Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this.

A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis.

1. i) Treatment choice of antipsychotic for patients

93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy.

1. ii) Treatment choice if trainees developed psychosis

89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy.

1. iii) Factors influencing choice

These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance.

38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making.

Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.

Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees.

A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice.

Tables 1 summarise choices.

Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance.

No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.

Numerous reports have pointed out the risks adverse hematological effects associated with psychotropic drugs. We report a severe case of thrombocytopenia in a healthy 79 year-old patient happened after mirtazapine administration. Suggesting an immune mechanism.

Report a case of mirtazapina-induced inmuno tromnbocitopenia, review of bibliography and to propose monitoring and management strategies.

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Care report: PPD (n°HC 16996) treatment with mirtazapina 15 mg/d.Clinical: equimosis cutaneous multiple. Without focalidad. From the point of view etiológico discards organicity (aplasia megacariocítica, processes linfoproliferativos and infectious). An analytical previous examination supports normal platelets until April, 2009, in February the dose doubles from 15 to 30 mg (of mirtazapina). Fatal conclusion: exitus for hemorrhage intracraneal in September, 2009. Clinical judgment: Several Trombopenia, uncertain origin.

Literature review: The first well-documented case of mirtazapine-induced immune thrombocytopenia is “Glycoprotein IIb/IIIa complex is the target in mirtazapine-induced immune thrombocytopenia” (Blood Cells, Molecules, and Diseases, 2003).The analysis “Proportion of drug-related serious rare blood dyscrasias” (American Journal of Hematology, 2004) suggests that a substantial fraction of blood dyscrasias may be attributable to drug therapy.

Hematologic side effects from psychotropics may present as serious or even fatal consequences of treatment. Incidences of hematological changes for antidepressants were much lower (about 0.01%).

Before initiating therapy with antidepressants, a carefully case history, with special attention to heart disease, family record and medical treatments, should be obtained. Clinical best practice regarding the safe and effective use of psychotropic medications is based on appropriate monitoring of drug-related problems.

The results showed that the adolescents were more concerned about their physical appearance (body dissatisfaction and obsession with being thin), by their social environment (interpersonal distrust). The Anorexia (AN) has alarming increase of the disorders of the food conduct in the last two decades. The conception etiopatogénica current is multifactorial: biopsicosocial, where the more important are the sociocultural factors.

To assess the presence of symptoms of cognitive and behavioural symptoms characteristic of eating disorders in adolescents.

Clinical case: four neighbors of the same village, who initiated being adolescents, food restriction. Finally, three of them needed hospitable revenue. In our case, they are athletes, favorite children of the best families and they form part of the regional soccer team. Like a jobby, being children, they competed furtively “to see wich one lost more weight “

Theory Multifactorial postulates that the Anorexia nervosa would be a complex interaction betewing the psychological and family factors that would lead the teenager to rejecting the food; the consistent malnutrition would produce changes hipotalámicos and endocrine that would contribute to the disorders of the corporal image and the fear of the obesity.

Our adolescents with normal weight showed specific factors for developing eating disorders in the future. The sociocultural influences and concretly, “the longing thinness ” constitute the principal factor predisposition of maintenance of these disorders. It seems to be important to anticipate the clinical conditions that they could accompany on the future cases in our young men.

The schizophrenia has associated traditionally with major rates of comorbilidad physics. In addition the antipsychotic ones of the second generation are causers of the so called metabolic syndrome (increase of weight, dislipemia and diabetes) that favor directly the cardiovascular disease in our patients.

To develop a therapeutic plan to diminish the sobremortalidad and sobremorbilidad of our schizophrenic patients (according to different studies between 25-50 % of cardiovascular risk). To detect the factors of risk, which influence the metabolic Syndrome: a high level of cholesterol HDL, IMC, smoking and hyperglycemia.

To apply measures of prevention for the diabetes, for the arterial hypertension and the dislipemias.

Retrospective study is realized, checking the clinical histories of the patients beginning medication with aripiprazol for symptomatology psychotic and support the treatment at least 6 months later. We realized preventive specific measures in the patients including education to the patient, careful selection of the antipsychotic with substitution if there appear signs of metabolic syndrome.

39 patients that initiated treatment with aripiprazol, therapeutic doses. Of 39 patients 24 (61,54 %) is smoking, 18 (46,16 %) has an IMC> 25, 11 (28,39 %) hipertriglicerinemia, 5 (12,82 %) index of glycemia basal> 125 and 6 (15,38 %) with hipercolesterolemia.

The antipsychotic atypical alter the metabolic regulation. The treatment with aripiprazol suggests minor risk of metabolic syndrome, in relation to previous similar studies, with antipsychotic others. We think it performs vital importance the prevention of the overweight orientated to patients with the first psychotic episode.

There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.

The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.

Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.

Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.

EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.

