Several adolescents engaging in suicidal behavior represent a hidden population who do not receive professional help. Aim: to increase understanding of adolescents who were screened as being at high risk of suicide.

Sample: 1,409 pupils from 23 schools sited in Asturias (Spain) participants in the ‘Working in Europe to Stop Truancy among Youth’ Project (WESTAY) (48.55% males; mean age=15.16 years). Emergency cases: those with severe suicide ideation and/or suicide attempt (SA) in the past 2 weeks. 45 pupils identified as emergency cases (46.7% males; mean age=15.02 years).

Evaluation: Beck Depression Inventory II (BDI-II), Deliberate Self-Harm Inventory (DSHI), Strengths and Difficulties Questionnaire (SDQ), Well Being Index (WHO-5), Paykel Suicide Scale (PSS).

3.2% (n=45) of the sample self-reported acute suicidality (22 attended the clinical interview, 5 were referred to mental health services). More girls than boys were identified as cases, attended the interview and were referred to services. Emergency cases scored significantly higher (p=0.000) in SDQ total scores, emotional symptoms, conduct problems, hyperactivity and peer relationship problems, however, no significant differences were found in the prosocial scale. Emergency cases also manifested significant (p=0.000) higher level of depressive symptoms (BDI-II) and lower well-being. Emergency cases were more likely to have a history of DSH (p=0.000). No significant differences were found between those who attended the interview or not.

There is a high rate of self-reported acute suicidality among adolescents; however, their suicide risk after a clinical assessment was considered as low.

It was suggested that impulsivity is a temperamental risk factor for alcohol use and may be a fundamental mechanism in both the onset of excessive alcohol use and the relapse to alcohol use. Aim of this study was to evaluate the changes in impulsivity scores among alcohol dependents 12 month after inpatient treatment.

Among 78 consecutively admitted male alcohol dependents, 58 were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11) (10) both at the baseline and at the end of 12 months.

Among 58 alcohol dependent inpatients 61.8% (n=32) were considered as relapsed to heroin use during 12 month follow-up. Sociodemographic variables did not differ between the groups. Mean impulsivity scores did not differ between remission and relapsed groups at baseline, whereas only non-planning impulsivity was higher in relapsed group at follow-up. Impulsivity score decreased during 12 month follow-up in remission group, whereas increased in relapsed group. Among dimensions of impulsivity non-planning impulsivity decreased in remission group, whereas attentional impulsivity increased.

Results of the present study may suggest that while attentional impulsiveness may be the cause of alcohol use, non-planning impulsiveness may also be a vulnerability factor for alcohol dependency and relapse.

We hypothesized an increase in dorsolateral prefrontal cortex (DLPFC) glutamate levels would occur after three weeks of repetitve transcranial magnetic stimulation (rTMS) treatment and a decrease in major depressive disorder (MDD) symptoms.

We report six cases (four females) 15–21 years of age with treatment-resistant MDD. Participants had a mean age of 18.7 years and a mean IQ of 102.3. Short echo proton magnetic resonance spectroscopy (H-MRS) was used to quantify glutamate levels in the left DLPFC (4.5cc) before and after rTMS treatment. rTMS was localized to the left DLPFC and applied for 15 consecutive weekdays. Treatment response was defined as a greater than 50% reduction in Hamilton Depression Rating Scale scores (Ham-D).1H-MRS data was analyzed with LCModel to determine glutamate concentration.

Following rTMS, treatment responders (N=4) showed an increase (relative to baseline) in left DLPFC glutamate levels (11%), which corresponded to an improvement in depressive symptom severity (68% Ham-D score reduction). Treatment non-responders (N=2) had elevated baseline glutamate levels compared to responders in that same region, which decreased with rTMS (−10%). Procedures were generally well tolerated with no adverse events.

rTMS is feasible and possibly efficacious in adolescents with MDD. In responders, rTMS may act by Induced elevations in elevating DFPLC glutamate levels in the left DLPFC, thereby leading to symptom improvement. Transcranial Magnetic Stimulation for Adolescent Depression (TMSAD)

Recently, Functional Remediation (FR) has proven to be effective in improving the functional outcome of euthymic bipolar patients.

