Family and twin studies have shown that both common genetic variants and environmental factors contribute to vulnerability to suicide behaviour. Interactions between several candidate genes and environmental factors have been reported. In order to discover new candidate gene using an agnostic method we examined the association between common genome-wide variations and lifetime suicide behaviour (suicide attempt, SA, and completion, SC) (genome-wide association study, GWAS).

In the first, discovery, analysis allele frequencies of the common non-imputed 282'738 single nucleotide polymorphisms (SNPs) were compared between 833 SA, 235 SC and 1360 controls from the French-Swiss collaboration, genotyped with the Illumina Human 660W-Quad bead chips and HumanHap300 BeadChipsSNPs platforms respective. Thirty SNPs were associated at level p<10-5 for SA and 5 for SC. Strongest evidence of association for SA was observed 150kb from PLXNA2 (rs10779481, p=4×10-8) and for SC in the DROSHA locus (rs7726209, p=9.9 ×10-6). The combined sample of suicide attempters and completers, identified two SNPs (rs9038 and rs2574852) located at chromosome 17q25.3 within a gene encoding the septin 9 (SEPT9) that showed a trend for an association with SB (p=2.04×10-7 and 7.52×10-7).

Replication studies are now in progress by analysing existing comparable samples, a second new French-Swiss sample, and imputation. These results suggest that GWAS could identify new candidate genes involved in new candidate pathways involved in vulnerability to SA and SC.

Studies of normal aging have shown age-related decreases in functional connectivity (FC) within the default mode network (DMN), particularly involving the posterior cingulate cortex (PCC). Although psychiatric conditions are common and underdiagnosed, none of these studies have combined psychiatric structured interview and neuropsychological evaluation to select the sample.

to characterize age-related changes in PCC-FC connectivity in adults carefully screened to rule out neuropsychiatric disorders.

neuropsychiatric disorders were excluded by the Structured Clinical Interview for DSM-IV and neuropsychological evaluation. Restingstate functional MRI was acquired from 40, young, middle-age and elderly participants. After preprocessing, whole-brain, seed-based FC was estimated using a PCC seed. The relationship between age and PCC-FC was assessed using partial least squares.

age was positively associated with PCC-FC in the left dorsolateral prefrontal cortex, bilateral supplementary motor area, right insula and left cerebellum; PCC-FC in these regions was negative or close to zero in young adults. PCC-FC of the medial part of the ventral prefrontal cortex was negatively associated with age; this region presented high positive PCC-FC in young adults (see figure).

age-related increases in PCC-FC were found in regions which are anti-correlated with the DMN, suggesting a decrease in the magnitude of anti-correlation. This may reflect a dedifferentiation process or weaker inter-network interactions. The careful sample selection prevents confounds related to neuropsychiatric disorders.

There is paucity of published literature on antidepressants in a cost-consequence study design.

Measuring clinical outcomes of pharmacotherapy.

Costs and consequences determination in depressive episode acute medical care.

Cost-consequence analysis;Setting-Serbian tertiary university clinic(2010-2012). Patient visits to attending psychiatrists:baseline, 3,8 weeks. HDRS-17 and Q-LES-Q-SF scale were applied in each of control visits. Resource use patterns and costs were evidenced for up to 14 weeks from study entry. Micro-costing approach allowed for most direct and indirect costs measurement. Costs were expressed in national currency-Central Serbian Dinar(1€≈115.85CSD;2012). Societal perspective and 14 weeks time horizon were adopted. Random selection of 65 depressive patients was based on clinical criteria and their assignment to either one of three different treatment protocols.5 patients were lost to follow up.

There was no statistically significant difference in terms of therapeutic response by the HDRS scores before and after introducing treatment groups(χ2=4.339; ?=0.362). QALY value increased by 11.77(SSRI group);8.93(SNRI)and 12.54 (heterocyclics). Mean cost per QALY was 9,937.51 CSD for SSRI; 7,138.27 CSD in SNRI; and 6,164.96 CSD for heterocyclics. There were 28.69 depression with free days in SSRI, 21.78 days in SNRI, and 30.59 days in heterocyclic group. Cost-effectiveness assessment was was 346.38 CSD per day(SSRI); 327.74 CSD(SNRI), and 201.54 CSD(heterocyclics).

Heterocyclic antidepressants provide highest'value for money' in terms of QALY in depressive episode treatment and its treatment is most cost effective. Cost-consequence evaluations have heavier impact to clinical decision making with regards to major depressive disorder treatment in the absence of clear clinical superiority of any major pharmacological protocol.

