Patients with schizophrenia experiences varying clinical courses in the symptoms and up to 30-60% of patients with schizophrenia do not respond sufficiently to antipsychotics. Treatment-resistant Schizophrenia (TRS) can have several reasons, including early onset, nonadherence to oral medication regimens, and persistent negative symptoms known as deficit syndrome. Patients with TRS experience frequent exacerbations, leading to the need for higher doses of antipsychotics to achieve a clinical result.

Recently, dopamine supersensitivity psychosis (DSP) and tardive dyskinesia (TD), both of which could be caused by inappropriate pharmacotherapy, as typified by excessive dosages of antipsychotics, have also been presumed relevant to TRS. Several lines of evidence suggest that both DSP and withdrawal psychosis are closely linked to the supersensitivity of dopamine D2 receptors; this could be caused by a potent blockade of the receptors by antipsychotics. Indeed our study recently has found that patients with DSP are overlapped with the concept of treatment-resistance, and these patients can be recovered by long-acting injectable form, via amelioration of Dopamine supersensitivity state. However, it was also observed that one group did not improve at the clinical symptomatic level, despite the presence of DSP.

Here, we try to verify relation in patients with treatment-resistant schizophrenia between several classes of antipsychotics or clinical symptoms and treatment process with oral antipsychotics after the initiation of RLAI. This study is a naturalistic, one-arm design with a 12-month observation period of a moderate sample size (N=115).

As many as 1 in 5 children and adolescents have a mental illness, and it is estimated that of those, only 1 in 5 is diagnosed and receives treatment each year. Children with chronic medical illnesses are up to three times as likely to develop a psychiatric illness as their healthier counter-parts, and very few of these children are seen by a child and adolescent psychiatrist. The majority of these mentally ill children are treated either by their primary care physician, pediatrician, or consulted on by an adult psychiatrist. The aim of this workshop will be to educate the adult psychiatrist on the more common presentations of comorbid psychiatric illnesses as they present in the chronically medically ill child or adolescent in the hospital setting. We will discuss general principles of capacity, consent, and assent, as these topics are often overlooked and not well understood. Beyond this, we will explore why mental illnesses are under-diagnosed in the medical hospital setting. Medically ill children with comorbid psychiatric symptoms often present with vague physical complaints such as nausea, malaise, or GI distress. These symptoms can often mimic symptoms of the primary medical illness or even exacerbate primary physiological symptoms. It is often difficult to discern whether somatic complaints are representative of a psychiatric illness or a medical illness. We will analyze 2 cases of severe Conversion Disorder leading to repeated medical hospitalizations and how they were eventually psychiatrically managed to minimize repeated subsequent medical hospitalizations and improve quality of life.

Parkinson's disease is a disabling neurodegenerative disorder that affects 7-10 million people worldwide. Psychiatric symptoms are a significant non-motor feature of this disease and have been found to have significant impact on health related quality of life. Psychiatrists should have an awareness of nuances in diagnosis and management of psychiatric illness in this unique patient population. The pathophysiology of Parkinson's disease is complex, with neurodegeneration affecting dopaminergic, serotonergic, noradrenergic and cholinergic systems. As such, more than 50% of patients will develop symptoms of depression and/or anxiety. Medications used to treat Parkinson's disease, such as levodopa or dopamine agonists can produce manic and even psychotic symptoms. Patients can also develop an addiction to these medications and begin abusing them. This can result in mania, impulse control disorders and psychosis.

Pharmacology and management of patients with Parkinson's disease is complex due to interplay between treatments needed for their disease and the resulting psychiatric comorbidities. The role of an interdisciplinary team, composed of experts in neurology, psychiatry and even neurosurgery, is cruicial to success in treating these patients. This team becomes significantly more important when patients are evaluated for Deep Brain Stimulation (DBS). Psychiatrists should be aware of specific comorbidities, such as untreated severe depression or psychosis, which may make patients a poor candidate for this procedure. Psychiatrists should also be familiar with how to manage psychiatric complications following DBS along with the interdisciplinary team.

