Betel-quid use, the forth addictive habit in the world after nicotine, alcohol, and caffeine use, and was widespread in southern Asia. Betel-quid use has been associated with obesity and hyperglycemia. It is a popular habit among aborigines in Taiwan. Little research describing the association of the betel-quid use contributes to the metabolic syndrome in aborigines in Taiwan.

The aim of the study was to assess the prevalence of metabolic syndrome in adult aborigines and to test whether betel-quid use contributes to the metabolic syndrome.

A cross-sectional survey was conducted and 558 aborigines, aged? 40 years who had undergone the health examination in a aboriginal health care center were recruited into this study. The metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). Information on substance use (betel-quid, cigarette, alcohol) and depression were obtained by performing personal interviews using a validated questionnaire.

The prevalence of metabolic syndrome in adult aborigines was 30.6%, the prevalence rate was significantly higher in women than that of men (34.1% compared with 24.1%, OR: 1.57, 95% CI: 1.06-2.36). After covariate adjustment, betel-quid users were more likely to have metabolic syndrome (AOR: 1.51, 95% CI: 1.04-2.21). However, depression was not associated with metabolic syndrome.

These data suggest that betel-quid use is independently and positively associated with metabolic syndrome in adult aborigines.

To examine the prevalence of and factors associated with metabolic syndrome in patients with major depressive disorder.

All major depressive disorder (MDD) patients visited our psychiatric clinic were screened. Subjects who met inclusion criteria and did not have exclusion criteria were invited to join this project until reach 140 subjects. The metabolic syndrome criteria proposed by the American Heart Association/National Heart, Lung, and Blood Institute (updated ATPIII) and International Diabetes Federation were applied for diagnosing metabolic syndrome. Age, history of antidepressant and antipsychotic use, time of illness, severity of illness and family history of metabolic syndrome were assessed as factors associated with metabolic syndrome. Data was analyzed by using percentage, mean, standard deviations, student t-test, chi-square test and Fisher's exact test.

There were 140 subjects recruited. The prevalence of metabolic syndrome determine by the American Heart Association/National Heart, Lung, and Blood Institute (updated ATPIII) and International Diabetes Federation were 30%(42) and 31.4%(44) respectively. Family history and time of illness were significantly associated with metabolic syndrome in patients with major depressive disorder(p≤0.05).

Thai MDD patients are likely to have and develop metabolic syndrome. These findings support the importance of assessing and monitoring metabolic syndrome in MDD patients.

Neurodegeneration with brain iron accumulation (NBIA) comprises an array of progressive brain disorders presenting with neurological and psychiatric symptoms, sometimes accompanied by intellectual impairment and behavioural problems. Clinically, according to time of onset and deterioration gradient, the NBIAs can be subdivided into two major groups: early onset / rapid, and late onset / slow. To date, nine genetic types of NBIA can be identified.

Recently, a novel NBIA was described showing an additional specific neuroimaging pattern in the substantia nigra together with global cerebral atrophy, originally termed Static Encephalopathy of childhood with Neurodegeneration in Adulthood (SENDA). Shortly thereafter, it became clear that SENDA is caused by de novo heterozygous mutations in the WDR45-gene located in Xp11.2 that was named Beta-propeller Protein Associated Neurodegeneration (BPAN).

Investigating the neuropsychiatric phenotype of BPAN.

Diagnostic evaluation of three adult female patients.

Detailed neuropsychiatric examination of 3 patients with genetically proven BPAN.

All patients had a moderate to severe intellectual disability. In their early thirties autistic-like and depressive symptoms paralleled progressive motor and cognitive decline, ultimately resulting in wheelchair dependency. MRI of the brain demonstrated significant iron deposition in the globus pallidus and the substantia nigra as well as cerebral atrophy. Dystonia of the extremities and parkinsonian symptoms were most prominent. Treatment with levodopa/carbidopa was not effective.

The neuropsychiatric phenotype of BPAN is characterized by symptoms from the autistic and anxiety spectrum that, however, should be functionally interpreted as resulting form motor deterioration and severe cognitive inflexibility.

Rapid progress in genetic techniques has revealed several novel microdeletion syndromes that, besides their relationship with intellectual disabilities, are frequently associated with an etiologically specific neuropsychiatric, neuropsychological, neurological or somatic phenotype.

Investigating the neuropsychiatric phenotype of 16p11.2 microdeletion.

