Cycloid psychoses (CP) as described by Leonhard comprise the subtypes anxiety-happiness, confusion and motility psychoses. CP presents with an acute onset and have a favourable prognosis. The operational criteria by Perris and Brockington (P&B, 1981) are partly incorporated in ICD-10 as acute polymorphic psychosis (APP). The DSM-IV category Brief Psychotic Disorder (BPD) includes all psychoses with short duration.

Establishing concordance of Leonhard's CP with DSM-IV and ICD-10 categories.

This study was aimed to investigate the clinical characteristics of CP and to determine the prevalence of CP in patients with psychotic disorders.

80 patients with psychotic disorders were assessed by means of CASH, PANSS and CGI at baseline and after six weeks of treatment. CP's were identified according to Leonhard's descriptions. Furthermore, patients were classified using DSM-IV, ICD-10 and P&B criteria.

A diagnosis of Leonhard's CP was present in 12 patients. Overlap between Leonhard's and P&B-CP was modest. ICD-10 and DSM-IV classification showed considerable heterogeneity. Diagnoses of ICD-APP and DSM-BPD were mostly assigned to CP patients. Concordance between Leonhard's CP and these categorical diagnoses was small. Leonhard CP patients showed, compared to non-CP patients, more atypical symptoms like perplexity, pananxiety and psychomotor disturbances.

The estimated prevalence of CP in patients with psychotic disorders is 15 percent. Although identification of CP is of heuristic value, this is not warranted by current classification systems or operational criteria. Thorough clinical evaluation of psychotic disorders is required, especially in patients presenting with perplexity, psychomotor disturbances or severe anxieties.

The objective of this study was to compare the efficacy and safety of an occlusal splint vs. Gabapentin in the treatment of this problem.

Twenty subjects with sleep bruxism were divided into occlusal splints and gabapentin treatment groups. Sleep laboratory recordings by polysomnography were made before and 2 months after the interventions to assess the effectiveness of each treatment and in 4 subjects of each group on the third night after two weeks of wash-out, to evaluate the stability of treatment results. Data analysis was done by Harmonie 6.0 software. For statistical analysis, Willcoxon test was used.

Greater reduction in these parameters were found in Gabapentin group.

Occlusal splint was effective in reduction of massetter muscle activity (EMG).

Moreover, the subjects treated with Gabapentin showed a significant improvement in the total sleep time and sleep efficiency.

Gabapentin showed more improvement in duration of bruxism, whereas occlusal splint showed more reduction of massetter muscle contractions during sleep bruxism so Gabapentin can be an effective treatment modality in sleep bruxism especially in those with poor sleep quality.

Reviews of the association between psychotic disorder, the metabolic syndrome, diabetes, and antipsychotic drugs, conclude that there is a need for active, routine physical health screening of patients’ prescribed antipsychotic drugs.

To evaluate local practice of recognition of metabolic syndrome.

case notes review of 20 cases recently admitted to an in-patient psychiatric unit and comparison with national studies.

The results clearly show that routine screening for metabolic syndrome is not being carried out as recommended in national guidelines. Results were particularly poor at screening for and recording cholesterol and glucose measurements. Blood pressure is routinely checked for patients rather than as a specific screening for metabolic syndrome which explains whilst why a greater number of patients had BP checks. Cholesterol was again more likely to be checked in older patients as a risk stratification for cardiovascular disease as opposed to Metabolic syndrome.

Routine BP, glucose, a measure of obesity and cholesterol to be taken at baseline for all inpatients, especially if antipsychotic medication is likely to be started. In-patient teams to liaise with patients GP on discharge to ensure routine monitoring in the community for all patients on antipsychotic medication.

The AGNP-TDM group (AGNP: Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie; TDM: Therapeutic Drug Monitoring) published consensus guidelines for the use of TDM of psychtropic drugs in psychiatry (Baumann et al., 2004). The main objective of these guidelines was to offer a tool to psychiatrists and laboratories for optimising pharmacotherapy.

By an analysis of the scientific literature which cited this publication, the use of these guidelines for research purposes was evaluated.

The citations of the paper (Baumann et al., 2004) by Web of Science were analysed for their content, in categorising the domains of research for which this reference appeared to be useful.

Between 2004 and September 2011, this paper was cited 199 times, as reported by Web of Science. The analysis of the citations showed that the following main categories of research were particularly represented:

1. 1) Development of analytical methods for drug analysis;

2. 2) Fundamental research in psychopharmacology;

3. 3) Studies about the drug plasma concentrations - clinical outcome relationship;

4. 4) Usefulness of TDM in clinical practice;

5. 5) Pharmacovigilance, drug safety.

