Suicide and cardiovascular disease rank among the leading causes of disability and premature mortality worldwide. Young adult suicide attempters are at increased risk of mortality from cardiovascular disease even compared to those with major depressive disorder suggesting an increased burden of cardiovascular risk factors. We compared the cardiovascular risk burden between youth attempters and other high-risk individuals.

Participants were from the Collaborative Psychiatric Epidemiology Surveys (CPES), a U.S. population-based study, aged 18–30 years [suicide attempt (SA): n = 303; suicidal ideation (SI): n = 451; controls: n = 3671]; and psychiatric inpatients admitted for a SA (n = 38) or SI (n = 40) and healthy controls (n = 37) aged 15–30 years. We computed a cardiovascular risk score and high- and low-risk latent classes based on risk factors of high blood pressure, obesity, and smoking.

Suicide attempters showed an increased cardiovascular risk score (CPES: B = 0.43, 95% confidence interval (CI) 0.31–0.54, p < 0.001; inpatient sample: B = 1.61, 95% CI 0.53–2.68, p = 0.004) compared to controls. They were also more likely to be classified in the high cardiovascular risk group (CPES: odds ratio (OR) 3.36, 95% CI 1.67–6.78, p = 0.001; inpatient sample: OR 9.89, 95% CI 1.38–85.39, p = 0.03) compared to those with SI (CPES: OR 1.15, 95% CI 0.55–2.39, p = 0.71; inpatient sample: OR 1.91, 95% CI 0.25–15.00, p = 0.53).

Youth attempters show an increased burden for cardiovascular risk compared to other high-risk individuals in inpatient and population-based samples. Clinicians should pay particular attention to cardiovascular risk factors among suicide attempters in order to reduce their risk for cardiovascular events.

Obsessive-compulsive disorder (OCD) and tic disorder (TD) represent highly disabling, chronic and often comorbid psychiatric conditions. While recent studies showed a high risk of suicide for patients with OCD, little is known about those patients with comorbid TD (OCTD). Aim of this study was to characterize suicidal behaviors among patients with OCD and OCTD.

Three hundred and thirteen outpatients with OCD (n = 157) and OCTD (n = 156) were recruited from nine different psychiatric Italian departments and assessed using an ad-hoc developed questionnaire investigating, among other domains, suicide attempt (SA) and ideation (SI). The sample was divided into four subgroups: OCD with SA (OCD-SA), OCD without SA (OCD-noSA), OCTD with SA (OCTD-SA), and OCTD without SA (OCTD-noSA).

No differences between groups were found in terms of SI, while SA rates were significantly higher in patients with OCTD compared to patients with OCD. OCTD-SA group showed a significant male prevalence and higher unemployment rates compared to OCD-SA and OCD-noSA sample. Both OCTD-groups showed an earlier age of psychiatric comorbidity onset (other than TD) compared to the OCD-SA sample. Moreover, patients with OCTD-SA showed higher rates of other psychiatric comorbidities and positive psychiatric family history compared to the OCD-SA group and to the OCD-noSA groups. OCTD-SA and OCD-SA samples showed higher rates of antipsychotics therapies and treatment resistance compared to OCD-noSA groups.

Patients with OCTD vs with OCD showed a significantly higher rate of SA with no differences in SI. In particular, OCTD-SA group showed different unfavorable epidemiological and clinical features which need to be confirmed in future prospective studies.

The process of migration has been described as a “trauma”, with psychic consequences conceptualized as post-traumatic stress disorder. As many clinical and extra-clinical variables are involved, there is a need for a better understanding.

A case report is described and discussed, under the joint perspective of three different approaches to human suffering, namely that of a neuro-rehabilitation physician, a psychiatrist and a social worker.

