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.

Electroconvulsive Therapy (ECT) is a safe and effective technique widely used in our area. Scientific literature related to the application of this technique is continuously developing, specifically with regard to the placement of the electrodes, the amplitude of the stimulus pulse administered, the initial charge used, and the anesthetic agent involved.

The primary aim of this study was to analyze technical variables associated with the use of ECT in our hospital, and compare them to the guidelines of the protocol developed in our hospital and international standards.

We performed a review of Clinical Histories of the patients that were treated with ECT in the “Hospital 12 de Octubre” (Madrid, Spain), in the period comprised between January 1st, 2008 and December 31st, 2009. We collected data related to the application of the technique, socio-demographic variables and clinical profiles. We used descriptive statistics to analyze our data.

During this period, 602 ECT sessions were applied. Placement of the electrodes was unilateral in 58% of subjects with Affective Disorders and 8% of subjects with Schizophrenia. The amplitude of the stimulus pulse was 1 ms. Mean charge administered in the initial and final session was 236.85 mC and 357.16 mC, respectively. Etomidate was used as anesthetic in 68% of cases.

ECT technical variables applied in our hospital are adjusted to guidelines of our area and international recommendations. Longitudinal studies are warranted in order to objectively assess techinical variables associated to ECT.

Varicella Zoster Virus infection is quite a common condition overseas, for which Acyclovir seems to specifically help reducing the duration and severity of its symptoms.

Some central nervous system side-effects have been described while receiving treatment with Acyclovir or one of its analogs Ganciclovir and Valacyclovir, and eventually psychiatric disturbances between them.

We report the case of an Acyclovir-induced psychosis with manic symptoms in a 22 years-old woman with no previous psychiatric history.

The patient presented with irritable mood and grandiose delusions 72 hours after starting oral Acyclovir for a chickenpox infection coursing with diseminated rash.

The patient was admitted to the psychiatric unit 2 weeks after stopping treatment, albeit symptoms persisted. She was treated with Olanzapine in first place with modest improvement and Haloperidol in second place, finally recovering her previous mental state with no residual symptoms.

There is a significant body of evidence warning about neuropsychiatric disturbances as a side-effect of treatment with Acyclovir and its analogs, specially when using intravenous administration, or in a renal failure condition. Although uncommon, psychosis with manic symptoms in young and healthy patients should be kept in mind in order to recognise it and offer best support.

Disturbed eating behaviors are a significant health concern among child and adolescents with type 1 diabetes mellitus (DM1) and are generally related to poor glycemic control, ketoacidosis, hospitalization and microvascular complications. Rates of eating problems among youths with DM1 have been reported to be as high as 38%.

To review clinical characteristics, demographic profiles and risk factors for the development of eating disturbances among child and adolescents with DM1.

We performed a literature research of articles from 1980 until present, in which a Disturbed Eating Behavior appeared comorbid with DM1 in children and adolescents, using Medline database.

Almost all studies selected report a high prevalence of eating disturbances of child and adolescents with DM1 when compared with healthy pairs. This population trend to develop body image discontent and lower self-esteem. They are more likely to diet, skip meals, and omit insulin. All these practices have been associated with worsening diabetic medical complications and poorer psychological outcome.

Due to the high prevalence and severe medical and psychological complications associated with disturbed eating behaviors among pediatric population with DM1, clinicians and school professionals may benefit from specialized training to identify the range of unhealthy weight control behaviors used by youths with DM1. Preventive programs that address disturbed eating behaviors should be provided for adolescents with DM1 in order to reduce the psychological and medical impact of this comorbid situation.

1) To examine the nature and extent of cognitive impairment in first-episode early-onset psychosis (EOP) and 2) To search for differential cognitive impairment profiles among the diagnosis subgroups.

This study describes the basal neuropsychological results of the child and adolescent first-episode psychosis study (CAFEPS), a spanish multicenter longitudinal study. One hundred first-episode patients with EOP and 98 healthy controls underwent a comprehensive neuropsychological assessment. Three diagnostic categories were established: schizophrenia spectrum disorders (n=45), affective psychosis (n=28), and psychosis not otherwise specified (n=28). Baseline diagnoses were confirmed at a 6-month follow-up visit.