This study shows that Consensus guidelines developed for the daily practice are also of considerable value for research purposes.

People with Schizophrenia have excess mortality due to physical illness. Guidelines recommend monitoring of physical health at least once a year with both primary and secondary Care having a role to play.

The aim was to improve the monitoring of the physical health of patients with severe mental illness on antipsychotic medications.

The objectives were to look at the standards derived from NICE and Maudsley guidelines which included parameters like weight, blood pressure, ECG and blood tests and compare the current clinical practice and improve the annual monitoring of these in both primary and secondary care.

Data was collected retrospectively from case notes and pathology laboratory results from August 2009 to August 2010. Inclusion criteria were patients between 18 and 65 years in the community who were on antipsychotics. Sample size obtained was 82.

Weight, Blood Pressure and ECG were recorded in less than 10% of cases and blood parameters were recorded in less than 20% of cases in secondary care. Around 60% of patients had their blood parameters monitored in primary care. There was no communication of these results between primary and secondary care. In 60% of cases an annual physical health check was not recommended by Psychiatrists to General Practitioners.

Monitoring of Physical health needs to be more robust. We have devised a proforma to record results of the monitoring. We have developed a post for a Nurse Practitioner to facilitate liaison and more effective communication between the two services.

Lithium is a widely used pharmacological agent with efficacy in the management of affective disorders. Lithium has a narrow therapeutic range with a clear propensity to cause toxicity. Optimisation of safe lithium use mandates knowledge of the clinical features of lithium toxicity, drug interactions and other risk factors/clinical situations that may precipitate toxicity. Such knowledge may facilitate reversal or minimisation of risk factors.

Evaluate current levels of safe prescribing and monitoring of lithium with focus on clinical areas aforementioned.

Ascertain current safety standards of lithium use and subsequently deliver clinical sessions concentrated on knowledge deficits identified in the audit hence maximising safety for our patients.

This audit devised a local standard for safe prescription and monitoring of lithium via consulting the pharmacy department, BNF and NICE guidelines 2006.

A random sample (n = 50) of medical and nursing staff involved in the care of patients on lithium therapy was obtained.

Three four-item multiple choice questions were devised for medical and nursing staff with distinct questions for each discipline focusing on important clinical situations and risk factors in lithium use. The audit was anonymous but details were collected on the healthcare role and level of training. Participants also selected their level of confidence for answering each question on a five item scale.

Data processing is underway for this audit however at this preliminary stage important trends indicating opportunities to improve clinical knowledge and practice are identifiable.

Conclusions will be made once data processing is complete.

There are no data on the comparative efficacy of venlafaxine to other SSRI's in severe MDD.

In a post hoc analysis, data were pooled from 8 double-blind active controlled studies in outpatients with a diagnosis of MDD. Patients randomly assigned to venlafaxine (dose range 75-225 mg) or SSRI (fluoxetine (20–80 mg/day), fluvoxamine (100 mg/day), or paroxetine (20 mg/day)) were included in the analysis. Severe MDD was defined as baseline HAM-D17 >24 and alternatively as baseline MADRS≥ 31. Treatment groups were compared by mean improvement in the 17-item Hamilton Rating Scale for Depression (HAM-D17) (and alternatively MADRS) scores from baseline to last observation carried forward (LOCF). Secondary outcomes included HAM-D17 response (≥50% reduction in HAM-D17) and remission (HAM-D17 ≤7) rates, MADRS response (≥50% reduction in MADRS) and remission (MADRS≤10). Changes from baseline for the primary end point were evaluated using analysis of covariance with treatment, study, and baseline in the model.

A total of 1503 patients were included in the analysis (venlafaxine n = 805; SSRI, n = 698); 649/1503 (43%) patients had severe depression (HAM-D17 >24) at baseline. Venlafaxine improved HAM-D17 scores vs. SSRI in patients with severe MDD (venlafaxine, −15.26 [0.73]; SSRI, −12.91 [0.81]; P = 0.003). Response and remission were significantly higher in venlafaxine compared with SSRI (Response: Venlafaxine = 63% vs SSRI= 53% (p = 0.004); Remission: 41% vs. 31% (p = 0.005)). The results of the analyses were similar when baseline severity was defined by MADRS scores.

In this retrospective pooled analysis, venlafaxine was superior to SSRI's in treating severe MDD.

Weight gain is a common side effect of antipsychotic and antidepressive drug therapy, difficult both to avoid and to treat. In several randomized controlled studies, add-on treatment with metformin has been demonstrated to reduce olanzapine-induced weight gain. In our department of psychiatry and psychotherapy, metformin has been used against antihistaminic-drug-induced weight gain since 2008.

