General hospital-based studies may help towards improving the treatment of psychiatric disorders.

Based on five representative studies in general hospital admissions, we will represent a comparative overview of suicidal events due to overdose and of the most common medical comorbidities in psychiatric disorders of ICD-10 classes F1–F4.

In secondary analysis one-way Anova and Tukey HSD test were used for comparisons of interval variables. Suicidal events and medical comorbidities with prevalences > 10% were compared between studies using the OR and the 95% CI.

Individuals with psychiatric disorders of ICD-10 classes F1–F4 were young (44.7–50.0 years), had an extended length of hospital stay at initial hospitalization (3.8–8.1 vs. 2.9–3.4 days), and significantly more likely suffered of suicidal events due to overdose than controls, contributing from 4.1% (OR = 4,1) to 11,6% (OR = 25.2) to general hospital admissions. Additionally, individuals with schizophrenia (SCH) significantly more likely suffered of type-2 diabetes mellitus (OR = 2.3, 95% CI 1.5–3.6) than individuals with major depressive disorder (MDD), anxiety disorder (ANX), and alcohol dependence (AD), but equal likely as individuals with bipolar disorder (BD). Asthma and hypertension contributed significantly more to hospitalizations in the MDD and ANX samples compared to the SCH, BD, and AD samples. In the AD sample, alcoholic liver disease was more prevalent than in all other samples.

In psychiatric disorders, the frequency of suicidal events due to overdose in general hospitals is significantly determined by the diagnostic class. Additionally, different medical comorbidities contribute more than other medical comorbidities to general hospital admissions in various psychiatric disorders.

The authors have not supplied their declaration of competing interest.

The increasing number of dementia is of major public health concern. This study aims to calculate the projected number and prevalence of dementia in Japan, using data from the Toyama Dementia Survey.

The Toyama Dementia Survey was conducted 6 times in 1983, 1985, 1990, 1996, 2001, and 2014. In the 2014 survey, the subjects were randomly chosen from residents aged 65 or more in Toyama prefecture, with a sampling rate of 0.5%. Of those, 1303 men and women agreed to participate (participation rate: 84.8%). An interview with a screening questionnaire was conducted by public health nurses. Psychiatrists and public health nurses further investigated for the suspected cases of dementia and diagnosed whether the cases had dementia. The 1985–2001 surveys were conducted in a similar way, and, therefore, data from the 1985–2014 surveys were used in the analysis.

The prevalence of dementia in Toyama prefecture increased from 4.7% in 1985 to 15.7% in 2014. Using the age and sex-specific prevalence of dementia in the 2014 survey, the projected number of dementia is approximately 4.8 million (prevalence rate: 14.1%) in 2015, 6.1 million (16.7%) in 2025, and 7.2 million (19.2%) in 2035. Using the age and sex-specific prevalence of dementia as estimated by linear regression models, the projected number of dementia is approximately 4.7 million (13.9%) in 2015, 7.1 million (19.5%) in 2025, and 9.7 million (25.8%) in 2035.

The number of dementia in Japan could double in the next 20 years, which corresponds to 1 in 4 elderly people.

The authors have not supplied their declaration of competing interest.

Forensic psychiatric services are costly and highly restrictive for patients. Clinical experience and the limited research available indicate some patients stay for too long in these settings. A proportion of patients may, however, require long-term (potentially life-long) secure forensic psychiatric care but their needs may not be met by existing service provision designed for faster throughput.

We conducted a national, multi-centre, cross sectional study exploring the prevalence of long-stay and characteristics of long-stayers in high and medium secure forensic psychiatric care in England.

(1) Estimate the prevalence of long-stay in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care); (2) describe the characteristics, needs and care pathways of long-stay patients. Develop recommendations following the exploration of international models for this patient group.

We employed a mixed-methods approach including the analysis of administrative data, case file reviews, patient interviews, consultant questionnaires, interviews with clinicians and commissioners and a Delphi survey.

