Atypical antipsychotics are actually the first-line treatment in schizophrenia. Obsessive–compulsive symptoms (OCS) are common in patients suffering from schizophrenia and seem to worsen prognosis. Whilst atypical antipsychotics can be a useful augmentation strategy in refractory Obsessive Compulsive Disorder (OCD), their efficacy in case of comorbid obsessive compulsive symptoms in schizophrenia remains unclear.

The purpose of this literature review was to examine the relationships between atypical antipsychotics, Obsessive Compulsive Symptoms (OCS) in schizophrenia.

A systematic MEDLINE database was run using the following key-words: atypical antipsychotics, obsessive compulsive symptoms and schizophrenia (27 articles).

Clozapine, risperidone,olanzapine and quietiapine may induce or exacerbate OCS in patients with schizophrenia due to their anti-serotoninergic properties. There was no study with ziprazidone,aripiprazole nor amisulpiride. For schizophrenic patients with comorbid OCS, the first line strategy appears to be combination therapy with clomipramine or an Selective Serotoninergic Reuptake Inhibitors (SSRIs)(fluvoxamine, sertraline, fluoxétine) and an atypical antipsychotic. Moreover, in these cases, cognitive behavioural therapy should also be considered.

Obsessive Compulsive symptoms and schizophrenia are an ongoing matter of debate in terms of comorbidity or constitution of a specific "schizo-obsessive" subtype. Nevertheless, according to the worsening prognosis of this phenomenon, combination therapy (atypical antipsychotics and SSRIs) remains the most relevant therapeutic approach. Moreover, cognitive behavioural therapy studies in this area are required.

Impulsive behaviours (impulse control deficit) and compulsive behaviours (over control) have been considered at the core of different disorders, but patients often present with mixed features of impulsive and compulsive behaviours (i.e. patients with OCD and borderline personality disorder). Therefore, a clinical spectrum from impulsivity to compulsivity could exist, in which obsessive compulsive disorder (OCD) and impulsive personality disorders (borderline personality disorder, antisocial personality disorder…) would be the endpoints.

Regarding treatment, SSRI have demonstrated high efficacy in the treatment of both impulsive and obsessive-compulsive symptoms. On the other hand, topiramate has been described as an effective agent in treating impulsive behavior.

The aim of this study is to test the hypothesis that coadjuvant treatment with SSRI and topiramate would improve the outcome of patients with comorbid OCD and impulsive behaviour disorders.

We will describe two clinical cases admitted to our Psychiatric Hospitalization Unit. Case 1 is a 39 years old female diagnosed with OCD, borderline personality disorder and alcohol dependence and case 2 is a 38 years old male with OCD, mixed personality disorder and cocaine abuse.

Treatment with topiramate (range dosage: 250-400 mg/daily) as well as SSRI (paroxetine 40 mg/daily- case 1; sertraline 200 mg/daily-case 2) improved affective instability and impulsive symptoms in both patients. Topiramate was well tolerated without important side effects.

Topiramate could be an interesting alternative in the coadjuvant treatment of OCD with impulsive features.

The present study addresses the empirical basis for alerting health professionals to potential risk factors for excessive gambling. On the basis of international and Swiss literature on gambling, an explanatory model for the development of gambling problems is developed.

This work is based on the hypothesis that the prediction rule for excessive gambling, based on a sample of the general population and for different types of frequent gambling preferences, differs from the prediction rule for disordered gambling in patients, seeking psychiatric treatment. The goal of this study is, therefore, to contribute to an early identification of disordered gambling behaviour in the general population, as well as in the target group of patients seeking psychiatric treatment.

Various sources of information were analysed separately, in order to develop and test a prediction rule for excessive gambling, namely the 2002 Swiss Health Survey, which is a survey of the general population, involving 19'706 participants, as well as the data of psychiatric patients of Lausanne/Geneva, recruited consecutively from 1996 to 2004 at the Psychiatric Hospital of the University of Lausanne. This patient population comprised a total of 886 patients. Further data from the Centre for Excessive Gambling are presented, covering 105 patients.

Results show that indicators of depressive behaviour as well as smoking are good candidates for the early identification of gambling problems. On the basis of these data it is safe to assume that signs of depressive behaviour should encourage health professionals to enquire about gambling problems.

The subdivisions of the corpus callosum (CC) were attempted to define corresponding areas of the cortex from which the fibers originate. Previous neuroanatomic studies of the CC provide impetus for investigating its role in obsessive-compulsive disorder (OCD).

In this study diffusion tensor imaging (DTI) was employed to microstructural abnormalities of white matter of the CC in OCD patients. Nine patients with OCD and matched control subjects underwent DTI. Fractional anisotropy (FA), an index of the integrity of white matter tracts, was determined in the seven subdivisions of the CC. We placed each reagions of interest (ROI) over the sagittal plane and all subdivisions were measured.

