Studies have shown that people with Intellectual Disabilities (ID) develop mental illness at rates similar to or higher than general population1.

There is no previous study on mental health of adults with ID in Turkey.

The purpose of this study was to investigate the prevalence and associated factors of mental disorders in adults with ID in Turkey.

151 participants with ID aged 18 and over were recruited from care homes, rehabilitation centers and from people attending to psychiatry outpatients for the first time. Every participant underwent face to face assessment by a psychiatrist supported by an informant and previous notes. A structured purpose designed socio-demographic form was used. Diagnoses were drawn according to DSM-5. Point prevalence of disorders was calculated and associated factors were investigated.

63.5% of the participants met criteria for one psychiatric disorder, 21% had more than one disorder. The most common disorders were: challenging behavior (34%), autism spectrum disorders (%13.9), and anxiety disorders (13.9%) and attention deficit hyperactivity disorder (10.6%). Living in a care home and being young were associated with mental ill health (P < 0.05) [1].

This study demonstrates high psychiatric comorbidity in adults with ID. Young age and care homes were the associated factors in this sample. These results are important to raise awareness of professionals and service providers about mental health of adults with ID.

This project was funded by the Scientific and Technological Research Council of Turkey (TUBITAK) with a project number of BİDEB 115C015. The funding body did not have any involvement with data collection, analysis or writing up.

In May 2015, NICE published guidelines for people with intellectual disabilities whose behavior challenges (NG11). Eight quality standards were subsequently developed by NICE to help service providers, health and social care practitioners and commissioners implement the necessary recommendations within the new NG11 guidelines.

We used a Quality Improvement (QI) methodology including process mapping, driver diagrams, and fortnightly QI team meetings. We conducted a baseline audit of the quality standards and used Plan-Do-Study-Act (PDSA) cycles to pilot interventions generated by the team to improve compliance with the standards.

Baseline compliance with the quality standards was low. We identified four priority areas for intervention: annual physical health checks, recording the indication of medication, multidisciplinary case discussion and concurrent psychosocial interventions for those prescribed medications for challenging behavior. Using a PDSA cycle for each intervention, we have demonstrated improved compliance with the NG11 guidelines. Compliance for the recording of indication of medication for all case reviews was previously 0% and now 100%. At least one target case is discussed at each MDT team meeting. Full results for annual health checks are awaited, but intervention has already shown an improvement in the uptake from 40% to 70%. Staff and carers knowledge of psychosocial interventions for people with challenging behavior showed an improvement after training.

Quality Improvement methodology was successful in improving adherence to NG11 guidelines. We are currently assessing whether this is leading to reductions in challenging behavior and improvements to people's well-being.

Stigma in psychiatry is pervasive, it does not stop at illness and marks all those who are ill, their families across generations, institutions that provide treatment, psychotropics’, and mental health professionals. Stigma directed towards psychiatry as a branch & psychiatrists in particular has not been systematically studied in the Indian context.

To study the Indian psychiatrists perspective of stigma directed towards psychiatry & psychiatrists.

An online survey containing “The World Psychiatric Association Stigma Questionnaire” was sent to the members of the Indian Psychiatric Society. Two hundred and three Indian psychiatrists filled out the questionnaire which assesses the stigmatization of psychiatry and psychiatrist as perceived by the psychiatrists themselves.

One hundred and thirty-two psychiatrists completed the survey with a completion rate of 65%, 75% of the respondents were male and most of their clientele was from urban catchment area. Sixty percent of the psychiatrists were either working in a psychiatry hospital or a psychiatry unit in a general hospital setting. More than a third had high-perceived stigma but had a very low stereotype agreement. Discrimination experiences were noted by more than 75% of psychiatrists, however less than 8% had a negative stigma outcome.

Though most of the Indian psychiatrists perceive themselves as being stigmatized, the stereotype agreement was found to be low and the discrimination experiences did not have significant impact on job performance. Though this might reflect resilience, we must attempt to improve the image of psychiatry and strive towards achieving a larger public acceptance of mental health services in India.