Performance of patients was between 0.88 and 2 standard deviations below that of controls in all cognitive domains: attention (p<0.001), working memory (p<0.001), executive functioning (p<0.001), and memory (p<0.001). The three diagnostic subgroups did not differ from one another in terms of impaired/preserved cognitive functions and degree of impairment.

The pattern and degree of cognitive impairment in first-episode EOP patients is similar to that reported in first-episode adult-onset patients. Our results failed to identify significant differences among diagnostic subgroups at the onset of the illness. The longitudinal design of the present study will allow for identification of potential differences in the course of cognitive impairment.

Childhood or Early Onset Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant, associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice, atypical agents have become the treatment of choice in patients with EOS.

To review the different pharmacological strategies, in which an atypical antipsychotic was used in the management of EOS in childhood and adolescence.

We conducted a literature search of articles related to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database.

Several atypical antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics, it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults.

Antipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this problem and be careful when monitoring this type of treatment.

It is well known that impulsivity and stress are risk factors for the development of addictive disorders, and more specifically alcohol dependence. Impulsivity has two dimensions: behavioural inhibition and delay of reward. The Fear- Conditioning paradigm of the Startle response (SR), which refers to the potentiation of the startle amplitude after the exposure to aversive stimulus, can be used as a stress test. The aim of this study was to explore the correlation between impulsivity laboratory tasks and the Fear-Conditioning (FC) paradigm of the SR as risk factors for the development of alcohol dependence.

The sample included 40 abstinent alcoholic men, who met DSM-IV criteria for Alcohol Dependence and had been abstinent for at least one month. Impulsivity was assessed using two laboratory tests: Stop-Signal Task (SST) and Differential Reinforcement for Low-Rate Responding (DRL6). The FC paradigm of the SR was used as a stress test. Patients were compared to 40 matched controls.

We found a positive correlation between SST tasks and the FC paradigm of the SR (p < 0,05) and a negative correlation between the DRL6 tasks and the FC paradigm of the SR (p < 0,05) in the patient's group. This significant correlation was not found in controls.

Impulsivity and stress are significantly correlated in alcohol dependent patients. This means that while healthy subjects cope with stress, alcohol dependent patients react with higher impulsivity when they are exposed to stress situations and this could lead them to drink alcohol to relieve anxiety and depressive symptoms.

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.

An under-recognized life-threatening adverse effect of clozapine is the gastrointestinal hypomotility. It represents a serious problem. Clozapine is an atypical antipsychotic which commonly produces ileus. The risk is higher when we associate clozapine to drugs, such us anticholinergic and tricyclic. Ileus can produce the death in our patients, therefore we will check constipation in our daily clinical practice as a measure to avoid these side effectS.

We looked through Medline for articles published since 2005 regarding Clozapine and Ileus. We will present the case of a patient who developed Ileus as the side effect of clozapine.

Constipation is very common in patients with schizophrenia (until 50%). Risk factors developing ileus in psychotic patients are: women, age, anticholinergic drugs, first generation of antipsychotics, clozapine, opioids and tricyclic antidepressants. Taking into account that this side effect can be mortal some recommendations that can reduce gastrointestinal hipomotility in this population are: a high fiber diet, exercise and the use of a softening laxative. In the case a patient treated with clozapine suffers from ileus we should shift the clozapine to aripiprazole or Amisulpride treatment. Moreover, we can use prokinetic drugs and surgery in the most complicated cases. Then, clozapine can be introduced after the ileus problem has been solved.

1 Gastrointestinal hypomotility has a high prevalence in psychotic treatments. 2 Avoiding the use of other drugs that produce constipation. 3 Offer advice to avoid the constipation. 4 If ileus is present, stop the clozapine treatment and shift it to aripiprazole or Amisulpride.

Endocannabinoid system has been highlighted as one of the most relevant research topics by neurobiologists, pharmacists, basic scientists and clinicians. The association between endocannabinoids and its congeners and mood disorders is relatively recent. However, evidence from both clinical and preclinical studies is increasing and many researchers point out endocannabinoid system and particularly endocannabinoids and congeners as promising pharmacological targets.

