The psychological autopsy aims to reach an understanding on the psychological aspects of a specific death.

Interview of relatives and friends require sensitivity to their emotional condition. Since Edwin Shneidman started to use this method, one of the most important questions is when to arrange the interview.

To evaluate family and friends satisfaction with the interview, in order to determinate when is the best moment to settle the psychological interview.

We studied the results of 271 suicides psychological interviews, and analyzed two variables: the satisfaction (measured using rating scale from zero to ten) and the time passed since the suicide.

The overall satisfaction was high (8´75), and the average time that we lasted to carry out the interview was 8´54 months.

When we analyzed the satisfaction through the months, we did not find differences in the values of the rating scale.

Although the best time to contact friends and relatives has been established to be between 2 and 6 months after the suicide event, in our study we did not find any relation between the timing and the satisfaction.

The results of this study show that the fact of when is the best moment to settle the psychological autopsy interview is still unclear.

A better konwlodge about this could improve the satisfaction of relatives and friends with the psychologial autopsy.

To examine whether positive and negative life events precede bipolar mood symptoms or whether bipolar mood symptoms precede life events in bipolar I and bipolar II outpatients.

173 bipolar outpatients with a diagnosis of bipolar disorder type 1 (BD I) or 2 (BD II) were assessed every three months for a total of two years. Life events were assessed by Paykel's self-report questionnaire. The NIMH monthly retrospective life chart method (LCM-r) was used to assess monthly functional impairment due to manic or depressive symptomatology. Mood symptoms were assessed every six months with the Quick Inventory of Depressive Symptomatology- Self Report (QIDS) and the Young Mania Rating Scale (YMRS).

Multilevel regression analyses (linear mixed-models) showed that negative life events are significantly associated with both subsequent severity of mania and depressive symptoms and functional impairment, whereas positive life events only preceded functional impairment due to manic symptoms and mania severity. These associations were significantly stronger in BD I patients compared to BD II patients. For the opposite temporal direction, we found that mania symptoms preceded the occurrence of positive life events and depressive symptoms preceded negative life events.

Life events appear to precede the occurrence of mood symptoms and functional impairment, and this association is stronger in BD I patients. Mood symptoms also precede the occurrence of life event, but no differences were found between BD I and II patients.

Recovery is an important concept in schizophrenia that has not been well defined or researched. It is crucial to determine its predictors.

To determine sociodemographic and clinical factors associated with remission and recovery in a population of patients with schizophrenia.

The design was an observational, cross-sectional and analytic study. We recruited all of the outpatients with schizophrenia or schizoaffective disorder (according to DSM IV-TR) who consulted psychiatry ward F from the 1/2//2013 to the 31/3/2013. Clinical and sociodemographic data for patients were gathered using an ad-hoc structured questionnaire. Clinical remission was defined according to criteria from the Remission in Schizophrenia Working Group (RSWG). Recovery was defined according to the following criteria from a Meta-Analysis by Jääskeläinen et al. (2013): a clinical remission (RSWG criteria) with a social remission (Global Assessment of Functioning score >=61) and no hospitalisation in the last two years.

Our sample comprised 44 patient (65.9% were females and 34.1% were males). Remission was achieved in 36.4% of the cases and was correlated with paranoid schizophrenia (p=0.024) and schizoaffective disorder (0.02) diagnoses. Recovery was achieved in 15.9% of the cases and had higher rates in females (p=0.4).

Better remission rates in paranoid schizophrebia and schizoaffective disorder is a finding which is broadly consistent with numerous previous studies. In opposite, the fact that female patients are more likely to achieve recovery remains controversial.

General practitioners (GPs) are well placed as gatekeepers for depression and suicidal ideation, but not properly prepared to detect and treat depression and suicidal behavior. Training programs aiming to increase the GPs’ capacity have been recommended as a useful strategy for suicide prevention. The current study aimed to increase the GPs’ attitudes toward depression and its treatment as well as attitudes toward suicide prevention and confidence in dealing with depression and suicidal ideation in daily practice.