The Danish psychiatric system has gone through several structural changes in the last four decades. The deinstitutionalization of the mental healthcare system was implemented in Denmark in the late 1970s with the intention of increasing outpatient treatment. One of the aims in the reorganization was to treat the patient in the local environment rather than during long-term hospitalization.

This study focuses on the changes in the utilization of hospital facilities for patients diagnosed with schizophrenia.

The aims of this study were to analyze the development of admission/readmission, bed days and occupancy rates over four decades (1970–2012) in Denmark in schizophrenia treatment using admission statistics for in-patients only.

Using register data from secondary healthcare treatment of patients diagnosed with schizophrenia in Denmark 1970–2012, we analyzed the development in the use of hospital facilities.

Our major finding was a 220% increase between 1970 and 2012 in the total number of hospital admissions due to schizophrenia each year, while at the same time the number of annual schizophrenia bed days was reduced by 76%. Furthermore, the readmission rate within a year after discharge with a diagnosis of schizophrenia reached 70% in 2012 compared to 51% in 1970. Finally, the total bed occupancy continued to rise over the four decades and has exceeded 100% in several years since 1999.

The findings indicate that the reorganization of the Danish mental healthcare system has created a problem of “revolving door” schizophrenia patients’ who since the 1970s have been increasingly hospitalized but for shorter periods.

The authors have not supplied their declaration of competing interest.

International treatment guidelines recommend that key elements to reduce the burden of psychosis are the early identification of people and the adoption of specific evidence based interventions.

To investigate the pathway to care and patterns of interventions provided by community based-mental health services (CMHS) to a cohort of first-episode psychosis (FEP) patients over 5-years period, exploring in which degree guidelines are met in routine clinical practice.

Study conducted in the context of the Psychosis Incident Cohort Outcome Study (PICOS), a multisite naturalistic research conducted in the Veneto Region (Italy) on FEP patients in a 4.6 million inhabitants catchment area. A comprehensive set of standardized measures was used, including ad hoc schedules to collect information on referrals to psychiatric services and on pharmacological and psycho-social treatments according to a multiwave follow-up design (1-, 2- and 5 years).

Three hundred and ninety-seven FEP patients were assessed at BL, 286 at 1 year, 233 at 2 years and 205 at 5 years. 47.4% of patients were helped to seek care by a relative and more than one half entered the treatment route through an emergency access. Regarding the interventions received, 96% of patients had been prescribed neuroleptics and atypical were the most prescribed class (66.9%). Only half received a psychosocial intervention during the first year and this percentage progressively decreased at each FU.

Findings highlight discrepancies between interventions provided by CMHS and the best treatment options recommended by guidelines, suggesting the need to implement specific initiatives aiming to close the gap between research and clinical practice.

The current literature indicates that people with intellectual disabilities (ID) present quantitative and qualitative peculiarities of various socio-environmental factors than the general population. Although the identification of such peculiarities would have very important implications for the development of preventive, rehabilitative and inclusive procedures, valuable data are still lacking. The aim of the present paper was to assess the significance of the relationship between socio-environmental variables in person with ID, with particular reference to individual history and life contexts.

A consecutively recruited sample of 112 participants with ID attending residential or clinic/rehabilitative services across Italy was evaluated by the administration of ISTORIA (Historiographical organized interview for adult intellectual retard), a semi-structured questionnaire designed to investigate clinical and personal history of the person. A considerable percentage of the samples have co-occurent psychiatric disorder. Scores obtained were statistically processed through frequency analysis and calculation of correlation indexes.

Significant correlations were found between the family, the educational/professional environments, and the inclusion in society. Further associations concerned social relationships within and outside the family, the changes of living accommodation, and the level of environmental stimulation received.

Both findings from previous research and the ones of this work confirm the importance of investigating the mechanisms involved in the acquisition of social skills by persons with ID, through family dynamics and participation in community life, as protective factor against the worsening of disabilities and potentially of psychopathological vulnerability that affects this population.

