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.

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 [NCT00812461].

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 317 patients: placebo N=162; nalmefene N=155 (mean age 44.8±10.3 years; 69% men; mean HDDs: 22±6.2/month; mean TAC 111±47.9g/day). Mean number of HDDs decreased to 10 days/month and mean TAC decreased to 43g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-2.7 [95% CI: -5.0;-0.3];p=0.0253) and TAC -10.3 [-20.2;-0.5];p=0.0404). Improvements in clinical status and alanine amino transferase were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events were more common with nalmefene; incidence of adverse events leading to dropout was at the placebo level.

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

Patients with sleep disorders have a significant increase in suicidal ideation and suicide attempts, at the assessment and lifetime (Goodwin et al, 2008; Chellappa et al, 2007; Wojnar et al, 2009; Li et al, 2010).

To evaluate the relationship between sleep disorders and suicidal behavior.

To study factors associated with a diagnosis of insomnia in patients admitted to the Emergency Department.

Participants were 843 patients consecutively admitted to the Emergency Department of the Sant’Andrea University Hospital in Rome, Italy, between January and December 2010. All patients admitted were referred to a psychiatrist. A clinical interview based on the MINI and a semi structured interview were performed. Patients were asked about “ongoing” suicidal ideation or plans for suicide. Clinical diagnoses were assigned according to ICD-10 criteria.

48% received a diagnosis of a mood disorders (BD and MDD) or anxiety disorders, 17.1% Schizophrenia or other non-affective psychosis. Patients with insomnia had more frequently a diagnosis of BD (23.9% vs. 12.4%) or MDD (13.3% vs. 9.5%; P< 0.001). Patients with insomnia less frequently had attempted suicide in the past 24 hours (5.3% vs. 9.5%; P< 0.05) than other patients, but suicide attempters with insomnia more frequently used violent methods (64.3% vs. 23.6%; P< 0.01) than suicide attempters without insomnia.

Our results support a relationship between sleep disorders and suicidal behavior. Clinicians should pay attention to sleep disorders when assessing suicide attempters; in fact, such conditions may have important clinical implications.

Low assertiveness and difficulties in emotion's regulation can perpetuate symptoms and worsen the outcome in patients with eating disorders (ED).

Cognitive-behavioral-therapy (CBT) is the most effective treatment for bulimia nervosa (BN) and binge eating disorders (BED). Group training helps patients to cope with interpersonal difficulties.

To examine the effects of a CBT-group-training on assertiveness, emotion's regulation and binge behaviors in patients with ED.

Scale for Interpersonal Behavior (Arrindell et al, 1984; Sanavio, 2002), Difficulties in Emotion Regulation Scale (Gratz et al, 2004; Sighinolfi et al, 2010), Bulimic Investigatory Test of Edinburgh (BITE) were administered at baseline and one and three months after a CBT-training to 20 patients with ED (BED, NES, BN, EDNOS) (90% women, age 25-69 years).

Patients who took part in the training improves assertiveness and emotion's regulation.

[SIB]

[DERS]

CBT-group-training increases assertiveness, improves emotion's regulation, has little effects on binge behaviors severity.

Patients with severe mental illness have significantly reduced lifespans. Excepting suicide, cardiovascular risk is the biggest cause. The problem is exacerbated by psychotropic medication and poor primary care engagement. Therefore psychiatrists should maximise every opportunity to promote physical health.

We audited physical examination, investigations, and documentation of past medical history (PMH) & assessments in inpatients. We used the Royal College of Psychiatrist's Physical Health in Mental Health Scoping Group 2009 guidelines as our standard.

We audited notes of all 125 patients admitted to four wards at Ladywell unit over two months (01/07/2011- 31/08/2011). We surveyed trainees to identify training and resource needs and facilitate focussed interventions.

Physical Examination: 102/125(82%) received physical examination, 60/125(48%) on admission. Average delay before examination 12 days.

Blood tests/Investigations: 89/125(71%) received blood tests: 50/125(40%) thyroid function, 67/125(54%) liver function, 28/125(22%) glucose, 1/125(0.8%) HbA1c, 38/125(30%) lipid profile. 48/125(38%) had urine drug screening, 55/125(44%) ECG.