Significant reduction in FA was found in the rostrum of the CC of patients with OCD compared with one of controls. FA of the other subdivisions except the rostrum in OCD patients did not differ significantly compared with control subjects. Higher FA in the rostrum correlated significantly with lower Y-BOCS scores (r = -0.803, p = 0.009).

The rostrum contains fibers from inferior premotor as well as medial and caudate/orbital prefrontal regions. These results supported the theory of dysfunction of prefrontal cortex and striatal circuits in OCD and suggested the implication of the orbitofrontal circuit for symptom severity in the OCD patients.

To investigate the feasibility, and patient/psychiatrist acceptability, of an SMS text messaging system reminding patients receiving quetiapine to take their medication.

8-12(mean:9.4) week, non-interventional, psychiatrist assessed, pilot study of 27 outpatients receiving quetiapine (mean age[range]: 35.3[19-57] years). Patients were asked to reply to SMS messages sent twice daily to their cellular phone to remind them to take their medication (morning) and enquire about their well-being (evening). Patients' response (morning-yes/no; evening-positive/negative/neutral) was monitored by psychiatrists (n=7) via a website, and subsequently used to assess technical feasibility. Psychiatrists rated acceptability and feasibility of the system by completing case report forms (CRFs). Data are from the LOCF population.

Patients responded to 77% (compliance) of the 5,000 SMS messages sent (84% correctly, 13% inaccurately, 3% responded late [eg, day after]). 7/27 patients withdrew prematurely. The most common benefits expressed by patients were that they felt cared for (n=11/21) and were reminded to take their medication (n=7/21). Psychiatrists' ratings of the system improved over time, with SMS compliance and increased patient contact seen as the most valuable aspects. At study end, CRF data showed psychiatrists felt the system was valuable to 19/22 patients, 16/24 patients remained compliant with the system and 16/22 patients felt the frequency of SMS messages was acceptable. There was a strong correlation between patients giving positive well-being responses and SMS compliance (R Pearson=0.72, p<0.001).

The high levels of SMS compliance and benefits expressed by patients and psychiatrists support a larger-scale assessment of this system.

Despite the achievements made in the treatment of obsessive-compulsive disorder (OCD), there still remains a high non-response rate to SSRIs. Furthermore, response is often delayed, increasing non-compliance. Even among responders, many do not reach remission and although symptoms are alleviated, functional impairment is still significant for some patients. These unmet needs would benefit from the development of strategies and treatment algorithms, including data on the role of antipsychotics and the potential therapeutic effects of new pharmacological agents. A better understanding of neurotransmitter involvement in the pathogenesis of the disorder, and the neurobiology of OCD might also pave the way for new treatments.

Twelve international experts in the field of obsessive-compulsive related disorders produced a consensus statement with the goal of updating the data, and discussing controversies, following a two-day consensus meeting. The statement is divided into chapters discussing: dimensions and diagnosis, the neurobiology of OCD, current and emerging treatments, and populations of special concern.

With the suggested changes to the diagnosis of OCD in the upcoming DSM-V, and the broader view now taken towards disorders to be included in under this heading, the biology of impulsivity and uncontrollable urges takes on an additional meaning and opens up a variety of potential new treatments. The specific outcome of the statement will be discussed briefly in view of the limitations of a poster.

There is emerging evidence from basic science and imaging that can be potentially harnessed for improving diagnosis, and consequently treatment interventions, in OC-related disorders.

The Modified Mini- Mental State Examination (3MS) is a brief cognitive testbattery designed to detect cognitive impairment.

To adapt the 3MS in German and to assess the effectiveness of the 3MS in identifying Alzheimer's disease (AD) in comparison with the conventional Mini- Mental State Examination (MMSE) in a German population.

A clinical group composed of 31 patients with early AD and 5 patients with moderate dementia of AD etiology was compared with 46 cognitively normal participants matched for gender and age. The 3MS scores were adjusted for educational attainment.

The 3MS and MMSE were validated against an expert diagnosis based on a comprehensive diagnostic work- up. Statistical analysis was performed using the Receiver Operating Characteristics (ROC)

ROC curves demonstrated the superiority of the 3MS over the MMSE in identifying AD. The optimal cut- off score for the 3MS for detecting dementia was 88, which had a sensitivity of 98% and a specificity of 94%.

The German version of the 3MS is a short and practical but accurate test battery for the identification of AD.

The prevalence of cerebro-vascular disease in patients with Alzheimer disease varies widely among studies depending on being autopsy-based or clinical-pathology or neuro-image based.

AD+CVD patients may show some degree of variability on the diagnoses and therapeutic approach across different clinical specialists.

To observe potential differences among physicians on the diagnosis and therapeutic approach of patients with AD+CVD.