The last decades’ considerable advances of the psychiatric assessment in People with Intellectual Disability (PwID) do not include the ability to identify Behavioural Equivalents (BE) of psychiatric symptoms and their relationship with different psychiatric syndromes. Recent reports have found BE to be differentially associated with one or more specific Psychiatric Disorders (PD).

The present study was aimed at evaluating the correlations between BE and DSM-5 syndromic groups of symptoms, in a wide multicentric sample of PwID.

An observational cross-sectional analysis was performed for a sample of 843 adults with ID, randomly or consecutively recruited among those living in residential facilities of the National Healthcare System, or in private institutes of care, or those attending psychiatric outpatient clinics. The total sample was administered with the SPAID-G (Psychiatric Instrument for Intellectual Disabled Adult - General version), which is a checklist for the detection of significant behavioural changes from the baseline. The items of the checklist represents BE of the symptoms of the main psychiatric disorders included in the DSM-5.

Many significant correlations were found, some of the most relevant were for mood disorders. Psychomotor agitation, aggressivity, disorganised behaviour and distractibility were most pronounced in bipolar patients; for depressed patients, irritability and weight loss had higher correlations than in other diagnostic groups.

Although not diagnostically specific, some BE seem to be more strongly related with specific PD. This line of research could improve the definition of the specific expression and clustering of psychiatric symptoms in PwID.

Psychiatric assessment and care of people with Intellectual Disability (ID) is complex due to their cognitive and communication impairments. Demand for further training in this area by trainees in psychiatry has been well documented. The main of aims of this study were to explore the attitudes and perceptions of psychiatry residents and non-residents (non-trainees) with regards to care of patients with ID as well as their knowledge and training in this area.

The study was conducted as an anonymous survey at the Institute of Mental Health, Singapore. A survey questionnaire developed by the study team was sent to residents and non-residents in psychiatry.

Forty-eight out of the 76 questionnaires were returned with a response rate of 63.16%. Twenty-eight participants described themselves as non-residents and the rest were residents. All participants responded that postgraduate training was required in the area of ID and mental health and majority reported that available training was inadequate. Ninety percent of respondents believed that people with ID were vulnerable to exploitation by other patients in the inpatient unit and 94% of respondents believed that people with ID should be managed by a specialist team.

Currently residents and non-residents in psychiatry see that training in ID and mental health as well as services for people with ID as inadequate. Efforts should be made to include specialist training in psychiatry of ID in the Singapore psychiatry curriculum to enhance the confidence and expertise of psychiatrists in this field.

Epilepsy is the second most common cause of premorbid mortality in the ID population. Rates of SUDEP are considered up to 9 times higher in the ID population. Cornwall UK (population 600.000 i.e. 1% of UK) runs a specialist ID epilepsy community service for adults with ID. It delivers reasonable adjustments and person centered care to this population. We measured how service outcomes on SUDEP compared to regional and national averages.

Data of all Cornwall epilepsy deaths 2004–2015 using the Cornwall Coroner's database and the Public Health Cornwall was reviewed systemically. We identified patients with and without ID.

There were 113 epilepsy deaths of which 57 were SUDEPs of which 3 were identified to have a clinical diagnosis of ID. In another 2 cases it was not evident if they had an ID or not. None of the 5 was known to the ID Epilepsy service. Mean and 95% confidence intervals were calculated using a binomial calculation, making no prior assumptions about the population distribution.

Cornwall's specialist ID epilepsy service is a rarity in the UK. A recent study using the Leicestershire ID Register revealed 26 people with ID of the total deaths of 83 SUDEP. This contrasts greatly with Cornwall only 5.26% of SUDEP deaths had ID compared to 23.4% in Leicestershire and similarly when compared to neighboring Plymouth (population 300.000) which had 26% ID deaths in its SUDEPs between 2004–2012. It is possible that having an ID dedicated epilepsy service saves lives.

