Parental alcoholism may lead to adverse psychological outcomes for those who grow up in such family environments.

Several studies show that children of alcoholics (COAs) live in family climates characterized by conflict, unpredictability, and manifestations of contempt. Moreover, COAs are exposed to a high level of expressed emotion due, for instance, to threats and denigration.

We compared a group of COAs with a group of non COAs measuring the family climate, the level of expressed emotion and the parental attitudes on the basis of both children and parents' point of view.

25 COAs (mean age 17,8 ± 3,3 years) and 25 non COAs (mean age 18,3 ± 3,3 years), matched for age and sex, were evaluated in the frame of an observational naturalistic study design. Self-administered rating scales were used to assess the level of expressed emotion in the family (Level of Expressed Emotion Scale - LEES), the parental (Parental Attitudes Scales - PAD) and family (Family Attitudes Questionnaire - FAQ) attitudes.

The two groups did differ for FAQ total score and for the FAQ subscale assessing the relation between parents. They also differed for the level of expressed emotion (i.e., LEES total score) and for the LEES subscale assessing tolerance and expectations.

COAs are characterized by the perception of a negative family climate that is primarily expressed in terms of conflict and deterioration of relationship between parents.

In order to improve global functioning in psychotic patients is necessary to know the kind of variables influencing those.

To research that of a clinical and epidemiological variables group which of them are associated to a better outcome in global functioning in patients affected by psychosis.

A total of 73 psychotic patients were included in this study. All of them were evaluated through a battery of tests including GAF and SIX, PANSS, S-GPTS and a comprehensive questionnaire for clinical and epidemiological variables. A binary logistic regression analysis was applied to the data set of global functioning scores divided by the median in two halves: better and worse global functioning. The model included the following variables: positive, negative and general psychopatology PANSS subscales, PANSS subtype, first or second generation antipsychotic, stimulants drugs use, tobacco use, sex, age, onset age, number of psychotic episodes and S-GPTS score.

Treatment with second generation antipsychotics and lesser scoring in S-GPTS scale were associated with a better outcomes in global functioning. We found an association between lesser negative symptoms and lesser number of psychotic episodes with a better functioning which showed a marginal statistical significance.

We raise the question about preferential use of second generation of antipsychotics as opposed to older antipsychotics and the necessity of improving adherence to treatment for breaking the vicious cycle between psychotic episodes and a worse global functioning. Further studies with greater sample are needed to explain these and another questions.

Epidemiological studies estimated that amongst patients with schizophrenia a large subgroup of up to 25% also suffers from comorbid obsessive compulsive symptoms (OCS). The association between these comorbid OCS and neuropsychological impairment remains unclear and somewhat contradictory. Longitudinal approaches which investigate the stability of OCS related cognitive deficits are missing.

37 patients with schizophrenia and comorbid OCS and 43 schizophrenia patients without OCS were assessed with a comprehensive cognitive test-battery and compared at baseline and again 12 months later.

Schizophrenia patients with comorbid OCS showed significant pronounced deficits with increasing effect sizes over the 12 month assessment period in specific cognitive areas such as visuo-spatial perception and visual memory (WAIS-R block design, Rey-Osterrieth Complex Figure Test), executive functioning (perseveration in the Wisconsin card sorting test) and cognitive flexibility (Trail making test B). These cognitive domains correlated with OCS severity and are known to be candidate domains in obsessive compulsive disorder (OCD).

OCS in schizophrenia is associated longitudinally stable specific cognitive deficits. Prospective studies involving patients with at risk mental states for psychosis are necessary to decipher the interaction of cognitive impairment and the clinical manifestation of schizophrenia and OCS. This might facilitate the definition of patients at high risk for OCS, an early detection of subclinical levels, therapeutic interventions and clinical monitoring.

Depression in children and adolescents is still underdiagnosed. Valid and brief screening-tools for these age groups are missing.

For children and adolescents in particular, we developed the screening-tools ChilD-S and DesTeen and assessed their validity as opposed to established instruments.

Both screeners were validated in a paediatric (228 children, 316 adolescents) and a clinical sample (77 children, 87 adolescents). Gold standard for validation were ICD-10 diagnoses of a depressive episode or dysthymia based on a structured interview. Using receiver operating characteristic analyses, the area under the curve (AUC) and the cut-offs with the highest sum of sensitivity and specificity were computed. In addition, it was examined whether the instruments differed significantly in validity measures.

Point-prevalences were 5.3% (children) and 9.8% (adolescents) in paediatric care and 23.5% and 26.1% in clinical care.The 8-item ChilD-S yielded AUCs of 98% and 93% in the paediatric and in the clinical sample. Sensitivities were 100% and 94%, with specificities of 87% and 78%.The abbreviated 6-item DesTeen showed an AUC of 95% in both settings. Sensitivities were 100% and 91% in the paediatric and in the clinical sample, specificities were 82% and 89%. Being even shorter, the two screening-tools performed equally well or better than the established instruments.