Catechol-O-methyltransferase (COMT) play an important role in modulating cortical dopaminergic catabolism and has been associated with schizophrenia. However, it remains unclear that if the variations in dopamine signaling affect the gray matter (GM) structural maturation in typically developing individuals, and whether such effect are disrupted in schizophrenia patients. This study aims (1) to explore the relationship between the functional polymorphisms Val158Met of COMT gene and GM volume in first-episode treatment-naïve patients with schizophrenia and healthy controls, (2) to investigate the influence of COMT Val158Met on TMT performance, (3) to investigate the relationship among GM volume, cognitive deficit and psychiatric symptoms.

Whole GM volume which was computed by an automated SPM and clinical performances were evaluated in 150 first-episode treatmentnaïve patients with schizophrenia and 100 healthy controls. In addition, 2-sample t-tests was used to explore the main effect of diagnostic group, a full factorial model was used to obtain genotype-by-diagnostic interaction in the volume of GM according to genotypes of above the polymorphism, and multiple regression was used to explore the correlation whole GM volume with TMT measurements and clinical syndromes, with age and sex as covariance.

A significant GM volume reduced in the right precentral gyrus [MNI: 37 -16 70], right cerebellum anterior lobe [MNI: 6 -56 26] and left Postcentral gyrus [MNI: -8 -36 80] (P < .05, FWE corrected) in schizophrenia. There was also a strong for a group× genotype interaction on the right precuneus (P < .001, uncorrected). A significant negative correlation of the GM volume over the cluster located at cerebellum anterior lobe with TMT-A and TMT-B within schizophrenic patients (P < .05, FDR corrected). A significant positive correlation of the GM volume over the cluster located at middle frontal gyrus [MNI: 36 60 15] with PANSS subscales for general psychopathological symptoms within schizophrenic patients, the negative correlation of the GM volume over the cluster located at parahippocampa gyrus [MNI: 27 -10 -25] with PANSS subscales for negative symptoms within schizophrenic patients (FDR correction at p < 0.05).

These findings suggest that COMT Metvariant was associated with disruption of dopaminergic in?eunces on GM maturation and may be the pathogenesis of schizophrenia, and maybe that the abnormal GM structure were association with cognitive function and clinical syndromes.

The discharge letter is the principal means of communication between the inpatient and the primary care physicians in the UK health care system. Good-quality correspondence between specialist services and general practitioners (GPs) is fundamental to patient care and makes transition from secondary to primary care as smooth as possible for patients

The aim of this study was to assess and improve the quality of discharge communication from the specialist substance misuse inpatient unit to general practitioners

This study was carried out in North Staffordshire Combined Healthcare NHS Trust in July 2013, UK. Fifty three Patients who were admitted to the inpatient unit between March & May 2013 were randomly selected from the Health Informatics Service. A proforma was designed based on approved mental health discharge summary headings from the Royal College of Psychiatrists UK and the results were compared against a previous audit done in 2012 which only looked into some of the component included in the present study

The study showed that most components of GP details, Patient Demographics, Admission Details, Clinical Details and discharge recommendations were well documented in the discharge letters analysed. The sub components where documentation were not adequate included Gender (0% documented), discharge destination (34% documented), mental capacity (1% documented), allergies (0% documented), Risk assessment (68% documented). However the findings were significant better than the previous audit in most areas.

This re-audit revealed that the quality and standards achieved for most aspects of discharge summaries were high. However not all aspects met the standards, some very important aspects including risk assessment, drug allergy, details of care coordinator and discharge destinations recordings were poor. There may be reasons for failure to meet the standards; Gender was never recorded in the discharge letters but one could easily assume the gender of the patients from the narrative of the discharge letters. It was noted that discharge destinations were more likely to be recorded if patients were not discharged home. Mental Capacity was not recorded in 98% of cases, as most admissions to the Inpatient unit are planned and patients come on a voluntary basis and have capacity regarding the admission and treatment

Decreased vesicular glutamate transporter type 2 (VGLUT2) in schizophrenic brain indicates the deficit of glutamatergic function which may produce cognitive impairment in the patients. Bacopa monnieri (Brahmi), a traditional Indian Ayurvedic medicinal plant and popularly known as a cognitive enhancer might be a novel therapeutic agent for the cognitive deficit treatment in schizophrenia by changing cerebral VGLUT2 density.

To study effects of Brahmi on attenuation at cognitive deficit and cerebral VGLUT2 density in sub-chronic phencyclidine (PCP) rat model of schizophrenia.

Rats were administered PCP or vehicle. Half of the PCP-group was treated with Brahmi. Discrimination ratio (DR) representing cognitive ability was obtained from novel object recognition test. VGLUT2 immunodensity was measured in the prefrontal cortex, striatum, cornu ammonis 1 (CA1) and cornu ammonis 2/3 (CA2/3) of hippocampus using immunohistochemistry.

