Internet Gaming Disorder is listed in DSM-5 under conditions for further studies and is defined by nine criteria adapted from pathological gaming and addiction. Given this call for further structured research, it seems necessary to have a detailed look at the affected persons.

We interviewed 20 male adolescents (14 to 20 years old) of an inpatient treatment center for Addictions and Pathological Video Gaming.

. We aimed at a description of video game addicted patients regarding their addiction, video gaming behavior, comorbidities (Axis I, II), medical peculiarities, cognitive abilities, environmental abnormalities and experiences of impairment.

SCID-I, -II as well as a semi-structured Interview for video game addiction were conducted and analyzed according to common standards. Cognitive performance and symptoms of ADHD were assessed.

All subjects could be identified as excessive video gamer or internet users. In addition, most of them fulfilled criteria of a current video game addiction. Most patients showed average IQ-scores. Some patients fulfilled criteria of either an Axis I or an Axis II disorder (mostly anxiety and affective disorder or defiant oppositional behavior), others showed disorders on both Axes. Only a few patients didn’t show any comorbidity. Furthermore, family conflicts or bullying experiences were often reported.

Video game addiction was shown to lead to suffering and to neglecting important areas of life. Other comorbid mental disorders as well as family conflicts and bullying experiences need to be considered in this population. We claim for longitudinal research to untangle the question of causality.

Excessive problematic use of the internet has been a topic of discussion in the academic literature for many years. Problematic internet use (PIU) has been grown world-wide about 2 billion users.

The aim of this study is to explore the characters of internet use among the medical students, and discover the prevalence of internet mal use and its risk factors.

A cross-sectional study of 321 medical students at Assiut University Medical School using the Internet Addiction Scale was carried out.

The current study found that the most important correlates for Internet Addiction among Assiut Medical Students were mother's education, sex, residence, suicidal ideation.

Internet Addiction is an important behavioral disorder affecting medical students and may interfere with their normal life and studies.

The association between depression, hopelessness and anxiety is relatively ignored in the literature of the Arab World, particularly using Beck Depression, hopelessness, and anxiety inventories.

To examine the relationship between depression, hopelessness and anxiety in a Kuwaiti adolescence.

The participants were 616 (308 boys & 308 girls) first year Kuwait University students. The genders were matched in age (18.15±0.36 & 18.18±0.38, t=0.94, p>.05), and BMI (24.12±3.27 & 23.50±4.85, t=0.54, p>.05). The Arabic versions of Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS) and demographic surveys were administered to participants in the class. All participants read and signed a consent form before test administration. Independent Sample t Test, the exploratory factor analysis, correlation matrices, and stepwise regression model are used in this study.

Internal consistency of scores were satisfactory for the BDI-II, BHS & BAI inventories respectively (Cronbach's alpha = .83, .85, .90). The girls scored significantly higher than boys did on the BDI-II (t=10.25, p<.001), BHS (t=13.53, p<.001) & BAI (t=11.76, p<.001). A correlation of .59 between the BDI-II and BHS to .42 with BAI. Meanwhile the correlation of .33 between BHS & BAI. A principal-axis factor analysis with oblique rotation suggested one factor, accounting for 63.27% of the common variance. Multiple regression revealed that the main predictor of depression was hopelessness.

The current data provides strong evidence that among Kuwaiti depressed teenagers feel hopeless and anxious.

Immune dysfunction is thought to play a critical role in the pathophysiology of bipolar disorder (BD). Better insight into the genetic control of innate immune responses is of importance due to possible interactions with environmental risk factors such as infectious agents, particularly early in life.

Given the importance of Toll-like receptors (TLRs) in innate immunity, we analysed the association of selected genetic variants of TLR-2 and TLR-4, both major sensors of pathogenic infectious and non-infectious structures, with BD.

Explore possible implications of the innate arm of the immune response in BD.

Genomic DNAs from 572 BD patients and 202 controls were analyzed for the distribution of polymorphisms on the TLR-2 and TLR-4 loci using TaqMan®. Associations were examined using Chi-square test.

