Current data suggest that at least three psychophysiological paradigms are involved in Alcohol Dependence: attentional bias; affective modulation of the startle reflex and behavioural inhibition. These three paradigms have not been studied together in a sample of alcohol dependent subjects.

To show that the performance on these three psychophysiological processes allows discriminating alcohol dependent subjects (with different severity) from healthy controls.

59 alcohol dependent subjects were assessed with the following three psychophysiological tasks: The dot probe task (which assesses attentional bias), the startle response when viewing alcohol cues (which evaluates affective modulation of the startle reflex), and the Modified- Stop Signal-Task (which measures behavioral inhibition). The Severity of Alcohol Dependence Scale (SAD) was used for grouping patients based on their dependence severity. 52 healthy subjects were assessed as the control group.

All three paradigms correctly discriminated between patients and controls. Patients were divided into three subgroups according to their scores on the SAD (mild, moderate and severe dependence). The performance of the three groups in the three paradigms studied was also different. Patients with more severe dependence had more attentional bias for alcohol cues, exhibited lower magnitudes of startle response when viewing alcohol cues, and showed lower capacity to inhibit their behaviour when words related to alcohol were being seen.

Subjects with alcohol dependence showed different psychophysiological response patterns compared to controls in the three paradigms studied. These response patterns seem to be associated with the severity of dependence, and they could be used to determine the outcome of the treatment in patients with alcohol dependence.

Cognitive and emotional development of children is closely related to the environment, where they live. It is supposed that children in foster care or institutional care may be exposed to long-time changes in development and can show significant growth and developmental delays.

We have conducted 2 years longitudinal study of children in foster care (n = 70), in institutional care - D (n = 50) and in functional biological families (n = 50). We have evaluated the stage of cognitive and emotional development at the beginning and the end of the 2 years period.

The results of the presented study showed that emotional and cognitive development of children in institutional care is comparing to other groups statistically significantly slower than in children in foster care and functional biological families (p, 0.01). Children in foster care show similar development progress to children in biological families.

The results of the study propose that children institutional may show developmental delays due to absence of individual contact with a care giver, while foster care may be in cases of necessity acceptable substitution of biological family.

The study was supported by J&T Foundation.

Mental development is influenced by the possibility to experience long term and stable relationship with a caregiver. Children in institutional care usually may not have this possibility. There is growing evidence that long term stay in institutional care may substantially influence occurrence of psychopathology symptoms in children.

We have conducted 2 years longitudinal study of children in foster care (n = 70), in institutional care - D (n = 50) and in functional biological families (n = 50). We have assessed presence and intensity of psychopathology signs at the beginning and the end of the 2 years period.

The results of the presented study showed that psychopathology significantly persist or develops in children in institutional care, while in children in foster care and biological families tends to reduce. (p, 0.01).

The results of the study propose that children institutional may be substantially endangered by the higher occurrence of psychopathological symptoms, comparing to foster care and biological families. Foster care thus seems to be more suitable for children's development than the institutional care.

The study was supported by J&T Foundation.

Abrupt discontinuation of antidepressants, especially Selective Serotonin Reuptake Inhibitors (SSRI) and Dual-Action Antidepressants such as Venlafaxine, can lead to several psychological and somatic symptoms, which includes restlessness, psychomotor agitation, nervousness, anxiety, crying spells, irritability, depersonalization, decreased mood, memory disturbances, decreased concentration, and/or slowed thinking, nausea, dizziness and headache. Additionally, it has been demonstrated that sudden discontinuation of antiepileptic drugs in free-seizure patients, can increase the risk of suffering a seizure episode.

The aim of this study was to review the discontinuation syndrome associated with antidepressants and antiepileptic drugs, it's pharmacological management and strategies to prevent it.

We searched in MEDLINE selecting all the studies from 1990 until the present, related with the discontinuation of antidepressants and anticonvulsants. All kind of studies and reported cases are included. We also describe the case of a 47 year old patient, diagnosed with Obsessive Compulsive Disorder (OCD), who developed delirium and two seizure episodes after sudden cessation of his treatment with Venlafaxine 225 mg/ day and Pregabaline 225 mg/ day.

