We recently demonstrated that patients with major depression (MDD) with and without electroconvulsive therapy referral (ECTs vs. NECTs) qualitatively differ in neuropsychological profile. ECTs presented severe executive but minor visuospatial memory deficits, suggesting mainly frontostriatal involvement; NECTs presented the opposite pattern, compatible with temporohippocampal involvement. Here we follow up on ECT treatment effects on both cognitive domains.

15 ECTs were assessed with Hamilton Depression (HAMD-24), Hamilton Anxiety (HAMA) and Mini-Mental State Examination (MMSE) scales and 5 tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) at hospitalisation (PRE-ECT), immediately after ECT (POST-ECT) and 2 months later (FOLLOW-UP). ECTs at FOLLOW-UP were also compared to 15 matched non-psychiatric CONTROLS who underwent neuropsychological testing once.

There was significant clinical improvement (reflected by reduced HAMD-24 and HAMA scores: p < 0.001) between PRE-ECT and FOLLOW-UP. After a minor decline POST-ECT, MMSE scores showed significant increase at FOLLOW-UP (p < 0.02). At FOLLOW-UP, Paired Associates Learning (PAL) showed significant improvement (p < 0.001). Stockings of Cambridge (SOC) performance also improved (decrease in early abandonments, p < 0.04) POST-ECT and at FOLLOW-UP. However, clinical improvement did not result in improvement in Intra / Extradimensional Shift (IED): at FOLLOW-UP, ECT patients were indistinguishable from CONTROLS in all neuropsychological measures except IED (p < 0.04).

Clinically successful ECT treatment was accompanied by improved global cognitive functioning, visuospatial memory and spatial planning, but offered no benefit in attentional flexibility. This residual deficit suggests ‘trait’ frontostriatal involvement in this patient group.

Electroconvulsive therapy is widely used for treatment-resistant psychiatric patients. There is controversy about the minimum seizure duration required for clinical efficacy.

Characterize socio-demographically the electroconvulsive therapy unit of CHPL; find a correlation between improvement on PSAS, PANSS and HAM-D and both mean seizure duration and mean electric charge used; evaluate outcome in patients with seizure < 20s.

Three groups of patients were created according to ICD-10 diagnosis. The scales mentioned were applied at the beginning and end of the treatment: depressed (F31.3-5; F33; F20.4; F25.1) - HAM-D; schizophrenic/ schizoaffective/ bipolar-manic or mixed (F20.X, F25.X, F31.0, F31.6) - PANSS; with any of these diagnosis: PSAS. The correlation between the improvement on each scale and both mean seizure time and mean electric charge was investigated using the Pearson product-moment correlation coefficient. The groups were subdivided by seizure duration (cut-off 20s) and the mean improvement on the different scales was determined for each subgroup.

There is no correlation between any of the variables analyzed (α = 0,05). HAM-D variation (N = 102): seizure duration (r = 0,004) and electric charge (r = 0,106). PANSS variation (N = 43): seizure duration (r = 0,07) and electric charge (r = 0,046). PSAS variation (N = 147): seizure duration (r = −0,043) and electric charge (r = 0,143). There is no difference statistically significant in mean HAM-D, PANSS or PSAS improvement between subgroups >20s and < 20s (11.29 vs 13.94; 30.85 vs 29.19 and 19.07 vs 22.65, respectively).

Mean seizure duration and electric charge didn’t correlate with clinical outcome. Seizure duration below 20 seconds didn’t imply poorer outcome.

TDCS for modulating neurophysiology is known since the 1960s. tDCS trials in patients with depression showed promising results.

22 patients with therapy resistant major depression (DSM-IV criteria) were included in a four week cross-over trial, 10 received 1 mA tDCS, 12 received 2 mA tDCS, 2 dropped out. Patients received add-on tDCS under a stable antidepressant treatment over 3 weeks and were randomized to active or sham tDCS treatment. The sham condition was evaluated in 10 healthy volunteers and was indistinguishable.Both, active (1 mA resp. 2 mA) and placebo tDCS were applied for 20 min per day and for two weeks and then switched to the other condition. The anode was positioned over F3 and the cathode over the contralateral supraorbital region. For placebo tDCS a novel sham device (neuroConn, llmenau, Germany) was used which is indistinguishable for the applying person. Severity of depression was assessed by HAMD, BDI, CGI and CORE scales and raters were blind to treatment conditions.

