This study aimed to analyze the relationships between personality disorders (PD), substance use disorder (SUD) and criminal behavior.

120 convicted offenders underwent two interviews to be evaluated for Axis I and Axis II disorders using the MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW – MINI 5.0 (1994, 1998, 2000, Sheehan DV & Lecrubier Y. – Brazilian Version 5.0.0) and the STRUCTURED CLINICAL INTERVIEW FOR DSM-IV AXIS II DISORDERS – SCID-II (First, Gibbon, Spitzer, Williams, & Benjamin, 1999 – Brazilian version). A random selection was made among all offenders who were serving sentences in closed conditons in two prisons with the largest population located in the State of Minas Gerais, Brazil.

Among the investigated population, Antisocial PD was the most frequent, occurring in nearly 57.7% of the sample; Dependent and Schizoid PD were uncommon. SUD were prevalent in 89.14% of the sample.

• Among the investigated population, Antisocial PD was the most frequent, occurring in nearly 57.7% of the sample;

• SUD was significantly associated with PD. It was especially significant for those with Antisocial PD, what leads to the conclusion that Antisocial PD increases the risk for SUD. This association was significant for people with Antisocial PD;

• Severe offences against life and against the person committed by the use of intentional violence were related with Antisocial PD.

• People with PD and with a history of SUD, although generally considered criminally responsible for their actions, need urgent medical and psychological care in Brazilian prisons.

All offenders commited neonaticide were mothers of killed nweborn. Analysis of forensic psychiatry examination reports showed only 12 offenders (21.4 pr.) with psychiatric disorders which caused diminished responsibility and irresponsibility. There were 8 offenders with severe depression and 2 – with schizophrenical psychosis in irresponsible offenders group. Diminished responsibility was found in 2 offenders with light mental disorder. In 44 (78.6 pr.) reports offenders were found responsible for criminal act. Main diagnosis of this group was personality disoeder (N 30), alcohol addiction was found in 5 cases. In cases responsible for crime of neonaticide some reasons for criminal action were disclosed : material difficulties (N9), unwanted child (N8), spousal revenge (N7), not mentioned reason (N20).It was no more mentioned material difficulties as reason for neonaticide in cases after 2002 year. Conclusion :Neonaticide was commited by psychiatrically ill persons in only one fifth part of examined cases. Main diagnosis in cases responsible for neonaticide was personality disorder. The results of analysis show psychosocial prevention work, health education and adequate psychiatric diagnoses and treatment are neccesary in pregnant women for avoiding neonaticide.

There is mounting evidence that music therapy can be beneficial in mental disorders. Whilst there is much literature on it’s role in psychiatry, there is little research on the place of music education and moreover, in a forensic setting.

To determine how patients with a history of serious violence and difficulties in engagement experience music education and to review it’s place within the recovery model in a high secure psychiatric hospital.

Qualitatively, to consider the role of music education from the perspective of a forensic psychiatric patient and to determine impact on clinical outcome.

Semi-structured interviews explored three areas with six patients; past exposure to music, involvement in the music department and reflection upon the experience. Case histories were compiled through retrospective data collection via electronic records.

Opportunity to overcome difficulties such as violent episodes, a sense of empowerment through achievement and instilling of hope were emergent key themes. Creating music was described as a means of enabling expression of topics difficult to verbalise. The skills and mind-set nurtured were considered a foundation for vocational work. Therapeutic benefit extended to the wider team, manifest as increased willingness to engage.

We demonstrate that music education can play a significant role in recovery and furthermore, in patients that present a unique set of challenges. Future studies could increase sample size and consider objective measures to additionally demonstrate benefit. In the context of a multi-disciplinary approach this may well impact on planning services in the future.

Growing literature suggests that the sense of coherence (SOC) positively influences well-being in later life.

This study reports the assessment the following psychometric properties: distributional properties, construct, criterion and external-related validities, and reliability, of the Orientation to Life Questionnaire (OtLQ) in an cross-national population of older adults.

We recruited 1291 community-dwelling older adults aged between 75-102 years (M=83.9; SD=6.68). Convenience sampling was used to gather questionnaire data. The construct validity was asserted by confirmatory factor analysis, convergent and discriminant validity. Moreover, criterion and external-related validities, as well as distributional properties and reliability were also tested.