DR in PCP-group was significantly decreased compared with control. This occurred alongside reduced VGLUT2 density in the prefrontal cortex, but not in striatum, CA1 and CA2/3. PCP with Brahmi showed a significant increase in DR score compared with PCP alone. This occurred alongside significant increase in VGLUT2 density in the prefrontal cortex.

Cognitive deficit observed in PCP-administered rats was mediated by VGLUT2 reduction in the prefrontal cortex. Interestingly, Brahmi could recover this cognitive deficit by increasing VGLUT2 in the prefrontal cortex to normal. Conclusively, Brahmi could be a new frontier of cognitive deficit treatment in schizophrenia.

The purposes of this study were to explore elderly outpatients’ perceived reasons for, opinions of, and suggestions for elderly people considering suicide in Taiwan.

Elderly outpatients (N=83) were recruited in 2011-2012 by convenience sampling from three randomly selected medical centers in Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by content analysis.

Findings revealed that most participants had heard of elderly suicide, with television news as the main source for their information. Their opinions about elderly suicide reflected judgmental attitudes, negative emotional reactions, expectations of social welfare, and could happen after losing one's meaning in life. Their suggestions for elderly people considering suicide fell into four major themes: give up suicidal ideas, seek help, enhance social welfare, and attend religious activities.

Since television news was the main source for participants’ information about elderly suicide, this mass medium should be used in suicide prevention to disseminate suicide knowledge, increase access to help, and strengthen suicide-protective factors among the elderly. Furthermore, no participants mentioned depression as a reason for attempted or completed suicide among older people despite depression being a well-known suicide-risk factor. Future suicide-prevention programs should emphasize the role of depression in suicide among older people. Participants also did not suggest that older people considering suicide seek help from the health system. Thus, older people should be educated about the role of the health system in suicide prevention and trained as gatekeepers to recognize signs of suicide ideation and respond appropriately.

Physical comorbidity needs special attention in depressed patients who frequently do not understand the complex interrelationship between depression and physical comorbidity. Consequently, we investigated whether the burden of comorbidity and its relevance on general hospital mortality differed between patients with- and without depressive disorders in a 12-year follow-up in general hospital admissions.

During 2000 - 2012, 9,604 patients with (unipolar) major depression were admitted to three General Manchester Hospitals. All comorbidities with a prevalence ≥ 1% were compared with those of 96,040 age- and gender matched hospital controls. Comorbidities that were predictors for inpatient mortality were identified using multivariate logistic regression analyses.

Compared with hospital controls, depressed patients had a substantial higher burden of comorbidity and a more severe course. The highest comorbidities included hypertension, asthma, and anxiety disorders. Subsequently, twenty-six other diseases were disproportionally increased. In deceased depressed patients chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) were the most frequently recorded comorbidities, contributing to 18.6% and 17.1% of hospital deaths. Further predictors of in-patient mortality included fifteen other physical conditions, many of them linked to diabetic complications. There were no differences in their impact on mortality compared to controls with the same comorbidities.

In general hospitals clinically relevant depressed patients succumb to the same physical diseases as their age-gender matched peers without depression. COPD and T2DM may need special attention in depressive disorders. Prospectively, it has to be investigated why depressed patients have more physical diseases than non-depressed patients.

Physical comorbidity is highly prevalent in bipolar disorder (BD). Consequently, we investigated whether physical comorbidity and its relevance on general hospital mortality differs between patients with- and without BD in a 12-year follow-up in general hospital admissions.

During 1 January 2000 and 30 June 2012, 621 bipolar patients were admitted to three General Manchester Hospitals. All comorbidities were compared with those of a prevalence ≥ 1% in 6210 age- and gender matched hospital controls. Comorbidities that were predictors of general hospital mortality were identified using logistic regression analyses.

Type-2 diabetes mellitus (T2DM) was increased in the bipolar population compared to the control population. Additionally, T2DM was significantly elevated in the 60 bipolar patients that died during the study period (25.0%) compared to those 541 bipolar patients that survived the study period (11.2%), and deceased bipolar patients had significantly more suffered T2DM than deceased control subjects (25.0% versus 14.6%). However, T2DM did not significantly contribute to explain the outcome hospital death in the control population. Further predictors of inpatient mortality in BD were hypertension, chronic obstructive pulmonary disease, pneumonia, bronchitis, and ischemic stroke. There were no differences in their impact on hospital death compared to the same comorbidities in hospital controls except T2DM.

T2DM represents a major predictor of general hospital mortality in BD. The study gives support for an aggressive multidisciplinary approach to identify and treat T2DM to prevent diabetic-, respiratory- and vascular complications in all bipolar patients.

Body mass index (BMI) was measured for six females housed within a Residential Treatment Facility (RTF) by the staff members at pre and post-testing time points. Data was analyzed using descriptive statistics including cross-tabulations.