We found that TLR-4 rs1927914 AA and rs11536891 TT genotypes were more frequent in BD patients than in controls (corrected p; pc = .02 and .02 respectively) particularly in early-onset BD (EOBD) patients (pc = .004 and .006) born during the summer season (pc = 02 and .002 respectively). We also found that TLR-2 rs3804099 TT and rs4696480 TT genotypes were significantly more prevalent in EOBD group as compared to the late-onset BD (LOBD) subset, the latter only after excluding patients with positive family history of psychiatric disorders (pc=0.024 and 0.002 respectively).

We report an association between BD and TLR-2 and TLR-4 genetic variants suggesting an important role for pathogens in disease development.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) persist into adulthood in many patients.

Analyse post hoc the impact of sex and age on the efficacy of lisdexamfetamine dimesylate (LDX) in the treatment of adult ADHD.

In NRP104.303, a 4-week, double-blind, forced-dose study, adults with ADHD were randomized (2:2:2:1) to receive LDX 30, 50 or 70 mg/day, or placebo. NRP104.304 was a 12-month, open-label, dose-optimized, extension to NRP104.303. In both studies, the primary efficacy outcome was the change from baseline in ADHD Rating Scale (ADHD-RS) total score.

In NRP104.303 (N=420), least-squares mean changes from baseline to endpoint in ADHD-RS total score (standard error) were significantly greater for LDX (range across doses, −16.2 [1.06] to −18.6 [1.03]) than placebo (−8.2 [1.43]). Post hoc analyses revealed similar improvements with LDX in sex (male, LDX −16.7 [1.50] to −18.6 [1.53], placebo, −8.9 [2.12]; female, LDX −15.5 [1.56] to −19.3 [1.46], placebo −8.0 [2.02]) and age (18−39 years, LDX −15.3 [1.34] to −18.9 [1.31], placebo −5.6 [1.87]; 40−55 years, LDX −16.1 [1.81] to −17.1 [1.87], placebo −12.8 [2.52]) subgroups. In study NRP104.304 (N=349), improvements from baseline to endpoint in mean (standard deviation) ADHD-RS total score were similar between the overall population (−24.8 [11.7]) and sex and age subgroups (male −24.5 [11.5]; female −25.2 [12.0]; 18−39 years −25.3 [11.4]; 40–55 years −24.1 [12.2]).

In short- and long-term adult studies, LDX was associated with improvements in ADHD symptoms in sex and age-related subgroups.

Supported by funding from Shire.

is to assess the cognitive function and cerebral structure in children with type 1 diabetes 5 years after the onset of disease who are exposed to recurrent episodes of moderate and severe hypoglycemia.

In this cross-sectional comparative study forty patients with type 1 diabetes 5 years after the onset of disease and 40 healthy control subjects age and sex matched were included. All diabetic children and controls were subjected to neuropsychologic (NP) testing, and 20 diabetic children were subjected to magnetic resonance imaging (MRI) scans of the brain. Diabetes onset age, preceding severe hypoglycemia exposure, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology.

Children with type 1 diabetes performed more poorly than control subjects on measures fluid intelligence (performance IQ), memory, attention, excutive function, problem solving, abstract reasoning ability and knowledge (general and social knowledge). Diabetics and control groups had not differed on a measure of full-scale and verbal IQ. There was significant association between the severity of hypoglycemia and cognitive dysfunction. MRI brain showed subcortical arteriosclerotic leucoencephalopathy (SASL) in 55% of subjects, prominent perivascular (Virchow. Robin) space in 60%, and prominent lateral ventricle in 15% of the cases.

Children with type 1 diabetes who exposed to frequent hypoglycemic episodes have poorer neuropsychological profiles than healthy control subjects and have structural MRI brain changes.

Mental disorders in the general population are associated with increased mortality, but few studies have diagnosis made by interviewing psychiatrist.

To investigate long-term risk of death for specific diagnosis in a random population-based sample interview by psychiatrist.

To examine excess mortality associated with psychiatric diagnosis during 41 year follow-up

REBUS is a community sample collected in Stockholm County in 1970. a total of 1896 men and women 18-65 years of age participated in clinical examination, including interview by a psychiatrist (89% participation). Diagnoses were made according to the 8th version of International Classification of Disease. Information on mortality was obtained from tax registers. Excess mortality was assessed with Cox proportional hazard regression models.