M. B. is a 36 year-old male, single and high school-educated, who migrated from Morocco to Italy in 2003. In 2006, he fell accidentally from a scaffolding at work, causing himself a traumatic brain injury with transient loss of consciousness, occipital fracture and bilateral frontal haematomas. He was taken in charge by Social Services. Over the following months, he developed multi-sensorial pseudohallucinations and hallucinosis, changes in character and behaviour, demoralisation, insomnia. M.B. was referred to psychiatry and to a neuro-rehabilitative outpatient service, where he was found to be suffering from severe dysexecutive syndrome, attention deficits and verbal working and long-term memory impairments. Integration of neuro-rehabilitative, psychiatric and social interventions was established to deal with M.B.’s complex needs.

In the experience of M.B., the biological head trauma pairs with the social trauma of migration and the psychological trauma of forced interruption in the migration parabola. The interrelated meanings of trauma - breaking up of a psycho-somatic balance with consequences on cognition, emotions, behaviour and social functioning - require a narrative and collaborative approach to care, addressing complex bio-psycho-social needs.

Brain connectivity changes have been recently demonstrated in victims of psychological traumas treated with the eye movement desensitization and reprocessing (EMDR).

Forty victims of psychological traumas were investigated at the first EMDR session (t0) and at the last one performed after processing the index trauma (t1).

To investigate differences in EEG functional source connectivity during bilateral ocular stimulation (BS) during EMDR therapy at t0 and t1.

Brain electrical activity during whole EMDR sessions was record with a 37-channel EEG. EEG functional connectivity analysis was based on the lagged phase synchronization (LPS), derived by a two-step eLoreta procedure: dimensionality reduction of inverse matrix from 6239 voxels to 28 regions of interest (ROIs); LPS index computation, for each spectrum band, in all possible ROI pairs.

Significant differences were detected between t0 and t1 in alpha band LPS indexes. A prevalent enhancement in right intrahemispheric functional connectivity was found in t1 respect to t0, particularly among ROI pairs of (a) frontal regions (anterior frontal, orbital frontal, lateral frontal cortices) and limbic structures (anterior cingulate cortex, ACC), (b) frontal regions and associative areas (insula cortex, parietal lobe), (c) ACC and primary visual cortex and (d) ACC and associative areas.

These findings suggest that EMDR efficacy is associated to electrical brain connectivity changes during BS. An enhancement in the right hemisphere alpha band functional connectivity of areas involved in cognitive control, emotional processing and visual associative functions may play a key role in the elaboration of psychological traumas.

Obsessive symptomatology can sometimes be worsened when a patient with this personality trait suffers through a period of increased stress.

To review articles in PubMed related to how vorticoxetine affects obsessive symptoms in patients with depression.

We review the case of a 45-year-old male with obsessive personality traits diagnosed of recurrent depression. He was going through a period of stress at work that had worsened his obsessive symptoms (primarily obsessive thoughts). In a previous depressive episode, he was treated with an antidepressant that triggered sexual dysfunction as a side effect. Trying to prevent another antidepressant-induce sexual dysfunction, we decided to use voricoxetine because of its low tendency to interact with the sexual function.

We started treatment with vorticoxetine reaching a dose of 10 mg/day. Three weeks later the patient reported a decrease in his levels of anxiety, a slight upturn of his mood and a relieve of his obsessive symptoms.

Vorticoxetine can be considered a good therapeutic option in the treatment of obsessive symptoms in a depressive episode with patients with a history of antidepressant-induce sexual dysfunction.

The authors have not supplied their declaration of competing interest.

An appropriate early intervention (EI) after the onset of a first episode of psychosis (FEP) is a key factor to prevent relapse, cognitive and functional impairment related to neurotoxicity as it is a critical period in order to get good adherence to treatment. This is the most reported factor linked to relapse. Therefore, interventions focused on getting good adherence to treatment may make the difference in terms of outcome.

To compare relapse rates, symptom severity and level of functionality before and after treatment with Paliperidone Palmitate Long-Acting Injectable (PP-LAI). To analyze prior antipsychotic treatments and side effects registered before and after the introduction of (PP-LAI).

This is a cross-sectional descriptive study. We analyzed a sample of 15 patients, recruited from PAFIP (an specialized EI unit) and treated with variable doses of PP-LAI. They all met diagnostic criteria for schizophrenia according to DSM-IV. Clinical and functional data of the two years before and after treatment intoroduction were recorded.

