White matter hyperintensities (WMHs) may be associated with increased risk of suicidality in subjects with major affective disorders. Unfortunately, they may be frequently confounded by the use of previous medications and duration of illness.

Although findings from the current literature are quite conflicting, we proposed that WMHs are important markers/endophenotypes of specific subgroups of individuals with major affective disorders such as those at high suicidal risk.

A literature search has been performed aiming to examine the presence and severity of WMHs in patients with major affective disorders, and the association with suicidal behavior. The reference lists of the selected studies were also scanned for additional relevant studies.

Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of major affective disorders. Several studies reported a significant association between WMHs, in particular periventricular WMHs, major affective disorders, and suicidal behavior. A significantly higher number of suicide attempters were found to have WMHs than nonattempters.

WMHs may represent neurobiological markers between the underlying susceptibility and clinical expression of major affective disorders. Clinicians should carefully investigate patients with major affective disorders for the presence of WMHs in order to identify specific subgroups of subjects at-risk for a poor outcome.

Schizophrenia is a mental disorder, which is characterized by positive and negative symptoms, such as disorders in the professional and social area.

Today, the dominant trend in Psychiatry is ‘social and community psychiatry’. In this paper we present the progress of the disorder, of a patient who suffers from schizophrenia -disorganized type- over the past 20 years and in which psychosocial intervention was aimed towards the prevention of hospitalization and his best possible functionality, despite the reduction of the medication received.

The material used, is from the medical records of the patient in the different structures of the Psychiatric Hospital of Corfu.

During the research we have studied the medical records of the patient, the reports of the nursing, social, psychology services, his medications since 1999 up to now, as well as his behavior particularly for the last 2 years.

The patient's, supervised, independent living, during the last 2 years, his participation in social activities, the encouragement by the medical team to make him become involved in new things (learning computer, Internet use) has resulted in the prevention of his hospitalization to the Psychiatric Hospital and the reduction of the medication received.

Despite the pessimistic outlook and the stigma of the society as far as the schizophrenic and their ‘recovery’ is concerned, it seems that these patients can improve the conditions of their life and regain their communication skills through which they can express feelings and interact with others. Although, no totally effective therapy has yet been devised, it is important to remember that many people with this illness could improve enough so as to lead independent, satisfying lives. As we learn more about the causes and treatments of schizophrenia, we should be able to help more patients achieve successful outcomes. Targeted psychosocial interventions may lead to the reduction of the severity and the number of relapses, with the minimal medication received.

To analyze lifetime narratives, risk factors, family profiles, internal and external signs of distress and environmental reaction to it, using the method of psychological autopsy and narratives typology analysis in order to better understand and predict suicide in high schools.

The psychological autopsy of 70 high school students suicide victims (54 Jewish, 50 males, 43 born in Israel) were analyzed post mortem using quantitative, qualitative and narrative approach.

We traced two leading narratives: tragic and regressive. Specific risk factors were found including gender, school mal-behavior and truancy, low school grades and learning disorders. Fight with parents and teachers especially with humiliation aspects were a major facilitating factor. Despite the fact that most of the victims gave sings of distress, the adults in their life did not notice it while the peers noticed but refused to believe they are true. Methods of suicide did not differ significantly between genders in this sample. Yet, 20% of the suicide victims were excellent students and fitted the tragic life narratives. They had lower rate of mental disorders (p=0.03), shorter crisis (p=0.006), and less life events (p=0.03) when compared with those with regressive narratives.

We identify two major life narratives in high school students suicides: tragic and regressive. School truancy for the regressive narratives and fight with authority figures and humiliation for the tragic narratives are major risk factors at high school and should be a focus of prevention programs.

Guernsey is a British Protectorate island (population 65000) in the English Channel. Illicit drugs are difficult to import and expensive people look to alternative substances.

To establish patterns of drug misuse among patients referred for treatment.

Case note audit of all referred patients in 2011, cross referenced with sudden unexpected death case review results.

198 patients were referred, 80 (40%) for mainly drug dependency. Reported patterns of use tended to follow local availability and polydrug misuse was common. Of the drugs clients, 96% reported misusing prescription only medicines (POMs) and over the counter (OTC) drugs, particularly opiates and benzodiazepines. Buprenorphine products were most commonly misused (26%), followed by benzodiazepines (25%), dihydrocodeine (22%), heroin (11%) and codeine (6%) (more than 1 drug may be reported so totals <100%). A high risk sub-group (9%) injecting fentanyl (derived from fentanyl patches) was identified. On the island in 2011 there were several fentanyl-related deaths at post mortem case review.