Twenty-five percent (n = 401) of our sample were experiencing long-stay. This patient group has a heterogeneous set of characteristics and needs relating to their diagnosis, offending history, risk and therapeutic need and have experienced a variety of care pathways through secure care.

We found a greater number of long-stay patients than originally estimated with a set of characteristics and needs that are arguably different to that of the general forensic population, therefore calling for a specific care pathway and service provision for this patient group with a greater focus on autonomy and quality of life.

The authors have not supplied their declaration of competing interest.

There are many studies of HIV-infected patients where have found higher prevalence of substance use disorders than in general population. Moreover some factors, like presence of legal problems, substance abuse and HIV are also frequently related with poorer clinical results.

The aim of this study is to analyze the relationship between substance consumption and presence of legal problems among HIV-infected patients.

Our study is a cross-sectional case-control survey. Cases were defined as HIV-infected patients who referred presence of legal problems in a sociodemographic questionnaire. Controls were defined as HIV-infected patients who denied presence of legal problems. Both groups were interrogated about illegal substance use (cocaine, heroin, cannabis, stimulants or benzodiazepines) and alcohol problematic use during previous year. Logistic regression was employed as statistical analysis. Results were adjusted for age, gender and race.

Our sample was compound by 63 patients: 44 controls and 19 cases. A statistical signification was found between illegal substance use variable and presence of legal problems (P = 0.003) but not with alcohol problematic use. The condition of illegal substance use during previous year increased the risk to have legal problems 5.353 times. Another important result was found in gender, the condition of male increased the risk to have legal problems 2.32 times than female condition.

In our sample, substance use (cocaine, heroin, cannabis, stimulants or benzodiazepines) during previous year was related to have more legal problems. Gender, specifically male condition, also was linked with more risk to have legal problems.

The authors have not supplied their declaration of competing interest.

Description through a survey of physical aggressions suffered by Spanish Medical Trainees of all specialties.

We developed a survey through an online platform that was distributed to all Spanish trainees of all medical specialties. In that survey, we ask residents if they ever have been physically assaulted, for how many times, the year of residence when it occurred, if they have in their hospital an aggression protocol, and if it included a specific topic for trainees. We also asked them about their feelings after they have been assaulted.

We collected 282 answers from the survey. We could observe that 12.9% of respondent trainees had been assaulted as least once. Fifty-one percent of times, it occurs during the first year of residency. Among assaulted residents, 25.5% were psychiatric trainees, and 44.4% were medical trainees, but no psychiatrist. Twenty-three percent were psychiatric trainees, and the 35% of them had been assaulted once. Only 25.2% of the residents knew the aggression protocol of their work center, but the majority (65.5%) did not know it. About how do they feel after being assaulted, most of them responded that they felt anxiety, helplessness, fear and they had even thought of leaving de residency or change it.

Aggressions during the trainee period seems to be prevalent (12,9%). Most trainees don’t even know if there is a aggression protocol in their hospitals, we think that a prevention and supporting guideline should be design for improve this prevalent situation.

The authors have not supplied their declaration of competing interest.

Pedophilia is a disorder where sexual preferences of adults are directed towards children. This disorder impacts society with 1–2 out of every 10 children being sexually approached by an adult, often resulting in prolonged negative psychological effects. Prior research reported structural and functional amygdala alterations in pedophilia. As the neurophenomenological model of sexual arousal suggests the importance of the amygdala in the emotional component, we focused on amygdala functional connectivity in pedophilia.

To investigate amygdala functional connectivity (FC) modulated by expectancy and salient stimuli in pedophilic patients.

Thirteen pedophilic patients and 13 matched healthy controls underwent a salience expectancy task in a 7T ultra high fMRI study. Subjects perceived pictures of naked adults and children. Half of the pictures were preceded by an expectancy cue. Participants were instructed to actively expect the picture depending on the cue. We conducted psychophysiological analysis (PPI) to examine amygdala FC changes in two amygdala sub-regions for child/adult stimuli during the expectancy period and the visual stimuli consummation period using as seed regions the basolateral (BLA) and central nucleus of the amygdala (CeA).

