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.

Cognitive dysfunction (CD) affects 10-36% of patients with systemic lupus erythematosus (SLE). Its pathogenesis comprise direct neurocytoxicity, vasculopathy, thrombosis, hipercholesterolemia and atherosclerosis. The aim of this study was to evaluate CD in SLE patients and to investigate whether it is influenced by selected immunological and cardiological parameters.

Thirty-two SLE patients in remission were enrolled. Anti-cardiolipin and anti-dsDNA antibodies were estimated using immunoenzymatic techniques. Transthoracic echocardiography was performed using Acuson CV70. Since at least some tests proposed by the American College of Rheumatology for neuropsychological evaluation have Polish language version, we have used the Cambridge Neuropsychological Test Automated Battery (Cantab) that employs non-verbal stimuli and requires non-verbal responses. The following Cantab tests were used: Motor screening (MOT); Big little circle (BLC); Paired associated learning (PAL); Stockings of Cambridge (SOC); Graded naming test (GNT).

In SLE results obtained in BLC, PAL, SOC PSMM, and GNT were lower than those of controls.

SOC Mean initial thinking time correlated with ACL IgG (r=0.42; p=0.42) and anti-dsDNA antibodies (r=0.47, p=0.23) and, also, with aorticdiameter (r=0.48; p=0.036). SOC Mean subsequent thinking time negatively correlated with Left-ventricular-end-systolic diameter (r=-0.5; p=0.02). GNT correlated positively with posterior-wall-systolic-diameter (r=0.45; p=0.049) and interventricular-septum-systolic diameter (r=0.61; p=0.005).

SLE patients are cognitively compromised. Immunological and cardiological correlates may indicate underlying vascular brain damage. Biological explanation of the observed correlates is, however, unclear and possible causality needs further studies to become elucidated.

The influence of socio-demographic characteristics, namely immigration, on the risk to develop schizophrenia is well known. However, the impact of these variables on its initial clinical presentation and long-term prognosis is less well established.

To compare socio-demographic characteristics, the clinical presentation of schizophrenia and other variables known to influence prognosis in immigrant and non-immigrant young patients (social performance, quality of life, psychopathology, therapeutic adherence, insight and premorbid adjustment).

A group of consecutive patients diagnosed with schizophrenia (ICD-10), aged 18 to 25, followed in our department's community-based early intervention in psychosis program were assessed using: ACECF short version for cognition, PANNS, WHOQOL short version for quality of life, ITAQ for insight, MARS for medication adherence, and PAS for pre-morbid adjustment. Information was also gathered on the following variables: gender, age, civil status, level of education, number of readmissions, and medication. The two groups (immigrants and non-immigrants) will be compared with the adequate statistical analysis.

Preliminary results demonstrated that the immigrant group showed significantly lower levels of attention and concentration, of medication adherence, and of risk of aggression compared to the non-migrant group. The two groups did not differ in any of the remaining variables studied. We are still waiting final results.

The results will contribute to a better understanding about the influence of the immigration status on the clinical picture of schizophrenia, and allow for the development of more comprehensive rehabilitative treatments.

It is difficult to differentiate whether neuropsychiatric symptoms are caused by systemic lupus erythematosus (SLE) or psychiatric background, coexisting disorders or drug-induced side effects. The aim of this paper is to present two cases of psychotic symptoms (bipolar and paranoid disorder) induced by chloroquine.

Case 1: Severe depressive episode with psychotic features appeared in the context of third SLE exacerbation and chloroquine treatment. Hydroxychloroquine was used instead and symptoms resolved. Later, manic episode (with psychotic features) emerged several days after chloroquine was prescribed for concomitant arthritis. Since that time, chloroquine has been withdrawn. Currently the patient is undergoing treatment with hydroxychloroquine and psychiatric drugs with good response.

Case 2: The second patient started to suffer from headaches and being lightheaded three days after chloroquine administration and within next few days feeling of derealization and poorly defining persecutory delusions accompanied by strong anxiety with occasional visual illusions occurred with clear consciousness. After eighteen days chloroquine was withdrawn and after two days all the symptoms resolved.