Our objective was to test the efficacy of FR programme in a subsample of euthymic bipolar II patients (BPII).

The main aim was improve the functional outcome in these patients.

Post-hoc analyses were undertaken using data of 53 DSM-IV diagnosed BPII outpatients who had participated in a multicentre, rater blind, randomized, controlled trial (RCT) exploring the efficacy of FR (n=17) as compared with a Psychoeducation (PSY) (n=19) and a control (n=17) groups which only treatment as usual (TAU). The primary outcome variable was a functional improvement measured as the mean change in the Functioning Assessment Short Test (FAST) from baseline to endpoint after intervention.

Data revealed a significant functional improvement from baseline to endpoint (Pillai's Trace =0.164; F =3.619; p =0.037), suggestive for an interaction between program pertinence and time (pre-post). Nevertheless, Tukey's post-hoc test only revealed a trend in favour of a better outcome for FR when compared to the TAU (p =0.058) and to the PSY group (p =0.062). We also found an interaction between program pertinence and time when analysing the subdepressive symptoms (Pillai's Trace =0.157; F =3.635; p =0.036), so that patients in FR showed a significant reduction in subdepressive symptomatology when compared to the PSY group (p= 0.041).

The FR program appears to be effective in improving the overall functional outcome in BPII patients, as well as in reducing subdepressive symptoms.

The aim of this study was to evaluate the changes in impulsivity scores among those who are still using buprenorphine as maintenance substitution treatment and those relapsed to heroin use in heroin dependent inpatients at the end of 12 month follow-up. We also controlled depression and trait state anxieties on the relationship between impulsivity and relapse.

Among 78 consecutively admitted male heroin dependents, 52 (66.7%) were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), Beck Depression Inventory and State-Trait Anxiety Inventory at the end of 12 months.

Among 52 heroin dependent patients that were avalible to examine by face to face interview 23 (44.2%) were considered as relapsed to heroin use during the last year, whereas 29 (55.8%) were still in the maintenance treatment. Relapsed group has less attended to polyclinic control, outpatient treatment, they did not change their social environment, continue to see their dependent friends and used other drugs during 12 monts. Mean impulsivity, depression and anxiety scores were higher in the relapsed group. State anxiety and impulsivity, particularly motor impulsivity determined the relapse in regression analyses.

Together with state anxiety, which may be mediated by craving, motor impulsivity predicted relapse. In response to stress or environmental cues, an individual with substance abuse could use the substance in a rapid unplanned action without regard to the consequences.

The full etiology of transsexualism is still unknown. However many factors, like biological and environmental, are being suggested as possible explanations to the cause of this entity.

We intend to revisit the major etiological theories of transsexuality, based on the description of two cases occurring in first-degree relatives.

A mother and her daughter both diagnosed with Gender Identity Disorder are followed at Multidisciplinary Clinical Sexology Group in our facilities since 2011.

This case is related to a young girl who in her childhood felt and behaved himself as a boy by adopting male gender stereotypes. She has lived with distress during the development of female secondary sexual characteristics, and the age of 17, after identifying his problem decided to tell his mother. However our patient founded that her mother, with 38 years old, was already resigned by living with a sex gender that didn't recognize as her own. In the end they decided to confront the social and family environment, joining both in the process of sexual reassignment.

The transsexualism is a complex phenomenon. The occurrence of two cases of transsexualism in a mother and daughter highlights the importance of consider and extend the knowledge about the biological aspects of gender identity disorder.

It is relevant to communicate the cases occurring within the same family to contribute to the etiology investigation in this area. In the literature the rare cases described of family transsexuals are among brothers, which makes this case between mother and daughter special.

