Recent epidemiology studies have reported the prevalence of adult ADHD to be approximately 4%, however approved treatments are limited.

Primary objectives were to confirm the clinically-effective and safe dosage range of MPH-LA in adults with ADHD and evaluate the 6-month maintenance of effect.

Treatment Period (TP) 1: Patients were randomized to double-blind placebo, MPH-LA 40, 60, or 80 mg/day for 9- weeks (3-week titration, 6-week fixed-dose) to evaluate change in DSM-IV ADHD-RS and Sheehan Disability Scale (SDS) total score in TP1. TP2: 5-week titration to individual optimal dose. TP3: Patients were randomized to their optimal dose or placebo for 6-months double-blind withdrawal period to evaluate percentage of treatment failures during TP3.

Improvement from baseline in total score on the DSM-IV ADHD-RS and SDS was significantly greater than placebo for all MPH-LA dose levels (table). Patients treated with MPH-LA had significantly lower treatment failure rates (21.34%) compared to placebo in TP3 (49.6%; odds-ratio (95%CI=0.3 (0.2, 0.4); p< 0.0001). The safety results were consistent with the established safety profile for MPH-LA.

[Improvement by week 9: DSM-IV ADHD-RS and SDS].

MPH-LA administered at 40-80mg/day demonstrated superior ADHD symptom control and reduction in functional impairment compared to placebo and demonstrated maintenance of effect over 6 months. No unexpected adverse events were observed.

Several studies so far have addressed the issue of haematological and biochemical changes in depressed patients, but the results have been contradictory.

Twenty four depressed patients (7 male/17 female, age:42.72±12.22) and 30 control subjects (6 male/24 female, age:43.60±10.25) were studied. Beck Depression Inventory (BDI) was used to assess their emotional state and haematological, biochemical tests were conducted. Because of the small sample sizes, statistical significance was examined using non-parametric Mann-Whitney test.

As expected, patients had higher BDI total score than controls (mean±SD: 22.0±17.21 vs. 8.77±6.79, mean rank: 25.32 vs. 15.15) and higher values in most (13/21) BDI statements. Patients also had higher Hct (mean rank: 33.90 vs. 22.38), Hgb (mean rank: 33.52 vs. 22.68), urea (mean rank: 32.19 vs. 23.75), cholesterol (mean rank: 32.04 vs. 23.87) levels than controls, but lower serum glucose levels (mean rank: 21.69 vs. 32.15).

Although higher serum lipid levels have previously been connected with depression, to our knowledge, no such association has so far been established for higher serum urea, lower serum glucose levels, or higher Hct and Hgb.

Cardiometabolic diseases are under-diagnosed and under-treated in psychiatric inpatients. A common solution is implementation of screening guidelines. However, we often forget to ask the essential question: Why were our patients underdiagnosed in the first place?

To identify causes of under-diagnosing and under-treatment in the context of local clinical practices.

All consecutive admissions (n=63) over 93 days were screened for hypertension, diabetes, dyslipidemias and abdominal obesity. Patients identified with both (a) undiagnosed and untreated disease and (b) admission on a separate occasion within the previous two years to the ward in question, were selected for a retrospective patient file review. These patients (n=32) had their medical records scrutinized for information on how each cardiometabolic measure was assessed at previous admission.

Relevant examination were performed in 38% of cases and test results were abnormal for 54% of these. Abnormal test results were evaluated in 14% of cases and none of the evaluated results were acted upon.

Rigorous examination and testing of patients is only of value if clinicians have the essential knowledge to interpret the results and feel responsibility to do so. These barriers must be broken down before implementing screening guidelines in routine clinical practice.

Nutrition has been linked to the development and deterioration of cognitive functions in normal and disordered populations. Drug-dependent individuals show a variety of cognitive deficits and seem to differ in their diets from healthy people. Despite this, there has been very little investigation into the potential relationship between nutrition and cognition in drug dependence.

To investigate the effects of nutritional factors on cognitive performance in drug-dependent individuals.

