Overweight and weight cycling represent common problems in individuals with bipolar disorder. Furthermore, substance dependency including alcoholism has been found to be a frequent co-morbid disorder, which affects the course and prognosis of bipolar disorder. Recently, substance use disorders have been related to weight cycling in a non-bipolar sample (Whyshak, 2006).

The study aimed to investigate the association between weight cycling (loosing and regaining weight in the last four years for at least three times) and substance abuse (drug and alcohol abuse) in patients with bipolar disorder.

The study took place at the Department of Psychiatry of the Medical University of Graz, Austria and 90 euthymic patients with bipolar disorder were included. Questionnaire data about weight and weight cycling were collected. A’SCID-I’ was conducted to evaluate bipolar symptomatology and co-morbid disorders.

Findings showed that bipolar patients with a history of weight cycling are prone to demonstrate a comorbid alcohol use disorder compared to non-weight cyclers (F1,87=5,531; p < .05). However, we could not find a significant relation between weight cycling and other drug or polydrug abuse in our bipolar sample (F1,87=1,548; p > .05).

Although, a relation between weight cycling and the co-morbidity of alcohol dependency has been detected, we do not know which phenomenon causes the other. Further studies on this topic including investigation of the relationship between alcohol abuse, weight cycling, and therapy outcome would be important. To conclude, the therapy of bipolar disorder should aim for a stable weight.

In bipolar disorder (BD), reduced white matter (WM) integrity in the corpus callosum has been reported, but its detailed localization difference has not been clarified. In this study, we examined fiber integrity in 7 segments of the corpus callosum and their relationships with clinical symptoms in BD.

Patients with BD (BD group, n = 17) and age-matched healthy controls (HC group, n = 24) were examined using diffusion tensor imaging tractography. The corpus callosum was divided into 7 segments (orbital frontal, anterior frontal, superior frontal, superior parietal, posterior parietal, temporal, and occipital) based on their cortical projection zones, and fractional anisotropy (FA) value of each segment was estimated. Differences in FA of each segment between the groups were examined using ANOVA with repeated measures. Correlations between FA of each segment and clinical symptoms (HAM-D, YMRS) were assessed using Spearman's rank correlation test in the BD group.

The BD group showed reduced FA in the orbital frontal, superior frontal, and posterior parietal-callosal segments compared to the HC group. In addition, the BD group showed a significant negative correlation between FA in the orbital frontal-callosal segment and HAM-D scores.

Our results suggest that WM integrity in the anterior part of the corpus callosum is reduced in BD and that orbital frontal-callosal disintegrity may be related with severity of bipolar depression.

The epidemiology of suicidal behaviours (SB) reflects our lack of understanding of these complex behaviours, as well as our difficulty to predict them. It is now admitted that vulnerability to SB relies on the interaction between genetic predisposition and environmental factors. Serotoninergic genes and orbitofrontal cortex (OFC) dysfunction are potential biomarkers for SB.

Three groups of euthymic participants were included: 1) suicide attempters—individuals with a past history of both major depressive episode and suicidal behaviour; 2) affective comparison subjects—individuals with a past history of major depressive episode but no history of suicidal acts; 3) healthy comparison subjects—individuals with no past history of any DSM-IV axis I diagnosis. We compared neural activity using functional MRI while performing face processing (happiness, anger, sadness visualisation) and decision-making tasks (Iowa Gambling Task). We characterized of our sample for five genotypes: 5HTTLPR, TPH-1 rs1800532, TPH-1 rs7933505, MAOA u-VNTR, and TPH2 rs7305115. We performed a priori ROI analysis focused on OFC.

We found decreased activation during risky vs. safe choices and increased activation during wins vs. losses in left OFC in suicide attempters in comparison to controls. Left lateral OFC activation was correlated with IGT net score in suicide attempters. We found an increased activation of right lateral OFC cortex in suicide attempters in comparison to affective controls when viewing angry but not happy or sad faces vs. neutral faces. Lateral OFC activation was modulated by 5HTTLPR polymorphisms.

