One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.

Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.

During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.

This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.

According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described.

To describe the current therapeutic management and psychiatric comorbilities of opiate-dependent patients undergoing a RMP in Spain.

We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included.

624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers.

Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066).

The most frequent replacement therapy was methadone (94%), usually in ≤ 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention.

Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.

Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.

To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.

This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.

A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.

We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.

There are few studies about the characteristics of Substance Use Disorder patients that relapse, defined by restart of the substance use that motivated the intake, after discharge from a Detoxification Unit.

To analyze the percentage of patients who had a relapse in the following 3 months after discharge and to describe their sociodemographic, clinical and therapeutical characteristics.

We prospectively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2009. Data was gathered at admission on demographic (gender, age), clinical (main abused drug, psychiatric comorbidities, polydrug users) and therapeutical variables (hospitalisation duration, prescribed treatment). Patients were followed up for 3 months and assessed for relapse at 1 and 3 months by clinical interview, alcohol screening test and/or urinalysis. Results from patients with and without relapses were compared.

The study sample included 103 patients (77,7% men, average age 38,31±9). At month 3, 57,3% of the patients had relapsed. We found significant differences between the relapse and the non-relapse group on the percentage of polydrug users (68,6% vs 31,4%, p=0,05), on heroine as main drug of abuse (76% vs 24%, p=0,05) and psychiatric comorbidities (60,8% vs 39,2%, p=0,04), being psychotic disorders the most frequent. No significant differences were found between the 2 groups concerning therapeutical variables.

More than half of the patients that ended the detoxification process relapsed in the first 3 months. Polydrug use, opiate dependence and having a psychiatric comorbidity might be considered as risk factors for relapse.

Four psychotherapies have been recognized as effective with scientific evidence for the treatment of BPD, but are long term techniques. It is necessary to explore new time limited psychotherapies in order to be more accessible.

We have developed a specific manualized psychotherapy for BPD named Psychic Representation focused Psychotherapy (PRFP)

To assess the efficacy of the PRFP in BPD in an outpatient care setting compared to a control group receiving psychiatric treatment “as usual” in several specific symptoms and in diminishing the disability due to the illness.

60 subjects with BPD were randomized to one of the two treatment groups. The study group has received PRFP with 20 sessions on a weekly basis; the control group has received treatment “as usual”. Both groups may receive psychopharmacological treatment. The assessment is done in four time-points: at baseline, after the psychotherapy or conventional treatment (six months), and at a six and twelve month's follow-up period.

Preliminary results of the first 30 patients (control group 17, experimental group 13, without significant differences, Age 18–35 years; 70% women) assessed at the baseline and at the end of the intervention (six months). Experimental group reached a statistically significant clinical improvement over the controls in all measured variables: Scales: SCL-90; Zanarini ; MDRS; Barrat; STAI anxiety state; Rosemberg self-esteem and SASS social adaptation.

The preliminary results are encouraging and reveal that this method could be effective. This study state the interest in develop more studies about time limited psychotherapy for BPD.

Psychiatric illnesses have a high prevalence in the general population. Psychiatric illnesses affect the way other medical processes develop: age of onset, distribution by gender, type an evolution, and the training of the psychiatrists in caring for them.

To describe the characteristics and the medical problems of patients who have been consulted by an Internal Medicine Liaison Unit while hospitalized in the Psychiatric Unit of a third level hospital. Comparison of the general profile of these patients and their consultations with that done to patients hospitalizad in the rest of the hospital.

Descriptive retrospective study from September 2007 to May 2010. Use of a centralized database created with of all the administrative and clinical details regarding the consultation. A p ≤ 0.05 has statistical significance.

648 patients were identified (40,7% men). Mean age 52.4 years. Mean stay 3 days. 34,4% were solved in one visit. Mortality rate 0,3%. 94,1% of discharges were due to recovery, the rest were transfered to another service.

Distribution by major diagnostic groups: infectious 16,2%, cardiorespiratory 15,4%, mental illness 12,9%, metabolic 10,4%, tumoral 8,5%, digestive 8,2%, not defined 8,2%, hematologic 5%, others 15,2%.

The psychiatric patient is clearly younger and the female gender is slightly higher (59,3%) than in the control group. In this group the infectious and cardiorespiratoty illnesses predominate. The percentage of psychiatric consultations (34,1%; 648) over our global (1906) is impressive since the number of psychiatric inpatients is not proportional to this number.

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

ADHD in adults is associated with a significant impairment in many life activities increasing the risk of chronic stress in everyday life. Previous studies reported normal cortisol awakening response (CAR) in children with ADHD without comorbidities, nevertheless there is a lack of studies in adults.

The aim of the present research is to examine CAR in adults with ADHD and to assess possible differences between the combine and inattentive subtypes.

Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample consisted of 50 adults, age between 18 and 51 years (mean 35.24 ± 9.21) fulfilling current diagnostic criteria for ADHD (DSM-IV criteria). All patients were naïve to stimulant medication. Psychiatric and organic comorbid disorders were excluded. To assess CAR, four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening.

The mean increase in CAR for the whole group of patients was 10.34±8.79 nmols/l. T-test comparisons showed no significant differences in the mean increase of CAR between the inattentive (mean: 9.47±9.04 nmols/l) and combine (mean: 11.25±8.67 nmols/l) subtypes (t=0.610; z=0.546).

Despite there were no significant differences in salivary CAR between ADHD subtypes in adults, the mean increase of CAR was higher in combine than in the inattentive subtype. Salivary CAR needs to be further explored as an index of vulnerability to stress in these patients.

A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.

To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.

All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.

N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).

Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.

The study of associated stigma to mental illness has been usually oriented to psychotic disorders. Recently the ASPEN Project has had the objective to study the stigma associated to depressive disorders worldwide. As a part of this study, we present the results of a Spanish sample. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder. Additionally we investigated whether experienced discrimination is related to severity of depression and level of self-esteem.

In a cross-sectional survey, 100 adult outpatients with a diagnosis of major depressive disorder were interviewed with the discrimination and stigma scale (version 12; DISC-12). Severity of depression and self-esteem were measured by the Hamilton-17 questionnaire and the Rosemberg scale respectively. Socio-demographic variables were included.

the life domains where the major proportion of individuals experienced discrimination were: treatment by their family (46%), in marriage or divorce (30%) and been avoided or shunned by people who know their mental health problem (34%). 60% of patients anticipated discrimination avoiding intimate relationships and 67% of them concealed or hid his/her mental health problem from others. Experienced discrimination had a significant association with the severity of depression and with a low level of self-esteem.

Discrimination related to depression acts as a barrier in some fields of social life. Non-disclosure of depression could be a barrier to seeking help. It is important to consider effective actions to prevent stigma and discrimination in the field of depressive disorders. INDIGO-ASPEN Group

The objective of the present study was to examine the short-term effectiveness of a 11-week chess training course for children with ADHD. This is a naturalistic, descriptive clinical intervention study.

Sample and procedure: Parents of 44 children between 6 and 17 of age with a primary diagnosis of ADHD consented to take part into the present study. Parents completed the Spanish version of the Swanson, Nolan and Pelham Scale for parents (SNAP-IV) and the the Abbreviated Conners Rating Scales for parents (CPRS-HI) prior to 11-week chess training course. Statistical Analyses: We used a paired t test statistic to compare pre- to post- intervention outcomes, and Cohen-d calculations to measure the magnitude of the effect. Statistical significance was set at p< 0.05.

After 11 weeks of these pilot programme, more than 80% of children showed improvement in the severity of ADHD. T-test revealed that children with ADHD improved in both the SNAP-IV (t=6.23; d.f.=41; p< 0.001) and the CPRS-HI (5.39; d.f.=33; p< 0.001). Our results suggest a large effect in decreasing the severity of ADHD as measured by the SNAP-IV (d=0.96) and the CPRS-HI (d=0.92)

Depression and obesity are highly prevalent major public health problems that frequently co-occur. Shared aetiological factors have been found between depression and obesity. The role of the fat mass and obesity associated (FTO) gene in body mass index (BMI) and obesity has been confirmed in many independent studies. Recently, we reported the first study implicating FTO in the association between depression and obesity.

We aimed to confirm these findings by investigating the FTO rs9939609 polymorphism in a meta-analysis of 13,701 individuals.

The sample consists of 6,902 depressed cases and 6,799 controls from five studies (Radiant, PsyCoLaus, GSK, MARS and NESDA/NTR). Common inclusion criteria were information available on a lifetime DSM-IV diagnosis of major depressive disorder (MDD), BMI and genotype data. Linear regression models for quantitative traits assuming an additive genetic model were performed to test for association and interaction between rs9939609, BMI and depression. Fixed and random-effects meta-analyses were performed.

Fixed-effects meta-analyses support a significant association between rs9939609 polymorphism and BMI (whole-sample: ß=0.07, p=1.29×10-12, depressive-cases: ß=0.12, p=6.92×10-12). No association was found in controls (ß=0.02, p=0.15). Meta-analyses further support a significant interaction between FTO, BMI and depression (fixed-effects: ß=0.13, p=3.087×10-7; random-effects: ß=0.12, p=0.027), wherein depressed carriers of the risk allele have an additional increase of 2.2% in BMI.

This meta-analysis demonstrates a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. Depression-related alterations in key biological processes may interact with the rs9939609 FTO risk allele to increase obesity risk.