To test the hypothesis that stimulant (cocaine or amphetamine)-dependent individuals’ and healthy volunteers’ diets significantly differ, and that these differences are related to their cognitive performance.

Stimulant-dependent individuals (N=58) and age-matched healthy volunteers (N=63) completed a Food Frequency Questionnaire to assess usual food intake, a set of computerised neurocognitive tests, and a selection of clinical questionnaires.

Controlling for their levels of education, stimulant-dependent individuals performed significantly worse than healthy volunteers on tests of learning, memory and attention. The nutritional content of stimulant-dependent individuals’ diets also differed significantly, controlling for differences in caloric and alcoholic intake. However, whilst healthy volunteers’ ingestion of nutrients such as fruit and electrolytes were related to their processing speed in a test of sustained attention, no such relationship was found in the stimulant-dependent group.

The study of non-memory cognitive functions after ECT has been relatively neglected. Event-related potentials (ERP) are thought to reflect some cognitive processes. ERP P300 is a sensitive indicator of disturbances of attentional and working memory processes.

Aim of this study was to examine the effect of course of ECT on auditory ERP P300.

P300 potential was recorded in 22 patients. 12 patients had schizophrenia spectrum disorders and 10 patients had various mood disorders. Mean age of patients was 40±13 years (from 22 to 72 years). ERPs were recorded before the first ECT procedure and after the last ECT. Recordings were made at Fz, Cz and Pz electrode sites. Peak-to-peak (N2-P3) amplitude and latency of P300 wave were analyzed. Correlation between P300 parameters, clinical symptoms (measured using PANSS, MADRS, HAM-D scales) and parameters of ECT procedure - delivered energy, seizure energy index (SEI) and duration of seizure - was evaluated.

After ECT clinical symptoms have improved. There was also a statistically significant increase in P300 amplitude. Increase was greater in the 20-39 years old patient group. Decrease in P300 latency was insignificant. Correlation between P300 latency and SEI, and between P300 amplitude and delivered energy was more reliable in the mood disorders group. According to HAM-D the improvement of depression symptoms correlates with the decreased latency and increased amplitude of the P300 potential.

ECT may improve information processing in patients with treatment-resistant schizophrenia spectrum disorders and mood disorders as assessed by event-related potential P300.

Ahe adult patients with attention deficit hyperactivity disorder (ADHD) are characterized by an increased vulnerability to daily life stressors. Cortisol awakening response (CAR) can be used as an index of the adrenocortical activity that relates to chronic stress. Although gender differences in cortisol response have been explored in children with ADHD, there is a lack of gender studies in adults with this disorder.

The aim of the present study is to evaluate possible gender differences in CAR in adults with ADHD.

A total of 50 patients (22 female, age 37.00±8.62 years, and 28 male, age 33.86±9.57 years), with ADHD were recruited from the program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. Patients fulfilled current DSM-IV diagnostic criteria for ADHD. Psychiatric and organic comorbid disorders were excluded and all the patients were naïve to psychostimulant treatment. Four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening (work days).

Mean increase in CAR was 10.39±8.68 nmols/l for men and 10.29±9.13 nmols/l for women. T-test comparisons showed no significant gender differences in CAR in adults with ADHD (t= 0.033, z=0.974).

As reported in children, adults with ADHD show no differences in CAR. Albeit these results are still preliminary, they suggest some gender differences in CAR between adults with ADHD and cortisol response in general population.

To demonstrate the complex correlation existing in patients with eating disorders between hormonal alterations and psychopathological symptomatology, that has been little studied until now.

60 women aged between 16 and 35 years and diagnosed with Anorexia Nervosa and Bulimia Nervosa according to the DSM-IV were assessed using the SCL-90-R, EDI, BAT and DES II. A blood sample was taken from each patient in the morning, on the seventh day of the menstrual cycle or on the corresponding day from the women with amenorrhea; the following hormone levels were measured: TSH, FT3, FT4, LH, FSH, 17-beta-estradiol, cortisol, DHEAS. Pearson's Correlation Coefficient has been used to test the correlation between hormonal level and test scores.

