Disruption within the working memory (WM) network is an integral feature of schizophrenia. The WM network, and the dorsolateral prefrontal cortex (DLPFC) in particular, undergo significant remodeling in late adolescence. Our aim was to determine whether DLPFC activation and functional connectivity related to WM are differentially affected over time in patients with early-onset schizophrenia (EOS) and healthy individuals.

The study sample included 45 youths; 25 EOS patients and 20 matched healthy individuals. They were scanned with 1.5T scanner whilst performing the WM task N-back at two time-points 3 years apart. Within-group effects in WM and the interaction between time and diagnosis were tested. Psychophysiological interaction analysis was used to examine DLPFC connectivity at baseline and follow-up.

EOS patients showed reduced activation compared to healthy adolescents at baseline in the left DLPFC, bilateral ACC and right frontal operculum and at follow-up, in the right frontopolar and the left DLPFC. In healthy controls the DLPFC showed increased positive connections compared to EOS patients with the ACC, the inferior parietal lobule and the middle occipital gyrus at baseline and with the superior temporal gyrus and the intraparietal lobule at follow-up as well as increased within connectivity at both time-points. Prefrontal connectivity increased with time in both healthy individuals and EOS patients. However, the loss of prefrontal connectivity associated with EOS was not eliminated at the follow-up.

EOS is associated with sustained deficits in prefrontal connectivity. The normal trajectory of prefrontal connectivity changes may be disrupted in EOS.

Antipsychotic-induced weight gain (AIWG) is a major drawback in the treatment of schizophrenic patients with second-generation antipsychotics (SGAs). Pharmacogenetic studies have established several polymorphisms in genes of different pathways contributing to the development of weight gain in schizophrenic patients. However interactions of genetic polymorphisms and clinical predictors have not been studied extensively enough to reliable predict weight gain before initiating antipsychotic treatment.

We analyzed several single-nucleotide polymorphisms (SNPs) of candidate genes (e.g. APOA, GHRL, SNAP-25, LDLR, LPL, INSIG2, Resistin, 5HTR2C, MC4R) and clinical predictors (e.g. age gender, BMI at baseline, number of episodes, pretreatment, PANSS-scores) in a sample of 259 (n=138 for regression analyses) schizophrenic patients participating in different monotherapeutic trials of atypical antipsychotics (risperidone, olanzapine, quetiapine, amisulpride, aripiprazole) with up to six weeks of treatment. We used Univariate tests, regression analysis and Classification and Regression-Tree (CART)-analysis to determine relevant clinical and genetic predictors and their interactions.

We found younger age, male gender and weight at baseline as strongest clinical predictors. APOA variants and the Resistin -420 C/G rs1862513 polymorphism were associated with weight gain in the overall patient sample. Heterocygotic GC-allele carriers (n=53) gained less weight (1 kg) compared to 2,2 kg in homocygotic G-allele carriers (n=76) (p<0.0075). We found several interactions of the clinical predictors and genetic variants or type of used SGAs in linear regression models. Use of quetiapine and olanzapine and PANSS total scores showed significant interactions over the time. APOA polymorphisms showed a tendency towards significance in linear regression models (p=0.09). The Resistin -420 C/G rs1862513 polymorphism showed significant interaction in patients treated with risperidone (p<0.0001) and amisulpride (p=0.0006) in a model adjusted for all clinical predictors. CART-analyses support to some extend the relevance of the Resistin polymorphism.

In this sample we found a polymorphism in the Resistin gene (-420 C/G rs1862513) to potentially contribute to AIWG. CART-analysis shows interactions of several clinical predictors and this polymorphism. Our approach of combining clinical and genetic predictors may help to identify subgroups of patients a priori of SGA treatment in order to reduce development of severe weight gain. Further investigations on larger samples are necessary to confirm our results.

Improvements in study designs, in statistical methods and the use of ’real world’ data as well as better safety monitoring helped in better defining efficacy, effectiveness and safety of drugs. New formulations of available drugs have been developed. Better information on efficacy, effectiveness and safety and larger variety of formulations help to improve the selection of the right drug for different patient groups and for individual patients.

The aims of this study are to examine 1/. How different formulations of antipsychotic drugs may impact on treatment? 2/. How recent comparative analyses of treatment efficacy/effectiveness and safety may help clinicians and patients in making better selection from the available pool of antipsychotic drugs?

Selected review of the literature on antipsychotic treatment. Variables: all-cause treatment discontinuation and patients’ preference.

