A considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders.

It is not known how clinical diagnoses correspond to transitions to psychosis (TTP).

We aimed to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients.

In the European Prediction of Psychosis Study project, 245 young help-seeking CHR patients were examined, and their baseline and life-time diagnoses were assessed by the Structured Clinical Interview for DSM-IV (SCID-I). TTP was defined by continuation of BLIPS for more than seven days.

Altogether, 71 % of the CHR patients had one or more life-time and 62 % one or more current SCID-I diagnosis; about a half in each category received a diagnosis of life-time depressive and anxiety disorder. Currently, 34 % suffered from depressive, 39 % from anxiety disorder, 4 % from bipolar and 6.5 % from somatoform disorder. During follow-up, 37 (15.1 %) TTPs were identified. In multivariate Cox regression analyses, current bipolar disorder, somatoform and unipolar depressive disorders associated positively, and anxiety disorders negatively, with TTP.

Both life-time and current mood and anxiety disorders are highly prevalent among help-seeking CHR patients and need to be carefully evaluated. Among them, occurrence of bipolar, somatoform and depressive disorders seem to predict TTP, while anxiety disorder may predict non-transition to psychosis. Treatment of bipolar, somatoform and depressive disorders may prevent CHR patients from developing full-blown psychotic disorders.

Functional impairments are an essential diagnostic feature of schizophrenia. Empirical evidence supports the relevance of social cognition, negative symptoms and functional capacity as mediators between neurocognition and functional recovery in schizophrenia. However, no study has assessed these variables at different measurement points in order to infer the temporal order postulated by the mediator model. Moreover, comparing resulting models of the treatment and control group could shed light on potential change mechanisms.

Data were collected in the context of an international RCT evaluating the Integrated Neurocognitive Therapy (INT). 169 outpatients with a diagnosis of schizophrenia according to DSM-IV-TR participated in the study. The sample was analyzed separately for INT (n = 86) and TAU group (n = 83). We adopted a longitudinal design with three measurement points (baseline: neurocognition; after 3 months/after therapy: social cognition, negative symptoms and functional capacity; and after 1 year: functional recovery). Path analysis was first performed linking all variables in the model. Post hoc modifications were based on theory, model fit statistics and the statistical significance of each path.

Social cognition, negative symptoms and functional capacity served as mediators between neurocognition and functional outcome in the INT group. All indirect paths were significant and resulted in a good model fit. This result could not be confirmed in the TAU group.

The results of this study provide further evidence for integrated treatments. Social cognition, negative symptoms as well as functional capacity seem to be viable targets to optimize current cognitive remediation therapy approaches.

Addiction, or Substance Use Disorder (SUD), among adults with Autism Spectrum Disorders (ASD) has never been studied before, contrary to SUD in ADHD. However, we know from clinical practice that comorbid SUD in ASD can present with a considerable impairment. Distinguishing between ASD and ADHD can be challenging, but becomes increasingly so in case of comorbid SUD.

The main objective of this study was to gain insight into the aspects of comorbid SUD in ASD on three levels: a phenotypical, an endophenotypical, and a genetic level. A second objective was to determine how ASD differs from ADHD in adult patients on these three levels, with and without comorbid SUD.

We studied 130 patients with ASD (n = 75) or ADHD (n = 55) with or without SUD. We looked at risk factors for developing SUD, prevalence, and outcome. Furthermore, we studied personality profiles and autism spectrum profiles (AQ). We assembled neuropsychological and genetic data.

Comorbidity of SUD with ASD is less common than in ADHD, but the consequences are just as severe. Comorbid SUD is not always associated with a negative outcome, at least in the perception of the individual. Assessment of adults with ASD and SUD can be misleading when the neuropsychological functioning is not also taken into consideration. Finally, in the absence of SUD, ASD and ADHD in adults share many features on the (endo-)phenotypical level, but may be distinguishable at a genetic level. In the presence of SUD, differences between ASD and ADHD are more pronounced.