Traumatic brain injury (TBI) is one of the most common causes of disability and death. The consequences of not only severe but also a mild head injury are unpredictable and can cause the development of gross mental disorders. An important task is to identify the main factors determining the prognosis of traumatic brain injury. The aim was to determine the risk factors for poor prognosis of TBI, resulting in severe mental disorders. Using clinical examinations, psychometric scales, flow cytometry, and determining the level of melatonin we have examined 437 patients with a history of head injury, which caused different psychopathological symptoms (study group). The patients who had brain injury in the past, which did not lead to distant psychotic effects (72 patients), represented the control group. 1.5-2 years after the brain injury in the study group, reduction of level and disorders of melatonin rhythm synthesis were detected in 69%, which was associated with insomnia, flattened diurnal temperature curve and uncontrollable asthenia. In the future, patients with disorders of melatonin synthesis have so-called psychopathological 'heat lightning'. 3 years after traumatic brain injury in the study group patients using the flow cytometry, we were able to detect active caspase cascade self-destruction of the target cells. Clinically, it led to appearance of hallucinatory-paranoid features and cognitive impairment. In the control group, such symptoms were not detected. Functional disorders in patients, who have had mild TBI lead to permanent adjustment disorders.

Sulpiride is a commonly used treatment for depression in Europe and Japan. Here we describe its use in combination with a complex homeopathic preparation based on the Krebs cycle elements for the treatment of depression. Sixty-seven women with depressive symptoms selfselected treatment with low-dose sulpiride (20mg) and homeopathy (n=35), sulpiride alone (n=32), or homeopathy alone (n=15), administered parenterally as once-daily subcutaneous injections for three months. Depressive symptoms were assessed semi-quantitatively before and after treatment using the Hamilton rating scale for depression (HAMD). The HAMD score significantly decreased in the group treated with combined sulpiride and homeopathy (from 21.3 ± 5.0 before treatment to 8.8 ± 4.1 after treatment; p<0.0001), but not in the other treatment groups. This observation suggests that a low parenteral dose (20 mg) of sulpiride, when administered subcutaneously with a complex homeopathic remedy, may have a synergistic effect when used for the treatment of mild to moderate depression. Further clinical testing in randomized controlled trials is warranted.

The world of Web 2.0 involved the shift of media from passive viewing to active bi-directional interface. The new generation of technology makes access to others much easier through social networking, blogging, and the abundance of information available via search engines.

A simple Google search of a physician's name will grant a patient access to their health grades, publications, office website, Facebook/Twitter/Linkedin accounts and on some occasions cell phone, email, and home address. With more and more young physicians using the web for both personal and professional reasons, caution should be taken in the amount of information available and be wary of possible boundary and privacy violations. Several physicians have made national headlines over information posted on social networking sites, such as the OB/GYN who reprimanded her patient over Facebook for being late to appointments. Young physicians should be aware of potential pitfalls of patients have easy accessibility to physicians such as a suicide threat sent via Facebook message, text, or email.

The purpose of this workshop will be to provide education to psychiatrists about the specific guidelines as they relate to interfacing with Web 2.0 including using social networking sites, blogs, email and text in both personal or professional interactions. Potential boundary and HIPAA violations will be presented using real life examples. Discussion will be fostered among attendees on ways to handle situations such as a friend request from a patient, an inappropriate post from a colleague, a suicide threat over email, and how to monitor your Internet presence.

The ECT it continues being one of the principal treatments available and used in Psychiatry for the serious mental illnesses. A considerable variability exists between physicians and between geographical regions with regard to the use of the ECT as treatment of the first line or only of secondary form when the patients do not answer to other interventions.

The ‘therapeutic inhibition’ largely can be due to a stigma that is based on antiquated and old-fashioned beliefs to near the treatment, in spite of that the utilization of the ECT has been supported by numerous studies.

This practice can deprive the patients of an effective treatment, delay the response and prolong the suffering and possibly contribute to the resistance to the treatment.

With this study one tries to know the characteristics and diagnostic indications of all the patients who have been attended in the unit of Mental Health of the hospitable complex of Albacete, which they have needed treatment with ECT.