Documentation: The following was documented: 102/125(82%) PMH, 82/125(66%) allergies, 90/125(72%) smoking status. The following was scanned into records: 23/55(42%) ECG, 72/125(58%) physical observation chart.

Survey: The trainee survey highlighted need for training updates on physical health and problems in equipment provision.

Physical assessment is inconsistent, neglecting metabolic screening. Admission is a vital window for screening/modifying physical health.

Focussed assessment guidelines should be formulated. Following the survey, teaching led by consultant physicians has been organised on identified topics including metabolic syndrome. Lack of equipment will be addressed by creation of comprehensive equipment lists, to be distributed to ward administrators.

Cognitive and Behavioural Therapy (CBT) is a successful treatment of obsessive-compulsive disorder (OCD). It is known to induce changes in cerebral metabolism, but the dynamics of these changes and their relation to clinical evolution remain largely unknown, precluding the identification of individualized response biomarkers.

We performed systematic clinical and fMRI evaluation of 35 OCD patients immediately before a three-month course of CBT, halfway through and at its end, as well as 6 months after in order to study the dynamics of treatment response. To sensitize fMRI probing, we used an original exposition task using neutral, generic and personalised obsession-inducing images.

CBT produced a significant improvement in OCD, already predicted by response at midtherapy (r2=0.67, p< .001). Initially, patients were more sensitive to personalised than generic or neutral images and had stronger related activations in the anterior cingulate, orbitofrontal and parietal cortices. In the high responder group (ΔYBOCS>45%), behavioural sensitivity to generic stimuli was reduced, even more so for personalised ones. Clinical improvement was markedly concomitant to a decrease of activity in the anterior cingulate and left but not right orbitofrontal cortices.

Using an innovative and highly sensitive exposition paradigm in fMRI, we show that clinical and metabolic phenotypes have parallel evolutions during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the earlier stages of the therapy.

Cocaine dependence has been associated with emotional dysfunction as well as social inhibition. Given the drug's powerful effect on emotional state, chronic use may impact the neural networks used for emotional processing, and this impact may manifest in altered behaviour.

To test the hypothesis that stimulant-dependent individuals less accurately identify expressions intended to elicit inhibitory or avoidant responses (ie fear, anger, disgust), and that this behaviour may, in part, be related to differences in the underlying neural networks for processing these emotions.

To detect differences in facial expression classification and corresponding neural networks in cocaine-dependent individuals versus healthy controls.

Cocaine-dependent men (N=32) and age-matched, healthy men (N=29) completed two computerized facial classification tasks (Benton Facial Recognition test and Emotion Hexagon task) and underwent structural MRI scanning.

Performance on the Benton task did not differ between groups. There were significant differences between cocainedependent individuals and controls in accurately classifying fear and anger as well as differences in misclassifications of these two ‘inhibitory’ emotions. No group differences were observed when classifying facial expressions of happy, surprise, sad, and disgust. A multivoxel analysis method (Partial Least Squares) confirmed the involvement of neural networks implicated in fear and anger perception, but showed significant differences between the groups.

The Benton task confirmed that differences in facial expression classification are not attributable to differences in facial processing. Cocaine-dependent individuals were less accurate at identifying ‘inhibition’ emotions and showed significant abnormalities in the brain systems implicated in fear and anger.

The aim of this prospective study was to gain a complete picture of the biopsychosocial effects of interferon-α treatment of patients with chronic hepatitis C. The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability would be measured with the inclusion of the social context. Furthermore, the effects of interferon treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites, and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with interferon-α were examined over the entire period of treatment as well as three months later, applying a holistic biopsychosocial model.

Psychiatric and biological assessments were carried out at six different times: before, during (at one, three, six and nine months), and after the end of interferon-α treatment.

During IFN-α treatment 22 (53.7%) patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired role physical, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and role emotional.

The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

Delirium is a frequently under-recognized finding in post-cardiopulmonary bypass patients that is potentially reversible but often associated with short-term complications, increased mortality and prolonged hospitalisation.

