To explore changes in functioning with flexible doses of paliperidone ER in a large international study in patients with schizophrenia previously unsuccessfully treated with other oral antipsychotics.

Prospective 6-month open-label study. Functioning was assessed using the Personal and Social Performance Scale (PSP), including four domains:

1. (1) personal and social relationships,

2. (2) socially useful activities including work and study,

3. (3) self care and

4. (4) disturbing and aggressive behavior.

1812 patients were included (59.9% male, mean age 40.1±12.6 years, 75.8% paranoid schizophrenia); most were enrolled because of lack of efficacy (n=1026) or lack of tolerability (n=490) with prior antipsychotic treatment. The median mode dose of paliperidone ER was 6 mg/day. 70.7% of patients completed the study. Most frequent reasons for early discontinuation were patient choice (8.8%), lack of efficacy or adverse event (5.1% each). AEs reported in >= 5% of patients were insomnia (9.2%) and anxiety (7.2%). Mean total baseline PSP score was 57.7±14.5, which improved to 64.1±15.6 at endpoint (mean change +6.4±13.5; 95% confidence interval 5.8;7.0, p< 0.0001); 49.0% of patients improved by at least one 10-point category in PSP. At baseline, 84.3% of patients had moderate to severe functional impairment, mostly driven by at least marked difficulties in socially useful activities (46.4.%) and personal and social relationships (36.4%). These percentages decreased to 30.6% and 22.9%, respectively.

In this large prospective flexible-dose study, results from recent randomized controlled studies are supported that paliperidone ER is associated with a clinically meaningful improvement of functioning in patients with schizophrenia.

Alzheimer Dementia (AD) is known as the most common cause of degenerative dementias that decrease patient life expectancy, quality of life and increase caregivers burden. Objective: To determine the evolution of cognitive and non-cognitive symptoms under donepezil treatment and to evaluate the impact of these symptoms evolution over the caregivers.

This prospective, open-label, trial included a group of 56 patients, 34 male and 22 female, mean age 72.4, diagnosed with AD according to DSM-IV-TR criteria. Patients received either donepezil (n= 30) or 1400 UI/day mean dose of vitamin E (n=26). We evaluated these patients monthly during 1 year using Mini-Mental State Examination (MMSE), AD Assessment Scale (ADAS), Hamilton Depression Rating Scale (HAMD)-17 items, Brief Psychiatric Rating Scale (BPRS)- 18 items, Global Assessment of Functioning Scale (GAF), Burden Interview (BI).

Patients presented significant better evolution under donepezil on cognitive symptoms as scores evolution on ADAS-Cognitive behavior subscale (+1.5+/-0.2 vs. +10.4+/-0.8, p<0.0001) and MMSE (-0.8+/-0.2 vs. –7.7+/-0.4, p<0.0001) reflected. The non-cognitive symptoms evolution was also better under donepezil treatment, as the ADAS-Noncognitive behavior subscale (+2.6+/-0.4 vs. +8.2+/-0.7, p<0.0001), HAMD (increases of 4.5 vs. 8.2, p<0.001) and BPRS (increases of 6.7 vs.14.2, p<0.0001) reflected. The evolution of GAF was better in the donepezil group (-10.5 vs. –27.5, p<0.0001) and the burden of caregivers was significant less in the same group (+10.2 vs. +30.8 on BI, p<0.0001).

Donepezil is efficient in controlling both cognitive and non-cognitive symptoms in mild to moderate AD and therefore it decreases also the caregivers burden.

Patients with schizophrenia that are treated with first generation, but also with several second generation antipsychotics, frequently describe negative changes in self-perception and daily activities due to weight gain. A systematic analysis of the weight gain influence over the body image is necessary because it could offer a perspective over the patient's discomfort, improving his/her chances to therapeutic compliance and a better life quality. Psychotherapy, change of antipsychotics, nutritional counselling, ocupational therapy or physical exercises scheduling could be solutions to these cases.

A group of 34 patients, 18 female and 16 male, diagnosed with chronic schizophrenia (DSM IV TR), mean age 45.3, treated with antipsychotic agents for at least 2 years (haloperidol 15 cases, olanzapine 10 cases, amisulpride 5 cases, risperidone 4 cases) were evaluated in order to configure a body image profile, using self-reports, investigator-based reports and Draw-a-Person-Test (DAP). Patients included in this evaluation presented a mean weight gain of 10%, reported to their premorbid value.

The body image was negative in 82.3% with marked dysfunctional believes about self in 64.7%, while the rest of 17.6% had mild to moderate levels of self-blame or hopelessness automatic thoughts associated to weight gain. Only 17.7% patients had a neutral or positive body image, also their mean weight gain was equally to the negative body image group.

