring conventions, and revised anchor points for problematic or inconsistently rated items.

To conduct a survey of clinicians’ experience using the GRID-HAMD.

To evaluate the clinical acceptability of GRID-HAMD.

A survey distributed to 74 clinical trial raters covered usability and ease of use of the GRID-HAMD, including 20 statements rated from strongly disagree to strongly agree, and listed four statements asking raters to compare the GRID-HAMD with the SIGH-D.

Fifty-seven questionnaires were completed (77%). Most raters agreed that wording of GRID-HAMD questions made it easy to administer (77%), the conventions were clear (82%) and helpful (86%), and guidelines for rating symptom intensity were clear (79%). Fewer rated it ‘easy to decide on a frequency level’ (61%). A large majority (89%) thought ‘having the scoring conventions integrated into the interview guide has made scoring easier.’ More than half (54%) of 44 raters who had used both preferred the graphical layout. However, slightly more preferred the SIGH-D for its ‘ease of use’ (50% vs. 45%) and ‘efficiency’ (39% vs. 36%), and expressed ‘overall preference for the SIGH-D’ (45% vs. 43%).

The raters evaluated clarity and ease of use of the GRID-HAMD positively. Surprisingly, they did not indicate overall preference for the GRID-HAMD over the SIGH-D. Several areas of improvement were indicated for both, and the ‘most difficult’ items were highlighted.

Bipolar patients have an increased risk of cardiovascular diseases for lifestyle habits and the use of antipsychotics that correlates with endothelial dysfunctions, in particular the decrease of eNOS activity and plasma NO levels. We aimed to examine the effects of the new atypical antipsychotic Asenapine on NO release and oxidative stress in porcine coronary endothelial cells (CEC).

NO production was measured in CEC isolated from coronary arteries of pigs and plated in 0.1% gelatin-coated dishes with starvation medium overnight at 37 °C with 5% CO2. Cells were treated with asenapine 10 pM-100 μM and asenapine+inhibitors. Oxidative stress was generated with 200 μM hydrogen peroxide in the presence of asenapine for 15 min. The cells undergoing apoptosis were measured and proteins extracted from cell lysates were quantified and used for electrophoresis and immunoblotting studies.

Asenapine increased NO release in CEC in a time-dependent way (p<0.05) by the phosphorylation of eNOS and plateau was reached at 120s stimulation; no effect was observed on iNOS activation. The association of asenapine and inhibitors suggested the involvement of cAMP/PKA, PLC, p38MAPK, PI3K and ERK1/2 in the intracellular signaling and the β2 adrenergic receptors-related pathway. Data were confirmed by Western blot analysis. Pre-treatment of CEC with asenapine prevented cell death and mitochondrial membrane potential collapse caused by hydrogen peroxide (p<0.05) and counteracted the activation of apoptotic markers.

Asenapine could play a protective role on endothelial function and cardiac cell survival, reducing the risk of cardiovascular disease in maniac patients.

The prodrug lisdexamfetamine dimesylate (LDX) is licensed in several European countries for treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with an inadequate response to methylphenidate (MPH) treatment.

To evaluate post hoc the impact of ADHD medication history on the efficacy of LDX.

In this 7-week, dose-optimized, double-blind, study, patients (6–17 years) were randomized 1:1:1 to LDX, placebo or osmotic-release oral system methylphenidate (OROS-MPH). Efficacy assessments included ADHD Rating Scale IV (ADHD-RS-IV) and Clinical Global Impressions-Improvement (CGI-I) scores.

The full analysis set (FAS) comprised 317 patients. Baseline characteristics were similar across treatment groups and previous treatment subgroups. At endpoint, the mean change from baseline in ADHD-RS-IV total score and proportions of responders based on a CGI-I of 1 or 2 for LDX, OROS-MPH and placebo are presented below.

LDX and OROS-MPH were associated with clinically relevant improvements in ADHD symptoms irrespective of ADHD medication history.

Study funded by Shire

Implementation research is crucial in the mental health field given that evidenced-based care still lack implementation, even in developed countries. In Portugal, the National Mental Health Plan included actions to change the operational model for mental health teams and a case-management (CM) training program was launched by the Ministry of Health.

This study aims to evaluate the fidelity of a CM programme implementation process, according to the measurement of intervention techniques and resources used by mental health professionals.

The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a CM course (SAMHSA procedures), in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009).

Mental health professionals assessment (n=71) showed a 15% good implementation rate and a 43% fair implementation rate, but still not enough implementation in 42%. Mean use of the model resources (e.g. duration and family involvement) was lower when compared with the use of techniques (e.g. goals definition, psychoeducation and relapse prevention).