Mean HAMD decreased by 25% in the whole population after four weeks of tDCS. Active tDCS performed significantly better (p = 0.0492) than the control treatment. However this positive association was restricted to the first study phase as there was also a significant (p = 0.0271) influence of the study phase in the cross-over design and an almost significant (p = 0.0864) interaction between treatment and study phase.

Though active tDCS was not superior to sham treatment, we observed hangover effects in weeks 3 and 4 depending on the first condition.

There were 16,482 administrations of Electro-convulsive Therapy (ECT) to 2835 individuals in England between January-March 1999. Controversy still surrounds the safety, ethics and necessity of ECT with some patients reporting severe adverse effects and feeling particularly strongly about it being administered without their consent. NICE guidelines along with the ECT accreditation service (ECTAS) sought to address these concerns and raise standards for ECT in UK.

To identify any barriers to compliance with NICE guidelines regarding consent for ECT.

All patients newly started on ECT during a 3 month period at Hellesdon Hospital were enrolled into this study. Case notes were analysed for 16 patients against the 21 standard ECTAS consent criteria.

The hospital rated good (70–89%) or excellent (90–100%) for all guidance except the one which requires patients to complete some sections of the consent form. Only 63% of the patients had completed these, however 100% went on to sign the consent form before every session. Guidance compliance was excellent for 15 (72%) of items examined.

There is good compliance with NICE guideline relating to consent for ECT. The only barrier to full compliance was inadequate documentation by patients in some sections. Steps to improve patient participation can now be implemented. This will provide assurance that ECT is used appropriately and that the process fully enables informed consent. Further research is required to discover the reasons for unsatisfactory patient participation in the consent process.

Electroconvulsive therapy (ECT), which is a safe and effective treatment option for many of the psychiatric illnesses, is still negatively perceived by lay public. It could be hypothesized this negative view can affect the patients and their relatives. This study aimed to evaluate the attitudes of patients’ and their relatives’ toward ECT.

Sixty-four ECT treated patients were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were evaluated with Clinical Global Impression Scale, Mini Mental State Examination and Columbia ECT Subjective Side Effects Schedule. Both patients and their relatives were interviewed by using a questionnaire for assessing attitudes toward ECT.

The mean number of ECT sessions was 8.50 ± 1.85. The most common side effects according to the patients were subjective feeling of slowed down and memory problems. The majority of both patients and their relatives stated that they had not received adequate information about ECT. Moreover, their knowledge about technique and mechanism of ECT was very limited. However, their overall perception of ECT was very positive. The relatives of the patients were more satisfied with the benefits of ECT than the patients.

Although perception of ECT among patients and their relatives was very positive, it should be noted that this was mostly subjective in regard to inadequate knowledge about ECT. Thus, clinicians should pay utmost attention to inform both patients and their relatives about ECT.

Transcranial direct current stimulation (tDCS) is a non-invasive and safe neuromodulation technique that induces prolonged excitability changes of the human cerebral cortex. We have shown that patients with severe major depression treated with tDCS twice a day for 5 days improve by some 30% their depressive symptoms.

To optimize the tDCS protocol for the treatment of major depression.

To assess the therapeutic efficacy in severe drug resistant major depression of tDCS over the dorso-lateral prefrontal cortex (DLPC) twice a day for ten days.

We studied 15 hospitalized patients aged 37–68 years, with severe major depression. Mood was evaluated using the Beck Depression Inventory (BDI) and Visual Analogue Scales (VAS). tDCS was delivered over the DLPC (anodal electrode was placed on F3 and cathodal electrode on F4) at the intensity of 2mA, for 20 minutes, twice a day for 10 days. Depression scales were administered at baseline and after the last tDCS session on day 10. Drug treatments were maintained unchanged since six weeks before the tDCS study.