Now-a-days, obesity and other cardiovascular risk factors (CVRF) became a matter of concern in Schizophrenia, due to their potential relation with atipical antypsychotics. The high prevalence of CVRF in schizophrenic patients is a consensual issue, but there are only a few studies in Portugal.

This is an observational transversal study thats aims to evaluate the presence of CVRF, and to establish the relationship between these ones and anthropometric measurements evaluating global and regional adiposity, in a population of schizophrenic patients.

The authors studied a population of 25 schizophrenic patients followed at our Department of Psychiatry. These instruments were used: PANSS (Positive and Negative Symptoms Scale), and a semi-structured interview, with sociodemografic data, and information about life style, medication and schizophrenia. These informations were completed according to the clinical process. The following measurements were recorded: weight, height, abdominal circunference, lipidic and glicemic values, and blood pressure.

The high frequency of CVRF in the population of this study confirms the importance of regular medical evaluations, in every patients with Schizophrenia, to allow early diagnosis/monitorization of CVRF. However, our results dont confirm the benefit of anthropometric measurements as screening methods, possibly due to our small sample. Curiously, we found a week correlation bettween CVRF and environment factors (as medication or life style), what can reforce the hold ideia of Schizophrenic susceptibility to CVRF.

Despite the well established genetic basis of schizophrenia, the relationship between genes and the disorder itself is still elusive. Individual endophenotypes, which reduce the complexity of genetic analyses, allow statistical approaches with quantitative trait methodologies. P200 abnormalities of event-related potentials have been reported in schizophrenia with conflicting results. The present study aims to characterize the P200 in first-episode patients and to compare it with that of first-degree relatives and controls.

ERPs were recorded at 19 sites with an auditory oddball for 21 first-episode patients with schizophrenia (mean age=25.14; SD=6.20), 41 of their first degree relatives (mean age=47.65; SD=15.53) and 19 healthy controls (mean age=26.32; SD=7.16). Potentials were averaged for frequent stimuli and P200 amplitude and latency measures were obtained.

Analysis of midline electrodes revealed significant group effects for P200 peak amplitudes (F(2, 78)=3.315, p=.042), but not for peak latencies. Post-hoc analyses revealed that patients with schizophrenia present significantly lower P200 amplitudes (M=2.466; SD=1.564) than controls (M=5.037; SD=2.500) at Pz (T(38)=3.851, p=.003). No other significant differences were found.

The results obtained do not straight-forwardly support the P200 peak amplitude nor peak latency as an endophenotype of schizophrenia. However, the trends of our results may suggest that the P200 amplitudes of relatives may present intermediate values between healthy controls (with higher amplitudes) and patients (with lower amplitudes). Further statistical analyses will be required in order to disentangle the effects of possible confounding variables.

Sexuality is an important dimension of life. To promote the well-being and quality of life of people with Schizophrenia, they must experience their sexuality in healthy ways. However, the lack of studies about this topic makes difficult to develop interventions in this area.

Understand the knowledge, beliefs and attitudes related with sexuality of schizophrenic individuals.

Data were collected using a questionnaire intentionally prepared for this study, with questions related to biologic, emotional and social dimensions of sexuality, evaluating: knowledge, beliefs and attitudes about sexuality; sexual activity; emotional intimacy, friendship and social life. The sample was composed by 35 individuals with Schizophrenia: 83% male and 17% female; mean age 41 years.

The data revealed that 86% of the sample is single and only 6% have an affective relationship. They have difficulties to have friends, to have a satisfactory social life, and only 20% have a job. Despite the correct knowledge about sexuality, they reveal difficulties in fulfilling emotional or intimate relationships, they feel lonely and unsatisfied about their sexual life. They also feel negative effects of anti-psychotic drugs, often neglected by health professionals, views as non-preoccupied with the quality of the sexual life of the patients.

The sample valorized being asked about their sexuality, revealing that this topic is forgot by the professionals. It seems necessary to develop interventions regarding the sexuality of those individuals. Our future research is to ameliorate the questionnaire, preparing it to be useful when professionals discuss sexuality with schizophrenic individuals.

Despite society argues that all citizens have equal rights and equal opportunities, mentally ill individuals face discrimination, especially in the employment context. Research reported benefits of working and have a job, witch help play social roles and feel useful, key components in social inclusion and recovery of mentally ill individuals.

Employers have an important role in the access of mentally ill individuals into work. They take decisions that affect life opportunities, but, due to their powerful position, their attitudes can influence all enterprise and maintain stereotypes and stigma.

Know perceptions and stereotypes about mental illness in Portuguese employers.

Data were collected using a translation of Attitude Scale for Mental Illness (Hahn, 2002), evaluating dimensions such as separatism, stereotyping, restrictiveness, benevolence, pessimistic prediction and stigmatization. The scale was fulfil using online anonym way, by 50 employers from small (under 250 employees) metallurgic or textile enterprises (60% male, 40% female; mean age 45.9 years).