A descriptive study is realized, observacional, restrospectivo by a group of patients who have been necessary the ECT in a period of study understood between 3/4/2008 to 31/10/2013. Variables will be analyzed sociodemográficas and diagnostic as; Distribution for age, sex and marital status, number of meetings of received ECT, hospitable needed stay, indications for diagnosis, response to the ECT and side effects.

In the literature there are examples of comorbidity of respiratory tract diseases (particularly chronic obstructive pulmonary disease and asthma) and mental diseases, especially anxiety, depressive and cognitive disorders.

The research project was aimed to confirm a connection between psycho-intellectual functioning and suffering from aforementioned diseases. Participants of the research project were divided into 3 groups. In the asthma group there were 17 people, mean age 51. The COPD group was formed by 22 people, mean age 67. The control group included 18 people, mean age 49. Patients from all groups underwent spirometry, sputum induction and the following tests: Mini-Mental State Examination, Trail Making Test, Beck Depression Inventory – and State-Trait Anxiety Inventory for Adults.

In the TMT tests (Part A and B) results were as follows: in control group 31 s and 70 s, in the asthma group 36 s and 96 s and in the COPD group 41 s and 104 s. In the Beck Depression Inventory the lowest mean score was obtained in the control group - 7 points, then in asthma group - 8 points and in COPD group - 12 points. Results for STAI (Part A and B) were distributed as follows: in the asthma group - 35 and 40 points; in the COPD group 39 and 43 points and in the control group 34 and 36 points.

Concluding, in the research study the level of anxiety and depression measured by self-assessment questionnaires in the study groups was higher and cognitive functions were worse than in healthy control.

Thoughts of death and suicide attempts are important factors in major depression. Rare suicide methods as well as common suicide methods may also be encountered in suicide behaviors. In this case, 39 year-old female patient with depressive episode in bipolar disorder who had suicide attempt with henna (lawsonia inermis) is presented. Toxic effects of henna, risk of death and rare suicide methods were discussed. A rare and bizarre suicide attempts can be related the form of suicide and selected objects. Henna use is similar to a suicide attempt with drug but is interesting as the selected object. Physicians should be careful about rare bizarre suicide attempts.

Ulrich Hegerl and the EAAD members

A variety of factors such as undertreatment of depression and other psychiatric disorders, access to lethal means, media coverage of suicidal acts, stigmatisation of patients with mental disorders and alcohol consumption contribute to the high numbers of completed and attempted suicides in Europe. The 4-level-intervention concept developed within the model project’Nuremberg Alliance against Depression’ provided evidence for the efficiency of an intervention approach targeting simultaneously several of the above mentioned factors (1). Up to now, similar 4- level interventions have been implemented in more than 100 regions in Europe (2). This was done via large EU-funded projects, namely the’European Alliance against Depression’ (EAAD; www.eaad.net) and OSPI-Europe (www.OSPI-europe.com; 7thFramework Programme). From these projects data on suicidal behaviour during interventions in comparison to baseline and control regions (3) and on process evaluation will be presented. Via the EAAD, the intervention concept, the intervention materials and the broad experiences with the implementation of 4-level interventions in different cultures are offered to interested regions in and outside of Europe.

Within the vigilance regulation model the hyperactivity and sensation seeking observed in overtired children, ADHD and mania are interpreted as an autoregulatory attempt to stabilize vigilance (central nervous arousal) by increasing external stimulation. Correspondingly the withdrawal and sensation avoidance in major depression is interpreted as a reaction to a state of tonically high vigilance (1, 2). Using an EEG-based algorithm to classify automatically short EEG-segments into different vigilance stages as observed during the transition from active wakefulness to drowsiness and sleep onset (VIGALL), both patients with ADHD and mania show an unstable vigilance regulation with rapid drops to lower vigilance stages under quiet rest. The contrary was found in unmedicated patients with major depression (2). Studies will be presented supporting the validity of VIGALL (simulataneous EEG-fMRI and EEG/FDG-PET studies, as well as the neurophysiological, clinical and predictive validity of the vigilance regulation model of affective disorders. Among the far reaching consequences of the vigilance model is the question whether psychostimulants have similar beneficial effects in mania as observed in ADHD (3), an aspect which is presently studied in an international, randomized controlled trial (4).