In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.

Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.

Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).

The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.

Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”

20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:

1. - SCID

2. - PANSS

3. - SCIP (schizophrenia cognitive screening)

4. - Scale GEOPTE (social cognition in schizophrenia)

5. - Social Functioning Scale (SOFAS, PSP)

6. - Scale of disease awareness

7. - IPDE (TP)

8. - Hamilton Scale (anxiety-depression)

The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:

1. 1. 60 item-Scale, specific on each chapter, evaluating:

1. - Attention

2. - Concentration

3. - Memory

4. - Comprehension of the main plot

5. - Comprehension of subplots

6. - Dialogues

7. - Other

8. - Self-identification of deficiencies or errors

• 2. Heteroapplied analogical scales

• 3. Semi-structured qualitative interview

Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.

To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.

We include 9 variables from 104 first assessments carried out in our center.

48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.

As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.

We aimed to explore the expert perspective on relevant issues of individuals with bipolar disorder. The specific aims are to identify problems in functioning important to individuals with BD and to quantify these using the ICF.

An online survey on functioning in BD was conduced. For each ICF domain one question was presented. Recruited participants were psychiatrists, general physicians, psychologists, nurses and social workers worldwide. Answers were linked to the ICF according to predefined rules (Cieza, 2001). Data analyses include frequencies of ICF categories named by experts.

Health professionals from all WHO-world regions and from different professional backgrounds accepted our invitation to participate. The Americas was the highest represented region (36%) and a significant part of the professionals involved were psychiatrists. From all the concepts contained in the answers, body functions categories with highest frequency of appearance were emotional functions (3,5%), mentioned by 62% of the experts and sleep functions (2,4%) mentioned by 58%. The body structure brain corresponds to 2% of the total categories obtained and was included by 56% of the experts. Maintaining one's health was the most mentioned activity and participation (2,8%), referred by 36% of the participants and important environmental factors include health services (4,8%) and immediate family(3,8%), which appeared in 82% of the questionnaires.

The present study is an important step in applying of the ICF to BD. It also shows an important level of agreement between experts around the world regarding central issues of the disorder.

Funded by MURINET-MRTN-CT-2006-035794

Suicide is a serious public health problem. In 2005, 793 people were hospitalized in Madrid due to suicide attempt. However, most of the attempts do not require hospitalization and patients are discharged after the intervention in the emergency units. With the aim to implement local policies to prevent suicide, it is important to know the whole spectrum of suicide attempts that contact emergency units in Madrid.

To explore the incidence of suicide attempts assisted in the public health system in Madrid and to analyze their characteristics and the response of the health system.

Clinical reports of all patients attempting suicide were analyzed during 4 months in 4 general public hospitals (covering 44.7% of the whole population) in the Community of Madrid.

1009 suicide attempts committed by 921 people (66.2% women) were collected, with an incidence of 34.3 people per 100.000 in 4 months. 57 people (6.2%) committed more than one attempt (range 2 to 10, mean=2.5 ± 1.3). After the emergency intervention 71.9% of the patients were discharged, 25.3% hospitalized, 2.6% fled, and 0.2% died. Regarding suicidal ideation, 7.5% presented very high levels during evaluation, while 13.1% had high levels, 20.3% moderate and 47.3% had no suicidal ideation.

Compared with other European countries, our findings show moderate incidence of suicide attempts, most of which were mild, treated in the emergency units and derived to outpatient psychiatric follow-up. These results suggest places to develop and implement prevention measures.

Funded by Instituto de Salud Pública de Madrid.

In last years, studies on the families of patients with eating disorders (ED) have tried to identify family needs, as well as to determine their coping strategies.

To identify the coping strategies in families of patients with eating disorders.

Forty relatives were evaluated (mean age=49.4 years, S.D.=6.7); 52% women and 48% men; 94.6% married. COPE scale (Carver et al., 1989) was used to measure individual coping strategies, and F-COPES scale (Olson and Larsen, 1987) was used to evaluate family coping strategies. Statistical analysis was realized using SPSS.19.

The relatives had higher scores in the following COPE subscales: planning, suppression of competing activities, active coping; they had lower scores in drug/alcohol intake, behavioral disengagement and denial. In F-COPES subscale the higher scores were in reframing and the lower ones in passive appraisal.

It of patients relatives faces their trying change, avoiding other activities or thoughts that distract them. As family, they identify the problems and try to handle them looking for support in nearby persons.

The project PARADISE (Psychosocial fActors Relevant to BrAin DISorders in Europe) funded by the European Community (Grant Agreement 652 no. HEALTH-F2-2009-241572) is being carried out in terms of the theoretical conceptualization of “horizontal epidemiology”, which argues that the psychosocial difficulties (PSDs) people have to deal with when they have a brain disorder - either psychiatric or neurological - And the determinants of those PSDs are common across brain disorders.

