The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes.

To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal.

Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA.

675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = −.26; p = .05) and heart rate (r = .33; p = .01).

Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.

Identifying schizophrenia vulnerability factors requires testing specific hypotheses concerning etiopathogenic models, candidate genes, and environmental factors involved. We hypothesized that patients developing schizophrenia after using regularly cannabis represent an homogenous phenotypic entity which could result from a specific interaction between genetic polymorphisms (SNPs) of CNR1, CNR2 and COMT genes and cannabis use (an environmental factor intervening lately in the neurodevelopment).

The main objective was to confirm that patients using cannabis before the onset of schizophrenia had fewer markers of early-neurodevelopmental impairment. The secondary objective was to identify a gene environment interaction in this subset of patients.

Patients were prospectively included and underwent a standardized interview and an evaluation of cognitive functions and neurological soft signs. Blood and saliva samples were collected. For the case-case genetic study, those patients were pooled with patients included in a cannabisdependent schizophrenic-patients cohort. Eight CNR1, CNR2 and COMT SNPs were analyzed.

We included 61 patients in the clinical part. Regular cannabis users before the onset of the disorder had fewer neurological soft signs, less cognitive impairment and a different clinical symptomatology. For the genetic part 26 patients were added to the 57 patients from the clinical part (4 non Caucasian patients excluded). Results were in favor of a gene environment interaction for rs1049353 of CNR1.

We found that regular cannabis users before the onset of schizophrenia had less neurodevelopmental impairment. In this subset of patients, cannabis could play a causal role in a gene environment interaction leading to schizophrenia.

Administration of psychoactive drugs increases dopaminergic receptor stimulation, improves mood and stimulates motor activity. Structural and functional changes can be observed in particular structures of the central nervous system (CNS).

This study aims to assess the saccadic refixation parameters in opioid addicted subjects treated with methadone compared to control group.

Eighty-six patients from the substitution program were examined. The study included 36 subject of the control group. The trial was conducted twice: before and about 1.5 hours after the administration of therapeutic dose of methadone. Performed Latency Test(LT) with Saccadometr diagnostic system.

The statistical analysis showed that the mean duration before and after the administration of methadone was a statistically significant increases (p=0,0001) in the subjects from substitution program compared of the control group but after administration of methadone the value greatly increased in experimental group (before 52ms, after 56ms). It was observed that the mean amplitude after the administration of methadone increased statistically significantly in experimental group compared of the control group (p=0,02). Mean peak velocity of latency after the administration of a therapeutic dose of methadone was statistically significant decreased in experimental group compared of the control group (p=0,0004).

The results indicate a change in the dynamics of saccade after methadone administration. The observed changes in values for eye movements may be due to the inhibitory effect of methadone on CNS.

Schizophrenia evolution have negative effects on social functioning, with substance abuse, low coping capacity and social-economic losses for patients and their families. Identifying and assessing the impact of social factors can create the preconditions to improve the evolution of the disease.

Determining the correlation between social functions and quality of life in schizophrenic outpatients.

Study on 81 patients diagnosed with schizophrenia and hospitalized in Craiova Mental Health Center (July 1st, 2007–June 30th, 2012) using Personal and Social Performance Scale and WHOQOL–BREF.

Social-demographic data revealed the dominance of female (59.26%), average age 45.36±8.50 years, urban residence (85.18%), average educational level (49.38%), and unemployment (92.59%). There is a high incidence of paranoid schizophrenia (74.09%) with insidious onset (67.90%) between 20-29 years (50.62%) and aggressive behavior (69.14%), with 2 admissions in the last 5 years (60.50%), and poor level of social functioning (95.06%). Moderate-severe social and personal inabilities were significantly correlated with the aggressive behavior, the poor social adjustment, stationary or worsened evolution and unemployment. The assessment of the quality of life was influenced by several clinical and social-demographic variables: the number of readmissions, the patient's condition upon discharge, the patient's gender, educational level and level of social adjustment.

These correlations demonstrating the influence that social stress elements have on the schizophrenic outpatient's quality of life representing the genuine risk factors for unfavorable evolution.

The urgent children and adolescent psychiatric consultations have increased recently[1] and may be the first contact with the mental health network[2].

To describe and analyze the population<18 years old admitted at the psychiatry emergency department(ED) of Hospital Clínic of Barcelona between june/12-may/13.

Demographic and clinical data were collected, using SPSSv.19.0 for statistical analysis.