Withdrawal symptoms are common during discontinuation of antidepressants, especially in the case of SSRI and Venlafaxine. They are more frequently associated with their prolonged use and with agents with a short half-life. These symptoms are usually mild and transient. However, there are several cases reported in the literature describing the occurrence of delirium as a result of abrupt discontinuation of antidepressants. Additionally, it has also been reported that stopping antiepileptic drugs in seizure-free patients can increase the risk of developing a seizure episode.

Withdrawal Syndrome associated to the discontinuation of antidepressants and antiepileptic drugs is well established. Psychiatrists and General Practitioners should be aware of possible withdrawal symptoms when interrupting these treatments. Management strategies include gradual tapering of doses, clinical monitoring and patient education.

Posttraumatic stress disorder (PTSD) is characterized by a reduced expression of FKBP5, a key modulator of the glucocorticoid receptor. Smaller hippocampal volume has also been documented in PTSD. In this study we explored FKBP5 gene expression, brain structure and cognitive flexibility in patients with PTSD before and after cognitive behavioral therapy (CBT)

We measured peripheral FKBP5 RNA, volumes of the hippocampus, amygdala, and medial orbitofrontal cortex and cognitive flexibility in 39 patients with PTSD before and after CBT. The control subjects were 31 trauma-exposed individuals without PTSD who were also assessed twice.

At baseline, patients with PTSD showed lower FKBP5 gene expression and smaller hippocampal and medial orbitofrontal cortex, but not amygdala, volumes relative to control subjects. At follow-up, we found significantly increased FKBP5 expression and increased hippocampal volume in patients with PTSD. At follow-up, patients did not differ from control subjects in hippocampal volume. Improvement in PTSD symptoms was predicted by increased FKBP5 expression and increased hippocampal volume, but the primary predictor was FKBP5 expression. There was a positive correlation between the performance on a partial reversal task which tests cognitive flexibility and treatment responsiveness.

Clinical improvement in individuals with PTSD was associated with increased expression of FKBP5, increased hippocampal volume and better cognitive flexibility. The three variables were positively correlated.

Bipolar disorder is characterized by depressive and manic mood episodes. Despite an overall high heritability, environmental factors play a critical role in bipolar disorder. Stress negatively influences the clinical course bipolar disorder and may trigger mood episodes. Surprisingly, the study of stress reactivity in bipolar patients has remained relatively unexplored. Moreover, it is unknown whether altered stress reactivity may be a trait marker in unaffected siblings of bipolar disorder patients who possess an increased genetic risk for this disorder.

Male and female euthymic bipolar disorder patients (N=49), unaffected siblings (N=27) and healthy controls (N=48) were exposed to a validated social stress test. The endocrine stress response was measured using saliva cortisol levels, whereas salivary alpha-amylase (sAA) were determined as an index for the adrenergic stress response.

Exposure to stress resulted in a differential endocrine and adrenergic stress reactivity between bipolar disorder patients and their unaffected sibling. Importantly, bipolar disorder patients displayed a blunted endocrine but exaggerated adrenergic response.

Our findings illustrate the importance of measuring stress reactivity in bipolar disorder. These results provide insight into stress system functionality of euthymic bipolar disorder and enable a direct comparison with unaffected siblings who display an increased risk but have not developed bipolar disorder.

Schizophrenia and psychotic disorders represent psychiatric disease patterns characterized by great impairment due to disease severity with a great effect in patient's health related quality of life, which still remain a challenge in everyday clinical practice.

To investigate group differences in health related quality of life(HRQoL) in patients with psychosis during in hospital treatment.

174 inpatients in a psychiatric ward in Athens-Greece participated in the study. 120(69%) were males and 54(31%) females. Of them, 0(11.5%) had bipolar disorder(BD), 126(72.4%) psychosis and depression(PD) and 28(16.1%) comorbit alcohol addiction(PAA). Patients filled a battery with tests of HrQoL, psychotic symptoms, negative motions, optimism, self-esteem, happiness and life-satisfaction. Stepwise regression models were used to determine the best predictors of compliance with SPSS.

