Pain is one of the most common complaints reported by patients, universal, disabling and often unspecific as to diagnosis, etiology and physiopathology. It is a complex experience, truly bio-psycho-social in its essence and therefore demanding multidisciplinary assessment and management.

The database of the Modena Consultation Liaison Psychiatry (CLP) Service, operating in a 700-bed University General Hospital and providing an average of 1200 first psychiatric assessments annually, was searched quali-quantitatively to provide relevant examples illustrating the process of diagnosis and management of chronic pain: specifically, collaborations with the headache outpatient clinic, rheumatology and onco-ematology were analyzed and compared.

In the assessment and management of pain in a CLP context, the following aspects are particularly relevant: 1) need to include systematic, standardized assessment of pain (by means of simple instruments like VAS); 2) psycho-pharmaceutical issues, i.e. related to abuse and addiction to pain-killers or anesthetic actions of psychiatric medications; 3) contextualization of pain within patients’ life- and health-history, i.e. the meaning of pain in the migrant patient; 4) the role of pain in the agitated patient with delirium/dementia.

CLP and psychosomatic medicine play a crucial role in the management of patients with chronic pain, on many different levels, i.e. psychotherapeutic understanding of pain; research on neurobiology; integration and coordination of multidisciplinary care.

Lack of insight in schizophrenia is frequently associated with deficits in self-assessment of cognitive and functional abilities, as well as quality of life outcomes.

The aim of this analysis was to evaluate the impact of treatment-related improvement in illness awareness on changes in cognition and functional outcomes in a double-blind, controlled study.

Clinically unstable patients with schizophrenia (N=488) were randomized to once-daily, fixed dose treatment with lurasidone 80 mg (LUR 80), lurasidone 160 mg (LUR 160), quetiapine XR 600 mg (QXR) or placebo (PBO), followed by a 12-month, double-blind extension. Impairment of insight (G12 ‘lack of judgment and insight’), cognitive performance, quality of well-being (QWB scale), and UPSA-B were assessed at baseline, week-6 and month-6 of extension (32 weeks). Mixed effects model was applied.

PANSS insight scores were significantly improved for all treatment groups compared to placebo after 6 weeks. Improvement in insight at week-32 was significantly greater in subjects treated with lurasidone compared with quetiapine XR. Improved insight at week-6 was a significant mediator for the effect of LUR160 (vs. placebo) on neurocognitive composite score (p<0.05), UPSA-B total score (p<0.05), and QWB (p<0.05) at week-6. Improved insight was significantly associated with increase in UPSA-B score and health-related quality of life at weeks 19 and 32.

Improvement in insight at week-32 was significantly greater in subjects treated with lurasidone compared with quetiapine XR. Our findings suggest treatment-related improvement in illness awareness had significant impact on cognition and functional outcomes in a doubleblind, controlled study.

Antipsychotic long-acting injections have been a great progress in the management of mental disorders and have improved the adherence to treatment. Paliperidone palmitate permits once a month administration, has a good antipsychotic power, is well tolerated and has a few adverse affects.

We want to study wether there is a reduction in the drop out and admissions in hospital rates.

We take all patients in treatment with paliperidone palmitate from commercialization of the product two years ago (n=70), at two community mental health center in Malaga, Spain. We are going to measure the following variables: age, gender, average dosage, presence or not of politherapy with other antipsychotcs, time in treatment, diagnosis, attitude towards medication (using Drug Attitudes Inventory –DAI-), drop out and its cause and number of admissions before and after treatment with paliperidone palmitate.

We are analysing data. Up to date we have the following results: n=70; 65% male, 35% female; average 38,2 years, most of them in politherapy; average 339 days in treatment: the majority of patients has received the diagnosis of schizophrenia, although there are other diagnosis like bipolar disorder, schizoaffective disorder, personality disorder and substance abuse disorder. We have observed a reduction of medication drop out and number of admissions, but it has not been measured yet.

Our group consider (with the preliminary results) that paliperidone palmitate involves an advance in the treatment of schizophrenia and other mental disorders, a reduction of number of admissions and an improvement of adherence.

S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.

Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).

At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.

At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.

FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.

An aging world population provides challenges for diagnostics within the field of geriatric psychiatry.

The Memory Diagnostic System(MDS) is a computerized cognitive test instrument developed for the detection of amnestic mild cognitive impairment(aMCI) in Korea. In current study, its diagnostic utility for application within Korean clinical practice was evaluated.

This study was conducted to evaluate the concurrent and discriminant validity of computerized verbal and visuospatial memory tests of the MDS.

To determine the concurrent validity, we recruited normally aging individuals and conducted a correlation analysis between these participants’ MDS scores and their scores on well-known measures used to assess each component construct: the Korean Auditory Verbal Learning Test (K-AVLT) and the Korean Rey Complex Figure Test (K-CFT). We also evaluated aMCI patients in comparison to healthy controls using the MDS as a screening instrument.