596 emergency visits from out of 420 patients were recorded[46.3% male, mean age 14.52(6-17)years]. The most frequent consultation reason was behavior disorder(54.4%), being the most common diagnosis externalizing disorder(51.2%). 44.8% had been previously attended an average of 3(1-17)times in our ED. 85.6% were already under psychiatric follow-up and 67.8% had been psychopharmacologically treated. Prior psychiatric hospitalizations occurred in 35.1%[average 1-3times]. 27.4% required acute hospitalization at the ED discharge.

Most of consultations were between 12:00–13:00PM and 18:00–20:00PM, maximal activity was detected on Monday(17.6%) and minimal on Sunday(9.1%). Holiday periods coincided with a consultation decrease while April-May-June period accumulated a third of them. The stay time average in ED was 6.41 hours(15min-3days) and a 32.6% required pharmacological treatment.

Since 2009 a reduction of 14.16% of the total psychiatric emergencies has been detected in our ED, but children and adolescents consultations have increased an 18%.Data obtained of the most common diagnosis and circadian and weekly distribution of visits are consistent with previous studies[1]. Greater prevalence of behavioral disorder was found in frequenters (3emergent consultations/year), which calls for further studies to optimize the approach to this problem.

The vulnerability-stress model assumes that psychotic symptoms emerge from the interaction between stress, basic symptoms and information processing deficits. Despite the large amount of data on first episode psychosis, this particular topic has been investigated to a minor extent in patients readmitted to acute psychiatric wards.

To assess the association between basic symptoms and subjective stress, life events, and executive functions.

To identify the factors associated to basic symptoms during relapses.

Patients affected by schizophrenia, schizoaffective and bipolar disorder according to DSM-IV TR were recruited from the acute psychiatric wards of two University Hospitals in Rome. They were evaluated through: a) Frankfurt Complaint Questionnaire (FCQ); b) Stress-related Vulnerability Scale (SVS); c) Paykel Interview for Recent Life Events (IRLE); d) Wisconsin Card Sorting Test (WCST).

Forty-nine patients were enrolled (65% women; mean age 42.7 ± 10.5 years; education 12.4 ± 3.2 years; disease duration 17.6 ± 11.4; 63% affected by bipolar disorder). Basic symptoms were positively associated to SVS total score (rho = 0.66, p < 0.01), IRLE marital subscale (rho = 0.3, p < 0.05), while negatively associated to WCST number of completed categories (rho = −0.32, p < 0.05).

Preliminary results of this study show that basic symptoms are positively associated to perceived stress and marital life events, while negatively associated to executive functions, during psychotic relapses.

Adults with Attention-deficit hyperactivity disorder (ADHD) often suffer from serious education, occupational and interpersonal impairments that can induce stress in these patients. The aim of the present study is to evaluate stress responses in adults with ADHD using the Trier Social Stress Test (TSST).

Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample included adults with ADHD, naïve to medication, fulfilling current DSM-IV criteria. Psychiatric and organic comorbid disorders were excluded. Maximum cortisol increase and’Area Under the Curve’ with respect to the ground (AUCG), were calculated. Subjective stress was also studied using the Perceived Stress Scale (PSS).

The sample of ADHD patients included 28 men and 22 women. Maximum cortisol increase compared to baseline was statistically significant in the group of men (t=2,62; p= 0,014) but not in the group of women (t= 0,965; p=0.347). TSST-AUCG was 43,78±22,29 nmols/l for men and 36,50±30,99 nmols/l for women. T-test comparisons revealed no significant differences between men and women in TSST-AUCG (t=,948; p= 0,348) or in the PSS (t=,454; p=0,652).

Compared to women, men with ADHD showed a higher peak of cortisol after stress induction. Nevertheless, no differences were found in the whole cortisol response (AUCG). There were no differences between men and women with ADHD in the subjective stress measures. The influence of ADHD subtype (Inatentive vs. Combine) on stress responses cannot be excluded.

The ROAMER project, funded by the European Commission, has been designed to develop a comprehensive, consensus-based roadmap to promote research on mental health in Europe. It has been repeatedly affirmed that the different people involved in the mental health field hold different views about the desirability of clinical outcomes and the general principle is that research agenda should reflect the needs and values of the people who use health services.

To involve different stakeholders in the development of the agenda for mental health research.

To identify priorities in mental health research in Europe for the next ten years.

An online survey was conducted with national associations/organizations of psychiatrists, other mental health professionals, users and/or carers, and psychiatric trainees in the 27countries of the European Union.

