In recent years, special attention has been paid to the quality of life in dual psychotic patients.

To study quality of life in psychotic patients with co-occurring substance use recently treated with long-acting injectable paliperidone palmitate (PPLAI) in monotherapy.

An open-label, non-interventional, observational study was carried out in 42 dual psychotic outpatients who were recently treated with PPLAI in monotherapy. At baseline, main demographic and clinical variables were recorded. The Health Status Questionnaire (SF-36) was assessed at the time of the study inclusion, and after 3 and 6 months. Thirty-five patients completed the study.

81% were men, and mean age was 39 years. 31% had an alcohol dependence disorder, 26% opiates, 24% cocaine, 14% cannabis, and 100% nicotine dependence. 95% had co-dependence substance use disorders. 38% per cent were diagnosed as having an unspecified psychosis, 36% schizophrenia, 57% Axis II and 55% III disorders. 29% were previously treated with oral antipsychotics, and 71% received long-acting injectable risperidone (RLAI). 83% were treated with other non-psychopharmacological drugs. After 6 months of treatment, higher scores were found in the following SF-36 items: Vitality (31 vs.77), social functioning (48 vs.85), mental health (49 vs 78), health subjective perception (45 vs.70), and health improvement (65 vs.87). Transaminase levels did not change after treatment. Mean PPLAI dosage at baseline: 111.18 mg; mean dosage at 6 months: 132.86.

High psychopathological and organic comorbidity was found. Quality of life improved after 6 months of treatment. PPLAI 100 mg was the most common prescribed dosage.

The problem of adolescent suicide is becoming essential both in urban areas and in the countryside. Outpatient and inpatient service of treatment and preventive measures supported by healthcare system and relevant authority instructions need to be created.

All cases of self-destructive behavior in the biggest state mental hospital of Moscow in 2012 have been analyzed and classified. Gender, age, variants of suicidal behavior, social and family status of patients, clinical peculiarities of comorbid conditions, methods of treatment and rehabilitation have been studied.

36% of urgently hospitalized patients have revealed suicidal behavior. Self-destructive behavior was associated with affective instability, histrionic personality traits, egocentric and asocial behavior. Most part of the patients had also different psychosocial problems. Depressive disorders have been revealed in 28% people with suicidal behavior.

Due to the multiplicity of predisposing factors of self-destructive behavior the diagnostic system of suicidal risk has to be modernized based on specific features of adolescents. Medical and legal standards of mental health care for these patients including civil commitment should be more precise. The terms, ways and methods of medical assistance and rehabilitation of patients in post-suicide period have to be improved.

The use of atypical antipsychotics (SGAs) is hindered by the frequent occurrence of metabolic side effects, resulting in worsened quality of life and greater mortality as a result of increased risk factors for metabolic syndrome [2] [3] in schizophrenic patients compared with general population [1].

To establish the relationship between antipsychotic efficacy and side effects, especially the impact of various antipsychotics on metabolic parameters after 20-year treatment with atypical (SGAs) and typical antipsychotics (FGAs)

To identify advantages and disvantages of SGAs in terms of quality of life, costs and benefits.

Forty-five psychiatric inpatients diagnosed with schizophrenia or schizoaffective disorder (DSM-IV-TR diagnosis), treated with typical (haloperidol) and atypical (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) antipyschotics, were studied retrospectively during 20 years. We use data at baseline, follow-up: 1, 5, 10, 20 years. Rating scales administered: CGI-I, SAPS, SANS, PANSS.

The results have underlined a statistically significant variations(p value <.05) of the lipidic and glicidic profile. We have also found a reduction of the recorded values at endpoint vs baseline in aripiprazole and haloperidol groups. The glicemic values, were not statistically different in quetiapine, aripiprazole, risperidone and haloperidol groups. No significant statistical variations were observed in complete blood count, electrocardiogram, liver enzymes blood pressure and body weight.

The results confirm studies on efficacy and effectiveness of both SGAs and FGAs, and their influence on metabolic profile and other biological parameters. These data can represent a’real world’ study in patients observed during our daily out-patient practice.

