The basic helix-loop-helix (bHLH) transcription factor TCF4 was confirmed in the combined analysis of several large genomewide association studies (GWAS) as one of the most significant schizophrenia (SZ) susceptibility genes. TCF4 influences verbal learning and memory in humans and modulates sensorimotor gating in SZ patients. We showed recently that transgenic mice overexpressing Tcf4 in forebrain (Tcf4tg) display profound deficits in fear memory and sensorimotor gating.

We investigated the influence of different environmental conditions on the behavior and cognitive performance of Tcf4tg mice by exposing 4 weeks old animals for 4 weeks to single cage housing (SH) or to group housing in enriched environment (EE). In SH, animals were housed under poor conditions without any enrichment. In contrast, EE cages contained two separate compartments: the first with one-way entrance and one-way exit for drinking/feeding, and the second compartment with tubes and a running wheel enabling physical exercise. Animals underwent a profound analysis addressing basic behavior and cognitive performance.

We demonstrated that SH (isolation stress) increases whereas housing in EE (combination of social support with physical exercise) rescues the cognitive impairment of Tcf4tg mice. We provided evidence that the manifestation of the phenotype of Tcf4tg mice depends strongly on environmental factors. This substantiates the importance of G×E interactions in the manifestation of schizophrenic phenotypes.

The observed phenotype of Tcf4tg mice may resemble the situation in patients where symptoms can be elicited by the ‘second hit’ (social stress) and can be ameliorated by social support or physiotherapy.

Knowledge of drug prescription is essential for pharmacovigilance, i. e. for classifying adverse drug reactions (ADR) in clinical routine and for methods of their elimination and prevention.

Since the frequency of ADR is correlated with age, multi-morbidity and polypharmacy, special attention should be given to the medication of elderly or chronically ill patients.

To determine the rate of all kinds of ADR inpatient data (number, gender, age, and psychiatric diagnoses), drug prescriptions and occurrences of ADR were surveyed.

Once in a week for a period of six weeks data from all inpatients of an open station of each of the departments social psychiatry and geriatric psychiatry of the kbo-Inn-Salzach-Klinikum gemeinnützigen GmbH were determined.

The 34 inpatients of geriatric psychiatry were on average 75 years old with on average eight prescribed drugs. Leading diagnosis was recurrent depression’ (17%); leading prescribed agent was sertraline (13%). In 55% of cases ADR occurred, mostly eliminated by medicinal counteractions (34%).

The 54 inpatients of social psychiatry were on average 41 years old with on average four prescribed drugs. Leading diagnosis was paranoid schizophrenia (24%); leading prescribed agent was risperidone (14%). In 36% of cases ADR occurred, mostly eliminated by stopping medication and medicinal counteractions (each 31%).

In general, new drugs were prescribed in a cautious dose-regime. Clozapine was still of high relevance. Drug prescriptions were age specific as was the occurrence of ADR. Although ADR occurrence was high (55% and 36%), severe cardiac and circulatory troubles were relatively rare.

Increasing evidence suggests that clock genes may be implicated in a spectrum of psychiatric diseases, including sleep and mood related disorders as well as schizophrenia. The bHLH transcription factors SHARP1/DEC2/BHLHE41 and SHARP2/DEC1/BHLHE40 are modulators of the circadian system and SHARP1/DEC2/BHLHE40 has been shown to regulate homeostatic sleep drive in humans.

In this study, we characterized Sharp1 and Sharp2 double mutant mice (S1/2-/-) using online EEG recordings in living animals, behavioral assays, global gene expression profiling and bioinformatic modeling. Gene expression in human brains samples was performed with qRT-PCR.

EEG recordings revealed attenuated sleep/wake amplitudes and alterations of theta oscillations. Increased sleep in the dark phase is paralleled by reduced voluntary activity and cortical gene expression signatures reveal associations with psychiatric diseases. S1/2-/- mice display alterations in novelty induced activity, anxiety and curiosity. Moreover, mutant mice exhibit impaired working memory and deficits in prepulse inhibition resembling symptoms of psychiatric diseases. Network modeling indicates a connection between neural plasticity and clock genes, particularly for SHARP1 and PER1, which are also significantly downregulated in the frontal cortex of schizophrenic patients.

Our findings support the hypothesis that abnormal sleep and certain (endo)phenotypes of psychiatric diseases may be caused by common mechanisms involving components of the molecular clock including SHARP1 and SHARP2

Stress has been associated with depression in the past, but large enough, prospective studies to demonstrate this relationship still have to be produced.

To investigate the relationship between stressful life events and depressive symptomatology in a large sample of adolescents, in a prospective setting.