Schizophrenia is a devastating and complex disease, which occurs in approximately 1% of the general population. Symptoms include hallucinations, delusions and patients’ social withdrawal. Schizophrenia's etiology remains unclear, however, both patients’ genetic profile and environmental factors play a significant role.

Our study's primary objective was to identify genetic variants related with schizophrenia's development in non-Caucasians populations and to explore whether these polymorphisms can be also found in schizophrenia patients of Caucasian origin.

To achieve that, we screened Science Direct and PubMed medical literature databases to identify research articles correlating genes and variants with the development of schizophrenia. Next step was the categorization of studies according to samples’ origin and the identification of genomic variants that are correlated with schizophrenia (P < 0.001) but have never been studied in Caucasian populations.

In total, 108 and 47 studies, in non-Caucasian and Caucasian populations respectively, were identified, in which 157 (P < 0.05) and 18 (P < 0.001) variants were associated with the development of the disease in non-Caucasian populations.

From our qualitative meta-analysis 18 variants that were correlated with schizophrenia's etiology were identified (P < 0.001), which will be further investigated in a multi-cultural Caucasian cohort.

Neurocognitive disorders are the only psychiatric disorders which underlying pathogeny can potentially be determined. This has important implications, for it makes possible the use of biomarkers in order to gain better diagnosis, and opens a door to more accurate treatments. Nonetheless, as biomarkers are not exclusive of a single disorder, the lengths of its utility are still unknown.

To understand the values and limitations of biomarkers in differential diagnosis of dementias.

We present three cases followed in the Neurology ward of our hospital, in which they were admitted for diagnosis and treatment of a subacute form of dementia. Medical history, core symptoms, screening tests for cognitive impairment, MRI, EEG and biomarkers in cerebrospinal fluid were used for diagnosis.

Two cases had consistent clinical features and complementary explorations, and they were respectively diagnosed as Creutzfeldt-Jakob Disease and Lewy Body Dementia; however, the last case showed contradictory results between clinic and complementary explorations, particularly 14-3-3 protein, which was positive and led to the initial diagnosis as Creutzfeldt-Jakob Disease, which was proven wrong once necropsy was practiced.

Although complementary explorations, and biomarkers in particular, are of invaluable utility in the accurate diagnosis of multiple psychiatric diseases, they must always be considered within a context given by biography and clinical features, because, when failing to do so, they can lead to misdiagnosis and delay of correct treatment.

The peripersonal space is described as that area within the boundary between self and non-self. An accurate judgment of peripersonal space boundaries may depend on the capacity to create an organized and structured mental representation that integrates signals from different sensory modalities and brain regions. Empirical evidence suggests that these functions are altered in schizotypy, which is thought to reflect the subclinical expression of the symptoms of schizophrenia in the general population. A number of clinical studies reported that interpersonal interaction and social stimulation have an impact on the onset and progress of schizophrenia.

We conducted a study on personal space in a sample of student screened for schizotypal traits using a paradigm that was not affected by emotional and social interference.

The aim was to evaluate the relationship between personal space and schizotypy traits.

Thirty-four subject recruited for the study completed the Schizotypal Personality Questionnaire (SPQ). According to the SPQ results participants were splitted into two groups (High, Low). Each participant performed a PeriPersonal Space (PPS) task.

Our results show a more extended boundary of the peripersonal space in people with high schizotypy compared to people with low schizotypy even without emotional and social interference.

People with high traits of schizotypy suffer from a difficulty in social integration because of being unable to adapt the social behavior. A better understanding of the mechanisms for abnormal interactive behavior could provide significant valid guidelines for innovating insertion programs that aims to improve social functioning.

The authors have not supplied their declaration of competing interest.

Finding the right medication in psychiatry can be very demanding both for the doctor and for the patient. It becomes extremely grueling when the patient has a rare type of metabolizing enzymes, and many drugs may be ineffective or cause side effects.

To highlight the therapeutic difficulties in psychiatric treatment of the patient with complex genetic cytochrome P450 system alterations.