The ChilD-S and the DesTeen discriminate well between depression and depression-like symptoms in somatic diseases as well as between depression and other forms of mental disorders. Valid and brief, they can both be recommended for usage in paediatric and clinical settings.

There is widespread concern over the perceived indiscriminant prescribing of antipsychotic medications in children, particularly for those residing in low-income households or foster care. Ongoing safety and efficacy monitoring is suggested by many professional associations.

Describe reported diagnosis and symptomology for over 15,000 children prescribed antipsychotics in the 17- month period from April 2011 through August 2012.

Increase appropriate monitoring of children who are prescribed antipsychotics.

A policy was developed by the North Carolina Division of Medical Assistance, in collaboration with Community Care of North Carolina, that requires prescribers to register patients via a web portal before reimbursement is allowed to the pharmacy. Required registration elements include a patient's primary diagnosis, target symptom for medication use, initiating prescriber, caregiver support of medication use, adverse drug event reporting, and metabolic monitoring deemed best practice by the literature review.

From April of 2011 through August 2012, a total of 1,241 prescribers have written 29,691 prescriptions for 15,194 patients in the A+KIDS program. Unspecified Mood Disorder was the first most common representing 22%.of patients. Bipolar Disorder, Autism Spectrum Disorder, and ADHD, followed at 14%, 12%, and 12% respectively. “Aggression towards others,” “Irritability” and “Tantrums/temper” were the most common target symptoms (representing 63.6% of patients).

Mental distress among medical students is often reported. Social phobia is a highly prevalent yet often overlooked psychiatric disorder that can cause severe disability but fortunately has shown responsiveness to specific pharmacotherapy and psychotherapy. The aim of this work was to study the prevalence of social phobia problem and potential risk factors that may be associated with social anxiety among medical students.

The present study was designed to identify the manifestations and correlates of social phobia among medical college students. The sample for this investigation consists of 321 (170 female and 151 male) students aged 19-26 years. For detection of social phobia among the studied sample, we used Social phobia inventory which is a self rating scale that capture the spectrum of fear, avoidance and physiological symptoms. It demonstrates good test-retest reliability, internal consistency, convergent and divergent validity.

The sample consisted of participants from all medical stages (this was a proportionate representative sample from each classes), 56% were from higher income groups, nearly 45% had their residence in hostel, 21.5% of the students had a SPIN score of 19 and more, mean social phobia was present in almost 22% of the population. There was no statistically significant difference in prevalence of social phobia with respect to gender, family income or type of residence.

Social phobia has a high prevalence and marked impact on life, early identification and adequate treatment by college counseling centers will successfully help in reducing the burden of this common condition.

Anxiety disorders are common in children. Much of anxiety in children is embedded in the parent- child relationship. In Asian countries many cultural practices can lead to insecure attachment and severe stress in children, especially in girls. Appropriate psychotherapeutic intervention must be sensitive to cultural influences.

To report clinical symptoms, individual and family dynamics, important points in psychotherapy for a girl with an anxiety disorder.

A Thai-Chinese 9 year- old girl presented with obsessions about her mother dying and herself killing her mother. She also had hallucinations which she described as “voices telling me to kill my mother”. She was diagnosed as having OCD with psychotic features. The patient was the first twin and was described as a ‘moody’ and ‘not so smart’, while her twin brother, the only male grandchild of the family, was described as ‘pleasant’ and ‘clever’.

Family assessment revealed cultural practices that led to severe frustration and anxiety in this girl. The main factor was the practice of son preference. This, together with severe punishment, led to insecure attachment, feelings of rejection, anger, guilt and shame. Family therapy and behavior management were the main psychotherapeutic interventions in the early phase. CBT was initiated in the later phase. Interesting points in treatment and the VDO tape of psychotherapy sessions will be presented.

The case vignette illustrated the role culture plays in initiating severe anxiety in girls. Understanding such a role will enable therapists to treat anxiety in girls more effectively.

Vortioxetine is a 5-HT3, 5-HT7 and 5-HT1D receptor antagonist, 5-HT1B receptor partial agonist, 5-HT1A receptor agonist and inhibitor of the 5-HT transporter (SERT).

To study the in vitro properties of vortioxetine at rat and human targets and relate them to rat brain target occupancies and effects in rat models assessing antidepressant activity and cognitive function.