There were a statistical significant difference in compliance between BD and PAA(good compliance 100%) and PD(good compliance 66.7%)(x2=21.09p=.001). Multivariate analysis revealed that good reaction to treatment(beta=−.736), atypical antipsychotics(beta=− .312), antidepressants(beta=−.270), days of hospitalization(beta=.203), bipolar disorder(beta=.199), sleeping pills(beta=.169) and stabilizers(beta=−.188) explained 74.5% of the variance in compliance(adjusted R2=.745 p<0.001). In a second model with the inclusion of personality and emotional characteristics in the model, stress(beta=−.381) negative emotions (DASS)(beta=.290) and subjective happiness(beta=.120) explained an additional 3% in compliance with therapy(adjusted R2=.775 p<0.001).

It seems that depression comorbidity is an effective factor affecting therapy compliance in psychosis, with days staying in hospital for treatment. Also if the patient is prior to the therapy happy with his life complies better with the pharmacological approach that was used during the days of treatment.

Considering the current global economic crisis, it is an urgent need to discuss the potential effects of the crisis in family environment in Greek population.

This study examined the effect of borrowing on family orientation strategies.

This study aimed at detecting the interaction of borrowing on family acquiring social support and problem-solving behaviors.

273 community individuals from different regions of Greece participated in the present study. The measure used was the Family Crisis Oriented Personal Evaluation Scales.

Multivariate analysis was applied for the statistical analysis of data, and the results was: The loan recipients have statistically higher average than non-loans at family mobilization to accept help in the periods when the family is in crisis 11,13±4,65. Particularly interesting result of this study by using linear regression analysis was the finding that additional 1.000 euros of family income per month increase per unit the mobilizing of family to acquire and accept Help, while lending itself was associated with 1,76 per unit increase of mobilizing family to accept help (p=.016 and p=.014 respectively).

Table 1Results of regression analysis

The present study highlights the strong association between income and ways that Greek families externally handle their problems due to economic crisis.

White matter hyperintensities (WMHs) may be associated with increased risk of suicidality in subjects with major affective disorders. Unfortunately, they may be frequently confounded by the use of previous medications and duration of illness.

Although findings from the current literature are quite conflicting, we proposed that WMHs are important markers/endophenotypes of specific subgroups of individuals with major affective disorders such as those at high suicidal risk.

A literature search has been performed aiming to examine the presence and severity of WMHs in patients with major affective disorders, and the association with suicidal behavior. The reference lists of the selected studies were also scanned for additional relevant studies.

Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of major affective disorders. Several studies reported a significant association between WMHs, in particular periventricular WMHs, major affective disorders, and suicidal behavior. A significantly higher number of suicide attempters were found to have WMHs than nonattempters.

WMHs may represent neurobiological markers between the underlying susceptibility and clinical expression of major affective disorders. Clinicians should carefully investigate patients with major affective disorders for the presence of WMHs in order to identify specific subgroups of subjects at-risk for a poor outcome.

Schizophrenia is a mental disorder, which is characterized by positive and negative symptoms, such as disorders in the professional and social area.

Today, the dominant trend in Psychiatry is ‘social and community psychiatry’. In this paper we present the progress of the disorder, of a patient who suffers from schizophrenia -disorganized type- over the past 20 years and in which psychosocial intervention was aimed towards the prevention of hospitalization and his best possible functionality, despite the reduction of the medication received.

The material used, is from the medical records of the patient in the different structures of the Psychiatric Hospital of Corfu.

During the research we have studied the medical records of the patient, the reports of the nursing, social, psychology services, his medications since 1999 up to now, as well as his behavior particularly for the last 2 years.

The patient's, supervised, independent living, during the last 2 years, his participation in social activities, the encouragement by the medical team to make him become involved in new things (learning computer, Internet use) has resulted in the prevention of his hospitalization to the Psychiatric Hospital and the reduction of the medication received.