One hundred and eight associations/organizations out of the 154 contacted returned the questionnaire(response rate:70%). According to all categories of stakeholders, the five most frequently selected research priorities were early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and new medications for mental disorders. The top five research areas in terms of importance were quality of mental health services, suicide prevention, early detection and management of mental disorders, rehabilitation and social inclusion, prevention of mental disorders. The least developed research areas in each country were molecular bases of mental disorders, environmental risk/protective factors for mental disorders, resilience and mental health, prevention of mental disorders, health and well-being of carers.

These results show that some rebalancing in favour of psychosocial and health service research is needed.

Sexual dysfunction, such as low libido, erectile dysfunction and anorgasmia, is very common in patients taking serotoninergic antidepressants (SSRIs). These adverse effects persist throughout the treatment period, are not self-limited, and drive many male patients to treatment discontinuation in order to recuperate normal sexual functioning.

The purpose of the present study was to investigate the sexual function of male patients treated with antidepressants for major depression, before initiation of treatment, during treatment and two months following withdrawal of SSRIs.

This observational study comprised 25 male patients (age: 30–50 years) followed-up on an outpatient basis for major depression.

Sexual functioning was assessed with the Arizona Sexual Experience Scale (ASEX) and depressive symptoms with the Hamilton Rating Scale for Depression (HDRS) at three time points: baseline (period free of medication), three months after starting treatment with SSRIs, and two months following antidepressant discontinuation.

Paired samples t-tests were used for comparisons between numeric variables at the three time points and Spearman's correlation coefficients were calculated between factors associated with sexual dysfunction.

Mean values ??(± SD) of ASEX and HDRS scores at the initial, second and final assessment are shown in Table 1.

Correlation coefficients between ASEX, HDRS and age at the three points of evaluation are presented in Table 2.

Antidepressants (SSRIs) have a negative impact on sexual functioning of male depressed patients. Quality of sexual functioning is negatively associated with age and the severity of depressive symptoms before the administration of antidepressant treatment. Sexual functioning significantly improves after discontinuation of antidepressants; this improvement is even superior to the pre-treatment period of sexual functioning.

SPECT DaTSCAN is used in clinical practice for differential diagnosis between Parkinson disease and other movement disorders, dementias and drug induced parkinsonism (Park 2012, Scherfler 2007). Nevertheless, its rational indication in patients with psychiatric comorbidity has not been clearly identified.

To assess the rationale for the indication of SPECT DaTSCAN in psychiatric population, explore the therapeutic consequences and clinical outcomes.

A prospective case series of DaTSCAN applications requested from the department of psychiatry of a general hospital (2008–2012). Reason of request, sociodemographic and clinical data, side effects (UKU Rating Scale), diagnostic (DSM-IV-R) and outcome after one-year follow-up were recorded.

18 cases were included (13 hospitalized, 55.5% women, 65±13 years old). Baseline UKU showed: 89.5% bradikinesia, 68% rigidity and 31.5% tremor. The indications for DaTSCAN were: 1) Atypical extrapiramidal syndrome (AES; 55.5%) and 2) Parkinsonism presumably induced by drugs (PPID; 44,4%).

AES group (N=10): 80% of patients had an affective disorder and 20% a psychotic disorder; DaTSCAN identified three cases of Parkinson disease (30%), two non-parkinson dementia (20%) and one Huntington disease (10%).

PPID group (N=8): 50% of patients had an affective disorder and 50% a psychotic disorder; DaTSCAN identified one case of Parkinson disease (12.5%) and five of drug-induced parkinsonism (62,5%).

After one year follow-up, AES group showed a worse outcome and an important functional decline, while most of patients of PPID group experienced complete remission

The results of this study enable to establish the profile of psychiatric patients that would beneficiate most from DaTSCAN.

Donepezil is an acetylcholinesterase (AChE) inhibitor recommended as an option for managing mild to moderate Alzheimer's Disease (AD) by NICE (National Institute of Clinical Excellence) UK. Donepezil is generally well tolerated but it can have potential side effects, contraindications and drug interactions. It is essential that a risk-benefit analysis is carried out before prescribing.

The memory service in Gateshead uses an agreed pro-forma based on the Patient Group Directive (PGD) standard – for nurse led administration. It includes demographics, diagnosis, contraindications, hypersensitivity, drug interactions and side effects.

Our PGD also assesses capacity, pre and post Donepezil psychometric testing – including screening for other psychiatric symptoms and assessment of carer stress in order to provide a more comprehensive assessment of this patient group, facilitating improved care and if necessary referral/input from other services.

This audit looked at completion of this documentation in order to review current practice and identify any potential areas for improvement.