After ten days of tDCS the BDI improved by about 40% [(Mean ± SEM) Before: 29.1 ± 3.5; After: 19.4 ± 3.7, p < 0.01]. The feeling of happyness and sadness as evaluated by VAS improved after tDCS (happiness p < 0.01; Sadness p < 0.05).

The improvement reported by patients after ten-days tDCS protocol is greater than that we previously reported after the five-days tDCS protocol. Hence, our preliminary findings suggest that ten-days tDCS protocol should be preferred to the five-days protocol for major depression.

The influence of repetitive transcranial magnetic stimulation (rTMS) on mood in healthy people is uncertain, as former studies show divergent results. Previous studies in healthy volunteers focused exclusively on the immediate effect of a single session of rTMS on mood.

The aim of this study was to analyse the influence on mood of a series of 9 High Frequency (HF) rTMS stimulations of the left dorsolateral prefrontal cortex (DLPFC).

44 young healthy male volunteers were randomly assigned to receive 9 sessions of active HF-rTMS (n = 22) or sham rTMS (n = 22) over the left DLPFC. Each session in the active group consisted of 15 trains of 25 Hz starting with 100% of motor threshold. Sham stimulation was performed following the same protocol, but using a sham coil. The variables of interest were the Beck Depression Inventory (BDI) and Visual Analogue Scales (VAS) which quantified “mood”, “enjoyment” and “energy”.

We found a significant reduction of the BDI score in the active group (GLM, p < 0.001) whereas no significant changes of the BDI score were caused by sham stimulation (GLM, p = 0.109). We did not find significant differences caused by active or sham stimulation in VAS scales except for the VAS labelled lively/gloomy immediately after stimulation. The active group was found to be more “gloomy” (p = 0.001).

Our data support the hypothesis that a 9-day long series of HF-rTMS of the left DLPFC improves mood, analysed by BDI in healthy young men.

Recent investigations into motor cortex excitability with paired pulse transcranial magnetic stimulation technique (ppTMS), have shown inhibition deficits in ADHD which correlate with the clinical symptomatology. Methylphenidate effects on cortical excitability in adults with ADHD are contradictory. Therefore, we use long-acting methylphenidate (LA-Mph) to consider cortical excitability effects under stable medication conditions.

Systematic evaluation of the effects of LA-Mph on motor cortex excitability in adult patients with ADHD with the ppTMS technique.

Investigation of the putative influence of LA-Mph on motor inhibition and facilitation in adults with ADHD.

Thirteen drug naïve adult ADHD patients were included in this ppTMS study. Measurements took place before and under treatment with LA-Mph (30–54 mg daily dose). Statistical analyses were performed to investigate treatment effects and correlations with clinical symptomatology.

LA-Mph significantly decreased the relative short intracortical motor inhibition (SICI) magnetically evoked potential (MEP) amplitude at 3ms interstimulus interval (conditioned/ unconditioned MEP amplitude: 0.84 ± 0.76 drug-free vs. 0.29 ± 0.19 with LA-Mph; p = 0.020). The relative intracortical facilitation (ICF) MEP amplitude at 11ms interstimulus interval (conditioned/ unconditioned MEP amplitude: 1.51 ± 0.92 drug-free vs. 1.79 ± 0.95 with LA-Mph) was not significantly increased. The decrease of the relative SICI MEP amplitude with LA-Mph correlated significantly with the improvement of the psychopathological ADHD self-rating total scores (p = 0.034) and hyperactivity/impulsivity subscores (p = 0.029). These results show that in adult patients with ADHD, LA-Mph significantly improves motor disinhibition without influencing motor facilitation.

LA-Mph might have differential stabilizing effects on motor hyperexcitability in adults with ADHD and correlates with the clinical improvements.

Electroconvulsive therapy is widely used for treatment-resistant psychiatric patients, with remission rates close to 50% and response rates between 60–70%. Post ictal suppression index (PISI) has been positively correlated with clinical outcome.

Characterize the treatment results of the electroconvulsive therapy unit of CHPL; find a correlation between improvement on HAM-D, PANSS and PSAS and PISI.

