Bipolar Disorder (BD) is associated with abnormalities in brain functional engagement during working memory tasks. Neuroimaging studies have consistently shown that working memory (WM) engages a distributed neural network that primarily includes the dorsolateral prefrontal (DLPFC), the parietal (PAR) and the anterior cingulate cortices (ACC).

To measure connectivity between the WM engaged areas in BD patients and healthy controls (HC).

To provide a mechanistic account of the differences observed in short-term neuroplastic responses between BD patients and HC during a WM task.

To achieve this we measured effective connectivity between the PAR, ACC and DLPFC using Dynamic Causal Modeling (DCM) of functional magnetic resonance imaging data obtained from forty-six HC and forty-one BD patients during a verbal 2–back task.

Our data demonstrate that WM was associated with increasing forward (i.e. posterior to anterior) effective connectivity within the WM network for both diagnostic groups, while the HC showed right-hemisphere dominance compared to BD patients that showed left-hemisphere dominance. Furthermore, BD patients showed significant reduced connectivity from the left to the right DLPFC (p = 0.003) and vice versa (p = 0.002) compared to HC, as well as an decreased connectivity for the backward connection from the left DLPFC to the left ACC (p = 0.026).

Our results indicate that for the BD group there is abnormal functional integration of brain regions involved in WM processes, especially between the left and right DLPFC, regions involved in cognitive control.

Suicide is one of the main causes of premature mortality in Belarus, bringing considerable loss of human lives. The alarming increase in the occurrence of suicide in Belarus in 1990s has resulted in the country having one of the highest suicide rates in the world. Epidemiological analysis has showed that rates of suicide vary noticeably between the regions in Belarus with the regular spatial pattern in suicides distribution.

The aim of this study was to consider the effect of regional alcohol consumption as a factor responsible for suicides regional variations.

The cross-sectional time series analysis of suicides and alcohol psychoses (as a proxy for alcohol consumption) rates by the regions of Belarus during the period 1990-2010 was performed.

The analysis indicates that the regional variations of suicides and alcohol psychoses incidence rates have a similar spatial regularity, which means that the regions with a high suicide rate also have a high alcohol psychoses incidence rate. The effects of alcohol psychoses incidence (as a proxy for alcohol consumption) on suicide rates were generally positive and significant; only Minsk city obtained a non-significant estimate. The largest estimates were found in Minsk region (0.68) and in Mahiliou region (0.55). The estimates for Brest and Vitebsk regions were somewhat lower (0.41).

The findings on spatial relationship between suicides and alcohol psychoses incidence rates seem to support the hypothesis that considers regional pattern of alcohol-related problems as a factor responsible for suicides rate regional variations in Belarus.

Stroke is one of the major cause of death in the developed world and a top ten contributor to the global burden of disease. Recent research evidence suggests that psychosocial distress has been implicated as both a precursor to stroke and significant risk factor for death in those with established stroke. Russia has one of the world's highest stroke incidence and mortality rates. Some experts have underlined the importance of the psychosocial distress of economic and political reforms as the main reason for the stroke mortality crisis in Russia in the 1990s.

The aim of the present study was to estimate the effect of psychosocial distress on stroke mortality rate in Russia.

Trends in age-adjusted, sex-specific suicide (as an integral indicator for psychosocial distress) and stroke mortality rates in Russia from 1965 to 2005 were analyzed employing a distributed lags analysis in order to assess bivariate relationship between the two time series.

Time series analysis indicates the presence of statistically significant association between the two time series for males (R=2.02; p<0.000) and for females (R=4.64; p<0.05) at lag 0.

These findings indicate that psychosocial distress is an important contributor to the high stroke mortality rate in Russian Federation. The results from present study also suggest that the Russian stroke mortality crisis in the 1990s is most likely to have been precipitated by the psychosocial distress imposed by rapid societal transformation.

A First Manic Episode (FME) can evolve differently and some patients remain chronically ill (Poor Outcome Manic Syndrome = POMS). Even, the majority of subsequent episodes reoccur over the time; few studies have looked at the long-term course of a FME. The aim is therefore to look at the longitudinal clinical characteristics of FME in a hospital setting.