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that persists into adulthood. Though symptoms of inattention and hyperactivity-impulsivity are the two core symptom sets of the disorder, recent reviews argue that emotional dysregulation is an additional feature of ADHD criteria. In the DSM-5 emotional dysregulation does not appear. In a study by the Mental Health Center (MHC) of Arganda, 42 outpatients, all older than 18, we'll look for:

1. ○ Examine the comorbidity of ADHD, in relation to Axis I and personality disorder (PD) from the DSM-IV. In addition, to see if emotional dysregulation is present in these patients.

1. ○ The proposal is that there exist comorbidity with PD, in addition to emotional dysregulation symptoms.

1. ○ Transversal descriptive study of out-patients.

2. ○ A diagnosis of ADHD with: ASRS-V1.1, the ADHD, the CAADID and the WURS scale, reduced version.

3. ○ Emotion dysregulation was assessed by the Impulsivity/Emotional Lability scale from the CAARS and by the DERS and PD with the SCID-II questionary.

A high comorbidity is observed with PD and depressive symptoms. The combined type of ADHD is the most frequently found, with higher severity and frequency of PD. The association with depressive symptoms is more often found in the inattentive subtype and the combined type with substance abuse. Preliminary data is included on emotional dysregulation and ADHD.

ADHD is a disease observed in out-patient adults with a high frequency of comorbidity with PD and depression.

It is necessary to look for the dimension of emotional dysregulation.

The term hysterical psychosis has been in common usage for longer than half a century, but has never become part of the standard nomenclature. This entity is characterized by acute onset, often following the occurrence of an emotionally disturbing event, absence of any characteristic thought disturbance, and affectivity changes in the direction of volatility. Its manifestations can also include hallucinations, delusions, depersonalization and behavior disorders. Though the acute episode seldom lasts from one to three weeks, it has good prognosis and there is practically no residue after the symptoms disappear.

A review about the evolution and the actual interest and adequacy of this clinical entity. The very existence of hysterical psychosis as a diagnostic entity has been questioned as part of the general difficulty in defining both hysteria and psychosis.

A non-systematic review of PubMed articles.

The hysterical psychosis occurs in patients with a hysterical personality / histrionic, with more colorful psychotic symptoms, which are somehow characteristic. This seems to condition the definition of a well defined nosological entity, as long as diagnostic, prognostic and therapeutic implications. It still seems questionable whether the concept of hysterical psychosis should be kept as an entity with well-defined etiologic determinants, however in clinical terms this approach may have advantages.

The prevalence of personality disturbances associated with some common somatic conditions are gradually increasing in Russian population and might be accompanied by the high level of negative consequences. On the other hand, it is still unclear the common manifestations of this disorder.

To describe the essential features of personality disorder due to a general medical condition and to define common negative consequences.

We have sorted out of 87 inpatients with the diagnosis of ‘Personality Change Due to a General Medical Conditions’ according to the DSM-IV criteria.

The clinical manifestations can be combined into four subtypes: 1) labile type (50,3%) where such features as affective lability, impulsivity, parasuicide and tend to self-inflicted injury predominate; 2) dysphoric type (32,7%) that is characterized by dysphoria, vindictiveness and negative emotions; 3) antisocial type (12%) with manipulations, repetitive lie and aggressive behavior as the essential features; 4) asthenic type (4%), if the predominant features are indecisiveness, tiredness and fear of abandonment. Social consequences included stealing (38%), death threat (10%), storage of drug (10%) as well as infliction of mild bodily (9%) and more likely to be associated with disphoric and antisocial subtypes.

Despite of some differences, three subtypes (labile, disphoric, antisocial) have a lot of overlapping features. Appears that dimensional approach to personality change due to a general Medical Condition with focus on level of severity and specific dimensions (affective lability, disphoria, aggressiveness, indecisiveness, negative consequences, ect.) rather than identification of contradictory personality subtypes is closer to the clinical reality.