The intervention was delivered within the RTF and was designed to elicit healthy lifestyle changes through modification of food choices and menu options as well as increased fitness and activity levels. Each participant developed an action plan that detailed key strategies to address diet and exercise.

At pretesting, 100% of the participants were measured as either obese or overweight. Conversely, at posttesting, only 50% of the participants were measured in the obese BMI range. More specifically, one individual had moved into the normal category of BMI range and two participants moved into the overweight BMI range. The average weight loss, in pounds, was 7.8 pounds per person, with weight loss ranging from 2 to 19 pounds.

Though a small pilot study, the findings of this study have strong implications for both practice and research areas of child and adolescent wellness. The health and wellness intervention provided a means through which adolescents were effectively able to improve BMI levels through education regarding and modification of lifestyle behaviors and habits.

Cognitive impairment is a debilitating symptom of schizophrenic patients causing functional disability. Neither typical nor atypical antipsychotic drugs are able to control it. There is a strong potential that Bacosides A and B from the plant Bacopa monnieri (Brahmi) could be a novel neuroprotective compound for the prevention of cognnitive deficits in schizophrenia.

To study neuroprotective effects of Brahmi on novel object recognition tasks and the cerebral VGLUT2 density in rat models that are schizophrenia induced through sub-chronic phencyclidine (PCP) administration.

Rats were divided into 3 groups; Group-A: Control; Group-B: PCP and Group-C: Bacosides A and B + PCP. Discrimination ratio (DR) representing cognitive ability was obtained from novel object recognition test. VGLUT2 density was measured in prefrontal cortex, striatum, cornu ammonis fields 1 (CA1) 2/3 (CA2/3) of hippocampus using immunohistochemistry.

DR in the PCP-group was significantly decreased compared with the control group. This occurred alongside reduced VGLUT2 in the cingulate gyrus. Bacosides A and B + PCP group showed a significant increase in DR score compared with PCP alone. This occurred alongside a significant increase in VGLUT2 in the cingulate gyrus.

Cognitive deficit observed in rats receiving PCP administration was mediated by VGLUT2 reduction in the cingulate gyrus. Administration of Bacosides A and B before PCP administration can restore this cognitive deficit by increasing VGLUT2 density in this brain area to normal level. Conclusively, Bacosides A and B could be a novel neuroprotective compound for prevention of cognitive deficits in schizophrenia.

The clinical case report has a long-standing tradition in the medical literature. While its scientific significance has become smaller as more advanced research methods have gained ground, case reports are still presented in many medical journals. Some scholars point to its limited value for medical progress, while others assert that the genre is undervalued.

To assess the medical scientific community's viewpoints on the merits and limitations of the case report.

We searched PubMed and Google Scholar and select textbooks on epidemiology and medical research for articles discussing the merits and limitations of clinical case reports and performed a non-systematic review.

The major merits of case reporting were these: Detecting novelties, generating hypotheses, pharmacovigilance, high applicability when other research designs are not possible to carry out, allowing emphasis on the narrative aspect (in-depth understanding), and educational value. The major limitations were: Lack of ability to generalize, no possibility to establish cause-effect relationship, danger of over-interpretation, publication bias, retrospective design, distraction of reader when focusing on the unusual.

Despite having lost its central role in medical literature in the 20th century, the genre still appears popular. It is a valuable part of the various research methods, especially since it complements other approaches. Furthermore, it also contributes in areas of medicine that are not specifically research-related, e.g. as an educational tool.

Forensic-psychiatric services are costly and very restrictive for patients. Clinical experience and the limited research available indicate that some patients stay for too long in these settings. A proportion of patients may, however, require long-term, potentially life-long, secure forensic-psychiatric care but their needs may not be met by existing service provision designed for faster throughput. Here we report the initial findings of a three year study on long-stay patients in forensic care conducted in England.

The overall objective of this project is to improve the quality and cost-efficiency of the care and management of patients who stay for prolonged periods in secure forensic-psychiatric settings.

1. 1. Estimate the number of long-stay patients in secure settings in England (length of stay over 5 years in medium secure care or 10 years in high secure care)

2. 2. Describe their characteristics, needs, care pathways and reasons for prolonged stay

3. 3. Identify patients’ perceptions of their treatment pathways, long-term needs, service provisions and quality of life

4. 4. Develop recommendations following the exploration of international models for this patient group

This project uses a mixed-methods approach including analysis of administrative data, case file reviews, patient interviews, interviews with clinicians and commissioners and a Delphi survey.

Initial findings indicate that up to 25% of the forensic population fulfill criteria for long-stay, a much greater number than originally estimated.

The high number of long-stay patients in high and medium secure services calls for specific service provision for this patient group, which we will explore further.