Agomelatine, a melatonergic agonist and 5-HT2c-antagonist, has demonstrated antidepressant efficacy in clinical trials.

Aim of VIVRE was to document treatment with agomelatine non-interventionally in daily-practice over 3 months.

Evaluation of the effectiveness of agomelatine on depressive symptoms, anxiety symptoms within depression, social functioning and tolerability in naturalistic setting.

1891 outpatients aged>18 years treated with agomelatine 25-50mg once daily were observed by 616 German psychiatrists and specialized practitioners over 3 months. Antidepressant effectiveness was evaluated by Clinical-Global-Impression (CGI) by doctors and Patient- Global-Impression (PGI) by patients, effects on social functioning by Sheehan-Disability-Scale (SDS), anxiety symptoms within depression by COVI-Anxiety-Scale (COVI). ADRs were documented at every visit.

According to CGI, 30.3% had responded after 2 weeks, 82.1% at study-end (CGI-I≤2), and 39.9% were classified as remitters (CGIS≤ 2) by physicians after 3 months. Anxiety symptoms within depression (total score) improved in 92.9% of patients. Patients documented response (PGI-I≤2) in 16.4% after 2 weeks and 73.1% at study-end, remission (PGI-C≤2) in 47.6% after 12 weeks. SDS-total-score decreased from 20.4 at baseline to 7.7 after 12 weeks corresponding improvement of functional impairment for 94.5% of patients. Improvement in domains work/school, social life and family-life/home were observed for 91.8%, 91.1% and 91.9% respectively. Adverse drug reactions (mainly headache, nausea, dizziness) were reported for 2.6% of patients, in 0.5% (n=10) ALT/AST>3ULN were documented.

Antidepressant effectiveness of agomelatine, improvement of anxiety symptoms within depression as well as social and emotional functioning and good tolerability were observed in daily-practice over 3 months.

Up to today, there are experimental evidences pointing out the usefulness of cognitive-behavioral interventions for the treatment of children with Attention Deficit / Hyperactivity Disorder (ADHD), including the Parent Training, classified as’empirically validated treatment’ and mainly suitable to build specific parenting skills (Pelham, Wheeler e Chronis, 1998; SINPIA, 2006).

This study examines a process of Parent Training carried out with a group of parents of children with ADHD.

Improving the parenting knowledge and skills in the strategies of management of children's problematic behaviors; encouraging the expression of emotions and managing parental stress.

The training takes place in 12 meetings, the group is formed by 4 couples of parents of children diagnosed with ADHD.

Evaluation of the effectiveness of the treatment: subjective criterion, concerning the degree of satisfaction expressed by parents in using the educational intervention techniques, learned and experienced in the group work, and objective criterion through the use of standardized pre-and post-treatment assessment tools: Parent Stress Index (PSI -RR Abidin, 2008) and Alabama Parent Questionnaire (APQ - Frick, 1991).

Acquisition of a specific knowledge of the Attention Deficit Disorder / Hyperactivity, of the strategies to manage the child's behavior, development of a parental attitude oriented toward problem-solving, becoming thus positive models of behavior, in order to promote family relationships.

This intervention adds to the management of the problems related to ADHD, the support and the management of the emotional aspects related to parental competence.

Family psychoeducation is an effective intervention extensively used in the treatment of mental disorders.

To examine the efficacy of group psychoeducation in anxious and depressive symptoms in relatives of patients with addictive behaviours. To investigate satisfaction levels in relatives.

Seventy relatives of 53 outpatients were included into group psychoeducation between January and July 2012. This 8 session structured psychoeducational group is designed as follows: 1.5 hours every 3 weeks. To assess psychopathological symptoms, we used the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), at baseline and at the end of the follow-up period. Family satisfaction levels were assessed by using the Visual Analogue Scale (VAS).

