We analyzed longitudinal course of illness in schizophrenia until age 43 years, and its correlates to antipsychotic medication and cognition.

Northern Finland 1966 Birth Cohort Study has been followed serially since mid-pregnancy. Structural and functional MRI, cognitive, and clinical examinations were performed at ages 34 (73 schizophrenic psychoses, 104 controls) and 43 (63 schizophrenic psychoses, 192 controls); 40 cases and 75 controls participated in both surveys. Psychiatric outcomes have been ascertained through data linkage to a national case registers, hospital charts and clinical evaluations.

Prognosis of schizophrenia is heterogeneous: minority of individuals experience recovery, some achieve remission, but many are on disability pension, and excess mortality (especially suicides) is common. Long duration of untreated psychosis, early age of illness onset and presence of suicidal ideation associated with poorer long-term outcome. Both cases and non-psychotic controls show a small decline in verbal learning and memory, but the difference in decline is not significantly more pronounced in cases. Higher doses of antipsychotics at age 43-years associated to lower education and poorer clinical and functional outcomes, and high cumulative life-time use of antipsychotics associated to decrease of verbal learning and memory in 9-year follow-up.

Based on this naturalistic sample, midlife progression of schizophrenia may follow a variety of different trajectories. Poor clinical course is common but not necessary outcome. Compared to controls, more pronounced cognitive decline was not seen in schizophrenia cases. However, high doses of antipsychotics may relate to a decrease of verbal learning and memory.

Suicide is an increasing phenomenon in Albania. There is a lack of epidemiological studies on suicides, especially in Albanian capital city, Tirana. The broad aim of the study was the assessment of the morbidity of suicide victims in the district of Tirana over the period of time 2001-2010.

This is a retrospective study. Data was collected from the records of the Prosecution Office of Tirana district. Medical data and the statements of the witnesses were studied.

A total of 254 people have committed suicide in the district of Tirana from 2001 to 2010. The prevalence of suicide was found 0.04% (95%CI 0.035 - 0.045). The mean age of the victims is 38.5 years old. Suicide is most frequent among males 65% and in individuals with a low socioeconomical level. Suicides are more common during autumn 28% or during the months of April 13.8% and September 14.2%. The prevalence among married 52% is significantly higher compared to single individuals 41%. The most affected were workers, 25%, followed by housewives 16% and farmers 10%. The most frequent method was poisoning in 39.4%, followed by hanging in 20% of cases. 65% of cases were previously diagnosed with mental illnesses and 78% out of them were diagnosed with depression, while only 45% were treated before the suicide.

A large number of the victims have had psychiatric disturbances (78% of them depression), but they have not sought medical help. A small number of cases were treated before the suicide.

The separate diagnosis of Attention Deficit/Hyperactivity Disorder in adult patients (AADHD) is rare, while psychiatric co-morbidities are very frequent. In recent years, the often investigated co-morbidity, particularly in female patients, is eating disorders (ED). We summarize our data on the occurrence of AADHD and therapeutic possibilities in our conditions, based on the analysis of existing research literature, our research results and our first experience with a support program for these patients.

From June 2011 we have been carrying out an ongoing study of co-morbid AADHD in patients with ED, following an international study INTACT (EU Marie Curie Research Training Network). By October 2013, 93 patients were enrolled in the study (90 women and 3 men). All of them met ICD-10 criteria for ED. The average age was 25.4. The patients stated that they suffer from ED in the time period from 4 months to 27 years. None of the patients was previously diagnosed with ADHD.

We are presenting preliminary results obtained by the use of Barkley Adult ADHD Rating Scale- IV. 9 patients (9.7 %) from our sample were detected as being likely to have co-morbid ADHD. For detected patients, whose suspected diagnose of AADHD will be confirm by diagnostic interview and Integrated Visual and Auditory test, we can offer specialized treatment program (including support group sessions, cognitive remediation and CBT). This program is now being tested for its efficacy on a pilot group of AADHD patients (N=8).

