Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from two Phase III, randomized, double-blind, placebo-controlled, flexible-dose, 3-week trials of cariprazine 3-12mg/d (NCT01058096) and cariprazine 3-6mg/d or 6-12mg/d (NCT01058668) in adults with bipolar I disorder and acute manic or mixed episodes.

Evaluate the efficacy, safety, and tolerability of cariprazine in mania associated with bipolar I disorder.

Primary and secondary efficacy parameters were change from baseline to Week 3 on the Young Mania Rating Scale (YMRS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 312 (NCT01058096; 154 placebo, 158 cariprazine 3–12mg/d) and 497 (NCT01058668; 161 placebo, 167 cariprazine 3–6mg/d, 169 cariprazine 6–12mg/d). Improvement from baseline to Week 3 on YMRS was significantly greater for each cariprazine group vs placebo (P<0.001): least square mean difference (LSMD) was −4.3 (3–12mg/d), −6.1 (3–6mg/d) and −5.9 (6–12mg/d). For each cariprazine group, significantly more patients met YMRS response and remission criteria vs placebo. Cariprazine also was significantly superior to placebo on the CGI-S: LSMD was −0.4 (3–12mg/d, P=.0027), −0.6 (3–6mg/d, P<.001), −0.6 (6–12mg/d, P<.001). The only common cariprazine-related TEAEs (≥5% and twice rate of placebo) that occurred in both studies were akathisia and tremor. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of bipolar mania.

Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from 2 Phase III, randomized, double-blind (6-week), placebo-controlled trials of fixed-dose cariprazine (3mg/d and 6mg/d, NCT01104766) and flexible-dose cariprazine (3–6mg/d and 6–9mg/d, NCT01104779) in adults with acute exacerbation of schizophrenia.

Evaluate the efficacy, safety, and tolerability of cariprazine in schizophrenia.

Primary and secondary efficacy parameters were change from baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 617 (NCT01104766; 153 placebo, 155 cariprazine 3mg/d, 157 cariprazine 6mg/d, 152 aripiprazole) and 446 (NCT01104779; 147 placebo, 151 cariprazine 3–6mg/d, 148 cariprazine 6–9mg/d). Improvement from baseline to Week 6 on PANSS total scores was significantly greater with cariprazine vs placebo: least square mean difference (LSMD) was −6.0 (3mg/d, P=.0044), −6.8 (3–6mg/d, P=.0029), −8.8 (6mg/d, P<.0001), and −9.9 (6–9mg/d, P<.0001). Cariprazine was significantly superior to placebo on CGI-S: LSMD was −0.4 (3mg/d, P=.0044), −0.3 (3–6mg/d, P=.0115), −0.5 (6mg/d, P<.0001), and −0.5 (6–9mg/d, P=.0002). Aripiprazole (active control, NCT01104766) was superior to placebo on both measures (LSMD: PANSS=−7.0, P=.0008; CGI-S=−0.4, P=.0001). The only common cariprazine-related TEAE (≥5% and twice rate of placebo) that occurred in both studies was akathisia. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of schizophrenia.

The clinical vignette aims to provide how PM could assist psychiatry treatment.

A 43-years-old woman with a 12-years history of Multiple Chemical Sensitivity (MCS), also affected by celiac disease and gastroesophageal reflux. In 2011, she was diagnosed with breast cancerin a surgically treatable stage. Due to previous severe drug adverse events, with undefined cause, no medical team accepted to take care her. Then she developed a depressive syndrome with hypochondriac features, based on DSM-IV-TR criteria.

Pharmacogenomic testing for the main enzymes involved in drugs metabolism (fig. 1) was performed and database interrogation was used to select the safer drug combination, based on the personal genomic profile. Illness progression was evaluated by Ham-A, Ham-d, BPRS, VGF and MMPI-2 scales (fig.2).

Genomic profile (fig. 1) was compatible with reported previous toxic effects following assumption of different drugs. The personal genome-based choice of pharmacological therapies allowed to avoid surgery-related adverse effects. Through genome-guided therapy selection, rapidly we set-up an efficacious psychotropic therapy. After a year the access to the PM Service, the patient showed an important improvement in both social impairment and quality of life, allowing her to get out, without a surgical mask.