Primary: To demonstrate the efficacy of metformin for prophylaxis of antihistaminic-drug-induced weight gain in a cohort of psychiatric in-patients under naturalistic conditions. Secondary: To identify side-effects of add-on metformin therapy in non-diabetic psychiatric in-patients.

Retrospective case-control analysis of in-patient charts from 3400 psychiatric therapies between 2008 and 2010 at Ulm University Department of Psychiatry and Psychotherapy III. Cases were identified on the basis of metformin prescription without a diagnosis of diabetes. Controls were matched for gender, age, BMI, diagnosis, and drug treatment. Evaluation will be performed with descriptive statistics, covariance analyses and mixed models.

No serious side effects could be attributed to metformin therapy on the basis of the charts reviewed. Further results will be presented at the meeting.

Metformin appears to be safe with regard to side effects in psychiatric in-patients taking anti-histaminic drugs.

A large body of research has shown that Oxytocin (OXT) is an important prosocial peptide and there is also initial evidence that the central OXT system is altered in several mental disorders that are characterized by severe social disturbances and deficits, such as anxiety disorders disorders with prominent social dysfunction (e.g., schizophrenia) mood disorders and borderline personality disorder. In particular, Feifel et al. (2010) and Pedersen et al (2011) recently conducted two randomized, placebo-controlled study of intranasal oxytocin in schizophrenia patients to test the hypothesis that oxytocin can reduce symptoms of this disorder. Their results support the hypothesis that oxytocin may reduce psychotic symptoms and may diminish certain social cognition deficits that are not improved by current antipsychotic medications.

to review the main studies conducted on oxytocin and its relation with mental disorders.

We will present a systematic review on the studies conducted on oxytocin and mental disorder, both in non-clinical and in clinical samples. In order to overcome some of the limitations of the previous studies, we will present a study which is going to be run, aimed at testing whether the intranasal administration of the neuropeptide oxytocin as adjunct to antipsychotic treatment improves positive and negative symptoms its effect on social cognition, social functioning and empathy in patients with schizophrenia.

The Selective Serotonin Reuptake Inhibitors (SSRIs) act on a serotoninergic system. Serotonin is involved in mood regulation, however it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects. It was reported that in some cases, a high serum concentration of citalopram in elderly patients has been associated with increased somnolence and movement difficulties but not with delirium.

We report the case of a 65-years-old depressive man in whom i.v. citalopram in monotherapy induced delirium.

Our patient was admitted to a closed geriatric ward as a psychotically depressed with somatic and depressive delusions and suicidal thoughts. Because he rejected all per os drugs we started only with citalopram i.v. (1 ampoule of citalopram in 500 ml NS) and after 3 days he became delirious and physically aggressive because of what he was restrained. We stopped citalopram. Next day he was alert and oriented, there was no evidence of psychotic symptoms, hallucinations, or delusions. Patient was euthymic. He was not suicidal at the time of evaluation. In few days he became depressed again with depressive and nihilistic delusions. We started with dual-acting antidepressant and atypical antipsychotic what led to remission. Depressive episodes were not observed in four-year follow up.

In this report, we described a patient with acute hyperkinetic delirium associated with a i.v. citalopram what is the first description of this kind of sideects of i.v. citalopram.

Evidences that anxiolytics has limits in the treatment of anxiety disorders (AD) are growing: maximal efficacy demonstrated in AD of simple structure and decreases when structure becomes more complex.

Evaluation of therapeutic action and effectiveness realization of different by spectral characteristics anxiolytics in AD of different structure.

To compare effectiveness of benzodiazepine derivate Phenazepam and mercaptobenzimidazole derivate Afobazol in relation to clinical picture.

This randomized comparative study of Phenazepam (2 mg/day, n = 36) and Afobazol (30 mg/day, n = 30) included patients with generalized anxiety disorder (GAD), panic disorder (PD) and nosophobia. Study included placebo lead-in and active treatment periods (14 days) and utilized HARS, ASRS Zung, Spielberger's State Anxiety Inventory and CGI scale.

Study revealed significant differences of drugs’ therapeutic action. Phenazepam promotes anxiolytic effect with hypno-sedative and muscle relaxant properties. Afobazol has selective anxiolytic action with stimulatory component. Nevertheless both drugs shared efficacy pattern.

Study found no differences between drugs on anxiety and effectiveness measures, though in GAD Afobazol demonstrated some advantage on efficacy due to its stimulatory action.

Study favored notion that therapeutic capabilities of anxiolytics in the AD treatment have limits regardless of drugs effects’ spectral characteristics. Effectiveness is higher in simple (GAD) and affective-loaded anxiety (linked to phobias) and lower when agoraphobia, avoidance, heteronomous sensations and overvalued hypochondriaс ideas are presented.