The effects of the revolutionary Italian law (180/1978) closing the mental hospitals, limiting the TSO (compulsory treatment) to the general hospitals, have received scant analysis from researchers, for various reasons explaned in the paper.

To confirm if TSO may represent a useful indicator to evaluate the reform. TSO is currently under debate in the Italian Parliament dispite the absence of reliable data. Furthermore the legislation elsewhere in Europe is comparatively different.

To conduct a statistical survey to observe diachronically the variations in characteristics (modality, length, diagnoses, frequency, gender, age, nationality...)

Quantitative and qualitative analysis of the written records of TSOs in the City of Turin from 2006 to 2011, over 13,000, stored in Turin court archives (special ad hoc software was created to enable investigation) and a comparison of the results with those of a similar study conducted by our Department of Mental Health for the years 1985-1998.

Many results are discussed but we highlight the TSO length (7 days, renewable) which does not need to be modified, the disclosure of diagnoses reveals how much TSO serves as a tool of social control and how diagnoses are prevalently behavioural and outside the leading classification systems. Comparing the 2006-2011 and 1985-1998 results showed that the number of foreign persons and average age of the subjects has increased considerably in the last twenty years. Finally there has been a significant increase of personality disorders and a reduction of schizophrenic psychoses.

While the introduction of new drugs into psychiatric practice has alarmingly slowed down due to the large decrease in discovery of new drugs, there is an increase in knowledge about the available drugs.

The aims of this presentation are to summarize practice relevant research data and existing gaps in clinical psychopharmacology.

Selected review of the literature.

1. 1. Recent research failed to produce breakthroughs in the identification of new drug targets.

   The industry sharply decreased its investment into psychopharmacology research.

2. 2. Psychiatric classification systems have not been successful in integrating new findings from genetics, neuroimaging, cognitive sciences, etc. NIMH suggested to use Research Domain Criteria (RDoC).

3. 3. Large databases were developed about clinical studies and real life data and powerful statistical methods have been introduced, which helped in better defining the comparative effectiveness of available drugs.

4. 4. While low response rates have been reported in many psychiatric disorders, guidelines provide little help to clinicians in selecting drugs with best efficacy: side effects ratio.

5. 5. Many areas highly relevant for the practice are underresearched, e.g. the role of polypharmacy, the optimal length of pharmacological treatments or multimodal treatment.

Treatments based on better knowledge of evidence based differences in the efficacy and safety of psychotropic drugs are helpful in achieving better outcomes both in terms of psychopathology and functioning.

Independent educational programs in psychopharmacology and better residency training in psychopharmacology are needed, which could be supported by the EPA initiated Psychopharmacology Curriculum for Residents’ Training.

There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive protein (CRP). Ondansetron is a serotonin (5-HT3) receptor antagonist widely used to prevent nausea and vomiting in patients receiving chemotherapy for cancer. Small studies have suggested that adjunctive Ondansetron is efficacious against schizophrenia symptoms. We carried out a feasibility study in schizophrenia patients (within 5 years of first diagnosis) to explore the adjunctive use of simvastatin and ondansetron on positive, negative and general psychopathology.

This was a 12 week rater blind placebo controlled study. All to gather 36 patients with DSM-IV diagnosis of schizophrenia were recruited, 12 in each arm. Patients were assessed at baseline and at 12 weeks using PANSS, CGI, GAF and AIMS.

Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual (TAU) on PANSS total score, although, this was not statistically significant. In the secondary analyses, no significant differences were seen on CGI, GAF and AIMS.

Anti-inflammatory treatments have shown to have some beneficial effects in schizophrenia. Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual. This study has led to a larger SMRI-funded, double blind, randomized control trial.

Higher all-cause mortality and shorter life expectancies for people with severe mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) have been frequently reported. Cancer contributes a substantial proportion of mortality (20 to 30%) as the second or third leading cause of death among people with SMI. Outcomes of cancer incidence studies in SMI were considerably heterogeneous, varying by cancer types and mental disorders.