Longitudinal cognitive change before and after acetyl cholinesterase inhibitor (AChEI) treatment initiation in Alzheimer's disease has never been described previously in a representative clinical population.

To model longitudinal changes in cognitive function for before and after AChEI prescription.

To further investigate differences in response by cognitive function at treatment initiation.

A retrospective longitudinal analysis was carried out of all 1843 patients from the South London and Maudsley NHS Foundation Trust (a large mental health provider to a catchment population of approximately 1.2 m) who were prescribed AChEIs between 2003–10 and had a minimum of one MMSE score within 1 year before treatment initiation and one MMSE score within 3 years after this. Manually extracted MMSE scores were analyzed over this period using three-piece linear mixed models.

Rates of MMSE change were −1.9 (95% CI −2.3,−1.4) in the year before treatment initiation, +1.3 (0.9,1.7) in the 6 months after treatment initiation, and −2.4 (−2.6,−2.3) from 6 months to 3 years. The difference between pre-treatment and 6-month-post-treatment slopes was −0.6 (−1.8,0.6) at baseline (treatment initiation) MMSE of 25 or over, +2.7 (1.7,3.7) at MMSE 21–24, and +4.6 (3.6,5.7) at MMSE 10–20.

In this naturalistic sample, a clear cognitive response to AChEI treatment was observed over the first six months followed by an unchanged decline. Response was substantially higher for patients with lower MMSE scores at treatment initiation.

Altered cancer mortality among psychiatric patients has been reported, but competing death causes were often ignored.

To investigate whether observed cancer mortality in patients with various psychiatric disorders might be biased by competing death causes.

To assess the importance of cancer as death cause and as cause of physical comorbidity among patients with a mental illness.

In this retrospective cohort study on data from the Psychiatric Case Register Middle Netherlands linked to the death register of Statistics Netherlands, the risk of cancer death among patients with schizophrenia (N = 4,590), bipolar disorder (N = 2,077) and depression (N = 15,130) and their matched controls (N = 87,405) was analyzed using a competing risk model.

Compared to controls from the general population, higher hazards of cancer death were found in patients (schizophrenia: HR = 1.61, 95%CI: 1.26−2.06; bipolar disorder: HR = 1.20, 95%CI: 0.81−1.79), depression: HR = 1.26, 95%CI: 1.10− 1.44). However, the HRs of death due to suicide and other death causes were more increased. Therefore, among those who died, the 12-years-cumulative risk of cancer death was significantly lower among the three patient groups.

Our analysis shows that, compared to the general population, patients with a mental illness are at higher risk of dying from cancer, given that they survive the much more increased risks of suicide and other death causes.

Since 2003, the Food and Drug Agency (FDA) issued a number of advisory warnings regarding the association between use of antidepressants (ADs) and suicidal behavior, especially among young people. These warnings have led to a more restrictive use of ADs, also among adults.

We investigated the rates of (fatal) suicide attempts associated with different classes of ADs at different ages.

To contribute to finding a favorable balance between safety and the challenge to offer efficacious treatment.

By linking the Psychiatric Case Register Middle-Netherlands, which contains patients of psychiatric services in the Utrecht region, Agis Health Database, which contains registered insurance claims, and the death register of Statistics Netherlands, rates of (fatal) suicide attempts were estimated.

For 7,725 patients with a depressive disorder (mean age 43.2 years) and with at least one AD delivery, 35,224 episodes of use, 23,840 episodes of no use, 32 suicide events, and 357 suicide attempts were established. No significant differences were found in suicide and suicide attempt rates between the different classes of ADs. Compared to episodes of no use, episodes of use of ADs were significantly associated with higher frequency of suicide attempts but suicide rates were similar. A trend towards an unfavorable effect of ADs on suicide risk at younger age was found (P = 0.0718).