The patient data was collected and divided according to ICD-10 diagnosis. Evaluation scales were applied at the beginning and end of treatment: depressed patients (F31.3–5; F33; F20.4; F25.1) - HAM-D; schizophrenic/ schizoaffective/ bipolar-manic or mixed patients (F20.X, F25.X, F31.0, F31.6) - PANSS; with any of these diagnosis - PSAS. A correlation between the points of improvement on each scale and PISI was investigated using the Pearson product-moment correlation coefficient.

Of 101 depressed patients, 33,7% showed remission and 49,5% showed response, over 11 sessions (average). The reduction on HAM-D score was significantly greater for patients with initial HAM-D score > 18 versus HAM-D ≤ 18 (52,9% versus 37,75%). Patients with unipolar depression (N = 72) and bipolar depression (N = 22) showed comparable results (response:47,2% versus 52,4%; remission: 30,6% versus 40,1%). Schizophrenic patients (N = 43) had higher response rates: 88%. No correlation was found between PISI and HAM-D, PANSS or PSAS improvement (r = -0,1;-0,01;-0,07).

Response and remission rates in depressed patients were inferior to other ECT studies, except in patients with higher severity. Those rates were comparable for schizophrenic patients. PISI did not correlate with clinical outcome.

Electroconvulsive therapy is nowadays one of the most useful treatments for severe mental disorders. A lot of patients refer an improvement or even a remission of their psychopathology after this treatment.

To demonstrate how cinema has favoured the creation of a social stigma against mental health professionals, against the treatments we use and, most of all, against the people we treat.We based this project on the portrait cinema has meade of electroconvulsive therapy (ECT).

ECT appears in more than thirty films. We take into account the most representative ones shot from 1948 to 2008.

ECT makes its debut in cinema in 1948, ten years after its first use as a psychiatric treatment. During 60 years, ECT comes on stage in more than 30 films. The main indication in cinema to use ECT is to control and punish antisocial behaviors. Medical consent is not asked in most of the films. The ECT modified procedure doesn’t appear.

Cinema has contributed to stigmatize mental illness, psychiatrists and treatments we use, specially electroconvulsive therapy.

Repetitive transcranial magnetic stimulation (rTMS) on the left dorsolateral prefrontal cortex (DLPFC) is safe and efficient for treatment-resistant depression (TRD). More intensive rTMS protocols could improve clinical outcome.

We report on an intensive high frequency (HF)-rTMS treatment protocol in patients unresponsive to current treatment strategies.

Monitoring effectiveness and tolerability.

Patients were diagnosed with TRD, schizoaffective disorder, bipolar type or bipolar type I disorder, mixed episode. All were unresponsive to adequate therapy (rTMS excluded).HF-rTMS was administrated on the left DLPFC under MRI guidance. In each 20 Hz stimulation session, the patient received 40 trains of 1.9 seconds duration at 120% of the motor threshold. The 20 HF-rTMS sessions were spread over 4 days (5 times/day), yielding a total of 31,200 stimuli.

There were neither seizures nor important adverse events. The bipolar patient clinically responded (Hamilton Depression Rating Scale (HAMD) from 20 to 9) following treatment day 1. After completing the protocol a week earlier, the TRD patient's HAMD went from 28 to 5. There was a 5 point decrease in the score of the schizoaffective patient. He improved on the brief psychiatric rating subscales blunted affect and emotional withdrawal. No positive symptoms occurred. None of the patients had significant elevations in YMRS scores or in psychomotor activity.

‘Intensively’ targeting the left DLPFC was tolerated and safe. Our results suggest a strategy of HF-rTMS protocols in non-responders to classical treatment. Larger sham-controlled HF-rTMS studies should substantiate these recent findings.

In 1890 Ball defined hallucinations as perceptions without real object with sharp features and embodiment of that approach actual sensory perceptions.

We present the case of an elderly woman with cataract. Previously we maked a review of the literature and its controversies.