The subjects, developing POMS, were patients admitted to hospital with at least 2 hospitalizations for mania and having received continuing psychiatric care for ≥ 5 years. The control group subjects were FME patients with only one admission. The data was gathered from hospital discharge summaries for all 472 subjects with FME (age 14–64) admitted to a Quebec regional psychiatric hospital for the first time during a 30 year period (1980-2011).

Amongst all first admitted FME patients, 27% ended up with POMS. A logistic regression analysis indicates the subsequent development of POMS was correlated with younger age, male gender and alcohol misuse at the time of the initial admission to hospital. The historical data available (median=11 years) shows that the diagnosis evolved towards bipolar disorder (76%), schizoaffective disorder (17%) and schizophrenia (6%).

The results indicate that development of POMS is an inevitable clinical reality. The influence of alcoholism on the evolution of FME is clearly adverse. It is particularly associated with more manic episodes. The results underline the necessity for concomitant intervention for alcoholism in the presence of FME.

The relationship between skin, neuron system and mental status is complicated. Pemphigus is severe and painful autoimmune skin disorder that occurs in 0.5–1 person in 100000 (Mooler & Stanley, 1990).

Regarding the critical role of mental status in autoimmune diseases such as pemphigus, the aim of this research is to study of psychiatric comorbidity in patient with Pemphigus.

The society of this research included the patients with Pemphigus inferred to Razi Hospital of skin diseases in Tehran. Participants were 200 persons who were selected through available sampling. Finally 198 persons filled out the demographic questionnaire and SCL-90.

This research showed that the prevalence of psychiatric disorders in this sample was 62.62%. 28.78% of patients were male and 33.84% were female. In both genders the symptoms of paranoia were the most prevalent disorders (45% in female and 60% in male) and phobia was the least prevalent in our sample. The upper grade in education, the less prevalent disorders. 81.45% of participants with mental disorders were married and 18.55% of them were single. Of patients only 26.32% had visited the psychiatrist or psychologist and 95.15% of them had used medications.

The results showed that psychiatric disorders in patients with Pemphigus is high compared to general population. Thus dermatologists must recognize and manage these comorbidities to treat patients effectively and to improve the quality of life in patients with autoimmune diseases such as Pemphigus.

Many studies have shown the efficacy of cognitive – behavioral therapy and psychological debriefing in treatment of post traumatic stress disorder (PTSD) and a few evidences are available for using these techniques in large scale disasters.

This study aimed to asses the effect of some psychological interventions in reducing PTSD symptoms after Bam earthquake in different age groups.

In a before-after quasi experimental clinical trial, we compared the efficacy of one session of psychological debriefing and three sessions of group cognitive-behavioral therapy in bam earthquake PTSD symptoms in different age groups. We evaluated PTSD symptoms before and immediately and three months after interventions by CAPS scaling system and analyzed data.

one hundred and thirty persons entered in the study and 51 persons excluded during interventions because of migration. Interventions were showed to be effective only in short term period. The means of PTSD symptoms frequency and severity of avoidance symptoms were reduced during three months period of study which were statistically significant P<0.05. Interventions showed no efficacy for recall symptoms in long term and hyper arousal symptoms in short term and long term periods. There was no statistically significant difference among age groups.

Psychosocial supportive interventions may be effective on some of the PTSD symptoms but there is no difference in different

The opioid system modulator nalmefeneis the first pharmacological therapy approved in the European Union for reduction of alcohol consumption.

To evaluate the clinical relevance of the reduction of alcohol consumption in patients with at least high drinking risk level at screening and randomisation from the two, identically designed, randomised controlled 6-month studies ESENSE1 (NCT00811720) and ESENSE2 (NCT00812461) of nalmefene versus placebo.

Study medication was taken as-needed. All patients received a motivational and adherence-enhancing intervention (BRENDA). Response criteria were based on alcohol consumption at month 6 and Clinical Global Impression – Severity of Illness/Improvement (CGI-S/I), Short Form Health Survey version 2 (SF-36) mental component summary(MCS) scores at week 24. Clinical relevance was also studied using the Drinker Inventory of Consequences (DrInC), Alcohol Dependence Scale (ADS), and liver function variables.