Despite the fair global implementation rate of the CM model in the Portuguese mental health services, the rate of good implementation is still low. Implementation science may help to reduce the gap between evidence-based practices and their use in routine care, and thus contribute to improve the fidelity of evidence based care models for patients with severe mental illness.

According to Torre's approach, dynamic images from movies may help to reflect on empathy-related issues, to develop a compassionate approach to patients and their sufferance, and to enhance awareness about stigmatizing attitudes. Since its development this method has been used by the Psychiatric Institute of the Università del Piemonte Orientale Amedeo Avogadro, Novara, for the education and training of medical students and, broadly speaking, of people involved in helping professions.

To describe the preliminary results about the impact of this intervention in a sample of medical students.

cinemeducation seminars lasted 6 months, and included 12 meetings. Movies were discussed from a psychological perspective in a group setting and experiences were integrated with the help of the group-leader. Data were collected anonymously via self-report questionnaires from 40 randomly selected participants. Assessment scales (Attitudes Towards Psychiatry, ATP-30; Social Distance Scale, SDS; Interpersonal Reactivity Index, IRI; Rosenberg Self-Esteem Scale, RSES; Toronto Alexithymia Scale, TAS) were administered both before and after the workshops.

a significant increase was found in the ATP-30 score (p = .034), and a reduction of the SDS (p = .022) and IRI-PD (p = .010) scores.

although these results are preliminary, an improvement in students’ attitudes towards psychiatry was found, together with an increased ability of students to tolerate their own anxiety when experiencing others’ distress. This approach to movies allows developing both cognitive and emotional knowledge, which should be considered particularly important in medical education.

was to study familiar and cytogenetic risk factors of depressive disorders in children.

Genealogical and cytogenetic analysis has been carried out in 50 children and adolescents with depressive disorders, aged 6 to 16 years. Statistical treatment: Excel, SPSS Statistics 17,0.

It has been found that 48% of the patients’ families had DD cases among relatives to the third degree. Non-infectious diseases such as mental disorders, DD included, were more frequent in the first-degree relatives (17,2%) as compared to the second- and third-degree relatives (4,3% and 2,6%, ?<0,001). Neurological diseases also prevailed in the first-degree relatives (19,7%) as compared to second- (8,7%) and third- (0,8%) degree relatives. Endocrine diseases (thyroid gland pathology, diabetes mellitus type 1 and type 2, obesity) and oncopathology (lung, stomach, uterine, breast cancer) occurred with the same frequency.

Cytogenetic analysis has shown that the occurrence of chromosomal abnormalities in the patients with DD is 13,1% which is 6,7-fold as compared to the level of spontaneous mutations in healthy peers (1,95%). The occurrence of chromatid (6,9%) and chromosomal (3,4%) aberrations was higher than their level in healthy peers (1,5% and 1,2%).

Socio – cultural factors play an important role in people’ s perception of child mental health problems and services.

To measure the perception of child and adolescent psychiatry in a small town, from the south-western part of Transylvania, Romania.

To analyze whether the level of medical training influences the addressability to psychiatric services.

The 90 respondents of the study included 27 doctors (other than psychiatrists), 32 nurses from the local hospital and 31 teachers. We randomly selected the participants, by consulting the list of the two institutions’ employees, in a specific day.

The questionnaire consisted of 12 questions about demographic profile and perception of pediatrics psychiatry, as a medical specialty. Participation was voluntary and anonymous. Two questionnaires were precluded because of not having all the items answered. To examine the statistical significance of the differences, one way ANOVA and nonparametric Kruskall Wallis test were used.

More than half (51%) considered that psychiatric medication may both diminish the symptoms, but can also have side effects on subjects. 68% of respondents said that a child is stigmatized when being in psychiatric service evidence. There was a valid statistical correlation between the medical level of training and the addressability to psychiatric services (r +0.39, p<0.001). Doctors would take their child to psychiatric services, as a personal decision, while teachers would apply to psychiatric services at recommendation of general practitioner/pediatrician (p<0.05).

The addressability to psychiatric services is related to the level of medical training.

The use of best practice guidelines had an exponential growth in the last 15 years, including in mental health. However the dissemination and use of guidelines has not always been followed by the critical appraisal of the their quality, specially when translation and cultural adaptation for other countries is involved. To increase the odds that a guideline will generate a better practice, they must be evaluated and strategies to their improvement need to be developed.

This study aims to evaluate a clinical guideline used to implement a case management model in the Portuguese mental health services.