59% of relatives were men, and mean age was 55 years. 45% of the patients had a cocaine dependence disorder, 34% alcohol dependence disorder, and 93% co-dependence disorders. 74% had a dual diagnosis (Psychosis, affective disorders, or personality disorders). 90% had psychosocial stress (60% moderate or severe). Anxious symptoms were found in 30% of the relatives, being psychic anxiety most common in women than in men. Furthermore, depressive symptoms were found in 30% of relatives (mild:30%; moderate:25%, severe:15%). Women were more likely to have moderate-severe depression and men mild-depression disorders. After 8 sessions, mean satisfaction levels assessed by EVA Scale were 9.2

Statistically significant gender differences in anxious and depressive symptoms were found in relatives. Satisfaction levels were higher than expected, and a significant reduction in anxiety and depression was found after the group psychoeducation.

Treatment non-adherence is a major factor contributing to poor clinical outcomes in mental health disorders1(MHD). Patient adherence to treatment is likely to be influenced by a complex interaction of treatment, patient, and clinician factors. This compels the clinician to undertake a thorough clinical assessment with each patient to enhance the likelihood of engagement in treatment and develop strategies to improve treatment adherence2.

a. to assess the main strategies used by mental healthcare professional (MHP);b. to evaluate beliefs that difficult to implement strategies to enhance adherence to treatment.

The study explored the strategies used by MHP and their beliefs about patients with MHD.

We used the Difficulties Implementing Adherence Strategies3(DIAS) and Medication Alliance Beliefs Questionnaire4(MABQ). In DIAS, the participants were asked to rate how often they had difficulties using each of the 33 strategies with consumers who were nonadherent. The 22- item MABQ was used to assess clinician attitudes towards non-adherence.

A convenience sample of forty-five MHP working in a variety of settings is being collected. The results demonstrate that only 48.9% of MHP use strategies of adherence on a regular basis and the most used, according DIAS, is ’Discussing with the patient the link between disruptions in their life and the need to take medication’(n=45;often:53,3% and always:26,3%).

A vast literature has been developed on strategies to enhance patient adherence to treatment 5. This study also established the utility of the DIAS and MABQ to facilitate future work in this area-in particular, the identification of strategies and specific attitudes that might form barriers to the implementation of adherence strategies.

Healthy first-degree relatives to patients with depression have increased risk for developing depression and show brain structure and response anomalies in regions responsible for processing rewards. However, inherent behavioral and neural abnormalities related to valuebased decision making have not been explored in these individuals.

To address this, in a functional MRI study we investigated healthy mono- or dizygotic twins with or without a co-twin history of depression (high risk: n=36 and low-risk: n=31, respectively). Using SPSS10 and SPM8 statistical packages we compared behavioral and neural responses to gambling choices of twins at increased familial risk with twins without familial risk for depression.

We found no differences in risk choice behavior between high- and low-risk twins. Across groups, increased behavioral risk correlated with response in anterior and posterior cingulate cortex, ventral striatum, insula and raphe nucleus, as expected. Compared with twins at low risk, high-risk twins showed increased activation of left insula with increasingly risky choices (Fig1).

Healthy individuals at high hereditary risk for depression show elevated activity in left insula when making high-risk choices, region previously found to be causally involved in value-based decision-making by promoting risk taking. This might indicate a higher neural effort in these individuals during risk taking.

Suicide is a leading cause of death worldwide and a top leading cause of death among youths. Since younger age groups spend more time with internet-based applications, chances and risks of health forums have been scrutinized. It has been assumed that the use of health forums increases suicidality.

This study aims to disentangle the presumed causality between the use of online health forums and suicidality.

A German representative telephone survey and a two-wave online panel survey with same question wording have been concurrently conducted in 2013. Both surveys included questions on suicidality (Pöldinger, 1968) and internet-based health forums use.

The German representative cross-sectional data show significant positive correlations between suicidality and online health forum use, especially among younger age groups (Table 1). Using a large-size online access panel, we estimated an autoregressive model that reveals a positive cross-lagged effect of suicidality on internet-based health forum use one month later (Figure 1).

Despite the wide-spread notion that online health forums can increase suicidality our data shows an inverse effect. These results point to the preventive potential of accessible and helpful information in online health forums.

Table 1

Bivariate correlations between suicidality and internet-based health forum use for different age groups in a German representative survey.