Data gathered with the 29-items OtLQ scale showed overall good psychometric properties, in terms of distributional properties, construct, criterion and external-related validities, as well as reliability. Three factors were validated for the OtLQ scale: (a) comprehensibility; (b) manageability; and (c) meaningfulness.

We validated the 3-factor OtLQ scale, which produced valid and reliable data for a cross-national sample with older adults. Hence, it is an adequate instrument for assessing sense of coherence among older people in health care practice and program development contexts.

Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Rapid reliable identification of clinical subtypes can allow for more targeted and research efforts.

The aims of this study are to evaluate the concurrent validity (agreement) and reliability (internal consistency) of DMSS-4 in a new cohort of delirious hospitalised patients.

We explored the concordance in attribution of motor subtypes between the DMSS-4 and the original DMSS (assessed cross-sectionally) and subtypes defined longitudinally using the Delirium Symptom Interview (DSI) method.

We included 118 elderly patients developing DSM-IV delirium after hip-surgery [mean age 87.0±6.5 years; range 65–102; 66% females; 28 (23.7%) had no previous history of cognitive impairment]. Concordance was high for both the DMSS-4 and original DMSS (k=0.80), and for the DMSS-4 and DSI methods (k=0.82). The DMSS-4 also demonstrated high internal consistency (McDonald's omega = 0.78). The DMSS-11 and DMSS-4 had higher inclusion for motor subtypes than the DSI method.

The DMSS-4 provides an ultra-rapid means of identifying motor-defined clinical subtypes of delirium and is a reliable alternative to the more detailed and time-consuming original DMSS and DSI methods of subtype attribution. The DMSS-4 can be readily applied to further studies of causation, treatment and outcome in delirium.

To investigate the use of a video monitoring system for automatic event recognition for the assessment of autonomy in Instrumental Activities of Daily Living (IADL) in dementia patients.

Three groups of participants (healthy control, Mild Cognitive Impairment and Alzheimer's disease) had to carry out a standardized scenario consisting of directed tasks (single and dual task) and IADLs such as preparing pillbox. During this time they were recorded by 3D video cameras capturing all their activities. The performance quality of each participant was manually annotated and assessed based on the amount of successfully carried out activities. Recorded data was processed by a platform of video signal analysis in order to extract kinematic parameters detecting activities undertaken by the participant. We developed a classifier based on the extracted video features for diagnostic prediction and further autonomy performance prediction.

Overall activities were correctly automatically detected. The most accurate detected activities were: using the phone with 91% accuracy and preparing pillbox with 88% accuracy. The diagnostic group classifier based on the automatically extracted video features obtained accuracy of 71.79 % when combining directed tasks and IADLs. Autonomy group classifier obtained an accuracy of 84.61% when combining directed tasks and IADLs.

The results suggest that it is possible to assess autonomy with the help automatic video monitoring system (AVMS) and that the use of such technologies could provide clinicians with diagnostic relevant information and improve autonomy assessment in real time decreasing observer biases.

More than a quarter of depressed older persons is physically frail. Understanding the associations between frailty and depression may help to improve treatment outcome for late-life depression. The aim of this study is to test whether physical frailty predicts the course of late-life depression.

A cohort study (N=285) of depressed older persons aged ≥60 years with two years follow-up. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at two-year follow-up. Severity of depression was assessed with the sum score as well as subscale scores of the Inventory of Depressive Symptomatology (IDS) at six-month intervals. Physical frailty was defined as ≥3 out of 5 criteria (handgrip strength, weight loss, poor endurance, walking speed, low physical activity).

Frail patients were more severely depressed compared to their non-frail counterparts. Multivariable logistic regression showed that physical frailty at baseline was associated with depression at two years follow-up, adjusted for socio-demographics and lifestyle factors. Linear mixed models showed that improvement of mood symptoms over time was independent of frailty status, whereas frailty had a negative impact on the course of the somatic and motivational symptoms of depression.

The negative impact of physical frailty on the course of depression may point to the potential importance of incorporating multi-facetted interventions in the treatment of late-life depression. Further understanding of the mediating mechanisms underlying the association between frailty and depression may further guide the development of these interventions.

Methylenetetrahydrofolate reductase (MTHFR) 677CT marker influences the risk and severity of Alzheimer's disease (AD) and whether AD is associated with homocysteine, vitamin B12, and cholesterol levels in Egypt.

