Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.

The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.

169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.

The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.

Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.

Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties.

Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference)

Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning (F = 9.88, p < 0.01) and processing speed (F = 5.92, p < 0.05) measures, suggesting that the REHACOP experimental group improved significantly when compared to the control group's performance on both domains.

Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.

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.

Verbal fluency deficits have been pointed out as a possible endophenotype in schizophrenia (Szöke et al., 2008). However, whether these deficits are specific or linked to semantic-verbal inability remains unclear. Additionally, this cognitive domain is already affected in early psychosis and do not improve despite early clinical interventions.

Authors tested the efficiency of a cognitive intervention specifically developed for improving fluency in psychosis.

Ninety patients with first-episode psychosis were randomly assigned to one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy. Patients at the REHACOP group received one month structured group rehabilitation sessions (3 per week) to improve fluency. Repeated assessments of semantic fluency and phonological fluency were conducted before and after the treatment.

Compared to occupational therapy, the experimental group produced significant additional improvements in phonological fluency (F = 6.87, p < 0.01), but not in semantic fluency (F = 0.61, n.s). The composite verbal fluency score was also significant (F = 4.65, p < 0.05). The improvement remained 3 months after the treatment end.

The cognitive treatment using REHACOP has proven to be effective in treating phonological fluency deficits in first-episode psychosis, whereas socialization or communication in group therapy by itself do not. The differential pattern showed by semantic fluency is consistent with the proposal of Szöke et al 2008, who suggest that semantic fluency is a putative endophenotype for schizophrenia with links to genetic basis compared to phonological fluency.

Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.

Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.

This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.

The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.

In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.

Comorbidity has been defined as the coexistence of somatic and psychiatric diseases with diferent physiopatology in the same person, and it can appear simultaneously to the schizophrenia or during the patient's lifetime. There are two types of comorbidity: episodical or taking place during the lifetime of the patient. We can diffferenciate between comorbidity itself (in cluster, dependent or associated) to the so-called pseudo-comorbidity. Besides, comorbidity has been classified as a co-syndrome and it is considered a prognosis indicator of this disease, which can determine an increase in the rates related to relapses, worse response to treatment, less capacity to cope with social situations, and suicide in patients suffering from schizophrenia.

177 schizophrenic patients were assessed for affective symptoms and suicide behaviour. 24.3% were suffered for depression. 35% had a previous record of autolytic attempts. The rate of suicide history were higher among depressed schizophrenics (50%) than non-depressed schizophrenics (20%) (p<0,05).

We point out the clinic importance of suicide in schizophrenic patients suffering from depression. Moreover, the study shows the necessity to carry out longitudinal studies to recognize indicators of depression in advance and establish the diagnosis of depression, and, also, to acknowledge the importance of the gender factor in the depression of schizophrenic patients.

To describe possible differences in the initial cognitive profile between schizophrenia and non-schizophrenia first episode psychosis patients.

We assessed attention, working memory, and executive functioning in 57 first episode psychosis patients at baseline and at a one-year follow-up.

No significant differences were detected in the cognitive profile among schizophrenia (n=20) and non-schizophrenia (n=37) patients at baseline or at the one-year follow-up. For the overall group, significant reductions in the percentage of omission and commission errors for the sustained attention task (p< 0.001 and p=0.001 respectively), in the total time to complete the Stroop-I task (p< 0.001), in the percentage of omission errors for the working memory task (p=0.001), and in the percentage of perseverative errors for the WCST (p< 0.001) were detected, as well as a significant increase in the number of categories completed in the WCST (p< 0.001). The other cognitive variables analyzed remained stable (4 of the 10 variables tested). The pattern of change was similar for schizophrenia and non-schizophrenia patients in the areas of attention and working memory. For executive functioning, the non-schizophrenia group showed a more beneficial pattern of change.