In the context of a large European multilevel research project (OSPI-Europe) a standardized training program was developed and provided to 215 GPs in Germany, Hungary, Ireland, and Portugal. Core outcomes were assessed before training, after training, and at three months follow-up with the Depression Attitude Questionnaire, the Attitude toward Suicide Prevention scale, and the Morris Confidence Scale.

At baseline GPs showed moderately favorable attitudes toward depression and its treatment, fairly positive attitudes toward suicide prevention, and little confidence to deal with depression and suicide in their professional life. Importantly, the training program resulted in significant improvements in the GPs’ confidence to deal with depression and suicide and in their attitudes toward suicide prevention. After three months follow-up, training effects with respect to confidence could be sustained.

The OSPI-training program was able to reshape the attitudes of GPs toward suicide prevention and to boost their confidence in dealing with depression and suicide. Effects on the GPs’ attitudes toward depression and its treatment were less convincing. Recommendations are formulated for future training programs.

The subclinical behavioral and psychological characteristics of schizophrenic children have not been sufficiently investigated to present specific evidences. To elucidate the picture of them, and to find out indicators which predict later development of schizophrenia, childhood behaviors of the adult schizophrenia subjects were investigated in a questionnaire-based retrospective study.

Schizophrenia outpatients in his/her twenties and normal healthy subjects were investigated. All patients are diagnosed according to DSM-IV-TR as schizophrenia, and who present now mainly negative symptoms after passing an acute stage. By modified use of the CBCL (Child Behavior Checklist) as a retrospective assessment questionnaire, the parents of the patients and of control subjects rated their childhood (aged 6–8 years) behavior.

Among the eight CBCL syndrome subscale T-scores, those of’Withdrawan’,’Anxious/Depressed’,’Social problems’ and’Attention problems’ were significantly associated with schizophrenia, although any of these scores were not in clinical range. Patients also showed a significantly attenuated aggression. The hit-rate when classifying the schizophrenic and normal subjects by logistic regression analysis using the eight CBCL syndrome subscale T-scores totaled 87.8%.

The results suggested that subclinical behavioral and psychological characteristics of schizophrenia already exist in the patients’ childhood. With some assessment tool using obtained logistic regression formulas, the quite early screening for the risk of schizophrenia could be possible.

Adult Separation Anxiety Disorder (ASAD) is related to greater personal dysfunction and to a reduced sensitivity to conventional treatment, such as cognitive-behavioural therapy or anti-panic drugs, even considering severity of anxiety symptoms, number of co-morbid disorders, socioeconomical status, disease duration, and severity of agoraphobia.

To evaluate separation anxiety, psychiatric co-morbidity, levels of anxiety, character and temperament personality traits, and global functioning, in subjects with anxiety disorders attending a tertiary-level outpatient clinic.

To predict the outcome and customize treatment for anxiety disorders.

After symptom stabilization of one month (T0) 40 patients with anxiety disorders were assessed by means of SCI- SAS, SASI, ASA -27, MINI, HAM- A, TCI-R, GAF. Prospective evaluation is planned at T60 and T180.

According to preliminary cross-sectional data, higher scores of separation anxiety show statistically significant correlations with some domains of the TCI-R; in addition, patients with ASAD show greater psychiatric co-morbidity. No correlations were found between the presence of separation anxiety and levels of anxiety at HAM-A or GAF scores at baseline.

The prospective study of long-term response to treatment is ongoing and the sample will be expanded. The comprehension of anxiety symptoms appraisal in the framework of psychobiological personality characteristics is expected to influence the choice of both pharmacological and psychological therapeutic tools, particularly in patients showing higher levels of dysfunction.

According to the literature, consumption of cigarettes has been related to suicidal behavior. Furthermore, evidence suggests that increased consumption of cigarettes is associated with an increased risk of suicide.