Clinicians should be vigilant for possible psychiatric disorder when using chloroquine in patients with SLE. Such cases are probably rare and may include both paranoid and bipolar spectrum disorders. Studies on interactions of chloroquine with brain neurotransmitter systems are needed. Hydroxychloroquine may represent lower risk considering psychiatric complications. Mechanism of the difference is currently not known.

There is growing literature regarding the controversial subject of the placement of early intervention in psychosis programs (EIP) in the psychiatric services network.

To review the literature concerning the different organizational models in early intervention in psychosis and their positioning with local psychiatric services.

To describe our community based early intervention program, integrated in a general adult psychiatry service. We intend to reflect about our experience, on the weaknesses and strengths of our service's model.

A non-systematic literature review about different models of service organization in early intervention in psychosis was performed, using Medline database and Google Scholar search-engine as well as reference textbooks.

The current debate is centered on whether EIP should be organized as autonomous services or integrated in broader psychiatric services.

The PSIC Programme is an assertive community-based programme for patients with a first psychotic episode. It was developed by the Psychiatric Department of Prof. Doutor Fernando Fonseca Hospital in 2001 through the cooperative use of the existing human and financial resources.

The integration of early intervention programs in general psychiatric services, allows for the delivery of specialized rehabilitative treatments while maintaining the continuity of care even after the critical period.

Early intervention programs encapsulate a new optimism within community mental health teams. Inevitably the high standards imported from early intervention, begin to be benchmarks for all services for psychotic individuals.

The corticosteroid-induced neuropsychiatric symptoms may occur at any time of corticosteroid use and include depression, mania, psychosis and delirium.

To present corticosteroid-induced neuropsychiatric symptoms of patient with atopic dermatitis.

A case report of acute manic episode induced by a short course of dexamethasone.

A thirty-six year old female was referred to the Department of Dermatology and Venereology, Medical University of Lodz because of insufficient clinical improvement of a treatment regimen ordered, and due to psychiatric problems associated with the use of dexamethasone.

History of any other skin disease, psychiatric problems or internal disorder was not relevant. After two days of treatment with dexamethasone 8 mg, the patient developed progressively increasing symptoms of psychomotor agitation, elevated mood, distractibility and early waking up. Six days later she started to experience increasing sensitivity to acoustic stimuli, startle response, feeling of being almighty and anxiety. On the ninth day dexamethasone was withdrawn. After a psychiatric consultation she was prescribed sodium valproate from 75 mg to 300 mg. The patient was also taking perazine 25 mg in the evening together with valproate. All the symptoms resolved two weeks after administration of antipsychotic treatment.

Understanding the neurobiological mechanism involved in glucocorticoid-induced affective disorders is crucial for effective prevention and treatment of these complications. Further studies are needed to elucidate if patients with atopic dermatitis represent a special risk group considering psychiatric complications of systemic steroid treatment.

Impulse control behaviours (ICB) are repetitive and excessive activities that are subsyndromal, unfulfilled the diagnostic criteria but potentially challenging problem. Impulse control disorder (ICD) on contrary is an established diagnosis which requires clinical attention.

To determine the proportion of patients with ICD among those screened positive with ICB among patients with Parkinson's disease in an Asian population. The factors associated with ICB were also examined.

Eighty consecutive patients attending neurology clinic who fulfilled the inclusion criteria i.e. diagnosis of idiopathic Parkinson's, on stable dopaminergic medication for at least 3 months were recruited in this prospective cross-sectional study. ICB were identified using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson's disease (QUIP). Those who were screened positive, with controls, then underwent semi structured interview based on SCID-ICD.

11.3% were screened positive for ICB; these were significantly associated with higher education (p=0.022), advanced stage of disease (p=0.026) and higher levodopa dosage (p= 0.01). The most frequent ICB was compulsive medication use (7.5%), followed by hobbyism (6.25%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.25%). 50% of those with positive QUIP (section1) fulfilled the criteria for ICD (50% positive-predictive value) while none with negative QUIP had ICD (100% negative predictive value).

About 1 in 10 patients with Parkinson's disease displayed ICB, half of which might have a diagnosable ICD. The risk should alert the physicians of the need for routine assessment of impulse control problems in patients with Parkinson's disease.