The aim of the study was to investigate the development of the psychiatric emergency situation in the city of Ulm, Germany, over a decade ranging from 2004- 2013.

All reports regarding medical emergencies in the city of Ulm (110,000 inhabitants) from 2004 to 2013 were examined. Psychiatric emergencies were identified and worked off retrospectively with respect of demographic variables, diagnosis, pharmacotherapy, general medical treatment and time trends.

Data were available of 933 psychiatric emergency care episodes. 40% of episodes concerned male patients (60% female). Average age was 45.3 years. Diagnoses were made on a syndromal level on the basis of a classification by Hippius (Hippius H: Psychiatrie. Springer, Berlin, 1979). The most frequent syndromal diagnoses were 'state of psychomotor excitement', 'suicidal syndrome', 'syndrome of addictive behaviour' and 'acute intoxication'. These syndromal diagnoses occurred with increasing frequency later in the day. Medication interventions comprised mostly midazolame followed by haloperidol, diazepam and lorazepam.

The results of our study are roughly in line with those described in the literature based on studies dating back to the 1980s and 1990s. Emergency medicine is an multidisciplinary subject, in which psychiatric disorders account for a substantial proportion of episodes of care.

Eating Disorders (ED), including obesity, with and without Metabolic Syndrome (MetS), are associated with anxiety and depression. Increased levels of cytokines and their consequences on the pathway of kynurenine (KYN), the main metabolite of tryptophan, have been proposed to account for these associations.

To review the evidences suggesting biochemical connections between the Depression and Anxiety Spectrum (DAS), MetS and ED, respectively, focusing on the role of the KYN pathway.

Three PubMed searches of the literature conducted in October 2013 (key words:‘kynurenine’ ‘eating disorders’; ‘kynurenine’ ‘waist circumference’; ‘kynurenine’‘obesity’‘metabolic syndrome’) provided 2, 3 and 7 references, respectively.

The metabolism of L-tryptophan through the KYN pathway depends on the following three factors: 1) NUTRITION; in underweight ED LKYN metabolites (quinolinic acid, kynurenic acid, 5-hydroxyindoleacetic acid) are significantly reduced until the restoration of normal body weight. In overweight and obesity with and without MetS, increased KYN levels and KYN/tryptophan ratio are found, with abdominal fat content as strongest factor for an increase of the KYN/TRP ratio. 2) AGE; KYN/TRP ratios are markedly increased vs. decreased in overweight and obese adults vs. juveniles, respectively. 3) INFLAMMATION; IFN-gamma induces the indoleamine 2,3- dioxygenase (IDO)-catalyzed synthesis of KYN, whose derivatives increase in diabetes (xanturenic acid), psychosis (kynurenic acid), and depression (quinolinic acid).

The KYN pathway may link DAS, MetS and ED explaining the frequent association of DAS to so many different disorders. Further studies are needed in order to understand these complex connections.

Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.

Describe a case of a 53-year-old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address these behavioral problems. Her husband noticed that she had become’hyper’ in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.

Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.

Prednisone was suspended and Risperidone 2mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.

These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.

In this study, it was aimed to evaluation of alexithymia in male patients before open-heart surgery. The correlation between alexithymia and psychopathology was also investigated.

Thirty-two male patients who had cardiovascular disease were enrolled before open-heart surgery. Socio-demographic characteristics and clinical features of the patients were determined. Symptom Checklist-90-Revised (SCL-90-R), Toronto Alexithymia Scale (TAS), Hospital Anxiety and Depression Scale (HADS), State-Trait Anxiety Inventory (STAI) were applied.

The mean age of the patients was 55.20± 11.72 years. The mean scores were 51.71±9.90 for alexithymia, 6.44±3.86 for anxiety, 5.06±3.61 for depression, 38.91±10.21 for state anxiety and 41.22±7.46 for trait anxiety. The positive correlations between Toronto Alexithymia Score and Depression, Interpersonal sensitivity, Hostility, Paranoid Ideation, Psychoticism and Global Severity Index subscales of SCL-90-R were statistically significant. There were no statistically significant correlations between TAS and HADS, and STAI scores.

The most interesting finding was that there is a correlation between alexithymia and paranoid ideation, and psychoticism in these patients. Contrary to expectations, this study did not find a significant correlation between alexithymia and anxiety and depression. Further research should be done to investigate the comparative studies in patients with different diseases at pre-and post-operative period.

The aim of the study was to investigate the influence of agomelatine and venlafaxine on driving skills and on driving performance in an on-road driving test in depressed inpatients.

