The capacity to accumulate information over time is crucial to our functioning in an ever-changing world. Recently, in healthy subjects, we showed that brain uses a distributed and hierarchical network of brain areas to process information over time. Specifically, we revealed hierarchy of information processing over time from early sensory areas toward high order perceptual and cognitive areas. Here, we investigate this issue in first-episode schizophrenia patients.

Previous studies posited that schizophrenia is the result of impairment of hierarchical temporal processing by the brain, claiming for impairment in use of context while being processing information. The hierarchical temporal deficit is a fundamental trait that may be a better target for the study of etiology and pathophysiology of the disease.

We intended to map, in schizophrenia patients, the topographical organization of temporal scales using an ecologically relevant auditory stimulus - a real-life story. In addition, we assumed that studying healthy siblings, who are at high-risk for cognitive dysfunctions, will enable to determine functional neuromarkers of predisposition to disorder.

The fMRI data were analyzed using inter-subject correlation approach. The time-courses within each brain area in schizophrenia patients were estimated against healthy controls and unaffected siblings of the patients.

Among patients, we observed impaired hierarchy with processing intact in low level but disturbed in high level. The sibling group showed an intermediate effect.

Better understanding of the underlying neural circuit involved in information processing in schizophrenia patients may assist in early identification of functional neuromarkers for the disease.

According to the data from literature the neurocognitive changes in schizophrenia are mild to moderate and are modestly related to negative symptoms. Cognitive deficits in schizophrenia are regarded by many psychiatrist as an important symptom, which requires appropriate treatment and rehabilitation. There are different conditions, which may have an influence cognitive impairment in schizophrenic patients. One the factors differentiating subgroups of schizophrenic patients when neuropsychological functioning is analyzed is sex.

This Review was focused on cognitive functioning of schizophrenic patients of different sexes. In order to achieve this result PubMed was searched using following terms: cognitive functions, schizophrenia, gender differences, sex hormones, memory, attention, neuropsychological, psychopatological symptoms.

Most of the analyzed papers reflecting the cognitive differences between men and women suffering from schizophrenia postulate a worse performance in neuropsychological test by male patients. However according to some authors there are no gender differences in cognitive functioning in schizophrenic patients or those differences are not clinically significant.

The above analysis shows that there is a number of studies, according to which differences between men and women among schizophrenic patients are present, however the problem of sex-specific differences in cognitive functioning in patients in schizophrenia needs further investigation.

Lurasidone has demonstrated efficacy in the treatment of schizophrenia in a series of short-term placebo-controlled trials.

To evaluate the safety, tolerability and effectiveness of lurasidone in the long-term treatment of patients with a DSM-IV-TR diagnosis of schizophrenia.

Patients who completed a 6 week, double-blind, placebo-controlled trial received once-daily, flexible-doses of lurasidone, 40–120 mg in a 22 month open-label extension study. An observed case analysis was performed on change from pre-treatment baseline in safety and efficacy parameters.

250 subjects entered the study; 39.8% completed 12 months and 26.8% completed 22 months of treatment. Lurasidone treatment was associated with a mean endpoint change in weight of +0.7 kg. Median endpoint change at Month 12 and Month 24, respectively, was -1.0 and −9.0 mg/dL for total cholesterol; 0.0 and −1.0 mg/dL for LDL; +1.0 and −11.0 mg/dL for triglycerides; +4.0 and +2.0 mg/dL for glucose; 0.0 and +0.1% for HbA1c; and −1.3 and −1.1 ng/mL for prolactin. The mean PANSS total score was 69.5 at extension baseline. The mean (95% CI) endpoint change from extension baseline in PANSS total score was −0.5 (95%-CI: −0.7, −0.3). Overall, 14.7% of patients discontinued due to an adverse event. Adverse events occurring with an incidence ≥10% were schizophrenia (12.4%), akathisia (10.8%) and somnolence (10.8%).

In this 22 month extension study, treatment with lurasidone was associated with minimal effects on weight, glucose, and lipids. Subjects demonstrated sustained improvement in the PANSS total score for up to 24 months of lurasidone treatment.