Healthy controls, relative to patients showed significant stronger left CeA to right post-central gyrus FC during expectancy of adult > child picture. For picture condition (adult > child picture) we found significant stronger left CeA to left dorsolateral prefrontal cortex FC in patients compared to healthy controls.

These findings add to the recent literature by indicating that amygdala dysfunctional connectivity is involved in development of deviant sexual behavior.

The authors have not supplied their declaration of competing interest.

Historically, psychopathic individuals have mainly been described as characterized by pervasive callous-unemotional traits, with dramatic implications for clinical and forensic practices – such as the tendency to deem psychopathic individuals as untreatable. However, recent evidence with community samples have highlighted that psychopathic traits may be in fact related to emotion dysregulation rather than being the mere reflection of an underlying ‘unemotionality’. Yet, it is no clear if this association extends to populations with more severe forms of psychopathy (i.e., offenders).

We wanted to replicate previous evidence of an association between emotion dysregulation and psychopathic traits in a sample of incarcerated offenders.

To investigate the associations among emotion dysregulation dimensions and psychopathic traits, exploring similarities and differences between the Interpersonal-Affective and the Antisocial-Lifestyle facets of psychopathy.

A sample of male offenders incarcerated in Italian jails completed the Self-Report Psychopathy Scale (SRP-4; Paulhus, Neumann, & Hare, 2015) and the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004).

In line with the expectations, emotion dysregulation dimensions did predict higher levels of psychopathic traits. Structural Equation Modelling revealed that selected dimensions of emotion dysregulation were associated with different facets of psychopathy.

Based on our findings, we argue that psychopathic traits may be associated to a certain extent with emotion dysregulation, and thus a focus on improving emotion regulation skills may hold the promise to dampen the therapeutic pessimism when dealing with psychopathic offenders.

The authors have not supplied their declaration of competing interest.

The diagnoses of autism spectrum disorders (ASDs) are based on a phenotype, characterized by impaired social interaction and communication and by repetitive and restricted interests. However, this might not represent a single clinical entity, but a behavioral manifestation of different neurodevelopmental deficits with a multifactorial etiology. Small studies have shown elevated levels of oxidative stress and lower levels of anti-oxidants in patients with ASD, and correlations with the severity of ASD. Therapies targeting oxidative stress have shown improvements regarding behavior, social interaction and verbal communication in patients with ASD, supporting the oxidative stress theory.

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD.

There is a need to understand the neurobiology of ASD, therefore this study analyzes the level of oxidative stress in a larger cohort of patients with ASD and compares to controls.

The study includes 350 patients over 18 years of age diagnosed with ICD-10 diagnoses F84.0, F84.1, F84.5 or F84.8 and compared to gender and age matched neurotypical controls. The included probands will have their serum and plasma analyzed for levels of oxidative stress (superoxide dismutase 1 and 2, catalase, glutathioneperoxidase, malonialdehyde, thiobarbituric acid reactive substances and xanthinoxidase).

The preliminary results will be presented at the EPA in March 2016 in Madrid.

With this study we aim to elucidate some of the neurobiology in ASD. This could lead to new potential targets for treatment and prevention of the disorders.

The authors have not supplied their declaration of competing interest.

Micro-RNAs (miRs) are involved in processes associated with MDD such as neural plasticity, neurogenesis, synaptogenesis and stress response. MiRs are detectable in biological fluids; however, no data is available regarding the use of plasma circulating miRs as markers of MDD, only whole blood or serum being reported so far.

We investigated plasma miR profiles as potential markers for MDD in patients treated with antidepressants.

To detect and characterize differentially expressed miRs in the plasma of MDD patients, before and after treatment with escitalopram.