40 depressed inpatients were randomly assigned to treatment with either agomelatine (n=20) or venlafaxine (n=20). Patients were tested before pharmacologic treatment (t0), and on days 14 (t1) and 28 (t2) with computerized tests and additionally were rated in an on-road driving test on day 28 by a licensed driving instructor. To control for retest effects a group of 20 healthy subjects was examined in the same time schedule.

After two weeks of treatment with agomelatine or venlafaxine patients showed a significant reduction in depressive symptoms, and a distinct improvement in concentration and stress-tolerance. Furthermore, prior discharge to outpatient treatment (day 28), 72.5% of patients were labeled abundantly fit to drive in the on-road driving test, in 22.5% of cases a satisfactory performance was certified and in 5% of our patient sample there were slight concerns with respect to fitness to drive. Patients did not however reach performance level in functional domains of healthy controls. Significant differences between treatment groups could not be observed.

Our results indicate that depressed patients treated with agomelatine or venlafaxine show a better test performance on tasks related to driving skills than do untreated patients Besides, most patients could be rated as fit to drive, on an actual driving test conducted by a licensed driving instructor, prior discharge to outpatient treatment.

Homosexuality and bisexuality have been associated to increased risks of substance use. Affiliation with the gay culture is one of the explanatory models. According to this model, homosexual persons should, compared to heterosexual persons, preferentially use (or at least try) substances which are usual within the gay scene.

To explore the choice of lifetime substance use among heterosexual, bisexual and homosexual men.

The C-SURF study concerns young Swiss male adults who have to go through the mandatory recruitment process at the Swiss army. Data were collected between August 2010 and November 2011. The questionnaire was about the participants’ socioprofessional and family background, their consumption of alcohol, cannabis and other drugs, as well as their personality. The final sample included 5990 males between 17.9 and 31.4 years old (mean=20.01, sd=1.24).

5371 (89.7%) of subjects declared being exclusively attracted by females, 442 (7.4%) by males and females and 62 (1.0%) by males only. A multinominal logistic regression revealed an increased risk of homosexual men to have ever used poppers (OR 1.57), party drugs (Ecstasy, GHB etc.) (OR 2.18) and cannabis (OR 1.34). Homosexual men had an increased risk of lifetime use of poppers (OR 7.29), and cocaine (OR 4.47), and a reduced risk of alcohol use (OR 0.45).

The choice of drugs seems to be influenced partly by sexual affinities. In addition to the affiliation with the gay culture (especially poppers), the minory stress model may help to explain cannabis use among bisexual subjects

To define neural correlates of cognitive dysfunction in major depression and to disentangle the role of cognitive, default mode and limbic networks in emotional and cognitive problems of depressed patients

We will review brain imaging studies of executive function and rumination in depression. We will also describe results of a recent study conducted in healthy volunteers (n=41) using cognitive tasks related to ruminative processes. During fMRI acquisition subjects were asked to read sentences and to engage in an analytical or an experiential self-referential task.

Several studies using executive tasks related cognitive effort in depressed patients with increased activation of the dorsolateral prefrontal cortex. This hyperactivity of lateral prefrontal cortex is associated with abnormal deactivation of medial brain structures such as the medial prefrontal cortex. Consistent with this review, our study in healthy volunteers showed that subjects with High score in rumination showed lower activity in medial brain structures in relation with difficulties to differentiate analytical and experiential self-focus.

Overall these findings support the hypothesis of abnormal interaction in cognitive and default mode network in depression and may help to refine our understanding of how rumination promotes depression through maladaptive self-focus.

Since about 30% of children and adolescents attending primary care and pediatric outpatient departments have psychiatric disorders that cause significant distress and social impairment, the proper functioning of National Health System assumes a determinant role on promoting early detection and intervening in the prevention of mental illnesses which can almost only be done through an efficient matching between primary care and hospital care.

This paper aims to characterize the pediatric population hospitalized sent by their general practitioners to our outpatient clinic, on a level III Pediatric Hospital, evaluating the existence of psychopathology.

Retrospective analyses of 309 cases, at their first appointment on our outpatient clinic from June 2002 to March 2013. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children and adolescents.

During 10 years, 185 male (45,95% 4–10 years; 54,05% 11–17 years) and 124 female (50,0% on each age group) were evaluated. Eighty-four percent of cases, scored for’any psychiatric disorder’. Correlation between parent-reported and self-reported data was found, slightly higher for male gender. Pronounced divergences were found regarding child and adolescents’ perception and their parents, concerning everyday life difficulties and hyperactivity scores, that is also valid for age group and gender. Total scores: emotional symptoms (51,8%), conduct problems (58,3%), hyperactivity score (59,2%).

