The annual global suicide mortality rate is 16 per 100,000 and suicide attempts are 20 times more frequent. We aimed at comparing patients referring to the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, in order to assess possible predictors of self-injury.

Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2011 at the ‘Maggiore’ Hospital in Novara. A multivariate analysis was performed using a logistic regression in order to assess the potential predictors of self-injury behaviors. Results are expressed as Odds Ratio (OR) with 95% Confidence Intervals (95%CI). Statistical significance was set at p≤0.05.

In a sample of 1888 psychiatric consultations, 280 (14.8%) were due to self-inflicted injuries. Female gender (OR: 1.51; p=0.005) was found to positively correlate with attempted suicides, whereas unemployment (OR: 0.68; p=0.013) and being in the colder months of the year (OR: 0.75; p=0.043) were found to be negative correlated. A positive trend without statistical significance was observed for foreign nationality, being not married and living with parents/own family vs a negative trend was found for history of psychiatric disorders.

In accordance with other studies, we observed the female gender positively correlates with attempted suicides and sunlight may act as a trigger. In contrast with literature, individuals with a permanent job would be at higher risk of self-injury behaviours, whereas having a history of psychiatric disorders and being under the care of a psychiatrist might be a protective predictor.

Activation of microglial cells is currently explored in schizophrenia pathophysiology. Post-mortem immunohistochemistry remains the most accurate method to investigate microglial morphology and function, since high microglial plasticity limits extrapolation of in vitro and animal research results to the human brain.

To investigate microglial morphology and activation patterns, we performed immunohistochemistry with specific microglial markers: Iba1 (marker of resting and activated microglia), CD68 (marker of microglial lysosomes, indicative of phagocytic microglia) and CD64 (FcγRI, binds IgG) on formalin fixed paraffin embedded brain tissue from the Corsellis Collection (BRAIN UK), in 15 schizophrenia cases and 15 nonneurological controls. Immunostaining was quantified by image capture and analysis (Image J, NIH, US) to provide a measure of protein load. We also reviewed existing literature on microglial immunostaining in schizophrenia using Pubmed.

Few studies have examined post-mortem microglia in schizophrenia, mostly with HLA-DP/DQ/DR markers. Although frequently studied in neurological disorders Iba1, but also CD64 were never previously investigated in schizophrenia patients. Two studies explored CD68, but results were misinterpreted for resting state tissue macrophages. Our pilot study shows Iba1, CD68 and CD64 can detect microglial cells in schizophrenia brain tissue, but considerable heterogeneity exists both in patients and controls, probably due to confounding by clinical variables, e.g. age and cause of death.

Future research needs careful selection of cases and controls to minimize heterogeneity due to confounding clinical variables. Highly specific microglial markers such as Iba1, CD64 and CD68 are very useful and ought to be introduced into schizophrenia research.

Eating Disorders (EDs) are chronic illnesses requiring long-term care and significant involvement of carers. Expressed Emotion (EE) is a measure of the ‘emotional temperature’ of a family: an index of the relative's emotional answer in a certain situation. Literature suggests that EE scores are usually low in EDs families and the degree of family EE correlates with patients’ outcome.

To compare EE, life events and anxiety between patients with diagnosis of EDs and patients with other psychiatric diagnosis.

To measure the level of EE in EDs families in order to improve the quality of health care.

We administered the following tests to 20 patients with EDs and 20 patients with other psychiatric diagnosis: the Level of Expressed Emotion Scale (LEE) in two versions, one for patients and one for relatives with the purpose of evaluating intrusiveness, emotional response, attitude toward disease, tolerance and expectation; the Paykel's Interview for recent life events in which the subjects had to point out stressful events; STAI Y1 concerning state anxiety and STAI Y2 concerning trait anxiety. We also recruited co-habiting relatives and compared the relative's EE and the EE perceived by patients.

Statistical analyses are still in progress. Our preliminary results suggest that levels of EE are higher among the patients with a diagnosis of EDs, in contrast with results obtained by literature.

We expect that our results will help to shed light on the issue of EE correlates to EDs.

NGR3 substance is usually in the form of a white powder that is consumed by humans to create a legal high; feelings of euphoria and reduce tiredness. It is a GHB analogue and when consumed turns into GHB in the body. A 40year old male patient who ingested NRG3 was admitted thrice with symptoms of hearing voices, hyperactivity, agression and the inability to sleep.

