Current guidelines on management of first-episode mania recommend augmenting with Valproate or other mood-stabilisers if antipsychotic proves ineffective.

To study if timing of starting mood-stabiliser augmentation would influence recovery outcomes in first-episode mania with psychosis.

To study how ‘time to start augmentation’ is related to ‘time to recovery’ and ‘hospital stay’

11 patients with first-episode mania with psychosis (FEM-P) presenting to a specialist early-intervention service in South London, part of naturalistic study of 150 cases of first-episode psychosis. Patients interviewed using the standard rating scales. Other details of treatment obtained from systematic review of case-notes covering 18 months. Operational criteria defined recovery. Correlation and regression analysis carried out to test hypotheses using SPSS-19. Set of predictor variables such as age, DUP, type of antipsychotic, substance misuse used in regression.

All 11 patients started on atypical-antipsychotic (Olanzapine 5, Risperidone 6). 9 patients required augmentation with Valproate, with a mean time of 74 days (s.d.=91) to start augmentation. The mean time to first recovery was 86 days (s.d.=39). Regression analysis with ‘time to recovery’ as dependant variable and ‘time to start augmentation’ as covariate with other predictor variables yielded significant relationship (F=9.2, t=3.1, p=0.02, CI 0.07-0.56). Also time to ‘start augmentation’ showed correlation at trend-level with ‘hospital stay’ (mean= 40, s.d.= 40.3) (Pearson correlation =0.57, p=0.09).

When there is insufficient response with antipsychotic in treatment of FEM-P, augmentation with mood-stabiliser such as Valproate without delay can shorten time to recovery and hospital stay.

Borderline personality disorder (BPD) is associated with aberrant processing of emotional facial expressions and emotional memory which may contribute to patients’ interpersonal difficulties. However, findings are conflicting and warrant further investigation.

To clarify whether patients with BPD show deficits in facial expression recognition and self-referent incidental memory.

To examine facial expression recognition and/or in emotional categorization and recall of self-referent personality characteristics in a cohort of female patients with BPD in comparison with healthy controls.

14 patients and 11 healthy controls were given a facial expression recognition task and a self-referent emotional categorization and recall task using positive and negative personality characteristics; both tasks were from the Emotional Test Battery (P1Vital, Oxford).

BPD patients showed general impairment of facial expression recognition as reflected by increased response latency (F(1,23)=4.58, p=0.043). Examination of each emotion across different intensity levels revealed specific reduction in the sensitivity to happy expressions (F(1,23)=4.74, p=0.040). Patients also demonstrated reduced categorization accuracy for positive versus negative self-referent words (F(1,23)=5.15, p=0.033) and generally increased response latency on this task relative to controls (F(1,23)=4.46, p=0.046). This was associated with subsequent reduction in overall recall of these self-referent words in patients versus controls (F(1,23)=7.69, p=0.011).

These preliminary findings highlight deficits in facial expression recognition and emotional categorization and recall as potential biomarkers of BPD, which may contribute to patients interpersonal difficulties.

The aim of the study was to compare P50 suppression, prepulse inhibition (PPI) and antisaccade (AS) measures in first episode and chronic schizophrenia patients to assess the predictive validity and progressive changes of selected parameters.

Unmedicated first-episode (15 subjects) and chronic (15 subjects) schizophrenia patients participated in the study. The patients’ symptomatology was rated with the Positive and Negative Syndrome Scale (PANSS). Control group included 21 healthy subjects.

P50 suppression and acoustic startle prepulse inhibition (PPI) were estimated according to standard protocols (Olincy et al., 2010; Calkins et al., 2007). In AS task subjects had to look as quickly as possible at the horizontal mirror position of the peripheral target. Saccade and contingent negative variation (CNV) parameters were evaluated.

Higher PANSS scales values were found in chronic patients compared to first episode ones. Both patients’ groups displayed significantly reduced P50 suppression (p<0,001) and prepulse inhibition deficit at 60 ms lead interval (p<0,05) compared to controls. Patients of both groups exhibited increase in the correct AS latency and larger number of errors in AS task compared to controls (p<0,05). The pronounced decline of CNV amplitude in frontal regions was found in chronic patients only (Group x Area interaction, p<0,05).

Results of the study corroborate the evidences of P50, PPI and AS measures predicting validity. The CNV analysis revealed pronounced prefrontal cortex dysfunction in chronic patients only. These data are compatible with the hypothesis of progressive brain changes in schizophrenia.