To compare the incidence of overall and each type of cancer between people with SMI in southeast London and general population in UK.

Using the anonymised linkage between a regional monopoly secondary mental health service provider covering four southeast London boroughs and a population-based cancer register, we carried out the comparisons of cancer incidences between people with SMI and general population by age- and gender-standardisation in 2011.

Among SMI subjects with cancer (N=105), the most common cancer types were lung and colorectal cancer followed by breast cancer for women and prostate cancer for men in this area. Standardised incidence ratios (SIRs) for all cancers in SMI were 1.19 (95% CI: 0.97-1.44) overall, 2.43 (95% CI: 1.98-2.94) in men (n=61), and 0.98 (95% CI: 0.71-1.31) in women (n=44). Based on relatively small case numbers, raised SIRs were found for lung cancer in men (SIR=7.57, 95% CI: 3.04-15.6) and women (SIR=7.61, 95% CI: 2.79-16.6), and in women for colorectal (SIR=7.85, 95%CI: 2.55-18.32) and breast cancer (SIR=7.86, 95% CI: 4.58-12.59).

Specific pattern of elevated risks of cancer incidence were found for people with SMI.

The incidence of depressive symptoms among adolescents has been increasing in the last years and several risk factors have been associated with depression which has become a major public health issue.

Assess the prevalence and determinants of depression in a Portuguese sample of adolescents.

A cross-sectional study was designed with a sample of 447 adolescents aged 12 to 19 years old, attending a public school in S tao, Portugal. A self-administered questionnaire with questions about socio-economic status, risk behaviours and sleep disorders was answered by adolescents. Depressive symptoms were assessed by the Portuguese validated version of the Beck Depression Inventory, and the cut-off point for depression was 13 points. We considered the following global scores: 0-13:minimal depression; 14-19:mild depression; 20-28:moderate depression; and 29-63:severe depression. Prevalence was expressed in proportions and compared by the Chi-square test.

The prevalence of depressive symptoms was 13.2%. According to the severity of depressive symptomatology, the prevalence of minimum, slight and moderate depressive symptoms was 57.4%, 5.4% and 2.3%, respectively. Depression was associated with insomnia (yes, OR=7.9 95%CI=3.1-19.9), residence area (urban, OR=1.4 95%CI=1.1-2.1), father’s educational level (<9yrs, OR=3.4 95%CI=1.1-10.2), alcohol consumption (OR=1.6 95%CI=1.1-2.2), coffee consumption (OR=1.4 95%CI=1.0-1.9) and smoking habits (OR=1.5 95%CI=1.2-1.8).

Adolescents who develop depression are also likely to develop insomnia. Depressive symptoms are associated with sociodemographic variables and addictive habits. Mental health promotion should be considered in school programmes in order to decrease the risk of depression and associated diseases.

Our social environment can have important consequences for the development of emotional processes, mental health problems and/or wellbeing among individuals and communities. Recent research suggests that stigma and discrimination has been increasing, as measured by social distance of the general public. The context of public stigma in relation to people with mental health problems could have significant consequences in terms of exclusion and thus, impact the health and well-being of people with mental illness.

To describe new research in the field of social psychiatry which investigates the impact of the macro-social context on individuals, especially in terms of stigma and social exclusion.

This session will present recent research which looks at aggregate population data including structural policies or legislation in addition to public attitudes or beliefs and how this relates to individual outcomes of mental health and well-being including self-stigma, unemployment and suicide.

Initial research highlights the importance of macro-micro contexts for the social exclusion of people with mental health problems. Further research is needed to further delineate the mechanism of how individual internalize their social environment and how we might better intervene at the population level to improve the mental health and well-being of communities.

Further to the recent debate about the future and the identity of psychiatry, we argue that social psychiatry will play a major role in psychiatric research and practice in the future.