To develop and test an innovative approach to collect clinical data on the PSDs based on the horizontal epidemiology.

1) To determine the PSDs and determinants commonly relevant across brain disorders. 2) To create a data collection protocol to describe and assess PSDs and their determinants across brain disorders.

In the first phase, a pilot data collection protocol was developed based on literature reviews and focus groups in 9 brain disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's Disease, schizophrenia, stroke and substance use disorders) as well as data analyses of surveys and expert consultations. in the current second phase, the protocol is being tested in a sample of 700 patients across Europe.

The pilot data collection protocol contains 63 PSDs and 64 determinants, which have been identified as common across brain disorders.

If we are right about the hypothesis of horizontal epidemiology in brain disorders, this way of collecting information would have profound consequences for how we organize and deliver services to people with brain disorders across Europe, improving their lives and life opportunities.

There are some data that suggest the existence of a dysfunction of the Hypothalamic-Pituitary-Adrenal (HPA) Axis in patients with eating disorders (anorexia nervosa –AN- and bulimia nervosa -BN-). If such a dysfunction exists, it would result in an altered cortisol response to stress.

To compare the cortisol response to stress in a group of patients with AN, BN and a control group.

Seventeen female AN patients, 17 female BN patients and 26 healthy female controls were compared. The Trier Social Stress Test (TSST) was used to induce stress. Throughout the test, seven samples of saliva were collected from each subject, and cortisol was investigated in each of the samples using radioimmunoassay (RIA).

Each group had a specific profile of cortisol release. Upon arrival at the laboratory, the AN patients had higher cortisol levels, but they quickly returned to normal values, becoming similar to those of controls. In contrast, in the BN patients the cortisol levels were at any time significantly lower than those of the AN patients and the controls, displaying a globally blunted response.

The results support the hypothesis of a dysfunctional functioning of HPA axis in patients with eatings disorders, althoug suggest that it might be particularly important in BN patients.

Supported by grants PI060974 (Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica [I+D+I]. FIS. Instituto Salud Carlos III. Ministerio de Sanidad, Servicios Sociales e Igualdad) and GRU09173 (Plan de Investigación Regional de Extremadura. Gobierno de Extremadura y European Social Fund).

Fantasies, despite their constant presence in the human being, are a phenomenon which has a scarce interest in academic psychology (Kinsey y cols, 1948; 1953). Unlike sexual fantasies, where there are systematized studies from the 1940s, in relation to latent aggressiveness there is an important vacuum.

This study will try to throw evidences about the relation between different types of personality and the level of sadism and/or latent aggressiveness that prevails in each one of them, as well as the modus operandi that can be attributed to them. It also aims at check the evolution of the latent aggressiveness in relation to age.

Have been applied in the evaluation of the sadistic fantasies and aggressiveness the test MCMI (Millon, 1983), the test MACI and the Questionnaire of Sadism and Criminality (CSyC, 2013) which allows to predict certain criminal behaviors as well as know their modus operandi if they are carried out. The sample was formed by a group of adolescents aged between 13 and 18 years old and another group of adults from 40.

Latent aggressiveness levels seem to point a normal curve, being established the maximum peak in adolescence. Further, the qualitative study reflects relations between certain psychopathological profiles of personality and particular modus operandi.

The results of this study show the evolution of the levels of sadistic fantasies according to the age and the role that personality has in different criminal acts.

Abrupt discontinuation of antidepressants, especially Selective Serotonin Reuptake Inhibitors (SSRI) and Dual-Action Antidepressants such as Venlafaxine, can lead to several psychological and somatic symptoms, which includes restlessness, psychomotor agitation, nervousness, anxiety, crying spells, irritability, depersonalization, decreased mood, memory disturbances, decreased concentration, and/or slowed thinking, nausea, dizziness and headache. Additionally, it has been demonstrated that sudden discontinuation of antiepileptic drugs in free-seizure patients, can increase the risk of suffering a seizure episode.

The aim of this study was to review the discontinuation syndrome associated with antidepressants and antiepileptic drugs, it's pharmacological management and strategies to prevent it.

We searched in MEDLINE selecting all the studies from 1990 until the present, related with the discontinuation of antidepressants and anticonvulsants. All kind of studies and reported cases are included. We also describe the case of a 47 year old patient, diagnosed with Obsessive Compulsive Disorder (OCD), who developed delirium and two seizure episodes after sudden cessation of his treatment with Venlafaxine 225 mg/ day and Pregabaline 225 mg/ day.