The main objective of this study is to compare the plasma concentrations of endocannabinoids and congeners between a sample of patients with depression and a sample of control subjects, and the influence of variables such as age, body mass index, gender, severity of symptoms, and antidepressant medication.

Plasma concentrations of endocannabinoids and congeners will be analyzed in 69 patients with depression from primary care and 47 controls using mass spectrometry analysis.

Statistically significant differences in 2-arachidonoylglycerol and monoacylglycerols were found between both samples. Somatic symptoms of depression seems to be more related to these compounds that to cognitive-affective symptoms. In addition, differences between mildly and moderately depressed patients were found in concentrations of AEA, LEA, DGLEA and POEA. Patients with antidepressant medication showed higher levels of 2-AG, DGLEA and OEA.

The results of this study provide evidence supporting the hypothesis that in depression there is a dysregulation of the inflammatory signaling and, consequently the immune system. The results of this study could also support the realization of translational research to better understand the mechanisms of this widely distributed system.

The authors have not supplied their declaration of competing interest.

Suicide is a major public health problem, especially in young people. It is one of the most significant causes of mortality and potential years of life lost. Medical students are a vulnerable group presenting mental health problems.

To study the prevalence of common mental illnesses among medical students from the university of Valladolid in order to assess the need for intervention programs.

Cross-sectional study in which, 584 students participated during the academic year 2015–2016 by completing an online self-administered questionnaire. Mental health outcomes were measured by different batteries of depression, anxiety and suicide (BDI, GAD-7 and MINI). Information about possible related risk factors was also obtained. Statistical Chi2 and Student t-tests were applied to estimate associations between socio-demographic, socioeconomic data and clinical results.

We found a prevalence of 15.8% for depression, 11.6% for ideation suicide and 38.5% for anxiety, with gender differences in the latter case. Prevalence rates were higher than those described in general population. Compared to other international studies, prevalence estimates were also higher among our sample.

This study shows for the first time data of these three psychiatric disorders among medical students in Spain. It suggests the urge to implementing preventive activities to alleviate maladaptive behaviors, academic stress, improve the quality of life and adaptation of students to college life. Larger, prospective, multicentre studies are needed to draw conclusions about the causes and consequences of students’ stress, since evidence shows that mental health problems are perpetuated throughout professional performance.

The authors have not supplied their declaration of competing interest.

Endocannabinoid System (ECS) has been highlighted as one of the most relevant research topics by neurobiologists, pharmacists, basic scientists and clinicians (Skaper and Di Marzo, 2012). Recent work has associated major depressive disorder with the ECS (Ashton and Moore, 2011). Despite the close relationship between depression and bipolar disorders, as far as we know, there is no characterization of ECS and congeners in a sample of patients with bipolar disorders.

The objective of this work is to characterize the plasma levels of endocannabinoids and congeners in a sample of patients with bipolar disorders.

The clinical group was composed by 19 patients with a diagnosis of bipolar disorders using SCID-IV (First et al., 1999). The control group was formed by 18 relatives of first- or second-degree of the patients.

The following endocannabinoids and congeners were quantified: N-palmitoleoylethanolamide (POEA), N-palmitolylethanolamide (PEA), N-oleoylethanolamide (OEA), N-stearoylethanolamide (SEA), N-arachidonoylethanolamide (AEA), N-dihomo-γ-linolenoylethanolamide (DGLEA), N-docosatetraenoylethanolamide (DEA), N-linoleoylethanolamide (LEA), N-docosahexaenoylethanolamide (DHEA), 2-arachidonoylglycerol (2-AG), 2-linoleoylglycerol (2-LG), and 2-oleoylglycerol (2-OG).

The result showed statistically significant lower levels of AEA, DEA and DHEA in clinical sample. Previous research also identified lower levels of AEA in depressed women (Hill et al., 2008, 2009). Until date, it is unknown if DEA and DHEA have some effect on EC receptors, and whether they have some direct effects on endocannabinoids.

It would be necessary to carry our other research with a larger sample, which could allow the control of potential confounding variables.

The authors have not supplied their declaration of competing interest.