To report priority areas in mental health research according to different categories of European stakeholders and to analyze pitfalls in training in social psychiatry.

To review the current state of knowledge on social psychiatry and to propose future actions for research and practice in mental health.

In this presentation we will report data from the ROAMER stakeholders’ survey on priorities for mental health research in Europe according to the national associations of psychiatrists, other mental health professionals, users and/or carers, trainees in psychiatry, and the results from the activities of the European Psychiatric Association - Early Career Psychiatrists Committee (EPA-ECPC).

Social psychiatry is a priority in mental health research according to all categories of stakeholders. In particular, the most important research areas indicated by the 108 respondents are early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and stigma and discrimination. According to the survey carried out by EPAECPC, social psychiatry, psychopathology and forensic psychiatry are the areas most neglected during training

Our results show the general tendency that social psychiatry is a priority in mental health research and training. Actions should be taken as soon as possible in order to: a) fight stigma; b) improve employment rates of mentally ill; c) develop strategies to manage migrants’ psychiatric problems; d) improve quality of mental health services; e) promote mental health in the population.

Antiparkinsonian drugs increase dopaminergic system activity in order to compensate dopamine neurons degeneration in corpus striatum.

To study antiparkinsonian drugs hallucinatory side effect

Our study included 28 geriatric patients enrolled in a private long-term care institution with mean age 84.93 ± 5.71 years old, weight mean 66.36 ± 2.83 kg with Parkinson’s disease.

Drugs administered to patients with Parkinson’s disease were studied.

The association of L-DOPA and DOPA descarboxylase inhibitor (benserazide) were administered to 53%(15) in doses between 2.0-19.0 mg/kg/day.

L-DOPA associated to catechol-O-methyltransferase inhibitor (entacapone)

3 mg/kg/day were given to 7.14% (2) patients.

Bromocriptine 0.04 mg/kg/day were given to 3.57% (1) patient.

39.29% (11) did not received any antiparkinsonian drug.

Mental confusion and hallucination side effect were observed in 53.33%(8) patients treated with L-DOPA associated to DOPA descarboxylase inhibitor (benserazide).

The increase of dopamine levels due to the administration L-DOPA, in corpus striatum improved Parkinson’s disease symptoms although undesirable effect related to dopamine activity at mesocortical pathway such as confusion and hallucination were observed.

• • Determine how the Resilience could understand itself as protective factor, which avoids the anxiety and depression symptoms development in adolescents, who are exposed to different big stress factors, such as, Immigration Vs. Armed Conflict.

• • Demonstrate probable consequences in Mental Health, during migratory process in Adolescents.

Resilience is the human capacity to face overcome and make stronger or transformed by experiences of adversity. We can identify resilience factors in 4thcategories: I have, I am, I feel, I can.

It is a research focus an ecological descriptive study, concentred on obtaining through 62 Semiestructural interviews, with application of four(4) individual test: STAIC(Anxiety),BDI(Depression),Family-APGAR(linkage),and Resilience-in-front-of Adversity(Resilience), with the reference population sample selected for the study; to verify the existence or not of the Anxiety and Depression Sintomatology, secondary stressor event, related to violence situation or immigration described; in the same age group, twelve to seventeen, in two gepgraphycal zones, and different social stressors, but of the high complexity (Armed Zone Vs. Immigration Zone). The population was in two zones in order to take the samples. Zone-1: Adolescents, residents in Colombian armed conflict-(Arauca-Department). Zone-2:Adolescents, residents of Barcelona province-(Catalunya, Spain), who were born and came from Latin-America.

• • Resilience is defined as a human capacity, present in different communities of adolescents, that allows to face the adversities of life -violencearmed conflict-immigration, both in communities migrants/immigrants and residents in war area present in the study.

• • The Immigration is cause of anxiety in adolescents, including states of rejection, vulnerability and change in their identity.

• • Resilience also means life experience, it is a building life experience.