Our results support the FDA advisories in which ADs are treated alike. Use of ADs is indicative of a high risk of suicide, which reiterates the need for close monitoring of patients, especially at young age.

Being able to predict a chronic course in depressive disorders is highly relevant for clinicians. Naturalistic studies on clinical predictors at symptom level are scarce.

To investigate the predictive value of individual depressive symptoms measured with the widely used Beck Depression Inventory self-report scale (BDI-II) on naturalistic outcome (remission/response; measured on the observer-rated Montgomery Äsberg Depression Rating Scale [MADRS]) in a large cohort of depressive outpatients in a psychiatry outpatient setting.

We used a cohort of 1489 adult patients aged 18–65 years with MDD or dysthymic disorder established with the MINI-Plus diagnostic interview. All patients had a Routine Outcome Monitoring (ROM) baseline measurement in 2004–2009, with a maximum of two years of follow-up. We used multivariable Cox regression models to predict remission and response measured on the MADRS, and adjusted for clinical and demographic characteristics that had been identified as correlates of outcome in earlier studies.

Of the 21 BDI-II items, the symptoms pessimism and loss of energy independently predicted non-remission and non-response. For pessimism, the HRs for remission and response were 0.81 (95% CI: 0.73–0.89, P< 0.001) and 0.86 (0.78–0.94, P = 0.001), respectively. For loss of energy, the HRs for remission and response were 0.81 (0.72–0.92, P = 0.001) and 0.84 (0.75–0.95, P = 0.003), respectively.

These findings in a naturalistic treatment setting may help clinicians to identify depressive patients at risk for an unfavourable outcome.

It was the aim of this study to estimate effects of depression and anxiety on permanent disability and death in a workers' population.

128,001 health insurance clients were followed for a mean period of 6.4 years. Excess risks were calculated for patients suffering from anxiety, depression or both with Cox proportional hazard models adjusted for age, gender, education and job classification.

In several strata patients who received outpatient treatment for anxiety disorders or depression had a higher rate of permanent disability (females/anxiety: odds ratio (OR) 1.3, depression 1.3; males/anxiety not significant, depression 1.7) but a lower premature mortality (females/anxiety 0.4, depression 0.6; males/anxiety 0.6, depression not siginifant) than controls. Inpatient treatment and co-morbidity was generally associated with even higher rates of permanent disability. Depressive inpatients also had a higher premature mortality. While both illnesses were less frequent in men they showed more frequent disablement.

The reciprocity of disability and mortality among outpatients calls for a stronger focus on occupational functioning and therapy in the outpatient setting, but also raises the question why these patients obviously do better in terms of survival, in spite of worse occupational prognosis. Practitioners also need to be aware of the gender aspects and qualitative difference between depressive outpatients and inpatients in terms of survival.

The main aim of the present studies is to determine whether, or to some extent, specific cognitive domains could differentiate the main subtypes of mood disorder in the depressed and clinically remitted status respectively.

Three groups of bipolar I (n = 92), bipolar II (n = 131) and unipolar depression patients (n = 293) were tested with a battery of neuropsychological tests at baseline and after 6 weeks of treatment, contrasting with 202 healthy controls on cognitive performance.

At the acute depressive state, the three patients groups (bipolar I, bipolar II and unipolar depression) showed cognitive dysfunction in processing speed, memory, verbal fluency and executive function but not attention compared with controls. And post comparisons revealed that bipolar I patients performed significantly worse in these impaired cognitive domain than bipolar II and unipolar depression patients in verbal fluency and executive function. After treatment, clinically remitted bipolar I and bipolar II patients only displayed cognitive impairment in processing speed and visual memory in relative to controls, while remitted unipolar depression patients showed cognitive impairment in executive function in addition to processing speed and visual memory.