Extensive diagnostic evaluation of a 32-years-old male patient with autistic-like symptoms and a history of periodic regressive and catatonic behaviours.

Detailed genetic, neuropsychiatric and neuropsychologivcal examination.

The patient failed to complete his university studies due to social and motivational mismatch (problems with inititative and structuring of daily life). Aged 25 a diagnosis of Asperger's disorder was made and the patient was admitted to a specialized department for diagnosis and treatment of autism spectrum disorders. EEG, MRI, and DAT-SPECT were all normal. The diagnosis was confirmed and he subsequently entered a sheltered home facility. Several years later he was referred for detailed re-evaluation of his persistent amotivational behaviour for which no explanation could be given.

At examination, no dysmorphic features were found. His behaviour showed autistic-like elements. No major psychiatric symptoms could be detected. Neuropsychological assessment revealed a KAIT Total IQ of 112 and undisturbed cognitive functions. As to personality and social interaction, an anxious disposition and feelings of distrust were noticed that established a marked vulnerability to psychotic experiences. Microarray analysis showed a de novo interstitial deletion of 970kb in 16p11.2.

Here a never reported 16p11.2. microdeletion syndrome was demonstrated that appeared to be associated with a specific neuropsychological phenotype characterized by psychosis proneness.

Our objective was to examine whether transcranial Direct current Stimulation (tDCS) applied over the left temporoparietal junction (assumed ’inhibitory’ - cathode) and the left prefrontal cortex (assumed ’excitatory’ - anode) can impact clinical symptoms and functional connectivity of targeted regions in patients with schizophrenia presenting treatment-resistant auditory verbal hallucinations.

In a double blind sham-controlled randomized clinical trial, thirty patients with schizophrenia and treatment-resistant auditory verbal hallucinations were randomly allocated to receive either 20 minutes of active 2mA tDCS or sham stimulation twice a day during 5 consecutive working days. The anode was placed over the left prefrontal cortex according to 10/20 EEG international system (PFC/F3FP1) and the cathode over the left temporoparietal junction (TPJ/T3P3). Seed-based functional connectivity maps were compared before and after stimulation sessions (5 minutes resting state fMRI). Seed were placed in regards of the electrode locations. Analyses were done using Brain Voyager QX on resting state fMRI maps.

Clinical impact of tDCS was investigated in the initial sample of 30 patients. tDCS resulted in an improvement of global symptoms (−12%) and auditory hallucination (−31%) for at least 3 months.

The impact of tDCS on seed-based functional connectivity was investigated in a subsample of 21 patients. We reported a significant decrease of functional connectivity in fronto-temporal network (language-related brain areas including left TPJ, dorso-lateral PFC, Broca's area and their right homologues) after active tDCS compared to sham treatment.

tDCS seems to be a promising tool to modulate brain networks underlying clinical symptoms in schizophrenia.

Auditory verbal hallucinations (AVH) are a characteristic symptom of schizophrenia. Previous studies have investigated 1-Hz repetitive transcranial magnetic stimulation (rTMS) to the left temporoparietal region as a non-invasive treatment option for treatment-resistant patients, with several studies with large sample sizes not demonstrating efficacy of rTMS compared to sham stimulation. A new stimulation protocol using continuous theta-burst rTMS could provide a more effective therapeutic option.

In a double-blind study, forty-one patients with AVH were randomly allocated to either continuous theta-burst rTMS or sham treatment. The theta-burst TMS group received 10 treatments over left temporoparietal cortex distributed over five consecutive days. The placebo group received 10 treatments of sham stimulation following the same procedures as the theta-burst group. Severity of AVH was assessed using the psychotic symptom rating scales (PSYRATS), the auditory hallucinations rating scale (AHRS) and item P3 of the positive and negative syndrome scale (PANSS) before treatment, after five days of treatment, and during follow-up one month later. Data were analyzed using repeated measures ANOVA.

Significant main effects of treatment were observed for the PSYRATS (p=0.017) and a trend was observed for the AHRS (p=0.053), indicating lower hallucination severity scores after treatment. No significant interaction effects were observed for any of the hallucination severity scales, indicating that AVH did not significantly improve after theta-burst stimulation compared to sham stimulation.

These results suggest a placebo effect of continuous theta-burst rTMS on the left temporoparietal region.