The aim of this study was to determine the genotype and allele frequencies of the rs1801133 SNP and to evaluate the influence of genotype on risk and severity of disease in Egyptian patients with AD.

Forty-three Alzheimer's cases and 32 non-AD controls were genotyped for the 677C>T polymorphism. Clinical characteristics and levels of homocysteine, vitamin B12, and cholesterol were assessed.

No significant differences in the frequencies of the MTHFR alleles or genotypes between AD cases and controls (P= 0.14) were identified. The 677T mutant allele was significantly overrepresented in AD cases compared to controls (OR = 2.22; P= 0.03). The 677T/T frequency was three times higher in AD patients than in controls, which could increase plasma homocysteine levels. Severe cases of AD were the most frequent in patients with the T/T genotype (11.6%). The effect of the MTHFR polymorphism on the risk of AD may be independent of homocysteine, vitamin B12, or even cholesterol levels.

The MTHFR 677C>T polymorphism—especially the presence of one copy of the T allele—appears to confer a potential risk for the development of AD. The T/T genotype may contribute to hypercysteinemia as a sensitive marker.

Second-generation antidepressants dominate the medical management of major depressive disorder (MDD). Some have questioned whether these medications are equally effective in older adults.

To compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, venlafaxine, vilazodone, and vortioxetine for the treatment of MDD in older adults and to assess whether efficacy differed in older adults compared with the adults of all ages.

To identify relevant studies, we searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL through December, 2014. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias. We conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants and we conducted meta-regression by assessing whether efficacy differed in trials that enrolled older adults compared with trials that enrolled adults of any age. The outcome was treatment response as measured by ≥50% improvement from baseline on the HAM-D.

Evidence on older adults compared with adults of any age is sparse. In older adults, evidence indicates that efficacy does not differ substantially among second-generation antidepressants; however, there may be some differences in adverse events. Our meta-regression found a trend toward lesser efficacy of SGAs in older adults than adults of any age.

Our findings suggests that SGAs may be less effective in older populations. There is a great need for research focusing directly on the efficacy and safety of SGAs in older adults.

In the last years and due to the progressive aging of the population, consultations in people over 65 have increased, and this fact is also evident in psychaitry. This also affects in inpatients psychiatric units.

The objective is to review patients older than 65 years admitted over a year in an inpatient psychiactric Unit.

It is to analyzed using a descriptive study of sample patient over 65 who have been admitted during the year 2013, analyzing their most important characteristics, and the main differences with respect to the overall package of the adult population that income during the same year.

We reviewed a total of 679 patients during the 2013, of which 61 income corresponded to persons older than 65 years. The most important results were that the income in this age group were increased approximately 20% compared to the previous year. The average stay of income was one more day (16 versus 17.3 days), due to the fact that 80% of the patients had somatic comorbidity during admission.

In this group of age, the reasons for admission and the diagnosis at discharge were the same, affective disorders (36 % and 41 % respectively).

The elderly patients occupies an increasingly important place in our society due to the aging of the population and the constant need of resources, both social and health. As we have seen, differs from the general population, which would bring attention to their needs in a more specialised way.

Trieste is a city characterized by a high mean age of the resident population, with 6,000 people with a cognitive impairment. Evidences show that is necessary to have a multidisciplinary approach, making alliances with the social network and families, while dealing with people with cognitive impairment. Because of this, the 3rd catchment district has developed a Mobile Daily Centre that aims to promote health, abilities and socialization giving the possibilities for these people to stay in a social context.

Evaluating the impact of the Mobile Daily Centre on QoL of people with Cognitive Impairment.

Considering the rate of hospitalization and access to the first aid unit at the general hospital.

Retrospective Observational Study for the period between 01.01.2012 and 30.04.2014 on people in charge to the MDC. We have considered socio-demographic variables such as age, gender, care-givers; clinical variables such as psychopharmacotherapy and acetylcolinesterase-inhibitors drugs; rates of hospitalization, number of accesses to the first aid unit and of interventions of the MDC.

in the period of the study 20 patients have been followed by the MDC; half of them had a psycho-pharmacological prescription. Very low rates of institutionalization have been detected.