This was a cross-sectional, multi-center, nation-wide study performed in Spain.

The investigators participants worked in three clinical specialties: neurologists, geriatricians and psychiatrists.

A total of 107 investigators were involved in this study. Three out of four doctors (76%) were neurologists (81), 14% were geriatricians (15), and 8.4% were psychiatrists (9). The investigators included 720 patients diagnosed with AD+CVD.

Neuro-image techniques (NIT) and medical history (MH) were the most common methods of diagnosis. The scanner was performed in 69% AD+CVD patients, and magnetic resonance image was performed in 45%.

There were significant differences among physicians on the frequency of use of MH (98% of neurologists/geriatricians used MH vs. 85% of psychiatrists (p<0,04)), and also on the use of NIT (99% of neurologists/geriatricians vs. 84% of psychiatrists (p<0,0001)).

Galantamine (60%) and memantine+donepezil (19%)were the most common prescribed drugs by psychiatrists.

Psychiatrists used primarily MH to diagnose patients with AD+CVD, while neurologists used more frequently NIT. Geriatricians used both methods and vascular risk factors for the diagnosis of AD+CVD.

More than a half of physicians used galantamine as first-election treatment in patients with AD+CVD.

The vesicular monoamine transporter (VMAT2) plays a major role in the synaptic accumulation and release of monoamines.

We assessed high affinity [3H]dihydrotetrabenazine binding to platelet VMAT2, in a group of untreated male Tourette's syndrome (TS) patients (age: 8-17.5 years, n=9) and in a comparison group of age-and sex-matched healthy controls (age: 9-16 years, n=16).

Significantly decreased platelet VMAT2 density (Bmax) (-23%, P=0.016) was observed in the TS patients. The affinity (Kd) of the ligand to platelet VMAT2 was similar in both groups.

If the lower platelet VMAT2 density also occured in the brain, it may serve as an adaptive mechanism geared to decrease dopamine storage in the presynaptic neurons and thereby to diminish the dopaminergic overactivity and ameliorate the movement disorder.

Both Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD) are characterized by abnormalities in cognitive and executive domains. The diagnostic criteria of these neurodevelopmental disorders are described in behavioral terms. Criteria for developmental disorders have not been adjusted for adulthood, both in quantitative and qualitative terms. Furthermore there is a substantial symptomatic overlap on a behavioral and clinical level.Various executive functions have been proposed as cognitive endophenotypes.

Based on the literature we hypothesised: 1)larger discrepancies between V-IQ and P-IQ. 2)lower scores on verbal comprehension, vocabulary and comprehension in the ASD group. 3)ADHD low on working memory, high processing speed and the opposite in ASD. 4)ADHD perform poorly on fluency and inhibition and perform well on the Rey, the WISC and planning (ToL).

The comparison was done in each 20 patients with ADHD and ASD.

it was only to a marginal extent possible to discriminate the groups on these neuropsychological functions.

There is a considerable overlap between ASD and ADHD on several neuropsychological functions.

Low-dose interferon-α is standard therapy for hepatitis C. Psychotic disorders have been described as a scarce complication of the treatment that resolves with its termination.

we present a patient with negative personal and familial psychiatric history who developed serious chronic psychotic disorder with persistent cognitive impairment on the level of dementia after seven month interferon-α therapy. Profound parkinsonian side-effects of neuroleptic treatment accompanied the disturbances.

Potentially severe brain consequences of long-term low-dose interferon-α therapy for hepatitis C in a susceptible individual may emerge. The underlying cause of the susceptibility remain obscure, however dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as HPA axis hypersensitivity might be supposed. This biological vulnerability might interact with the cytokine's action on brain. Relatively frequent and in some cases serious neuropsychiatric adverse effects of interferon-α therapy indicate the necessity of regular psychiatric consultations during the treatment.

To analyze correlation between clinical symptoms and histological changes of human a.basilaris.

We retrospectively studied relation between histological changes of a.basilaris and psychoneurological state in 10 cases of 40-70 years old patients, who died by accident.

Analyzing retrospectively case histories we found such symptoms in psychical neurological state: basilar syndrome, emotional lability, rapid changes of mood, asthenia. 6 patients were diagnosed basilar syndrome by neurologists, 4 patients were diagnosed symptoms of F 06 group (according to ICD-10). Histological changes in a.basilaris were reduced amount of elastic fibre in blood-vessel media, increased quantity of collagen fibre and widening of intima.

Most frequent symptoms correlating with a.basilaris structural changes were basilar syndrome and organic mood, anxiety disorders.