To determine the probability of onset of psychotic symptoms as an effect of ingestion of NRG3.

To apply Naranjo's ADR probability scale and on the basis of the weighted questions of the scale, which examine factors such as temporal association of drug administration and event occurrence, alternative causes for the event, drug levels, dose-response relationships and previous patient experience with the substance NRG3.

Using the scale, the score indicated that there was a definite adverse drug reaction with NRG3.

A definite adverse drug reaction of psychotic symptoms did occur with the ingestion of NRG3.

Baseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation and sensory perception have been poorly studied in unipolar depression, although they could help to characterize different dimensions harder to capture by clinicians, give new insights on how patients are improved, and offer new markers depicting how early changes testify later treatment response.

1565 adult outpatients with MDD receiving agomelatine completed QIDS-C, CGI and MATHYS scales at inclusion, W2 and W6. The MATHYS includes 20-item self-rated visual analogue scales (from inhibition -0- to activation -10- with -5- representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation and sensory perception).

All dimensions increased from inclusion to W2 and from W2 to W6 (p<10−3). Roughly, improvement was 2-point (out of 10) for motivation, 1.5 for psychomotor function and 0.5 for other dimensions.

Motivation: (1) had a trend as being more severe at inclusion in later non-responders (t=1.25, df=1563, p=0.10) (2) displayed the highest difference at W2 in later responders versus non-responders (t=7.98, df=1563, p<10–6) (3) correlated the highest with QIDS-C improvement (r=0.22, df=1563, p<10–6) (4) best predicted at W2 later treatment response as per the highest area under the ROC curve (AUC=0.606, 95%CI[0.588–0.643], p<0.001).

Motivation had the earliest capacity to be improved, the best predictive value for treatment response and the largest global margin of progress in depressed outpatients. Assessing self-reported motivation in MDD could offer an interesting paradigm shift while assessing linear changes of depressive symptoms.

Schizophrenia has genetic, epigenetic and environmental components. Recent reports showed that the IL3 gene, colony stimulating factor 2 receptor alpha (CSF2RA), beta (CSF2RB) and IL-3 receptor alpha (IL3RA), the IL-specific receptor subunits for CSF2 and IL3, respectively, are associated with schizophrenia.

Association analyses of rs6603272 variant of the IL3R gene and rs4129148 variant of CSFR2A gene with schizophrenia have been studied.

We had 166 schizophrenic patients and 246 healthy controls. In both case control studies, a PCR-RFLP method was used.

The genoype frequencies of the IL3R gene rs6603272 variant were TT, 54.8, TG, 40.4, GG, 4.8 % in cases, TT, 57.7, TG, 36.2 and GG, 6.1% in controls. The frequency of T allele in controls and cases was 76% and 75% respectively. Similarly, the genotype frequencies of the CSFR2A gene rs4129148 variant were GG, 44.6; GC,39.8; CC,15.7 % in cases and GG,43.9; GC,43.1; and CC, 13.0% in controls. The G allele frequency was 64% in cases and 65% in controls.

In our study, we did not find an association between the rs66033272 variant of IL3RA gene and schizophrenia (χ2=0.896; P=0.639). Nor did we find an association between the CSFR2A rs4129148 variant and schizophrenia (χ2= 0.770; P=0.681)

Alzheimer's disease (AD) is the most common form of dementia. What is less apparent to the casual observer are thepsychological costs borne by the caregiver. Their lives are marked with significant changes concerning family relationships and social life.

The purpose of this study was to define the correlation between the psychophysical functioning of the AD patient, the quality of caregiversufferer relations and the psychological costs borne (depression and burden) by the caregiver.

The design is a cross-sectional study. This study encompassed 292 caregivers. The following questionnaire methods were used: BDI, Caregiver Burden/Burnout Inventory, Emotional Bond Questionnaire (caregivers) and MMSE and ADL (patients).

The study indicated the greatest level of depression and caregiving-related burdens in the spouses group, and the least in the friends/others group. The most important predictor of the level of burden turned out to be the nature of the caregiver-patient relationship. The positive experiences with the AD patients from the pre-onset time are an important protective factor in all the groups of caregivers.

