Duration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcome in schizophrenia. The long DUP and its relation to poor short-term outcome of schizophrenia has been studied in meta-analyses, but the conclusions remain unclear regarding the long-term effects of DUP.

To study the association between DUP and long-term outcome in a meta-analysis.

A systematic literature search of studies on DUP and long-term outcome in schizophrenia was performed using seven electronic databases. Studies were included if the follow-up was at least two years, the majority of subjects had a diagnosis of schizophrenia and DUP was studied with at least one of the following outcome categories: positive, negative, general and total symptoms, need of treatment, social functioning, employment, global outcome, quality of life and remission. Random effect methods were used to pool the effects of original studies.

2636 unique publications were identified of which 37 met our pre-defined selection criteria. Long DUP correlated with more severe positive (number of studies n=16; r=0.17), negative (n=17; r=0.14), general (n=4; r=0.29) and total symptoms (n=7; r=0.14) and with poor social functioning (n=13; r=0.13), poor global outcome (n=15; r=0.22) and less likely remission (n=16; r=0.14). The association between long DUP and decreased need of treatment was close to statistical significance (n=12; r=0.12). Employment (n=5) and quality of life (n=5) were not associated with DUP.

Severe symptoms and decreased functionality does not seem to increase the need of treatment or decrease the quality of life or employment.

Effective and safe prescription of individualized opioid-doses for opioid-dependent is a complicated task for the clinician, due inter-individual differences in dosage requirements and narrow therapeutic range.

Mu-opioid receptor gene (OPRM1) plays a key role in addiction. A118G-rs1799971 polymorphism in OPRM1 is probably the most promising biomarker of better response in opioid-dependents.

Gene polymorphisms in CYP450-isoenzymes (CYP3A5, CYP3A4, CYP2D6, CYP2B6, CYP1A2, CYP2C9 and CYP2C19) also significantly influence pharmacokinetics and effects of opioids and concomitant treatments.

Association of heroin-dose requirements to OPRM1-rs1799971, CYP3A4-rs2740574 and CYP3A5- rs776746 gene polymorphisms in patients from a Heroin Prescription Program (PPH) in Andalusia.

Series of cases: 15 patients with opioid-addiction. Collection of heroin-doses/patient administered for a year. Genotyping of A118G, CYP3A4 and CYP3A5 polymorphisms was performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism.

Eleven patients were AA homozygous (11/15;73.33%) and four heterozygous AG (4/15;26.67%) for A118G-OPRM1; median doses: 179.57[157.85,225.49] and 271.38[145.11,288.88]mg/day respectively were no statistically different (p=0.240). Four subjects presented doses>250mg/day, showing an association of AG-OPRM1 genotype with higher doses, OR:30.00(CI95%:1.41,638.15);p=0.033.

Fourteen patients were homozygous AA and GG for CYP3A4 and CYP3A5 respectively (14/15;93.33%), and one patient was heterozygous AG(1/15;6.66%) for both isoenzymes and presented a high dose(280 mg/day).

Higher heroin-doses (>250mg/day) were associated to AG genotype for OPRM1-A118G, despite the great variability in the dose prescription avoided to find an association between OPRM1 genotype and the specific administered dose.

Pharmacogenetic analysis, focused on OPRM1-A118G, may be a useful tool to adjust the pharmacotherapeutic dose in each case.

Interferon-alpha (IFN-α) and Ribavirin is the recommended treatment for chronic hepatitis C (CHC). Common treatment side-effects include neuropsychiatric symptoms such as anxiety, which impairs patient's quality of life and treatment adherence. Inflammation and neurotransmission systems may play a role in the pathogenesis of IFN-α-induced anxiety. The GC/GG genotype at a polymorphism located in the interleukin-6 synthesizer gene (IL6 gene) has been related with a higher production of IL-6 and “higher inflammation response”. A polymorphism in the serotonin transporter gene (SERT) has been related with anxiety and antidepressant response. The aim of the study was to assess the role of IL6 and SERT polymorphisms as predictive variables of IFN- induced anxiety.

A cohort of 385 Caucasian outpatients with CHC initiating antiviral treatment. Patients were euthymic and without current anxiety disorder (SCID) at baseline. Anxiety evaluation: Hospital anxiety and depression scale. Assesment: Baseline, 4, 12, 24, and 48 weeks after antiviral treatment initiation. DNA was extracted and polymorphisms genotyped. Hardy- Weinberg equilibrium: IL-6 (p=0.72) and SERT (p=0.41). Statistical analysis: linear mixed-effects.