Positive correlations exist between BMI and FT3 and LH, which decrease when BMI decreases. We can observe positively significant correlations between LH and FSH levels and the BAT scale scores.No one significant correlation was found between hormonal levels and dissociative symptoms as measured by DES. With regard to EDI, the following psychopathological features correlate with hormonal assessment: the wish to be thin, body dissatisfaction and perfectionism.

Our findings suggest a significant correlation between psychopathological features we considered and hormonal readings, especially LH, FSH, TSH, FT3. When these hormonal readings decrease, the patients’ self-ratings and their body dissatisfaction decrease. That attributes a protective meaning to the dietary symptom akin to an effective measure that relieves the person's feelings of inadequacy.

Studies point to an adverse effect of detention on the mental health of asylum seekers, yet the use of detention has been rising in several recipient countries. In general, many asylum seekers suffer from psychological disorders and symptoms, and a large percentage has been subjected to torture. The UNHCR recommends that torture survivors generally should not be detained. Due to a lack of systematic screening it is often unknown whether the asylum seeker is a torture survivor. This causes several hindrances for the protection of this vulnerable group from potentially harmful factors such as deprivation of liberty.

To examine the impact of detention on the mental health of adult torture survivors.

To produce a comprehensive review of the literature and bring attention to a potentially harmful praxis.

The systematic review follows the PRISMA guidelines. The search was made in PubMed (Medline), PsychINFO, PILOTS and IBSS. A screening of reference lists identified additional studies. The search was broadened to ‘asylum seekers’ as very few studies were found on torture survivors specifically.

Presently (Oct. 2012) the review is in the stage of analyzing, thus results are preliminary. Currently the identified studies amount to 26. All studies report mental health problems among the asylum seekers and some identify detention itself as a contributing factor to these problems.

Detention does pose a risk factor in regard to deteriorating the mental health of asylum seekers. Although torture survivors might be an especially vulnerable group, research is almost non-existent.

To explore tolerability, safety and treatment response of flexible doses of paliperidone palmitate in adult non-acute patients with schizophrenia previously unsuccessfully treated with oral antipsychotics.

Interim analysis of a prospective 6-month, open-label study. Outcomes were change in the Positive and Negative Syndrome Scale (PANSS) score, Clinical Global Impression-Severity Scale (CGI-S) and patient functioning (Personal and Social Performance Scale; PSP) from baseline to endpoint, weight change and adverse events (AEs).

Of the first 403 patients enrolled (63.3% male, mean age 39.4±12.0 years). 74.4% completed the study. Most frequent reasons for discontinuation were subject choice (10.7%), and AE (5.5%). The recommended initiation regimen was administered in 94.0% of subjects. Mean PANSS total score decreased from 71.9±15.2 at baseline to 60.8±18.4 at endpoint (mean change -11.1±15.4; 95% confidence interval [CI]-12.6;-9.6; p< 0.0001); 61.2% of the patients showed an improvement of ≥20% in PANSS total score. The percentage of patients rated mildly ill or less in CGI-S increased from 33.2% to 62.1%. Patient functioning improved from a mean PSP baseline score of 57.9±13.7 to 65.2±15.3 at endpoint (95%CI of change 6.0; 8.7; p< 0.0001). AEs reported in ≥5% were injection site pain (13.9%), insomnia (7.9%), anxiety (6.9%), psychotic disorder (5.7%) and somnolence (5.2%). Mean weight change from baseline to endpoint was 1.4±5.2kg (95%CI 0.8; 1.9).

These data support results from recent randomized controlled studies that flexibly dosed paliperidone palmitate is safe, well tolerated and associated with a clinically relevant treatment response in non-acute patients with schizophrenia previously unsuccessfully treated with oral antipsychotics.

To report recent official data of completed suicide in Italy during the time of economic crisis as related to gender and age.

Data for the years between 2006-2007 and 2008-2009 were extracted from the Italian Mortality Database to include all deaths by suicide and to obtain information on their age and gender.