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1. - To verify the association between the consumption of cigarettes and completed suicide.

2. - To confirm a higher consumption of cigarettes in completed suicide versus controls.

Completed old suicide and controls were recruited through the Institute of Legal Medicine of the province of Seville, Spain. After the physical autopsy was conducted, family members were asked for a posterior interview following the Psychological Autopsy methodology.

There were 412 subjetcs collected for this study; 270 completed suicide and 142 controls.

Only one third of suicides did never smoke whether almost half of controls did so (27.5% vs. 47.2%; c2=23.73; df:3; p<0.0001). We did not find any difference between the quantity of cigarettes used by those subjects that smoke daily in suicides (53.2%) and controls (44.5%). However this lack of association may be due to the type of controls. Controls were in a substantial percentage cardiac sudden death subject and smoking tobacco has been largely associated with cardiovascular disorders.-Almost 50% of controls had never smoked (compared to 27% of suicides).

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1. - There are fewer subjects that have never started smoking within the suicide subjects compared to controls.

2. - The number of cigarretes in those who smoke daily was not associated to any group. This results may be influenced by the characteristics of our control population.

Patients with Mild Cognitive Impairment (MCI) do not have significant deficits in their activities of daily living (ADL) and therefore questions exist as to whether carers of patients with MCI experience burden. Caregiver burden (CB) is defined as the adverse consequences of providing care. Studies report 20–30% of caregivers of MCI patient experience a significant degree of burden. CB is associated with poor outcomes for both patients and carers of people with dementia.

The main objective of this study is to look into the association of apathy and caregiver burden in patients with amnestic Mild Cognitive Impairment (aMCI) and also identify other significant predictors of caregiver burden.

This was a retrospective cross sectional study. We selected 92 consecutive patients diagnosed with aMCI who had a comprehensive battery of neuropsychological tests and a behaviour rating scale of interest for this study recorded. Nonparametric correlational analyses examined relationships between apathy, behavioural pathology, executive function, anxiety scores, depression scores, instrumental activities of daily living (IADL), cognitive scores and caregiver burden scores. Linear regressions identified predictors of CB.

There was significant relationship between apathy, impairments in IADL, behavioural pathology and CB in aMCI patients. However linear regression analysis showed that apathy was the only significant predictor of CB.

Apathy is highly prevalent and a significant contributor to caregiver burden in amnestic MCI. Improved identification and early interventions to improve apathy symptom is likely alleviate CB and thereby improving the prognosis and QoL of both the patients and caregiver.

Because of the interest about the physical health in psychiatric patients was made this study, to analyze, in a sample of patients with schizophrenia, the possible occurrence of metabolic disorders, their relationship with treatment, and the interventions need in this regard.

• Check if patients with schizophrenia treated with antipsychotics have metabolic disorders

• Check if the introduction of information about metabolic disorders influences the habits of life.

• A 6 months prospective study with patients followed up in the Day Hospital with an atypical antipsychotic.

The results describe a young population with 59% of males, without adequate dietary habits and with a low activity level. Most patients showed overweight or obesity.

On the other hand the presence of metabolic syndrome was higher in patients with olanzapine and risperidone long-acting injectable, although it was not statistically significant.

In the sample has been found the influence of certain doses of these antipsychotics and their influence on weight. Of note is the decrease in weight with olanzapine, usually associated with antipsychotic drug weight gain and that this study gives an opposite result that may be related to psycho-educational interventions on healthy lifestyles and the consequent change in the behavior in this regard and that received the most study patients.

There are metabolic disorders and overweight problems that are need to investigate into the possible mechanisms of control and early detection. This problems also be likely to be influenced of a healthy lifestyle, which could be the subject of a psycho-educational treatment.

Individuals with major mental illnesses (MMI) die significantly younger than the general population. Rates of Cardiovascular morbidity and mortality have fallen in the general population, due to effective primary prevention through the use of accurate cardiovascular risk assessment algorithms. This reduction has not occurred in individuals with MMI and there is evidence that the mortality gap is widening.

