Limbic encephalitis is an autoimmune inflammation of the brain tissues. This category has been increasingly diagnosed over the last few years. This is important as clinicians in neurology and psychiatry need to raise their awareness about this disease.

This is a case of a 63 years old retired man who was admitted following a three week history of generalized weakness, gait disturbance and flu like symptoms.

During admission he developed nystagmus and agitation and was treated with high potency vitamin B complex and Thiamine on the suspicion of Wernicke's Encephalopathy.

A referral was later made to the liaison psychiatry team as the patient was trying to leave the ward and was verbalizing suicidal thoughts.

A suspicion of limbic encephalitis was considered and anti-neuronal Voltage gated potassium antibodies VGKA were measured. The results came back as significantly positive.

He was treated with high dose of steroids. The patient became less aggressive and agitated with time and was eventually discharged to a nursing home.

Limbic Encephalitis is a potentially treatable cause of encephalopathy that can present in a variety of neuropsychiatric manifestations like psychotic symptoms, agitation, memory and sleep impairment. Early diagnosis and treatment is very important as in many cases the disorder is associated with malignancies.

Further emphasis and research is needed on this topic. There is a tertiary centre at the John Radcliffe Hospital, Oxford, UK that follows up patients from all over the United Kingdom.

The existence of a close relationship between the brain and the immune system has been demonstrated based on the results of several studies. Specific autonomic, neuroendocrine and neuropeptides mediators form the biological basis of this interrelationship, as has been demonstrated. The aim of this study is to review and systematize the current scientific knowledge related to the integration of these two systems, and it's clinical correlation.

Review of the literature that addresses the theme

Studies in humans have shown that stress and low immunity have a close connection. Works continuously prove this relationship.

Recently, the view that the interaction between the brain and the immune system is bidirectional has been preferred to that in which the direction of communication is exclusively from the brain to the immune system.

It is increasingly recognised that brain structure and function show experience dependent modification throughout our lifespan. The current presentation summarizes four lines of evidence regarding brain plasticity in bipolar Disorder.

We present data on brain plasticity changes in BD inferred from behavioural, cognitive and neuroimaging data.

(a) We defined the first empirically derived staging classification of BD based on two underlying dimensions, one for illness severity and another for cognitive function. We identified a good and poor functional outcome groups defined by the degree of impairment in inhibitory control, density of episodes and level of residual depressive symptoms; (b) We derived a cognitive typology of patients with BD which was robustly replicated in three independent patient samples. Patients could be classified in three groups with poor (20–30% of the samples), normal (50% of the samples) and higher (20–30%) cognitive performance across multiple domains, (c) We are developing diagnostic tools for the assessment of individual patients based on their structural and functional neuroimaging data. This work is still in development but our initial results suggest that we can achieve diagnostic accuracy of approximately 80%, (d) We have analysed longitudinal data from a sample of 2200 Dutch youth assessed at aged 11, 13,16 and 19 and we have mapped individual trajectories to disease expression in BD based on the CBCL-MS new scale for the identification of subclinical manic symptoms.

Our data demonstrate a range of approaches that can be used to examine brain plasticity in BD.

Cancer patients treating in the specialized Oncological hospital, and psychotherapy in any specialized form almost unavailable (no psychotherapist in the staff), and mental health care is possible through counseling, in the form of a transfer to a psychiatric hospital. A study was designed to assess the effectiveness of 20 mg fluoxetine monotherapy and in combination with psychotherapy.

27 patients with cancer of the urinary system were included. 10 patients were randomized to a fluoxetine-monotherapy treatment group (FT), 10 patients to a fluoxetine prescibing combined with psychotherapeutic intervention treatment group (FPT) and 7 patients to a psychotherapeutic treatment group (PT). The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hamilton Depression Scale (HDS), the Hospital Anxiety and Depression Scale (HADS), were used to assess the efficacy of fluoxetine.

The response rate, defined by HADS lower than 8 after 4 weeks of treatment, was not significantly higher in the FT group (10%) compared to the PT group (8%), but lower than in the FPT group (13%). Patients in the FT and FTP groups showed a significantly greater decrease in HADS mean score after 4 weeks. No difference between the three groups was found in observer-reported assessments (MADRS, HAS and HDS).