Research on the impact of suicide reports is traditionally focussed on two possible outcomes: On the one hand, there is ample evidence for additional copycat effects after media coverage of suicides referred to as ‘Werther-Effect’, on the other hand, suicide rates decrease after appropriate media depictions of suicides referred to as ‘Papageno-Effect’. In contrast, studies that only limitedly support these imitative or preventive effects – i.e. all ambiguous findings – are hardly regarded.

The present study exclusively focuses on all studies (n = 28) with equivocal findings on the connection between media coverage of suicides and factual suicides and aims to systematically analyse central characteristics of these studies.

A qualitative content analysis of identified studies has been conducted whose results are systematized in Table 1.

The analysis shows that a lion's share of ambiguous studies draws on aggregate data and unidirectionally hypothesises harmful media effect, which only insufficiently describes reality.

Future hypotheses on the imitation of suicides should be formulated in a more differentiated (bi-directional) way and studies should include content analyses of media coverage as far as possible.

Table 1 Analysis of all studies that ambiguously prove copycat suicides after media coverage of suicides.

to assess the cortisol level, the cognitive deficits in schizophrenia and to assess the correlation between cognitive functions, severity of positive & negative symptoms and cortisol level in patients with schizophrenia.

This is a case control cross sectional study. After taking approval from Scientific and Ethical Committee in kasr El Aini hospital, 30 patients having the diagnosis of Schizophrenia diagnosed according to DSM-IV criteria recruited from the Psychiatric outpatient clinic and inpatient from Kasr El Aini University hospitals. All patients gave consent to participate in the study. Thirty control subjects (healthy volunteers among medical and paramedical personnel staff of Kasr Al-Aini University hospitals. All the scales show absence of psychopathology in the control group. They were matched in age and sex. Tools: All subjects were subjected to designed socio-demographic data sheet, Positive and Negative Syndrome Scale, Selected subtests from Wechsler Adult Intelligent Scale, Selected subtests from Wechsler Memory Scale- Revised. Laboratory: Salivary samples for cortisol levels assessment.

Elevated level of cortisol in the patient group, There are highly significant statistical differences between the two groups as regarding the cortisol level. There is no correlation between positive &negative syndrome scale and salivary cortisol level.

The patients with schizophrenia have impairment in cognitive performance. The level of cortisol is elevated in patient with schizophrenia than normal people. There is no correlation between cortisol level and symptoms expression, cognitive performance. There is negative correlation between the cognitive performance and the severity of symptoms.

Neuregulin-1 (NRG1) and DISC1 may be important factors in pathogenesis of schizophrenia due to their role in neurodevelopmental processes. NRG1 and DISC1 link directly into a common pathway mediated by Erb receptors and P13K/AKT1 signaling and have been implied to play role in cognitive impairments. Digit Symbol Coding Task (DSCT) from WAIS-R is a sensitive measure for cognitive decline in schizophrenia as well as it indexes poor prognosis and functional disability in schizophrenia.

The study was carried out to investigate the association of a polymorphisms of the NRG1 gene (rs62510682) as well as of DISC1 gene (rs1538979) and schizophrenia with respect to performance on DSCT.

We included 103 patients diagnosed with schizophrenia according to ICD-10 criteria and 578 controls. In addition to unstructured interviews and review of medical records, the patients were evaluated for lifetime psychotic symptomatology using OPCRIT checklist. DCSTR was administered to 80 patients.

The polymorphisms were in HWE for healthy controls and schizophrenia patients. In single marker analysis, we did not find an association for the SNPs tested. However; with respect to DCST we found that with respect to NRG1 gene T allel carriers performed worse than G allel carriers (p<0.5) and with respect to DISC1 gene patients with TC genotype performed worse than with CC genotype (p<0.05).

Our data do not support the role of NRG1 or DISC gene polymorphisms in the predisposition to schizophrenia; however, they might be considered as risk factors for the cognitive decline in schizophrenia.