Our results indicate a lack of specificity of cognitive alterations related to the degree of affectation, at least during the first year after instauration of treatment. The course of cognitive deficits in first episode psychosis showed significant improvements over this period, being the patter of change in executive functioning slightly more beneficial for patients with a non-schizophrenia psychosis.

The Eiffel study is a longitudinal, naturalistic study of patients with first episode psychosis (FEP) designed to evaluate the predictive value of defective insight on treatment adherence and global functioning.

Five hundred seventy-seven patients with FEP were assessed at baseline and at a 1-year follow-up. They were compared in terms of sociodemographic factors, psychopathology, insight, treatment adherence and functional outcome. Longitudinal functionality was prospectively assessed with the clinical global impression (CGI) and global assessment of functioning (GAF) rating scales.

At baseline, up to 50% of our sample presented with a lack of insight. Most clinical symptoms, including insight, improved over the follow-up period. Insight, education and social withdrawal significantly predicted CGI and GAF at follow-up. Insight and level of education were predictive of treatment adherence.

Insight significantly predicted the general clinical course, treatment adherence and functional outcome in our FEP sample after 1 year. Only education additionally accounted for the longitudinal course. Since our results suggest that better insight improves treatment adherence and consequently clinical course and functional outcome, insight could be a specific target of treatment in early intervention programs.

The objective of the present study was to examine the predictive value of clinical and cognitive -including the cognitive reserve (CR) - variables on the severity of the patient's illness at one year of follow-up.

A study was held with 45 patients with first episode psychosis (FEP) from 3 main hospitals in the Basque Country (Spain). All patients underwent cognitive, clinical, and functional assessments at baseline and at 6 months follow-up. The cognitive measures included were: the Stroop test, Vocabulary sub-test from WAIS-III, the WCST, and Trail Making Test. The clinical and functional measures included were: Positive and Negative Syndrome Scale (PANSS), Young Mania Scale, Montgomery-Asberg Depression scale, and CGI (Clinical Global Impression).

Six-months follow-up data were available for 29 patients. Regression analysis was performed with the 6-month follow-up CGI measure as a dependent variable. Results showed that after controlling for CGI at baseline, -PANSS Negative Symptoms Scale (B = 0.47, p ≤ .05) and the CR measure -Vocabulary from WAIS-III- (B = 0.36, p ≤ .05) were the only two which significantly predicted severity of illness after 6 months (R2 = 0.44) and remained significant when CGI at base line was controlled in the regression analysis. The rest variables did not reach statistical significance.

These findings emphasize that CR have a role on outcome in first episode psychosis, and enhance that exist a relation between cognition and clinical measures in psychosis.

Basque Government, Health Department (2008111010); EITB-Maratoia (BIO 09/EM/015).

To determine patient adherence to generic venlafaxine versus brand-name venlafaxin (Vandral®) and its impact on costs and outcomes in subjects with Generalized Anxiety Disorder (GAD) in routine medical practice in Spain.

A retrospective, observational new-user cohort study was designed. Electronic medical records linked from medical database of BSA, a health provider in Badalona (Spain), and corresponding community pharmacies dispensing's were extracted for analysis. Participants were beneficiaries aged 18+ years with pharmacy dispensing drug coverage between 2008 and 2012, an ICD-9-CM code for GAD and who initiated treatment with generic-venlafaxine or Vandral®. Assessments included adherence (measured as the medication possession ratio [MPR] and time until discontinuation up to 1 year follow-up), healthcare costs funded by NHS and outcomes (measured as the reduction in severity of anxiety symptoms with the HAM-A scale). Differences were estimated using a general linear model with covariates.

A total of 841 patients (60.7 years, 64% women) were identified: brand-name; 370 (44%) and generic; 471 (56%). The average MPR was 78% in the generic arm and 82% in the brand-name (p=0.047). Median persistence was 8.1 and 8.8 months, respectively (p=0.002). A 16% reduction in the adjusted healthcare cost was observed favoring brand-name; €1,110 vs. €928€; -€182 (p=0.020). Brand-name was associated with higher reduction in symptoms severity: -15.3 (62%) vs. -12.6 (49%) points (p<0.001).