Use monotherapy Fluoxetine20 mg justified out the most acute affective reactions as a maintenance therapy. The most effective use of combination therapy (Fluoxetine + psychotherapy session).

To study the dynamics of affective disorders in alcoholic patients, admitted to inpatient clinic, during the period of hospitalization (3 weeks).

All patients were evaluated using the Hospital Anxiety and Depression Scale (HADS).

45 patients admitted to inpatient clinic were examined. The median age was 38,8 ± 9,8 years.

Clinically expressed depression (12 ± 4 points) was in 12 patients.

Anxiety disorder (14 ± 5 points) was found in 5 patients.

Co-occurance of anxiety (15 ± 7 points) and depression (10 ± 4 points) was in 28 patients.

Escitalopram at a daily dose 10 mg 3 weeks was used to treat clinically expressed depression.

Patients with depressive disorders with anxiety treated by Venlafaxine with daily dose 75 mg.

First 5 days after the admission to the clinic patients appointed Diazepam 20–40 mg/day according to clinical protocols.

All 45 patients had improve the level of affective disorders. The level of anxiety has decreased on average by 6 ± 4 points, the depression decreased by 5 ± 3 points during the treatment. It was recommended to continue prescribed treatment in outpatient conditions.

The data indicate a high level for both depression and anxiety in patients that allows you to treat alcoholic affective disorders from the perspective of modern addictions as urgent recidive status. In the process of therapy inpatients with affective disorders declined significantly, thus reducing the clinical manifestations of alcoholic anxiety and prevent development of relapse.

The etiology of acute and persistent pain is complex, multifactorial and poorly understood. In addition to known factors such as obesity, stress, and inflammation, vitamin D is a potentially important variable.

To examine how vitamin D is linked with pain in a genetically informative sample.

Generalized Estimating Equations were used to estimate the contribution of vitamin D levels to clinical and evoked pain. Within-pair zygosity-stratified correlations were examined to explore the heritability of vitamin D level.

96 female twin pairs (76% monozygotic), some pain-free and some selected for persistent pain, were recruited from a large community-based twin registry. Twins individually provided clinical pain ratings using a validated visual analog scale of the degree of pain experienced over the past 30 days, and evoked pressure pain ratings at threshold using dolorimetry. Serum 25-hydroxyvitamin-D levels (25(OH)D) were assayed in all.

Higher 25(OH)D (>50 ng/mL) was associated with higher clinical pain ratings (B=−.481, p=.02) and higher evoked pressure pain ratings at threshold (B=−.458, p=.05) controlling for age and body mass index. Within-pair correlations suggested low heritability of 25(OH)D.

Vitamin D insufficiency or deficiency was unassociated with pain in this sample, whereas vitamin D sufficiency was associated with greater clinical pain and higher evoked pain ratings, indicating greater pain sensitivity. Given the low heritability of 25(OH)D, these associations are unlikely to be confounded by shared genetics. Differences in vitamin supplementation or outdoor activity and sun exposure between twins with and without pain conditions might partially explain these findings.

Portugal is a country with severe economic difficulties for the last 2 years. Considering the volatile and vulnerable economic social system today, in Portugal, the number of jobs decreased, unemployment increased and, as a consequence, mental illnesses as well. Because of it, and, the request for quicker treatments of mental health by the population are increasing significantly.

Our objective is to evidence in Portugal one of the very first IPT researches as an advisable treatment of acute major depressive disorder, mainly in the current economic scenario, contributing to evidence an effective way to combat mental illness in Portugal.

The ongoing longitudinal study consist of adult outpatients (n=50), diagnosed with acute major depressive episode. The intensity of depression was measured is sessions 1, 6 and 10, with the Center for Epidemiological Studies Depression Rating Scale (CES-D). The procedure is focused in one of four IPT problem areas (role transitions, disputes, grief and loss, and difficulties initiating or sustaining relationships).