9032 adolescents that participated in all the waves of the SEYLE project were included. Mean age of our study group was 14.84 ± 0.88 years. 56.5% of the participants were females. We used the Beck Depression Inventory (BDI) to assess the depressive symptomatology and Kendler's Life Events Checklist to assess the life events. We build several multivariate linear regression models controlling for age, sex and baseline depressive symptomatology.

Total number of life events occurred in the previous 12 months seems to be significantly related to the intensity of the depressive symptomatology. Personal life events seem more closely related to depressive symptomatology than network life events. Out of the personal life events, the ones in the Interpersonal, Work (School), Marriage (Intimate relationship), and Financial categories seem to be the most important for this relationship.

Our study supports the hypothesis that life events can lead to depression in adolescents and draws attention on the most important categories of life events for this relationship.

Family disintegration due to workforce migration is a relatively new phenomenon affecting quite a large number of families in developing countries around the world that raised a lot of concerns regarding the mental health of children and adolescents left behind.

To investigate weather family disintegration is associated with suicide risk in adolescents.

The 12395 adolescents from the SEYLE baseline evaluation were included. Mean age in this group was 14.91 ± 0.90. 55.2% of the participants were females. We used the direct questions in the SEYLE baseline questionnaire to assess for families in which at least one parent was working abroad and for suicide attempt history. A binary logistic regression model was used to test this hypothesis, controlling for significant depressive symptomatology (assessed using the Beck Depression Inventory), substance misuse, the presence of a physical disability or chronic illness and the number of life events.

Our data revealed that parental migration, along with depressive symptomatology, substance misuse and the total number of life events reported in the previous 6 months were the items most closely associated with suicide attempt history.

Family disintegration due to workforce migration is associated with a higher risk for suicide in adolescents.

Disturbed body image perception and personality features and the way they influence eating disorders have been frequently studied in patients with eating disorders, but not in children's non clinical samples.

To analyze the influence of body image perception and personality features on eating disturbances in a non clinical sample of children

Longitudinal study. The sample was composed of 100 children, who were assessed at eleven and thirteen. Emotional, cognitive and behavioral aspects of the body image were evaluated using BPSS, BSQ, DST, BIAQ and body mass index (BMI). To assess personality features the EPQ was used and to assess eating disorders three scale of EDI-2 (drive for thinness, bulimia and body dissatisfaction) were used. For the statistic analysis, stepwise regression was used.

In the boys’ group, introversion ate 11 positively correlated with drive for thinness at 13. Neuroticism predicted higher bulimia score and body mass index predicted body dissatisfaction. In the girls’ group, neuroticism predicted drive for thinness, psychoticism predicted higher bulimia and higher BMI predict body dissatisfaction.

Personality features and BMI seem to predict at eleven the eating disturbances that will be detected later, at thirteen.

The incidence of different psychiatric diagnoses in Danish Psychiatric Hospitals are characterized by fluctuations. This phonemena could be due to changes in true incidence, changes in the entry into the health care system, changes in the diagnostic practices and the possibilities of treatment for a given disease, or due to changes in the attention towards the disease within the population, the profesionals or the medias.

Nowadays there is a notable increase of the number of new ADHD diagnoses among children and adults.

There is a need for epidemiological measures in ADHD in The Danish Psychiatric Health Care System.

To investige treated incidence in ADHD in adults in Denmark through the period of 1995–2012, and to investigate psychiatric comorbidity, latency from the first contact to the ADHD diagnosis and mortality.

From The Danish Psychiatric Central Research Register all patients with following diagnoses given for the first time ever after their 18th birthday were identified: ICD-10: F.90.0, F90.1, F90.8, F90.9, F98.8.

These data are used to make an age standardized incidence rate throughout the period differentiated with gender and possible existence of previous childhood psychiatric diagnosis. We will also analyze for psychiatric comorbidity after their primary ADHD diagnosis.

The statistical analysis are still in progress.

There is a marked increase in treated incidence in adult ADHD from the introduction of ICD-10 to 2012. Further results about psychiatric comorbidity and mortality will be presented.

The first goal of schizophrenia treatment in the past was to reduce positive symptoms, because it is thought that due to psychopathology and poor awareness, patients were unable to assess themselves and their needs. Recently, the goal of the treatment is improvement of social life and emphasizes the assessment of quality of life and life satisfaction as a priority of the service providers.

Quality of life and life satisfaction assessment in schizophrenia, evidence of anxiety and depression in schizophrenia and connection between the above variables.

Exploration of quality of life and life satisfaction in patients suffering from schizophrenia.

Subjects were120 outpatients diagnosed with schizophrenia by psychiatrists. Data were obtained using: Quality of Life Questionnaire, Hopkins Questionnaire for Depression and Anxiety, Life Satisfaction Questionnaire and The McGill Illness Narrative Interview.