Previous research demonstrates various associations between depression, cardiovascular disease (CVD) incidence and mortality. Differences between studies may occur as a result of different methodologies.

This work investigated the impact of using two different methods to measure depression and two different methods of analysis to establish relationships.

The work investigated the association between depression, CVD incidence (CVDI) and mortality from coronary heart disease (MCHD), smoking related conditions (MSRC), and all causes (MALL), in a major population study using depression measured from a validated scale and a depression measure derived by factor analysis, and analyses based on continuous data and grouped data.

Data from the PRIME Study (N=9,798 men) on depression and ten year CVD incidence and mortality were analysed using Cox proportional hazards models.

Using continuous data, no relationships with CVDI were found, but both measures of depression resulted in the emergence of positive associations between depression and mortality (MCHD, MSRC, MALL). Using grouped data, no associations with CVDI or MCVD were found, and associations between the measure derived from factor analysis and MSRC and MALL were also lost. Positive associations were only found between depression measured using validated items, MSRC and MALL.

These data demonstrate a possible association between depression and mortality but detecting this association is dependent on the methodology used. Different findings based on methodology present clear problems for the determination of relationships. The differences here suggest the preferential use of validated scales and suggest against over-reduction via factor analysis and grouping.

'A nation-wide staff training program for family psychoeducation in severe mental illness'

Despite all the evidence regarding its cost-effectiveness, psychoeducational family interventions for non-organic psychotic disorders are still not steadily applied in everyday routine practice. In Portugal, these interventions are seldom used, even in well-staffed psychiatric departments. Following the recommendations of the Portuguese National Mental Health Plan, a psychoeducational training program has been prepared by the Ministry of Health.

a) to conduct a psychoeducational training program on a national basis and b) to evaluate obstacles to implementation in routine practice.

Professionals from public mental health services across the Country attended a 3 days full-time program in which they were trained in the psychoeducational intervention through presentation of guidelines, demonstrative audios and role-playing.

The trainees' acquisition of skills was found very satisfactory. The most prevlent barriers in the implementation of the intervention included work overload, the difficulty to integrate family work with other duties, and the poor allowance of time from the service to run the intervention on a regular basis.

Measures should be taken in order to cope with obstacles limiting the use of family interventions in practice, including changes in the services governance and increased autonomy for professionals involved in the process.

The present study attempted to examine the barriers and the facilitators to the use of mental health services by Japanese university students in order to enhance early detection of and intervention for mental disorders.

A total of 138 students from four universities in Japan participated in this study and completed the survey. They were asked to show if they were reluctant to consult a mental health professional and the reasons thereof (barriers). Additionally, they described when they would visit a mental health professional (facilitators).

About half (48.5%) of the students showed reluctance to visit a mental health professional. The barriers (in descending order of frequency) were'I don't want to consult other people (I feel ashamed),''I don't need it (It's enough),''I am unsure the consultation will be effective,' and'I am afraid of what others will think of me'. On the other hand, the facilitators were,'when my condition is severe,''when people close to me recommend me to do so,''when the atmosphere around the institution is good,''when I can't consult people close to me,' and'when the professional is someone I know'.

Some barriers and facilitators for consulting mental health professionals were found. Mental health professionals have to consider these factors in their daily clinical practices.

Changes in DNA-methylation patterns in alcohol-dependent patients have been described in various studies. However, epigenetic regulation of genes responsible for the ethanol metabolism has not been in the focus of recent research.

Aim of our study was to evaluate changes in DNA-methylation of the aldehyde dehydrogenase 2 (ALDH2) in respect to genetic variants (rs886205 ALDH2-SNP) in blood samples of alcohol-dependent patients compared with healthy controls.

During an inpatients detoxification treatment we draw blood samples from 82 alcohol-dependent, male patients on day 1, day 7 and day 14. Bisulfite-treated DNA was subjected to methylation analysis via sequencing. Findings of the alcohol-dependent group were compared with results of a healthy control group (N=34)

Our results show decreasing methylation levels of a repressive ALDH2 promoter fragment to control levels only in homozygous A-allele patients of the rs886205 SNP.