Compared with initiating generic-venlafaxine, patients initiating brand-name venlafaxine were more likely to adhere, had lower NHS funded healthcare costs and showed higher reduction of anxiety severity symptoms in routine clinical practice.

Chronic hepatitis C infection (CHC) represents a public health problem that affects around 3% of population worldwide. Pegylated Interferon-alpha (PegIFN-α) and Ribavirin (RBV) is the recommended treatment reaching about 40–80% of sustained virological response. However, a common treatment side-effect is induced-depression that impairs patient's quality of life and treatment adherence (1,2). This paper showed polymorphisms in HTR1A, NCR1, TPH2 genes as predictive variables of IFN-induced depression.

396 consecutive, euthymic, CHC outpatients treated with PegIFN-α/RBV were included. Patients were assessed at baseline, 4, 12, 24 and 48 weeks of treatment using PHQ and MINI-DSM-IV-R interview to diagnose depression. Survival analysis was performed. in the univariated analysis functions were compared using logrank test. Significative variables (0.1 level) were extracted for the multivariated model, using a Weibull regression model.

The incidence of induced-depression along the treatment was 39.4%. Polimorphisms on HTR1A (P = 0.0104), TPH2 (P = 0.0231) and NRC1 (P = 0.0702) genes predicted IFN-induced depression.

Genes related with serotonine and inflamation system may play an important role in the pathogenesis of IFN-induced depression. Knowledge of predictive variables for IFN-induced depression may help to better manage patients at risk.

Panic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms. The diagnosis frequently is associated to other comorbid axis-I psychiatric disorders, especially depressive disorders. Moreover panic disorder can also be comorbid with axis-II diagnosis of Personality Disorder1(PDs).

The aim of this study was to evaluate the existing comorbidity between current DSM-IV axis I panic disorder with and without co-occurring depression and current DSM-IV axis II PDs.

We review all database from 1987 until January 2012 of all relevant cross-sectional and case-control studies which evaluate the comorbidity between panic disorders and PDs.

We found 97 possible papers, 20 entered in the review. Among patients with a current DSM-IV panic disorder 44.3% [34.6, 54.2] had any PDs; 6.3% [3.1, 10.4] had any cluster A-PDs; 17.9% [12.2, 24.2] any cluster B-PDs, and 34.9% [25.6, 44.7] had any cluster C-PDs. Among patients with a current DSM-IV panic disorder and co-occurring depression 61.8% [44.6, 77.7] had any personality disorder 7.2% [4.4, 10.5] had any cluster A-PDs; 24.0% [17.6, 30.9] any cluster B-PDs, and 38.6% [25.7, 52.2] had any cluster C-PDs.

The comorbidity between Panic disorder and Personality disorders is common. Cluster C-PDs was the most frequent PDs subtype related to panic disorder. Personality disorders were more prevalent among individuals with panic disorder and co-occurring depression. Further evaluations including dimensional and characterial dimensions are needed.Goodwin RD, Brook JS, Cohen P. Panic attacks and the risk of personality disorder. Psychol Med. 2005;35:227-35.

Medical record, general examination, laboratory findings, neuropsychological interview and multidisciplinary consideration are essential to establish differencial diagnosis and correct approach in amnesic episodes.

To describe differences between organic and psychogenic anterograde amnesia.

Single case report and literature review.

A 51-year-old man with only diagnosis of DM I, single, a good relationship with his family, without any personal or familiar psychiatric or neurological history, came to the hospital emergency department brought by his sisters referring disorientation, acute memory loss and mood changes, prevailing indifference to the situation for the last three days. After general exploration, including psychopatological examination and higher brain functions study, we arrived to the conclusion that the patient suffered from anterograde short-term severe amnesia as the only symptom, with evident conservation of autobiographic memory. The family referred as a possible stressor factor his mother's recent transfer to a different city, which had caused constant repeated questions about her location. Given the questionable presentation and trigger we shared the case with the neurologist, who ordered an array of tests to rule out any organic cause (LP, CT, MRI…), obtaining as a final result a diagnosis of limbic encephalitis, treated and effectively solved in two weeks with high-dose glucocorticoids.