Quetiapine extended release (XR) was developed to provide convenient, once-daily dosing and rapid dose escalation when compared to the immediate-release (IR) formulation.

To review preclinical and clinical study data on the efficacy and safety of quetiapine XR in bipolar depression and major depressive disorder (MDD).

Review of published studies and presentations at scientific congresses.

Quetiapine fumarate demonstrates a broad spectrum of efficacy in psychotic and mood disorders. In pharmacologic studies, quetiapine and its major active metabolite, norquetiapine, have actions on 5-HT2A receptors and D2 receptors, considered to explain efficacy in psychosis and mania. Norquetiapine, unlike quetiapine and other atypical antipsychotics at relevant doses, has affinity for the norepinephrine transporter in-vitro and demonstrates binding in-vivo, which may contribute to antidepressant efficacy. Quetiapine XR as monotherapy (300 mg/day) was significantly more effective than placebo in a study of patients with acute bipolar depression, with onset of effect as early as 1 week. In large, placebo-controlled studies, quetiapine XR as monotherapy (50-300 mg/day), or adjunct therapy (150-300 mg/day) to antidepressants, has demonstrated efficacy against depressive and comorbid symptoms in MDD, with rapid onset of effect. The safety profile of quetiapine XR in these studies was broadly consistent with quetiapine IR. Sedation intensity during initial dose escalation was significantly lower with quetiapine XR than IR in 1 study in patients with bipolar depression.

Quetiapine XR is effective in bipolar depression and MDD and has a safety profile consistent with quetiapine IR.

By funding from AstraZeneca Pharmaceuticals LP.

Antipsychotic drugs cause prolongement in QTc interval and may cause sudden cardiac death in patients.The purpose of this study is to reveal the effects of metoprolol and diltiazem on drug induced (ziprasidone) prolonged QTc(QT correct) interval.

In this study 18 Sprague-Dawley adult male rats is used.Before application of anti-pshychotic, under anesthesia,ECG is taken in derivation(D) I and normal QTc interval was determined. For calculate QTc Bazett's formula was used.

Rats were divided into 3 groups (n = 6).For first group 3 mg/kg ziprasidone and saline, for second group 3 mg/kg ziprasidone and 1 mg/kg metoprolol,for the third group 3 mg/kg ziprasidon and 2 mg/kg diltiazem is applicated intraperitoneally.

2 hours later after application of drugs, under anesthesia, QTc was calculated by taking ECG in derivation I.

İn the first group rats which is taken ziprasidone and saline QTc(0.161 ± 0.01 s) is significantly(p < 0.05) prolonged than rats before application QTc(0.125 ± 0.009 s).

İn the second group rats which is taken ziprasidone and metaprolol QTc(0.123 ± 0.009 s) is significantly(p < 0.05) shorten than rats which is taken ziprasidone and saline(First group) QTc(0.161 ± 0.01 s) İn the third group rats which is taken ziprasidone and diltiazem QTc interval (0.125 ± 0.004 s) is significantly(p < 0.05) shorten than rats which is taken ziprasidone and saline(First group) QTc(0.16 ± 0.01 s).

High dose ziprasidone make prolongement in QTc interval. Metoprolol and diltiazem prevent ziprasidone induced elongation in QTc interval. The prophylactic use of this drugs may be an hope by reducing the ventricular arrythmias and sudden cardiac death in patients taking antipsychotics.

Venlafaxine is a serotonin and norepinephrine reuptake inhibitor widely used for the treatment of depression, generalized anxiety, and social anxiety disorders, as well as a number of other psychiatric conditions for which serotonergic antidepressants are often employed. Although urinary incontinence is listed as one side effect of these drugs, there are few reports in the literature.

To present a case report of venlafaxine-induced urinary incontinence and a review study regarding the theme with articles available in Medline.

A case report is presented in sequential detail and literature review of this theme shortly reviewed.

A 56-years-old caucasian man, average weight, with no prior medical or substance use history, with personality disorder and comorbid depression. This subject had his medication dosages increased from venlafaxine 150 mg/day to venlafaxine 225 mg/day; almost immediately he reported an increase in the urinary frequency, urge and incontinence. These clinical features remitted 72 hours after the dose was decreased to 150 mg/day. Animals studies suggest that incontinence secondary to serotonergic antidepressants could be mediated by the 5HT4 receptors found on the bladder. Further research is needed to delineate the frequency of this side effect and how best to treat it.

Urinary incontinence is an important medical condition with clinical and social implications. Clinicians who prescribe venlafaxine or other serotonergic antidepressants should be aware of the potential development of incontinence and need to query patients, particularly those at highest risk, with direct questions about this potential adverse effect.