Deficits in social functioning, including communication, work, social skills, and community functioning, are a defining feature of schizophrenia. Functional outcomes of schizophrenia are affected by several factors such as social cognition, neurocognition, psychopathology, and clinical outcomes. The multifaceted association among these factors and functional outcome continues to be unclear. Given the significant role of functional outcomes in schizophrenia, there has been increasing importance in factors that may underlie these outcomes. If the characteristics of these factors can be defined, interventions may be developed to improve them, which, in turn, will have a parallel impact on long term functioning and outcome. The current study examines whether social cognition, neurocognition and clinical symptoms have a relationship on functional outcomes in patients with schizophrenia.

37 patients with DSM-IV schizophrenia were assessed for: Neurocognition; MCCB-MATRICS, Clinical Symptoms: PANSS, Social Cognition: MSCEIT, Emotion Recognition-40 (ER-40), Dynamic Social Cognition Battery (DSCB: Emotion Identification - Facial, Verbal and Non Verbal), Functional Outcomes: University of San Diego Performance Based Assessment (USCD-UPSA), Social Skills: Personal and Social Performance Scale (PSP). Structural Equation Modeling (SEM) employed with maximum likelihood estimation for test effects.

The overall model fit was χ2=39.6, P<0.14. Fit indexes: Cmin/df=1.25, NFI=0.96, Tucker-Lewis index (Bentler and Bonnet nonformed fit index)=0.97, RMSEA=0.044. Regression weights of the latent variable 'Marder Negative Factor' were significant and high (β=0.91) and a substantial amount of variance could be explained by negative symptoms, indicating that the negative factor is a reliable measure of the latent variable. In addition, the regression weights of the latent variable social cognition to the 3 indicators were moderate and significant (Emotion Recognition DSCB: β=0.77, ER-40: β=0.46, and Nonverbal Emotion Identification, β=0.44). Like social cognition, the latent variable functional assessment explained a substantial amount of variance in the latent variables of working memory (45%). Impact of social cognition on negative symptoms (β=0.91) was greater than the direct impact of social functioning (β=0.78) and functional assessments (β=0.63).

This study suggests that 49% of negative symptoms could be explained by impaired social cognition and that 49% of social functioning skills could be explained by social cognition. Our findings suggest that social cognition may be an essential target to improve functional outcomes. These findings provide evidence that may help develop novel interventions.

Electroconvulsive therapy (ECT) has a long history in treating depression and its benefits are well known. Repetitive transcranial magnetic stimulation (rTMS) has been introduced more recently to the treatment spectrum.

To test the equivalence of rTMS with ECT, and compare the neurocognitive side effects of both treatment modalities.

This is a randomized comparative study, forty patients with major depressive disorder referred for ECT were randomly assigned to either a 20 session course of r TMS to the left dorsolateral prefrontal cortex or a standard course of ECT. The primary outcome measure was the score on the Hamilton Depression Rating Scale HAM-D. Secondary outcome measures were cognitive battery that assessed different aspects of cognitive functions and a subjective mood visual analogue scale. The cognitive battery comprised the Rey-Osterrieth complex figure test, the Trail making test A and B, the Digit span subtest from the Wechsler Adult Intelligence Scale.

ECT was more effective than rTMS in the short-term treatment of major depressive disorder as evident by HAM-D scores. rTMS was well tolerated with less impact on the cognitive functions compared to ECT. Level of improvement by ECT was correlated with older age, and severe baseline HAM-D symptoms, while the level of improvement by rTMS was correlated with more memory affection at the end of treatment.

ECT was more effective than rTMS in the short-term treatment of major depressive disorder regarding the overall mood symptoms. rTMS was well tolerated with less impact on the cognitive functions.

Suicidal behavior is a serious public health problem, being one of the leading causes of death in our country. Therefore, the identification of factors that increase or decrease the level of suicidal risk is of great importance for the close link with the conduct. There are several risk factors, including family and contextual, among which are the loss of significant others, including those that have been produced by suicide.

In this paper, we analyze these factors in a group of patients performing a Group Therapy.

Several studies point to the existence of a moderate correlation between the BDI item 9 (‘suicidal impulse’) with a higher score on the SSI. Another goal is to check whether this relationship is between the members of our group.