In the last period for which official data are available (2008–2009), there was a ten percent increase in suicide deaths among men 25 to 69 years of age suggesting that suicide rates are on the increase for those involved in the labor force. We also found a decrease in suicides among those aged above 70 years pointing to a lesser impact of the economic crisis on suicide among the elderly who retired from their work.

According to this findings there was an increase in suicide rates among Italian men which is suggestive of a possible contributing role of the economic crisis on such trend.

Previous studies have shown in alcohol dependence patients an attentional bias (AB) under related substance cues which can be a factor of relapse. This AB can be evaluated by the “Alcohol Stroop Test” (AST). The AST is a modified Stroop task while participant have to name the color of the word. This word could be alcohol-related word or a neutral word. AB is the response time's difference between alcohol-related words and neutral words. The goal of the current study was to examine the relation between withdrawal hospitalization and AB.

Individuals with alcohol-dependence disorders (DSM IV) and admitted for withdrawal in addictology unit of CHU Clermont-Ferrand (n=42) and participant with no alcohol or psychiatric disorder recruited from colleagues and friends from the staff performed the AST (n=16) (‘Control Group’) were recruited. For inpatients, one group performed the AST in admission (n=19) (‘Admission Group’), and another group immediately before discharge (n=23) (‘Discharge Group’).

Results show an AB only for patients saw at admission (t(18) =2.12; p< .05). Moreover, we observe that the AB in ‘Admission Group’ (M=34 ms, SD= 70.06) is greater than the AB in ‘Control group’ AB (M = 23 ms, SD = 93.42), itself greater than the AB in ‘Discharge Group’ (M = -12 ms, SD=93.55), (t(55) = -1.71; p =.09).

Although, results are preliminary, the present study provides evidence for the evolution of AB during alcohol addiction treatment and for the value of incorporated method to improve AB during detoxification cure.

To explore tolerability, safety and treatment response with flexible doses of paliperidone palmitate in adult patients with an acute episode of schizophrenia.

Interim analysis of a prospective 6-month, open-label, multicenter study in adult patients with schizophrenia. Outcomes were change in the Positive and Negative Syndrome Scale (PANSS) total score from baseline to endpoint, Clinical Global Impression-Severity Scale (CGI-S), patient functioning (Personal and Social Performance Scale; PSP), weight change and adverse events (AEs).

Of the first 104 patients included (54.8% male, mean age 37.6±11.8 years, 81.7% paranoid schizophrenia, recommended paliperidone palmitate initiation regimen used in 89% of subjects), 65.4% completed the study. Most frequent reasons for discontinuation were AE (13.5%), subject choice (8.7%) and loss to follow-up (5.8%). Mean total PANSS score decreased from 99.5±15.5 at baseline to 71.0±26.9 at endpoint (mean change -28.6±26.2; 95% confidence interval [CI] -33.8; - 23.4; p< 0.0001) with 60.6% of the patients showing improvement of ≥30%. Mean CGI-S score changed from 5.0±0.8 at baseline to 3.6±1.3 at endpoint (95%CI -1.7; -1.1; p< 0.0001). Patient functioning improved from a mean PSP baseline score of 42.7±13.9 to 59.0±18.7 at endpoint (95% CI of change 12.7; 19.9; p< 0.0001). AEs reported in ≥5% were psychotic disorder (15.4%), insomnia (14.4%), injection site pain (13.5%), headache (8.7%), salivary hypersecretion (6.7%) and anxiety (6.7%).

These data support results from recent randomized controlled studies that flexibly dosed paliperidone palmitate is safe, well tolerated and associated with clinically meaningful treatment response in patients suffering from an acute episode of schizophrenia.

Current findings place cognitive and introspection disturbances at the very heart of schizophrenia. In real life, a person is usually free to choose which aspects of an event to relate, how much detail to volunteer, and what degree of confidence to impart. The decision will depend on a variety of situational and personal goals.

To explore whether patients with schizophrenia are able to achieve a compromise between accuracy and informativeness when reporting information from memory, and pave the way for metamemory-based cognitive remediation.