Bipolar I, bipolar II and unipolar depression patients have a similar pattern of cognitive impairment during the state of acute depressive episodes. At the clinically remission, still both bipolar disorder and unipolar depression patients showed cognitive deficits in processing speed and visual memory, and executive dysfunction might be a status-maker for bipolar disorder, but a trait-marker for unipolar depression

A history of previous suicide attempt is a potent risk factor for suicide later on. Crisis intervention initiated at emergency medical facilities for suicide attempters are considered important components for suicide prevention. The primary aim of this trial is to examine the effectiveness of an extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention.

ACTION-J is a single blinded randomized controlled trial. In this trial, case management intervention were provided at 19 emergency medical facilities in Japan. After psychiatric evaluation and psychological education, subjects were randomly assigned to either a group receiving continuous case management or standard care. Suicidal ideation, depressive symptoms, and general health condition were evaluated as secondary measures. The stratified logrank test based on allocation factors will be performed for all eligible participants in the intent-to-treat analysis. The study protocol was reviewed and approved by the Central Ethics Committee of the J-MISP. The protocol was also reviewed and approved by the On-site Research Ethics Committee at each participating hospital.

The intervention was initiated in July 2006. By December 2009, 914 subjects were randomized. Subject follow-up continued for 1.5 to 5 years, till the end of June 2011. ACTION-J would provide valuable information on suicide attempters and may develop effective case management to reduce future risk for suicide attempters. (ClinicalTrials.gov: NCT00736918.)

The present study compared the expression profile and made the classification with the leukocytes by using whole-genome cRNA microarrays among patients with SSD, major depressive disorder (MDD) and healthy controls.

Gene expression profiling was conducted in peripheral blood leucocytes from drug-free first-episode subjects with SSD, MDD, and matched controls (8 subjects in each group) using global mRNA expression arrays. Support vector machines (SVMs) were utilized for training and testing on candidate signature expression profiles from signature selection step.

We identified SSD and MDD gene signatures from blood-based gene expression profile and build a SSD- MDD disorder model with higher predictive power. Firstly, we identified 63 differentially expressed SSD signatures in contrast to control (P <= 5.0E-4) and 30 differentially expressed MDD signatures in contrast to control, respectively. Then, 123 gene signatures were identified with significantly differential expression level between SSD and MDD. Secondly, in order to conduct priority selection for biomarkers for SSD and MDD together, we selected top gene signatures from each group of pair-wise comparison results, and merged the signatures together to generate better profiles used for clearly classify SSD and MDD sets in the same time. In details, we tried different combination of signatures from the three pair-wise compartmental results and finally determined 48 gene expression signatures with 100% accuracy.

Blood cell-derived RNA may have significant value for performing diagnostic functions and identifying disease biomarkers in SSD and MDD. These 48 gene model could classify SSD, MDD, and healthy controls.

We investigated the relationship between tyrosine hydroxylase (TH) polymorphisms rs11042978, rs2070762 and rs6356 and early-onset schizophrenia in the Chinese Han population.

The tag single nucleotide polymorphisms (tag SNPs) rs11042978, rs2070762 and rs6356 in the TH gene were genotyped in 315 early-onset schizophrenics (188 male patients,127 female patients)and 391 controls subjects (219 males,172 females). Single nucleotide polymorphism association and haplotype analysis were performed.

There were significant differences in allele and genotype frequencies between patients and normal control subjects for rs11042978 allele (χ2 = 4.47, df = 1, P = 0.034) and genotype (χ2 = 6.35, df = 2, P = 0.042). No statistically significant differences were found in allele or genotype between patients and normal control subjects for rs2070762 and rs6356. The haplotype analysis revealed that there were significant differences between patients and normal control subjects for haplotypes GAC (χ2 = 6.35, P = 0.012).

Our study indicates that the TH gene may play major roles in the susceptibility to early-onset schizophrenia in the Chinese population.