The in vitro properties were assessed using radioligand binding and cell-based functional assays, brain target occupancies were studied using ex vivo autoradiography, antidepressant activity was studied in conventional behavioural models and in a progesterone withdrawal model, and effects on cognitive function were assessed by quantitative EEG [qEEG] and after 5-HT depletion in recognition and spatial memory tasks.

Vortioxetine was more potent at human than rat 5-HT1A and 5-HT7 receptors and the SERT, whereas the opposite was found for 5-HT1D and 5-HT3 receptors. The rat in vitro and ex vivo potency rank orders were aligned. Vortioxetine showed antidepressant activity in conventional models and the fluoxetine-insensitive progesterone withdrawal model. qEEG analyses demonstrated increases across power bands with vortioxetine, but not duloxetine or escitalopram. Vortioxetine restored memory deficits induced by low 5-HT, whereas duloxetine and escitalopram had no effect.

1. 1. Species comparisons of target activities and inclusion of target occupancy measures in animal studies supports thetranslation from preclinical to clinical settings.

2. 2. Vortioxetine exerts antidepressant and memory-enhancing effects in rats via mechanisms beyond that of SERT inhibition.

Among minority patients with depression, the CCM is significantly more effective in achieving treatment response and remission compared to usual care. Adaptation of this model across various population groups should be considered.

Mounting evidence suggests that immune dysfunction may play a crucial role in the pathophysiology of autism spectrum disorders (ASD). In addition, several studies have reported that congenital and postnatal infections may contribute to the neurobiological basis of ASD.

This study aimed to investigate the relationship between infections during pregnancy and after birth, and ASD.

A case-control study design was adopted. Both cases and controls were retrieved from a historic birth cohort (HBC) maintained at Statens Serum Institute in Copenhagen/Denmark and were followed up retrospectively during pregnancy and after birth over four pre-defined periods. Study subjects were followed-up utilizing Danish nation-wide health registers for outpatient and hospital admissions due to infections. Associations between infections and ASD were analyzed using Mantel- Haenszel estimate of the odds ratio (OR) and logistic regression models.

In total, 414 ASD cases and 820 controls were followed-up during pregnancy and a mean 16.3 years after birth. Crude, but not adjusted estimates showed that ASD cases had an increased risk of hospital admission due to infection at the end of the first year of life (OR = 1.48 [range: 1.07-2.05], P = 0.02) and at the end of the follow-up period (OR = 1.30 [range: 1.02-1.64], P = 0.03).

The present findings indicate that infections have a potential role in the pathophysiology of ASD; however, further studies are necessary to determine if infections etiologically contribute to ASD or if they act as an epiphenomenon due to distorted immunity in children with ASD.

The diagnosis of personality disorder (PD) in individuals with an intellectual disability (ID) is clinically relevant, but there is little research on the subject. Because the impact of PD on both patients and carers is substantial, it is important to increase the understanding of how ID and PD co-occur.

The aim of the present study was to examine the prevalence of all axis II DSM-IV-TR PD diagnoses in a well- defined sample of ID out-patients in two specialized secondary care ou-patient treatment centers, in the Netherlands. Special attention was paid to borderline ID (70≤Total IQ < 85), prevalence of co-morbid axis I disorders and associations of PD with several demographic variables.

The present study was a cross-sectional medical chart review. On January first, 2011, 599 patients were registered at the two centers. Diagnostic information was available for 576 patients. Diagnoses were based on Došen's integrative approach and formulated according to the DM-ID.

194 patients (33.7%) were diagnosed with a PD. PD NOS (19.1%) was most common, followed by borderline PD (8.7%). Patients with borderline ID were most likely to be diagnosed with a PD (43.7%). 85.1% of patients diagnosed with a PD had at least 1 co-morbid axis I diagnosis. PTSD was the most common co-morbid disorder (23.7%).

Diagnosed according to strict criteria, PDs often occur in ID out-patients, mostly together with axis I disorders. Importantly, PDs and PTSD often co-occur in this group, indicating special care needs and signifying an interesting direction for further research.

A full time urgent consult clinic was opened for adolescents presenting with risk to self or others. To date these adolescents have presented to ERs, held in the ER or admitted to the ward added to waitlists. This study is a part of a 1 year outcome study to examine whether urgent assessment and brief crisis intervention reduce ER visits, admissions and reduce the waiting lists.

1. a) examine 3 month outcome after urgent clinic assessment

2. b) examine variables that may affect outcome

3. c) examine effect of urgent consult assessment and intervention on ER visits, admission, repeat presentation and waitlist for other child and adolescent psychiatric outpatient clinics.

Adolescents 12 -17 years of age seen in the UCC will be given information sheet and consent form to participate. Data will be gathered on demographic variables and a number of other pertinent variables including reason for referral, suicidality previous contact with MH services, past psychiatric history, family history of psychiatric disorders, diagnosis and management. The patients will complete a mental health screen, CDI and Connors Questionnaire Parents will complete the CBCL. The data will be checked against ER contact,admissions and wait lists at 3 month post assessment. Data analysis will be conducted using SPSS.

