To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA.

Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression.

São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.

Adolescents (12–16 years) living in São Paulo (n 189) and USA (n 787).

ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99).

Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.

To analyse the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD) on the utilization of health care resources and corresponding costs.

Multicentre, prospective and observational study conducted in outpatient psychiatric clinics selected at random and weighted by geographical density of population. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and health care resources and corresponding costs were recorded during a 6-month period.

A total of 3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV criteria group (DG) and 1,264 in broad criteria group (BG). Both groups were similar on their sociodemographic characteristics at baseline. Type of treatments prescribed at psychiatric clinics during the study were similar in frequency; anti-depressives (77.0% in DG vs. 75.3% in BG, ns), benzodiazepines (71.5% vs. 67.2% respectively, ns), and anti-convulsants (72.1% vs. 67.0% respectively, ns). Health care resources utilization were statistically reduced to a similar extent in both groups as a consequences of treatments yielding to a cost-of-illness in the 6-month period of 1,196 (1,158) and 1,112 (874), respectively; p=0.304.

In a large sample of subjects, broadening of GAD criteria could lead to earlier diagnosis that would not be associated necessarily to an increase in health care resources utilization or costs to the National Health System.

Suicide is a major public health problem, one of the leading causes of death and one of the first causes of years of life lost. It is a voluntary act that can be carried out by men and women, children and adults, rich and poor, people of every race and religion.

The aim of this text is to outline the most popular suicides and briefly discuss the representation of suicide in art. Painters such as Vincent Van Gogh, Edvard Munch, Jackson Pollock, musicians as Kurt Cobain, Jim Morrison, Janis Joplin, Jimi Hendrix, the actresses Lupe Vélez, Carole Landis, Pier Angeli, Capucine, Marylin Monroe, Lucy Gordon and the actors Heath Ledger and Freddie Prinze decided the end of their lives in different ways and at different stages.

In the literary field, we find the world renowned suicides of Socrates, Seneca and Caton. Other famous and more recent suicidal writers are Ernest Hemingway, Dylan Thomas, Virginia Woolf, Yukio Mishima, Alfonsina Stormi and Cesare Pavese among others.

Suicide has been represented in several plays and operas, not only people of flesh and blood kill themselves but also fictional characters. the love-death of Liu in Turandot and Tosca in the opera of the same name Are noteworthy, both were composed by Giacomo Puccini. In Hamlet, tragedy written by William Shakespeare, is Ophelia who dies drowning at the sea.

To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined the evolution of GAD symptoms in two groups of newly diagnosed patients; one group according to DSM-IV criteria and the other, according to broader criteria.

Multicentre, prospective and observational study conducted in outpatient psychiatric clinics. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period.

3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG). Both groups were similar on their sociodemographic characteristics at baseline and most patients (about 80%), even newly diagnosed were exposed previously to pharmacological therapies (mainly benzodiazepines) of their anxiety symptoms. As a result of treatment at psychiatric clinics, the percentage of patients without symptoms of anxiety as per HAM-A scale were 49.0% and 58.0%, respectively at the 6 month visit (p=0.261). Similarly, responder rate (≥ 50% reduction of baseline scoring) were, respectively, 59.7% and 67.7% (p=0.103). Improvement in MADRS scores were observed in both group to a similar extent; 12.1 and 12.5 points average reduction respectively (p=0.264).

Broadening of GAD criteria could lead to earlier diagnosis that will benefit patients by starting appropriate treatment sooner.

To analyse the effect of Pregabalin (PGB) on anxiety and depression symptoms in patients with refractory-severe Generalized Anxiety Disorder (GAD) and severe concomitant depressive disorder.

Post-hoc analysis of a multicentre, prospective and observational study conducted in outpatient psychiatric clinics to ascertain the impact of broadening GAD criteria. Men and women above 18 years, with GAD (DSM-IV criteria), PGB naïve and refractory to a previous course of benzodiazepines and/or anti-depressive drugs (minimum 3 months) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were included. Changes in HAM-A and MADRS were assessed after 6 months of receiving PGB as per psychiatrist's judgement.

159 patients [69.2% women, 45.9 (12.6) years] fulfilled criteria for analysis. Respectively, 92% and 90% of subjects were previously exposed to benzodiazepines and anti-depressives before adding PGB [mean dose: 223.1 (126.3) mg/day]. PGB therapy reduced both anxiety and depressive baseline symptoms by a mean of, respectively in HAM-A and MADRS scales, 57.9% (from 35.5±5.8 to 14.8±9.4; p< 0.001, effect size: 3.57) and 58.1% (from 39.4±4.3 to 16.5±10.3; p< 0.001, effect size: 5.33). As a result, the percentages of patients without symptoms of both anxiety and depression were 34.4% and 40.9%, respectively at the 6 month visit (p< 0.001 in all cases). Similarly, responder rates (≥ 50% reduction of baseline scoring) were 63.1% and 62.9%.

Despite limitations, Pregabalin therapy had a meaningful and significant effect of symptoms of anxiety and depression in patients with severe refractory GAD and concomitant severe depressive disorder.