Negative body image is usually associated to weight gain as a side event to antipsychotic drugs, therefore is important to ventilate the patient's dysphoric feelings and to choose the optimal therapy.

Venlafaxine extended release (XR) stands as an optimal therapeutic choice for the major depressive disorder (MDD) and generalized anxiety disorder (GAD) dual diagnosis.

We focused upon the evaluation of venlafaxine XR efficacy in treating MDD and GAD dual diagnosis patients, using an selective serotoninergic reuptake inhibitor comparator, fluoxetine.

A 23 patients group, 13 male and 10 female, mean age 36.7, admitted in our clinic, that met the DSM IV TR criteria for both MDD and GAD, were distributed in two groups, receiving venlafaxine XR in 75-150 mg flexible dose (n=12) or fluoxetine 20-40 mg flexible dose (n=11). We assessed patients evolution under treatment every two weeks for 6 months using Hamilton Depression Rating Scale 17 items (HAMD-17), Hamilton Anxiety Scale for Anxiety (HAMA), Global Assessment of Functioning Scale (GAF) and Clinical Global Impressions (CGI).

In the intent-to-treat (ITT) and last-observation-carried-forward (LOCF) analysis, differences between groups became statistically significant at week 4, venlafaxine XR treated patients improved better as HAMD-17 (-7.8 points, p<0.05) and HAMA (-8.9 points, p<0.05) reflected. The end-point HAMD-17 and HAMA scores were smaller in the venlafaxine treated group (6.7 and 9.1, p<0.05). Endpoint CGI (1.5) and GAF (92) scores were also better in venlafaxine XR treated group (p<0.01).

The 6 months clinical trial proved venlafaxine XR superior to the active comparator, fluoxetine, in the treatment of MDD and GAD dual diagnosis.

Spatial notions’ peculiarities specific to individuals who suffer from schizophrenic spectrum disorders of the different degree of intensity.

Schizophrenia (ICD-10, F20) (30 individuals), schizotypal disorder (F21) (30) and conditionally healthy (60). Exception criteria: organic affection lesions CNS, epilepsy (G40), mental retardation (F70-F79). The experimental base: Moscow mental hospital №13.

To analyze and to describe spatial notions’ peculiarities specific to individuals who suffer from schizophrenic spectrum disorders (sexual differences are taken into consideration).

The following groups of methods were used to achieve the aim of research: methods intended for “direct” space perception research; projective and reflexive techniques; methods intended for the thought peculiarities research.

Blatant violations of the spatial perception were found in experimental group. Sexual differences were defined: more abstract and nonstandard decisions are specific for men, more concrete and fragmentary - women.

It should be noted that errors amount wasn’t rising in the experimental group with the complication of the tasks.

Blatant violations of the spatial perception include emasculation, image distortion, perseveration, notion agglutination, decision paradoxicality, ambivalence etc. These violations are classified as the peculiarity of the negative psychopathological manifestations of thought and perception specific to the schizophrenia.

In some case, spatial idea can expose predisposition to the latent psychic pathology of endogenous origin.

Although the mechanisms explaining metabolic impairments observed during antipsychotic treatment are not well known, there are important differences between drugs regarding the possibility of inducing lipidic and glucose impairments.

To assess the effects of atypical and typical antipsychotics -olanzapine, aripiprazole, risperidone and haloperidol over the weight, glucose and HDL-cholesterol levels, during 24 weeks of treatment.

A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N=12) 10-20 mg/day, aripiprazole (N=11) 15-30 mg/day, risperidone (N=10) 4-8 mg/day or haloperidol (N=10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity.

Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients.

There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.

One of the most serious forms of abuse is sexual abuse (SA), especially when the victims are children. Questions still remain: what actual long-term consequences of child sexual abuse effect the mental health of children.

Examined-68 people (22 boys, 46 girls) having detected by physicians fact of SA, and recognized as victims in legal status. The group was split by age (3-6 years), and by the type of SA: family abuse and extrafamilial abuse. Group of 38 children – catamnesis study over a 5-year period.

To reveal long-term mental health consequences of child SA taking into accountd the type (family and extrafamilial).

All the children were examined repeatedly during the follow-up period, clinically and paraclinically by psychiatrist (clinical observation, dialog with the child and parents), by neurologist and clinical psychologist (projective techniques and standardized personality questionnaires).

Psychopathologic consequences of SA are divided into acute (reaction to stress), subacute (6 months after the trauma) and remote (observation during 5 years). In acute and subacute period the disorders are qualified as acute reaction to stress and PTSD.

In long-term period clinical characteristics were defined as conduct disorder (personality development disorder), primarily of mixed type. In the structure of remote psychopathologic presentations, especially as the consequences of family SA are – hyperemotivity, neuroticism (trichologia, onychophagia, enuresis and encopresis, asthenic syndrome and subdepressive syndrome, obsessive fears, dysmorphophobia and others).

