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.

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.

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

To investigate associations between perfectionism dimensions and psychological distress 421 pregnant women (M=29.8, SD=4.48 years) completed measures of Self-Oriented Perfectionism (SOP), Socially-Prescribed Perfectionism (SPP) (MPS; Hewitt & Flett, 1991; Soares et al., 2003), mood (POMS; McNair et al., 1971; Azevedo et al., 1991) and depressive symptomatology (BDI-II; Beck et al., 1996; Coelho et al., 2002).

A 2-factor model of Perfectionism with SOP and SPP dimensions and a 3-factor model with SOP, SPP-Others’ High Standards and SPP-Conditional Acceptance factors were explored. Correlations and Linear Regressions were calculated between perfectionism factors and mood variables/depressive symptoms.

Higher levels of SPP factors were in general associated with increased Anxiety, Depression, Anger, Fatigue and Confusion, with decreased Vigour and with more severe depressive symptomatology. SPP dimension and both SPP sub-scales explained depressive symptoms.

Our results, in contrast with those from the study of Campbell and DiPaula (2002) did not confirm a preferential association between SPP-Conditional Acceptance and psychological distress (PD), revealing that both components of SPP were associated with PD.

Bipolar Disorder is a serious, common and disabling mental disorder which is associated to high morbidity and high suicide attempt rates.

To identify clinical and social-demographic variables associated to suicidal behaviour in Bipolar Disorder.

The samples comprises 124 patients (62.1% females) diagnosed with Bipolar Disorder (ICD-10 diagnosis following DIGS/OPCRIT). The variables selected to the analysis were extracted from DIGS and OPCRIT.

Suicidal behaviour occurs in 27.1% of the patients; the most used method was voluntary drug poisoning; it's more frequent in females, with males using more violent methods - remaining results still unavailable.

This study identifies several clinical and social-demographic variables that can help the clinician to delineate a suicidal profile among his Bipolar patients, hence improving his ability to develop an early intervention plan and suicide prevention strategies.

Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.

In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.

One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.

The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.

The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

The importance of early recognition and treatment of the first psychotic episode is well documented in literature. This study aims to describe and analyze the sociodemographic and clinical characteristics of a sample of patients admitted in a psychiatric ward for their first psychotic episode.

Data from 48 patients was retrospectively analyzed using a specific clinical protocol. Inclusion criteria were admission with a first psychotic episode during January 2003 to June 2005. Patients with primary affective and organic disorder were excluded. ACESS was used for statistic analysis.

Patients were aged 19-56, mainly of the masculine gender (77%), single (68%), living with own family (89%), and receiving any kind of social support (13%).

Main diagnoses were Schizophrenia (54%); Persistent Delusional Disorders (17%); Acute and Transitory Psychotic Disorders (29%).

Age of onset was 28 years (median) for males and 36 years for females. Onset was

insidious for 44% of the patients and the Time Disease Untreated (TDU) mean-2,2 month; median 18,8 month, witch is similar with literature data. Ten percent were involuntarily admitted and 84% were taking oral atypical antipsychotic with total compliance for 33% and partial for 25% of patients.

Only 23% of the patients or their families were attending therapeutic groups.

The results of our study in part agree with the data from the literature on the other hand they reflect the characteristics of our healthcare system and population, and can provide ways to improve care.

This study examines the relationship between the personality traits of Neuroticism and Extroversion and sleep patterns and others sleep behaviours in medical students.

Neuroticism and Extroversion were assessed using the Portuguese version of the Eysenck Personality Inventory. Sleep was assessed with a self-response questionnaire covering a wide range of sleep-wake habits and difficulties. A factor analysis with varimax rotation was performed with seventeen items of the questionnaire and four factors were extracted: Sleep Disturbance, Sleep Timing, Insufficient Sleep and Dreams/Nightmares. A total of 203 third year medical students (127 females, 62.6%) mean age 20.01 (SD=1.09; Range=18-24) participated in the study.

There were no significant gender differences in Neuroticism and Extroversion mean scores (Neuroticism: p=.454; Extroversion: p=.891). Extroversion was significantly correlated with Sleep Timing (p=.000), whereasthere was a trend for Neuroticism to be associated with Sleep Disturbance (p=.095). Concerning the relationship of Neuroticism and Extroversion mean scores with other Sleep problems, Neuroticism was found associated with concentration difficulties in the morning (p=.006), inadequate sleep duration (p=.001), sleep problems (p=.012), and use of sleep medication (p=.052). No significant associations were found with Extroversion.

Neuroticism was significantly associated with sleep problems, use of sleep medication, inadequate sleep duration, and concentration difficulties in the morning. Extroversion was correlated only with later Sleep Timing.

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

The role of perfectionism as a correlate of perinatal depressive symptomatology, and as a predictor of postpartum depressive disorder was examined.