Application of pharmacogenomic screening to patients undergoing composite therapies could be an effective tool to improve clinical outcomes and minimize side effects.

Fig.1: Genomic profile

Despite the multidimensionality of suicidal behavior, to date there is no precise depiction of suicide attempters according to their features. In this study we investigate if a sample of suicide attempters can be clustered in homogeneous subgroups according to the characteristics of their suicidal behavior. Once the main clusters were identified, we have compared the main risk factors between the groups to establish clinical profiles.

Patients between 18 and 84 years old were recruited as part of a suicide attempters study (n=1009). They were consecutively hospitalized and survivors of a current suicide attempt in a specialized unit of the Montpellier University Hospital. We used an Ascending Hierarchical Classification following Ward's method to identify clusters among suicide attempters. Clusters were then compared with regards to phenotypic and genetic variables.

Three clusters were identified. Attempt planning, substance use, and few possibilities of rescue characterized the first cluster (‘reflexive’, n=40). The second cluster (‘moderate’, n=604) did not plan the attempts but used non-severe non-violent means. Finally, the third cluster (‘impulsive’, n=365) made the first attempt at an earlier age, made more attempts, and more violent attempts. Significant differences between clusters were also found regarding gender, tobacco smoking, childhood abuse, family history of suicide and several genetic polymorphisms.

Three clearly differentiated clusters of suicide attempters were identified. Phenotypic and genetic differences allow the identification of these clusters in clinical settings. Prevention programs might be improved by targeting specific subgroups of attempters.

A growing body of literature suggests that people affected by psychotic disorders are more likely to be unemployed, tend to live alone, have a poor social network, and are not able to establish long-term relationships (Morgan et al., 2008).

To investigate social disadvantage in a sample of first-episode of psychosis patients and geographically matched controls.

The study sample consists of 52 healthy controls and 37 FEP who were assessed using the MRC Sociodemographic Schedules.

Preliminary results suggest that, consistently with the literature, cases are more exposed than controls to social disadvantage. They tend to reach a lower education degree (OR 6.66; CI 95%, 1.67–26.50, p 0.005) and to have an underpaid job 5 years before the onset (OR 2.84; CI 95%, 1.08–7.45, p 0.03). Furthermore, cases are more likely to live longer with their parents rather than independently (OR 3.33; CI 95%, 1.25–8.86, p 0.01) and are more exposed to house overcrowding (OR 3.92; CI 95%, 1.03–14.93, p 0.05). It was also found that an higher percentage of cases have never been in a stable relationship in the previous 5 years (OR 2.61; CI 95%, 1.08–6.27, p 0.03).

In line with the previous literature, we found that lower educational and occupational status and poor relationship status are associated to risk for psychosis. However, in contrast with North European cases, Italian FEP are more likely to live with their family rather than alone and, therefore, to be exposed to house overcrowding.

Catatonia is a neuropsychiatric syndrome characterized mainly by motor disturbances, known to be caused by a variety of psychiatric, medical, neurological and toxic conditions.

There have been few cases reported in the literature of catatonia due to benzodiazepine withdrawal, with predominance in elderly population. Here we report the case of an elderly woman with initial symptoms of dementia and abuse of lorazepam, who showed catatonic symptoms after a sudden reduction of her habitual daily dose during hospitalization.

A 73 year old woman with a history of depression and recently onset of cognitive impairment compatible with dementia, was admitted at the psychiatry ward after the worsening of the behavioural disturbances. The patient had been a regular user of lorazepam for more than 10 years, which was maintained at the same dose. After two days she abruptly presented symptoms of inhibited catatonia. A family member reported on further enquiries a suspicion of abuse of lorazepam treatment.

After administration of intravenous Diazepam, a dramatic recovery was observed, and sustained improvement was achieved after an increment of the habitual lorazepam dose. Psychiatric and medical conditions were ruled-out during follow-up, and diagnosis of dementia of Alzheimer type was made after further assessments.

