Alcoholism has a high prevalence and impacts on morbidity, mortality, life quality, and the economy. Heritability estimates of alcohol dependence are 50-61%. Putative psychological, cultural, and genetic susceptibilities to alcoholism have been identified but understanding of the genetic components is still underdeveloped.

Identify genetic vulnerabilities predisposing individuals to alcoholism and co-morbid psychiatric disorders in the largest study of its kind.

12 centres including 10 trainees are currently collecting blood and clinical samples. Nearly 1700 of 2000 cases of ICD-10/DSM-IV alcohol dependence have been collected; 500 with standardized assessments of alcohol use and comorbdity; and 2000 ancestrally-matched supernormal controls from UCL/collaborators. Genomic DNA will be isolated following standard procedures. Genotyping will be performed using the Affymetrix Gene Chip Human Mapping 1M Array to type up to 1 million single nucleotide polymorphism (SNP) and copy number variant (CNV) markers. Chi-square analysis of allelic association for the alcoholic sample versus controls will occur.

n=65; 57% male; mean age 45years; mean age onset harmful alcohol use 19years; mean age onset withdrawals 32y; mean alcohol intake 21 units; primary depression 27%; secondary depression 49%; antisocial personality disorder 14%. The candidate gene approach in this sample has shown that the GABA receptor B1 (GABRB1) and the tachykinin receptor 1 (TACR1) are involved in genetic susceptibility to alcoholism. The D2 dopamine receptor is next.

Preliminary data suggests high psychiatric comorbidity in a clinical alcohol dependence sample and implicated candidate genes. Next is genomewide analysis of markers, sequencing and biological pathway/systems alterations.

Pervasive Refusal Syndrome (PRS) is a relatively new diagnostic concept, that describes a rare and potentially life threatening condition, in which children refuse to walk.

talk, eat, drink, engage in self care, and take part in day to day activities (Lask et al, 1991).

PRS is not included in any of the psychiatric classification systems (ICD 10, DSM IV), although consensus exists within the literature as to its existence. Lask comments in his paper on Pervasive Refusal Syndrome that he has consulted on only 50 cases worldwide (Lask, 2004).

The authors will share their clinical experience of treating seven new cases of PRS in a Regional CAMHS inpatient hospital. Patients with PRS often require hospital admission for assessment and exclusion of other medical, neurological and psychiatric disorders. However, because of the rarity many medical and psychiatric professionals have little experience of the treatment and rehabilitation required.

The specific MDT management approach necessary to meet the complex needs of patients with PRS will be discussed, as treatment is often counterintuitive, and some approaches can result in deterioration rather than improvement.

In terms of improvement and recovery from the disorder, less is known about long term follow-up, as only a few studies have reported on immediate outcome. The authors have undertaken a long term follow-up (in press) and will discuss issues relating to prognosis.

A specific MDT treatment approach for PRS will be discussed, alongside the clinical decisions and dilemmas involved in following this approach.

First Rank Symptoms (FRS) - a group of intriguing experiences characterized by striking breach of ‘self versus non-self’ boundaries - have had a critical influence on the diagnosis of schizophrenia. Inferior Parietal Lobule is implicated in the pathogenesis of FRS in Schizophrenia. However, the role of Planum Parietale (PP) in the genesis of FRS is yet to be examined.

This first time study (to the best of our knowledge), aims to examine antipsychotic-naïve schizophrenia patients for the effect of FRS status on volume of PP.

In this study we examined the volume of PP in antipsychotic-naïve schizophrenia patients (n = 32; M:F = 16:16) in comparison with age, sex, and handedness matched (as a group) healthy comparison subjects (n = 34; M:F = 16:18) using valid method with good inter-rater reliability.

Female Schizophrenia patients showed significant volume reduction in right PP in comparison with female healthy controls (F = 7.2; p = 0.01). However, male patients did not. There was a significant effect of schneiderian FRS in female patients in that those who had FRS had significantly smaller volume of right PP than healthy controls (F = 3.8; p = 0.03); where those female patients who were FRS negative did not differ. Left PP volume did not differ between patients and controls.

Current study supports previous studies which have implicated the role of parietal lobe in pathogenesis of FRS. Specific role of PP in FRS generation and possible implication of sex differences needs further systematic studies.