Pooled study population: 667 patients (placebo N=332; nalmefene N=335). The proportion of responders was higher in the nalmefene group than in the placebo group with odds ratios for response consistently significantly (p<0.05) in favour of nalmefene. The difference in the proportions of responders translated to numbers-needed-to-treat ranging from 6 to 10. Significant differences to placebo (p<0.05) in the SF-36 MCS and physical component summary score, ADS, DrInC, CGI-I/S and liver enzymes further supported the clinical relevance of the treatment effect.

In view of the immense alcohol-related burden to society, the harm to the individual and the large treatment gap partly due to a reluctance to engage in abstinence, the effect of nalmefene is clearly clinically relevant.

The aim of our study was to investigate the effects of continuous action of ultrasonic waves of variable frequencies on behavior of rats in ’classical’ tests used to reveal depression-like behavior, to evaluate the influence of different antidepressants on rates and to analyze expression of several genes involved in pathogenesis of depression.

: Rats in individual cages were exposed to ultrasonic irradiation of variable frequencies (20–45 kHz) for 21 days.

48 male non-pedigree albino rats were divided into 5 groups: non-ultrasound-saline, ultrasound-saline, ultrasound-fluoxetine, ultrasound-bupropion and ultrasound-tianeptine. Administration of each drug was carried out daily from the first to the last day of the experiment. Behavioral tests were include: Social Interaction test, Porsolt and Anhedonia Test. Than rats were decapitated and expression genes coding serotonin receptors (5HT1, 5HT2 subtypes), SERT and BDNF were measured in prefrontal cortex, midbrain and hippocampus using Quantitative real-time PCR analysis.

Depression-like behavior manifests itself in reduced social activity in Social Interaction Test, increased immobility in Porsolt Test and lower sucrose consumption in Sucrose Preference Tests. The administrated antidepressants demonstrated their effectiveness. RT-qPCR gene expression analysis showed increased expression of SERT gene in all studied structures; decrease expression of 5-HT2A in prefrontal cortex and midbrain, increase 5HT1A in hippocampus. Expression of gene coding BDNF in hippocampus is significant decreased.

The obtained data allow to conclude that this model meets the main requirements set to animal models (face, predictive and construct validity) and can be used in pre-clinical studies of new antidepressants.

Psychological debriefing is a way for prevention and reducing post traumatic stress disorder (PTSD) symptoms. Many studies have shown the efficacy of cognitive behavioral therapy in treatment of PTSD. Few evidence is available for using of these techniques in large scale disasters.

This study was carried out to evaluate the efficacy of psychological debriefing and cognitive-behavioral group therapy combination on Bam earthquake-related PTSD symptoms in adolescents.

In a before-after trial, we evaluated the efficacy of one session psychological debriefing and three sessions of group cognitivebehavioral therapy in Bam earthquake adolescents survivors with PTSD symptoms. The mean age of participants was 16.4 years and no one had severe PTSD or other psychiatric disorder that needed pharmacological intervention. Before, immediately and 3 months after interventions we evaluated PTSD symptoms using Clinical Administrated PTSD Scale for DSM-IV and analyzed them.

30 persons were included in the study, 8 of whom were excluded during interventions because of migration. The mean frequency of PTSD symptoms reduced immediately after interventions which was statistically significant (P< 0.05). There was no efficacy for intensity and severity.

Psychological debriefing and group cognitive-behavioral therapy may be effective in reducing the frequency of avoidance symptoms.

Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder.

We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.

In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy; group CBT plus art and sport interventions; art and sport interventions without group CBT; and control group.

Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.

Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we could not find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.

Marchiafava-Bignami Disease is a rare complication in malnourished patients with chronic alcohol use. Due to its rarity, its pathogenesis is poorly understood. Patients suffering from Marchiafava-Bignami Disease can present with a plethora of symptoms including acute change in mental status, dementia, seizures and neurological dysfunction. This condition is characterised by corpus callosum demyelination with reported cases of white matter involvement.

To highlight the possibility that patients exhibiting predominant psychiatric symptoms with a history of chronic alcohol use might also be suffering from Marchiafava-Bignami Disease and that such a diagnosis should not be ruled out purely because of the psychiatric symptoms.

We report a 41-year-old man who presented with sub-acute cognitive decline, poorly defined psychotic symptoms and minimal neurological signs. MRI showed atrophy of the corpus callosum, consistent with Marchiafava-Bignami Disease. Despite timely diagnosis and adequate treatment, his psychotic symptoms have remained persistently debilitating.