The classification of psychiatric illnesses was essentially based on stage theory, the idea that a given illness progressed from stage to stage. This was in contrast to the Kraepelinian scheme of classifying illnesses – with the exception of manic-depressive illness – on the basis of current phenomenology. According to the previous stage theories such as Zeller, Magnan and Griesinger, a major illness would typically begin with a mood picture (mania or melancholia), transition into psychosis (Verrücktheit, délire), then transition again in dementia. This illness course tended to be life-long, the order of the stages invariant (rarely was psychosis seen as the primary disorder, or did dementia yield to yet another stage). These concepts would be innovative in terms of the DSM system, which recognizes stage theory only in bipolar disorder.

To clarify the nature of linear illness pictures (‘stage theory’) in a psychiatric presentation.

To revive a traditional psychiatric concept of the linear illness entity (‘stage theory’) in the interest of improved diagnosis and treatment

An analysis of the large past psychiatric literature in French, German, Italian, and English

The illness courses of many past patients do seem to have unfolded in stages.

Stage theory stemmed from senior clinicians of vast experience, whose ideas were are not entitled patronizingly to dismiss. The DSM system is now under assault and it may be time to reassess the usefulness of stage theory.

Suicide is a leading cause of death and suffering worldwide, mental disorder being a major risk factor for it. Recent data suggest that the underlying temperament may be more important as a risk factor than the exact psychiatric diagnosis.

A cross-sectional non-interventional study of 79 patients with DSM-IV major depressive episode (58 females, 21 males; aged 19–66 years), evaluated by M.I.N.I. Their temperament was assessed through the self-rated TEMPS-A. Patients were distributed into four groups: 1) fMDE - first major depressive episode (n=16); 2) RMD - recurrent major depression: at least 5 years duration of illness, no previous (hypo)manic/mixed episodes, and no first-degree relatives with bipolar disorder (n=23); 3) BDI - MDE with at least one previous manic episode (n=19); 4) BDII – two or more MDE with at least one previous hypomanic episode (n=21).

No significant intergroup differences in the level of suicidal risk measured by the M.I.N.I. No gender difference in the M.I.N.I. risk for suicide, however, female gender was associated with a higher number of previous suicide attempts (p=0.001). The fMDE group had higher mean score for hyperthymic temperament, and the RMD group had higher mean score for anxious temperament. After controlling for the diagnosis and gender, a significant positive correlation was found between level of suicidal risk and mean score for depressive, cyclothymic, and irritable temperament (p<0.05), while the correlation was negative for hyperthymic temperament (p=0.001).

We suggest that hyperthymic temperament is a protective factor against suicide in patients with affective disorders.

A series of meta-analyses points to the benefits of different psychotherapy approaches in the treatment of persons with schizophrenia such as psycho-educational family interventions or cognitive behaviour therapy for psychosis. However, the advantages of these specific psychotherapeutic interventions as compared to non-specific supportive interventions are moderate. This challenges the validity of the presumed specific therapeutic ingredients.

To analyse the significance of specific therapeutic ingredients of evidence-based psychotherapy approaches for schizophrenia all efficacy studies with component control designs were identified by systematic electronic searches. Subsequently, moderator analyses of the standardized weighted effect sizes differences between psychotherapy approaches with different therapeutic components were performed. The effect size differences were integrated by transforming them into weighted mean point-biserial correlations between single therapeutic components and outcome variables. Furthermore, studies relating common factors such as therapeutic alliance or self-efficacy expectations of patients with outcome were searched, and weighted mean Pearson's correlations between common factors and outcome variables were calculated.

The findings indicate that specific therapeutic components such as psycho-education, cognitive restructuring or skills training represent key therapeutic ingredients of evidence-based psychotherapy for schizophrenia. However, also common factors such as positive therapeutic relationship, changing expectations for self-efficacy or successful mastery efforts are associated with positive outcomes.

There is an urgent need to dismantle the actual therapeutically active components in order to promote the targeted, personalized and, thereby, efficient implementation of evidence-based psychotherapy approaches for persons with schizophrenia in routine care.

Schizophrenia is an aetiologically complex disorder associated with significant familial risk. It is marked also by reductions in whole brain, grey and possibly white matter volumes. How these pathological abnormalities are influenced by schizophrenia's genetic and environmental risk remains uncertain.

We investigated the relationship between familial and environmental risk on brain volume in twin pairs varying in their zygosity and concordance for schizophrenia, and healthy control twins, using a variety of complementary imaging strategies. These included region of interest and automated tissue segmentation volumes and voxel based morphometry.

We found that whole brain, grey, white, frontal and right hippocampal volumes were smaller in probands with schizophrenia compared to healthy controls. Well co-twins from MZ discordant pairs showed a trend towards lower white matter volume compared to the healthy controls. Well co-twins from DZ discordant pairs had smaller hippocampal volumes compared to the healthy controls. The patients with schizophrenia and their well co-twins from MZ discordant pairs differed in the superior frontal cortex using both region of interest and VBM techniques. Lower birth weight and hypoxia were both associated with lower whole brain volumes, and with lower white and grey matter volumes respectively.