The prevalence of obesity and associated cardiometabolic comorbidity is significantly higher among patients diagnosed with schizophrenia compared to the general population (Mitchell et al. Schizophr Bull 2013;39:306-18)

To evaluate the effect of 12 months of treatment with lurasidone, risperidone, or quetiapine XR (QXR) on weight and body mass index (BMI) in subjects with schizophrenia.

A post-hoc, observed case (OC) analysis was performed on pooled data from 6 clinical studies that evaluated the safety of 12 months of treatment with lurasidone (40–120 mg/day; n=471), risperidone (n=89), and QXR (n=33).

The mean weight at baseline in the lurasidone, risperidone and QXR groups was 72.8, 80.8, and 72.4 kg; with 18.5%, 32.6%, and 15.2%, respectively, meeting standard BMI criteria for obesity. The mean change in weight (kg) in the lurasidone, risperidone and QXR groups, respectively, was −0.5, +1.7, and +1.5 at 3 months; −0.4, +2.2, and +1.5 at 6 months; and −0.4, +2.6, and +1.2 at 12 months. A clinically significant increase in weight (≥7%) occurred in the lurasidone, risperidone and QXR groups in 15.7%, 25.0%, and 15.2% of subjects, respectively, at 12 months; and a decrease of ≥7% in weight occurred in 18.6%, 6.8%, and 9.1% of subjects, respectively at 12 months. Similar changes in BMI were observed at 12 months.

The results of this pooled analysis of subjects with schizophrenia who completed 12 months of treatment suggest that lurasidone is associated with a low potential for clinically significant weight gain.

The healthcare needs of the elderly are seldom assessed in practice. Research in clinical populations with neuropsychiatric disorders generally unravels high levels of unmet needs. Although there are Portuguese studies in needs assessment, explorations of community or social services’ scenarios have been scarce.

By gathering data from health and social services research, and from an epidemiological survey in the same region, we aimed to better characterize the unmet needs of Portuguese elderly.

We report on studies with old age people in Seixal, near Lisbon: 1) the Camberwell Assessment of Need for the Elderly was used for auditing a non-profit organization, with day-centre and home support services (n=95), and in a survey of family carers of dementia outpatients (n=116); 2) the 10/66 DRG community prevalence study (n=670) used comprehensive assessments to provide psychiatric diagnoses, data on health and psychosocial needs, and the use of services.

In the social service audit, unmet needs were mainly related to food, company, physical health and daytime activities. Domiciliary care users had more unmet needs than day centre users (p<0.001). Informal caregivers of dementia patients reported information and psychological distress needs. Finally, these 10/66 DRG study partial results highlighted a high prevalence of depression (20.4%; 95%CI 17.4-23.7) and huge health services’ utilization needs.

Systematic assessments of needs for care generally unravel high proportions of health and psychosocial problems lacking adequate interventions, in clinical and community populations. This may provide a more consistent basis for health services planning.

Comorbidity is common among adults with ADHD, including substance abuse. Researchers have undertaken studies on the role of self medication in symptom control in adults with ADHD. Individuals with ADHD may use specific drugs, such as cocaine, that act in a manner similar to prescribed ADHD medications to lessen symptoms.

Assessment of rate of abuse of stimulants among patients with comorbid ADHD and other SUD.

The aim of this study was to estimate prevalence rate of stimulant use among patients with comorbid ADHD and SUD and to compare it with patients diagnosed with SUD only.

This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Type of drug of abuse was determined using Urine screen and semi-structred questionnaire.

Thirty six patients out of the 102 patients screened positive for Adult ADHD (35.3%). Four patients of the ADHD group were abusing cocaine (11.1%) while non of the non ADHD group used cocaine (FEp = 0.014).

Patients with adult ADHD have significant higher rates of abuse of cocaine in comparison to patients with SUD only.

Agitation is a common presentation among patients hospitalized for an acute exacerbation of schizophrenia. Rapid and effective control of agitation is an important early treatment goal.