Findings of this study reveal a specific genetic-epigenetic interaction in ALDH2 regulation which may have crucial importance for the understanding of epigenetic regulation of ethanol metabolism in humans

About 45% of civilian suicides see a doctor within one month of death. Thus, educating primary care physicians (PCP) to detect and mitigate depression is an important suicide-prevention strategy. However, the pre-suicide PCP consulting rate has not been examined in a military population. The authors investigated the utilization of primary health care and mental health services by active-duty military personnel suicide cases (SC) prior to death in comparison to matched military controls (MC).

All suicides (N=170) were extracted from a cohort of all active-duty Israeli military male personnel between 2002 and 2012. Applying a retrospective nested case-control design we compared SC primary care services utilization with demographic and occupationally matched MC (N=500).

Whereas 38.3% of SC contacted PCP within the last month before death only 27.6% of SC contacted a mental health specialist during their entire service time. The PCP contact rate within one month before death or index day did not differ between SC and MC (38.3% vs. 33.8%, X2 = 1.05, df= 1, p = 0.3). More SC contacted a mental health specialist within service time than MC (27.6% vs. 13.6%, X2 = 10.85, df= 1, p = 0.001).

Even though PCP contact rate by military suicides is slightly lower than that reported for civilian suicides prior to their death, it is higher than mental health specialist contact rate and higher than age matched civilian suicides. These results imply that PCP education is a viable approach to suicide-prevention in a military setting.

Recent meta-analysis in schizophrenia report that patients treated with long-acting injectable antipsychotics (LAI) show a significant improvement in hallucinations. However, little evidence supports their efficacy in non-prominent hallucinations in delusional disorder (DD) patients.

To examine treatment effectiveness of LAI antipsychotics (PPLAI and RLAI) with other oral antipsychotics in DD with non-prominent hallucinations.

A prospective and observational study was carried out by including 60 consecutive cases of DD outpatients, as part of the DEVCODEL Study. All patients were followed up for at least 6 months. Outcome variables: Scores in PANSS, HRSD-17 items, PSP for functionality, and C-SSRS for suicide. To investigate whether differences between treatment groups were biased by confounding variables, scores in assessment scales at 6 months served as dependent variables, and hallucinatory and treatment groups were included as between-subject factors when analysis of covariance (ANCOVA) was applied.

24(40%) patients had non-prominent hallucinations. Although not statistically significant, when uncorrected for influencing factors, DD patients receiving PPLAI or RLAI (n=27;45.5%) were less frequently treated with antidepressants (32%vs.68%) and showed lower suicidality (44.4%vs.55.6%). Patients treated with PPLAI or RLAI had lower scores in psychotic symptoms and suicidal ideation intensity, and higher functionality. After adjustment, patients with non-prominent hallucinations receiving PPLAI or RLAI showed a tendency of improvement in functionality, lower scores in PANSS positive (p=0.003) and negative (p=0.047) subscales, and suicidal ideation severity (p<0.001) compared to those treated with oral antipsychotics.

Non-prominent hallucinatory patients treated with PPLAI or RLAI showed a significant improvement in psychopathology and suicidal ideation.

Paliperidone palmitate (PP) is a long acting depot antipsychotic that received marketing authorisation in the UK in 2011. It is costly compared to first generation antipsychotics (FGAs) and there are no robust trials comparing PP with FGAs. We examined the effectiveness and use of PP in a mental health trust as well as the characteristics of patients prescribed PP.

We identified all patients prescribed PP in North Staffordshire (population 470 000) since launch and examined records for demography, diagnosis, bed and medication use. We examined the effectiveness of PP using a mirror image design with bed use as the primary outcome.

52 patients received PP in a time frame allowing a one year follow up. 58% were male and the mean age was 41 years. Over half were detained under the 1983 Mental Health Act. 51 patients had a psychotic diagnosis. There was a significant reduction in bed occupancy (44 v 26 days, P=0.018) and admissions (1.1 v 0.2, P=0.0001). The mean dose was 100mg. Lack of effectiveness was the primary reason for starting PP in 84%. Two patients stopped due to side effects and 26% due to lack of efficacy.

Within the limitations of the methodology our results show a reduction in psychiatric bed use in the year following PP initiation on an intention to treat basis. The reduction in bed use equates to a minimum saving of £5400 per patient. PP at the mean study dose costs £3769.

Inconsistent results indicate that plasma levels of homocysteine (Hcy), folic acid (FA) and vitamin B12 are altered in first-episode schizophrenia (FES) patients.

The aim of this study was to assess the association between alterations in plasma Hcy, FA, vitamin B12 and lipid profile and schizophrenia.

