Risperidone is an antipsychotic used as the first-line treatment of schizophrenia. Risperidone is metabolised by enzyme CYP2D6. Activity of this enzyme can be predicted by genotypization.

To explore the possibility of different response rate to risperidone in first-episode schizophrenia patients with different CYP2D6 genotype.

To asses the utility of CYP2D6 pharmacogenetic testing in patients with schizophrenia treated with risperidone.

CYP2D6 genotype was assessed in 22 first-episode schizophrenic patients by use of automatic sequencing of DNA isolated from peripheral leukocytes. PANSS score was assessed every week of treatment until the change in medication or patient release.

Response was defined as at least 30% reduction in total PANSS. Differences in response rate between groups were tested by Fisher's exact test.

10 CYP2D6 extensive metabolisers (EM), 8 intermediate metabolisers (IM) and 4 poor metabolisers (PM) were identified. Criteria for response met 4 EM, 4 IM and 1 PM. Differences in response rate between groups were not statistically significant.

Although group of IM had higher response rate than EM and PM, differences in response rate did not reach statistical significance. Further differences may be found by extending the sample size. An useful approach would be also to examine differences in occurrence of adverse effects and subjective tolerance of the treatment.

The study was supported by the grant of Czech Ministry of Health No. NS 9676-4/2008.

CYP2D6 gene encodes an isozyme of the P450 cytochrome mono-oxygenase family, responsible for hepatic metabolism of the majority of neuroleptics. Phenotypes of CYP2D6 activity are ultrarapid, extensive, intermediate, and poor metabolizers. Prevalence of poor metabolizers is relatively high in European Caucasian population and ranges between 5–10%. The subjects with such phenotype are more likely to manifest adverse reactions and toxicity following administration of drugs in standard doses.

We describe a case report of a 16 year old male patient with dystonia and acute psychotic episode who developed neuroleptic malignant syndrome (NMS) associated with antipsychotic medication and a non-functional CYP2D6*4 allele.

The patient's clinical course is a case report.

The patient developed NMS after treatment with standard doses of antipsychotics. Genotyping revealed that this patient was homozygous for non-functional CYP2D6*4 allele. Ziprasidone was used for a follow-up treatment after recovery from the NMS. Persistent neuropsychiatric impairment was noted after 9-months.

Initial symptoms developed by this patient may be explained by overuse OTC cough medication. This case suggest that as in adult population, non-functional CYP2D6 allele could be associated with NMS in pediatric population. This means that screening for CYP2D6*4 allele in pediatric patients with NMS and history of adverse drug reactions could be helpful in the treatment of residual state after NMS.

Venlafaxine is a serotonin-norepinephrine inhibitor, mainly metabolized by CYP2D6 to its active metabolite ODV. Depending on CYP2D6 activity, patients may be identified as Poor, Intermediate, Extensive or Ultrarapid Metabolizers. There is some evidence that a PM phenotype is associated with poor tolerance more often than an EM; while a UM patient would only respond to a greater dose of Venlafaxine1.

To evaluate the impact of CYP2D6 phenotype on the efficacy of Venlafaxine XR in depressed patients.

This observational study evaluated 27 Caucasian adult patients (F = 18, M = 9), satisfying DSM-IV criteria for Major Depressive, Bipolar Disorder or Personality Disorder receiving treatment with Venlafaxine 75–300 mg/die.

CYP2D6 alleles were evaluated with INFINITI CYP2D6 assay, which employs AutoGenomics proprietary film-based microarray technology.

Most patients were identified as EMs, 4 as PMs, while only one was identified as UM. The only statistically significant difference between Extensive and Poor Metabolizers was, in contrast with current literature, the need of a greater mean dose of Venlafaxine in the second group (225 mg/die vs 159.38 mg/die, t student: p = 0.01).

Likewise, in contrast with literature, the UM patient was responsive to average doses of Venlafaxine.

On the contrary, we found no statistically significant differences as far as efficacy, adverse events or duration of treatment are concerned.

In our sample, CYP2D6 metabolizer status does not seem to affect treatment response nor adverse events related to Venlafaxine.

Psychiatric enterprise is inextricably bound to philosophical inquiry. Clinical practice, psychiatric theorizing and mental health policy each inevitably engage philosophical ideas. Despite this, psychiatry still cleaves to its traditional self-conception as a medical subspecialty. The purpose of this poster is to expose the philosophical presuppositions inherent within psychiatry and to highlight the need for philosophical approaches to this branch of medicine.