There were 883 death during the 41 year long follow-up. Age, sex and comorbidity adjusted hazard ratios were for functional psychosis 2.22 (95% confidence Intervals (96%CI), 1.15-4.30), psycho-organic symptoms 1.94 (95%CI, 1.31-2.87), depressive neurosis 1.71 (95%CI, 1.22-2.39), psychopathy 2.88 (95%CI, 1.02-8.16), alcohol use disorder 1.91 (95%CI, 1.40-2.61) and substance use disorder 3.71 (95%CI, 1.80-7.65). There was no significant risk for those with neurosis other than depressive neurosis, for character neurosis, psychosomatic disorders or mental retardation.

This study confirms the increased risks of death associated with functional psychosis, psycho-organic symptoms, depression, alcohol and substance use disorder and antisocial personality disorder found in psychiatric community samples based on diagnosis made from structured interview.

Soft neurological signs (SNS) are minimal, nonlocalizing, objective abnormalities that result from disrupted cortico-cortical and cortico-subcortical connectivity. They can be subdivided into impairments of motor coordination, sensory integration, sequencing of complex motor acts, orientation and hard signs and can be measured by the Heidelberg scale. SNS are supposed to reflect specific cognitive deficits and not a general brain dysfunction that makes them a suitable target for research on endophenotypes in schizophrenia and BD.

The aim of our study was to compare the incidence of various SNS in adult BD patients to healthy controls (HC).

We report preliminary data on 16 DSM-IV-TR BD I patients having a current manic, mixed or depressive episode and 20 HC with no Axis I or II mental condition. Both groups were assessed by the Heidelberg Scale.

BD patients had significantly higher SNS total score in comparison to HC (p<0.01), as well as significantly higher scores for motor (p<0.05), sensory (p<0.001), and complex (p<0.05) SNS. There were no inter-group differences in orientation and hard signs scores.

Our results suggest that in comparison to HC, BD patients have much more motor, sensory and complex SNS. Our future research will also aim to reveal whether these deficits are trait or state markers in BD, whether the episode polarity has any impact on their incidence, and whether SNS are more common in first degree relatives of BD patients than in HC. The final aim is to aid the construction of valid endophenotypes in BD.

A considerable social stigma is attached to psychiatric disorders in general. However, research also shows differences between psychiatric disorders related to stigma. There are indications that the portrayal of schizophrenia in the media is particularly negative.

To compare the coverage of autism and schizophrenia in the Flemish newspapers regarding stigma.

On the websites of the seven Flemish newspapers all articles published between 2008 and 2012 were screened for the keywords autism/autistic and schizophrenia/schizophrenic. The collected articles (N=4,181) were then graded to stigmatizing content.

In the collected articles the coverage of autism was mostly positive and the coverage of schizophrenia was predominantly negative. The contrast is very substantial (p<0.0001) and the negative coverage of both disorders increased over time.

The social stigma that rests on schizophrenia is poignantly reflected in the Flemish newspapers. The observation that a somewhat similar disorder such as autism is covered in a clearly more favorable way indicates that a more positive image of schizophrenia is not only desirable but also possible.

The National Program of Tobacco Control was recently implemented in the Addictology and Chemical Dependency Ambulatory of UFMG Clinical Hospital. The program is performed with group sessions and it has cognitive behavioral therapy and pharmacological treatment as theoretical basis. The protocol followed was proposed by National Cancer Institute (INCA) and it is set as 4 weekly group sessions, with 10 to 15 people, lasting 90 minutes. All sessions hold 4 steps know as: individual attention, strategies and information, revision and discussion, and at last, home assignments orientations are given. In addition to informative material, some topics are taught, such as techniques to avoid relapses, skill training, stress management, and psychoeducation.

Evaluate qualitatively the efficiency of this program on stopping patient's smoking habits according to criteria's suchs as associated factors with treatment outcome and the grade of patients’ satisfaction.

Transversal and qualitative study, using focal interviews conducted by telephone and a default questionnaire for evaluation of users. Then, patients who completed the program were compared to those who have discontinued.

A low adherence rate to the program was observed in comparison to other anti-smoking groups. In spite of this, the project was very highly rated by patients and well recommended by them. The participants evaluated themselves with low scores of willpower.

However the original approach strategies must be further elaborated on, new strategies need to be considered, and individual stimuli must also be incorporated in order to make this program even more successful.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood, but are recognised as often persistent into adulthood. Impairments in day-to-day functioning associated with ADHD in adults include deficiency in executive function.