Blood was collected from patients with MDD before and after 12 weeks of treatment. Plasma profiles of 1008 miRs were measured by real time PCR. The fold change of expression between time points was calculated and a paired t test was used for statistical significance. Gene targets and pathways were assessed in miRWalk2.0.

From 222 plasma miRs expressed, 40 were significantly different after treatment. Upregulated miRs (23) belonged to 43 pathways, down-regulated miRs (17) belonged to 46 pathways; the top 5 significant pathways identified being pathways in cancer, Wnt signalling, endocytosis, axon guidance and MAPK signalling. Six of these miRs are common to all five pathways: miR-146a-5p, miR-146b-5p, miR-221-3p, miR-24-3p, miR-26a-5p.

Our analysis of significant changes in plasma miRs after escitalopram treatment of MDD might open new avenues for the understanding of its mode of action and its side effects. To our knowledge, this is the first study to assess miRs affected by antidepressant treatment in plasma of MDD patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

To study the association gene of candidate NPSR1 rs324981 with sleep disorders in the open population of men 45–64 years of Novosibirsk.

The study of the association candidate gene polymorphisms with sleep disorders was carried out during the examination of a random representative sample of men 45–69 years (n = 1770). The response rate was 61%. The median age is 56.5 year. Every 12 a man was selected for genotyping (n = 147). To assess the level of sleep was used a questionnaire which was filled with self-test. Statistical analysis was performed using SPSS-11.5.

The level of sleep disorders in the male population of 45–64 years was 79.9%. The frequency of homozygous C/C genotype of neuropeptide S (gene NPSR1 rs324981) was 19.4%, T/T genotype occurs in 27.8%, C/T genotype −52.8%. Men dominated the T allele of −54.2%, and the C allele −45.8% growth trend Fnd dissatisfaction with the quality of their sleep among men. Men T-allele carriers, most evaluated their sleep as “satisfactory” in 69% of cases, (χ2 = 15,713 df = 8, P < 0.05).

Association found men carrier T-allele of neuropeptide S (gene NPSR1 rs324981), a sleep disorder.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.

The aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.

Two hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.

We found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).

Our results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.

The authors have not supplied their declaration of competing interest.

Both MMSE and MoCA are two widely used cognitive screening test. Comparison of the two tests has been done in specific populations (Parkinson) but not in general elderly psychiatric populations. In research, equating methodologies has been used to compare results among studies that use different scales, which measure the same construct.

To explore their level of agreement within a particular clinical setting.

(a) To find MoCA and MMSE agreement. (b) To derive a conversion formula between the two scales and test it in a random population of similar setting.

Prospective study of consecutive community dwelling older patients who attend outpatient clinic or day hospital. Both tests were administered from the same researcher the same day in random order.

The total sample (n = 135) was randomly divided in two. One from where the equating rule derived (n = 70) and a second (n = 65) in which the derived conversion was tested. Agreement of the two scales (Pearson's r) was 0.86 (P < 0.001), and Lin's Concordance Correlation Coefficient (CCC) was 0.57 (95% CI 0.45–0.66). In the second sample, we convert the MoCA scores to MMSE scores according to equating rule from the first sample and after we examined the agreement between the converted MMSE scores and the originals. The Pearson's r was 0.89 (n = 65, P < 0.001) and the CCC 0.88 (95% CI 0.82–0.92).

Although the two scales overlap considerably, the agreement is modest. The conversion rule derived showed promising accuracy in this population but need further testing in other populations.

The authors have not supplied their declaration of competing interest.

Providing care to people with dementia is a stressful experience and has been associated with high burden of care. Such issue has been under-researched in Arabic/Islamic parts of the world.

The aim of this study is to determine the degree of burden of care among caregivers of people with dementia attending the Old-Age clinic, Sultan Qaboos University Hospital, Oman.