The first results show significant trend to identify the Disputes as the main problem-area. The intensity of the depression is significant lower along sessions with same patients. In 8th session, there is a significant decrease of the depressive symptomatology and the patient is more functional and adapted.

Our research evidences the vulnerability to social context amidst the Portuguese economic crisis to depression, as well it evidences the effectiveness of IPT as a brief psychotherapy that responds to the current needs of a population with growing economic difficulties.

To investigate the effect of risperidone and (or) Xiao Huan Tang on activity and preferences behavior of glutamate dysfunction mice model.

70 kunming mice were randomly divided into 5 groups, one group as blank group. Rest groups intraperitoneal injection MK- 801(0.072mg/ml, 5ml/kg/day) continuously 14 day, then randomly numbered: model group, risperidone group, Xiao Huan Tang group and risperidone combined Xiao Huan Tang group. Gavaged corresponding drugs for each group one month, at the same time observe high activities and changes in the preferences of five groups.

Compared with the blank group, activity of model groups was increased (36.8±16.2 vs blank group 11.3±14.5, P<0.05). After gavaged one month, model groups of high activity was decreased, especially risperidone combined Xiao Huan Tang group. There was no statistical meaning in inquiry activity of five groups (P > 0.05). Compared with model group, latent period of step-through test was prolonged 34.1s (P<0.05), of step-down test was prolonged 20.2s in risperidone combined Xiao Huan Tang group.

the combination of Xiao Huan Tang and risperidone can suppress the high activity, prolong harmed memory time, and protect preference behavior of schizophrenia mice.

IDEA project is the outcome of Association for the Improvement of Mental Health programme and coordinated at Institute of Psychiatry, King's College London.

Are to explore experience of people treated in a mental health setting across nations, determine how inpatient experiences can be improved. Experience gained from interviews will be used to propose questionnaire for routine use, develop versions of interview for other services, inform a possible follow-up study.

30 consecutive patients are interviewed on day of discharge in own language. Semi-structured interview covers physical condition in institutions, experiences of treatments like medication, satisfaction with staff, privacy, dignity and whether rights were respected. Responses are summarized on several visual analogue scales and quantitative analysis were performed. The scale was also be analysed by demographic indices within centres to see whether different groups have different experiences.

Qualitative responses were analysed thematically, both within and between centres, identifying core themes for each domain and core themes for the protocol as a whole.

10 countries are participating, 577 interviews are completed. We followed on visual analogue scale the degree patients felt their stay was beneficial, degree of satisfaction with staff, perceived harm in the hospital, if the right to confidentiality was respected, if individual rights and preferences were respected.

It will be a better understanding of the size, structure and staffing of the institutions included in the study, which will help us with our observations about inpatient experiences by putting them in context and make recommendations to institutions.

Auditory hallucinations are core symptoms of the schizophrenic psychosis, but in some subjects thought process is associated to voice hearing, without the presence of other psychotic-like symptoms. These individuals have the perception of their-own thought as an inner voice.

In the last years, research has provided evidences about neurophysiological correlates of hallucinations, which include alterations in Mismatch negativity, just after the N100, and in P300 (especially the P3a component). However, no study explored subjects with sound thinking.

This paper reports a single-case neurophysiological study performed with a 29 year-old woman, reporting sound thinking and past drug abuse, who came to clinical attention for an anxiety disorder.

Patient's EEG data were compared with EEG data of two control subjects. Electrophysiological data were collected by means of an high-density EEG (Geodesic NetStation), during an active stimulation by Oddball and Go-NoGo Paradigm. EEG data were processed through the EEGLab package for Matlab. An Independent Component Analysis was performed followed by Clusters analysis.

One of the 5 Clusters extracted aggregated two ICs, produced in the scalp central areas, present both in control subjects and in the sound thinking subject: in the last one, the Intertrial Coherence, expecially at Theta frequency band, was much less evident and the P300 appears to be less wide relative to healthy controls.

These results are in line with those found in patients with hallucinations, suggesting the presence of a reduced ability to reorganize the cortical activity in response to external stimuli.