386 women in their third trimester of pregnancy (mean age = 30.08 years; SD = 4.205; range = 19–44) completed the Portuguese versions of Multidimensional Perfectionism Scale, Beck Depression Inventory-II/BDI-II, Postpartum Depression Screening Scale/PDSS and three additional questions evaluating anxiety trait, life stress perception and social support. Diagnoses of depression (ICD-10/DSM-IV) were obtained using the Portuguese version of the Diagnostic Interview for Genetic Studies/OPCRIT system. Women who were clinically depressed in pregnancy (ICD-10/DSM-IV) were excluded from the analysis.

Self-Oriented Perfectionism/SOP and Socially Prescribed Perfectionism/SPP subcomponents were significant correlates of depressive symptomatology (BDI-II/PDSS) in pregnancy. SPP-Others High Standards/OHS was a significant predictor of postpartum depressive symptomatology (BDI-II/PDSS), and SPP-Conditional Acceptance/CA was a predictor of postpartum depressive symptomatology (PDSS). None of the perfectionism subscales predicted postpartum depressive disorder (ICD-10/DSM-IV).

SOP and SPP have shown to be relevant correlates of depressive symptomatology in pregnancy. In the present study, SPP-OHS and SPP-CA were also significant correlates of perinatal depressive symptomatology, as well as important risk factors for depressive symptomatology in postpartum. Perfectionism subscales were not significant predictors of postpartum depressive disorder (ICD-10/DSM-IV). While SPP maladaptive influence was supported, SOP was shown to be more heterogeneous in its consequences. These findings may have important implications both for clinical practice and for research.

The objective of this study was to examine the sleep patterns of medical students and its associations with significant health behaviours.

Sleep was assessed with a self-response questionnaire covering a wide range of sleep-wake habits and difficulties. A factor analysis with varimax rotation was performed with seventeen items of the questionnaire and four factors were extracted: Sleep Disturbance, Sleep Timing, Insufficient Sleep and Dreams/Nightmares. The questionnaire also included questions on coffee use, cigarette smoking, alcohol intake and physical exercise. The sample consisted of 212 females (M age=20.32 years, SD=1.26) and 128 males (M age=20.19 years, SD=1.23) third year medical students.

Habitual alcohol intake was reported by 6.5% of the students (males=14.8% vs females=1.4%; p=.000) and regular physical exercise by 37.9% (males=47.7% vs females=32.1%; p=.004); The mean number of coffee cups used per day was 2.16±1.16 (males M=2.18±1.35 vs females M=2.13±1.03; NS) and the mean number of cigarettes smoked per day was 3.69±5.71 (males M=4.41+6.55 vs females M=3.25±5.10; NS). Students who regularly practice physical exercise reported less Sleep Disturbance (p=.004). Habitual alcohol intake was significantly associated with Sleep Timing (p=.051) and Insufficient Sleep (p=.007). Significant correlations were also found between cigarette smoking and Sleep Timing (p=.000), Dreams/nightmares (p=.023) and Insufficient Sleep (p=.001). Coffee use was correlated only with Sleep Timing (p=.000).

In this sample of healthy young adults habitual alcohol intake and cigarette smoking was associated with Insufficient Sleep and regular physical exercise was associated with less Sleep Disturbance.

Screening for perinatal depression is essential. The Postpartum Depression Screening Scale (PDSS; Beck & Gable, 2002) is a self-report instrument, composed of 35 items. The Portuguese version of the PDSS revealed to be a valid instrument to screen for perinatal depression (Pereira et al., 2010a,b).

To develop PDSS short version and to determine its cut-off points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria.

Participants were 452 women in their third month post-partum (M = 13.07 weeks post-partum; SD = 1.808). All women completed the Portuguese PDSS and were interviewed using the Mood Disorders Section/Diagnostic Interview for Genetic Studies. To select items for the short version the items that showed the highest correlations with their respective seven dimension scores were retained. ROC analysis was applied and both cut-off points and associated conditional probabilities adjusted to the real prevalence were determined.

For major depression/DSM-IV the cut-off point of 15, resulted in sensitivity of 77.8%, specificity of 88.9%, positive predictive value (PPV) of 21.7% and negative predictive value (NPV) of 98.9%; for depressive disorder/ICD-10 the cut-off point of 14 determined sensitivity 77.3%, specificity 84.0%, PPV 19.7%, NPV 98.6%; for mild/moderate depression with somatic syndrome or severe depression without psychotic symptoms/ICD-10 the cut-off point of 18 was associated to sensitivity 91.7%, specificity 94.5%, PPV 31.4% and NPV 99.8%.

The Portuguese short version of PDSS is a good alternative to the 35-items version, equally valid and precise, but more economic, faster and easier.