Fifty patients with dementia and their primary care caregivers were included in the study. The diagnosis of dementia was based on DSM 5 criteria and the severity was rated according to the Global Deterioration Scale for Assessment of Primary Degenerative Dementia and Clinical Dementia Rating. Level of dependency was measured using the Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) Scale. For the caregivers, burden of care was determined by Zarit Burden Interview (ZBI).

The majority of caregivers were adult children (90%) who are supported by other relatives. Overall, 70% of caregivers demonstrated high degree of burden as quantified by ZBI. Factors such as patient's age, duration and severity of dementia, level of dependency and female gender of the caregiver were associated with higher burden.

Burden is common among dementia caregivers and several factors interplay to influence the perceived stress. As increased burden was evidenced to be associated with higher incidence of mental disorders, screening and early intervention will impact positively on the caregiver as well as the patient.

The authors have not supplied their declaration of competing interest.

Medical assistance for elderly people with mental health problems increases at the same time that life expectancy does.

The aim of this work is to describe several demographic and clinical characteristics of elderly patients admitted for the first time to an acute inpatient psychiatry unit.

Observational, descriptive, and retrospective study from June 2013 to May 2015, where it is analysed patients older than 65 years admitted to the acute psychiatric ward of Hospital de Getafe in that period without psychiatric hospitalization in their personal background.

Seventeen patients were included of a total of 428 patients admitted in that period (3.97%). Mean age: 70.7 ± 4.7. A total of 10 male (58.9%). The average stay in the studied group was 18.5 days, slightly lower than general average stay in that period (19.2 days). No psychiatric background was found in 4 patients. The most common diagnoses was depressive episode (5 patients) followed by manic episode (4 patients) and delusional disorder. Every of them but one, were taking at least one antipsychotic drug at discharge.

Elderly patients represent a low percentage of the total of patients admitted to an acute inpatient psychiatry unit. Many of them, despite having long-term ambulatory psychiatric follow-up, require a first psychiatric hospitalization after 65 years, as well as other patients begin their treatment in the mental health services in that hospitalization. It is noteworthy that antipsychotic drugs are used very commonly in those patients.

The authors have not supplied their declaration of competing interest.

Frail individuals are highly vulnerable to minor stressful events, presenting a higher risk for adverse health outcomes (e.g. falls, disability, hospitalization), which can lead to a decline in quality of life (QoL). In this context, an early screening of elderly frailty is of crucial importance.

To compare how the Frailty Phenotype (FP) and the Tilburg Frailty Indicator (TFI) predict QoL in a two-year follow-up.

A longitudinal study was designed recruiting 110 community-dwelling elderly (≥ 65 years). The presence of frailty was assessed at baseline (FP ≥ 3 and TFI ≥ 6), whereas QoL was measured two years later with two different scales: the WHOQOL-OLD and the EUROHIS-QOL-8. Hierarchical regressions were conducted.

The mean age of the participants at baseline was 77.7 ± 6.9 years, and most were women (75.5%). According to FP, 33.6% of the participants were classified as frail, while the TFI detected frailty in 50% of the elderly. After adjusting for age and gender, the TFI significantly predicted QoL (WHOQOL-OLD: β = −18.9, t(106) = −6.97, P < 0.001; EUROHIS-QOL-8: β = −6.1, t(106) = −6.71, P < 0.001), whereas the effect of the FP on the outcome measures was non-significant.

Frailty at baseline was associated with a lower QoL at follow-up. A multidimensional frailty operationalization (TFI) showed a stronger predictive validity than an exclusively physical one (FP). The option of which frailty measure to use in a clinical setting should take into account its ability to predict specific adverse outcomes, conducing to targeted and effective interventions.

The authors have not supplied their declaration of competing interest.

Patients with serious psychiatric illness (SMI) have a reduced quality of life and life expectancy than the general population. Metabolic syndrome (MS) is a clinical aspect determining who should be considered to reduce the risk of serious and chronic organic factors, even more significant in the elderly.