Based on OFC dysfunction, suicide attempters may overevaluate social negative signs and underevaluate deleterious consequences of short-term rewarded choices.

Clonazepam is a benzodiazepine (BZD) authorized for treatment of epilepsy in France. Several evidences for clonazepam abuse liability and offlabel use were observed. Authorities changed the legislation to make clonazepam diversion more difficult. We asked if the three successive law changes between 2008 and 2011 have influenced clonazepam use and abuse.

To assess the impact of recent legislation changes on clonazepam abuse in the Paris Metropolitan Region.

A quantitative analysis of all clonazepam data from 2003 to 2012 of three epidemiological tools has been performed: NOT'S is a CEIP database of spontaneous NOTifications of drug abuse and dependence.

Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM), data from French health reimbursement system (FHRS) for all the country.

We aimed to compare clonazepam misuse and abuse evolution with diazepam and flunitrazepam to assess the legislation impact on clonazepam.

In NOT'S, between 2003 and 2007 the proportion of clonazepam misuse ans abuse seems to be stable (15% ±2 of all notifications). Clonazepam abuse increases between 2007 and 2010 (up to 30%) then starts to decrease after 2010 until now (23% of all notifications). These results are consistents with data from the FHRS, whereas in the OPPIDUM survey clonazepam use seems to be stable in addiction centres. Diazepam use is constantly increasing in the 3 epidemiologic tools whereas flunitrazepam use is stable or slowly decreasing.

Our results show an influence of the legislation on the misuse of clonazepam particularly in the untreated addicted population.

Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.

559 consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego- Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

Higher cyclothymia (27.7% vs. 20.0%, < 0.05) and irritable (34.7% vs. 22.9%, p < 0.05) temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II (22.9% vs. 44.6% vs. 40.7% p < 0.05) and higher anxiety than patients with other Axis I diagnoses (52.1% vs. 22.3%, p < 0.05). Severe’male’ depression was more common in BD-II patients compared to BD-I and MDD, respectively (33.7% vs. 16.3% vs. 22.9% p < 0.05). BD-I and patients with other axis I diagnoses reported lower BHS≥9 scores (41.6% and 36.6% vs. 61.6% and 62.5%, p < 0.05) than those with BD-II and MDD.

MDD patients were more likely to have anxious prevalent temperament, higher hopelessness and lower hypethimic temperament while BD-I patients had more frequently cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.

Kosovo war had a devastating effect in the country as evident in the increasing prevalence of depression and post-traumatic stress disorders in the population.

To investigate levels of Quality of Life and the presence of PTSD and Depression thirteen years after war at the most war-affected region of Kosovo-Drenica.

The study aimed to measure the levels of Quality of Life and explore correlations with the presence of PTSD and Depression.

The purposeful sample of general population of Drenica region have filled out PTSD questionnaires (adapted from DSM-IV), Beck Depression Inventory and The Quality of Life Scale. In the sample of 249 respondents (17-70yr, Mage=36, 6) 2/3 of them were males; 88% lived in rural regions; 18, 65% ex-soldiers; 66. All data was analyzed by SPSS 21.0 and Microsoft Excel 2007.

Results showed that 27% of the sample declared experiencing war trauma. We found PTSD in 17, 9% cases; depression at clinical level in 10, 7%. 38, 1% of the sample has perception of low level of Quality of Life. PTSD was significantly positively related with depression (r=.562; p<.01) and significantly negatively related with the level of Quality of Life (r=-.39; p<.01). Presence of PTSD predicted low level of Quality of Life while controlling for depression (r=-.26; p<.01)

The prevalence of PTSD in the specific region is still high and is obviously related to poor quality of life and depression. More effective programs are needed both to identify and treat PTSD and depression.

Studies in general and psychiatric populations have mainly reported higher rates of somatisation in immigrants. Cross-cultural studies, confirmed that East-Asian non-immigrant patients reported fewer psychological and more somatic symptoms in depression. However studies on somatisation in depression are lacking for Vietnamese migrants in Europe.