The fact that the group of spouses was found to be the most affected by the burden of care indicates the need to provide them with help. One of the most significant predictors of caregiving burnout in this group is a sense of loss and positive experiences. Therefore it seems reasonable to assume that refreshing and nurturing such memories could also enhance the caregiver's ability experiences and emotions predominate.

Dysfunctional coping patterns, low self-efficacy, and an excessive use of external control beliefs are assumed to be risk factors for psychosis. They are already present in patients with first-epsiode psychosis (FEP). However, it remains unclear if help-seeking patients symptomatically at-risk for psychosis (AR) show similar patterns of coping and competence/control beliefs as FEP patients.

We compared the frequency of deficits in coping, self-efficacy, and competence beliefs between AR according to the ultra-high risk and/or basic symptom criteria (n=21; mean age: 19.4±4.6) and FEP patients (n=22; mean age: 20.0±4.6). Coping strategies were assessed through the Stress-Coping-Questionnaires (SVF-120/SVF-KJ); self-efficacy and competence beliefs through the Competence and Control Beliefs Questionnaire (FKK).

Most AR and FEP patients demonstrated dysfunctional coping patterns, low self-efficicacy, and biases in control beliefs. Compared to FEP, AR patients reported even more deficits in positive coping strategies and self-efficacy than FEP. Moreover, they showed an excessive use of external fatalistic beliefs. In contrast, FEP patients demonstrated to be overly self-confident.

Dysfunctional coping and competence/control belief patterns are present before the onset of psychosis and are promising predictors of conversion to psychosis. Therefore, they appear to be important treatment targets for early intervention in psychosis. As deficit patterns of AR differ from those of FEP patients, interventions need to be tailored to the special treatment needs of both groups to prevent transition or relapse to psychosis.

chronic neurological diseases such as multiple sclerosis (MS) and Parkinson's disease (PD) determines highly social impact through direct and indirect cost burden, so that management of quality of life(QoL) of these patients is often difficult.

to assess whether the relantionship between depression and chronic neurological diseases is relevant in quantifying QoL.

to proove that associated depression in patients with serious neurological diseases should not be minimized.

we followed up 20 patients (10 with MS-mean age 39.1, mainly women and 10 with PD-mean age 55.8, mainly men) during one year after diagnosis of depression; the mean time of disease evolution was 7.83 years for MS patients and 6.33 for PD patients; we compared them with a lot o patients matching as age and sex diagnosed with depression, without other comorbidities. Both lots were assessed every 3 month by Beck Depression Inventory, Fatigue Impact Scale and QoL Short form-36 scores. Time of positive diagnosis was over one year, even if symptoms were present for at least double time.

patients with chronic neurological diseases had a less favourable outcome, especially young women, than control group, revealing more problems especially in somatization field and in accepting psychiatric help; there were also more drug interactions that led to patient compliance difficulties.

even if there is resistance in accepting psychiatric diagnosis and treatment, we must do all efforts to persuade patients to undergo specialized treatment and supportive psychotherapy in order to improve their's quality of life.

The incidence of psychotic disorders is increased among men and culminates in adolescence. After menopause, there is a second peak in the incidence among women. It has therefore been suggested that sex steroids, such as oxytocin and testosterone, may confer decreased or increased risks for psychotic disorders.

To investigate differences in peripheral oxytocin and testosterone plasma levels in patients with a first psychotic episode, their unaffected siblings and healthy controls.

Plasma hormone assays of oxytocin and testosterone were obtained from 85 patients with a psychotic disorder, 27 of their unaffected siblings and 59 healthy controls. Sex-hormone binding globulin (SHBG) was collected to calculate the free androgen index (FAI; testosterone/SHBG), a broad indicator of androgen status. We analyzed group differences in hormone levels, as well as associations with demographic and illness parameters.

There were no significant differences in plasma oxytocin levels or FAI across groups. Adjusted for age, smoking, time of blood draw and BMI, we found a significant group difference in plasma testosterone levels in males (F(6,72)= 2.8; p<0.05), not in females. This effect was primarily caused by significantly higher mean plasma testosterone levels in antipsychotic-naive men (n=15) compared to their unaffected brothers (p<0.01) and healthy controls (p<0.05).