Correlations between immediate recall, delayed recall, and delayed recognition scores on the computerized verbal memory test and the corresponding scores on the K-AVLT were 0.74, 0.61, and 0.50, respectively (p<0.01, n=30). The correlation between recognition scores (as measured by the computerized visuospatial memory test) and recall scores (as measured by the K-CFT) was 0.48 (immediate), 0.48 (delayed; p<0.01, n=30). The MDS was also useful for determining differential diagnoses between aMCI patients and healthy controls, suggesting the discriminant validity of the MDS.

The MDS is a useful instrument for discriminating between aMCI cases and healthy controls within clinical practice.

Executive function is a comprehensive measure encompassing attention shifting and processing speed; the effect of aging on memory appears to be mediated by executive function.

The computerized Korean version of the Trail Making Test(TMT) is a recently developed cognitive test instrument. Its diagnostic utility for application within clinical practice was evaluated in this study.

This study was conducted to evaluate the concurrent and discriminant validity of the computerized Korean version of the TMT.

The original version of the TMT was modified for the computerized version. In the computerized version of the TMT-B, letters from the Korean alphabet (the original targets) were replaced by lyrics from the Korean national anthem. To determine the concurrent validity of the new measure, we recruited normally aging individuals and conducted a correlation analysis between these participants’ scores on the computerized version of the TMT and their scores on the original version. To determine the discriminant validity of the computerized version of the TMT, we recruited subjects from an inpatient memory clinic who showed executive function decline.

The correlations between participants’ scores on the new measures and those obtained from original versions of the TMT-A and TMT-B were 0.58 and 0.64, respectively (p<0.01, n=30). The computerized version of the TMT was also useful for determining differential diagnoses between patients with executive functioning problems and healthy controls.

The computerized version of the TMT is a useful instrument for discriminating between patients with executive functioning problems and healthy controls within clinical practice.

Bipolar disorder type II(BDII) has a prevalence of about 5% of the population according to different studies(1). There is evidence that the diagnosis of bipolar disorder patients may be delayed in 8 to 10 years, and this is especially relevant in BDII, where hypomania is often overlooked (2). The HCL-32 is a widely used and reliable instrument for the detection of previous hypomanic episodes and was validated in several languages, including Spanish (3). The massive use of internet and new technologies, may help to make this tool available to a greater extend of the population and could help detect even more cases. Accordingly, we evaluated the online version of the HCL-32.

To evaluate the validity and reliability of the HCL-32 online Spanish version.

We recruited 110 consecutive outpatients with different diagnosis, who agreed to participate and signed an informed consent. They were asked to complete a paper version(Pv)of HCL-32 in addition to an online version(Ov) sent by email within two weeks. The results were analyzed using SPSS v21.

The HCL32 Pv showed a high internal consistency as well as the Ov(Cronbach's α, 0,91 and 0,90 respectively). The total score correlation between both versions was high(0,94, p<0,001) and there were no mean score significant differences. All Item-scale's correlation were significant.

The online Spanish version of the HCL-32 for the screening of hypomanic episodes has the same good psychometric properties as the paper version, which makes it suitable to be available to more people through Internet.

Yerba mate(ilex paraguariensis(IP))is a plant widely consumed in South America as a hot(mate)or cold infusion beverage(tereré). During the last years, there was an increasing interest in its health properties supported by a growing scientific evidence. These studies showed that the IP could have hepatoprotective, hypocholesterolemic, diuretic and antioxidant properties. Furthermore it showed to be a nervous system stimulant and protectant(1). Recently, there were reports about its invitro potential to inhibit the Monoaminooxidase(MAO) which can have effects on mood state(2).

Exploratory research to study possible associations between the use of IP and mood symptoms.

An observational cross-sectional study was conducted by an online survey in paraguayan population through an invitation. The survey collected data information about sociodemographics conditions, substance use(including IP), Spielberg's State-Trait Anxiety Inventory and PHQ-9 scale for depressive symptoms. A descriptive and multiple lineal regression analysis of the data was performed.

300 subjects accepted the invitation and information was obtained of about 76% of them. The sample mean age(SD) was 27(7,4), most of them females(61,6%)and with universitary studies(66,1%). The 86% of the sample consumed IP regularly and 56% daily. Only a 3,5% reported previous psychiatric history. A significant relationship was observed between the use of IP and daily alcohol(p=0,022). No relevant associations were found concerning IP use and anxiety trait-state or depressive symptoms after adjusting for the use of coffee, tea, alcohol and others sociodemographic variables.