Our data suggest that total brain and grey matter volume reductions in schizophrenia, possibly focused in part in the frontal cortex, are related primarily to unique environmental factors, including perinatal complications. The white matter and local hippocampal volume reductions suggest an additional vulnerability to genetic risk effects.

As the part of mental health reform in whole Bosnia and Herzegovina (BH) main attention has been given to rehabilitation of people with severe mental diseases. One of important ways to improve better outcomes for those patients is model of case management.

Whole CMHC team in Health Center Prijedor is educated for certificated case managers in period 2012 - 2013. During the well organized training provided by the Mental Health Project in BH we included two young persons with psychosis in case management together with their families.

To show overall improvement in patients who are involved in case management in our CMHC.

Three months follow up of the Plan of Care and Treatment made by case managers and two patients with psychosis in CMHC Prijedor (1 male and 1 female) using the following instruments: BPRS, AVON-My view, HoNOS, SQLS, Overall Risk Assessment, Specific Risk Assessment. Also, home visits by case manager and regular visits in CMHC were included.

The tree months follow up shows improvement in reduction of symptoms, higher self confidence and self esteem, lower self neglect (as the risk which was found in both patients. In last six months both patients had any crisis or hospitalization. It is established better relation with family and case managers. One patient found temporary job and both patients involved in local user organization.

Case management has proven to be efficient in daily practice as the best way of connection between patients, case managers, other professionals, family and community in general.

Somatic comorbidities are common among elderly patients with mental health problems, namely dementia and depression. Quite often, somatic problems are associated with a substantial impairment in daily routines, as well as to a worse outcome of the neuropsychiatric condition.

to investigate the level of impairment due to comorbid somatic problems in the elderly, as part of the implementation of the 10/66- Dementia Research Group Population-based Research Protocol in Portuguese settings.

A cross-sectional survey was implemented of all residents aged 65 in a semi-rural area in Southern Portugal. Evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). Training of the field researchers was conducted with the supervision of the 10/66-DRG coordinators (CF, MP).

703 elderly participants were evaluated. Interference with daily activities was present in every area assessed, with moderate to severe impact in the following areas: Arthritis or rheumatism (36,9%), eyesight problems (19,8%), hypertension (10,5%) and gastro-intestinal conditions (10,4%). 48,9% of the participants had at least one contact with a primary care health centre in the last three months, and 22,5% had at least one contact with a doctor in a general hospital.

Results showed a relevant degree of impairment due to somatic conditions, and a high use of services, namely at primary care level. The significant prevalence of comorbid somatic conditions should be taken into account regarding the organization of services directed to older patients with mental health problems, that has been considered a priority in the Portuguese Mental Health Plan 2007–2016.

Brain radiation therapy (BRT) is a mainstay of treatment for tumors in brain. The most determined adverse effects in patients after BRT are as follows: problems in new memory consolidation, attention, visuospatial and executive functions domains. Although studies about cognitive side effects are increasing in BRT literature, knowledge about social cognition is lacking. We aimed to investigate the alteration in facial emotion recognition ability in patients after BRT.

Thirteen patients with various brain tumors even primary or metastatic were enrolled in the study. All participants were asked to complete a manual based Facial Emotion Recognition Test. Bilateral hippocampi were delineated by use of contouring protocol of hippocampal avoidance during whole-brain radiotherapy for brain metastasis (Radiation Therapy Oncology Group)

No differences between initial and post radiotherapy among identifiying facial emotions of happiness (p=0.480), anger (p=0.336), disgust (p=0.157), neutral (p=0.276) while there was trends in identifying sad (p=0.054) and surprised (p=0.058) faces. Trends of improvement in sad facial emotion and impairment in surprised facial emotions have been detected. Identifying ability of fearful emotions was significantly better after radiotherapy (p=0.039). There was a positive correlation between frontal dose and impairment in identifying surprised face (p=0.050 and r=0.553) was detected.

Facial emotion recognition is an important cognitive skill for social adjustment, proper relationship, working and living independently and brain radiotherapy seems to have mixed effects on this ability. Amygdala has important role in recognizing fear and sad emotions and those emotions were found to be improved after brain radiotherapy.

The internalized stigma is a concept that is discussed mostly in severe mental illnesses and especially in schizophrenia. However, this concept is not studied in sexually traumatized people, yet. In this study, we aimed to investigate the internalized stigma and related features in sexually abused individuals.

The participants who were the victim of sexual abuse and sent by courts to be examined for mental state were planned to be included in the study and after giving informed consent, 44 females were included. Participants were asked to complete the scales of Internalized Stigma Questionnaire for Mental Disorders, Beck Depression and Hopelessness Scales.