To this end, two scales were administered prior to the start of Therapy: Beck Depression Inventory, a self-report scale, and the Scale of Suicide Ideation Beck (hetero).

Our study confirms the existence of a moderate correlation between BDI item 9 (‘suicidal impulse’) and SSI. Therefore, item 9 of the BDI predicts a moderate way the result of the SSI that is related to suicidality. Similarly there is a significant correlation between total BDI SSI. We conclude that the intensity of the symptoms of depression is related to suicidality.

Consider necessary after evaluation and detection of these high-risk individuals, conducting therapeutic work aimed at the prevention of suicidal behavior within the individual treatment plan for these patients.

In addition to producing antinociception, opioids exert profound effects on body temperature.

This study aimed at comparing antinociceptive and hyperthermic responses between two groups of μ-opioid receptor agonists: fentanyl (4- anilinopiperidine-type) and morphine (phenanthrene-type) derivatives in rats.

Analgesic activity was assessed by tail-immersion test in male Wistar rats (200–250 g). The distal 5 cm of the tail was immersed in a warm water bath (55 + 0.5°C) and the time for tail-withdrawal was measured as a response latency. The body temperature was measured by insertion of a thermometer probe 5 cm into the colon of unrestrained rats.

Fentanyl (F), (±)cis-3-methyl fentanyl (CM), (±)cis-3-carbomethoxy fentanyl (C), (±)trans-3-carbomethoxy fentanyl (T) and (±)cis-3 butyl fentanyl (B) produced dose-dependent increase in antinociception and hyperthermia. The relative order of analgesic potency was: CM(11.27)>F(1)>C(0.35)3T(0.11)3B (0.056). Similar to this, the relative order of hyperthermic potency was: CM(8.43)>F(1)>C(0.46)3T(0.11)3B(0.076). Morphine (M), oxycodone (O), thebacon (T) and 6,14-Ethenomorphinan-7-methanol, 4,5-epoxy-6- fluoro-3-hydroxy-a, a,17-trimethyl-, (5a,7a) (E) also produced dose-dependent increase in antinociception and hyperthermia. Among morphine derivatives the relative order of analgesic potency was: E(56)>O(5)3T(2.6)>M(1), and similar to this, the relative order of hyperthermic potency was: E(37)>O(3)3T(2.3)>M(1).

Morphine (phenanthrene-type) and fentanyl (4-anilinopiperidine-type) derivatives produced hyperthermia in rats at doses about 2 times lower, and 6 to 11 times higher, than their median antinociceptive doses, respectively. This study is first to identify difference between these two classes of opioid drugs in their potencies in producing hyperthermia.

Schizophrenia is a psychiatric disorder which involves chronic or recurrent psychosis and it is commonly associated with impairment in social and occupational functioning. Antipsychotic medications are a first-line treatment, however, most patients experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning and episodes of acute symptomatic relapse.

Systematic literature review in UpToDate and Pubmed.

To identify the most relevant intervention areas of systematic rehabilitation in schizophrenia.

45 years old schizophrenic male who admitted in a Medium Stay Psychiatry Unit with severe behavioural impairment and psychotic symptoms. At least 10 hospitalizations and pronounced disability in basic life skills despite optimal treatment. Poor insight and compliance, frequent relapses, co-morbid substance abuse and difficult family support. Clozapine was added to his treatment with improvement in psychotic symptoms. A multidisciplinary intervention was also done and he was discharged home with important improvement in social skills, better insight and familiar functioning

Despite following an adequate antipsychotic treatment, including Clozapine as the main medication in resistant schizophrenia, it is often partially effective with severe impairments in social and occupational functioning. Family-based interventions, cognitive behavioural therapy and social skills training, added to this medication seem to be essential in the systematic treatment of schizoprenia. It includes a multidisciplinary team and a specific length of time but it is based on the patient's status. Despite evidence of their efectiveness, the availability of these interventions varies widely, as does the availability of clinicians to provide them.