Benzodiazepine withdrawal is not an often, but still important cause of catatonia. Older patients are at special risk, as the increased probability of being hospitalized exposes them to sudden suspension or reduction of their habitual treatment. Nevertheless, aged related vulnerability to catatonia has not been well studied yet.

Paricipating in research is mandatory in the psychiatry higher training in the UK. The current view is that research should be embedded in the National Health Services (NHS) and that all trainees should have some involvement in research.

We aimed to assess the attitudes and satisfaction of trainees with the research activities in their training. We also aimed to identify the challenges they face and their views on how to improve the research experience.

We conducted an online survey of all General Adult Psychiatry (GAP) higher trainees in the Northwest of England. It was followed by Focus Groups during the regional training day involving 35 trainees. They were asked to reflect on the challenges to trainee's research and come out with solutions.

31 trainees returned the questionnaire giving a response rate of 66% of the GAP trainees. 83% of the trainees were participating in research. Half were in the preparatory stages, the rest progressed further. Of all participants 43% thought research should be part of the curriculum and 60% were satisfied with the research experience. The common challenges were time constraints, the difficulty in identifying a suitable project and lack of training in research methodology.

The provision of protected research time within the training is important. It is crucial to find innovative ways to link trainees to researchers and research centre. We advocate the adoption of a new policy with three research streams reflecting trainees desired level of involvement in research.

To reveal victims of the flood, assess the degree to which they were affected and determine risk factors

Comparative investigation of impact of various factors (such as age, sex, social-economic status and severity of stress) on the course and prognosis of Acute Stress Disorder.

Sixty two victims of the flood (28 men and 34 women) participated in the study. Stanford Acute Stress Disorder Questionnaire was used to evaluate presence and severity of Acute Stress Disorder symptoms among participants.

Vast majority (74.2%) of the flood victims were diagnosed with Acute Stress Disorder. Such factors as age (over 40 years) and (low/very low) social status were determined to negatively affect the onset and the course of Acute Stress Disorder*. In contrary, gender, education and, the most interesting, severity of stress were found out to not determine the prognosis of Acute Stress Disorder**. This may indicate that main contributing factors is rather realization of one's future difficulties in the struggle for comfortable life after the disaster, than the disaster itself. Improvement of social services work systemand implementation of property state insurance was recommended.

To develop a Support Vector Machine (SVM) algorithm as a predictive tool for diagnostic outcome in patients with FE-EOP, based on clinical and biomedical data at the emergence of the illness.

Two-year, prospective longitudinal study, where 81 patients (9-17 years of age) with a FE-EOP and stable diagnosis at follow-up and 41 age and sex-matched healthy controls (HC) were included. Structured diagnostic interviews, clinical and cognitive scales, a MRI scan and biochemical tests were conducted at baseline. Three SVM classification algorithms were developed (SSD vs HC group, non-SSD vs HC group, and SSD vs non-SSD group). Jackknifing was used to validate the algorithms and to calculate performance estimates. Enhanced-Recursive Feature Elimination was performed in order to gain information about the predictive weight for diagnosis of each variable.

The SSD-versus-non-SSD classifier achieved an overall accuracy of 83.1%, sensitivity of 86.6% and specificity of 77.8%. The variables during a FE-EOP with higher predictive value for a diagnosis of SSD were clinical variables such as negative symptoms preceding or during the psychotic onset, poor insight and duration of illness until first psychiatric contact. Biochemical, neuroimaging, and cognitive variables at baseline did not provide any additional predictive value.

SVM may serve as a predictive tool for early diagnosis of SSD during a FE-EOP. The most discriminative variables during a FE-EOP for a future diagnosis of SSD are clinical variables.

Depression is a serious illness that affects health, family and professional life of many people of all sectors of society. It also affects medical students, regardless of their geographical location. The stress of studying and the great responsibility awaiting students immediately after graduation may predispose the occurrence of depression.

To compare the level of depression among medical students from different countries.