Small but robust, in some cases significant differences exist between the efficacy/effectiveness of antipsychotics and their different formulations (1,2). Patients may prefer one formulation over the other and a high proportion of patients prefer to continue taking their prescribed drug, rather than switching to another one (3).

Clinically relevant differences exist between antipsychotic drugs and between different formulations of the same drug. Treatment patterns may influence treatment efficacy.

Longer duration of untreated bipolar disorder (DUB) can lead to a prolonged exposure to inflammatory and neurodegenerative processes, that are believed to underlie etiopathogenesis of bipolar affective disorder (BAD), and thus cause a more severe course of illness as well as difficulties in the maintenance of remission.

The aim was to determine the relationship between DUB and socio-demographic characteristics, along with clinical characteristics related to the course of illness, applied psychopharmacotherapy and the ability to maintain an adequate remission over 24 months period following hospital treatment.

The study used retrospective design and included patients with BAD (n = 127), hospitalized between 2006 and 2010. We acquired data on socio-demographic and clinical characteristics, previous treatment and the information on posthospital period between 0 and 24 months.

The average DUB was 130.59 ± 108.44 months. Patients with longer DUB presented with higher number of mood episodes of BAP, higher number of inpatient treatments, and required a significantly higher dose of lithium in the remission period. Female patients and those with metabolic syndrome more frequently failed to maintain remission for more than 24 months.

Interventions for monitoring of DUB, its diminishing duration, early detection and recognition, and timely treatment, would be useful for fewer relapses and therefore a better course and outcome of BAP. Furthermore, the results of the study strongly imply that a systematic, longitudinal monitoring of the course of illness and potential inflammatory, endocrine and metabolic markers that underlie its systemic nature is recommended.

The participant will get an insight in the challenges of the implementation of new systems in routine clinical practice. He will get an opportunity to learn about the positive impact of operations management in health care. He also will get an idea about the attitude of patients towards new systems.

Anxiety and somatic disorders are frequently comorbid, especially in the presence of depression and/or substance abuse both in children and adults. Chronic illnesses and exposure to pain in early childhood are major risk factors for anxiety disorders in children.

The aims of this study are to estimate the point prevalence of anxiety and somatic disorders and their comorbidity in European adolescents.

Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 European countries. Anxiety was measured by the Zung Self-Rating Anxiety Scale (SAS), and the following questions were on physical illnesses: Have you seen a doctor in the last 12 months?, Do you have a physical disability?, Do you suffer from any chronic illness?, Do these discomforts lower your ability or hinder other daily activities?, Overall, how would you describe your state of health these days?

Out of 12395 adolescents more than 80% saw a doctor in the last 12 months, 3% described their state of health poor or very poor, 3% reported of having physical disability and almost 15% reported of suffering from chronic illness. Eight percept of the responders was anxious based on the SAS. Anxiety as measured by SAS total score was significantly associated with describing the state of health as poor or very poor, having physical disability, suffering from chronic illness, reporting that discomforts lower the ability somewhat or certainly.

Patients with psysical illness should be screen for anxiety disorders.

We analyzed data collected from 271 patients with MS according IDF criteria, (aged 30 – 60 years) in Federal Research Program of the Risks of Cardiovascular Diseases. Mild cognitive impairment (MCI) was confirmed by psychodiagnostic interview according to the criteria of ICD-10. All patients passed through: MMSE test, Wechsler memory scale and Category Fluency test. Level of blood glucose and plasma indicators of lipid spectrum were assessed in the blood samples with «Abbott» kits. To assess the results the NCEP criteria were used.

As a result of research 271 subject were divided into 2 groups, group A – with CD and/or MCI (212 subjects) and the group B -without affective disorders (49 subjects). Using the Mann-Whitney test significantly strong connection between high levels of total cholesterol (TC), cholesterol low density lipoprotein (LDL-C), lipoproteins of very low density (VLDL), the GL and MCI in group A were obtained. Optional subjects with sings of PH, MS and MCI had a fairly high level of VLDL and LDL-C in comparison with subjects without MCI.

Our data support the assumption that there is link between MCI and components of MS. Prehypertension, MS, can provoke MCI in middleage subjects.

We analyzed longitudinal course of illness in schizophrenia until age 43 years, and its correlates to antipsychotic medication and cognition.