Evaluate the effect of lisdexamfetamine dimesylate (LDX) on ADHD symptoms in adults with ADHD and executive function deficit.

This phase 4, randomized, double-blind study enrolled adults (aged 18–55) with baseline ADHD Rating Scale IV with Adult Prompts (ADHD-RSIV- Adult) total score ≥28 and baseline Global Executive Composite T-score ≥65 on the Behaviour Rating Inventory of Executive Function–Adult Version. Patients were randomized 1:1 to receive optimized doses of LDX (30, 50 or 70 mg/day) or placebo for up to 10 weeks. The change from baseline in the investigator-rated ADHD-RS-IV-Adult total score was a secondary efficacy outcome.

The full analysis set comprised 154 patients (LDX, n=79; placebo, n=75). At baseline, mean ADHD-RS-IV-Adult total score was 39.9 in both groups (standard deviation [SD]: LDX, 6.83; placebo, 7.37) and mean changes from baseline to week 10 or early termination were −21.4 (SD, 11.27) and −10.3 (12.70) in the LDX and placebo groups, respectively. Statistical analysis showed a significant difference (LDX minus placebo) in least-squares mean changes of −11.1 (95% confidence interval: −14.9, −7.3), with an effect size of 0.94 in favour of LDX (p<0.0001). Safety outcomes were consistent with previous studies and the known effects of stimulant treatment.

Short-term treatment with LDX markedly reduced ADHD symptoms in adults with ADHD and impaired executive function.

Study funded by Shire.

Alcohol and other substance use problems are common among individuals with schizophrenia. Many of the previous studies have focused on clinical comorbidity, not on longitudinal studies aiming to look for possible causal associations. We aimed to investigate if premorbid or early substance use predicts long-term clinical and social course in schizophrenia.

A systematic review to identify potentially relevant studies was conducted. Only studies with a follow-up period of at least two years were included. We studied following outcomes: negative, positive and total symptoms, clinical remission, hospitalizations, social functioning, employment, and global outcome.

The search identified 9343 unique potentially relevant articles of which 20 studies presenting results from 24 samples met our inclusion criteria. The meta-analysis included 5 to 13 studies in each outcome category. The studied in outcome groups were mainly moderate to high heterogeneous. In meta-analysis, substance use associated modestly with outcome, all the associations (Spearman's r) were non-significant and between −0.05 and 0.10. Non-significant findings are explained by the fact that the original studies found often opposite results, indicating both worse and better long-term outcome for early substance users.

Although comorbid substance use associates with poorer outcome in schizophrenia, the early substance use has only a modest effect as a predictor of long-term outcome. This difference between these two designs may be explained for instance with poorer treatment adherence of dual diagnosed patients.

The diagnosis of psychotic disorders is based on the presence or absence of characteristic symptoms. However the presence of such symptoms varies during the course and treatment of these illness, which raises the question of how stable a diagnosis of psychotic disorder remains over time.

The aim of this study was to assess the 3-year diagnostic stability after first admission for psychotic disorders.

We performed a retrospective study at the Department of Psychiatry of Centro Hospitalar S.João (Porto, Portugal). Patients were admitted in the inpatient unit from 2007 to 2010 (n=59), for a first psychotic episode experience and fulfilled criteria for one of the following diagnosis: Schizophrenia, Schizoaffective Disorder, Bipolar Affective Disorder, Psychotic Disorder due to Substance Use, Acute and Transient Psychotic Disorders and Psychosis NOS (ICD-10). The diagnoses were extracted from clinical records, and reassessed three years after the initial diagnosis. Twenty patients were lost to follow-up and thus excluded from the study.

In our sample, 69.2% of the subjects kept the same diagnosis three years later and 30.8% were given a different diagnosis at follow-up. Schizophrenia and Bipolar Affective Disorder were the most stable diagnoses and Psychosis not otherwise specified and Acute and Transient Psychotic Disorder were more variable.

Diagnosis performed in the first episodes of mental disorders has important therapeutic and prognostic implications. With its characteristic fluctuating symptomatology, first episode psychosis may be more vulnerable to diagnostic change over time.