Twenty-seven percent of the patients resumed their work activity or studies and 33% of the patients increased their social activity. Thirteen percent of the patients improved from negative symptoms. Prior to treatment introduction, more than a half of the simple, had suffered one or two relapses. After treatment introduction, 87% did not experience more relapses while 13% experienced another relapse.

Treatment with PP-LAI is associated to a recovery of functional abilities, and a trend to clinical stability with high adherence to treatment related to few side effects.

The authors have not supplied their declaration of competing interest.

Most of elderly onset psychosis present as a consequence of one or more organic processes. We present the case of an 81-year-old patient with diagnosis of a posterior fossa meningioma. It emerged with abrupt positive symptoms of psychosis with important family and social disruption. The interest of the case lies in the low frequency of psychiatric symptoms associated to this type of tumor, given its location. Thus, these symptoms may be explained, by normal pressure hydrocephalus (NPH) secondary to the tumor.

To highlight the importance of performing a complete organic screening in elderly onset psycotic patients.

From the mentioned case, we performed a literature review of psychopathology associated with NPH.

Psychiatric examination demonstrated parasitization delusions and delusional misinterpretations; tactile and visual zoomorphic hallucinations were also present. They were compatible with Ekbom syndrome; anxiety and behavioral disorganization were prominent. We introduced treatment with risperidone 0.5 mg/12 h with important decrease of positive psychotic symptoms. Currently, the patient is waiting for a ventricular-peritoneal shunt.

The NPH usually presents with memory failures, psychomotor slowing, problems in calculating and writing. It may progress to a neurological impairment so intense that may be indistinguishable from Alzheimer's disease. From a psychopathological point of view, affective or psychotic symptoms and/or behavioral disorganization may also appear. In few cases, HNT onset shows with prominent psychiatric symptoms instead of neurological impairment. These symptoms may improve with pharmacological and surgical treatment. Thus, it is important to get an accurate diagnosis.

The authors have not supplied their declaration of competing interest.

The concept of obsessive-compulsive disorder (OCD) as a disorder that affects the basal ganglia arising to the phenomenological similarities found between idiopathic OCD and other conditions associated with basal ganglia disease such as Huntington's disease (HD) and Sydenham's chorea. Huntintong's disease is characterized by cognitive, motor and neuropsychiatric symptoms.

A review of articles published from 1989 to 2016 in Pub-Med and UpToDate about relationship between HD and obsessive-compulsive symptoms.

Case report of a 56-year-old male who was admitted at the acute unit of psychiatry with obsessive-compulsive symptoms marked by hypochondriac obsessive thoughts. He also had cleaning rituals in relation with meals and we observed an important functional impairment and depressive mood. No previous history except family chorea without cognitive impairment in study by neurology department.

Affective disorders are the most common psychiatric disorders in HD. Less frequently it can be found other psychiatric symptoms as obsessive-compulsive behaviour with prevalences between 10% to 52%. Psychiatric symptoms do not correlate with duration of disease or presence of dementia or motor symptoms.

It is necessary to complete the study of the patient to provide a more appropriate therapeutic option. The neurological signs of basal ganglia disorder should be evaluated when considering OCD diagnosis, especially in atypical presentation ages. Longitudinal studies are needed to determine the pathogenesis, disease progression and future therapeutic options.

The authors have not supplied their declaration of competing interest.

Atypical anti-psychotics are associated with an impaired in glucose and lipids homeostasis.

To evaluate, the effect in lipids and glucose levels after switching to long-acting injectable (LAI) aripiprazole.

This was a prospective, observational, 1 year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another anti-psychotic was indicated. We measured basal levels of glucose and lipids at the time to start the study and 1 year after switching to LAI-aripiprazole.