Northern Finland 1966 Birth Cohort Study has been followed serially since mid-pregnancy. Structural and functional MRI, cognitive, and clinical examinations were performed at ages 34 (73 schizophrenic psychoses, 104 controls) and 43 (63 schizophrenic psychoses, 192 controls); 40 cases and 75 controls participated in both surveys. Psychiatric outcomes have been ascertained through data linkage to a national case registers, hospital charts and clinical evaluations.

Prognosis of schizophrenia is heterogeneous: minority of individuals experience recovery, some achieve remission, but many are on disability pension, and excess mortality (especially suicides) is common. Long duration of untreated psychosis, early age of illness onset and presence of suicidal ideation associated with poorer long-term outcome. Both cases and non-psychotic controls show a small decline in verbal learning and memory, but the difference in decline is not significantly more pronounced in cases. Higher doses of antipsychotics at age 43-years associated to lower education and poorer clinical and functional outcomes, and high cumulative life-time use of antipsychotics associated to decrease of verbal learning and memory in 9-year follow-up.

Based on this naturalistic sample, midlife progression of schizophrenia may follow a variety of different trajectories. Poor clinical course is common but not necessary outcome. Compared to controls, more pronounced cognitive decline was not seen in schizophrenia cases. However, high doses of antipsychotics may relate to a decrease of verbal learning and memory.

Suicide is an increasing phenomenon in Albania. There is a lack of epidemiological studies on suicides, especially in Albanian capital city, Tirana. The broad aim of the study was the assessment of the morbidity of suicide victims in the district of Tirana over the period of time 2001-2010.

This is a retrospective study. Data was collected from the records of the Prosecution Office of Tirana district. Medical data and the statements of the witnesses were studied.

A total of 254 people have committed suicide in the district of Tirana from 2001 to 2010. The prevalence of suicide was found 0.04% (95%CI 0.035 - 0.045). The mean age of the victims is 38.5 years old. Suicide is most frequent among males 65% and in individuals with a low socioeconomical level. Suicides are more common during autumn 28% or during the months of April 13.8% and September 14.2%. The prevalence among married 52% is significantly higher compared to single individuals 41%. The most affected were workers, 25%, followed by housewives 16% and farmers 10%. The most frequent method was poisoning in 39.4%, followed by hanging in 20% of cases. 65% of cases were previously diagnosed with mental illnesses and 78% out of them were diagnosed with depression, while only 45% were treated before the suicide.

A large number of the victims have had psychiatric disturbances (78% of them depression), but they have not sought medical help. A small number of cases were treated before the suicide.

The separate diagnosis of Attention Deficit/Hyperactivity Disorder in adult patients (AADHD) is rare, while psychiatric co-morbidities are very frequent. In recent years, the often investigated co-morbidity, particularly in female patients, is eating disorders (ED). We summarize our data on the occurrence of AADHD and therapeutic possibilities in our conditions, based on the analysis of existing research literature, our research results and our first experience with a support program for these patients.

From June 2011 we have been carrying out an ongoing study of co-morbid AADHD in patients with ED, following an international study INTACT (EU Marie Curie Research Training Network). By October 2013, 93 patients were enrolled in the study (90 women and 3 men). All of them met ICD-10 criteria for ED. The average age was 25.4. The patients stated that they suffer from ED in the time period from 4 months to 27 years. None of the patients was previously diagnosed with ADHD.

We are presenting preliminary results obtained by the use of Barkley Adult ADHD Rating Scale- IV. 9 patients (9.7 %) from our sample were detected as being likely to have co-morbid ADHD. For detected patients, whose suspected diagnose of AADHD will be confirm by diagnostic interview and Integrated Visual and Auditory test, we can offer specialized treatment program (including support group sessions, cognitive remediation and CBT). This program is now being tested for its efficacy on a pilot group of AADHD patients (N=8).

The effects of the revolutionary Italian law (180/1978) closing the mental hospitals, limiting the TSO (compulsory treatment) to the general hospitals, have received scant analysis from researchers, for various reasons explaned in the paper.

To confirm if TSO may represent a useful indicator to evaluate the reform. TSO is currently under debate in the Italian Parliament dispite the absence of reliable data. Furthermore the legislation elsewhere in Europe is comparatively different.

To conduct a statistical survey to observe diachronically the variations in characteristics (modality, length, diagnoses, frequency, gender, age, nationality...)

Quantitative and qualitative analysis of the written records of TSOs in the City of Turin from 2006 to 2011, over 13,000, stored in Turin court archives (special ad hoc software was created to enable investigation) and a comparison of the results with those of a similar study conducted by our Department of Mental Health for the years 1985-1998.