To explore whether Vietnamese outpatients, who utilized a psychiatric outpatient clinic in Germany had a tendency to present more somatic symptoms in depression.

For FG Vietnamese outpatients, psychological symptoms were assessed by depression-scale (PHQ-9) and somatic symptoms were assessed by the Somatic-symptom-scale (PHQ-15) in Vietnamese language by a Vietnamese psychiatrist. German outpatients who were assessed in the same outpatient clinic where matched for age, gender and diagnosis of MDE. Differences in PHQ-9 and PHQ-15 scales where analyzed with an ANOVA and single-item-differences of PHQ where analyzed with Mann-Whithney-Tests.

43 FG Vietnamese immigrants and 43 native german outpatients where included. While we found no differences on the total score of the PHQ-9 between both groups, FG-Vietnamese outpatients had an overall higher total score on somatic-symptom-scale PHQ-15. When analyzing somatic items FG-Vietnamese outpatients reported significantly more somatic symptoms of headache, chest-pain, dizziness and fainting.

Depressed Vietnamese outpatients reported psychological symptoms of depression at similar levels as matched native German outpatients. Vietnamese outpatients had a higher total score for somatic symptoms, and that difference was driven by a subset of somatic items. We concluded, that emphasis on somatic symptoms does not reflect a minimization of psychological symptoms in FG-Vietnamese outpatients seeking help for depression.

The HCR-20 is the most widely used structured violence risk assessment tool in medium secure units in England and has good predictive validity for inpatient violence. However little is known about whether its predictive validity varies between different clinical and demographic groups.

1. 1) collect HCR-20 risk assessment and three month follow-up data for all eligible inpatients

2. 2) examine the ability of the HCR-20 to predict various indices of inpatient aggression using receiver operating characteristics (ROC), and

3. 3) compare AUC values derived from different groups (i.e. men vs. women)

determine if the HCR-20 performs equally across different clinical and demographic groups.

This study was conducted amongst inpatients at St Andrew's (N=505). Demographic (age, ethnicity, gender), clinical (diagnosis) and routinely collected risk assessment data (HCR-20) were collated. Incidents of aggression were coded using the OAS for the three months following assessment.

ROC analysis revealed that the HCR-20 total, Clinical scale and Risk Management scale were predictive of all types of aggression; the Historical scale was a significant predictor of verbal aggression and physical aggression towards objects but not physical aggression towards people. The predictive efficacy of the HCR-20 differed according to gender and diagnosis, with superior performance obtained with women and those with a diagnosis of personality disorder.

This study reveals differences in the HCR-20's efficacy between groups. Further development and optimisation of the HCR-20 may be required. Alternatively, interventions to prevent aggression may be more effective among some groups. Future research should address these issues.

Reduced white matter integrity in the corpus callosum (CC) has been reported in treatment-resistant depression (TRD). rTMS is assumed to have remote effect on interconnected area with the stimulation site, and this effect is speculated to be one of the therapeutic mechanisms of rTMS treatment. In this preliminary study, we examined changes of callosal fiber integrity in 5 segments of the CC before and after rTMS treatment for TRD.

The subjects were 2 patients with treatment-resistant unipolar depression and 1 patient with treatment-resistant bipolar depression, and 24 healthy controls (HC group). The patients underwent 4-week high frequency rTMS to their left DLPFC. In diffusion tensor imaging (DTI) tractography, the CC was divided into 5 segments (orbital, frontal, parietal, temporal, and occipital) based on their cortical projection zones, and fractional anisotropy (FA) value of each segment was estimated. We compared FA in the CC between the patients and the HC groups, and examined changes of FA in the CC after rTMS treatment in the patients.

The patients showed reduced FA in the frontal, parietal, temporal, and occipital-callosal segments compared to the HC group. All patients responded to the rTMS treatment, and FA in the orbital, frontal, parietal, temporal-callosal segments increased after the rTMS treatment.