Despite the pessimistic outlook and the stigma of the society as far as the schizophrenic and their ‘recovery’ is concerned, it seems that these patients can improve the conditions of their life and regain their communication skills through which they can express feelings and interact with others. Although, no totally effective therapy has yet been devised, it is important to remember that many people with this illness could improve enough so as to lead independent, satisfying lives. As we learn more about the causes and treatments of schizophrenia, we should be able to help more patients achieve successful outcomes. Targeted psychosocial interventions may lead to the reduction of the severity and the number of relapses, with the minimal medication received.

To analyze lifetime narratives, risk factors, family profiles, internal and external signs of distress and environmental reaction to it, using the method of psychological autopsy and narratives typology analysis in order to better understand and predict suicide in high schools.

The psychological autopsy of 70 high school students suicide victims (54 Jewish, 50 males, 43 born in Israel) were analyzed post mortem using quantitative, qualitative and narrative approach.

We traced two leading narratives: tragic and regressive. Specific risk factors were found including gender, school mal-behavior and truancy, low school grades and learning disorders. Fight with parents and teachers especially with humiliation aspects were a major facilitating factor. Despite the fact that most of the victims gave sings of distress, the adults in their life did not notice it while the peers noticed but refused to believe they are true. Methods of suicide did not differ significantly between genders in this sample. Yet, 20% of the suicide victims were excellent students and fitted the tragic life narratives. They had lower rate of mental disorders (p=0.03), shorter crisis (p=0.006), and less life events (p=0.03) when compared with those with regressive narratives.

We identify two major life narratives in high school students suicides: tragic and regressive. School truancy for the regressive narratives and fight with authority figures and humiliation for the tragic narratives are major risk factors at high school and should be a focus of prevention programs.

Guernsey is a British Protectorate island (population 65000) in the English Channel. Illicit drugs are difficult to import and expensive people look to alternative substances.

To establish patterns of drug misuse among patients referred for treatment.

Case note audit of all referred patients in 2011, cross referenced with sudden unexpected death case review results.

198 patients were referred, 80 (40%) for mainly drug dependency. Reported patterns of use tended to follow local availability and polydrug misuse was common. Of the drugs clients, 96% reported misusing prescription only medicines (POMs) and over the counter (OTC) drugs, particularly opiates and benzodiazepines. Buprenorphine products were most commonly misused (26%), followed by benzodiazepines (25%), dihydrocodeine (22%), heroin (11%) and codeine (6%) (more than 1 drug may be reported so totals <100%). A high risk sub-group (9%) injecting fentanyl (derived from fentanyl patches) was identified. On the island in 2011 there were several fentanyl-related deaths at post mortem case review.

High rates of pharmaceutical drug misuse on Guernsey may reflect the low availability of illicit drugs like heroin and cocaine. This increases demand for addictive POMs and OTCs. Prescribers in isolated communities need to be more cautious when prescribing addictive POMs, particularly fentanyl. Pharmacists may also need to monitor for OTC drug misuse, particularly of codeine-containing medications.

Previous studies have reported progressive brain changes and cognitive deficits in early-onset psychosis (EOP). Little is known on the relationship between longitudinal changes in brain structure and neurocognition.

Naturalistic 5-year prospective study comparing frontal gray matter (GM) volume and executive functions in adolescents with a first episode of EOP and a sample of healthy controls at baseline, 2-year and 5-year follow-up.

Thirty-six patients (age at baseline 15.8 ±.7, 66.6% male) and 34 controls (15.4±1.4, 55.9% male) comprised the study sample. Both patients and controls presented with frontal GM loss during the first five years of follow-up. During the first two years, patients presented with significantly greater GM loss than controls in the left (F=9.642, p=0.003) and right frontal lobe (F=7.585, p=0.008), with no significant differences between year 2 and 5. Patients with EOP performed significantly worse in executive tasks than controls in all visits. During the first two years of follow-up, controls, but not patients, presented with a significant improvement in executive functioning (F=7.523, p=0.009), with similar evolution of cognitive functioning between years 2 and 5 in both groups (F=0.908, p=0.346). Changes in frontal GM volume and executive functioning were not significantly correlated within the entire follow-up period.

Over the first two years of illness, patients with EOP show greater frontal GM loss and less improvement in executive functions than expected. This could be a critical period for the development of deficits in EOP, in which more intensive interventions would be warranted.