An 82 year old woman was referred to psychiatry for primary care physician for evaluation of visual hallucinations of 3 ½ months of evolution. Among somatic background are collected: arterial hypertension, cataracts and increased intraocular tension.

The detection of the picture is casual, for the comments that the patient makes to his daughter. She says that she sees her husband died 6 years ago, on the stairs. Reported to have a house full of people describing in detail the number of people and the characteristics of them. She claims that under the bed see rats and dogs.

She was conscious and oriented. No significant objective emotional impact of visual hallucinations. Is euthymic and without anxiety clinic. Complex visual hallucinations are objectified. The content of thought has developed a delusional elaboration of hallucinations with partial insight.

The primary care physician began treatment with haloperidol, the patient presenting extrapyramidal symptoms, so it was discontinued and olanzapine was started up to 10 mg. The clinical picture resolved completely within a few days.

Charles Bonnet described in the 1760s. Morsier is the first called the Charles Bonnet syndrome as a persistent or recurrent visual hallucinosis in older people with serious visual impairment and psychically healthy.

In recent years have seen significant advances in the treatment of bipolar disorder with the appearance of new drugs such as atypical antipsychotics. However, there is still a therapeutic challenge to effectively cover the prevention of relapse.

The appearance of new drugs such as paliperidone with demonstrated successful experience in the field of schizophrenia can expect the use of this drug in usual clinical setting like positive contribution

The aim of this study is to evaluate the efficacy and safety results after 6 months of combined treatment with paliperidone in patients diagnosed with bipolar disorder

This study is an observational retrospective of the effectiveness of paliperidone as adjunctive therapy in a sample of 11 patients with bipolar disorder I treated as outpatients in a mental health center.

Paliperidone addiction was caused by lack of efficacy or partial response to treatment. Scundary effects were collected during the study period

In all cases except two, was added paliperidone because of partial response to the treatment. After six months of treatment only one patient discontinued treatment due to problems of tolerability and another for lack of efficacy. The mean dose of paliperidone used was 5.7 mg / day. The addition of paliperidone significantly improved affective symptomatology.

Pharmacological treatment combined with paliperidone is effective and quite well tolerated in patients with bipolar disorder. The limitations of our study (small sample size, open study) do need more research and the realization of controlled clinical trials to confirm these findings.

This program aims to assist young people aged 16 to 35 years at risk for or who have a severe mental disorder, a psychosis both affected and unaffected, according to the principles of early intervention and assertive community treatment.

Assisting young people with psychosis in order to achieve symptomatic and functional recovery, return to provide standardized environment and prevent deterioration.

Initial assessment is made and individualized plan of work.

1. 1. Diagnosis: substance-induced psychotic disorder, schizophrenia and other psychotic disorders, bipolar disorder and mood disorders with psychotic symptoms

2. 2. age: 16–35 years

3. 3. Informed consent

PANSS, SCIP, CDS, CGI-S, PAS, CAN, EU, SFS, GAF, WHOQUOL-BREF, IEQ-EU, UKU, HoNOS, CGI-IP, CGI-IC

The sample consisted of 22 patients. 45.5% men and 54.5% women. Mean age 24 (SD = 4.74). Diagnosis: schizophrenia 54.5%, 27.3% acute psychotic disorder, 4.5% and 13.6% schizoaffective disorder manic episode with psychotic symptoms. Clinical stage at the beginning of the program: 45.5% stage 2, 4.5% stage 3a; 22.7% stage 3b, 3c stage 22.7% and 4.5% stage 4.

It is necessary to implement such programs to establish the treatment as soon as possible to the onset of the disease and improve prognosis.

In 2010, the American Diabetes Association (ADA) proposed that individuals with fasting glucose 100–125 mg/dl (5.6-6.9 mmol/l) or glucose 140–199 mg/dl (7.8–11.0 mmol/l) 2 hours after a 75 gm oral glucose tolerance test (OGGT) or hemoglobin A1c (A1c) 5.7–6.4% be classified as prediabetic to indicate a high risk for the development of diabetes.

To determine the prevalence of prediabetes in psychiatric patients receiving antipsychotics and to compare the clinical and metabolic features of patients with normal glucose tolerance, prediabetes and diabetes.