To provide an example on a complicated treatment course of the patient that is poor CYP2D6 and ultrarapid CYP2C19 metabolizer.

Literature review in scientific database–Pubmed–and case report presentation.

We report a case of a woman in her early twenties who was repeatedly referred for psychiatric treatment. A diagnosis of paranoid schizophrenia was established, but all treatment rounds were unsuccessful, the illness kept progressing, and major depressive disorder aggravated the clinical picture. The patient became suicidal and injured herself. During the sixth hospitalization in one year the CYP2D6, CYP2C19 and CYP2C9 genotyping was done. CYP2C19 ultrarapid (*1/*17) and CYP2D6 poor metabolizer (*4/*5) profile was discovered. Drugs, that should have been avoided due to the patient's genetic profile, had been prescribed throughout five hospitalizations in a row.

As ultrarapid CYP2C19 metabolizers compose around 3–4% and poor CYP2D6–6–10% of Caucasians, this case presents a rare genetic variant that only 0.18–0.4% of Caucasian population may have. These cases can be extremely clinically challenging and affect healthcare outcomes and costs. Further studies that would include clinical effectivity, drug concentration and genetic testing results are needed.

Weight gain is a side effect of pharmacological antidepressant treatments, causing a poorer compliance, increasing the risk of metabolic syndrome and periods of untreated disease.

The ability to precisely prescribe pharmacological treatments based on personal genetic makeups would increase the quality of the current antidepressant treatments.

The molecular pathways enriched during citalopram induced weight gain are identified.

643 depressed citalopram treated individuals with available clinical and genome-wide genetic information were investigated in the present contribution in order to identify the molecular pathways that holds the key to weight gain. Statistics were conducted in R environment (Bioconductor and Reactome packages), ANOVA and MANCOVA served when appropriate. Plink was used for genetic analysis in a linux environment.

One hundred and eleven individuals had their weight increased after treatment with citalopram. The axon guidance (P. adjust = 0.005) and the developmental biology pathway (P. adjust = 0.01) were found to be enriched in genetic variations associated with weight gain.

The development biology pathway includes molecular cascades involved in the regulation of beta-cell development, and the transcriptional regulation of white adipocyte differentiation. A number of variations were harboured by genes whose products are involved in the synthesis of collagen (COL4A3, COL5A1 and ITGA1), activity of the thyroid-hormones (NCOR1 and NCOR2), energy metabolism (ADIPOQ, PPARGC1A) and myogenic differentiation (CDON). A molecular pathway analysis conducted in a sample of depressed patients identifies new candidate genes whose future investigation may grant relevant insights in the molecular events that drive weight gain during antidepressant treatment.

Pharmacogenetics may inform an accurate prescribing of antidepressants by identifying the genetic background specifically responding to a certain drug. Despite decades of efforts though, pharmacogenetics appears to be still in its infancy.

A clearer understanding of the pharmacodynamics and pharmacokinetics events in combination with the genetic and epigenetic controls of cells and molecular cascade must inform the future of personalised medicine.

To systematically review the current cutting edge knowledge about pharmacognetics in the search for the next groundbreaking biological key events that may provide the keys to future treatments.

The major online databases are systematically searched with common keywords by two independent researchers and conflicting findings are solved during regular meetings dedicated to the topic in object. Manual searching of single bibliographies is also put in place.

Genes belonging to the serotoningeric, dopaminergic, glutamatergic and GABAergic systems are classic candidates for pharmacogenetics whose role was not confirmed by GWAS analyses, which, on the other hand, identified genes related to molecular pathways not associated with direct target of drugs used for the treatment of depression.

Both hypothesis driven candidate genetic investigations and GWAS analyses have been conducted so far, leading to the identification of a handful of potential good candidates, but the replication rate of the positive association findings lags behind expectations. The current knowledge about the pharmacodyncamic and pharmacokinetic genetic determinants of antidepressant response is critically analysed and new candidates are presented discussed.