Patients carrying the G allele (GC/GG genotype) of IL6 polymorphism (G vs. CC) had more anxiety symptoms (p=0.004) during antiviral treatment. We did not find a significant effect of SERT (S vs. LL) on anxiety (p=0.15). No significant interaction between both genes was reported.

GC/GG genotype, that implies higher seric concentrations of IL6, predicts interferon-α-induced anxiety supporting a role of inflammatory pathway on pathophysiology of anxiety.

PSICOCIT-VHC-P110/01827, and PSIGEN-VHC-EC08/00201. ERDF, European Union “One way to make Europe”.

Several studies evaluated the effects of changes in a price on various outcomes related to harmful alcohol consumption, including alcohol dependence, known to be specifically attributed to long-term alcohol abuse.

Against this background, it would be interesting to evaluate the relationship between alcohol affordability and alcohol dependence prevalence rates in post-Soviet Belarus.

To examine the relation between alcohol affordability and alcohol dependence prevalence in Belarus between 1990 and 2010 regression analysis was performed using the statistical package “Statistica”.

In the period from 1990 to 2010 the prevalence of alcohol dependence in Belarus increased by 42,7% (from 1419,1 to 2024,4 per 10.000 of the population). The affordability of alcohol has increased significantly since the early 1990s: the average salary in 1993 could by 7.3 litres of vodka compared with 73.9 litres in 2010. The results of time series analysis suggest positive association between alcohol affordability and alcohol dependence prevalence rates: a 0.3% increase in the prevalence of alcohol dependence rate following a 1% increase in affordability of alcohol.

The results from this study are consistent with previous findings suggesting a significant association between alcohol affordability and alcohol-related problems. The main reason for the growth of alcohol consumption and alcohol-related problems in Belarus was the liberalization of the alcohol policy and increase in the affordability of alcohol. Hence, to prevent a further increase of alcohol affordability, increases alcohol prices seems to be one of the priority options of alcohol control policy in Belarus.

Adolescents still lack knowledge about depression and its treatment. As a result, depressed adolescents are confronted with stigmata that are barriers to treatment-seeking. Studies in adults demonstrated that depression literacy can be increased by educational material.

We developed an information booklet on depression specifically addressing adolescents aged 13 to 17. For the first time, it was examined whether knowledge about depression in youth can be enhanced by reading an educational leaflet.

The information booklet was evaluated in 628 German ninth graders (M= 15.1 years, 58% boys) in a pre-postfollow- up design.Using study-specific questionnaires, knowledge about seven topics on depression was assessed. Key subjects were symptoms and treatment of depression as well as suicidality.In addition, students evaluated the booklet's layout, content and utility.

Power-analysis of the pre-post-follow-up-comparison yielded effect sizes of knowledge enhancement between eta2 = 0.07 (medium) and 0.56 (large) for all topics of the booklet.The largest effect sizes were found for the topics “symptoms” and “antidepressants”. Sub-analysis on school types and gender showed the highest increase in knowledge in well-educated students and in girls. The participating youth assessed the booklet positively regarding all categories, with a mean overallrating of 2.15 on a scale from 1 (very good) to 6 (fail).

Although students’ baseline knowledge about depression was good, girls and boys of all school types significantly increased depression literacy. Thus, the booklet can help reducing stigmata and treatment barriers in adolescents.

Described since the 19th century, menstrual psychosis is considered a forgotten disorder. Current classification systems do not include the diagnosis of menstrual psychosis, a condition comprising in psychotic episodes recurring during each menstrual or premenstrual period, but remitting the rest of the month. The world literature consists mainly of case reports. To our knowledge this is the first Romanian report of menstrual psychosis.

To describe the course of the condition in a patient with multiple and rapid recurring psychotic episodes from onset until the most recent hospitalization.

To better understand if this case could be considered a true menstrual psychosis.

Review of the medical charts of the 57 hospitalizations the patient has had between 1977 and 2012 in the “Prof. Dr. Al. Obregia” Psychiatry Hospital.