20 patient records from May 2012-March 2013 were randomly selected and analysed using the data collection tool.

The analysis highlighted 100% documentation with regards to demographic details, side effect explanation and drug tolerance assessment. However, the documentation with regards to psychometric assessments and caregiver stress attained only 90%. The documentation of diagnosis and hypersensitivities was documented only in a minority of cases.

Diagnosis, psychometric assessment including carer stress is essential in prognosis and monitoring treatment. Recommendation was made to review the areas for improvement and to do a re-audit.

Depression is both over- and underdiagnosed, especially in primary care. The ICD-10 criteria fail to provide a precise diagnosis because of depression heterogeneity and clinician rating biases. Better understanding of depression origin may result from combining different approaches to psychometric evaluation of depression.

To find out whether an approach to depression evaluation – clinician-rated scale, self-rated scale, behavioural test – affects determination of its core features.

85 primary care patients with ICD-10 depressive episode were examined. Depressive syndrome was evaluated with Clinical Interview for Depression and Related Syndromes (CIDRS; with items of HAMD-17), Beck Depression Inventory (BDI) and MMPI test. Data from different instruments were independently analyzed with factor analysis. General factors of each analysis were compared for concordance. Patients groups were formed in accordance with factor scores; first groups in each approach were compared for identity of participating patients.

General factors derived from analyses of different psychometric instruments data were found to be formed by distinct psychopathological features. For CIDRS these were lowered mood and diminished interest, for BDI – guilt and self-dislike, for MMPI – depressive tendencies and lack of social contacts. An approach to evaluation also determined what patients entered the nuclear depressives group.

Depressive syndrome represents a multidimensional clinical construct with its nuclear components being substantially dependent on an approach to its evaluation. Clinician-rated scales, patient-rated scales and behavioural tests should be regarded as complementary instruments in evaluating depressive syndromes in order to provide more precise diagnosis and treatment of depression.

Despite the increasing interest and social impact of mood disorders in elderly, there is no consensus regarding the frequency of depression in later life (LLD). A lack of epidemiological data mainly concerns the depression that occurs at age≥ 65 years, named Late Onset Depression (LOD).

To provide current estimates of the prevalence of LLD and LOD in elderly of the population-based GreatAge Study and to determine the prevalence of untreatment in both positive groups.

A cross-sectional analysis of the 500 participants (60% males) of the population-based GreatAge Study, aged≥ 65 years, was performed. Depression diagnosis was assessed through the SCID and categorized as major and minor depression (dysthymia, adjustment disorders and depression nos). The antidepressant's use was obtained from a standardized anamnestic interview.

The prevalence of positive population for any DSM-VI disorder amounted to 22% (29% females; 17,3% males). The prevalence of LLD was estimated to be 10% (14,5% of women; 7% of men) distinct as major (5,4%) and minor (4,6%) depression. The prevalence of LOD was estimated to be 5,2%. No differences for gender were recorded (p=0.694). In the whole sample major and minor LOD are equally distributed (2,6%). The prevalence of treated subjects amounts to 40% for LLD and 46,2% for LOD (p=0.355).

Population-based studies have been useful in defining clinical characteristics and prognostic indicators of LOD. Our frequency rates are generally comparable with the range identified by previous studies conducted in other Western countries. Exceptions are represented by subtypes and gender frequency.

Physical restraint of patients is applied when a patient is aggressive and violent, after application of medicaments and verbal therapy have failed to produce the expected results. One of the strongest arguments for using physical restraint is the potential harm the patient can cause to himself, others or both.

The objective of the study was to find which psychopathological manifestations required physical restraint, what diagnostic entities were related with application of physical restraint and how long the physical restraint lasted.

The retrospective study covered 84 patients who were treated in our institution in the period between 2011 and 2012 and were physically restrained at some point during that period. Additional parameters were used in the study: 1/ diagnosis, 2/ patient's age, 3/ sex, 4/ previous application of pharmacotherapy, 5/ number of instances of physical restraint.

Out of the total number of patients who were physically restrained, 52.4% (n=44) of them were diagnosed with schizophrenia. Average age of the patients was 28.2. The men (92.8%, n=78) outnumbered the women. 73.8% (n=62) of them received medication prior to being physically restrained. 5.9% (n=5) of the patients were physically restrained at least twice.

If applied in the presence of precisely defined indications and after other therapeutic modalities have been exhausted, physical restraint is a therapeutic intervention. In all other cases, and particularly if used for longer than is necessary, physical restraint is a form of punishment of the patient and abuse of psychiatry.