To determine the cardiometabolic risk profile and cardiovascular risk score in patients with schizophrenia compared to controls.

1,977 individuals with schizophrenia or related psychoses were compared to 215,165 controls. Cardiometabolic risk factors including cholesterol, BMI, systolic blood pressure, smoking status and diabetes were compared. Mean age and sex adjusted 10 year cardiovascular risk prediction scores were generated and compared using the Joint British Societies Score (JBS2).

Rates of diabetes, smoking and obesity were significantly higher in both men and women with schizophrenia compared to controls. In men with schizophrenia mean JBS2 score was lower than controls (10.2% vs. 10.9%). Rates of individuals at high risk of cardiovascular disease (JBS2 >20%) were lower in men with schizophrenia (28.4% vs. 39.3%). In women with schizophrenia mean JBS2 scores were higher (8.3% vs. 7.9%) and the rate of individuals at high risk of cardiovascular disease was higher than in controls (13.4% vs. 11.8%).

Despite high rates of cardiometabolic risk factors in men and women with schizophrenia across all age groups, cardiovascular risk algorithms may not adequately predict increased 10 year cardiovascular risk in men.

Psychiatrists and other Mental Health Professionals (MHP) are facing ethical problems in their daily practice. MHP usually can rely on their moral competence when dealing with ethical questions. However, in challenging situations doubts may arise concerning the ethical legitimacy of one's decisions. In Clinical Ethics Consultation (CEC), an ethics consultant aims at helping MHP to make ethically sound decisions. In psychiatry, CEC is less common than in somatic medicine. What is the additional benefit of using CEC when dealing with ethical problems in psychiatry?

A conceptual framework of CEC in Psychiatry is presented highlighting its reflective components. Two CEC cases from our service will be evaluated: A) a child psychiatric case where parental conflict split the team on prioritizing values in the care of the child; B) a geronto-psychiatric case with team dissent on the appropriate outpatient follow-up care for an alcohol-addicted patient.

In both cases, consensus was reached; moreover, underlying ethical components were articulated, e.g. A) the importance of a continuous informed consent process with the parents, B) the conflict of respecting the patient's autonomy versus the duty to prevent harm.

While the MHP experienced their difficulties, they benefited from ethics support formulating their own arguments precisely. Intuitive or emotional aspects of disagreement were transformed and entered into a target-oriented discourse on values and norms.

CEC provides the discoursive framework and – in the person of the ethics consultant – the methodological competence to strengthen ethical reflectivity to the clinical setting.

Psychotic depression is widely accepted as a specific subtype of unipolar major depression. Magnetic resonance imaging studies have begun to investigate the neurobiological changes that differentiate this subtype of major depression from non-psychotic depression. Any differences may eventually be useful in aiding diagnosis. This review collates the currently available evidence, with the aim of directing future study.

A systematic search of the Medline, PubMed & Embase databases was used to identify all articles comparing structural or functional magnetic resonance imaging (MRI) differences between psychotic and non-psychotic depression. The results were then collated and organised according to brain region.

Decreased frontal cortex grey matter volumes and, to a lesser degree, insula cortex volumes differentiate psychotic from non-psychotic depression. fMRI studies show associations between altered activity in these two regions and cognitive impairments in patients with psychotic depression.

The volumes of putative emotional processing regions including the amygdala, hippocampus and anterior cingulate show no difference between psychotic and non-psychotic depression.

Structural and functional changes in the higher associative regions of the frontal and insula cortices differentiate between psychotic and nonpsychotic depression to a greater degree than changes in putative emotional processing regions. The numbers of studies available and the sample sizes involved are both small but future studies aimed at understanding the neurobiology of psychotic depression may benefit from a more detailed assessment of these two regions.