The aim of this post-hoc analysis was to evaluate the efficacy of lurasidone in reducing agitation in patients with an acute exacerbation of schizophrenia.

The analysis was performed on pooled data from 5 six-week, placebo-controlled trials in the subgroup of patients with an acute exacerbation of schizophrenia who met (n=773), or did not meet (n=754), criteria) for agitation (PANSS-Excited Component [EC] score ≥14 at baseline, Citrome, J Clin Psych 2007;68:1876-1885). Patients were randomized to fixed once-daily doses of lurasidone (40-160 mg).

The mean baseline PANSS-EC scores were similar for lurasidone vs. placebo in the high (16.7 vs. 16.8) and low (10.9 vs. 10.7) agitation subgroups. In the high agitation subgroup, treatment with lurasidone (vs. placebo) was associated with significantly greater improvement in PANSS-EC scores at days 3/4 (-2.0 vs. -1.3; p<0.001) and day 7 (-2.6 vs. -1.8; p<0.001). At week 6 endpoint, improvement on lurasidone vs. placebo was greater in the high vs. low agitation groups on the PANSS-EC score (effect size, 0.43 vs. 0.31), and comparable on the PANSS total score (effect size, 0.57 vs. 0.58).

In this pooled post-hoc analysis, treatment with lurasidone significantly reduced agitation by day 3/4 in patients hospitalized with an acute exacerbation of schizophrenia. The magnitude of improvement at week 6 was similar in both the high and low agitation groups.

In the literature we can find an increasing number of examples of successful cognitive rehabilitation of patients suffering from schizophrenia. The aim of this study was to investigate the effectiveness and impact of the CogniTrain therapeutic method on cognitive neuroplasticity in patients suffering from paranoid schizophrenia. We expected an answer to the question, whether brain is sensitive to stress and if the efficiency of cognitive rehabilitation improves as a result of using CogniTrain computer training.

Two groups of test subjects were recruited of patients with paranoid schizophrenia. In the first and second groups the measurements of short-term memory, selective attention and level of anxiety were done two times, in the beginning and at the end of the treatment program. In one of the tested groups the CogniTrain cognitive training was applied. In order to diagnose mechanisms of memory we used the Free Recall method, CPT method was used to measure selective attention, and STAI was used to determine the severity of anxiety.

The patients participating in the CogniTrain trainings gained significantly better outcomes in the neuropsychological assessments than the patients who did not participate in the cognitive rehabilitation.

There is a need to develop and introduce into clinical practice neurocognitive rehabilitation programs in order to improve cognitive and social functioning of schizophrenic patients.

Clinically significant depressive symptoms are common in schizophrenia, and are associated with greater functional impairment and worse outcomes.

To evaluate the effect of lurasidone in patients with a DSM-IV-TR diagnosis of schizophrenia who presented with significant depressive symptoms.

Pooled data were analyzed from 4, six-week, double-blind, placebo-controlled schizophrenia trials, with available MADRS data. Patients with an acute exacerbation of schizophrenia were randomized to fixed, 40–160 mg (n=902) once-daily doses of lurasidone, or placebo (n=439). LOCF-endpoint data were analyzed using ANCOVA. MADRS remission was defined as an endpoint score <10.

At baseline, 45.0% and 24.5% of subjects had a MADRS score of ≥12, and ≥16 respectively. Treatment with lurasidone was associated with significantly greater improvement in the MADRS at LOCF-endpoint compared with placebo in the total sample (-2.8 vs. -1.4; p<0.001), and in each baseline depression severity subgroup: MADRS ≥12 (-6.7 vs. -4.8; p<0.005), and MADRS ≥16 (-9.3 vs. -6.3; p<0.005). Overall, the largest effect size was observed for the 160 mg dose of lurasidone (0.43). For the subgroup with MADRS≥16 at baseline, higher depression remission rates were observed for lurasidone 160 mg (47.8%) compared with lurasidone 80 mg (38.6%) and lurasidone 40 mg (28.6%).