None of the enterprises have employees with mental illness, neither integration policies. Employers prefer to give a job to people with physical disabilities than to people with mental illness, choosing people with schizophrenia as the last possibility. They have little contact with mentally ill individuals, 96% don’t know governmental policies for job inclusion and only 54% accepts to participate in meetings to understand those policies. Stereotyping, benevolence and pessimistic prediction present highest values.

Employers must be informed about governmental policies using work as a form of social inclusion from mentally ill people.

Despite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.

Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.

A semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.

Treatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.

Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.

Some differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.

Despite the well established genetic basis of schizophrenia, the relationship between genes and the disorder itself is still elusive. Individual endophenotypes, which reduce the complexity of genetic analyses, allow statistical approaches with quantitative trait methodologies. P200 abnormalities of event-related potentials have been reported in schizophrenia with conflicting results. the present study aims to characterize the P200 in first-episode patients and to compare it with that of first-degree relatives and controls.

ERPs were recorded at 19 sites with an auditory oddball for 21 first-episode patients with schizophrenia (mean age=25.14; SD=6.20), 41 of their first degree relatives (mean age=47.65; SD=15.53) and 19 healthy controls (mean age=26.32; SD=7.16). Potentials were averaged for frequent stimuli and P200 amplitude and latency measures were obtained.

Analysis of midline electrodes revealed significant group effects for P200 peak amplitudes (F(2, 78)=3.315, p=.042), but not for peak latencies. Post-hoc analyses revealed that patients with schizophrenia present significantly lower P200 amplitudes (M=2.466; SD=1.564) than controls (M=5.037; SD=2.500) at Pz (T(38)=3.851, p=.003). No other significant differences were found.

The results obtained do not straight-forwardly support the P200 peak amplitude nor peak latency as an endophenotype of schizophrenia. However, the trends of our results may suggest that the P200 amplitudes of relatives may present intermediate values between healthy controls (with higher amplitudes) and patients (with lower amplitudes). Further statistical analyses will be required in order to disentangle the effects of possible confounding variables.

To evaluate the efficacy, safety, and tolerability of fixed-dose agomelatine 25 and 50 mg/d in the treatment of outpatients with obsesive-compulsive disorder (OCD) compared to placebo.

In this 8-week, multicenter, double-blind, parallel-group trial, patients with DSM-IV-defined OCD were randomly assigned (1:1:1) to receive a once-daily dose of agomelatine 25 mg, agomelatine 50 mg, or placebo. The primary efficacy measure was the change from baseline to week 8 in the clinician-rated 17-item Hamilton Depression Rating Scale (HDRS(17)); other efficacy measures were The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression scale. The study was conducted between December 2009 and January 2010.

Agomelatine 25 mg/d was more efficacious based on the HDRS(17) total score (P = .01) compared to placebo throughout the treatment period, whereas for agomelatine 50 mg/d, statistically significant reduction in HDRS(17) total score could be observed from weeks 2 to 6 but not at week 8 (P = .144). A higher proportion of patients receiving agomelatine 25 mg/d showed clinical response (P = .013), clinical remission (P = .07), and improvement according to the Clinical Global Impressions-Improvement scale (P = .065) compared to those receiving placebo. No statistically significant difference between patients receiving agomelatine 50 mg/d compared to placebo on clinical response. Both agomelatine doses were safe and well tolerated, although clinically notable aminotransferase elevations were observed transiently in the agomelatine 50 mg/d group.

Agomelatine 50 mg/d provided evidence for its antidepressant efficacy until week 6 and was also safe and well tolerated.

People with mental illness are frequently perceived as dangerous, suffering social stigma and exclusion. Deinstitutionalization movement implies a closer contact between citizen and individuals with mental illness. However, social perceptions can be a barrier to social inclusion, provoking unfavorable attitudes. Some studies found that social rejection is different according the pathology. Vogel and Boysen (2008) found that different mental illnesses provoke different attitudes of social distance. Norman and colleagues (2008) found that social distance was associated with the diagnosis, provoking schizophrenia greater social distance than depression.

Compare the perceptions about mental illness (in general), depression, bipolar disorder and schizophrenia.

Data were collected using a translation of Mental Illness Stigma Scale (Day, 2007), fulfill on-line and in an anonym way by 315 Portuguese polytechnic students, studying in brief technological courses. The sample was composed by 69% male and 31% female; mean age 26.5 years.

Students have little contact with people with mental illness (mean = 1.5 in a Likert scale 1–5 points) but they fell comfortable when they contact a friend or a neighbor with mental illness (respectively, mean = 3.2 and mean = 2.7). They present some anxiety when they interact with people with mental illness and they avoid this contact, revealing attitudes of social exclusion. Schizophrenia and bipolar disorder was perceived more negatively than depression.

Deinstitutionalization movement provokes more contact between citizens and individuals with mental illness, but social stigma still exist. Students can learn how to interact with those persons without anxiety and help to do better social inclusion.