MDC, in these small numbers, has shown to reduce the number of improper institutionalizations while guaranteeing to the elder people to maintain their abilities and socialization and to their care-givers periods of relief. Moreover, it promotes social inclusion and destigmatization. These results suggest that more territorial work and further studies should be done.

The great number of subjective and descriptive characteristics of the chronic cerebral ischemia (CCI) arise a question of development of magnetic-resonance tomographic (MRT) criteria for CCI in relation to its genesis (hypertonic and atherosclerotic).

Concretization of MRT features of CCI in relation to its genesis.

MRI investigation was performed in 77 patients with CCI of average age 58,2±0,6 years. Patients were divided into 2 groups. Group 1 included 31 patients with CCI of hypertonic genesis, group 2 consisted of 46 patients with CCI of atherosclerotic genesis. M

Ischemic focuses were found subcortically in 22 (71,0%), periventricullary – in 9(29,0%) patients of group 1, in group 2 – in 18(39,1%) and 28(60,9%) P<0,01, respectively. In group 1 the single focuses were in 2(6,5%) patients, few – in 10(32,3%) and multiple – in 19(61,3%) patients. In patients of group 2: single – in 14(30,4%), few – in 21 (45,7%) and multiple – in 11(23,9%). The small sites were diagnosed in 13(41,9%) patients of group 1 and in 34(73,9%) in group 2 (P<0,01). The large sites were found in 18(58,1%) and 12 (26,1%) P<0,01, respectively. The total area of of leusoareosis in regimen T2 was 8,6±1,2cm2 in group 1, and 3,5±0,5 cm2 in group 2.

MRT picture of CCI of hypertonic genesis was characterized by multiple, large focuses, predominantly cubcortically distributed, by diffusive-confluent leucoareosis. MRT findings of atherosclerotic genesis were differed by small periventricular areas and local leucoareosis.

Autism spectrum disorders (ASD) are characterized by deficits in social interaction and behavioral impairments. Several studies have reported differences in white matter generalized Fractional Anisotropy (gFA) in ASD.

We studied white matter microstructural integrity in individuals with ASD.

We conducted the first DWI-based whole brain tractography study to compare gFA in 22 deep white matter tracts in first-degree relatives of individuals with ASD to controls and individuals with ASD. Futhermore, we replicated our significants results in an independant sample.

Fifty-one first-degree relatives of individuals with ASD, 29 controls and 14 individuals with ASD participated.

We performed q-ball imaging whole-brain tractography based on 1.5 T diffusion weighted MRI over 32 non-colinear directions. Then, we computed mean gFA along 22 main deep white matter tracts. A linear mixed model using group, gender, age and IQ as fixed effects and family as a random effect was used and Bonferroni correction applied. We also recruited a replication sample comprising 23 individuals with ASD and 32 controls.

We demonstrated a significantly reduced mean gFA along the left IFOF in first-degree relatives of individuals with ASD and individuals with ASD compared with controls and replicated this finding in an independant sample of patients. A decrease in mean gFA was also observed in the left CST when we compared first-degree relatives of individuals with ASD to controls (no such decrease was present in patients).

Our work suggests that structural fronto-occipital disconnectivity may be an endophenotype of ASD.

The aim of this study is to explore connectivity between Medial Prefrontal Cortex and others areas of the Default Mode Network, by Functional Magnetic Resonance Imaging during Resting State, in subjects affected by schizophrenia and unaffected relatives.

We recruited a group of 29 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, who are and were clinically stable in the last 6 months and had an illness duration range from 5 up to 15 years. Patients who had received either electroconvulsive therapy or clozapine were excluded. We also recruited a group of 23 unaffected relatives, without history of other mental, neurological or somatic disease and a group of 37 healthy volunteers. No subject in any of the three groups met criteria for substance use disorders .

All three groups were clinically evaluated, and a functional magnetic resonance during Resting State was performed.

Functional images were reoriented to the first scan, normalized to the MNI EPI template and smoothed with an 8 mm Gaussian kernel, with SPM. The CONN-FMRI Toolbox v1.2 was used to create individual subject seed-to-voxel connectivity maps, to the corresponding seeds of the default mode network.

There are significant differences in the conectivity of de Medial Prefrontal Cortex and the default mode network, in patiens and unaffected relatives.