In this pooled, post-hoc analysis, 40-160 mg once-daily doses of lurasidone significantly reduced the severity of depressive symptoms in patients with schizophrenia. Daily doses of 160 mg demonstrated the largest effect size. These results warrant further evaluation of lurasidone in patients with schizophrenia and co-morbid depression.

Depressive personality disorder (DPD) is highly studied and common in clinical settings. Nevertheless, it is rife with controversies and often overshadowed by Major Depression and Dysthymia with which it shares many similarities but also is clinically distinct.

The objective of this research was to garner pre- and post-treatment clinical data among psychotherapy outpatients at a University clinic.

The specific aims of the study were to determine rates of DPD pre-treatment (i.e., baseline/intake), to evaluate the presenting clinical profile for those with and without DPD, and to assess pre- to post-treatment changes in levels of depression and global severity of symptoms.

One hundred fifty-nine patients participated in the study and completed a battery of measures assessing DPD, a range of psychopathology, and overall functioning at pre-treatment. These individuals were followed naturalistically (up to 40-weeks) and reassessed on the same variables at post-treatment.

Forty-four percent of entering psychotherapy outpatients qualified for DPD alongside their presenting clinical problem. Those with DPD showed a more severe and complex presenting profile; however, they made greater gains in treatment than those without DPD. Only 11% of the sample continued to endorse DPD following treatment.

The findings from this research suggest that in routine clinical situations, psychotherapy may benefit individuals with DPD

There are some data that suggest the existence of a dysfunction of the Hypothalamic-Pituitary-Adrenal (HPA) Axis in patients with eating disorders (anorexia nervosa –AN- and bulimia nervosa -BN-). If such a dysfunction exists, it would result in an altered cortisol response to stress.

To compare the cortisol response to stress in a group of patients with AN, BN and a control group.

Seventeen female AN patients, 17 female BN patients and 26 healthy female controls were compared. The Trier Social Stress Test (TSST) was used to induce stress. Throughout the test, seven samples of saliva were collected from each subject, and cortisol was investigated in each of the samples using radioimmunoassay (RIA).

Each group had a specific profile of cortisol release. Upon arrival at the laboratory, the AN patients had higher cortisol levels, but they quickly returned to normal values, becoming similar to those of controls. In contrast, in the BN patients the cortisol levels were at any time significantly lower than those of the AN patients and the controls, displaying a globally blunted response.

The results support the hypothesis of a dysfunctional functioning of HPA axis in patients with eatings disorders, althoug suggest that it might be particularly important in BN patients.

Supported by grants PI060974 (Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica [I+D+I]. FIS. Instituto Salud Carlos III. Ministerio de Sanidad, Servicios Sociales e Igualdad) and GRU09173 (Plan de Investigación Regional de Extremadura. Gobierno de Extremadura y European Social Fund).

Psychotropic medicines are widely used to treat mental illness in the community. In prisons, however, the equity, continuity and appropriateness of prescribing for mentally ill prisoners have been questioned. Currently, there are no robust data regarding prescribing patterns in English prisons; yet these are essential to managing the overall clinical, cost effective, and safe use of medicines.

We aimed to investigate patterns of psychotropic medication prescribing in English prisons.

• To establish psychotropic prescribing rates in prisons.

• To compare prison psychotropic prescribing patterns with the wider community.

• To gain insight into staff and patient perspectives on psychotropic prescribing in prisons.

We conducted a cross-sectional survey of 12 prisons to generate prescribing rates for antidepressants, antipsychotics, hypnotic/anxiolytics and/or central nervous system stimulants (chapters 4.1–4.4 of the British National Formulary). On census days, we used clinical records to collect demographic, clinical and prescription data on all patients in receipt of psychotropic medication. Equivalent data on community-based patients were supplied by the UK General Practice Research Database for comparison purposes. Qualitative interviews were completed with 16 members of staff and 17 patients and analysed thematically.