Alcoholism is a chronic relapsing disorder characterized by compulsive drinking, alcohol seeking, loss of control over alcohol consumption, and impaired social and occupational functioning. Treatment of Alcohol Dependence (AD) comprises two steps, detoxification and relapse prevention (RP). Traditionally, long half-life benzodiazepines have been the most widely used agents for alcohol detoxification. On the other hand, disulfiram, naltrexone and acamprosate are the three drugs that have been approved for relapse prevention. In the last decades, nevertheless, there is a growing interest in the use of anticonvulsant drugs in the management of both, detoxification and relapse prevention of alcohol.

To review the different pharmacological strategies in which an anticonvulsant was used in the management of AD.

We searched in MEDLINE and in the Cochrane Database System Review, selecting all studies from 1980 until present, in which a pharmacological intervention with anticonvulsant agents was made for alcohol detoxification or RP.

The most tested anticonvulsant drugs are the classical Carbamazepine and Valproate. Both have demonstrated to be efficacious in Alcohol Withdrawal Syndrome and RP. However, the use of these agents has been limited by their hepatic and hematologic toxicity. Novel anticonvulsants such as Gabapentin, Pregabalin, Topiramate, Oxcarbazepine and Zonisamide have also been found to be effective, with the advantage of rapid onset of action, lower toxicity and fewer side effects.

Anticonvulsants are efficacious and safe agents in the management of AD. Further randomized, double-blind, placebo-controlled trials are warranted to increase the evidence of the use of these agents.

Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.

566 consecutively admitted BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN). Patients completed a comprehensive assessment battery.

Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.

Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.

The purpose of this research was to analyse the effect of adding Pregabalin (PGB) on severe symptoms of anxiety and depression in patients with Generalized Anxiety Disorder refractory to duloxetin in daily medical practice in Spain.

This is a post-hoc analysis of a 6-month multicentre, prospective and observational study carried out in outpatient psychiatric clinics in Spain. Men and women, above 18 years, with a diagnosis of GAD according with DSM-IV-TR criteria, pregabalin naïve and refractory to a previous course of duloxetin (3 months or more) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were considered eligible for analysis.

A total of twenty-five patients [76% women, mean age; 49.3 (11.8) years, 82% with a comorbid depressive disorder] fulfilled criteria for analysis, and were previously exposed to duloxetin [mean dose: 71.7 (26.7) mg/day] for an average of 6.7 (3.7) months. Adding pregabalin [mean dose: 172.8 (75.5) mg/day], during 5.2 (1.8) months, reduced both anxiety and depressive symptoms by a mean of, respectively in HAM-A and MADRS scales, 54.1% (from 36.5 ± 4.3 pts to 16.6 ± 9.1 pts; p < 0.001, effect size: 4.63) and 52.8% (from 40.4 ± 4.6 pts to 19.0 ± 11.0 pts; p < 0.001, effect size: 4.65). As a result, the percentages of patients without symptoms of either anxiety or depression were 30% and 24%, respectively.

Despite small sample, adding pregabalin had a meaningful and significant effect on severe symptoms of anxiety and depressive symptoms in patients with severe GAD and concomitant depressive disorder resistant to duloxetin.

To explore the consequences of broadening DSM-IV criteria for Generalized Anxiety Disorder (GAD) on patient's disability.

A multicentre and observational study was carried-out in outpatient psychiatric clinics in Spain between years 2007 and 2008. Naïve diagnosed patients with GAD according to DSM-IV criteria or with anxiety symptoms fulfilling broadened criteria were compared. At least 1-month of excessive or non-excessive worry along with only two of the associated symptoms listed on DSM-IV for GAD were considered as broadened GAD criteria. Socio-demographic data, medical history and functional outcome measures were recorded.

A total of 3,549 patients were systematically recruited, 12.8% excluded because not found eligible for inclusion in analysis; 1,815 in the DSM-IV group (DG) and 1,264 in the broadening criteria group (BG). Both groups were similar on their sociodemographic characteristics. Total disability score in the WHO-DAS II scale was slightly, but statistically significant, higher in DG; 41.9 (17.1) versus 38.9 (16.0) points, p < 0.05. These weak differences were observed in all of the scale domains but mainly in domains “Getting around” [34.5 (23.6) versus 29.4 (22.8), p< 0.05] and “Life activities” [55.5 (27.1) versus 52.1 (26.2), p< 0.05], since differences in the other domains, even statistically significant, were negligible.

Patients with standard DSM-IV criteria for GAD appears to show slightly, but significant, worst level of disability than subjects with broadening diagnostic GAD criteria. Life-activities and participation in society domains seems to be the functional domains most impacted by symptoms of anxiety.

to examine short and middle-term effectiveness of a group cognitive-behavioral intervention (CBT) in pathological gambling (PG) and to analyze predictors of therapy outcome.