Initial diagnosis included discordant psychosis and atypical depressive state that shifted in time to schizoaffective disorder and various forms of schizophrenia. The history reveals cyclic episodes with short-term remissions and multiple hospitalizations. Treatment approaches also varied during the course of the disease, from ECT to second generation of antipsychotics without any consistent long-term remission. The frequency of episodes started to dramatically reduce only when the menopause installed.

Patients with a history of numerous admissions might benefit from a record review aimed at identifying temporal patterns. Clinicians should be aware of menstrual psychotic symptoms exacerbations in a minority of women with chronic mental disorders and therapeutic strategies need to be carefully considered and adjusted to each individual patient.

WAVE-bd provides information on the clinical management and outcomes of BDI and II patients in daily clinical practice.

To describe French patients (n=480) clinical outcomes up to 18 months.

WAVE-bd included patients with ≥1 mood event (index episode) in the preceding 12 months before inclusion and followed ≥ 9 months (total participation 12 to 27 months).

2896 patients were analysed worldwide, 17% in France (53% in private practice, 47% in public practice): mean age 47 years (SD: 12.51), women, 65%; BD-I, 59%; BD-II, 41%; index event depressive, 64%; hypomanic, 21%; manic, 9%; mixed, 6%.

During follow-up, 77 patients (16%) reported relapses (1.25 patient-years; 95%CI = [1.04; 1.49]) and 176 patients (37%) reported recurrences (0.65 patient-years; 95%CI = [0.57; 0.74]). The most common type of reported recurrence (n; %) was depressive (114; 24%) rather than hypomanic (64; 13%), manic (14; 3%) or mixed (11; 2%). Suicide attempt was reported in 25 patients (5,2%, 0.046 patient-years; 95%CI=[0.031;0.064]). The most common type of treatment during manic and hypomanic episodes was atypical antipsychotics AAP (69% and 49%, respectively) while during depressive episodes, the most common types of treatment were antidepressants (82%).

These results show a high incidence of relapse and recurrence of mood events and the more frequent depressive polarity in BD patients in France. Further analyses are required to evaluate which factors influenced the severity (relapse, recurrence and suicidality) of the disease. Overall, antipsychotics and antidepressants were most commonly prescribed for manic and depressive episodes, respectively.

The child pornography collecting process and the way the pornographer considers his collection need to be better understood. It is these psychopathological issues and the risk of the person acting out his fantasies that need to be analyzed.

We want to understand the phenomenon of child pornography, because it is sometimes a matter of deviance without leading to actual abuse.

The aim of our study is thus to identify the characteristics of people who download child pornography.

We collected datas from forensic psychiatric assessments. The criterion for inclusion was the possession of pornographic images of minors. We studied pathological characteristics of this sample.

Subjects were almost exclusively male with an average age of forty years. They have generally a good academic level. A significant difference is observed between the childhood aspects of child pornographers, sex online and offline offenders. A sense of loneliness is expressed in 32.8%.

Child generally fulfills a fantasy of a pedophile nature. Different profiles of child pornographers have been proposed which are not always related to pedophilia. Our study has permitted to have informations about the sexuality of child pornographers. The feel to not be well integrated could explain the use of virtual mean of telecommunication. Clinical differences can be made between child pornographers and sex online offenders.

Full findings from the European Commission funded EU-NET-ADB study (Safer Internet Programme) will be presented.

Empirical findings that elucidate the development of an internet addictive behaviour are still incomplete. This is also related to risk as well as protective factors of internet use. Here a process oriented approach to identify underlying conditions of an internet addictive behaviour was chosen.

The aim of the study is to enhance the knowledge and understanding of underlying processes which lead to situation were internet addictive behaviour can evolve.

In total 124 in-depth interviews were conducted with adolescents with an age of 14-17 year. Adolescents from seven different European countries (Greece, Spain, Poland, Germany, Romania, Netherlands & Iceland) participated in this study. Eligibility was granted when adolescents scored more than 30 point or equal in the Internet Addiction Test (IAT; Young, 1998). Data analysis was conducted by use of a step-wise full version of Grounded Theory (Strauss & Corbin, 1990; 1998).

Adolescents employed maladaptive and adaptive strategies in regard to their involvement in the internet. Thus different Digital Outcomes such as “I am addicted” (Stuck Online) ranging to more adaptive internet behaviour like (Juggling it All) and patterns of self-correcting (Coming Full Cycle) were identified. These Digital Outcomes were consequently linked to adolescent's developmental pathways and can be characterized by the core category “Navigating Adolescent Pathways”.