In basal analytic we observed these abnormalities: hyperglycemia (16.7%), high-levels of LDL-cholesterol (33.3%), low-levels of HDL-cholesterol (39%) and hypertrygliceridemia (22.2%). One year after switching to LAI-aripiprazole we found: glucose levels were normalized in all patients; levels of LDL-cholesterol were lower in 66.7% (in 33.3% levels were normalized) and they were higher in 16.7% (in 11% marked a change from normal to abnormal parameters); levels of HDL-cholesterol were lower in 23.3% and higher in 32.2% (in 11% levels were normalized); and finally, levels of tryglicerides were higher in 66.7% (in 8% marked a change from normal to abnormal parameters) and in 16.7% they were lower (in 7.3% levels were normalized).

LAI-aripiprazole has a beneficial effect in glucose and cholesterol levels. Although, it usually increases tryglicerides levels, only in seven cases there was a change from normal to abnormal parameters. Our study suggests that LAI-aripiprazol could be an alternative in patients with schizophrenia who have high levels of glucose and lipids related with atypical anti-psychotics treatment.

The authors have not supplied their declaration of competing interest.

Early stages after a first psychotic episode (FEP) are crucial for the prognosis of the disease. Those patients who drop out of treatment after a FEP show a significant increase in their vulnerability to relapse. Relapses associated a greater risk of neurotoxicity, chronicity, hospitalization, decrease of response to the treatment, increase of burden and functional decline.

To determine what antipsychotic is more effective in the prevention of relapse after a first psychotic episode.

PAFIP is an assistance program focused on early intervention in psychosis. Between January 2001 and January 2011, 255 patients were recruited and randomly assigned to treatment with haloperidol (n = 48), olanzapine (n = 41), risperidone (n = 44), quetiapine (n = 34), ziprasidone (n = 38) and aripiprazole (n = 50). We compared the rates of relapse and remission reached by haloperidol, olanzapine, risperidone, aripiprazole, ziprasidone and quetiapine during a 3-year follow-up. All of the patients were antipsychotic naives at the beginning of the treatment.

There were no statistically significant differences in regard to the rate of clinical remission. Patients assigned to the groups of aripiprazole, olanzapine and risperidone presented a solid trend to a significantly inferior rate of discontinuation for any reason since the beginning of the treatment.

These data point to a greater protection against relapse and a likely better prognosis related to the use of aripiprazole, Olanzapine and risperidone.

The authors have not supplied their declaration of competing interest.

Alcohol dependence belongs to one of the major risk factors to health worldwide. Alcohol consumption is a significant factor for mortality in the world: 6.3% in men and 1.1% in women. The alcohol use disorder is also very common: 5.4% in men, 1.5% in women. Despite its high frequency and severity of this disorder, only 8% of all alcohol dependents are treated once.

An interesting treatment option is geared toward reducing alcohol intake. Some patients in treatment for alcohol use disorder prefer an initial target of reducing consumption. Nalmefene, an antagonist naltrexone associated with opioid receptors, has been authorized in the European Union to help alcohol-dependent patients reduce their consumption. Antagonists’ opiate receptors are associated with reduced reward in relation to alcohol consumption, thus helping patients in reducing energy consumption.

A man of 39 years old, with a diagnosis of alcohol use disorder and depressive disorder and poor outcome despite different types of treatment (as aversive agents) was treated with nalmefene.

After a few months, nalmefene had a beneficial effect on the patient, with a significant reduction in the number of days of excessive alcohol consumption and total consumption in the sixth month. In addition, treatment was well tolerated, with no observed secondary effects.

Nalmefene appears to be effective and safe in reducing heavy drinking. Drugs such as nalmefene have demonstrated efficacy in association with a biopsychosocial approach to help patients achieve their personal objectives for this disorder.

The authors have not supplied their declaration of competing interest.

Several studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.

Despite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.

We present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.

Our limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.

Despite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.

A mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.

The authors have not supplied their declaration of competing interest.

Relapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.

To determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.

We analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.

Poor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.

After a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.

The authors have not supplied their declaration of competing interest.

More than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.

It is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).

The mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.

The authors have not supplied their declaration of competing interest.

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.

To review the incidence, clinical characteristics, diagnosis and treatment of NMS.

We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.

A literature review of the NMS was performed using the PubMed database.

The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.

NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.