In this prospective study the frequency of delirium after cardiac surgery with cardiopulmonary bypass (CPB) was determined. Furthermore, we investigated the impact of intra- and postoperative levels of albumin as a biomarker of delirium.

34 patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enrolled in this prospective study. During the Intensive Care Unit (ICU) stay and shortly after discharge from the ICU, delirious state was evaluated daily using the Delirium-Rating-Scale. Albumin was assayed preanaesthesia, immediately after induction of anaesthesia, at the beginning of the heart-lung-apparatus period, immediately before the opening and 5 minutes after the opening of the aortic clamp, 24h and 48h postoperatively and on the day before discharge.

After CPB, a clinical significant delirious state was observed in 11 patients (32.4%). The albumin level decreased during the surgical intervention and increased postoperatively with a maximum level at the time of discharge. CPB patients with delirious state showed a significantly lower albumin level 24h and 48h postoperatively than those without delirium.

A postoperative delirium is a frequently observed finding in post-CPB patients. A low levels of postoperative albumin seems to be an useful biomarker to identify patients with high risk of delirious state after CPB.

Much speaks in favour of searches for biomarkers that might help to predict the emergence of delirium. Advance warning of the threats of this condition could potentially reduce significant morbidity, mortality, and costs of hospitalising patients.

Our prospective study investigates for the first time the impact of soluble interleukin-2 receptor (sIL-2R) as a biomarker of delirium after cardiac surgery with cardiopulmonary bypass (CPB).

34 patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enrolled. During the ICU stay and after discharge from the ICU, the delirious state was evaluated daily using the Delirium-Rating-Scale (DRS) by P. T. Trzepacz. sIL-2R was assayed before CPB, 24 h postoperatively and on the day before discharge.

After the CPB, 11 patients (32.4%) developed delirium. During the study period the sIL-2R level decreased at 24h postoperatively and increased afterwards. In the subgroup of patients with a postoperative delirious state longer than 24 hours the sIL-2R level is statistically significantly elevated 24h postoperatively in comparison with CPB-patients without a postoperative delirious state. Furthermore, as shown by a Spearman's rank correlation, CPB patients with higher Delirium-Rating-Scale scores 72h, 96h and 120h postoperatively had significant higher sIL-2R levels 24h postoperatively.

High levels of sIL-2R appear to be a useful biomarker to identify patients with high risk of delirious state.

Structural Analysis of Social Behaviour by L.S. Benjamin as revised by Scilligo represents self image by two axes: affiliation with love and hate as extreme points; interdependence with freedom and control as extreme points. Axes define a circumplex with 4 quadrants: loving freedom; hostile freedom; hostile control, loving control. Psychic wellness consists of high loving control and freedom and low hostile control and freedom. Quadrants are divided into 12 clusters: self-emancipation, self-affirmation, self-exploration, self-acceptance, self-protection, self-regulation, self-limitation, self-blame, self-attack, self-rejection, self-neglect, self-isolation.

The present study aims to enrich knowledge about intrapsychic world of people with Eating Disorders by analyzing self image of diagnostic subtypes.

Differentiating diagnostic subtypes self image in order to have a new key to choose therapeutic interventions.

250 women with ED, outpatients of the ED Unit of an Italian General Hospital, were administered the Intrex questionnaire, the operational definition of the 12 clusters. One-way ANOVA and post-hoc comparisons between diagnostic subtypes were performed.

Results indicate that ED patients have negative self-image. Bulimics show the highest level of self-blame, self-attack and self-rejection and the lowest of self-affirmation, self-exploration, self-acceptance, self-protection; anorexics show the highest level of self-regulation and self-limitation together with poor self-affirmation, self-exploration, self-acceptance. BED and EDNOS profiles appear less self attacking and more self acceptant.

Eating disorder diagnostic subtypes seem to have distinct intrapsychic profiles that can be reflected in different interpersonal behaviours. Such knowledge may help the therapist to choose the better interpersonal position to support therapeutic change.

Electroconvulsive therapy (ECT) is a treatment alternative in bipolar disorder (BD) depression. Cognitive side effects are the major concern limiting its use.