We recruited 45 FES patients and 23 healthy age-matched controls (HC). Diagnosis of schizophrenia was based on ICD-10 and DSMIV criteria, and confirmed using Operational Criteria for Psychotic Illness (OPCRIT). We excluded patients with drug and/or alcohol abuse within one year of onset of psychotic symptoms.

There was no difference in mean plasma biochemical parameters between FES patients and HC with exception of high density lipoproteins (HDL) level (FES: 52,69 ± 17.07 vs. HC: 68,35 ± 16.99 mg/dl, p = 0,001). However, there were significant differences between FES patients with and without positive history of life-time cannabis abuse/dependence in Hcy (16.11 ± 7.62 vs. 10.56 ± 3.61 μmol/l, respectively, p < 0,001), FA (4.82 ± 1.81 vs. 7.22 ± 3.29 ng/ml, respectively, p = 0,006) and HDL (45.87 ± 20.24 vs. 57.85 ± 13.27 mg/dl, respectively, p = 0,004). These differences were independent of age, gender, BMI and cigarette smoking. In addition, Hcy level was significantly higher and HDL was significantly lower in patients with positive family history of schizophrenia (p = 0.002).

Our results indicate that cannabis abuse or dependence and family history of schizophrenia may account for metabolic disturbances in FES.

An updated systematic review that included published and unpublished data of quetiapine for acute bipolar depression has not been performed.

To review the efficacy and the tolerability of quetiapine, either as monotherapy or in combination, in the treatment of acute bipolar depression.

We included all randomized control trials (RCTs) comparing oral quetiapine with other treatments in bipolar I or II disorders. Published and unpublished randomized, controlled trials were identified using the Cochrane Central Register of Controlled Trials, MEDLINE, ISI Web of Science, CINAHL, PsycINFO, and ClinicalTrials.gov. The primary outcome was the average change in depressive score, such as the Montgomery-Asberg Depression Rating Scale (MADRS) in adults or the Children's Depression Rating Scale-Revised (CDRS-R) in child and adolescents.

Overall, 11 RCTs with 3,488 participants were included. There was a significant difference, favoring quetiapine, in the change score of the MADRS (MD −4.66 CI −5.59 to -3.73). Quetiapine was also associated with significant improvement in clinical global impression, quality of life, quality of sleep, anxiety, and disability. Compared with placebo, quetiapine might cause more adverse effects of extrapyramidal side effects, sedation, somnolence, dizziness, fatigue, constipation, dry mouth, increased appetite, and weight gain.

The findings from this study underscore the efficacy of quetiapine as monotherapy for acute bipolar depression. It also highlighted the protective effect of quetiapine for the switching into mania. Limit data did not support the use of quetiapine in child and adolescents.

Personality dimensions have been repeatedly associated with individual differences in brain organisation during cognitive processing, especially working memory (WM). WM consistently engages the lateral prefrontal (DLPFC), parietal (PAR) and the anterior cingulate cortex (ACC). Within this network, Neuroticism has been associated with attenuated DLPFC function and frontoparietal anatomical connectivity.

To test that personality dimensions modulate task-dependent changes in effective connectivity within the WM network.

We predicted that WM-dependent changes in effective connectivity, will be either constrained or facilitated by personality traits.

We obtained fMRI data from 40 healthy adults while performing the 3-back WM task. Estimates of effective connectivity were obtained using Dynamic Causal Modelling based on a six-region model comprising bidirectional, ipsilateral and contralateral connections between the DLPFC, PAR and ACC. Personality dimensions were measured using the Neuroticism-Extroversion-Openness Personality Inventory-Revised.

The 3-back memory load (WM modulation) significantly increased the forward connection from the right PAR to the right DLPFC. The strength of the WM modulation on right PAR?DLPFC was associated with improved response time (r=−0.33, p=0.04). Higher Neuroticism scores were associated with reduced WM modulation (r=−0.867, p=0.001), while the opposite was found for Conscientiousness (r=0.746, p=0.001).

We found that neuroticism and conscientiousness, respectively, constrain and facilitate the functional integration between parietal and frontal regions. Our results demonstrate that personality dimensions impact on WM task-dependent plasticity, as measured by changes in effective connectivity, and suggest that this plasticity may be a central link between individual differences in behaviour, cognitive efficiency and neural function.