This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.

We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.

Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.

These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.

To evaluate the long-term tolerability and effectiveness of aripiprazole adjunctive to lithium or valproate in bipolar mania.

Completers of a 6-week double-blind comparison of adjunctive aripiprazole versus placebo in bipolar mania partially responsive to monotherapy were followed up over 46-weeks on open-label aripiprazole plus lithium (ARI+LI) or valproate (ARI+VAL).

283 (ARI+LI n=108; ARI+VAL n=175) patients entered and 146 (ARI+LI n=55; ARI+VAL n=91) completed the 46-week extension. Safety results for both combinations were consistent with the known tolerability profile of aripiprazole, lithium and valproate. No clinically significant changes in lipids or glucose were observed with either ARI+LI or ARI+VAL. Mean (SE) weight change from double-blind endpoint to Week 46 (LOCF) was 2.3 (0.6) kg with ARI+LI and 2.0 (0.4) kg with ARI+VAL. Temporal analysis of the time of first onset of adverse events showed that akathisia and insomnia tended to occur early in treatment, with few new cases in patients previously treated with aripiprazole during the 6-week study.

Significant improvements from baseline in YMRS total score and MADRS total score were sustained over the 52 weeks with both ARI+LI and ARI+VAL treatment.

Long-term aripiprazole adjunctive to lithium/valproate in bipolar mania was safe and well-tolerated. Improvements in manic and depressive symptoms observed during the first 6 weeks of treatment were maintained.

One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.

Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.

1. - Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.

2. - Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.

3. - 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.

Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.

Course and outcome in schizophrenia are heterogeneous. Numerous studies have shown an association between the presence of negative symptoms and psychosocial and occupational functioning of patients.

To analyse the prevalence of negative symptoms in the course of illness in first episode psychosis and chronic schizophrenia and to establish its relation with the functional outcome.

43 patients with a first-episode psychosis (FEP) from our area were compared with 43 chronic schizophrenic patients and 43 normal controls from a parallel area. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptom. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales.

We found significant differences between FEP and chronic patients in negative symptom severity (t = -4.97, p< 0.001) and global assessment of functioning (t = 7.58, p< 0.001). There was no statistically significant difference between the two groups in PANSS positive and general components or Clinical Global Impression. Negative symptom severity was associated with poorer GAF ratings in first episode psychosis and chronic schizophrenia.

Negative symptoms appear to be persistent. In our study negative symptom severity was associated with social and functional impairment, defined as Global Assessment of Functioning Scale score of less than or equal to 60.

Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.

In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.

No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).

Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.

Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent.

To investigate the relation of substance related disorder and suicide attempt.

Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010.

We identified 85 cases.

Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%).

Previous attempts were found in 43″8% of the patients.

Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose.

Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient.

We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts.

• - Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances.

• - As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers

Voluntary drug overdoses are an important part of psychiatric demand in the emergency service. Nevertheless, a protocolized attention for these cases does not exist. Therefore, its management only depends on doctors’ personal criteria. Many of these cases have been previously diagnosed as Personality Disorder.

Studying the differences in management of drug overdosing depending on previous diagnosis of personality disorder. Also, we look for associated factors that can influence the final decision.

We conducted a retrospective analysis of 112 drug overdoses attended from July to December 2009. Data were analyzed using SPSS software.

34 attended patients (30,4%) have previous diagnosis of personality disorder. In these, the most frequent diagnosis was parasuicide attempt in the Emergency Service. In contrast, the rest of the patients were diagnosed as suicidal attempt.

We found statistically significant differences (p < 0,05) in the destination after Emergency evaluation (ambulatory or hospitalization) depending on a previous personality disorder diagnosis.

The media of previous overdoses in personality disorder group was significantly higher (3,29 Vs 0,64; P < 0,01).

We found that humor and anxiety disease comorbility, associated toxicomany, alcohol or cocaine use during the overdose, were more frequent in the group with personality disorder.

Although drug overdoses in patients with personality disorder have less letal intention, these patients were hospitalized more frequently than the others. This finding could be explained because of the presence of other associated factors that contribute to the global risk of overdosing. Previous overdoses seem to have significant influence in final decision.

We aimed to identify best predictors of cognitive and functional disability in chronic schizophrenia over time.

We examined 95 hospitalised patients with schizophrenia (DSM-IV criteria) in a long stage unit and 53 healthy controls (matched for age, gender, and years of education). Neuropsychological assessment included tests for Verbal Memory, Working Memory, Executive Functioning and Processing Speed. Functional Disability was assessed with the Disability Assessment Schedule (DAS-WHO) both at baseline and 6 months after.