The guideline was assessed by two health experts working in the field of evidence based practices implementation: one from the mental health field and one from the communicable diseases field. The assessment was made with the AGREE Instrument 2 (second Portuguese version). Scores were calculated according with the rules of the AGREE Collaboration Group, 2011. Results

The assessment of the guideline on case management for people with sever mental illness showed good scores on the domains 1-Scope and Purpose (72%) and 4-Clarity of Presentation (77%), medium score for the domain 5-Applicability (54%) and low scores in the domains 2- Stakeholder Involvement (41%) and 3-Rigour of Development (28%).

Critical appraisal of guidelines is crucial for the development of best care. The identification of faulty domains in guidelines offers an opportunity to improve and to shape recommendations considering national and local needs. New guidelines can be organised by considering AGREE II dimensions.

was to estimate the level of spontaneous mutagenesis in children with DD.

Cytogenetic analysis has been carried out in 24 children of both genders with mental disorders (MD) in their family history, aged 9 to 17 years, examined in SI ‘ICAHC NAMS’. Control group I consisted of 23 children with DD and with no family history of MD; control group II consisted of 52 healthy peers. Statistical treatment: Excel, SPSS Statistics 17,0.

The level of chromosomal abnormalities in the patients with DD was 13,2%, being 7-fold as frequent as in healthy children (1,9%); the most prevailing were single fragments (7,3 and 0,9%) and paired fragments (3,7 and 0,8%); less frequent were polyploidy (0,7% and 0,1%) and premature centromere division (0,7% and 0,03%). The level of spontaneous mutagenesis in the lymphocytes of peripheral blood in the patients with and without family history of MD was more frequent than in healthy children (13,2; 12,9 versus 1,9%). Regardless of their family history of MD, the patients with DD had more significantly frequent occurrence of chromatid, chromosomal and genomic aberrations as compared to healthy children; nevertheless, the significant difference between the patients with DD and control group I was only found for the occurrence of premature centromere division.

Previous studies in other countries have reported that cyberbullying was related to Information and Communication Technology (ICT) use. Helweg-Larsen, (2011) reported that knowledge about safe internet use did not decrease the prevalence of cyberbullying. Less is known about this relationship with family functioning.

To examine the rates of cyberbullying and their relationships with ICT use and family functioning in a sample of secondary students in the UK

To study 1) associations between cyberbullying and ICT use 2) associations between family functioning and parental controls with ICT-use and cyberbullying.

A cross-sectional questionnaire of 2218 secondary students was completed

included demographic data, ICT use (levels and nature), Olweus bullying questionnaire adapted for cyberbullying, General Functioning subscale of the Family Assessment Device and parental controls (type and levels).

Response rate 80%, 45% males, mean (SD) age 14.97 (1.9) years. Cyberbullying seems to be related to the time spent online and to the general family functioning. Bullies or bully-victims spend significantly more time online than those who are not involved. The majority of students have been told how to be safe online; however only a few have parental controls on their computers. There is a significant positive correlation between worse family functioning and time spent online and with being involved in cyberbullying, even after controlling for the time spent online.

Our results suggest that increasing family communication may contribute to reduce children involvement in cyberbullying

Mental disorders require a comprehensive and specialized psychiatric and psychological assistance, so it is necessary to evaluate patients' mental state with specialized tools. The usability of Barratt Impulsiveness Scale and Liebowitz Social Anxiety Scale and their correlation with the Beck Depression Inventory to determine the mental state of the patient.

The study included 67 patients. The study group had 30 patients treated in open ward of the Department of Psychiatry and Psychotherapy GCM SUM throughout 11/2012-03/2013. The control group included 37 patients without mental disorders. Three questionnaires were used: Beck, Barratt and Liebowitz.

Analyzed groups had significant differences in terms of Beck Scale (U Mann-Whitney test p=0.000001).) Average score in study group: 22.8+/-12.8 median 22; in control group: 7.51+/-6.7 median 6. Groups had significant differences in terms of Liebowitz Scale (U test Mann- Whitney test, p = 0.0067). Average score in study group: 56.8+/- 29.3 median 57; in control group: 37.2+/-26.2 median 28. Groups had significant differences in terms of Barratt Scale (t-student test p=0.001). Average in study group: 66.7+/-10 median 67; in control group: 59.1+/-8.2 median 58. Significant positive correlation was observed between the results of Beck Scale and Liebowitz Scale (r = 0.602289).

The intensity of the Liebowitz Social Anxiety is directly proportional to the severity of depression according to Beck. The degree of impulsivity with Barrat scale does not correlate with the level of depression according to Beck scale.

Anorexia nervosa (AN), rare in young men, is potentially associated with severe medical complications. Mild liver involvement is common. However, rare cases of severe liver dysfunction associated with AN have been described.