Day Treatment Programs are on the uprise in Germany. The Pfalzinstitut's Day Treatment Program in the south-western part of Germany was established in 2006 and provides multi-professional, non-residential psychiatric and psychotherapeutic treatment to mentally disturbed children and adolescents aged 6 to 18 years. This program addresses patients with moderate to severe mental health disorders thereby offering access to patients who were referred to in-patients departments in earlier years. Work with adolescents will be outlined as most day treatment units in Germany focus on work with children aged 6 – 13 years. The treatment approach includes psychiatric and psychotherapeutic consultation (Individual and group), psycho-educational groups, pharmacotherapy, occupational and recreational therapy and school.

Data despription of a five years' clinical population. Variables include demographics, length of stay, diagnoses using multiaxial classification, problem severity and clinical outcome. The spetrum of diagnoses is compared to Pfalzinstitut's in-patient department data from the same period.

Non-residential day treatment can replace in-patient admission in a broad spectrum of psychiatric diagnoses in children and adolescents. The number of personal contact between parents and the therapeutic team is higher than in the in-patient variant of treatment. However, certain disorders such as psychosis, severe eating disorder, severe self injury and suicidal behaviour must be excluded from day treatment programs. Step-down treatment from former in-patient to day treatment is often less tolerated by adolescent patients.

Day treatment appears to be effective and equally efficient as in-patient treatment in a large spectrum of psychiatric diagnoses.

On the 1st of August 2010 guidelines aimed at ensuring the safe supply of over-the -counter codeine containing medicinal products came to force in Ireland.

The study aimed to examine the frequency of use as well as reasons for the use of non-prescription codeine containing medicines in an Irish psychiatric population before and after the introduction of regulations on the supply of codeine containing medicines.

Self administered questionnaires were designed and administered to patients before and after the introduction of guidelines regulating the sale of non-prescribed codeine containing medicines in Ireland. The results were compiled and analysed using descriptive statistics and chi-square test.

Significantly more patients reported that they often or regularly used codeine containing medicines before the introduction of the regulation compared to the period after that(33.3% vs. 17.4%, x2 = 6.354, p = 0.01). Significantly more patients also reported that others had expressed concerns about the frequency with which they used codeine containing medicines before the introduction of the regulation compared to the period after the introduction of the regulation (15.5% vs. 4.8%, x2 = 7.29, p = 0.03). Finally, significantly more patients stated that they would use codeine containing medicines either for the ‘feel good’ effect or to curb cravings before the introduction of the regulation than after the introduction of the regulation (15.9% vs. 1.9%, p = 0.00).

Tight regulations on the supply of non-prescription codeine containing medicines have the potential to reduce the abuse of such medicine among psychiatric patients in general.

Olanzapine misuse is a serious public health problem, among opiate-dependent patients in methadone program as it puts the patients at risk of life-threatening drug overdoses. However there is no study to assess how serious the problem is and what factors associated with Olanzapine abuse.

This study estimates the prevalence of olanzapine misuse in methadone program, and provides information on characteristics of olanzapine users.

A pilot study done in Drug Treatment Centre in Dublin and a survey was carried out at the methadone program. The patients were invited to participate in the survey on voluntary basis. Of the 25 patients invited to partcipate in the survey, 22 patients completed the survey.

13 out of 22 respondents had a history of olanzapine use, and out of 13 user only 5 had been prescribed Olanzapine for Co-morbid psychiatric conditions and the remaining 8 respondents used olanzapine without prescription. Out of the 8 users, 5 of them is regularly using 30–40 mg per day of olanzapine and had used 30/30 days in the last month. The remaing 3 users is intermittently using olanzapine. The current users reported more mental health problems like Anxiety, sleep disorder, and stress in the past 6 months.

The information on epidemiology of Olanzapine misuse suggest that most methadone programs do not address co-existing anxiety, sleep disorders and psycho-social stress. Based on the pilot study, a further study is currently undergoing which includes 200 opiate dependent patients on methadone program in Drug Treatment centre in Dublin.