This study contradicts previous findings of decreased testosterone and oxytocin levels in patients with a psychotic disorder. Increased plasma testosterone in antipsychotic-naive male patients may reflect social distrust and paranoid thinking. It further underlines a potential mechanism of antipsychotic medication of normalizing androgen activity.

There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.

To validate the self-administered PLE Scale.

In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).

The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).

Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.

The ABCB 1-gene product P-glycoprotein is an efflux pump in the blood-brain-barrier. Different alleles of the single nucleotide polymorphism (SNP) rs2032583 were associated with highly different treatment responses to antidepressants in a retrospective study suggesting a different activity of the P-glycoprotein resulting in different levels of antidepressant in the brain.

To prospectively test whether escitalopram is associated with a stronger REM-sleep suppression in homozygote or heterozygote cytosine-carriers of that SNP than homozygote thymine-carriers, suggesting higher escitalopram brain levels in cytosine-carriers.

10 male and 10 female healthy, young cytosine-carriers, 20 male and 10 female homozygote thymine-carriers received escitalopram 10mg/day for four days. Prior and after that period, polysomnography was recorded.

At baseline, sleep in males was worse in cytosine-carriers than homozygote thymine-carriers as indicated, for example, by a significantly longer time awake (cytosine-carriers: 85±15 min; thymine-carriers: 44±6 min). Sleep in females did not differ between groups. In both groups, REM sleep was significantly reduced after treatment but there were no significant differences (cytosine-carriers: 78±5 min (baseline) to 46±4 min; thymine-carriers: 89±4 (baseline) to 49±5 min. All treatment effects of escitalopram on sleep (prolonged REM latency and sleep onset latency, increased non-REM-sleep, stage 2 sleep, stage 4 sleep, reduced REM sleep) did neither depend on sex nor genotype.

Sleep in males but not in females is relevantly influenced by the alleles of SNP rs2032583 of the ABCB1-gene. However, our hypothesis of a different REM sleep suppression due to different brain levels of escitalopram was not corroborated.

Employing neuroimaging methods in psychotherapy research confronts us with substantial methodological challenges. These challenges are linked to the complexity and plurality of processes involved in the psychotherapeutic treatment. This specifically applies to depression, a multiform psychiatric disorder. The review outlines the state-of-the-art of research in the field with a specific focus on methodological questions. It depicts limitations and strengths of experimental designs employed in psychotherapy studies using functional neuroimaging.

PubMed and PsycInfo were screened for peer-reviewed publications in English or German from 1995 to 2013 using accurate keywords. Studies employing an active condition during neuroimaging were retained. The analysis of selected studies focused on methodological aspects of the experimental design applied: what kind of task was used during functional neuroimaging? Which features characterized the active and control condition? Were neurophysiological findings linked to other data derived from psychological testing? What kind of (control- / treatment-) groups were included?

Most studies have examined effects of Cognitive Behavioural Therapy and Interpersonal Therapy with respect to short-term treatment. During functional neuroimaging, many studies employed emotion regulation tasks, often aiming at the isolation of specific cognitive mechanisms. Results concerning the effects of psychotherapy on hemodynamic activation patterns in depression are heterogeneous, depending on methods employed.

Differences in experimental designs substantially contribute to the incongruity of findings concerning effects of psychotherapy in the treatment of depression. There is a strong need for the development of adequat and accurate experimental designs in the future.

Obsessive-compulsive disorder (OCD) symptoms are remarkably diverse, as regards both clinical presentation and severity1. Studies are conflicting about whether any specific phenotype of OCD is easier to treat or likely to benefit from a particular treatment. Duration of untreated illness (DUI) represents a modifiable parameter, whose reduction may positively influence the outcome and long-term course of specific psychiatric disorders2. The aim of this study was to evaluate possible differences concerning severity, duration of illness (DI) and DUI among OCD subtypes in a sample of OCD patients.

114 OCD outpatients were recruited and assessed using the Y-BOCS. The main OCD phenotypes were identified through the YBOCS- Symptom Checklist. A one-way ANOVA test was performed to compare DUI, DI and Y-BOCS scores in the sample.