A literature search was conducted along with a review of Jennifer Radden's canon The Philosophy of Psychiatry. The interrelatedness of psychiatry and philosophy was elucidated by analysing and discussing the epistemology of affective disorders.

My research reveals that the philosophical literature on depression proceeds along three main paradigms: the moral, the medical, and the social/political. Much of contemporary literature on depressive illness in philosophy centres on the moral and medical approaches to clinical depression. These two paradigms clash, the former being concerned with morality and the latter with therapy. According to proponents of the moral paradigm, depression may be a legitimate manifestation of truths about a sufferer's situation whereas advocates of the medical model propose that depression is merely a medical condition that needs medical attention and treatment. The social/political approach uses melancholia as an analytical category of social and political systems, rather than individuals.

Philosophical research on a psychiatric illness repeatedly demonstrates that the field is essentially interdisciplinary. The strength of this interdisciplinary work is that many important minds unite to think through the crucial questions that depressive illness poses for humanity.

Researches of the human factor in dangerous professions are actual because it raise reliability of professional activity in extra-risk conditions.

We consider that image of the professional is an important part of each profession, its formation should be carried out by science means.

During the period when aviation was as a show (1909–1912) image of the pilots with pathological characteristics: 1) a genetic pathology: «people-birds»; 2) a psychic pathology: «people-suicides» dominated.

During investigation we applied an archival method, a biographic method, a method of the analysis of the prose, poetry devoted to Russian aviation.

With the beginning of the organization of professional selection and vocational training based on aviation medicine, aviation psychology and aviation pedagogy image of the pilot has got characteristics of adequacy to norms of a flyinq profession. By the 1930s process of formation of scientifically well-founded image of the pilot has come to the end. It is necessary to notice that the image of the astronaut at once constructed on a scientific basis, has been deprived of pathological signs.

Hence, the medicine, psychology, pedagogy are good image-makers of the professional and profession. These sciences should be developed and should be constructed on a common philosophical basis.

Science (e.g. neuroscience) aims to “explain” phenomena (e.g. consciousness). Philosophy of science analyses the structure, consistency, range etc. of the respective scientific “theories” (e.g. philosophy of physics).

A philosophy of neuroscience could be established (Neurophilosophy) as neurobiology claims to “explain” mental states and processes. Some (analytical) philosophers (e.g. Hacker) criticize brain theories because of mereological fallacies (e.g. not the brain/neurons can “decide”, but a person), misconceptions (e.g. “information”), implicit Cartesianism etc. But also some neuroscientists devaluate philosophy (e.g. Crick, Edelman, Zeki). Obviously, a deep gap in communication between neuroscience and philosophy exists.

We propose an integrated systematic programme of “interdisciplinary neurophilosophy” that could help by integrating findings of philosophy, psychology, neurobiology and systems science.

For instance, it is useful to talk about the “brain” as an extremely heterogeneous interconnected system that encompasses the problem of “dynamic complexity” and to use views of “systems science” and/or “computational science” in order to understand the phenomenology of network-based neural processing and coding. Also more detailed medical/neurobiological definitions of the “conscious brain” (e.g. probably excluding the cerebellum) are important for the brain-mind debate. Additionally, psychological and psychiatric categories have to be reviewed with the aim of a functional language.

An institutionalized multidisciplinary neurophilosophy will help to proceed in brain-mind debate.

Post-traumatic stress disorder (PTSD) is a disorder which can develop following exposure to one or more severely traumatic events. Symptoms experienced by PTSD suffers include re-experiencing the trauma through intrusive ‘flashbacks’ and recurrent dreams or nightmares, distress when exposed to reminders of the trauma, hyperarousal and emotional blunting. These symptoms can cause significant impairment of function and reduction in quality of life for suffers. Both psychotherapies, including cognitive behavioural therapies (CBTs) and eye movement desensitisation and reprocessing (EMDR), and pharmacotherapy are used in the treatment of PTSD.

We audited patients with PTSD in Bedford East performed in November 2008. A re-audit was performed using data from August 2010 patient database. Demographic information, risk factors, co-morbidities, psychological therapy and pharmacotherapy were compared between these audit and re-audit.