Arrhythmia is a potentially fatal side effect of antipsychotics. A biologic predictive tool to prevent it is missing.

Identification of a genetic profile at risk for antipsychotic induced arrhythmia.

Identifying a molecular pathway enriched for antipsychotic induced QT-modifications.

Seven hundred and sixty-five SKZ individuals, M = 556, age = 40.93 ± 11.03 were included. QT-variation was a phase-specific created variable. A nested mixed regression served in R for clinical and molecular pathway analyses. Plink served for genetic analyses. Quality checking was standard, inflation factor was controlled by lambda values.

Quetiapine and Perphenazine were associated with QT variation (P = 0.002; Estimate = 5.79 and P = 5.67e-06; Estimate = 8.96 respectively). No other significant association was detected. No inflation was detected. Axon guidance and Collagen biosynthesis (Table 1) were associated with QT variation at a conservative (adjusted) P value < 0.01.

Two molecular pathways were identified as possibly involved in QT modifications during antispsychotic treatment in SKZ patients. Previous evidence supports a role of the same pathways in cardiac disorders [1,2]. Interaction of specific SNPs with the drugs will be focus of further research.

The authors have not supplied their declaration of competing interest.

Cognitive processes are impaired in Schizophrenia (SKZ). The nature of such impairment escapes definition.

Identification of a genetic profile at risk of cognitive impairment.

Identifying a molecular pathways enriched for mutations associated with cognitive impairment.

Seven hundred and sixty-five individuals from the CATIE, M = 556, mean age = 40.93 ± 11.03 were included. Verbal memory was outcome. R and Plink served for the analyses. Inflation factor was controlled by lambda values. Input for the pathway analysis were SNPs associated with outcome (P < 0.05) genomewide.

Gender (male, P = 2.34e–05;t = –4.26) and years of education (P = 1.57e–03;t = 6.502) were associated with verbal memory. Inflammation and oxidation were associated with outcome (Table 1, adj_P < 0.01).

Being male and poorly educated were associated with poorer verbal memory. Inflammation and the arachidonic acid pathway were enriched in mutations associated with poorer verbal memory. This finding is in line with previous reports [1,2,3].

The authors have not supplied their declaration of competing interest.

The glutamate system is implicated both in mood disorders and schizophrenia. Mice lacking metabotropic mGlu5 receptors (mGluR5 KO) display schizophrenia-like abnormalities. Additionally, mGluR5 antagonists represent promising alternative anxiolytics/antidepressants. However, the underlying age-specific molecular/cellular mechanisms are only partially understood.

We aimed at identifying molecular alterations associated with a genetically induced mGluR5 deletion, which results in a schizophrenia-like phenotype. Additionally, we investigated age-specific effects of mGluR5 antagonists on emotional behaviour and c-fos activation.

For analysis of mRNA and protein levels we performed Real-time RT-PCR and Western blot investigations of brains from mGluR5 KO and wild-type mice. Additionally we used classical behavioral tests for determining anxiety- and depression-like changes triggered by the mGluR5 antagonist 2-Methyl-6-(phenylethynyl)pyridine (MPEP). Finally, we used profiling of c-Fos expression, as marker of neuronal activity, induced by MPEP from postnatal day 16 (P16) to adulthood (P90).

We found reduced expression levels of reelin, GAD65, GAD67, parvalbumin, as well as NMDA and AMPA receptor subunits in mGluR5 KO mice, especially in the prefrontal cortex (PFC). We measured age-specific alterations in emotional behaviour of mGluR5 KO mice, with marked increase of anxiety during aging. There was a remarkably conserved activation of the paraventricular nucleus of the hypothalamus, implicated in stress regulation, by MPEP at all investigated ages, whereas the extended amygdala was specifically activated in adulthood only.

Our animal data provide new insights into the potential role of mGluR5 in neurochemical and behavioural changes associated with schizophrenia and mood disorders during the lifespan.

The authors have not supplied their declaration of competing interest.