Our results suggest that white matter integrity in the CC is reduced in TRD and that increased white matter integrity in the CC might be related with the therapeutic mechanisms of rTMS treatment.

Overweight and obesity are highly prevalent in bipolar disorder (BD), and have been observed to worsen treatment response and outcome. Moreover, a relationship between overweight/obesity and cognitive impairment has been reported previously. Clinical staging includes clinical features, data of biomarkers and cognition, and is related to global functioning in BD. Earlier stages of illness may be associated with a better prognosis and a higher treatment response.

The present study aims to evaluate the relationship between clinical staging and overweight/obesity in euthymic BD individuals. Clinical staging was hypothesized to be associated with overweight/obesity, especially with indicators of abdominal obesity.

A cohort of 100 euthymic BD patients was recruited and anthropometric variables (including body mass index and waist/hip circumference) were measured. Body composition was evaluated with lipometry measurement, an exact calculation of the subcutaneous adipose tissue thickness. Clinical staging was done according to the staging model by Kapzinsky et al. For statistical analyses, partial correlations controlled for age were used.

Findings show a positive correlation between staging and hip circumference r=.265, p<.05, and a tendeny towards significance between staging and total body fat: r=.183, p=.08).

As clinical outcome parameter, staging enables to unterstand the mechanisms underlying progression of BD and assists in treatment planning and prognosis. Based on the results we might suggest, that abdominal obesity is associated with a higher progression of BD accompanied with negative outcome characteristics. The data provide an updated quantification of the growing public health burden in BD.

To compare sensorimotor learning in stable schizophrenia patients, healthy age- and sex-matched controls and elderly controls in two variations of the classic Rotary Pursuit.

In Circle Pursuit (true motor learning), a target circle, rotating along a predictable circular path on the computer screen, must be followed by manipulating the pen on the writing tablet. The task consists of two trials of six rotations each, with target speed gradually increasing. In the eight-trial Figure Pursuit (motor and sequence learning), subjects learn to draw a complex figure by following a target circle that moves at a fixed speed along an invisible trajectory around several goals. Tasks were administered thrice (interval 2-7days) to 32 stable schizophrenia patients (S), 16 healthy age- and sex-matched controls (Y) and 16 elderly controls (>65y; E) and recorded with a digitizing tablet and pressuresensitive pen (200Hz frequency; 0.2mm spatial accuracy). Learning speed was assessed in a repeated-measures ANOVA of outcome variable accuracy (% of time cursor is within target).

All groups exhibited learning effects and significant group differences in accuracy existed (E<S<Y, p<0.01) in both tasks. However, within-subject analyses revealed a significant effect of group*trial number (p<0.01) and group*session (p0.02) only in Figure Pursuit, indicating a significant difference in learning between groups in this task.

In our Pursuit continuous sensorimotor task, group differences exist between schizophrenia patients and elderly and young healthy controls. When a sequence learning component is added (Figure Pursuit), there is also significant difference in the amount of learning.

The aim of the present study was to explore any heterogeneity in the 6-month clinical response in antipsychotic drug-naive schizophrenia patients, and to determine predictors of that outcome.

467 antipsychotic drug-naive schizophrenia patients were included in France nationwide and followed up over 6 months. In order to identify trajectories of clinical response, a latent class growth analysis was performed using the Clinical Global Impression-Severity (CGI-S) scores at baseline, 1, 3 and 6 months. Regression models were used to identify predictors of trajectory membership.

Five trajectory groups were identified: a rapid response group (n=45), a gradual response group (n=204), patients remaining mildly ill (n=133), patients remaining very ill (n=23) and a group with unsustained clinical response (n=62). Predictors of the 6-month clinical response were baseline CGI-S score (odds ratio 3.1; 95% confidence interval, 2.1-4.4) and negative symptoms (OR 1.5; 95%CI, 1.2-1.9). The sole predictor of rapid response as compared to gradual response was employment (OR 2.5; 95%CI, 1.2-4.9).