We present data from the Norwegian randomized controlled trial of ECT in treatment resistant depression in bipolar disorder.

To compare effects on cognitive function of ECT or algorithm based pharmacological treatment at the end of a six-week acute, BD depression treatment trial.

Prospective, randomised controlled multi-centre, six-week acute treatment trial. Pre- and post-treatment assessments with the MATRICS Consensus Cognitive Battery (MCCB); a neuropsychological test battery designed to be sensitive to changes in cognitive function.

N = 51 patients ≥ 18 years fulfilling criteria for treatment resistant BD depression (MADRS score ≥ 25).

ECT group: Three sessions per week for up to six weeks, total up to 18 sessions, and right unilateral electrode placement. Algorithm-based pharmacological treatment group: Based on Goodwin & Jamison, 2007.

Both groups showed a net gain on MCCB scores without significant differences between the study groups. Mean change in MCCB composite T-score was 4.0 (5.7) in the ECT group and 2.7 (3.6) in the pharmacological group (F = 0.78, eta2 = 0.021, p = 0.383).

In treatment resistant BD depression ECT and algorithm-based pharmacological treatment have comparable effects on cognitive function assessed with the MATRICS.

Cognitive dysfunction is a core feature in the course of bipolar disorder (BD) and persists during the remission periods. Only few studies valueted separately patients with BDI and BDII.

To analyze the pattern of neurocognitive dysfunction between healthy controls and euthimic patients with BDI and BDII.

27 patients with BD (17 BDI patients and 10 BDII patients, according to DSM IV TR) and 20 controls underwent a neuropsychological battery. The inclusion criteria for the bipolar groups was an Hamilton Rating Scale For Depression's score ≤ 7. The neuropsychological battery consisted of:

1. i) the Mini Mental State Examination

2. ii) The Corsi and the verbal span, to assess the short term memory;

3. iii) the Rey Auditory Verbal Learning Test (RAVLT) and the logical memory test, to assess the long term memory;

4. iv) the progressive Raven Matrices, to assess the logical - abstractive capacity

5. v) The frontal assessment battery and the phonetic verbal fluency, to assess the executive functions

6. vi) The continuos performance test to assess the selective attention.

Patients affected by BDI performed significantly worse to controls when the short term spatial memory, the long term verbal memory, logical abstractive capacity, the executive functions and the selective attention were measured (p< 0,05). Patients affected by BDII performed significantly worse (p< 0,05) to controls when the long term verbal memory was measured.

Euthimic Patients with BDI disorder seem to have a more severe cognitive profile respect of BDII patients.

The primary objective was to assess the reasons for antipsychotics switch to amisulpide and to evaluate the outcome at 6±1 months following the switch from any antipsychotic drug(s) to amisulpride (Solian®).

This is an open, non-randomized, multicentric, retrospective, non-interventional study that included 1165 subjects who were already stabilized on amisulpride for at least 6±1 months. These patients were previously switched from other antipsychotic to Solian®. Data were collected retrospectively on the patients’ status 6±1 months ago and their present status.

Reasons for switching previous antipsychotic treatment: inadequate control of symptoms in 79.3% of the patients, relapse of the disease under treatment 54.5%, adverse reactions 61.9%, reduced compliance 49.1%, comorbities 7.7%, patients request 28%, family request 24.5%, high cost 1.8%. Reasons for choosing Solian®: quality of life improvement 20.3%, cognitive function preservation 18.7%, better efficacy on positive symptoms 18.7%, better efficacy on negative symptoms 15.1%, low risk of extrapyramidal symptoms 12.3%, reduced weight gain 9.8%, minimal interactions with other drugs 4.2%. The compliance was significantly improved (61%), moderately improved (16%), unchanged (7.6%). Adverse reactions were significantly improved (53.5%), moderately improved (18.5%), unchanged (8.9%), minimum worsening (0.2%), medium worsening (0.1%). The efficacy was significantly improved (69.8%), moderately improved (19.2%), unchanged (2.2%), minimum worsening (0.1%).

The main reasons for antipsychotic switch were the inadequate control of symptoms, relapse of the disease under treatment and adverse reactions. Psychiatrists’ evaluation of the switch outcome at 6±1 months following the switch underlined significant improvement of compliance, adverse reactions and treatment efficacy.