This presentation will describe the rates, types and doses of medicines prescribed in prisons to treat mental illness. Appropriate community comparisons will be made, accounting for demographic and clinical characteristics. Staff and patient perspectives will be explored. Implications for patient safety, equivalence and appropriateness of prescribing will be discussed.

Since 2007 14 ACT-teams have been established in Norway. Despite the lack of clear evidence for efficacy, CTOs are used as a tool for supporting patients with severe mental illness that are difficult to engage to promote medication adherence and early identification of relapse. There is not much literature about the use of CTOs in ACT-teams.

This study explores the perceptions and experiences of users in Norwegian ACT-teams with recent experience of CTOs. According to the ACT-model establishing trust and a treatment alliance is of significant importance Beside exploring how CTOs influence upon the users‘life-situation and the relationship to the team-members, the study will also focus on the service users‘experience of whether their opinions and whishes are of importance to the treatment planning process.

In-depth interviews with 18 selected users from three ACT-teams will be analyzed by using a modified grounded theory approach, based upon initial, focused and theoretical coding and constant comparison.

The users perceive the uncertainty of the length of the CTO and the threat of being recalled to hospital if they don‘t comply with treatment difficult to accept. To receive support and respect from the ACT team has been important to increase their sense of safety and stability.

The results from this study can give useful information about how users‘perceive community treatment orders, which is important for how health personnel encounter ethical dilemmas and ambivalences that may accompany the use of committed community treatment.

Overweight and weight cycling represent common problems in individuals with bipolar disorder. Furthermore, substance dependency including alcoholism has been found to be a frequent co-morbid disorder, which affects the course and prognosis of bipolar disorder. Recently, substance use disorders have been related to weight cycling in a non-bipolar sample (Whyshak, 2006).

The study aimed to investigate the association between weight cycling (loosing and regaining weight in the last four years for at least three times) and substance abuse (drug and alcohol abuse) in patients with bipolar disorder.

The study took place at the Department of Psychiatry of the Medical University of Graz, Austria and 90 euthymic patients with bipolar disorder were included. Questionnaire data about weight and weight cycling were collected. A’SCID-I’ was conducted to evaluate bipolar symptomatology and co-morbid disorders.

Findings showed that bipolar patients with a history of weight cycling are prone to demonstrate a comorbid alcohol use disorder compared to non-weight cyclers (F1,87=5,531; p < .05). However, we could not find a significant relation between weight cycling and other drug or polydrug abuse in our bipolar sample (F1,87=1,548; p > .05).

Although, a relation between weight cycling and the co-morbidity of alcohol dependency has been detected, we do not know which phenomenon causes the other. Further studies on this topic including investigation of the relationship between alcohol abuse, weight cycling, and therapy outcome would be important. To conclude, the therapy of bipolar disorder should aim for a stable weight.

In bipolar disorder (BD), reduced white matter (WM) integrity in the corpus callosum has been reported, but its detailed localization difference has not been clarified. In this study, we examined fiber integrity in 7 segments of the corpus callosum and their relationships with clinical symptoms in BD.

Patients with BD (BD group, n = 17) and age-matched healthy controls (HC group, n = 24) were examined using diffusion tensor imaging tractography. The corpus callosum was divided into 7 segments (orbital frontal, anterior frontal, superior frontal, superior parietal, posterior parietal, temporal, and occipital) based on their cortical projection zones, and fractional anisotropy (FA) value of each segment was estimated. Differences in FA of each segment between the groups were examined using ANOVA with repeated measures. Correlations between FA of each segment and clinical symptoms (HAM-D, YMRS) were assessed using Spearman's rank correlation test in the BD group.

The BD group showed reduced FA in the orbital frontal, superior frontal, and posterior parietal-callosal segments compared to the HC group. In addition, the BD group showed a significant negative correlation between FA in the orbital frontal-callosal segment and HAM-D scores.

Our results suggest that WM integrity in the anterior part of the corpus callosum is reduced in BD and that orbital frontal-callosal disintegrity may be related with severity of bipolar depression.