Medical students from different parts of the world were asked to fill in an electronic form containing the Beck Depression Inventory(BDI). The form was created separately for each country, using official translation of the BDI, approved by the competent psychiatry association. The control group were students of the University of Technology. Google Drive and Statisticav10 were used for statistical analysis.

The form was filled in by 752 medical students from 7 countries: Poland-218, Taiwan-227, Germany-64, Portugal -102, Mexico- 65, Indonesia-45, Spain-31. The control group consisted of 195 students. The average score of the BDI of Polish medical students was 14.0+/- 10.0 points. The score of the BDI of the control group was: 9.5+/-8.2 points. The score of the BDI of the other countries: Taiwan-10,02+/-7,48, Germany- 7,57+/-5,92, Portugal-7,01+/-7,41, Mexico-9,85+/-8,05, Indonesia-11,33+/-8,96, Spain-7,24+/-6,92. There was statistically significant differences(p<0.05) between groups in terms of the mean score of the BDI.

Depression is a serious problem among medical students regardless the part of the world they are studying. A proper monitoring of depression is required, as well as rapid and appropriate help for those who suffer from it.

Sexual abuse of children and adolescents is a public health problem with potentially dire mental health consequences. Studies suggest that the first sexual experience of one out of three girls in sub-Saharan Africa is forced. However the relationship between sexual abuse and mental health problems among children and adolescents is grossly under-researched in Nigeria.

This study determined the association between sexual abuse and mental health problems in a sample of adolescents attending secondary school in Lagos, Nigeria.

A cross-sectional study of 230 secondary school students in Lagos, Nigeria. Participants completed a socio-demographic questionnaire, Global School-based Health Survey Questionnaire, Strength and Difficulties Questionnaire, Suicidality module of the Mini International Neuro-Psychiatric Interview and the Hospital Anxiety and Depression Scale.

The mean age of the participants was 15.9 (± 1.3) years, and 58.7% were males. A fifth (21.9%) of the respondents had experienced sexual abuse in the past year. Less than a tenth of the victims reported the abuse, and none had accessed mental health service. On regression analysis, being a victim of sexual abuse was independently predictive of depression (p=0.041), anxiety (p=0.007), peer problems (p=0.014), emotional problems (p=0.005) and suicidal ideation (p=0.014).

Exposure to sexual abuse is under-reported and un-detected among Nigerian school children, despite its association with several mental health problems. There is need for interventions targeted at facilitating the access of victimised children to timely supportive care and appropriate mental health intervention. Furthermore, efforts to protect children from sexual abuse must be intensified.

Pregnancy and postpartum are periods of increased vulnerability for psychiatric disorders, such as mood disorders, anxiety and psychotic disorders, that, when left untreated, imply serious consequences for the pregnant and the fetus. Since 1995, the Psychiatric Liaison Consultation in Bissaya Barreto Maternity (MBB) is part of the Early Intervention Unit (UIP), which consists of a multidisciplinary team that ensures a specific intervention in pregnant and postpartum women with psychiatric illness.

The authors conducted a case-control study to compare neonatal outcomes among pregnant women exposed to psychotropic drugs (antidepressants, antipsychotics, mood stabilizers and benzodiazepines), observed at the Psychiatry - Obstetric Consultation (n=100), with those of women followed at the Obstetric Consultation, without psychopathology during pregnancy, who were not exposed to psychiatric medication (n=93). The study was performed during a period of one year (October 2011 – October 2012)

The results were analyzed using the Statistical Package for the Social Sciences - SPSS (19th version).

Antidepressants and benzodiazepines were the most prescribed drugs during pregnancy. Concerning neonatal complications, there were no statistical differences between groups, in terms of gestational age at delivery, birth weight and APGAR score. Obstetrical and neonatal outcomes in the group exposed to psychiatric medication are as good as in the control group, supporting that the use of psychotropic drugs during pregnancy is safe to the mother and the baby, as long as used with caution. Early psychiatric intervention during pregnancy, in conjunction with obstetrics, is the gold standard to follow up pregnant women with mental illness.