Many results are discussed but we highlight the TSO length (7 days, renewable) which does not need to be modified, the disclosure of diagnoses reveals how much TSO serves as a tool of social control and how diagnoses are prevalently behavioural and outside the leading classification systems. Comparing the 2006-2011 and 1985-1998 results showed that the number of foreign persons and average age of the subjects has increased considerably in the last twenty years. Finally there has been a significant increase of personality disorders and a reduction of schizophrenic psychoses.

While the introduction of new drugs into psychiatric practice has alarmingly slowed down due to the large decrease in discovery of new drugs, there is an increase in knowledge about the available drugs.

The aims of this presentation are to summarize practice relevant research data and existing gaps in clinical psychopharmacology.

Selected review of the literature.

1. 1. Recent research failed to produce breakthroughs in the identification of new drug targets.

   The industry sharply decreased its investment into psychopharmacology research.

2. 2. Psychiatric classification systems have not been successful in integrating new findings from genetics, neuroimaging, cognitive sciences, etc. NIMH suggested to use Research Domain Criteria (RDoC).

3. 3. Large databases were developed about clinical studies and real life data and powerful statistical methods have been introduced, which helped in better defining the comparative effectiveness of available drugs.

4. 4. While low response rates have been reported in many psychiatric disorders, guidelines provide little help to clinicians in selecting drugs with best efficacy: side effects ratio.

5. 5. Many areas highly relevant for the practice are underresearched, e.g. the role of polypharmacy, the optimal length of pharmacological treatments or multimodal treatment.

Treatments based on better knowledge of evidence based differences in the efficacy and safety of psychotropic drugs are helpful in achieving better outcomes both in terms of psychopathology and functioning.

Independent educational programs in psychopharmacology and better residency training in psychopharmacology are needed, which could be supported by the EPA initiated Psychopharmacology Curriculum for Residents’ Training.

There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive protein (CRP). Ondansetron is a serotonin (5-HT3) receptor antagonist widely used to prevent nausea and vomiting in patients receiving chemotherapy for cancer. Small studies have suggested that adjunctive Ondansetron is efficacious against schizophrenia symptoms. We carried out a feasibility study in schizophrenia patients (within 5 years of first diagnosis) to explore the adjunctive use of simvastatin and ondansetron on positive, negative and general psychopathology.

This was a 12 week rater blind placebo controlled study. All to gather 36 patients with DSM-IV diagnosis of schizophrenia were recruited, 12 in each arm. Patients were assessed at baseline and at 12 weeks using PANSS, CGI, GAF and AIMS.

Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual (TAU) on PANSS total score, although, this was not statistically significant. In the secondary analyses, no significant differences were seen on CGI, GAF and AIMS.

Anti-inflammatory treatments have shown to have some beneficial effects in schizophrenia. Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual. This study has led to a larger SMRI-funded, double blind, randomized control trial.

Higher all-cause mortality and shorter life expectancies for people with severe mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) have been frequently reported. Cancer contributes a substantial proportion of mortality (20 to 30%) as the second or third leading cause of death among people with SMI. Outcomes of cancer incidence studies in SMI were considerably heterogeneous, varying by cancer types and mental disorders.

To compare the incidence of overall and each type of cancer between people with SMI in southeast London and general population in UK.

Using the anonymised linkage between a regional monopoly secondary mental health service provider covering four southeast London boroughs and a population-based cancer register, we carried out the comparisons of cancer incidences between people with SMI and general population by age- and gender-standardisation in 2011.

Among SMI subjects with cancer (N=105), the most common cancer types were lung and colorectal cancer followed by breast cancer for women and prostate cancer for men in this area. Standardised incidence ratios (SIRs) for all cancers in SMI were 1.19 (95% CI: 0.97-1.44) overall, 2.43 (95% CI: 1.98-2.94) in men (n=61), and 0.98 (95% CI: 0.71-1.31) in women (n=44). Based on relatively small case numbers, raised SIRs were found for lung cancer in men (SIR=7.57, 95% CI: 3.04-15.6) and women (SIR=7.61, 95% CI: 2.79-16.6), and in women for colorectal (SIR=7.85, 95%CI: 2.55-18.32) and breast cancer (SIR=7.86, 95% CI: 4.58-12.59).

Specific pattern of elevated risks of cancer incidence were found for people with SMI.