The authors have not supplied their declaration of competing interest.

Alcohol use disorder is a pressing problem in our society. However, only a small percentage of patients with alcohol use disorder are ever treated. Nalmefene acts as an antagonist of mu opioid receptors preventing the pleasurable sensation that often accompanies alcohol consumption, while its modulation of kappa opioid receptors can decrease the dysphoria associated with alcohol withdrawal.

Studying the effect of nalmefene on patients with alcohol use disorder who are trying to reduce their daily alcohol consumption.

This is a descriptive study that pretends to assess the effect of nalmefene 18 mg/day on alcohol intake in a sample of five patients (3 men and 2 women) that came to our psychiatric consultation from March to September 2016. They all had tried in the past to stop or reduce their alcohol consumption but were unable to do so. We initiate follow-up with the patients in psychiatric consultation for the next three months with a monthly frequency.

Out of the 5 patients, 4 reported to have reduced their alcohol consumption over the observation time, going from 32 drinks per week to 18 drinks per week on average. The fifth patient abandoned prematurely the treatment due to the appearance of side effects (nausea). No other relevant side effects were detected.

Nalmefene appears to be effective and safe reducing abusive alcohol intake and avoiding alcohol withdrawal syndrome. Therefore, nalmefene can be considered a good therapeutic option helping reduce alcohol consumption in patients with alcohol use disorder.

The authors have not supplied their declaration of competing interest.

Previous research on the prevalence of medical disorders among adults with dual diagnosis (DD) has been inconclusive.

The purpose of this study was to assess dual diagnosis and medical co-morbidity at the Brief Psychiatric Inpatient Unit of Marqués de Valdecilla Hospital, Santander in the period from January 2014 until March 2015.

Ninety-three patients were admitted at our hospital from December 2014 until March 2015. The simple was analyzed retrospectively. Sixty-two of the patients (66.7%) met criteria for Dual Diagnosis. We collected socio-demographic variables, drug abuse, mental pathology, and treatment received.

The mean age of the sample was 42.95 years (± 14 DS) with a male:female ratio of 1.8:1 (no significant differences by gender). Hypertension was more prevalent among patients without dual pathology (22.5%). Patients with dual diagnosis presented hypertension less likely (6.5%) (P < 0.005). This can be explained by the fact that patients without dual diagnosis had a higher mean age (47 years) than patients with dual diagnosis (42 years). We did not found statistically significant differences between both groups respect to diabetes mellitus, vascular brain disease, HIV and dyslipidemia.

Hypertension was less likely to appear among patients with dual pathology admitted to an ultra brief psychiatry unit. This could be explained for an earlier mean age at admission among these patients.

The authors have not supplied their declaration of competing interest.

Depot antipsychotic treatment has been a radical change in the evolution and prognosis of patients with schizophrenia. Long-acting injectable aripiprazole is an anti-psychotic dopamine partial agonist. It has a good tolerance in terms of metabolism and prolactine level.

Studying the causes of readmission at the acute unit of Marqués de Valdecilla university hospital (HUMV) in patients treated with Long-acting injectable aripiprazole LAI 400 mg.

This is a descriptive study which pretends to assess the causes of readmission in a sample of 30 patients (12 women, 18 men) with non-affective psychosis, which had entered the acute unit of HUMV from 1st January to 30th September 2016 because of psychotic decompensations and had been treated with long-acting injectable aripiprazole 400 mg.

Out of the 30 patients there were five readmissions during the observation time. Two of them for psychotic decompensation, two because of premature abandonments, with oral aripiprazole supplementation and the last one because of desertion of injectable drug. No gender differences were observed.

It is necessary 15 days of oral supplementation before and after the first dose of long-acting injectable aripiprazole to ensure that adequate therapeutic levels are achieved and to avoid readmissions by misuse of the drug. One of the limitations encountered in this work would be the small sample size and limited observation time. A longer-term research may allow to find more scientific evidence to clarify the clinical safety and efficacy of long-acting injectable aripiprazole in patients with non-affective psychosis.

The authors have not supplied their declaration of competing interest.