First-episode psychosis (FEP) patients show structural brain abnormalities. Whether the changes are progressive or not remain under debate, and the results from longitudinal magnetic resonance imaging (MRI) studies are mixed. We investigated if FEP patients showed a different pattern of regional brain structural change over a one-year period compared to healthy controls, and if putative changes correlated with clinical characteristics and outcome.

MRIs of 79 FEP (SCID-I verified diagnoses: schizophrenia, psychotic bipolar disorder, or other psychoses, mean age 27.6 (SD 7.7), 66% male) and 82 healthy controls (age 29.3 (SD 7.2) 66% male) were acquired from the same 1.5T scanner at baseline and one-year follow up as part of the TOP study, Oslo, Norway. Scans were automatically processed with the longitudinal stream in FreeSurfer. General linear models were used to analyze longitudinal change in a wide range of subcortical volumes and detailed thickness and surface area estimates across the entire cortex, and associations to clinical characteristics.

FEP and controls did not differ significantly in annual percentage change in cortical thickness or area in any cortical region, or in any of the subcortical structures after adjustment for multiple comparisons. Within the FEP group, duration of untreated psychosis, age at illness onset, antipsychotic medication use, and remission at follow-up were not related to longitudinal brain change.

We found no longitudinal brain changes over a one-year period in FEP compared to controls. Our results do not support early progressive brain changes in psychotic disorders.

To compare the white matter structural changes in specific axonal tracts detailed by diffusion tensor imaging (DTI) tractography in patients of bipolar disorder I, non-ill first degree relatives of the patients, and healthy controls in Indian population.

In a cross sectional study, we studied right-handed subjects consisting of 15 euthymic bipolar disorder I patients, 15 first degree relatives and 15 healthy controls. White matter tracts, including the anterior thalamic radiation, uncinate fasciculus, corpus callosum, and cingulum bundle were reconstructed by DTI tractography. Mean fractional anisotropy (FA) values were compared for group differences followed by post hoc analysis.

The three groups did not differ in terms of socio-demographic variables. There were significant group differences in the FA values between the bipolar disorder I, first degree relatives and the healthy control groups for corpus callosum (H=35.922, p<0.001), dorsal part of right cingulum bundle (H=23.562, p<0.001), hippocampal part of right cingulum bundle (H=8.992, p<0.001), hippocampal part of left cingulum bundle (H=26.034, p<0.001), right uncinate fasciculus (H=33.563, p<0.001) and left uncinate fasciculus (H=34.093, p<0.001). No significant difference was found between the groups for FA values of dorsal part of left cingulum bundle and right and left anterior thalamic radiations. FA values were significantly lower in bipolar disorder I patients as compared to family control group which in turn had significantly lower levels, compared to healthy controls.

The findings suggest that bipolar disorder patients and their first degree relatives show alterations in microstructural integrity of white matter tracts, compared to healthy population.

Impairments of attention and memory are evident in early psychosis, and often lead to severe, longstanding functional disability. Effective non-pharmacological interventions are needed due to the unsuccessful results of pharmacological interventions.

To determine whether yoga is effective for cognitive impairments, and the neural mechanism underlying these effects.

It was a randomized controlled study of 12-week of yoga and aerobic exercise (walking and cycling) intervention vs wait-list control for female early psychotic patients. Memory was measured with Hong Kong List Learning Test and Digit Span test, and attention was measured with Letter Cancellation test. Cognitive data analysis was based on the Intention-to-Treat method using a mixed-model analysis. Seed based functional connectivity was applied using posterior cingulate cortex (PCC) as seed with AFNI. Cortical thickness analyses were performed using FreeSurfer. Results from yoga and control groups were presented.

A total of 140 women were recruited and randomized into three groups. 95 completed the study, and 115 were included for cognitive data analysis. For imaging data, 42 participants were used for cortical thickness analyses; and 60 were included for neural connectivity analyses. Yoga group demonstrated significant improvements in working memory, verbal acquisition and attention (P=.01). Cortical thickness increased in the postcentral gyrus (P<.01); connectivity between PCC and bilateral inferior parietal gyrus increased after yoga intervention (P<.005).

Yoga has been found to be effective for memory and attention in early psychotic patients. The increases of thickness and neural connectivity indicate the possible neural mechanisms underlying the improvements of cognition.