Contextual and developmental factors that mediate the development of an internet addictive behaviour could be identified and linked to multiple Digital Outcomes.

Information about the perception of suicide attempters regarding prevention of their suicide attempt may be helpful in implementing preventive strategies.

To examine:

1. (i) sociodemographic profile,

2. (ii) distribution of the Suicide Intent Scale, and

3. (iii) differences according to the gender in the sample of participants in a controlled study to determine the effectiveness of case management programme in the prevention of recurrent suicidal behaviour.

106 suicide attempters who attended the Emergency Room of the Hospital of Asturias from July- 2011 to October- 2012 were included in the study [33% males; mean age (SD)= 41.82 (13.16)]. Instruments: Ad hoc Sociodemographic- Questionnaire; Suicide Intent Scale (SIS); SAD-PERSON Scale; Medical Damage Scale; List of Threatening Experiences; Hamilton Depression Rating Scale.

Profile: 45-54 years old (30.4%), married (34%), with bachelor's degree (42.5%), unemployed (29.2%), with children (61.3%) and living with partner (34.9%). 36.2% of the sample had the intention to repeat at the time of the suicide attempt (SA), while 22.6% actually repeated it. The intention to repeat the SA was associated with the commission of SA at 12-months follow-up (p=.002). SIS data: mean total score (SD)=15.99(4.71); mean objective score (SD)=5.69(2.48); mean subjective score (SD)=10.28(3.29). Significant differences in SIS scores were found by gender (p=.007), men scoring higher. Repetition of the SA was related with higher scores (p=.002).

SA severity and its repetition at 12-months follow-up was related with the intention of repetition; nevertheless we didn’t find relation between the SA severity and the repetition of SA one year later.

Earlier studies have examined the symptom dimensions of the PANSS (Positive And Negative Syndrome Scale) in patients with chronic schizophrenia, regardless predominance of symptoms. The aim of this study was to examine the component structure of the PANSS in patients with schizophrenia spectrum disorders and predominantly negative syndrome.

Data of PANSS were extracted from a cross-sectional and retrospective multicenter study in 1,704 adult psychiatric outpatients meeting DSM-IV criteria for schizophrenia, schizophreniform or schizoaffective disorder. We used 5 items of the PANSS negative subscale to individually determine the presence of a negative syndrome when the score on all of the 5-items were >3, with no extrapyramidal symptoms, anxiety, or depression and dose of haloperidol, when applicable, ≤15mg/day. Exploratory factor analysis was carried out using principal component analysis to extract domains. Eigenvalues above 1 according with Kaiser K1 rule were applied to extract factors. Items with a loading of ≥ 0.4 were considered to load on a component.

A total of 307 [61% men, mean age: 41 (SD:12) years] fulfilled criteria for inclusion in the analysis. Principal component analysis of the PANSS revealed four components: positive, negative (all negative items of the original PANSS plus items 15 and 16 of the general psychopathology subscale), mood and disorganization, explained 58% of the total variance. Internal consistency (Cronbach-alpha) of these 4 domains was high: 0.897, 0.874, 0.819 and 0.833, respectively.

This analysis suggest a four component structure of the PANSS in patients with schizophrenia spectrum disorders and predominantly negative syndrome.

A recent UK Government initiative has sought to address the management of personality disordered (PD) offenders, aiming to improve public protection by reducing reoffending whilst simultaneously improving the psychological health of offenders with PD. Case formulation (CF) is given primacy here as it enhances offender management through a psychologically informed approach and informs pathway planning through Criminal Justice System or NHS services. Probation services are given an important role in formulating cases as part of the new strategy.

Develop a consensus amongst professionals as to what makes a good Case Formulation (CF). Investigate whether probation services can be taught CF skills, and to enhance these skills.

Develop a case formulation training package for probation staff and evaluate the training.

The training package was informed by the results of a Delphi survey amongst professionals, and focus groups with probation staff, offenders and carers of individuals with PD.

There was consensus that CF allows for collaboration between client and therapist, helps with complexity through organisation of case notes and has utility in treatment planning. Themes highlighted for effective CF included background, trauma, offending, risk and current lifestyle. The theoretical model gaining most support was a CBT model. The assessment of formulations was identified as challenging.