We observed a positive impact of primary care medicine on referral network since the majority of the evaluated children and adolescents had psychopathology.

The Internet provides adolescents the chance to experience autonomy through the collection of information and contact with peers with whom to share experiences, emotions and thoughts. A misuse of the Internet can occur if a teenager avoids real relationships and surfing the web turns into a psychological defense, in contrast with a healthy mental development.

and Aims The research investigates forms and motivations of misuse of the internet among a group of Italian teenagers. Objective of the work is the hypothesis of a correlation between massive use of internet and behaviours of social retreat.

The research used a questionnaire. The areas of investigation were: school performance, hours of internet surfing, activity on the Internet (social networks, games, information research, gambling online), psychological reasons of the Internet use, behaviours of social retreat. 583 adolescents (45% males and 54% females, mean age 17 years) responded to the questionnaire.

The 6% of adolescents sample responded to always think the Internet even when not on the computer or gets irritated and reacts impulsively if someone bothers him while it is connected. The 5% prefer surfing rather then going out with friends. Hours of internet sulfing and responses of social retreat were correlated.

The social retreat can be one of consequences of the Internet misuse, with difficulties in socializing and use of the Internet as a psychological defense.

Animal research suggests that weight gain may be caused by olanzapine-induced melatonin suppression. We conducted a pilot study of psychiatric patients treated with olanzapine to examine if melatonin was suppressed and if so the dose needed to replace this deficit. The relationship between melatonin and metabolic indices was also examined.

Ten patients with schizophrenia (N=3), schizoaffective disorder (N=3), or bipolar disorder (N=4) completed the study. All patients were male, average age 50.6 years. Patients were treated with olanzapine for 5 weeks, then randomized to either 0.3mg (N=4) or 3mg (N=6) of melatonin supplementation in addition to the olanzapine for another 6 weeks. We obtained baseline, week-6, and week-12 measures of the major metabolite of melatonin in the urine, 6-Sulfatoxymelatonin (aMT6s) adjusted for creatinine excretion. We measures weekly weight, glycemia, cholesterol, and triglycerides.

Olanzapine treatment was associated with a trend toward decreases in melatonin from baseline to week-6 (p=.14). Analysis of a subsample of patients diagnosed with schizoaffective or bipolar disorder showed significant decreases from baseline to week-6 (p=.02). Both supplementation with melatonin by 0.3mg and 3mg increased urinary melatonin levels from week-6 to week-12 (p=.12 and p=.02 respectively). Total cholesterol increased initially but demonstrated a trend for decrease when melatonin was supplemented (p=.10).

Olanzapine appears to be related to melatonin suppression. Melatonin supplementation reverses this suppression and may have the potential to reverse metabolic effects associated with olanzapine. Further studies are needed to examine the metabolic effects of olanzapine with melatonin.

Electroconvulsive therapy (ECT) is a highly effective treatment for major depression with response rates of up to 80%. However, a significant minority does not respond, and no evidence-based guidelines are available for the management of ECT-resistance. Ketamine is an anaesthetic agent with N-methyl-D-aspartate-receptor-antagonist properties, that has a rapid but short-lasting antidepressant effect in treatmentresistant depression.

To present a case of ECT-resistant depression that responded when ketamine anaesthesia was used.

To review the available literature on ECT-resistance and augmentation of ECT.

A case is presented and discussed, followed by a systematic literature review.

We present the case of a 75-year-old woman with severe major depression unresponsive to several adequate treatments with antidepressants, augmentation with antipsychotics, and ECT with anaesthesia using propofol or etomidate. When ketamine was used for anaesthesia, she experienced remission of her condition. She remained well with a continuation of this treatment at a decreasing rate. A literature review revealed that most augmentation strategies for ECT concerned the optimisation of seizures by using of substances that lowered the seizure threshold (e.g. xanthines) or anaesthetics that do not increase the seizure threshold (e.g. remifentanil). Ketamine anaesthesia was shown to speed up response to ECT, but did not increase response rates. However, these studies were not done with ECT-resistant patients. This case suggests that switching to ketamine anaesthesia may be beneficial in these patients.

There are little evidence-based augmentation options for ECT-resistance. This case suggests that ketamine anaesthesia may be efficacious as augmentation in ECT-resistance.