Figure. 1

Higher suicidality (t0) influences the use of internet-based health forums or support groups one month later (t1).

Participants (n = 1319) were recruited from an online access panel (soSci Panel).

Suicidality was measured by the suicidality scale suggested by Poldinger (1968) and consisted of 16 yes/no questions. Internet-based health forum or support group use was measured on a 5-point Likert-like scale ranging from 1 “(almost) never” to 5 “(almost) every day”. For all scales, higher scores are indicative of more extreme responding in the direction of the construct assessed.

Coefficients are standardized coefficients.

p<.O5. **p<.01. ***p<.001 = 8.50

X2= 1, p <.01 ; = .075; SRMR = . 015; CFI= . 99; 71/=.96

The phase 3 programme investigating nalmefene for reduction of alcohol consumption in alcohol dependent patients comprised two 6-month studies (ESENSE1 and 2) and one 12-month study (SENSE), conducted in 19 European countries.

To investigate the tolerability and safety of as-needed use of 18 mg nalmefene.

1997 patients with a diagnosis of alcohol dependence were recruited. Adverse events (AEs) and other safety variables were recorded.

797 patients in the placebo group and 1144 patients in the nalmefene group received study medication; patients took study medication on 62% and 51% of the days, respectively. The incidence of AEs was high in both the placebo and the nalmefene group (62.7% and 74.7%, respectively), and was not dependent on the drinking risk level at baseline. While mostly mild or moderate, these AEs did lead to dropout in some patients: 47 patients (6%) in the placebo group and 149 patients (13%) in the nalmefene group. Patients continuing in the studies seemed to develop tolerance with time for the most frequent AEs. Median time to event and median duration of these AEs were generally shorter for nalmefene than for placebo (many started after 1st dose). 35 patients (4.4%) in the placebo group and 57 patients (5.0%) in the nalmefene group had serious adverse events (SAEs). The majority of SAEs were not related to study medication and no apparent trends with respect to overall incidence or distribution across organ systems were noted.

Nalmefene was well-tolerated and no major safety issues were identified.

Group psychoeducation is an effective psychotherapy in the treatment of addictive behaviours.

To evaluate the efficacy of group psychoeducation on quality of life in relatives of dual diagnosed patients.

To investigate the impact of group psychoeducation on treatment compliance.

A case-control study was conducted between January 2012 and July 2012. Case group: seventy relatives and 53 patients included into an 8 session systematic psychoeducational group designed as follows: 1.5 hours every 3 weeks. The control group was formed by 53 patients who did not participate in psychoeducation during the same period. To assess quality of life in relatives, we used the Health Status Questionnaire (SF-36). Attendance rates for appointments were recorded in patients from both groups.

At baseline, relatives had poor outcomes in quality of life (Vitality: 49.8; emotional role: 49.3; mental health: 51.8, and general health perception: 54.9). Psychoeducated, as compared to control group relatives, had significantly better outcomes in quality of life (Vitality 71.0; emotional role 82.6; mental health 72.6, and general health perception 66.5). When compared to the control group, mean psychiatric appointments were higher in patients whose relatives were psychoeducated (8.2 vs.3.6).

Our findings suggest that psychoeducation can improve quality of life in relatives of patients with addictive behaviours. Attendance rates for appointments were higher in patients whose relatives were psychoeducated.

Disturbed body image perception is a common feature in eating disorders. To further investigate the etiology of these disorders, we have to study in depth body image perception during puberty in non clinical samples

To analyze the changes and evolution of body image perception in boys and girls from age 10 to 14.

Emotional, cognitive and behavioral aspects of the body image were evaluated in order to determine the changes that take place during these years and if there were differences between genders. The sample consisted in one hundred school 10-years old boys and girls of the general population of Extremadura Community, who were followed-up for 4 years. Assessment tools were: BPSS, BSQ, DST, BIAQ and EDI. For the statistic analysis, repeated measures ANOVA was used.

Between 10 and 13 years body image perception improves in boys and worsens in girls. From age 11 and after these differences start to be statistically significant between boys and girls, the satisfaction with body image increasing in boys and remaing low in girls.