To evaluate metabolic screening of elderly patients with severe mental illness (SMI).

To evaluate the importance of routine screening of metabolic parameters in elderly guests of residential facilities with or without SMI; metabolic screening at baseline and after two of hospitalization.

Elderly inpatients (44 Tot) with Severe Mental Illness (SMI: bipolar disorder: 34%; schizophrenia: 46%; other: 20%) vs elderly inpatients (78 Tot). Data collected at baseline: psychiatric diagnosis; any previous diagnosis of hypertension, diabetes, dyslipidemia; ECG. At baseline and for two years were administered following scale: BPRS; PANSS; Qli; MMSE, ADL.

After two years metabolic screening has recorded at least one of the new interactions between the five factors of MS (ATP III) in 50% of patients with: one (34%); two (21%); three (11%); four (3%) new altered parameters. In MS inpatients, 53% of new metabolic alterations were recorded in 53% (MS inpatients) vs 23% without MS after two years.

Our results showed a higher frequency of MS in patients with SMI than comparison subjects. Haloperidol was the antipsychotic medication that caused minor impact on the development of metabolic disorders.

The authors have not supplied their declaration of competing interest.

Depression is a prevalent illness in elderly people. Cognitive deterioration associated to depressive symptoms is frequently considered as Dementia, especially in primary care. The study of the relation between both pathologies is necessary to correct treatment of mental illness in elderly people.

The aim of this study is to investigate whether depressive symptoms are related to certain areas of cognitive decline in elderly people.

The sample included community people older than 65 years (n = 927), mean age 72.9; 55.1% were women and 44,9% men. Instruments used were Beck Depression Inventory (BDI), Blessed Dementia Scale (BDS), Mini Mental State Examination (MMSE), verbal fluency test, clock drawing task, Wechsler digit substitution test and Wechsler similarity test.

Of the sample, 15,2% presented cognitive deterioration in Blessed Dementia Scale, with statistical significance in relation between growing age, female sex and cognitive deterioration (P < 0.005). Twenty-eight percent of the sample present cognitive decline, finding the same relation between sex, age and cognitive condition. Of the sample, 33.5% presented mild depression, 9.1% moderate depression and 1.4% presented severe depression using BDI. Correlations between depression and cognitive tests were analyzed. In demographic factors, social support was significantly correlated with depression but marital status, occupation and education were not correlated.

There is a high prevalence of depressive symptoms and cognitive deterioration in elderly people. High levels of depressive symptoms are associated with cognitive deterioration, especially in comprehension and judgment, delayed recall, verbal memory and visuospacial coordination in elderly people.

The authors have not supplied their declaration of competing interest.

Older patients with psychiatric conditions often have other disorders that include different levels of cognitive impairment, modifying the presentation of psychiatric symptoms and requiring treatment adaptations [1].

To describe clinical profile of hospitalized patients > 65 years, and its relationship with the presence of cognitive impairment and the length of hospital stay.

Descriptive and comparative study. Sample: 71 inpatients > 65 years (mean ± SD Age: 72.42 ± 5.96), admitted to “Hospital Universitario Central de Asturias”(Spain) from August 2014 to June 2015. Age, length of hospitalization, diagnosis, cognitive impairment and treatment data were collected (Table 1).

Days of hospital stay (mean ± SD) = 15.89 ± 11.53. No variable showed significant relation except number of antipsychotics taken (r = 0.307, P = 0.009). Cognitive impairment was significantly more frequent in men than women (45.5/15.8%; χ2 = 7.46; P = 0.006). No other variable showed significant differences.

A high percentage of psychiatric inpatients > 65 years present a cognitive impairment (29.6%) which was more frequent in males (45.5%). The length of hospital stay seems to be similar than in the rest of patients and not being affected by any of studied variables. More studies should be carried on to compare those results with similar variables in younger population and to analyze if there are differences between subgroups (65–75 vs > 75) [1].

The authors have not supplied their declaration of competing interest.