In prepubertal period-runaways, promiscuity, early alcoholization, taking drugs, behavior as a victim, sex-role identification disorder.

The body image development begins at an early age. Children with psychopathology may have body image disturbances. It is important to determine nosological specificity of body image disturbances in children.

To reveal body image disturbances in: 20 people (12 boys, 8 girls) having schizophrenia; 18 people (8 boys, 10 girls) with detected fact of sexual abuse (catamnesis study over a 5-year period); control group – 5 boys, 5 girls with normal psycho-physical development.

To reveal body image disturbance in children in case of psychopathology.

All the children were examined clinically and paraclinically by psychiatrist and clinical psychologist (projective techniques; standardized personality questionnaires and semantic method [analysis of statements]).

In children having schizophrenia specific disturbances of proprioceptive self-awareness in the form of senestopathy (feelings of compression, deformation, size loss or size gain of the body) and the idea of physical defect, are considered as the early symptoms of the body dysmorphic disorder. In this group of children disturbances of body scheme, difficulties in right/left orientation were detected. In the group of children with detected fact of sexual abuse the following disturbances took place: the body dysmorphic disorder (self-disgust, considering body to be tainted by the abuser, feeling dirty, compulsive body washing, sensitivity to touch) and senestopathy below one's waist, in the area of genitals, feeling dirtiness of the skin and clothes. In the pictures drawn by the children, they represented themselves older, grotesquely painted their faces, pictured strange haircuts, preferring bright and extravagant clothes.

The authors have not supplied their declaration of competing interest.

Improving the mental health diagnosis in young children is the high-priority problem in reducing the rate of child disability due to mental illnesses. In 2015, the Ministry of Healthcare (Russia) introduced the pilot project – the total screening of the paediatric population at an early age, detecting autism spectrum disorders (ASD) risk group.

To determine the broad range of mental disorders: from minor borderline states (states of risk) to serious mental disorders, with an emphasis on determination of ASD in children aged 16–24 months in general population.

The survey was conducted by the total screening in primary health care institutions (in the three largest regions of Russia: Volgograd, Novosibirsk, Chelyabinsk regions). The screening tool: checklist for parents aimed at detection of risk of occurrence of ASD in early children, for screening in general population.

During 2015, 34,770 parents of children aged 16–24 were questioned. Of these 4102 children or 11.8% (118:1000) formed the risk group in ASD. By the risk group in ASD predisposition (diathesis) is understood, that does not correspond fully to the clinical criteria of illness. This state of predisposition may last for several years and pass either to illness or to health.

The part of the children of the risk group in ASD were consulted by psychiatrist on a voluntary basis (2774 cases). Fifteen children (0.4:1000) were diagnosed with prominent clinical disorders in ICD-10 (F84). This prevalence rate cannot be extrapolated on the general population of the children at the considered age.

The authors have not supplied their declaration of competing interest.

Suicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.

To collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).

To analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.

Data were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.

Majority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.

Leading method of suicide was hanging, followed by jumping from high places and use of firearm.

Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.

The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.

Severe mental disorders are a major trigger of suicidal behavior.

Personal relationships should be targeted by suicide prevention interventions.

Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.

Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.

Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.

The authors have not supplied their declaration of competing interest.

Depression is one of several preventable causes of disability worldwide, with coronary heart disease (CHD) being the largest cause of disability. Depression has been confirmed as a risk factor for CHD.

Few studies tried to find an interrelation between depression and a risk of cardiovascular mortality according to systematic coronary risk evaluation (SCORE) chart.

The aim of study was to examine the correlation of depression with the risk of cardiovascular mortality (SCORE).

Study was conducted in 2015 within the framework of National Research Programme BIOMEDICINE. All patients aged 18 and older at 24 primary care facilities were interviewed with a sociodemographic questionnaire supplemented by measurements of blood pressure and total cholesterol. Within 2 weeks after the visit psychiatrist administered the Mini International Neuropsychiatric Interview (MINI) by telephone. SCORE was assessed using high risk chart.

Totally 920 patients age 40–69 were included in the data analysis. According to the MINI 9.3%(95%CI 7.5–11.5%) of 40–69 years old patients had current depression. Current depression was more common among women than men, 10.4% and 6.8%, respectively. The prevalence of current depression was highest among patients with SCORE 3–4%. Multivariate logistic regression did not suggest statistically significant odds ratio for having depression based on SCORE.

Only one of the measurements used for SCORE (smoking status) was significant predictor for having current depression, while systolic blood pressure and total cholesterol were not significant predictors for depression. As pharmacotherapies for reducing blood pressure and cholesterol are widely used by patients further research should include use of these medicines as potential mediators.

The authors have not supplied their declaration of competing interest.