High rates of pharmaceutical drug misuse on Guernsey may reflect the low availability of illicit drugs like heroin and cocaine. This increases demand for addictive POMs and OTCs. Prescribers in isolated communities need to be more cautious when prescribing addictive POMs, particularly fentanyl. Pharmacists may also need to monitor for OTC drug misuse, particularly of codeine-containing medications.

Previous studies have reported progressive brain changes and cognitive deficits in early-onset psychosis (EOP). Little is known on the relationship between longitudinal changes in brain structure and neurocognition.

Naturalistic 5-year prospective study comparing frontal gray matter (GM) volume and executive functions in adolescents with a first episode of EOP and a sample of healthy controls at baseline, 2-year and 5-year follow-up.

Thirty-six patients (age at baseline 15.8 ±.7, 66.6% male) and 34 controls (15.4±1.4, 55.9% male) comprised the study sample. Both patients and controls presented with frontal GM loss during the first five years of follow-up. During the first two years, patients presented with significantly greater GM loss than controls in the left (F=9.642, p=0.003) and right frontal lobe (F=7.585, p=0.008), with no significant differences between year 2 and 5. Patients with EOP performed significantly worse in executive tasks than controls in all visits. During the first two years of follow-up, controls, but not patients, presented with a significant improvement in executive functioning (F=7.523, p=0.009), with similar evolution of cognitive functioning between years 2 and 5 in both groups (F=0.908, p=0.346). Changes in frontal GM volume and executive functioning were not significantly correlated within the entire follow-up period.

Over the first two years of illness, patients with EOP show greater frontal GM loss and less improvement in executive functions than expected. This could be a critical period for the development of deficits in EOP, in which more intensive interventions would be warranted.

In Ukrainian practice of medical health and social work also in the World there is big cooperation between neurologists and psychiatrists in assistance to the people with disabilitating neurological diseases. The successes of neurology, neuropsychiatry, neuropsychopharmacology and related sciences give the hope to these patients. The significance of mental disturbances after neurological pathology is very high.

were to explore the impact of mental disturbances in the forming of the severity of disability due to the nervous system diseases.

clinical, clinical-psychopathological, anamnestical-catamnestical, statistical.

From 2477 clinically examined patients 1344 had disability and 1103 were applying for disability due to neurological diagnosis. In the continuum of disabled patients were included the patients with 3rd group of disability (706), 642 had 2nd group and 26 had 1st most severe group of disability according to Ukrainian legislation.

937 disabled patients and 351 applying for disability were examined once. Other patients (437 disabled persons) and (342 applying for disability patients) were observed for: 1 year (533), 2 years (67), 3 – 7 years (11). For 112 patients the group of disability was changed (increased) from no degree to 3rd or from 3rd to 2nd and from 2nd to 1st (most rarely). In this group the increasing of number of psychopathological symptoms is significantly higer than in the group of 421 other patients by U-Wilcoxon-Mann-Whitney criteria.

The severity and dynamics of mental disturbances are the important factors influencing on severity of desadaptation in patients with disabilitating neurological diseases.

To evaluate and compare clinical characteristics of men and women who were admitted to psychiatric hospital after parasuicide.

Clinical examination, The Pierce Suicide Intent Scale, Beck Suicide Ideation Scale, Beck Hopelessness Scale, Beck Depression Inventory, The Symptom Checklist 90 Revised, Global Quality of Life Self - Rating Scale, The Barratt Impulsiveness Scale, The Toronto Alexithymia Scale.

Suicide attempters over 15 years admitted to the psychiatric hospital within one month after parasuicide (N=264; 114 – men and 149 – women).

Level of depression according to the Beck Depression inventory was higher in women (M=19,1; SD=13,1) than in men (M=12,9; SD=9) with ρ<0,001. The scores of general psychopathological state were higher in women (M=87,7; SD=68,1) than in men (M=69,1; SD=49,7), ρ<0,04. There were no statistical differences in the level of hopelessness according to Beck Hopelessness Scale, impulsivity according to The Barratt Impulsiveness Scale, alexithymia according to The Toronto Alexithymia Scale and perception of quality of life according to the Quality of Life Self- Rating Scale. There was no difference in the level of suicide ideation according to the Beck Suicide Ideation Scale and suicide intention according to The Pierce Suicide Intent Scale.

There weren’t considerable difference of parasuicide risk factors between men and women hospitalized because of mental disorders. At the same time women more often percept their psychological state as more severe.

Research on neurobiologic underpinnings of psychotherapy in depression is still sparse, particularly in psychodynamic oriented research. At present, there is insufficient data on neurobiologic parameters that could allow a targeted use of therapeutic interventions. One reason for this is the methodological difficulty of investigating complex and individual phenomena relevant to the psychotherapeutic process with functional neuroimaging techniques. The Zurich Depression Study takes up this strong research need developing a pioneer study design.