To evaluate characteristics of the antipsychotic switch from any antipsychotic to amisulpride (Solian®) through the integration of the significantly variables.

This is an open, non-randomized, multicentric, retrospective, non-interventional study that included 1165 subjects who were already stabilized on amisulpride for at least 6±1 months. These patients were previously switched from other antipsychotic to Solian®. Data were collected retrospectively on the patients’ status 6±1 months ago and their present status.

The population consisted of 38.5% hospitalized patients at the moment of antipsychotic switch and 61.5% outpatients; 56.3% of the patients were in acute exacerbation at that moment. Previous treatment of the patients: 100% antipsychotic, 17.9% antidepressant, 38.8% mood stabilizer, 39.4% benzodiazepine and 22.2% other treatments. Switch type: sudden in 63.7% of the patients, gradual in 35.4% and unknown in 0.9%. The mean dosage of Solian at initiation was 581.04 mg/day. For 38.1% of the patients the initial daily dose of Solian® was of 600 mg, for 29.6% of them 400 mg and for 22.7% 800 mg. The mean dosage of Solian during the 6±1 months was 571.39 mg/day. For 39.8% of the patients the daily dose of Solian® was of 600 mg, for 30.5% of them 400 mg and for 20.7% 800 mg.

The switch to Solian® was made suddenly in a majority of patients, preferred start dose being 600 mg, while the mean dose was similar to baseline values (in almost 40% of cases) or smaller during the 6±1 months of the study.

The lack of social skills and self-image distorsions are frequently met in the avoidant personality disorder (APD) and although the personality disorders are egosyntonic, subjects could experience prolonged dysforic episodes and a will to change their relationship patterns.

To evaluate the efficacy of social skills training on the overall APD features and on the self-image distorsions, in particular.

A group of 12 subjects with APD, diagnosed using Structured Clinical Interview for Axis II Disorders of DSM IV (SCID II), were included in a psychotherapy program focused on social skills training with 2 sessions per week, for 3 months, with a follow-up visit after 6 months from baseline. These patients were included in an individual therapy (12 sessions) and group therapy (12 sessions). All of these subjects were monitored using a semi-structured interview focused upon the avoidant-type cognitive schemata and self-image related automatic cognitions. A diary was held by every patient and cognitive restructuring was monitored, as well as the effect of role-playing, imaginative and in vivo exposures.

The social skills training decreased the occurrence of social exposure associated discomfort, self-image self-reported automatic cognitions (as reflected by the diary entries). The overall evolution reflected an increase in self-confidence and a more stable sense of self in relationships, although the SCID II confirmed the maintenance of the APD diagnosis at follow-up visit.

Social skills training has a positive impact over the self-image, decreasing the social exposure discomfort and inadequacy feelings in the patient relationships.

Drug-related disorders are observed in 30–50% of the patients diagnosed with schizophrenia and is therefore an important problem to be adressed in clinical practice. There are many reasons for the overlap between addictive disorders and schizophrenia: the tendency to alleviate antipsychotic-related side effects, the need to decrease anxiety or depression, to interfere with sensory gating defficits etc.

To assess the effects of atypical antypsychotic treatment in decreasing the drug of abuse consumption in a population of schizophrenia diagnosed patients.

A group of 23 patients, diagnosed with schizophrenia and a drug related disorder (dependence 52.1%, polisubstance dependence 17.4%, substance abuse 26%, other 4.5%), according to DSM IV TR criteria, were monitored for 6 months, while being treated with atypical antipsychotics (olanzapine 43.4%, risperidone 34.7%, aripiprazole 17.4%, amisulpride 4.5%), using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Clinical Global Impressions (CGI) and Inventory of Drug Taking Situations (IDTS) every 4 weeks.

The evolution of IDTS scores were not parallel to the PANSS evaluations: while the psychotic symptoms decreased continuously during the 6 months of the study (-40.5% at week 12 and -67.5% at endpoint), the IDTS decreased initially (- 33.2% at week 12) but increased slightly to the end of the study (-31.2% at endpoint). The CGI-I score has a decrease of 50.4% at week 12 and of 55.6% at week 24.