In Ukrainian practice of medical health and social work also in the World there is big cooperation between neurologists and psychiatrists in assistance to the people with disabilitating neurological diseases. The successes of neurology, neuropsychiatry, neuropsychopharmacology and related sciences give the hope to these patients. The significance of mental disturbances after neurological pathology is very high.

were to explore the impact of mental disturbances in the forming of the severity of disability due to the nervous system diseases.

clinical, clinical-psychopathological, anamnestical-catamnestical, statistical.

From 2477 clinically examined patients 1344 had disability and 1103 were applying for disability due to neurological diagnosis. In the continuum of disabled patients were included the patients with 3rd group of disability (706), 642 had 2nd group and 26 had 1st most severe group of disability according to Ukrainian legislation.

937 disabled patients and 351 applying for disability were examined once. Other patients (437 disabled persons) and (342 applying for disability patients) were observed for: 1 year (533), 2 years (67), 3 – 7 years (11). For 112 patients the group of disability was changed (increased) from no degree to 3rd or from 3rd to 2nd and from 2nd to 1st (most rarely). In this group the increasing of number of psychopathological symptoms is significantly higer than in the group of 421 other patients by U-Wilcoxon-Mann-Whitney criteria.

The severity and dynamics of mental disturbances are the important factors influencing on severity of desadaptation in patients with disabilitating neurological diseases.

To evaluate and compare clinical characteristics of men and women who were admitted to psychiatric hospital after parasuicide.

Clinical examination, The Pierce Suicide Intent Scale, Beck Suicide Ideation Scale, Beck Hopelessness Scale, Beck Depression Inventory, The Symptom Checklist 90 Revised, Global Quality of Life Self - Rating Scale, The Barratt Impulsiveness Scale, The Toronto Alexithymia Scale.

Suicide attempters over 15 years admitted to the psychiatric hospital within one month after parasuicide (N=264; 114 – men and 149 – women).

Level of depression according to the Beck Depression inventory was higher in women (M=19,1; SD=13,1) than in men (M=12,9; SD=9) with ρ<0,001. The scores of general psychopathological state were higher in women (M=87,7; SD=68,1) than in men (M=69,1; SD=49,7), ρ<0,04. There were no statistical differences in the level of hopelessness according to Beck Hopelessness Scale, impulsivity according to The Barratt Impulsiveness Scale, alexithymia according to The Toronto Alexithymia Scale and perception of quality of life according to the Quality of Life Self- Rating Scale. There was no difference in the level of suicide ideation according to the Beck Suicide Ideation Scale and suicide intention according to The Pierce Suicide Intent Scale.

There weren’t considerable difference of parasuicide risk factors between men and women hospitalized because of mental disorders. At the same time women more often percept their psychological state as more severe.

Research on neurobiologic underpinnings of psychotherapy in depression is still sparse, particularly in psychodynamic oriented research. At present, there is insufficient data on neurobiologic parameters that could allow a targeted use of therapeutic interventions. One reason for this is the methodological difficulty of investigating complex and individual phenomena relevant to the psychotherapeutic process with functional neuroimaging techniques. The Zurich Depression Study takes up this strong research need developing a pioneer study design.

An individualized neuroimaging paradigm was developed based on the MIPQS (Maladaptive Interpersonal Q-Sort (Zimmermann et al., accepted), a self report instrument derived from the OPD-2 axis interpersonal relations (Operationalized Psychodynamic Diagnosis 2, Arbeitskreis OPD, 2006). Visual stimuli were developed and tested that systematically illustrate interpersonal behaviour patterns (Interpersonal Relations Picture Set (IRPS)). They are employed in an individualized fMRI experiment. The experiment was validated with ten healthy study participants

Preliminary results suggest that the experimental paradigm is an accurate method to be employed in psychotherapy research with depressed patients. Specific hemodynamic activation patterns observed during the individualized fMRI task involve brain regions commonly identified as playing a role in emotion processing and autobiographic memory. A final overview of these first results will be given at the EPA 2014 congress.