As expected, patients" performance was significantly lower than healthy comparison subjects on all neurocognitive variables at baseline. Most, but not all, neurocognitive measures were positively correlated with the Functional Disability domains at follow up, including Self Care Management, Vocational Outcome, Family Contact and Social Competence. Results of mediation analyses suggest that all significant relationships identified between cognitive measures and functional outcome were significantly mediated by the Index Processing Speed (PS) with various effects ((between p < 0.05 for PS (z = -2.06) and p < 0.01 for PS (z = -3.01)).

Our data show that Processing Speed plays a determinant role in the relationship among neurocognitive symptoms and Self Care, Vocational Outcome and Social Competence. the model emphasizes the role of PS as the best longitudinal predictor of the level of autonomy in chronic patients with schizophrenia. PS acts as a pathway through which VM, EF and WM predict the course of patients’ functional ability over time.

To examine the relative contributions of psychiatric symptoms, functional disability, neuropsychological functioning and sociodemographic variables to quality of life (QOL) in patients with chronic schizophrenia.

We examined 165 hospitalised patients with long term schizophrenia (DSM-IV). Measures of psychiatric symptoms included depression (Calgary depression Scale), insight (David Insight Scale), symptom severity (BPRS) and PANSS (Positive and Negative Symptom Scale). Neuropsychological battery included tests for verbal memory, executive functioning, verbal fluency, working memory, motor speed and processing speed. Functional disability was assessed with the Disability Assessment Schedule (DAS-WHO) and Quality of life was assessed with the Quality of Life Scale.

Age, years of evolution, negative symptoms, insight and neuropsychological variables (except motor speed) all were significantly related to level of quality of life. in a multiple regression analysis, entering the neuropsychological functioning, functional disability and negative symptoms generated a model which accounted for a 74.9% of the variance in QOL. Functional disability, as expected, accounted for 56% of the variance, whereas Processing Speed explained an additional 6.2%. Symptom Severity and Verbal Fluency predicted 3.7% and 3.5% of the variance, respectively. Negative symptoms, Verbal Memory and Vocabulary, were also significant predictors in the model, but had less predictive value. However, Positive Symptoms and Sociodemographic Variables did not significantly contribute to predict quality of life.

Our findings support the predictive value of neuropsychological functioning, functional disability and severity of negative symptoms in long term quality of life in schizophrenia.

Suicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.

To identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.

Review of the drug overdosings attended in our Hospital from July to December of 2009.

We identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.

We did not find significant differences when studying triggers (family, partnership, economical or others)

The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)

1. - Self-injurious behavior is one of the most common causes of consulting in the emergency services.

2. - Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.

Metabolic syndrome is a frequent, severe, undiagnosed physical comorbidity in patients with severe mental disorders.

To develop a predictive model of metabolic syndrome for patients with schizophrenic or bipolar disorders, useful for both clinical practice and research.

Naturalistic, one-year follow-up study conducted in Asturias, Spain. A total of 172 patients with schizophrenic (Sch-P) or bipolar (BD-P) disorders (ICD-10 criteria), under maintenance treatment, who gave written informed consent were included. Metabolic syndrome was defined according to the modified NCEP ATP-III criteria. Multivariate Adaptive Regression Splines (MARS), Genetic Algorithms (GA), and Support Vector Machine (SVM) analysis were performed.

Starting from a large set of demographic and clinical variables, and by means of intermediate MARS and GA models, an SVM model able to classify if a patient with schizophrenia or bipolar disorder suffers from metabolic syndrome with an accuracy of 98.68% (sensitivity 100%, specifity 94.4%) was obtained. The final model only needs 6 variables: Sch-P:

1. (1) Low HDL-cholesterol,

2. (2) Fasting glucose level,

3. (3) Family history of obesity,

4. (4) Triglyceride level,

5. (5) Family history of dyslipidemia, and

6. (6) Use of antidepressants; BD-P: (1), (2), (3),

7. (7) Use of lipid-lowering medication,

8. (8) Use of antipsychotics, and

9. (9) Use of mood stabilizers.

We developed a simple and easy to use predictive model to identify metabolic syndrome in patients with schizophrenic or bipolar disorders.

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.

Evaluate the efficacy and long-term safety of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Patients requiring chronic treatment for schizophrenia, not on aripiprazole monotherapy, were cross-titrated from other antipsychotic(s) to aripiprazole in an oral conversion phase (Phase 1). All patients entered an oral aripiprazole stabilization phase (Phase 2). Patients meeting stability criteria entered an ARI-OM stabilization phase (Phase 3), with coadministration of oral aripiprazole for the first 2 weeks. Patients meeting stability criteria were randomized to ARI-OM or placebo once-monthly (placebo-OM) during a 52-week, double-blind maintenance phase (Phase 4). Primary endpoint was time-to-impending relapse. Safety and tolerability were also assessed.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo-OM=134). The study was terminated early because efficacy was demonstrated by a pre-planned interim analysis. Time-to-impending relapse was significantly delayed with ARI-OM vs. placebo-OM (p< 0.0001, log-rank test). Discontinuations due to treatment-emergent adverse events (AEs) were: Phase 1, 3.8% (n=24/632); Phase 2, 3.0% (n=21/709); Phase 3, 4.9% (n=28/576); Phase 4, 7.1% (n=19/269). Most AEs were mild or moderate. Insomnia was the only AE >5% incidence in any phase. Headache, somnolence, and nausea had a peak first onset within the first 4 weeks of treatment. There were no unusual shifts in all phases in laboratory values, fasting metabolic parameters, weight, or objective scales of movement disorders.