Clinical response in schizophrenia patients 6 months after a first-ever antipsychotic drug initiation is heterogeneous. Therapeutic strategies in first episode should take account of symptoms severity and of early clinical response, in order to maximize the chances of recovery.

Adolescence is recognized as a period of emotional turbulence. In a post-war country like Kosovo it may be more evident in the experience of stress and depression.

The investigation of levels of stress and depression in adolescence

The examination of relationships between stress, depression and several socio-demographic factors such as age, place of residence, gender and academic success in adolescents.

It is a quantitative correlational study which measures the level of stress and depression among adolescents. The measures included the Scale of stressful life events for children (stress-D) and the CDI Scale (Children's Depression Inventory). The purposeful sample was selected of 246 students of secondary schools of Malisheva (Kosovo). 49.2% males / 50.8% females, aged 15-20 years. Data processing with SPSS 17.0 and MicrosoftExcel2007.

18% of adolescents did not have depression, 79% low-level, 2% average and 1% high level of depression. 62% had high levels of stress, 25% medium and 10% low levels; 3% reported no stress. The level of stress is significantly positively correlated with gender (girls +; r=.14, p<.05), and success in school (better success +; r=.24, p<.01), and significantly negative correlated with residence (village +; r=-.15, p<.05 and age (the youngest +;r=-.18, p<.01). Level of depression was significantly negatively correlated with residence (village +; r=-.13, p=.05). There is no significant correlation between levels of stress and depression.

Adolescents are experiencing high levels of stress. Young females living in rural regions, who are also more academically successful are also more vulnerable to stress and require more attention from psychological services.

Over the Last decades outpacients services become a substitute for psychiatric hospitals in Brazil. For most patients, Psychiatric emergency Services represents the entry point into health care system and an essential source of treatment. The Psychiatric Emergency Service of the University Hospital of Santa Maria (SEP/HUSM) has operated since 1972 and serves the 537,745 inhabitants of 31 municipalities in southern Brazil.

To describe the profile of SEP/HUSM visits in the years 2010 and 2011.

Define the profile and the quality of care of visits to SEP/HUSM. Evaluate the characteristics of the visitas in SEP/HUSM during the years 2010 and 2011 to compare the statistics with other services.

This is a cross-sectional study of 7853 visitas, with the data of a questionnaire defined in the SEP/HUSM, associated with the records of the HUSM and using demographics and clinical variables. Research approved by the ethics committee HUSM.

The majority of the patients are from Santa Maria (83,9%), male (52%), 25-44 years old, had Mood Disorders (39%) and Substance Dependence (28,3%), came to the SEP/HUSM during the weekdays, and were sent to the observation room (21.5%) or hospitalized (18,9%).

The profile of the care provided in the SEP/HUSM is similar to other centers. There is a great demand by patients without the appropriate profile of treatment in the SEP/HUSM, probably due to problems in the other units of the mental health system.

The burden of neuropsychiatric disorders in the elderly is high, considering patients, their families, and close or extended networks. In Portugal, the 10/66-Dementia Research Group population-based research programmes are running since 2011, with the community prevalence study. The protocol allows for valid diagnoses of dementia and depression, using comprehensive assessments which include the Geriatric Mental State- AGECAT.

We aimed to analyse informal caregiving arrangements and the psychological experience of caregiving in a subsample drawn from the ongoing 10/66 studies.

We report on 580 residents aged 65 + years of a defined catchment area in Portugal (Mora). Assessments included questionnaires on demographic and caregiving issues, the Self-Report Questionnaire (SRQ) on psychological distress and the Zarit Burden Interview (ZBI) on the caregiving experience.

In this subsample, 94 participants were in need of informal caregiving (dementia accounted for 28 cases, depression for 31, and other chronic physical/psychiatric conditions for the remainder). Most primary caregivers were family relatives (mostly wives and daughters) and were living with the patient. A large number were elderly people themselves (mean age 64.1±16.3years). Median scores were 3 on the SRQ (range 0-16) and 8 on the ZBI (range 0-66). Those who were caring for participants with more severe disabilities scored significantly higher on both measures.