In schizophrenia negative symptoms often persist and determine an unfavourable course. Reviews including studies with small sample sizes indicate improvement of negative symptoms in schizophrenia patients by repetitive transcranial magnetic stimulation (rTMS), but provide heterogenous results. To prove the clinical efficacy of rTMS on negative symptoms trials with larger samples of patients are needed.

In a multicentre randomized, sham-controlled, rater- and patient-blind clinical trial including 197 patients we investigated the efficacy and tolerability of a 3 week 10 Hertz (Hz) rTMS add-on to antipsychotic therapy (in total 15000 stimuli, stimulation intensity 110 % of the individual motor threshold) over the left dorso-lateral prefrontal cortex (LDLPFC) immediately after treatment and during a 12 weeks follow-up.

According to our primary outcome parameter we observed a significant decline in negative symptoms (negative sum score of the PANSS) in the verum and sham group (N = 124), but could not find a significant superior reduction in the verum group at day 21. At day 28 significant more patients in the verum compared to the sham group showed a clinical meaningful reduction of PANSS negative subscore (= 20 %) (N = 89; 57.5 % vs. 32.7 %, p = 0.033), however this effect did not persist at further follow-up.

High-frequency (10 Hz) rTMS of LDLPFC over 3 weeks provided only a small benefit in the reduction of negative symptoms, however HF-rTMS was well tolerated. We discuss our results in comparison to current meta-analyses and previous studies.

ClinicalTrials.gov NCT00783120.

Previous studies have reported that patient with schizophrenia have preserved hedonic capacity, but impaired ability to anticipate future reward (anticipatory anhedonia) that, according to some authors, may underlie other aspects of negative symptoms, such as avolition.

The aim of our study was to demonstrate an impairment of reward anticipation in patients with deficit schizophrenia (DS), characterized by primary and persistent negative symptoms, but not in those with non-deficit schizophrenia (NDS) with respect to healthy controls (HC), by means of functional magnetic resonance imaging (fMRI).

fMRI was recorded during the execution of the ’Monetary Incentive Delay’ task in 11 patients with DS, 23 patients with NDS and 23 HC, during the anticipation of five different outcomes, small (SR) or large (LR) reward, small (SP) or large (LP) punishment or no-outcome (NO).

The ventral striatum response to reward anticipation was preserved in subjects with schizophrenia. Only patients with DS, compared with HC, showed a significant reduction in the left caudate during the anticipation of reward. The reduced activity of the caudate correlated with the scores for avolition but not for anhedonia.

Our preliminary data suggest an involvement of the caudate in the abnormal processing of reward stimuli in patients with DS and show that avolition and anhedonia are subtended by different functional abnormalities.

Several factor analytic studies have shown than anhedonia and avolition are included in the same factor, suggesting that motivational deficits in schizophrenia are related to a reduced experience of pleasure; however other studies have not confirmed this hypothesis. More recently, it has been hypothesized that avolition is related to a difficulty in anticipating reward value and\or regulating behavior on the basis of the associations between value and action.

This study is aimed to verify an impairment of reward anticipation in patients with deficit schizophrenia (DS), but not in those with non-deficit schizophrenia (NDS) and its association with primary negative symptoms, using event-related potentials (ERPs).

ERPs were recorded in 11 patients with DS, 23 patients with NDS and 23 healthy controls (HC), during anticipation of five different outcomes, small (SR) or large (LR) reward, small (SP) or large (LP) punishment or no-outcome (NO), and during feedback processing.

Patients did not differ from HC on indices of anticipatory or consummatory anhedonia, but they showed reduced motivation. During reward anticipation, only patients with primary and persistent avolition showed ERPs abnormalities, with respect to HC, in the early processing stages and a reduced activity of cortical generators in the cingulate, in the temporal-occipital and fronto-parietal regions, that are involved in the attention modulation and visual perceptual processing.

Our data suggest that anhedonia and avolition are partially independent constructs and that avolition is related to the inability to modulate attention and amplify visual perceptual processing of reward stimuli.