Charles-Bonnet Syndrome (CBS) is a clinical entity characterized for visual hallucinations in patients with severe vision impairment and preserved cognitive state. Its pathogeny is still unknown, limiting management options. For diagnosis neurological and psychiatric disorders must be discarded. Treatment is based in three pillars: explaining to the patient the origin and nature of the symptoms, treating the visual deficit when possible, and pharmacotherapy with anti-psychotics.

To outline the main characteristics and etiopathogenic theories of the CBS, so as to improve diagnosis and treatment.

Basing on a case followed in mental health consults, we made a systematic review of the articles published in Medline (PubMed) in the last 5 years, with the following keywords, Charles-Bonnet Syndrome, hallucinations, deafferentation, visual impairment.

We found that all our case and the reported ones had in common the nature and characteristics of the hallucinations, the presence of a trigger, usually a new medicament, and the functional MRI patrons of activity; those patrons located the loss of input prior to the association cortex, which appeared hyper-excitable in functional MRI.

Although the aetiology and pathogeny of CBS is still unclear, present data suggests that the key mechanism may be a dysregulation in the homeostatic adaptation of the neural pathway when it is left without external input, traducing a hyper-function of a physiological process, probably mediated by acetylcholine, as opposed with other neuropsychiatric pathologies, in which the cortex is the primary affected area.

The authors have not supplied their declaration of competing interest.

The pathophysiology of psychosis is not fully discovered yet. However, during the last years many different risk factors are shown to prove to have a strong influence within the development of this pathology. Traumatic brain injury (TBI) is one of them.

Show TBI as a psychosis development risk factor.

Case report. A clinical vignette is presented followed by the results obtained in a bibliographic review.

A young 19-year old immigrant man, who lives with his parents in a social exclusion situation is brought to the hospital after having been observed making estrange religious rituals within a local river. During the anamnese he declares that God is “getting in touch with him” while he shows to be changed, with suspicion about being pursued. He also reveals to have suffered a mild-severe TBI with 8 years, having right ear audition problems since then. During the hospitalization some medical test were done, such as MRI, showing the lack of the inner right ear, as well as white matter abnormalities in his right hemisphere, which could be consequence of the TBI. Those findings make us think that this pathology might have been influenced, within other factors, by the traumatic brain injury.

This bibliographic review shows that traumatic brain injury may increase the risk of developing psychosis up to 65% from healthy controls, with a medium gap of 3.3 years between the TBI and the appearance of psychotic pathology.

The authors have not supplied their declaration of competing interest.

Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.

To evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.

This was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.

In basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.

Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.

The authors have not supplied their declaration of competing interest.

Suicide is the deliberate act of take off life to itself. According to WHO, more than one million people commit suicide every year.

Compare data of suicide attempts between 1996 and 2014 in the University Hospital of Valladolid. Influence of the economic crisis on suicide data. Expose the risk factors. Provide prevention strategies.

We have performed a study of epidemiological surveillance collecting descriptive data of suicide attempts; using the same methodology as in 1996. The variables studied were: sex, age, day, month, residence, method, personal status, education, employment status, religious believes, family history of suicide, psychiatric history and family and personal psychiatric history.

Increase in the rate of suicide attempts 27%. Distribution by sex is similar, but in 2014, a higher proportion was observed in males. The percentage of women is significantly higher than that of men in the group of teenagers (10–19 years old) (20% women vs. 4.5% of men; P = 0.005); 83.5% have a psychiatric diagnosis (54.2% of them have a depressive disorder). Unemployment and economic problems stand out as environmental stressors in 2014. The main suicide method used in Valladolid is the hanging, and the second method used is the precipitation.

The primary, secondary and tertiary prevention strategies are very important. Suicide is the major cause of mortality in the young age group (15–24 years old). Mortality in the general population has been on a downward trend; but suicide rates per 100,000 population has remained stable over the last decade.

The authors have not supplied their declaration of competing interest.

22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.

Twenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.

Prematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.

We considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.

Definition of velocardiofacial Syndrome and lack of consensus on terminology:

– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;

– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.

The authors have not supplied their declaration of competing interest.