Tourette's syndrome (TS) is a childhood-onset neuro- psychiatric disorder characterised by multiple motor and vocal tics lasting more than one year. An immune-mediated mechanism involving molecular mimicry has been proposed for PANDAS (Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). PANDAS may offer a new way to explore the pathogens of GTS. IL-1Ra86bp,IL-1βexon5 gene Polymorphism and Cognitive Function are studied in 86 Children with Tourette's Syndrome.

In the present study, we genotyped a large multiplex sample of GTS affected children for polymorphisms in IL-1Ra86bp,IL-1βexon5 genes. Associations were tested by the transmission disequilibrium test (TDT). 86 Han Chinese children with GTS were tested using a set of neuropsychological test(Stroop test, trail making test, verbal fluency test, modified Wisconsin Card sorting test) and compared with 51 healthy control group to understand the relationship between cognitive deficits and genetics.

No evidence for transmission disequilibrium was found for polymorphisms of IL-1 Ra86bp,IL-1 βexon5 gene in this GTS sample. The frequency of 410bp/240bp genotype and 240bp allele in combined ADHD were significantly different from GTS alone. Compared with normal children, The GTS group showed impairment on almost all psychological measures. No evidence show significantly difference among IL-1Ra86bp, IL-1βexon5 gene Polymorphism and Cognitive Function.

For the GTS+ADHD group, the 240bp allele of IL-1Ra gene Polymorphism perhaps is another risk factor.GTS patient has memory, attention and executive function defect, these defects may have something to do with the prefrontal dopamine disfunction.

22 patients were included.

All patients had neuropsychological and behavioural examination including Mini Mental Test (MMSE), Neuropsychiatric Inventory (NPI), and UPDRS for the motor activity assessment. Apathy dimensions, emotional blunting, lack of initiative and lack of interest were assessed using the Apathy Inventory (IA). Patients DA striatal uptake were assessed by 123I-FP-CIT (DaTSCAN®) SPECT. A method of quantitative 3D measurement was used in order to allow a precise quantification of modifications affecting striatal cerebral structures.

The two diagnostic subgroups were equivalent in term of age and MMSE score.

There were no correlations between the NPI delusion, hallucination, depression and anxiety score with DA uptake. There was a significant correlation between the IA total score and the bilateral putamen DA uptake. More specifically, lack of initiative significantly correlated with bilateral putamen DA uptake, whereas lack of interest significantly correlated with left caudate DA uptake. The UPDRS score was significantly correlated with left putamen and caudate DA uptake.

Using partial correlation coefficients controlling for the UPDRS score, the correlation remained significant between lack of initiative with right putamen DA uptake and left putamen DA uptake.

These results indicate that there is a relation between apathy and DA uptake, independent of motor activity.

Atomoxetine, a highly selective noradrenaline reuptake inhibitor, shows efficacy in the treatment of ADHD. Despite evidence that atomoxetine improved inhibitory control in animals and healthy volunteers, studies had yet to explore short-term cognitive effects in patients with ADHD.

The cognitive effects of a single oral dose of atomoxetine (60mg) were evaluated in n=22 adults with DSM-IV ADHD, using a within-subject placebo-controlled double-blind design. Assessment included the stop-signal test and Rapid Visual Information Processing test from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Cardiovascular responses were monitored. Normative cognitive data from 20 healthy volunteers were collected for comparison.

Atomoxetine was associated with shorter stop-signal reaction times (p<0.05) and lower numbers of commission errors (p<0.05) on the sustained attention task in the ADHD patients.

These findings suggest that atomoxetine exerts beneficial effects on aspects of inhibitory control in ADHD, which may belie the efficacy of this medication in the treatment of impulsive features of the disorder. These findings also have potential clinical implications for other impulse dysregulation disorders such as trichotillomania and Tourette's Syndrome.

In recent years there is the rising trend of anticholinergics use among high school students especially it is common to mix alcohol with anticholinergics. The characteristic features of anticholinergic intoxication are the rapid onset of alterations in mood, cognition and perception in the presence of a clear sensorium and following the ingestion of the drug in a commonly distributable form. But if psychotic symptoms are present in the absence of retained reality testing a diagnosis of substance-induced psychotic disorder may be warranted. Therefore, in same cases clinical picture presents a differential diagnostic dilemma.

The authors present the case report of twenty-one year old male with dependence of multiple drug use (according the criteria of ICD-X), who was observed in department of alcoholism. In early adolescence period he used different psychoactive substances (opioids and non-opioid psychoactive substances). At last two years he episodically consumed anticholinergics. Upon the mixed use of alcohol with anticholinergics he experienced auditory hallucinations, rapid and incoherent speech and paranoid ideation. He acted out his imperative hallucinations aggressively with violent behavior.

During hospital treatment he was treated with antipsychotic medications, benzodiazepines and supportive and educational therapies.

On this regiment psychotic symptoms resolved completely after two weeks.

Results of complete psychiatric-psychological examination did not indicate psychotic disorder.