An individualized neuroimaging paradigm was developed based on the MIPQS (Maladaptive Interpersonal Q-Sort (Zimmermann et al., accepted), a self report instrument derived from the OPD-2 axis interpersonal relations (Operationalized Psychodynamic Diagnosis 2, Arbeitskreis OPD, 2006). Visual stimuli were developed and tested that systematically illustrate interpersonal behaviour patterns (Interpersonal Relations Picture Set (IRPS)). They are employed in an individualized fMRI experiment. The experiment was validated with ten healthy study participants

Preliminary results suggest that the experimental paradigm is an accurate method to be employed in psychotherapy research with depressed patients. Specific hemodynamic activation patterns observed during the individualized fMRI task involve brain regions commonly identified as playing a role in emotion processing and autobiographic memory. A final overview of these first results will be given at the EPA 2014 congress.

Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from two Phase III, randomized, double-blind, placebo-controlled, flexible-dose, 3-week trials of cariprazine 3-12mg/d (NCT01058096) and cariprazine 3-6mg/d or 6-12mg/d (NCT01058668) in adults with bipolar I disorder and acute manic or mixed episodes.

Evaluate the efficacy, safety, and tolerability of cariprazine in mania associated with bipolar I disorder.

Primary and secondary efficacy parameters were change from baseline to Week 3 on the Young Mania Rating Scale (YMRS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 312 (NCT01058096; 154 placebo, 158 cariprazine 3–12mg/d) and 497 (NCT01058668; 161 placebo, 167 cariprazine 3–6mg/d, 169 cariprazine 6–12mg/d). Improvement from baseline to Week 3 on YMRS was significantly greater for each cariprazine group vs placebo (P<0.001): least square mean difference (LSMD) was −4.3 (3–12mg/d), −6.1 (3–6mg/d) and −5.9 (6–12mg/d). For each cariprazine group, significantly more patients met YMRS response and remission criteria vs placebo. Cariprazine also was significantly superior to placebo on the CGI-S: LSMD was −0.4 (3–12mg/d, P=.0027), −0.6 (3–6mg/d, P<.001), −0.6 (6–12mg/d, P<.001). The only common cariprazine-related TEAEs (≥5% and twice rate of placebo) that occurred in both studies were akathisia and tremor. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of bipolar mania.

Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from 2 Phase III, randomized, double-blind (6-week), placebo-controlled trials of fixed-dose cariprazine (3mg/d and 6mg/d, NCT01104766) and flexible-dose cariprazine (3–6mg/d and 6–9mg/d, NCT01104779) in adults with acute exacerbation of schizophrenia.

Evaluate the efficacy, safety, and tolerability of cariprazine in schizophrenia.

Primary and secondary efficacy parameters were change from baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 617 (NCT01104766; 153 placebo, 155 cariprazine 3mg/d, 157 cariprazine 6mg/d, 152 aripiprazole) and 446 (NCT01104779; 147 placebo, 151 cariprazine 3–6mg/d, 148 cariprazine 6–9mg/d). Improvement from baseline to Week 6 on PANSS total scores was significantly greater with cariprazine vs placebo: least square mean difference (LSMD) was −6.0 (3mg/d, P=.0044), −6.8 (3–6mg/d, P=.0029), −8.8 (6mg/d, P<.0001), and −9.9 (6–9mg/d, P<.0001). Cariprazine was significantly superior to placebo on CGI-S: LSMD was −0.4 (3mg/d, P=.0044), −0.3 (3–6mg/d, P=.0115), −0.5 (6mg/d, P<.0001), and −0.5 (6–9mg/d, P=.0002). Aripiprazole (active control, NCT01104766) was superior to placebo on both measures (LSMD: PANSS=−7.0, P=.0008; CGI-S=−0.4, P=.0001). The only common cariprazine-related TEAE (≥5% and twice rate of placebo) that occurred in both studies was akathisia. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of schizophrenia.

The clinical vignette aims to provide how PM could assist psychiatry treatment.

A 43-years-old woman with a 12-years history of Multiple Chemical Sensitivity (MCS), also affected by celiac disease and gastroesophageal reflux. In 2011, she was diagnosed with breast cancerin a surgically treatable stage. Due to previous severe drug adverse events, with undefined cause, no medical team accepted to take care her. Then she developed a depressive syndrome with hypochondriac features, based on DSM-IV-TR criteria.

Pharmacogenomic testing for the main enzymes involved in drugs metabolism (fig. 1) was performed and database interrogation was used to select the safer drug combination, based on the personal genomic profile. Illness progression was evaluated by Ham-A, Ham-d, BPRS, VGF and MMPI-2 scales (fig.2).