ARI-OM significantly delayed time-to-impending relapse compared with placebo-OM and was well tolerated as maintenance treatment in schizophrenia1.

Brexpiprazole is a serotonin-noradrenaline-dopamine agent that binds with high affinity to multiple serotonin, norepinephrine and dopamine receptors. In particular, Brexpiprazole is a partial agonist at dopamine D2/D3 and 5-HT1A receptors and an antagonist at 5-HT2A and norepinephrine alpha1B receptors.

We assessed the efficacy and safety of brexpiprazole versus placebo as adjunctive therapy to anti-depressant therapy (ADT) in subjects with MDD who demonstrated inadequate response to ADT.

This trial had 3 phases: a screening phase (7-28 days); a prospective phase (Phase A): 8-week, single-blind placebo plus an investigator-determined, open-label ADT; a randomized phase (Phase B): 6-week, double-blind, adjunctive brexpiprazole (2 mg/day) vs. placebo in patients with an inadequate response to ADT.

The primary efficacy endpoint was the change from the end of Phase A (Week 8) to the end of Phase B (Week 14) in MADRS Total Score. The key secondary endpoint was the change in mean SDS score. Other secondary endpoints were mean change in CGI-S, IDS-R, HAMD and HAMA.

Of 379 randomized patients, completion rates at Week 14 were high (92.9%). Statistically significant improvements in mean MADRS Total score were observed for subjects receiving adjunctive brexpiprazole 2mg/day compared with placebo (p=0.0001) at endpoint. In addition, on all secondary endpoints Brexpiprazole showed a statistically significant advantage over placebo.

Commonly reported adverse events in the brexpiprazole group (>5% and more than twice placebo) were weight gain (8.0%), akathisia (7.4%).

Brexpiprazole was effective and well tolerated as adjunctive treatment for MDD patients with an inadequate response to ADT.

Evaluate the effectiveness of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Detailed methodology has been published previously1. Briefly, the study consisted of 4 phases: oral conversion to aripiprazole (Phase 1); oral aripiprazole stabilization (Phase 2); ARI-OM stabilization (Phase 3), with co-administration of oral aripiprazole for the first 2 weeks; and an ARI-OM maintenance phase (Phase 4). Effectiveness assessments included Investigator's Assessment Questionnaire (IAQ) scores, a scale that evaluates effectiveness of current treatment vs. pre-trial medication, where a negative change in score signals improvement, and Personal and Social Performance (PSP) scale scores, where negative change in score signals worsening.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo once-monthly [placebo- OM]=134). Mean IAQ Total scores remained stable in Phase 2 (31.3) and Phase 3 (30.6). During Phase 4, the mean change in IAQ Total score was +1.3 for ARI-OM vs. +3.8 for placebo-OM (p< 0.0001). Mean changes in PSP Total scale scores showed improvement during Phase 2 (3.0) and Phase 3 (2.6). Mean change in PSP scores during Phase 4 showed greater functional stability with ARI-OM (−1.7) compared with placebo-OM (−6.2) (p=0.0002 vs. placebo-OM).

Improvements in effectiveness, as assessed by the IAQ and PSP Total scale scores, in the Phases 2 & 3 were maintained in Phase 4 for ARI-OM compared with placebo-OM. Treatment with ARI-OM improved symptoms, overall response to treatment and functioning.

The authors have not supplied their declaration of competing interest.

The DSM-5 defines psychomotor agitation as excessive motor activity associated with a feeling of inner tension. The activity is usually nonproductive and repetitious and consists of behaviors such as pacing, fidgeting, wringing of the hands, pulling of clothes, and inability to sit still. This kind of behavoir occurs in up to 25% of psychiatrics patients who consult in emergency medical services.

The main objective was to determine the efficacy of loxapine inhalation powder in acute agitation.

Ten agitated psychiatric patients scored Positive and Negative Syndrome Scale – Excited Component (P aNSS-EC) baseline and ten minutes after the administration of aD aSUVE®.

The efficacy of loxapine 10 mg in the acute treatment of agitation was established in a short-term (10 minutes).

Loxapine is the first and only orally inhaled medication for the acute treatment of agitation associated with psychiatrics disorders, which is a tool easy-to-use in emergency medical services.

The authors have not supplied their declaration of competing interest.