To present a rare, severe case of an adult male with AN.

Describe uncommon, potentially lethal, medical complications associated with liver dysfunction.

Describe medical/psychiatric presentation, course of disease and interventions during hospitalization and follow-up.

Male 35 y.o. with AN for 20 years (purging type with use of diuretics/ laxatives and intensive exercise) was transferred involuntarily to the Psychiatric Department from Gastroenterology because of continuing weight loss, excessive exercise, non-compliance of food/fluid intake recommendations and use of diuretics. The patient on admission had BMI 13.5 kg/m2 (recent weight loss of 20 kg), ascites, ankle edema, severe transaminases elevation (x20), and electrolytes dysregulation. In addition, the patient presented depressive symptoms, hoarding, and obsessive compulsive/avoidant personality traits. Feeding was started with parenteral administration, and then through nasogastric tube. Also, the patient was restricted to his room and energy expenditure was controlled. In addition, behavioral/family/cognitive psychotherapeutic interventions were employed. Patient was treated with S-Citalopram, Olanzapine, and Lorazepam. Weight gradually increased. After 4.5months of hospitalization, liver function was normal, BMI was 21 kg/m2, mood was elevated, and hoarding was diminished. In a 6 months outpatient follow-up the patient's BMI was 23 kg/m2 and he was both socially and personally functional.

Long hospitalization using an integrated approach that combines medical and psychotherapeutic interventions, may reverse severe liver dysfunction in life-threatening NA.

The psychological consequences on the caregivers taking care of mentally ill patients are well known; however, little evidence exists as to whether taking care of a mentally ill patient affects the physical health of the caregiver.

To examine the effect of caregiving on emotional and physical health.

To study the association between caregiving for mentally ill and physical illness.

One hundred twenty-eight caregivers, relatives of patients suffering from schizophrenia or bipolar disorder, who were hospitalized consecutively during the past three years (2011–2013), and 117 controls completed over telephone a structured questionnaire. Eligible patients were all those with duration of illness more than 5 yrs. Data included demographics and detailed information about past or present mental and/or physical illness. Data were analyzed using the Pearson's chi-square test and multivariate binary regression controlling for BMI, age, sex, and smoking.

Significant correlation was found between caregiving and anxiety (OR=4,1, p<0,0001), depression (OR=3,5 p=0,03), sleep disturbances (OR=2,6, p=0,05), arthritis (OR=2,5, p=0,03), rheumatopathy (OR=2,8, p=0.09) and allergies (OR=2,5, p=0,09). The association of caregiving with allergies/ arthritis was independent of anxiety and depression. No correlation was found with diabetes, hypertension and cardiovascular disease.

The stress of taking care of a mentally ill patient appears to affect physical health, specifically increasing the risk for autoimmune disorders (allergy, arthritis), independently of anxiety, depression and sleep disturbances.

Twenty percent of psychiatric inpatients have co-morbid substance abuse/dependence and their management is challening.

To investigate co-morbidity and patterns of substance use among inpatients in a general psychiatric unit.

To examine specific patterns and risk factors associated with substances/alcohol in psychiatric inpatients.

Participants included 487 inpatients consecutively admitted to the Psychiatric Unit, University Hospital of Crete between Nov 2011- Jun 2013. Data were analyzed using the Pearson's chi-square test and multiple regression.

Our sample, mean age 42.7±14.5yrs, consisted of 57.9% males, whereas 51.9% were admitted involuntarily. In addition, 60.3% were unemployed, 24.3% had a spouse and 38.1% had no previous psychiatric hospitalizations. Furthermore, 354 (72.8%) used no substances, while 16.1% used alcohol, 12.3% cannabis, 3.8% opioids, 2.5% cocaine, and 5.5% anxiolytics. Mean age of those abusing alcohol was 41.8yrs, cannabis 34.1yrs, opioids and cocaine 31.6yrs and anxiolytics 36.9yrs. In patients with Major Depression, alcohol (21.1%) and anxiolytics (9.8%) were the most prevalent, whereas, in patients with psychotic disorders and bipolar disorders, alcohol (9.8% and 5.8% respectively) and cannabis (11.9% and 15.2%) were the most frequent. Unemployment, and involuntary admission weren’t significant risk factors for alcohol/substance use.

Substance/alcohol abuse/dependence is present in 1/3 of our psychiatric population with alcohol, cannabis and anxiolytics the most commonly used. Alcohol was more frequent in older patients with depression, whereas cannabis was more frequent in younger patients with psychotic/bipolar disorder. Development of dual diagnosis centers, very scarce in Greece, are needed for the management of psychiatric patients with substance co-morbidity.