Genomic profile (fig. 1) was compatible with reported previous toxic effects following assumption of different drugs. The personal genome-based choice of pharmacological therapies allowed to avoid surgery-related adverse effects. Through genome-guided therapy selection, rapidly we set-up an efficacious psychotropic therapy. After a year the access to the PM Service, the patient showed an important improvement in both social impairment and quality of life, allowing her to get out, without a surgical mask.

Application of pharmacogenomic screening to patients undergoing composite therapies could be an effective tool to improve clinical outcomes and minimize side effects.

Fig.1: Genomic profile

Despite the multidimensionality of suicidal behavior, to date there is no precise depiction of suicide attempters according to their features. In this study we investigate if a sample of suicide attempters can be clustered in homogeneous subgroups according to the characteristics of their suicidal behavior. Once the main clusters were identified, we have compared the main risk factors between the groups to establish clinical profiles.

Patients between 18 and 84 years old were recruited as part of a suicide attempters study (n=1009). They were consecutively hospitalized and survivors of a current suicide attempt in a specialized unit of the Montpellier University Hospital. We used an Ascending Hierarchical Classification following Ward's method to identify clusters among suicide attempters. Clusters were then compared with regards to phenotypic and genetic variables.

Three clusters were identified. Attempt planning, substance use, and few possibilities of rescue characterized the first cluster (‘reflexive’, n=40). The second cluster (‘moderate’, n=604) did not plan the attempts but used non-severe non-violent means. Finally, the third cluster (‘impulsive’, n=365) made the first attempt at an earlier age, made more attempts, and more violent attempts. Significant differences between clusters were also found regarding gender, tobacco smoking, childhood abuse, family history of suicide and several genetic polymorphisms.

Three clearly differentiated clusters of suicide attempters were identified. Phenotypic and genetic differences allow the identification of these clusters in clinical settings. Prevention programs might be improved by targeting specific subgroups of attempters.

A growing body of literature suggests that people affected by psychotic disorders are more likely to be unemployed, tend to live alone, have a poor social network, and are not able to establish long-term relationships (Morgan et al., 2008).

To investigate social disadvantage in a sample of first-episode of psychosis patients and geographically matched controls.

The study sample consists of 52 healthy controls and 37 FEP who were assessed using the MRC Sociodemographic Schedules.

Preliminary results suggest that, consistently with the literature, cases are more exposed than controls to social disadvantage. They tend to reach a lower education degree (OR 6.66; CI 95%, 1.67–26.50, p 0.005) and to have an underpaid job 5 years before the onset (OR 2.84; CI 95%, 1.08–7.45, p 0.03). Furthermore, cases are more likely to live longer with their parents rather than independently (OR 3.33; CI 95%, 1.25–8.86, p 0.01) and are more exposed to house overcrowding (OR 3.92; CI 95%, 1.03–14.93, p 0.05). It was also found that an higher percentage of cases have never been in a stable relationship in the previous 5 years (OR 2.61; CI 95%, 1.08–6.27, p 0.03).

In line with the previous literature, we found that lower educational and occupational status and poor relationship status are associated to risk for psychosis. However, in contrast with North European cases, Italian FEP are more likely to live with their family rather than alone and, therefore, to be exposed to house overcrowding.

Catatonia is a neuropsychiatric syndrome characterized mainly by motor disturbances, known to be caused by a variety of psychiatric, medical, neurological and toxic conditions.

There have been few cases reported in the literature of catatonia due to benzodiazepine withdrawal, with predominance in elderly population. Here we report the case of an elderly woman with initial symptoms of dementia and abuse of lorazepam, who showed catatonic symptoms after a sudden reduction of her habitual daily dose during hospitalization.

A 73 year old woman with a history of depression and recently onset of cognitive impairment compatible with dementia, was admitted at the psychiatry ward after the worsening of the behavioural disturbances. The patient had been a regular user of lorazepam for more than 10 years, which was maintained at the same dose. After two days she abruptly presented symptoms of inhibited catatonia. A family member reported on further enquiries a suspicion of abuse of lorazepam treatment.

After administration of intravenous Diazepam, a dramatic recovery was observed, and sustained improvement was achieved after an increment of the habitual lorazepam dose. Psychiatric and medical conditions were ruled-out during follow-up, and diagnosis of dementia of Alzheimer type was made after further assessments.

Benzodiazepine withdrawal is not an often, but still important cause of catatonia. Older patients are at special risk, as the increased probability of being hospitalized exposes them to sudden suspension or reduction of their habitual treatment. Nevertheless, aged related vulnerability to catatonia has not been well studied yet.