25 Patients and their healthy matched controls answered general knowledge questions whose answers are numerical first freely, and second through a metamemory-based control. In the second step participants gave their answers with respect to two predefined intervals, one narrow and one large, then made a confidence level judgment for both answers, and had afterwards to select one of the two answers.

Patients were less accurate than healthy participants when reporting information at a self-paced level of precision. However, they benefited remarkably firstly from the framing of the responding, and secondly from the metamemory processes of monitoring and control to improve their memory reporting and to equate healthy subjects' accuracy.

In spite of their memory deficit in the free report, following accurate monitoring, patients strategically regulated the grain size of their memory reporting and proved to be able to manage the competing goals of accuracy and informativeness. These results lead to some optimism regarding the patients' possible adaptation to everyday life situations.

The diagnosis of Posttraumatic Stress Disorder (PTSD) and the experience of childhood maltreatment have been independently associated with a higher risk for suicide attempts.

To investigate if PTSD diagnoses following childhood abuse are correlated with markers of suicide severity, such as the age at the first suicide attempt, the number of attempts or the suicidal intent.

We studied a sample of 726 suicide attempters. Lifetime clinical diagnoses and history of childhood abuse were registered. The association of PTSD and childhood abuse dimensions with age at first suicide attempt, number of suicide attempts and suicide intent was studied. An adjusted multinomial logistic regression was performed to ascertain if combined childhood abuse and PTSD increased the severity of the suicidal behavior.

Several types of childhood abuse (emotional, physical and sexual abuse) when combined with a lifetime diagnosis of PTSD showed an increased risk for more suicide attempts and a higher level of suicidal intent compared with the absence of any or both risk factors.

The combination of PTSD and childhood abuse should be investigated in clinical settings due to an augmented risk for more severe suicidal behavior.

[Suicide intent associated with PTSD and/or abuse]

Experimental evidence indicates that patients with severe mental illness such as schizophrenia or mood disorders have a higher incidence of overweight and obesity (Daumit et al., 2003).

This review describes the neuropsychological functioning and therapeutical approaches (psychotherapeutic, pharmacological, surgical) in obese patients with psychiatric disorders.

To provide suggestions for good clinical practice in obese subjects with psychopathology, based on data found in the literature.

MEDLINE and PubMed databases (1962-2012) were searched for English-language articles.

Most of the literature says that the best treatment for these patients should use an integrated approach, starting from an assessment of the psychological and cognitive resources to set up a more effective and personalized therapeutic path.

Obese patients who have psychiatric disorders represent a population that requires specific treatment measures; in fact, the development, the maintenance and the outcome of the problem of weight are influenced not only by physical and life style factors, but also by specific factors related to psychopathology, neuropsycology, and side effects of certain drugs.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 1 year efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol dependent patients with high DRL from a randomised controlled trial [NCT00811941].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 187 patients: placebo N=42; nalmefene N=145 (mean age 46.2±11.9 years; 78% men; mean HDDs 19±6.3/month; mean TAC 101±45.0 g/day). Mean number of HDDs decreased to 7 days/month and mean TAC decreased to 33g/day at 1 year in the nalmefene group. At 1 year, there was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.6 [95% CI:-6.5;-0.7]; p=0.0164) and TAC -17.3 [-30.9;-3.8]; p=0.0129). Improvements in clinical status and in liver enzymes from baseline were larger in the nalmefene compared to the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 6 month efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol-dependent patients with high DRL from a randomised controlled trial [NCT00811720].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 350 patients: placebo N=170; nalmefene N=180 (mean age 51.9±9.4 years; 63% men; mean HDDs: 23±5.7/month; mean TAC: 101±41.7g/day). Mean number of HDDs decreased to 11 days/month and mean TAC decreased to 44g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.7 [95% CI: -5.9;-1.5];p=0.0010) and TAC (-18.3 [-26.9;-9.7];p< 0.0001) at month 6. Improvements in clinical status and liver parameters were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.