There is increased use of antidepressant augmentation between 2008 and 2010. While no patients in 2008 were on antidepressant augmentations, by 2010, 9 patients were. All 25 patients on anti-psychotics have important identified risk factors. There is no evidence of Psychosis in our PTSD patients except in two cases. There is an increase in Anti-psychotic use in our PTSD Patients. There is an increased use of Mood Stabilisers in our patients with PTSD.

PTSD is being identified more frequently in our patients, probably because of greater awareness and more accurate identification.

New patients being identified represent a group of more difficult to treat patients who represent severe risks. Present psychotherapies offered are not all recommended in present guidelines.

Complicated grief (CG) is currently under consideration for inclusion in DSM-V and a major issue is whether it can be differentiated from major depression (MDD) and post-traumatic stress disorder (PTSD).

There is evidence on the role of childhood but not separation anxiety as a significant risk factor for CG, and no study compared CG and PTSD patients with respect to these features.

To compare adult separation anxiety in patients with PTSD versus CG or both conditions. Further, to investigate the possible impact of mood spectrum symptoms in the same samples.

A total sample of 116 patients (66 PTSD, 22 CG and 28 with CG+PTSD) was recruited. Assessments included: the SCID-I/P, the Inventory of Complicated Grief (ICG), the Adult Separation Anxiety Questionnaire (ASA-27), the Work and Social Adjustment Scale (WSAS) and the Mood Spectrum-Self Report (MOODS-SR) lifetime version.

CG was strongly associated with female gender (8:1). MDD comorbidity was more common among patients with CG while bipolar disorder was highest among those with PTSD+CG. Patients with both CG and PTSD reported significantly higher ASA_27 (p = 0.008) scores than patients with either CG or PTSD alone. Patients with both diagnoses or PTSD alone reported significantly (p = 0.02) higher scores on the manic component of the MOODS-SR. No significant differences were reported in the WSAS scores.

Our results support differences between CG and PTSD, important to consideration of including CG as a new disorder in DSM-V.

Earthquakes are one of the most frequently occurring natural disasters and lot of studies have been conducted on exposed populations, particularly to evaluate post-traumatic stress disorder (PTSD). On April 6th 2009, the town of L’Aquila, central Italy, was struck by an earthquake, with a strength of 5.9 on the Richter scale, and 309 people have died, 1600 were injuried and more than 65000 were displaced.

To investigate the impact of PTSD in a sample of L’Aquila's people.

To evaluate the prevalence rates of PTSD, either full-blown or partial, among 512 students attending the last year of high school in L’Aquila, 10 months after the earthquake.

Assessments included the trauma and loss spectrum-self report (TALS-SR) and the Impact of Event Scale (IES). Gender differences in the symptoms reported were investigated. Partial PTSD is defined as the presence of symptoms in the DSM-IV Criterion B and C or D for PTSD diagnosis.

Our results showed the presence of PTSD in 192 (37.5%) of the students examined, with significantly (p = .000) higher rates in women than men (N = 120, 51.7% and N = 72, 25.7%, respectively). Moreover, 153 (29.9%) students reported partial PTSD (75, 32.3% women and 78, 27.9% men respectively). Significantly higher PTSD symptoms were reported by women with respect to men.

Our results show high rates of full or partial PTSD in adolescents survived to L’Aquila's earthquake. Women resulted more affected than men. These results highlight the need to carefully explore these conditions.

The confrontation with extreme events, such as a death threat, may release acute psychiatric troubles named “acute stress disorders” in the DSMIV-TR. Current operational context in Afghanistan is unpredictable and leads military surgeons to support soldiers facing major psychic suffering. Clinical practice confronts them with the difficulty to decrease the symptoms often strong, especially sleep disorders. Circadian rhythm disruption, lack of recovery may be at the origin of somatic and mental exhaustion.

We propose a debate about the principles of a medico-psychological handling based on the current operational experiences of the French military psychiatry. Special operational circumstances led military psychiatrists to prescribe an antipsychotic, small-dose, in the evening.

Unexpected results are observed on some symptoms like sleep disorders (improvement of sleep disorders, less traumatic nightmares, sensation of restorative night) and hyperarousal.

This clinical discovery leads to a reflection on physiopathological and pharmacological perspectives and to engage an observational study over 30 clinical cases and clinical trial project. Identifying, preventing, and treating operational stress at battlefront can provide the opportunity not only to improve operational performance, but also possibly to improve case by case the mental health.