Data collected were analyzed with SPSS 17. Description of the results includes descriptive data, cross table for nominal data and ANOVA and T test for averages. Average age was 41.6, range 21–67. Average of education was 10.1, range 4-19. The average age of diagnosis was 25.1, range 15–39.

Frequent changes of therapy have resulted in more anxiety and depression symptoms in patients suffering from schizophrenia. Individuals with more symptoms of anxiety and depression were found to have less life satisfaction. Quality of life was found to be the highest reported in individuals treated with atypical antipsychotics.

Publication of scientific research papers is important for professionals working in academic medical centres. Quantitative measures of scientific output determine status and prestige, and serve to rank universities as well as individuals. The pressure to generate maximum scientific output is high, and quantitative aspects may tend to dominate over qualitative ones. How this pressure influences professionals’ perception of science and their personal well-being is unknown.

We performed an online survey inviting all medical professors (n=1206) of the 8 academic medical centres in The Netherlands to participate. They were asked to fill out 2 questionnaires; a validated Publication Pressure Questionnaire and the Maslach Burnout Inventory.

In total, 437 professors completed the questionnaires. among them, 54% judge that publication pressure ‘has become excessive’, 39% believe that publication pressure ‘affects the credibility of medical research’ and 26% judge that publication pressure has a ‘sickening effect on medical science’. The burn out questionnaire indicates that 24% of medical professors has signs of burn out. The number of years of professorship was significantly related with experiencing less publication pressure. Significant and strong associations between burn out symptoms and the level of perceived publication pressure were found. The main limitation is the possibility of response bias.

A substantial proportion of medical professors believe that publication pressure has become excessive, and have a cynical view on the validity of medical science. These perceptions are statistically correlated to burn out symptoms. Further research should address the effects of publication pressure in more detail and identify alternative ways to stimulate the quality of medical science

Negative attitudes towards mental illness or the psychiatrist's role have repeatedly been reported in the literature among pregraduate medical students. Although a clerkship may improve the student's attitudes, negative perceptions regarding mental illness remained unchanged in about one-third of the students. When recovery is being assumed as a central concept of care, the presence of stigma among students represents an ethical challenge that the medical schools cannot avoid.

to implement a programme aiming i. to assess the stigma towards mental illness among pregraduate medical students, and ii. to tackle negative attitudes regarding mental illness and psychiatry.

The authors, targeting the 6th year medical students, have developed a one half-day program to be held before the 4-weeks psychiatric clerkship. The program offers sequentially an initial overview about the concept of stigma, several examples from experiences reported by patients, videos and role-playing exercises. Attitudes towards mental illness were assessed by the Kassam‘s et al Mental Illness: Clinicians’ Attitudes Scale MICA-2’ self-reported questionnaire.

106 students were evaluated. The acceptance was very good, with no refusals to participate in the program. After the clerkship, perceptions about patients’ dangerousness, the need for social protection, the assets and the role of psychiatry were significantly improved.

The good acceptance from the students and the preliminary results were very encouraging, suggesting that this program could change attitudes towards mental illness favorably. Given we’ve just evaluated a time span of one month, further studies are needed to assess the temporal stability of the changes.

International literature indicates that migrants have highest incidence of mental disorders compared to natives, especially for psychotic disorders. Few studies about mental health of migrants in Italy have been published, although net migration rate grew in the last twenty years.

to describe socio-demographic and clinical characteristics of migrants attending Community Mental Health Centre (CMHCs) of Borgomanero (Piedmont, Italy) and to evaluate differences in psychiatric diagnoses and pathway to care among different ethnic groups.

Migrants attending CMHCs between 1st January 2012 and 31 August 2013 were included in the study. Data were gathered retrospectively from clinical data sets.

97 Migrants attended the CMHCs. The most represented ethnicity is East European (36%), the less one is Asian (4%). Most frequent diagnosis is adjustment disorder (33%). In most cases, access to the service follows the family doctor's referral (46%), except for patients with schizophrenia, whose access is most frequently direct (they are usually brought to the service by family members) (33%). The majority of those migrating for working reasons suffers from adjustment disorder, schizophrenia or anxiety. Pathway to care and diagnosis seem to be statistically related (p-value 0,00052), as well as migration reason and diagnosis (p-value 0,0452). Lack of regular residence permit seems to be related to non-medical pathways.

Pathways to CHMCs are complex and influenced by many factors. Most of the sample received a diagnosis of adjustment reaction. More attention should be paid to developing psychiatric consultation liaison models that encompass the physician and social services.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

43 psychiatrists responded

All respondents agreed that reason for referral is essential.

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

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

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

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

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

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

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

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

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

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

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

To evaluate the clinical acceptability of GRID-HAMD.

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

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

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