Borderline Personality Disorder (BPD) describes pervasive and stable impairments in personal identity and interpersonal functioning with pathological personality traits. Most patients are prescribed multiple psychoactive medications despite none being indicated for BPD. Current evidence proposes long-term, BPD-appropriate psychotherapy as the most efficacious treatment

A residential BPD patient cohort was evaluated to determine whether BPD-focused psychotherapy reduced prescribing and BPD and co-morbid symptom severity

The pattern of psychotropic drug utilization at admission, discharge and one year follow-up was measured. Changes in the utilisation of pharmacotherapy were examined in the context of improvements in BPD and/or co-morbid disorder symptom severity

There were 74 female participants, most with more than one Personality Disorder diagnosis and co-morbid mood disorders. Residential treatment included individual and group psychotherapy for BPD. Self-reported use of psychotropic medications was ascertained at admission (T1); discharge from the program (3 to 6 months; T2), and one year post discharge (T3). The SCID (Structured Clinical Interview for DSM-IV) was used to confirm the BPD diagnosis and associated co-morbid conditions. The Beck Depression Inventory was completed at each time point

A significant reduction in the prescription of psychoactive medications was accompanied by significant decreases in the incidence and severity of self-rated depression as well as clinician assessed personality disorder, including BPD. These were most pronounced 12 months after discharge

Three to six months of BPD-specific psychotherapy provided lasting benefit for a range of mental health problems and reduced prescription medication use

Depression is known to be associated with low serum Brain-Derived Neurotrophic Factor (BDNF) and elevated levels of cortisol. Yoga has been shown to be associated with significant antidepressant effect as well as increase in serum BDNF levels and reduction in serum cortisol levels in these patients.

We examined the association between serum cortisol and BDNF levels in patients with depression who were on treatment with antidepressants, yoga therapy, and both in combination.

Fifty-one consenting drug-naive outpatients (29 males) aged between 18-55 years, diagnosed with Major Depression received antidepressant medication alone (n=15), yoga therapy with (n=18), or without (n=18) concurrent antidepressants. Subjects in the yoga groups practiced a specific Yoga module for three months. Depression was assessed using the Hamilton Depression Rating Scale (HDRS). Serum BDNF & cortisol levels were obtained before and after three months using sandwich ELISA method. The group differences were analyzed using one-way ANOVA. Correlations between Serum BDNF & cortisol levels were analyzed using Pearson's correlation.

Significant negative correlations were observed between baseline BDNF & cortisol levels in the Yoga+Medication group (r=0.569*; P=0.01), and between change in BDNF and cortisol level in the Yoga alone group (r=0.582*; P=0.01). No other significant correlations were found.

There is a significant association between serum cortisol and BDNF levels in patients with depression who underwent Yoga with or without antidepressants. This suggests that Yoga may have stress reduction and neuroplastic effects alone or in combination with medications in depressed patients.

There are a number of good standard practices available for prescribing long acting antipsychotics. Adherence to these guidelines will minimise any harm to the service users.

To compare depot antipsychotic prescribing practice with good standard practice guidelines of BNF, Trust and Maudsley guidelines.

To compare practice with standards in the areas of:

– licensed indication;

– dose/frequency range;

– avoiding poly-pharmacy;

– regular review of clinical and side effects.

Case notes of a randomly selected sample of 30 patients from the depot clinic at the City East Adult Community Mental Health Team Leicester, UK were retrospectively investigated. The data collected was analysed and the results were produced. Compliance with the best practice guidelines was calculated and recommendations made based on the findings.

One hundred percent compliance was noticed in licensed indications and dose/frequency within BNF range. However, 14% patients received poly-pharmacotherapy, 86% had regular outpatient review, but only 46% had review of side effects.

Better quality of documentations by the clinicians, improvised technology to elicit automatic review reminders, introduction of checklist for clinics to include review of all clinically important information, wider dissemination of the findings of this investigation, and re-auditing practice to explore impact of this investigation was recommended.

The authors have not supplied their declaration of competing interest.

The Indian subcontinent is prone to tropical cyclones that used to originate in the North Indian Ocean. Through this study, an inventory of disease outbreaks for the tropical cyclone-affected regions from 2010 to 2018 has been compiled. This inventory is used to assess the success of recent sanitation intervention, Swachh Bharat Mission, also known as the Clean India Mission.

Meteorological parameters from the Indian satellites were used to demarcate the cyclone-affected area. Disease outbreaks and epidemics during the tropical cyclones were compiled from the Integrated Disease Surveillance Program and other relevant sources. The inventory has been used to track the effect of recent sanitation interventions on disease outbreaks.

Districts in the eastern coast of India are frequently affected due to tropical cyclones that have originated from the North Indian Ocean. Infectious diseases like the acute diarrheal diseases, vector-borne diseases, viral fevers, enteric fevers, and food poisoning have recursively occurred during the cyclonic events and persisted up to 2 weeks from the cyclonic episode. The effectiveness of the Clean India Mission is evident during the recent cyclones, Ockhi, Titli, and Gaja, where a significantly lower number of infectious disease outbreaks were recorded.

The Clean India Mission has exhibited positive results on the public health consequences associated with tropical cyclones.

Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients.

A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model.

Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3–0.6%) and 0.05% (95% CI 0.03–0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection.

The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.