Despite suggestions that chronic stress is involved in the pathogeny of dementias, no systematic studies investigated the possibility of a link between dissociative amnesia and neurodegenerative dementias.

We analyzed data from over a dozen patients with functional dissociative amnesia, whom we investigated with neuropsychological methods, structural and functional neuroimaging. We followed prospectively approximately half of these patients for more than a decade.

We evidenced in a substantial sample of patients with dissociative amnesia with preponderant retrograde memory impairments a hypometabolism during resting state in the right temporo-frontal region, with a decrease in the infero-lateral prefrontal cortex. Additional preliminary data from DTI suggested a decreased integrity of long distance fiber tracts important for conscious mnemonic processing. We found a chronic course of the memory impairments in a substantial number of patients with dissociative amnesic conditions. In some chronic cases of dissociative amnesia we noted a fairly stable course, while in other cases we observed a progressive global cognitive deterioration.

These findings point to a non-homogenous course of dissociative amnesia.

The search for a link between dissociative amnesic conditions and dementia should take into consideration multiple variables, such as the age at the onset of trauma, gender, the recurrence, type and severity of trauma, the presence of psychiatric and medical co-morbidity, pre-morbid personality characteristics (e.g. neuroticism), genetic polymorphisms, educational and occupational attainment, cognitive reserve and the progression of metabolic and microstructural brain changes.

Opioid addiction is a serious mental health problem with substantial impact on society and healthcare. The diagnosis and monitoring of its treatment are almost exclusively clinical tasks and their efficacy is often unsatisfactory. This suggests a need to study potential biomarkers of opiod addiction. In this study, we used functional magnetic resonance imaging (fMRI) and our modification of the Stroop-task to investigate patients’ reactivity to emotionally relevant (drug-related) stimuli and its impact on their cognitive performance as a potential biomarker for opiod dependence syndrome.

40 patients with opioid addiction aged 25.9±2.6 years with mean narcotization period of 9±3.4 years were included. The control group consisted of 25 age- and gender-matched healthy subjects. fMRI was performed on 1.5T scanner Toshiba Vantage Titan. The original Strooptask was modified to investigate the effect of emotionally relevant distractor on the task performance by changing the background of the stimuli: emotionally neutral (furniture and everyday objects) and relevant (pictures of drugs, and drug paraphernalia). Group comparison of the activation maps was performed using two-sample T-test.

In comparison to the control group, patients with opioid addiction showed worse task performance, accompanied by the increased response of the left insula, dorsolateral prefrontal cortex, right amygdala and hippocampus.

We found that emotionally relevant stimuli worsen Stroop-task performance in drug addicts, which is accompanied by the increased activation of structures involved in emotional reactivity and cognitive control. The applicability of this combined imaging-neuropsychological task in practice is the matter of our future research.

Atypical antipsychotics and some other psychotropic drugs such as valproate, lithium or mirtazapine are known to induce several metabolic complications. However there is an inter-individual variability in developing metabolic features which may be explained by clinical and genetic factors.

To determine whether weight gain and/or appetite change after one month are predictors for a weight gain after 3 and 12 months of treatment.

A longitudinal clinical and pharmacogenetic study is presently ongoing in the Department of Psychiatry-CHUV. Several clinical data have been recorded over one year following the introduction of psychotropic treatment. 406 patients with weight at baseline, after one month and with at least a third weight measure during the first year of treatment were included in the present study.

Using Receiver Operating Characteristic (ROC) analyses, an initial weight increase of 5% was found to be a good predictor for a consequent weight gain at 3 months (ROCAUC=77) and one year (ROCAUC=68). By using a generalized linear mixed model corrected by several confounders, this weight change of 5% was found to be significantly associated (p-value<0.0001) with an important weight change (10 to 20% increase from baseline value) over one year. Appetite was not found to be good a predictor of weight gain over one year.

An initial weight gain of 5% during the first month following an introduction of atypical antipsychotics, lithium, valproate and/or mirtazapine is a predictor for further weight gain and should be a warning sign to introduce weight lowering strategies.