No significant differences were found between participants who had been diagnosed a psychiatric disorder or not after victimization according to total score of internalized stigma scale and subscale scores (p>0.05). There were significant correlations between mean Beck depression and hopelessness scale scores and internalized stigma scale mean total score and subscale scores (alienation, stereotype endorsement, discrimination experience, social withdrawal, and resistance to stigma).

Self-stigmatized behaviors are seen in all participants who have been sexually abused and there was no difference according to such behaviors between participants whom had been diagnosed as mentally ill or not after victimization. However, an existing self-stigmatization is increasing in the existence of psychopathology. The responsibility of the professionals in mental health should develop new therapeutic or rehabilitative approaches to all sexually abused victims whether they meet psychiatric diagnostic criteria or not.

Several adolescents engaging in suicidal behavior represent a hidden population who do not receive professional help. Aim: to increase understanding of adolescents who were screened as being at high risk of suicide.

Sample: 1,409 pupils from 23 schools sited in Asturias (Spain) participants in the ‘Working in Europe to Stop Truancy among Youth’ Project (WESTAY) (48.55% males; mean age=15.16 years). Emergency cases: those with severe suicide ideation and/or suicide attempt (SA) in the past 2 weeks. 45 pupils identified as emergency cases (46.7% males; mean age=15.02 years).

Evaluation: Beck Depression Inventory II (BDI-II), Deliberate Self-Harm Inventory (DSHI), Strengths and Difficulties Questionnaire (SDQ), Well Being Index (WHO-5), Paykel Suicide Scale (PSS).

3.2% (n=45) of the sample self-reported acute suicidality (22 attended the clinical interview, 5 were referred to mental health services). More girls than boys were identified as cases, attended the interview and were referred to services. Emergency cases scored significantly higher (p=0.000) in SDQ total scores, emotional symptoms, conduct problems, hyperactivity and peer relationship problems, however, no significant differences were found in the prosocial scale. Emergency cases also manifested significant (p=0.000) higher level of depressive symptoms (BDI-II) and lower well-being. Emergency cases were more likely to have a history of DSH (p=0.000). No significant differences were found between those who attended the interview or not.

There is a high rate of self-reported acute suicidality among adolescents; however, their suicide risk after a clinical assessment was considered as low.

It was suggested that impulsivity is a temperamental risk factor for alcohol use and may be a fundamental mechanism in both the onset of excessive alcohol use and the relapse to alcohol use. Aim of this study was to evaluate the changes in impulsivity scores among alcohol dependents 12 month after inpatient treatment.

Among 78 consecutively admitted male alcohol dependents, 58 were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11) (10) both at the baseline and at the end of 12 months.

Among 58 alcohol dependent inpatients 61.8% (n=32) were considered as relapsed to heroin use during 12 month follow-up. Sociodemographic variables did not differ between the groups. Mean impulsivity scores did not differ between remission and relapsed groups at baseline, whereas only non-planning impulsivity was higher in relapsed group at follow-up. Impulsivity score decreased during 12 month follow-up in remission group, whereas increased in relapsed group. Among dimensions of impulsivity non-planning impulsivity decreased in remission group, whereas attentional impulsivity increased.

Results of the present study may suggest that while attentional impulsiveness may be the cause of alcohol use, non-planning impulsiveness may also be a vulnerability factor for alcohol dependency and relapse.

We hypothesized an increase in dorsolateral prefrontal cortex (DLPFC) glutamate levels would occur after three weeks of repetitve transcranial magnetic stimulation (rTMS) treatment and a decrease in major depressive disorder (MDD) symptoms.

We report six cases (four females) 15–21 years of age with treatment-resistant MDD. Participants had a mean age of 18.7 years and a mean IQ of 102.3. Short echo proton magnetic resonance spectroscopy (H-MRS) was used to quantify glutamate levels in the left DLPFC (4.5cc) before and after rTMS treatment. rTMS was localized to the left DLPFC and applied for 15 consecutive weekdays. Treatment response was defined as a greater than 50% reduction in Hamilton Depression Rating Scale scores (Ham-D).1H-MRS data was analyzed with LCModel to determine glutamate concentration.

Following rTMS, treatment responders (N=4) showed an increase (relative to baseline) in left DLPFC glutamate levels (11%), which corresponded to an improvement in depressive symptom severity (68% Ham-D score reduction). Treatment non-responders (N=2) had elevated baseline glutamate levels compared to responders in that same region, which decreased with rTMS (−10%). Procedures were generally well tolerated with no adverse events.

rTMS is feasible and possibly efficacious in adolescents with MDD. In responders, rTMS may act by Induced elevations in elevating DFPLC glutamate levels in the left DLPFC, thereby leading to symptom improvement. Transcranial Magnetic Stimulation for Adolescent Depression (TMSAD)