The CF training package is currently being evaluated and findings will be presented at the conference, alongside outcomes of all phases of the research.

CF has the potential to enhance treatment planning. Its suitability for probation staff will be discussed.

Deep brain stimulation (DBS) for Parkinson's disease (PD) has emerged as a treatment with very good motor outcomes. However, a higher prevalence of anxiety following DBS has been reported.

To study the prevalence and associated factors of anxiety following STN-DBS

Data were retrospectively collected from medical records of PD patients who underwent STN-DBS at King's College Hospital, London from 2001 to 2010. Neuropsychiatric assessments were done pre-STN-DBS at baseline, and also approximately 6 months after the surgery.

Fifty eight PD patients underwent STN-DBS. After patients with missing data (n=2), patients who were not referred for post-DBS neuropsychiatric evaluation (n=5) were excluded, 51 patients were studied. Their mean age was 61.2±7.1 years old and the mean PD duration was 12±5.2 years. Post-STN-DBS anxiety was found in 8 patients (15.7%). All of them underwent bilateral STN-DBS and had uneventful recovery. Significant associated factors were female gender (n=6; 75.0%; p=0.056) and new-onset post-DBS apathy (n=7, 87.5%, p=0.0001). However, memory impairment (n=4; 50%; p=0.076) and depression post-DBS (n=4, 50%, p=0.055) did not show statistically significant associations.

The prevalence of post-STN-DBS anxiety in our study (15.7%) was lower than that from the previous reports in PD patients who received medication (25-43%) and STN-DBS (40%). The associated factors were similar to those reported in medication-treated PD patients. Given relatively low prevalence of anxiety following the operation, STN-DBS is likely to be a safe treatment for PD patients with high risk for anxiety disorders.

Patients presenting Personality Disorders and specially Borderline Personality Disorder are often admitted to Psychiatry Units in General Hospitals. Their impulsivity, affective disregulation and difficulties in interpersonal relations complicate the therapeutic atmosphere and cause problematic interactions with staff and other patients. We have developed a basic protocol to manage behavioural problems of those patients in the general hospital.

To study the effect of the protocol on the unit's work. Aims. To know the effect of the protocol on some specific variables related to the admission and specifically the use of mechanical restraint. Methods. Prospectively, we compare data on all patients admitted during 2010 (876 total, 87 PD) before establishing the protocol and all those admitted during 2011 (870 total, 112 PD) when the protocol was in use.

The proportion of patients with PD who experienced at least one mechanical restraint intervention went down from 43.7% in 2010 to only 2.7% in 2011 (p= 0.000). In the total group, figures also decreased from 17.3% in 2010 to 3.4% in 2011 (p= 0.000).

The use of mechanical restraints with PD patients in General Hospital Psychiatric Units can be drastically reduced using a protocol guiding the staff to better manage behavioural problems of the patients.

Substance abuse and mental health problems have been increasing among young population.

To find out the prevalence of alcohol and tobacco usage and their association with depressive symptoms among university students.

Web-based questionnaire was sent to all 13397 university students of Oulu University, Finland in November 2011. 2167 (16,2%) replied, 31,5% were males and 68,5% females. The questionnaire included Alcohol Use Disorders Identification Test (AUDIT-C), questions concerning tobacco, and Symptom Check List-90 (SCL-90). We analyzed the prevalence of alcohol and tobacco usage and their association with depressive symptoms by gender.

Among males 46,0% had hazardous drinking habits (AUDIT-C score 4-7) and 21,3% had very hazardous drinking habits (AUDIT-C score 8-12). Among females 63,2% had hazardous drinking habits (AUDIT-C score 3-7) and 4,8% had very hazardous drinking habits (AUDIT-C score 8-12). 14,8% of males and 12,1% of females were smoking tobacco irregularly and 4,8% of males and 4,4% of females smoked regularly. There was no statistically significant association between usage of alcohol and symptoms of depression among males or females. Among males, but not among females, there was statistically significant positive association between tobacco smoking and depressive symptoms (p=0,001).

The prevalence of hazardous drinking habits in our sample was very high compared to earlier studies conducted among university students. Contrary to earlier studies there was no association between hazardous drinking habits and depressive symptoms. In the future factors associating to hazardous drinking and the prevention of this phenomenon should be studied in more detail.