No significant associations were found in the sample studied between the use of IP and state-trait anxiety or depressive symptoms. Although, given the frequency of its use, the association with alcohol consumption and its potential clinical applications, more and bigger studies might be necessary.

To evaluate the association between ADHD and substance-related disorder (SRD) with and without depression, anxiety, conduct disorder and oppositional defiant disorder (CD/ODD) by age 19 years in a population-based birth cohort.

Among 5718 children in a population-based birth cohort, 343 ADHD cases and 712 age-sex matched non-ADHD controls were identified in a previous study employing medical and school records. Psychiatric diagnoses were abstracted from the medical records and collapsed into the 10 categories based on DSM-IV. The association between ADHD case status and SRD was summarized by hazard ratios (HR) and corresponding 95% CI estimated from a Cox proportional hazards model. The effects of three psychiatric disorders (depression, anxiety, CD/ODD) were evaluated separately by considering each as a time-dependent covariate in a Cox regression model.

ADHD was significantly associated with an increased risk of SRD (HR=3.70, 95% CI 2.51-5.46) by age 19 years. This association was observed in both boys and girls (HR=3.69 and 3.95, respectively). Among the boys without depression, ADHD was associated with four-fold increased risk of SRD, while the association was not present among boys with depression (HR= 4.07 vs. 0.98). Likewise, the association (HR) between ADHD case status and SRD was 0.78 and 3.77, respectively, among boys with and without CD/ODD.

The adverse effect of ADHD on SRD is more apparent for those without depression and conduct problems than it is for those with such comorbidities.

The use of psychotherapeutic strategies in people with intellectual disabilities (ID) is at different stages in various countries in Europe. The UK and Ireland use special modified psychotherapeutic programmes for people with ID but there appears not to be many resources in psychotherapy in other European countries. The presentation considers the different psychotherapeutic approaches published in the scientific literature within the last ten years.

To ascertain the use of psychotherapy in people with intellectual disabilities in Europe.

‘Psychotherapy‘, ‘intellectual‘, ‘developemental‘, and ‘disabilities’ were chosen as keywords in searching the databases. Abstracts of publications were grouped in to psychotherapy models, Cognitive Behavioural Therapy, Systemic Psychotherapy, Analytic Psychotherapy. Sub-groups included other models, for example group psychotherapy. The formats of publications were defined as case report, structured assessment, analysis of therapeutic methods

The database research revealed nearly 300 publications on psychotherapy in people with ID over a ten-year period. It supports the assertion of the use of psychotherapy in ID. Most publications reported on work undertaken in the United Kingdom. The presentation gives more detailed information about the relationship between cognitive behavioural and analytic-oriented strategies, intervention type and study characteristics.

There is currently a good evidence base on the use of psychotherapeutic methods in working with people with ID. Much of it is in the English language literature. There is potential for the development of models to be applied in ID. The use of psychotherapeutic approaches in ID needs to be encouraged across healthcare systems in Europe.

Aripiprazole is a new dopaminergic agent and has been reported to be clinically useful as an antipsychotic drug with fewer extrapyramidal signs (EPS) and metabolic disturbances. There are some case reports concerning EPS which include acute dystonia, tardive dyskinesia and parkinsonism with aripiprazole. We report on our experience in treating a patient with Bipolar disorder developed acute dystonia and tremor.

The patient was a 53-year-old male who has been diagnosed with Bipolar disorder for 22 years and hospitalized 10 times.

He was not use antipsychotics in few months but he was in remission. Aripiprazole, 5 mg daily, was initiated for maintenance treatment. The dosage was increased to 15 mg daily five days later. The patient was reported neck and arm movements approximately six days after the initiation of aripiprazole.

He consulted with neurology and internal medicine. Standart treatment strategies for EPS were used. Initially, biperiden HCL 2 mg daily was administered orally every 12 hours, the patient's movements didn’t resolved following biperiden. Biperiden was subsequently discontinued secondary to its lack of efficacy and lorazepam 1 mg daily was administered. In addition, propranolol 40 mg daily was used for preventing tremor. There was no improvement. Two weeks later, Aripiprazol was stopped and olanzapine was started. Dystonia was resolved following olanzapine, however tremor was not improved, propranolol 40 mg daily was continued.

We reported that, the possibility of developing EPS is not away even if a drug is safe, such as aripiprazole.

to find an association between substance use and risky sexual behavior and to find association between personality traits and risky sexual behavior among substance users.