During our review, the psychiatric symptoms proved to be a red-herring which masked the real diagnosis of this patient. However, based on the MRI findings, he was finally diagnosed with Marchiafava-Bignami Disease. Arrangements have been made to place him in a rehabilitation setting with regular neurological follow-ups to assess disease progression, which would facilitate further management.

This case highlights an atypical presentation of Marchiafava-Bignami Disease and raises the importance of thorough investigations in patients with a long history of alcohol consumption and the need to have a high index of suspicion. Concomitant conditions associated with chronic alcohol use should also be considered.

Bulimia is a psychopathological disorder characterized by the presence of episodes of binge eating, followed by compensatory mechanisms that aim to prevent weight gain. These episodes of uncontrolled ingestion of food are related with deficits in the inhibitory control of behavior (Fairburn & Harrison, 2003). The basal ganglia namely the Nucleus Accumbens (NA) and the Caudate nucleus (CN) are involved in the fronto-striatal circuits that allow the control of impulses.

The main goal of this study was to investigate the presence of structural alterations in the NAc and the CN in a sample of bulimic patients, when compared to normal controls.

Our sample was composed by 41 female participants, 21 diagnosed with bulimia and 20 healthy controls (CG) matched in socio-demographic features. The participants were submitted to the clinical assessment and to a structural magnetic resonance imaging (MRI) acquisition. The NA and the CN of the 41 MRIs were manually segmented using the software Slicer 3D.

No differences between patients with bulimia and healthy controls were found for the volume of the NA. However, the NC volume is significantly decreased in BN.

The reduction of volume in the CN of bulimic patients that was found in this study may be possibly associated with a lower functional activation of this brain structure, contributing to a lack of control of the excessive eating behavior of these patients.

The default mode network (DMN) is one of the best known resting state networks, which are active when the brain is “at rest” and the individual is not focused on any external demand. The DMN comprises areas of the posterior cingulate cortex (PCC) and adjacent precuneus; the medial prefrontal cortex (MPFC); medial, lateral and inferior parietal cortex and medial temporal cortex. DMN abnormalities have been found in several psychiatry disorders (Broyd et al., 2009) including depression and anxiety where increases in its connectivity namely on the MPFC have been reported (Greicius et al., 2007).

The goal of this study was to investigate the relationship between the DMN activation at rest and both anxiety and depressive symptoms.

Twenty-five participants completed the Hamilton Anxiety and Depression Rating Scales and were submitted to a functional magnetic resonance imaging task-free acquisition in which they were instructed to close their eyes and to think about nothing particular. Independent component analysis was used to extract the DMN maps of each subject and statistical analysis were performed in SPM.

Depression scores correlated positively with the activation of the orbitofrontal gyrus and middle frontal gyrus and negatively with the occipital gyrus, fusiform gyrus, PCC and precuneus. Anxiety scores correlated positively with the activation of the MFPC and ACC and negatively with parietal and temporal areas.

These results provide some support for the role of the DMN particularly its anterior nodes for the ruminative aspects that are common in depressive and anxious individuals.

Depression is a highly prevalent disease and its costs can be burdensome to both patients and payers.

To compare the short-term costs, outcomes, and cost-effectiveness associated with major depressive disorder (MDD) treatment with venlafaxine XR and major market comparators (duloxetine and two selective serotonin reuptake inhibitors [SSRIs], namely escitalopram and sertraline HCL) in Italy from the Italian National Health Service perspective.

To inform treatment decisions based on cost effectiveness of MDD treatments.

A decision tree structure was used to model MDD treatment over 1 year. Patients were treated with one of the model comparators and based on published clinical literature; either remained depressed, achieved response but no remission, or achieved remission. Drug costs were set to the reimbursed price for the recommended dose of each treatment. Costs of hospitalization and utility weights were based on depression status.

Venlafaxine XR was estimated to be the most effective treatment (0.736 quality-adjusted life years [QALYs]) followed by the SSRIs (0.731) and duloxetine (0.714). Total annual MDD-related costs for venlafaxine (€691) were estimated to be lower than all comparators (duloxetine=€1,308, escitalopram=€874) except sertraline HCL (€638), owing largely to drug cost differences and hospitalization savings associated with better projected depression status. Venlafaxine was cost-saving (more effective, less costly) compared with duloxetine and escitalopram. The incremental cost per QALY gained vs. sertraline HCL was €9,844.