GXR, a selective α2A-adrenergic agonist, is a non-stimulant treatment for ADHD (approved in the USA for children and adolescents and in Canada for children).

To assess the efficacy (symptoms and function) and safety of dose-optimized GXR compared with placebo in children and adolescents with ADHD.

To evaluate the efficacy (symptom and function) and safety of GXR for the treatment of ADHD. An atomoxetine (ATX) arm was included to provide reference data against placebo (NCT01244490).

Patients (6–17 years) were randomly assigned at baseline to dose-optimized GXR (6–12 years, 1–4 mg/day; 13–17 years, 1–7 mg/day), ATX (10–100mg/day) or placebo for 4 or 7 weeks. The primary efficacy measure is change from baseline in ADHD-Rating Scale-version IV (ADHD-RS-IV). Key secondary measures were defined as Clinical Global Impressions-Improvement (CGI-I) and the Weiss Functional Impairment Rating Scale-Parent (WFIRS-P). Safety assessments included treatment-emergent adverse events (TEAEs), electrocardiograms, and vital signs.

Of 338 patients randomized, 272 (80.5%) completed the study. Placebo-adjusted differences in least squares (LS) mean in ADHD-RS-IV total score, percent improvement versus placebo for CGI-I, placebo-adjusted differences in LS mean change from baseline in WFIRS-P score (family and learning and school domains) are shown in the Table. The most common TEAEs for GXR were somnolence, headache, and fatigue; 8 (7%) TEAEs were severe.

GXR was effective and well tolerated in children and adolescents with ADHD.

While several theoretical models imply that personality disorders (PD) show an altered cognitive processing of emotions (alexithymia), empirical evidence linking alexithymia with PD is controversial.

investigating whether alexithymia is associated with PD regardless of psychopathology severity.

1) evaluating the association between alexithymia (Toronto Alexithymia Scale, TAS-20) and PD, controlling for comorbid psychopathology severity; 2) evaluating whether alexithymia decreases over a 2-year follow-up as a function of the remission of PD, Axis I disorder or their interaction.

167 psychiatric outpatients (56 males) completed the Structured Interviews for DSM-IV Personality and Axis I disorders, the General Severity Index (GSI) of the Symptom- Checklist-90 and the TAS-20. At two-years follow-up, patients who had both an Axis I and II disorder at baseline (n=121) were re-evaluated, and TAS-20 reduction was calculated. The association between PD, TAS scores and severity and presence of Axis I disorders was assessed using Hayes’(2012) bootstrapping procedure for conditional effects.

At baseline PD criteria predicted TAS-20 score at low (CI=.238-1.364, p=.006) and average (CI=.153-.757, p=.003) levels of GSI, but not at high GSI scores (CI=-.174-.393, p=.44). At follow-up, TAS-20 reduction did not differ between non-remitted and remitted PD patients, but was higher among patients remitted from their Axis I conditions. However, the remission from PD was associated with a greater decrease in ‘Externally Oriented Thinking’ for men who still had an Axis I disorder (B=11.95, p=.01, CI= 2.33-21.57).

The relationship between alexithymia and PD could be influenced by comorbid psychopathology severity and gender.

Treatment in terms of standardised, time restricted, pre-coordinated care packages for anxiety disorders and other non-psychotic disorders has recently been introduced in the public mental health services in Denmark. Currently, the result of the implementation process and its impact on patient outcome and service delivery remains unknown.

To investigate i) the effect of care packages on patient outcome and ii) the implementation and service outcomes of care packages in clinical practice. The care package for anxiety disorders is selected as a case study.

The study is conducted as a quasi-experimental prospective pre-post study in a naturalistic setting. Patients included are aged above 18 years and randomly referred to care package treatment for anxiety disorders (F40-41) at two mental health centres in the capital region. In accordance with Proctor et al [1] outcomes are distinguished at three levels: Implementation, Service and Client. In this study the clinical outcome at client level are measured by the Symptom Check List-90R, Beck Anxiety Inventory, Global Assessment of Functioning and WHO Wellbeing Index. Implementation and services outcomes are measured in terms of time periods for waiting and treatment course and resource spending. An internet-based registration and questionnaire system accessed by patients, administrative personnel and therapists is used for data collection.

Inclusion is closed by December 2013. Implementation outcome results are expected by February 2014.