These preliminary results of the 10/66 epidemiological community studies support previous suggestions that caregiver strain is also high in subgroups of community samples. Most overburdened families (and individual caregivers) lacked appropriate, tailored interventions. Final results will be available soon.

Individuals with bipolar disorder (BD) are differentially affected by insulin resistance. Individuals without history of mental disorder with insulin resistance usually have high peripheral concentrations of phenylalanine (PHE) and tyrosine (TYR) together. Catecholamine dysfunction is described to be a state-dependend phenomen in patients suffering from BD. Catecholamines are synthesized from essential amino acids PHE and TYR which are biotransformed to dopamine and subsequently converted to nor/adrenaline. Amino acid dysregulation may be a possible mediator of insulin resistance in BD.

Peripheral PHE and TYR concentrations were investigated in euthymic adults with BD. Amino acid differences between normal and overweight individuals with BD were evaluated and outcomes were correlated with the measures of glucose homeostasis.

Mean plasma PHE to TYR ratio (PHE/TYR) was at the upper limit of the normal range in the whole sample. Enrolled subjects with PHE/TYR beyond the limits of normal exhibited the highest number of prior affective episodes. Sex-specific differences were noted as overweight BD females showed different profiles than normal-weight women. In the overweight females, PHE and TYR concentrations were significantly higher compared to normal-weight women. Significant correlations were noticed between PHE, TYR and PHE/TYR with insulin/Homeostasis Model of Assessment (HOMA)-IR in the whole sample and the subgroup of BD women.

These significant differences in gender, amino acid pathways and in correlations with immune marker as well as insulin function have not been reported previously. Taken together, increased levels of PHE in BD should be considered when adjudicating diabetes risk especially in women.

In studies of adult patients with attention deficit hyperactivity disorder (ADHD) atomoxetine (ATX) has demonstrated substantial improvements in ADHD symptomatology using Conners’ Adult ADHD Rating Scales (CAARS). The pattern suggests incremental response over time with no clear plateau of response.

To identify patterns of response to ATX in adult ADHD patients and to describe those trajectories over time

To determine if patients have distinct response trajectories using CAARS in two populations, short term (12 weeks) and long term (24 weeks) treatment data.

Data from 2502 ATX patients, who had an investigator-rated CAARS total score at ≥ short or long term time point, The numbers of trajectory clusters for short term (n=2502) and long term (n=1139) data were identified using hierarchical clustering methods. Linear mixed modelling was used to describe those different trajectories over time.

Using CAARS total, 4 trajectory clusters were identified in short term treated patients and 5 in long term. Three out of 4 short term trajectory clusters (representing 84% of patients) and 4 out 5 long term (representing 96%) showed more successful trajectories. In general clusters with less improvement were those with the worst baseline CAARS and minimal initial improvement. Distinct trajectory patterns of response were found that were incremental over time in all clusters.

Adult ADHD patients receiving atomoxetine have individual trajectories of response that can be divided into 4 short term trajectories and 5 long term trajectories. Further analysis is ongoing to describe these cohorts.

The analysis of the clinical outcome of a sample of subjects with schizophrenia, after 25 years of evolution.

. Highlighting some clinical and socio-demographic aspects that might play a role in the heterogeneity of the actual clinical status.

The study sample includes 50 subjects, admitted for the first time in the Psychiatric Clinic of Timisoara during 1985–1987, who were diagnosed with schizophrenia at onset and currently have the same diagnosis (2012). The following parameters were analysed: sociodemographic (gender, age at onset, education, family and professional status) and clinical (type of onset, symptomatology, number of admissions).

The onset was insidious in the majority of cases. There were statistically significant differences between the types of symptoms at onset and the actual clinical status.

The clinical outcome in schizophrenia can vary significantly among patients, even if the diagnosis remains stable over time.