The 2010 ADA criteria were applied to a large consecutive cohort of psychiatric patients treated at one institution in Belgium. All patients were evaluated with OGTT, A1c, insulin levels and lipid profiles.

The study sample was restricted to the 783 adult patients (mean age 37.6) without known history of diabetes. 413 (52.8%) patients had normal glucose tolerance, 290 (37%) were prediabetic and 80 (10.2%) were diabetic. The 3 groups were similar with regard to psychiatric diagnoses, severity of mental illness and antipsychotic treatment. A statistically significant crescendo gradient from normal to prediabetes and from prediabetes to diabetes was observed for age, body mass index, waist circumference, fasting insulin, homeostatic model of insulin resistance (HOMA-IR) and triglyceride levels. The intergroups differences for fasting insulin and HOMA-IR were confirmed for treatment with clozapine, olanzapine, quetiapine, risperidone and amilsulpride, but not for aripiprazole or first-generation antipsychotics.

Prediabetes is highly prevalent in adults treated with antipsychotic drugs and correlates with markers of intraabdominal adiposity and insulin resistance.

Studies using death certificates have indicated an excess of sudden cardiac deaths among users of antipsychotic drugs compared to the general population, but may have underestimated the presence of other known causes of sudden and unexpected death.

To assess the cause and risk factors for sudden death discovered by contemporaneous investigation of all deaths occurring over a 26-year period (1984–2009) in adult patients registered for care in one large psychiatric hospital in New York.

Circumstances of death, psychiatric diagnoses, psychotropic drugs and past medical history were extracted from the root cause analyses of sudden unexpected deaths. After the exclusion of suicides, homicides and drug overdoses, explained and unexplained cases were compared regarding clinical variables and the utilization of antipsychotics.

One hundred cases of sudden death were identified among of 119, 500 patient-years. The death remained unexplained in 52 cases. The incidence of unexplained sudden death was 125/100,000 (95% CI 88.9–175.1/100,000) patient-years in 2005–2009, 53/100,000 (95% CI 31.7–88.5/100,000) patient-years in 1999–2004 and 7/100,000 (95% CI 3.7–19.4/100,000) patient-years in 1984–1998. Explained and unexplained cases were similar regarding psychiatric diagnoses and treatment with any psychotropic class, including first- and second-generation antipsychotics. Dyslipidemia (p = 0.012), diabetes (p = 0.055) and co-morbid dyslipidemia and diabetes (p = 0.008) were more common in the unexplained than in the explained cases.

In a consecutive cohort of psychiatric patients, the unexplained sudden deaths were associated with known risk factors for coronary artery disease, but not with higher utilization of first- or second-generation antipsychotics.

Numerous studies show that patients with psychotic disorders have low rates of adherence, which is the main cause of relapses and hospital admissions. It is fundamental to long-term drug treatment in the management of patients with psychosis, both in preventing relapses and the consequences that flow from them (hospital admissions, clinical deterioration, loss of functionality and quality of life of patients)

Assess the benefits to be derived from the use of extended-release injectable antipsychotics in regard to adherence to treatment, the persistent improvement of psychotic symptoms and reducing the number of hospital admissions

Descriptive study. Sample: 40 patients diagnosed with schizophrenia or schizoaffective disorder treated at a mental health center. Patients are divided into two treatment groups: 20 patients are treated with risperidone in prolonged release of more than one year duration and the other group treated with oral antipsychotics.

Adherence to treatment is higher in the group treated with injectable antipsychotics (90%) than with oral (50%). The age range from 20 to 61 years. The average hospitalization was greater for the group treated with antipsychotic injections in the period prior to treatment (17) compared to post-injection treatment outcome (5). In patients with oral antipsychotics were 20 hospitalizations in total.

Confirms the results on adherence and hospitalizations compared to other similar studies. There is a clinical and functional improvement, fewer hospitalizations, shorter average stays and higher outpatient adherence in patients with extended-release injectable antipsychotics compared with the group of patients with oral antipsychotics.