Subjects were categorized into 4 clinical phenotypes,: aggressive/checking (n=31), contamination/cleaning (n=37), simmetry/ordering (n=32) and multiple phenotypes (n=14). DUI, DI and YBOCS scores were found significantly higher in aggressive/checking subgroup, compared to other subgroups (One Way ANOVA: F=3.58 p<0.01; F=3.07 p<0.01; F=4.390 p<0.01). Furthermore, the mean DUI of the whole OCD sample, (87.35 ± 110.75 months) resulted approximately half of the mean DI (172.2 ± 132.36 months).

DUI and DI resulted significantly higher in the aggressive/checking subgroup, compared to the other subgroups. YBOCS scores resulted significantly higher in the aggressive/checking subgroup compared to the others, showing that longer DUI and DI may condition a worse clinical outcome in this subgroup. Of note, within the total sample half of the whole DI was spent untreated.

Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. It is of utmost importance to valuation, assessment and pain relief, presenting these as vital elements in contributing to the welfare and quality of life of the individual, and its control a person's right and duty of health professionals.

To understand how nurses cope with the pain phenomenon and its evaluation in the context of a continuing care unit.

This is a descriptive-exploratory study, with qualitative methodological approach. Data were collected based using semi-structured interviews, participant observation and documentary analysis of nursing records. The study included five nurses from a continuing care unit at the Santa Casa da Misericórdia Hospital, Tábua, Portugal. There were conducted 10 interviews, 25 participant observations and consult of 25 nursing records, over a period of 60 days.

The results obtained allow us to know the main problems of the nurse in the identification and characterization of the pain of the user taking into account their individuality, the performance of non-pharmacological and/or pharmacological taking into account the degree of pain and subsequently identified the election by each nurse the information recorded in the register of Nursing.

Education about safe pain management will help prevent undertreatment of pain and the resulting harmful effects. Safety includes the use of appropriate tools for assessing pain in cognitively intact adults and cognitively impaired adults. Otherwise pain may be unrecognized or underestimated.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood and may persist into adolescence and beyond.

Evaluate the efficacy of lisdexamfetamine dimesylate (LDX) and atomoxetine in subgroups of children and adolescents with ADHD.

In this 9-week, double-blind study, patients aged 6–17 with ADHD and an inadequate response to previous methylphenidate therapy were randomized (1:1) to optimized doses of LDX or atomoxetine. Efficacy measures included ADHD Rating Scale IV (ADHD-RS-IV) total score and dichotomized Clinical Global Impressions-Improvement (CGI-I) score (improved, 1–2; not improved, 3–7).

The full analysis set (n=262) comprised 194 children aged 6–12 (LDX, n=93; atomoxetine, n=101) and 68 adolescents aged 13–17 (LDX, n=34; atomoxetine, n=34). Mean optimized doses were: LDX, 52.5 (SD, 16.10) mg/day; atomoxetine, 40.2 (20.05) mg/day. Baseline mean ADHD-RS-IV total score was similar across treatment and age groups. Table shows efficacy results; safety profiles were consistent with previous studies.

Within each treatment group, improvements in symptomatological scales and global improvement ratings were observed in children and adolescents.

Study funded by Shire.

This paper reports findings of a systematic review study (SR), with focus on comfort in nursing practice. There are a lot of research works about this phenomenon on different samples of patients or caregivers, frequently nurses, carried out abroad, that allow us to understand points of view and experiences of those care actors, separately. The elderly person is a client and a patient with specificities arising from the aging process, and this can change the patient's perspectives regarding live, health and comfort as opposed to adult's ones; so, elderly people should be studied separately.

This SR's goal is to identify qualitative studies that were focused in understanding the comforter care, in sample groups of elderly patients and their nurses. The research question is: How does nurse handle care that is experienced as comforter care by the elderly patient?

We used PI[C]OD methodology and a metasummary technique to analyse and integrate data.

We identified only three primary research studies in those circumstances and their findings were analysed and synthesized.

In conclusion, SR findings can only contribute to a partial knowledge about comforter care, and moreover, they don’t allow us to reach any conclusion regarding comforter care of elderly patients, especially due to the mixed nature of samples (adults and elderly people) on primary studies. It seems evident that it is necessary to undertake a research study to obtain knowledge about the way nurses handle care that elderly patients experience as comforter.

Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions.

To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age.

To describe a specific pattern of emotional dysregulation in ED patients.

ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP).

All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20).

The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples.

Clinical implications will be discussed.