It is expected that there will be a decrease in the number of adolescents presentating to the ERs, a reduction in ER admission to the ward and a decrease in the numbers of patients on the Outpatient wait list.

People with an intellectual disability (ID) are likely to experience traumatic events and more vulnerable to its disruptive effects and thus to post traumatic stress disorders (PTSD). Little is known about how these PTSDs present themselves in patients with ID and whether this presentation differs from patients without an ID.

The aim of the present study was to compare PTSD symptomatology in psychiatric outpatients with borderline to mild ID and outpatients without ID in naturalistic out-patient samples from psychiatric secondary care.

From June 1th 2010 to March 15th 2012, 56 patients were diagnosed with PTSD. Using Routine Outcome Monitoring (ROM), 45 patients (80.4%) had complete data on both the Impact of Events Scale Revised (IES-R) and the Brief Symptom Inventory (BSI). They were compared to 45 gender- and age-matched non-ID patients diagnosed with PTSD in the same period.

Preliminary results show that there are some small differences in general psychological symptom patterns between ID and non-ID patients with PTSD as shown on the subscales obsession-compulsion, psychoticism and depression of the BSI. On the IES-R, there was no difference between ID and non-ID patients. There was no difference in symptomatology between patients with borderline or mild ID.

PTSD symptomatology does not differ in ID patients compared to non-ID patients. Consequently, ID patients deserve the same evidence based care.

Bulimia nervosa is one the main subtypes of eating disorders. Recent neurobiological research is greatly contributing to the understanding of eating disorders.

To review and discuss current topics under investigation with neuroimaging studies in bulimia nervosa, as well as future interesting lines of research in this area.

To analyze the state of the art of neuroimaging research in bulimia nervosa.

MEDLINE and PubMed databases were searched for peer-reviewed studies, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms neuroimaging and bulimia nervosa. A selection of relevant articles to the study aim was carried out. An analysis of the reviewed studies including current topics of research and future suggestions was also done.

Articles reviewed encompassed functional and structural neuroimaging or clinical reviews, connectivity and neurotransmitter studies, as well as debate or opinion articles. The main topics addressed were cerebral activation secondary to food stimuli, neuropsychological paradigms, diagnosis and classification of eating disorders based on neurobiological findings, neurobiology of eating disorders, and disordered eating mechanisms. The main future research avenues proposed were development of eating disorder psychopathology-related fMRI paradigms, as well as connectivity-based and molecular imaging studies.

The neurobiology of eating disorders is a growing exciting field of research. Neurobiological studies, namely neuroimaging studies in bulimia nervosa, may provide an important research framework for a better knowledge of psychopathological mechanisms of eating disorders.

Binge eating shares some similar clinical features with addictive disorders, such as impulsivity, altered reward sensitivity, and compulsive behavior. Some authors support the concept of food addiction for both conditions, whereas others argue against it.

To review arguments in favor or against the concept of food addiction, and its relation with bulimia nervosa and binge-eating disorder.

To discuss and explore the concept of food addiction, and how it may be related to bulimic-type behaviors.

MEDLINE and PubMed databases were searched for peer-reviewed studies undertaking analyses of evidence in favor or against the concept of food addiction, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms addictive behavior and bulimia.

Several arguments in favor of the concept of addictive properties of food are present in many of the reviewed articles. However, many differences between substance addiction disorders and the so-called “behavioral addictions” are reported in the literature, underlining different neurobiological, psychological, and environmental mechanisms.

There is no consensus in the current literature regarding the concept of food addiction. Further studies concerning the issue are, therefore, warranted.

Compared to anorexia nervosa, bulimia nervosa has received less attention on neuroimaging research. However, in the past decade, more functional resonance imaging studies were done to study bulimia nervosa, by using different types of paradigms, namely symptom-related paradigms.

To review functional magnetic resonance imaging (fMRI) studies in bulimia nervosa using food stimuli.

To discuss recent contributions of functional neuroimaging to the understanding of bulimia nervosa.

MEDLINE and PubMed databases were searched for peer-reviewed articles, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms functional neuroimaging and bulimia nervosa. A selection of relevant papers to the aim of this review was carried out. The selected studies were reviewed with respect to type of paradigm, participant characteristics, main results, strengths and limitations.

Most studies reported altered functional activation in the frontal, cingulate, temporal, and parietal cortical regions secondary to food-related fMRI paradigms in bulimia nervosa.

The reviewed studies suggest that bulimia nervosa is associated with functional imaging brain abnormalities.