Certain features of the symptoms exploration in amnesic episodes such as reiterative questioning about a specific topic, a non-modified autobiography or the absence of a clear traumatic precipitant factor, are essential for a correct approach and may lead the clinic to an organic evaluation.

The authors have not supplied their declaration of competing interest.

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.

To review the incidence, clinical characteristics, diagnosis and treatment of NMS.

We have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.

A literature review of the NMS was performed using the PubMed database.

The frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.

NMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.

The authors have not supplied their declaration of competing interest.

Glucocorticoids are widely prescribed for a variety of diseases and are known to cause neuropsychiatric as well as somatic side effects.

To review the incidence, clinical characteristics, course and treatment of neuropsychiatric effects of glucocorticoids.

We have described the case of a 86-year-old woman. She had no personal and no psychiatric medical history in her family. She presented wrist arthritis requiring high doses of an oral corticoid treatment (prednisona 20 mg/d). After a week, she started with symptoms characterised by persecutory and surveillance delusions. Organicity was ruled out. The patient got a progressive recovery after starting anti-psychotic medication and progressive reduction of the steroid drugs.

We have performed a literature review of the neuropsychiatric complications of glucocorticoids using the PubMed database.

Neuropsychiatric effects of glucocorticoids involve affective, behavioural, and cognitive manifestations. The incidence is variable, between 2 and 60% of patients who receive steroids. Although the effects of glucocorticoids are unpredictable, the administered dose is the most significant risk factor for the development of neuropsychiatric symptoms. Dosage reduction typically results in clinical recovery. Although the limited data on this subject, it is a problem that clinicians face on their regular basis. The administration of anti-psychotics or mood stabilizers may be beneficial in the prevention and treatment of this syndrome.

The neuropsychiatric effects of glucocorticoids are unpredictable and non-specific. More controlled trials are needed in order to perform evidence-based clinical guidelines for the treatment with glucocorticoids and for the prevention of neuropsychiatric manifestations.

The authors have not supplied their declaration of competing interest.

This is the case of a 73 year old woman with a late onset, severe and refractory obsessive-compulsive disorder who experimented a sudden remission after a frustrated suicide attempt.

Our target is to make a reflection about the relation between traumatic closeness to own death and neurosis spontaneous remission.

Patient has been interviewed and her medical record studied.

Patient's psychiatric history shows major depressive disorder, recurrent (ICD 10 CM-F33). Patient is a housewife with primary education. In her psychobiography distinguish a conflictive relationship which probably acted as a trigger for obsessive-compulsive symptoms. These symptoms include obsessive thoughts of contamination, ritual hand washing and avoid contact with others people. In the course of the last 10 years, since the OCD (ICD 10 CM-F42.2) diagnose, the patient has been through a wide therapeutic arsenal, from cognitive-behavioural psychotherapeutic interventions to psychopharmacological treatment, resulting with limited effectiveness. The last treatment was fluoxetine 200 mg (0–0–1) and pregabalin 300 mg (1–0–1). Subsequently, the patient underwent a failed suicide attempt by hanging. After physical recovery, all OCD symptoms had subsided.

Traditionally, literature and philosophy considered catharsis as a purifying experience, and Breuer and Freud introduced this concept in modern psychology as a therapeutic method. More recent authors as Yalom have correlated the closeness to death as a stress factor with radical change in life's perspective and attitude. Although current research presents contradicting data about healing effectiveness through a catharsis processes, this case exposes a clear example of positive outcomes in this assumption.

The authors have not supplied their declaration of competing interest.