Two hundred and ninety PG patients consecutively admitted to our Unit participated in the current study. All participants were diagnosed according to DSM-IV-criteria. Manualized outpatient group CBT [16 weekly sessions] was given. Specific assessment before and after the therapy and at 1, 3 and 6 months follow-up was conducted. Logistic regression analyses and survival analysis were applied.

outpatient group CBT was effective with abstinence rates by the end of therapy of 76.1%, and 81.5% at 6 months follow-up. The dropout rate during treatment decreased significantly after the fifth treatment session. Psychopathological distress (p = 0.040) and obsessive-compulsive symptoms were identified as factors predicting relapses and drop-outs respectively.

our findings suggest that group CBT is effective for treating PG individuals. Several psychopathological and personality traits were identified as outcome predictors.

This study was performed to identify the predictive factors of functional capacity assessed by the Spanish University of California Performance Skills Assessment (Sp-UPSA) and real-world functioning assessed by the Spanish Personal and Social Performance scale (PSP) in outpatients with schizophrenia.

Naturalistic, 6-month follow-up, multicentre, validation study. Here, we report data on 139 patients with schizophrenia at their baseline visit. Assessment: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Sp-UPSA and PSP. Statistics: Pearson's correlation coefficient (r) was used to determine the relationships between variables, and multivariable stepwise linear regression analyses to identify predictive variables of Sp-UPSA and PSP total scores.

Functional capacity: scores on the PSP and PANSS-GP entered first and second at P < 0.0001 and accounted for 21% of variance (R2 = 0.208, model df = 2, F = 15.724, P < 0.0001). Real-world functioning: scores on the CGI-S (B = −5.406), PANSS-N (B = −0.657) and Sp-UPSA (B = 0.230) entered first, second and third, and accounted for 51% of variance (model df = 3, F = 37.741, P < 0.0001).

In patients with schizophrenia, functional capacity and real-world functioning are two related but different constructs. Each one predicts the other along with other factors; general psychopathology for functional capacity, and severity of the illness and negative symptoms for real-world functioning. These findings have important clinical implications: (1) both types of functioning should be assessed in patients with schizophrenia and (2) strategies for improving them should be different.

Schizophrenia is not only a mental disorder but also has other components affecting the physical part of the body. Several studies have suggested that neuroinflammatory processes may play a role in schizophrenia pathogenesis, at least in a subgroup of patients.

This poster reported the preliminary results of a project aiming to find schizophrenia biomarkers. We present biological parameters and clinical variables of patients with schizophrenia according to the lab results and the clinical assessments.

Cross-sectional, naturalistic study. Inclusion criteria: DSM-IV diagnosis of schizophrenia; age >17 years; and written informed consent given.

123 patients with schizophrenia. Mean age 40.75 (10.37), 67.5% males. There is relationship between homocysteine(oxidative stress) and psychopathology: PANSS [negative subscale 0.27 (p=0.003), general subscale 0.21 (p=0.028) and Marder factor 0.28 (p=0.003)], NSA [global score 0.24 (p=0.010), and some factors: communication 0.26 (p=0.005), affect 0.28 (p=0.002), motivation 0.30 (p=0.001) and motor retardation 0.27 (p=0.004)]; Functioning [(PSP total score -0.24 (p=0.011) and some PSP factors: work 0.30 (p=0.001), self-care 0.21 (p=0.022)]. However, there is no relationship between C-reactive protein(inflammation) and any clinical variable. On the other hand, there is relationship between: glucose and cognitive impairment; cholesterol and NSA motivation score, cognitive impairment and PSP (total score, self-care and work); triglycerides and HDRS (total score, melancholia factor and vitality factor), NSA motivation score and cognitive impairment.

The negative dimension of schizophrenia is associated with high homocysteine levels, which means an oxidative stress state. As well, a worse functioning level is associated with high homocysteine level.

Some coping strategies might serve as protective functions by regulating the negative emotions associated with stress, whereas others may exacerbate the effects of stress and contribute to maladaptation.

To examine the distribution of the Beck Depression Inventory II (BDI-II) scores in the Spanish sample of adolescents from the “Working in Europe to Stop Truancy among Youth” Project (WE-STAY) and study the differences according to the coping style.

Sample: 1409 pupils from 23 schools sited in Asturias (Spain) [48.55% males; mean age(SD) = 15.16(1.22)]. Instruments:

1. (1) Coping Across Situations Questionnaire (CASQ);

2. (2) BDI-II.

7.3% of the sample scored in mild depression, while 4.9% did so in moderate (BDI-II criteria). Significant differences were found by gender in BDI-II scores, females scoring higher in severe, moderate and mild depression (p< .005). Regarding to the coping style, 65.4% of the sample showed internal style. The least representative was the withdrawal style (13.9%). Significant differences were found in the coping style by gender, females scoring higher in both active and withdrawal styles (p< .050). Regarding to the relation between BDI-II scores and coping style, pupils with withdrawal style score higher in severe, moderate and mild depression (p< .000).

Although ideally would be an active style, pupils showed mainly an internal coping style (which includes assessing a situation and looking for a compromise). Coping style was related with the severity of depression. Withdrawal style (which includes denial) is related to a worsening of depression. Thereby, training coping skills may be important.