Participation is a central requirement of ethical quality in Child Psychiatry. Target criteria are obtaining and maintaining parental informed consent (PIC) and child assent (CA) to hospital admission and treatment. Clinical practice of PIC and CA displays considerable variability and deficits. We report how an innovative implementation strategy through Clinical Ethics Support (CES) impacted on practice.

Approach: explorative, comparative analysis of 10 cases in a Child Psychiatric ward pre and post ‘implementation of ethical target criteria’ in inpatient routine.

Material: patient charts with documented admission, case conference and dismissal.

Research question: evaluating documented changes after the implementation.

CES strategy: a) screening for ethical problems in daily rounds; b) informing case conferences; c) ‘ethics consultations on demand’; d) education; e) ethics policy regarding isolation.

5 pre- and 5 post-implementation cases were analysed (retro-/prospectively) with pairs of cases matched for complexity, severity and patient age.

Analysis shows that daily practice changed after implementation: 1. heterogeneity in PIC and CA reduced; 2. overall quality of documentation raised with voids about ethical aspects of PIC and CA filled; 3. standardized documentation of PIC and CA realized.

The approach is innovative and addresses a research of PIC and CA; results are clinically relevant, let alone their contribution to make the patients’ and their parents’ wishes better heard. Explicit documentation of the target criteria PIC and CA gives clear, fast and consistent information on the ethical status and eventual needs for further intervention, valuable for inpatient care as well as follow-up.

Despite important progress, the results of pharmacological treatment of schizophrenia are frequently unsatisfactory. Therefore some patients use natural medicines although it is unclear whether natural medicines are effective and safe. We assessed the evidence for natural medicines with and without antipsychotics in treating symptoms or reducing side effects of antipsychotics in schizophrenia.

A systematic review until April 2013. Only RCTs with a Jadad score of 3 or higher, were included.

105 RCTs were identified. Evidence was found for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6 for improving symptoms of schizophrenia when added to antipsychotics. Inconclusive or no evidence was found for omega-3, Dserine, D-alanine, D-cycloserine, B vitamins, vitamin C, dehydroepiandrosteron (DHEA), pregnenolone (PREG), inositol, gamma-hydroxybutyrate (GHB) and des-tyr-gamma-endorphin when added to antipsychotics. Omega-3 without antipsychotics might be beneficial in the prevention of schizophrenia. Only ayurvedic herbs (in one study), no other agents, seemed effective without antipsychotics. Ginkgo and vitamin B6 seemed to be effective in reducing side effects of antipsychotics. All natural agents produced only mild or no side-effects.

High quality research on natural medicines for schizophrenia is scarce. However, there is emerging evidence for improved outcome for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6, all with only mild or no side effects. Most study samples are small, the study periods are generally short, the studies only cover a modest part of the world's population and most results need replication.

60% of older people admitted to general hospital will have or develop a mental disorder (Department of Health, 2001). Mental disorder in this population is an independent predictor of poor outcome and is associated with increased mortality, greater length of stay, loss of independent function and higher rates of institutionalisation (The Royal College of Psychiatrists, 2005).

To examine if the liaison psychiatric intervention has improved the outcome for the patients and to introduce measures to improve quality, safety and efficiency within the service practice in the future

A total of 128 patients were referred to the geriatric liaison psychiatry service in a 6 months period between from an acute general hospital .50 patients were randomly selected from these referrals. Data's were collected from both the case notes as well as clinical information system using an audit data collection tool.

Majority (62%) were seen within 24 hours and 82% were seen within 48 hours. The main diagnosis was depression closely followed by dementia. Only a small minority (8%) of the patient needed inpatient psychiatric admission. 50% of the patients were discharged within a week of the Liaison assessment and majority of the cases (70%) patients were able to go back home.

Identification of mental illness in the acute hospital settings remains low. In spite of dementia being extremely common diagnosis, very few did appear to have been referred to the specialist memory service. Liaison Psychiatry intervention possibly improved outcomes for patients and the services.