The evolution of drug related disorders during the atypical treatment of schizophrenia doesn’t correlate with the severity of psychosis and necessitates a specific management.

There is a lack of evidence for the efficacy of stimulant pharmacotherapy in patients with substance dependence and comorbid attention deficit hyperactivity disorder (ADHD).

The aim of the present trial was to test the efficacy and safety of 180 mg extended release methylphenidate for treating ADHD in patients with amphetamine dependence.

54 incarcerated men, mean age 42 years, meeting the DSM-IV criteria for amphetamine dependence and ADHD were randomized to methylphenidate or placebo in a 24-week randomized double-blind, placebo-controlled trial, with parallel groups design. The medication started within 14 days before release from prison and continued in outpatient care with twice weekly visits including once weekly cognitive behaviour therapy. The primary end point was relapse to any drug use measured by urine toxicology. Secondary endpoints included relapse to amphetamine use, retention to treatment, and change in selfrated ADHD symptoms.

The methylphenidate group had significantly fewer drug positive urines compared to the placebo group (95% CI -0.31 to -0.05, P=.034), fewer amphetamine positive urines, (95% CI -0.36 to -0.07, P=.019) and better retention to treatment (95% CI 15.64 to 78.58, P=.001). Compared to the placebo group, the methylphenidate group also significantly reduced their selfrated ADHD symptoms (95% CI -21.09 to -3.37, P=.008) during the 24-week treatment.

This is the first randomized clinical trial to demonstrate the efficacy of a stimulant treatment for substance dependent individuals with ADHD. The treatment with MPH led to reduction in drug use and a clinically relevant improvement of ADHD symptoms.

Immigrants may experience several negative consequences as a result of their migration including discrimination, unsatisfactory economic conditions, and rejection from the host countries, which may contribute to psychiatric illness and vulnerability to suicidal behaviors. The purpose of the current study was to determine whether or not the theorized components of measured dimensions of suicidal ideation and psychopathology vary across samples of Italians and immigrants.

We investigated 310 Italians and 322 immigrants, who were administered self-report questionnaires to assess temperament (TEMPS-A), hopelessness (BHS), personality (EPQ-R), and self-other perception (9AP).

Multi-group Confirmatory Factor Analysis presented a final model with an excellent fit to the data (x2(53) = 57.56; CFI = .994; RMSEA = .014), significantly better than the previous models, showing the same pattern of relationships between suicidal ideation and psychopathology across Italians and immigrants.

Although immigrants represent a unique population and may experience specific stressors contributing to psychopathology and suicide risk, our findings suggest that the samples of Italians and immigrants may be more similar on the study variables under investigation than previously thought. Implications are offered for the improved identification and treatment of immigrants and resident citizens in Europe in general and in Italy in particular.

Several investigations have shown the influence of environmental factors, i.e. seismic activity on human health. However, no studies have focused on the effect of earthquakes on mental health. Crete is located within a rectangular region at the boundaries of Eurasian and African tectonic plates with high seismicity.

To investigate the effect of seismic activity on mental health.

To explore possible association between seismic activity and rates of hospital admissions of psychotic patients.

We compared the seismic activity (EQs with magnitude M>2) in a geographical area of Crete, and admissions to the Psychiatric Inpatient Unit/ University General Hospital of Heraklion, Crete during the years 2008–2010.

Our analysis showed (1) a very low rate of admissions of psychotic patients suffering from acute psychotic disorders, during the period with several great (M>6.4) and middle (4.5< M< 6.4) magnitude period earthquakes (EQs), (2) an increasing trend of admissions of acute psychotic disorders during a period with increasing number of relatively small EQs(r=0.667; p< 0.001), (3) a correlation between the number of total monthly admissions and the number of M>2 EQs.

It appears that strong EQs have a protective effect on the relapse of major psychiatric disorders, whereas small EQs are associated with an increasing number of relapses. We hypothesized that the beneficial/adverse effects are related to anomalous electric fields/Extra Low Frequency (ELF)-Ultra Low Frequency (ULF) emissions.