Based on the model, venlafaxine XR represents a cost-effective treatment option for MDD in Italy and may result in costsavings depending on the comparison.

Before October 2012 there was no service level agreement for psychiatry cover in Whiston Hospital, an acute trust in the UK. The Crisis team would visit on goodwill to assess patients. This changed when a Liaison Psychiatry (LP) service was commissioned to provide 24 hour cover, Monday to Sunday for the Emergency Department (ED) for adults.

To quantify waiting times to be assessed by psychiatry, comparing the new LP Service (intervention group) to its predecessor (control). The null hypothesis being that the waiting time for the control and intervention group are the same.

The authors prospectively collected data on all referrals received by the LP service in the first three months of operation n=305 and retrospectively collected data on a random sample of 50 patients referred from ED in the same months 2011 (control).

The median time from referral to the time of psychiatric assessment in the control group was 162.5 minutes [IQR 130–330], the mean time was 246.16 [95% CI 180 to 312]. The median time from referral to the time of psychiatric assessment following the introduction of the LP service was 30 minutes [IQR 15-90], the mean time was 79.63 [95% CI 65 to 93]. When the two samples were compared using an independent t test they were significantly different p<0.002.

The new LP service has decreased the median wait for a psychiatry assessment by 132 minutes. The team currently seeS 82% of referrals within 60 minutes. This improves patient safety and encourages appropriate and timely discharge.

to evaluate sleep modifications induced by chronic benzodiazepines (BDZs) abuse.

cohort study, comparison of sleep measures between BDZs abusers and controls. Drug Addiction Unit (Institute of Psychiatry) and Unit of Sleep Disorder (Institute of Neurology) of the Catholic University in Rome. Six outpatients were enrolled, (4 men and 2 women, mean age 53.3±14.8, range: 34 - 70 years) affected by BDZ chronic abuse; 55 healthy controls (23 men and 32 women, mean age 54.2 ±13.0, range: 27–76 years). All patients underwent clinical evaluation, psychometric measures, ambulatory polysomnography, scoring of sleep macrostructure and microstructure (power spectral fast-frequency EEG arousal, Cyclic Alternating Pattern - CAP), Heart Rate Variability.

BDZs abusers had relevant modification of sleep macrostructure and a marked reduction of fast-frequency EEG arousal in NREM (Patients: 6.6±3.7 events/hour, Controls 13.7±4.9 events/hour, U-test: 294, p=0.002) and REM (Patients: 8.4±2.4 events/hour, Controls 13.3±5.1 events/hour, U-test: 264, p=0.016), and of CAP rate (Patients: 15.0±8.6%, Controls: 51.2±12.1%, U-test: 325, p<0.001).

BDZs abusers have reduction of arousals associated with increased number of nocturnal awakenings and severe impairment of sleep architecture. The effect of chronic BDZs abuse on sleep may be described as a severe impairment of arousal dynamics; the result is the inability to modulate levels of vigilance.

Skin Picking behavior is characterized by repetitive episodes of digging, squeezing or picking the skin causing tissue damage, functional impairment and distress.

The aim of the study was to investigate the skin picking frequency and the picking episodes’ characteristics in the Polish students’ population.

The participants were 436 university students, 297 (68,11%) women and 139 (31,88%) men. The age of participants ranged from 19 to 30 years (M=23,21 (SD=8,84). All participants were assessed by the Skin Picking Scale and the Skin Picking Impact Scale translated into Polish by authors. They also completed the list of items concerning skin picking site, picking frequency, methods of picking and affective consequences of picking.

Two hundred ten (48,16%) of the participants reported that they currently pick their skin. One hundred thirty students (29,81%) endorsed the functional impairment caused by picking, ninety three of them (21,33%) felt distressed as a consequence of picking. Most participants, who endorsed the picking behaviors, pick from their faces, fingers and scalps, but numerous other sites were endorsed. Participants usually pick with their fingers and nails and were aware of picking during picking episodes. Forty three participants (20,47%) reported that their picking was preceded by an urge always or in most cases; however 66 participants (31,43%) claimed that they had never felt urge prior to picking. The commonest consequences of picking reported by participants were the experience of relief and the feeling of anger.

Skin picking is a common behavior among the Polish students.