Withdrawal symptoms are common during discontinuation of antidepressants, especially in the case of SSRI and Venlafaxine. They are more frequently associated with their prolonged use and with agents with a short half-life. These symptoms are usually mild and transient. However, there are several cases reported in the literature describing the occurrence of delirium as a result of abrupt discontinuation of antidepressants. Additionally, it has also been reported that stopping antiepileptic drugs in seizure-free patients can increase the risk of developing a seizure episode.

Withdrawal Syndrome associated to the discontinuation of antidepressants and antiepileptic drugs is well established. Psychiatrists and General Practitioners should be aware of possible withdrawal symptoms when interrupting these treatments. Management strategies include gradual tapering of doses, clinical monitoring and patient education.

Previous studies on depression reporting expert survey results have focused primarily on symptomatology (Cheung et al., 2007) or used a narrow selection of experts, e.g. only clinicians or social workers (Collimore Rector, 2014; Caan et al., 2006). The current study is the first to explore the whole range of interventions and psychosocial difficulties (PSDs) in depression, combining information from psychologists, psychiatrists, nurses, social workers and primary health care doctors.

The general objective of the ongoing project (part of <a href="http://www.maratoneproject.eu/">www.maratoneproject.eu</a>) is to provide comprehensive clinical recommendations on available interventions for PSDs in depression by means of a multi-informant approach.

This particular study aims to go beyond symptomatology and gather expert perspective on interventions for improving a wide range of PSDs in depression where literature might be scant.

The online survey will be available in 2015. Experts will rank the efficacy of existing interventions, specify the treatments effective for particular PSDs and report the determinants of efficacy according to their expertise. PSDs definition is based on World Health Organization's International Classification of Functioning, Disability and Health (ICF).

Preliminary results and expert data will be shown. We intend to attract part of our pool of experts during the 23^rd European Congress of Psychiatry.

Worldwide experts in the field of depression are invited to take part in this online survey. The future course planned out by literature focuses on potential personalization of interventions; therefore the current study is an excellent starting point in this direction.

Psychopharmacology study.

To evaluate Nalmefene effectiveness in clinical practice in patients diagnosed with alcohol use disorder.

Descriptive, prospective and observational study with patients diagnosed with alcohol use disorder, treated with Nalmefene during 6 months.

Twenty-seven patients (9 women and 18 men); average age: 47.92. A total of 64.28% with F10 as an exclusive main diagnosis. Drink urge perception at the beginning: 6.37 points over 10.6 months later, 3.25 points. Loss of alcohol drinking control perception at the beginning: 6.03 points over 10. Six months later, it is reduced down to 2.37 points. GGT reduction (from 107.18 to 36.5 U.I./L) and Mean Corpuscular Volume reduction (from 90.2 to 88.9 fl). The average of days/month with binge drinking at the beginning was 16.18 SD (standard drinks); and monthly total of alcohol consumption is 182.75 SD. After a month: 4.6 days and 66.52 SD. After 6 months, it decreases to 4 days/month and 63.3 SD. The results of the Rhode Island Change Assessment scale are: 7.4% in pre-contemplation stage, 70.37% contemplation stage, 3.7% action stage and 18.5% in maintenance stage. Six months later: 75% contemplation, 12.5% action and 12.5% maintenance stage. The main side effects were: nausea and vomiting, 22.22% at the beginning and 12.5% that persist with intakes; sexual side effects in 22.22% throughout the treatment; the 14.8% report increased sleeping and dreaming, 14.8% report restlessness, after six months drowsiness prevails with a 18%. At first, orthostatic dizziness appears in a 14.8%, disappearing 4 weeks later.

Nalmefene is effective in reducing alcohol consumption, with few side effects and good acceptance.

The authors have not supplied their declaration of competing interest.

Serial killer's (SK) familiar relations often present a disorganized adherence characterized by the paternal absence and the excessive maternal coldness or over-protection. This familiar diagram, joined to mistreatment situations, could generate different antisocial conducts in the child because of the vacancy of a significant strong figure.

To study, in the SK, the relation between having suffered childhood mistreatment and the sexual aggression to the victims before killing them.

A study is realized between the variables of childhood mistreatment and sexual aggression to the victims. The data has been extracted from 100 protocols of SK with different nationalities elaborated by the unit of analysis of criminal behavioral (University of Salamanca, Spain).

The results show a significant relation between both variables.

It can be confirmed that the SK who have suffered childhood mistreatment sexually attack their victims before killing them while those who did not experiment it during their childhood do not realize that conduct.

The authors have not supplied their declaration of competing interest.