The study was applied on 100 subjects classified into 2 groups: cases and control groups. Group 1(cases) 50 substance dependence patients are chosen sequentially from the addiction department of the psychiatry and addiction hospital in kasr-alainy and group 2 (controls) included 50 normal individuals, matched for age, sex and socioeconomic status. All participants are men, range from 18 to 40 years, were taking substances for at least 6 months, and all of them could read and write. Those with a comorbid axis I diagnosis were excluded from the study. Both groups were subjected to a full psychiatric sheet, sex risk subscale of risk assessment battery (RAB), and the Eysenck personality questionnaire (EPQ). Addiction severity index is applied on cases, urine sampling was done using urine drug screening strips and a laboratory test was done for HIV and hepatitis C virus detection.

no statistically significant difference between the 2 groups regards age, education, employment and social status. The most prevalent substance is Tramadol (96%) followed by Cannabis (72%) and Herion (58 %). Hepatitis C virus is detected in (16 %) of cases, non of them have HIV infection. There were statistically significant difference in extroversion and neuroticism between cases and controls. There were a statistically significant difference between cases and controls in the sex risk subscale of RAB.There was a significant correlation between psychotocism and criminality subscales of (EPQ) and the sex risk subscale of RAB.

Using opioid for recreational purposes has a very long history in Iran. Social influence is a useful framework in understanding how the social environment affects the individual's behavioral choices to use drugs.

This study aimed to compare coping styles between opioid dependent and healthy controls.

This study compared opioid dependent individuals entering methadone maintenance treatment program (n=150) with healthy controls (n= 225) on measures of coping strategies with Jalowiec Coping Scale (JCS) and some socioeconomic factors. JCS consists of 40 coping behaviors, 15 problem focused and 25 affective focused items. Analysis of variances (ANOVA), multivariate linear regression and binary logistic regression were conducted.

Compared to controls, opioid dependent subjects reported less use of problem focused coping (P = 0.04). Control group were significantly more single than opioid dependent group (76.4% versus 23.6%; P = 0.01). There was a significant relation between opioid dependence with cigarette smoking (P < 0.001), lower education (P = 0.006), being employed (P < 0.001), having children (P < 0.001). Also, cigarette smokers had a significantly lower problem focused coping scale in comparing with non smokers in general (P < 0.001).

Opioid dependent subjects showed more vulnerable toward the stresses of life such as marriage, having children and a job. Educational programs to improve problem solving and coping skills can be helpful to reduce the rate of dependency to opioid and cigarette.

This year marks the 80th anniversary of the professional withdrawal (at the end of 1933) of Gustav Kolb (1870–1938). He is considered the founder of the ‘Erlangen System’ of open care.

Nearly 80 years after Gustav Kolb was forced to retire (1st March 1934), the poster pays tribute to Gustav Kolb's ‘Life's work’, by delineating the formation, active period and the fall of his ‘Erlangen System’ in its historical context.

Relevant archive materials and secondary literature were assessed.

Beginning in 1914, Gustav Kolb, as Director of the psychiatric facility in Erlangen (1911–1933) introduced care of the emotionally ill in theirown families. In 1930, 4,200 of the 770,000 residents in a catchment area covering about 3,200 square kilometers were being treated in open care. The ‘Erlangen System’ was the largest organization of its kind in Germany. Kolb opposed the national-socialist health politics, withdrew professionally in 1933 and died 5 years later.

Gustav Kolb's organizational thoroughness, with its creation of a central register of people under open care in the Erlangen System, provided considerable biogenetic information. Tragically, this was abused as an important source in carrying out the national-socialist law for prevention of genetically-impaired offspring (14.07.1933).

Individual efforts to reestablish open care facilities after 1945 were not implemented. It was not until during the sociopsychiatric movement of the 1960s that Kolb's concept could achieve a Renaissance, although it was unnamed and unrecognized at the time.

Manifestation of schizophrenia significant depends on whether the impact factors that trigger the disease on individual. The influence of protective factors can reduce the risk manifestation of schizophrenia and even improve clinical presentation.

To study the impact environmental factors, in risk and protective role, on manifestation and clinical presentation of schizophrenia spectrum disorders (F 20 - F 29).

We recruited 108 cases (50 females; 58 males) of schizophrenia spectrum disorders (F20 - F 29) aged 17 to 35 years. and control was included 46 risk group persons, who had genetic predisposition, but were not ill. The relatives and persons were interviewed for perinatal pathology and bird, child and adolescent history factors.

Among the main group environmental factors were predominantly: maternal age at birth of 40 years 20.37 % (N = 22), transferred diseases during mother pregnancy 11.1% (N = 12), the availability of social deprivation, child abuse and psychological trauma in early childhood 38.9% (N=42), consuming alcohol and cannabis in adolescence 19.4% (N=21). In addition, psychological trauma in childhood and using psychoactive substances are correlated with early social disadaptation in schizophrenia. On the other hand, the projective factors were high levels of intellect and social functioning 60.9% (N = 28), emotional support from parents 87% (n = 40), excluding the use of toxic substances 89.1% (N = 41).

Therefore, lifestyle changes that encourage minimized exposure to known environmental factors may reduce the risk for schizophrenia.