Girls show more problems with body image perception than boys during these years. Further investigations during these period of life would be necessary.

Cannabis is one of the most commonly used illegal drugs worldwide. Cannabis use has been frequently associated with major affective disorders, and suicidal behavior.

We aimed to critically review the current literature concerning the possible association between cannabis use, major affective disorders and suicidal behavior. Early warning signs of affective conditions and suicidality in young adolescents who were cannabis users have been investigated providing a rationale for the importance of their early detection and assessment.

We performed a detailed Pubmed/Medline, and ScienceDirect search to identify all papers and book chapters focusing on the association between cannabis use, major affective disorders, and suicidal behavior during the period between 1980 and 2013.

Early warning signs of emerging affective disorders include behavioral, emotional and cognitive abnormalities. Hopelessness may be considered as a specific risk factor of negative outcome and suicidal behavior among depressed individuals with a history of early cannabis use. Vulnerable subgroups of individuals include those who were heavy users of cannabis during adolescence, and those with past suicidal attempts or current hopelessness. Socio-demographic, parental and individual risk factors for both suicide risk and early cannabis are discussed. Overall, cannabis use may be considered a risk factor for developing both psychiatric disorders and suicidal behavior.

Preventive programs should be directed at reducing cannabis use among young adolescents, as well as at preventing/treating modifiable factors such as adolescent hopelessness. The active engagement of patients in the early phases of affective disturbances is crucial to prevent psychosocial impairment.

Parkinson's disease (PD), PD dementia (PDD) and dementia with Lewy body (DLB), collectively termed Lewy body disease (LBD), characterize an array of emotional, neurobehavioral and cognitive symptoms. Pure psychiatric presentation (PPP) of LBD is the fourth subtype of LBD in which psychiatric symptoms lasted for many years in the absence of neurological disturbance.

The aim of this study is to localize the PPP and its clinical characteristics in subjects with low uptake of myocardial metaiodobenzylguanidine (MIBG) study.

Sixty MIBG-verified patients (28 women and 32 men) were grouped into three psychiatric pictures; depression (group D: 27 patients), isolated visual hallucinations (group V: 16 patients) and psychotic picture (group P: 17 patients). Fifty six cases were examined with cerebral single photon emission tomography study. Thirty-seven cases had hypoperfusion regions and 19 cases showed no abnormality. Final diagnoses of PD, PDD, DLB and PPP were evaluated with an aid of DSM-IV-TR, UPDRS part III, the Hoehn and Yahr Scale, MMSE and the movement disorder society task force diagnostic criteria.

Three clusters, PDD and Group P, DLB and Group V, and Group D and PPP-PD were found significantly with correspondence analysis. UPDRS average score showed negative correlation with average MMSE scores. All patients with PPP and majority of patients with PD featured depression.

PPP subjects are considered to be incidental LBD or depression of pre-motor PD. Psychotic parkinsonian features contributed highly to dementia of LBD, and visual hallucination was closely associated with DLB.

Evidence suggests that inflammatory mediators may play a critical role in the pathophysiology of major depression and suicidal behavior. Immunological differences have been found in patients with affective disorders and suicidal behavior. Especially, increased levels of pro-inflammatory cytokines have been reported to correlate with the severity of depression and various cytokines have been identified as potentially relevant in understanding the pathophysiology of affective disorders/suicidality.

We aimed to review the current literature to investigate the association between inflammatory cytokines and suicidal behavior.

A systematic review of the current literature was conducted to investigate the association between inflammatory cytokines and suicidal behavior. Only articles from peer-reviewed journals were selected for inclusion.

Most studies reported the association between suicidality and IL2, IL-6, IL-8, TNF-α and VEGF levels that have been found altered in suicidal behavior. The presence of major depressive disorder (MDD) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts. Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link. Also, not all studies showed a positive correlation between inflammatory cytokines and suicidal behavior.

Inflammatory cytokines play a key role in the pathophysiology of suicidal behavior. However, further additional studies should elucidate the molecular mechanisms of the immune activation pathways underlying suicidality.