Individuals with major mental illnesses (MMI) die significantly younger than the general population. Rates of Cardiovascular morbidity and mortality have fallen in the general population, due to effective primary prevention through the use of accurate cardiovascular risk assessment algorithms. This reduction has not occurred in individuals with MMI and there is evidence that the mortality gap is widening.

To determine the cardiometabolic risk profile and cardiovascular risk score in patients with schizophrenia compared to controls.

1,977 individuals with schizophrenia or related psychoses were compared to 215,165 controls. Cardiometabolic risk factors including cholesterol, BMI, systolic blood pressure, smoking status and diabetes were compared. Mean age and sex adjusted 10 year cardiovascular risk prediction scores were generated and compared using the Joint British Societies Score (JBS2).

Rates of diabetes, smoking and obesity were significantly higher in both men and women with schizophrenia compared to controls. In men with schizophrenia mean JBS2 score was lower than controls (10.2% vs. 10.9%). Rates of individuals at high risk of cardiovascular disease (JBS2 >20%) were lower in men with schizophrenia (28.4% vs. 39.3%). In women with schizophrenia mean JBS2 scores were higher (8.3% vs. 7.9%) and the rate of individuals at high risk of cardiovascular disease was higher than in controls (13.4% vs. 11.8%).

Despite high rates of cardiometabolic risk factors in men and women with schizophrenia across all age groups, cardiovascular risk algorithms may not adequately predict increased 10 year cardiovascular risk in men.

Psychiatrists and other Mental Health Professionals (MHP) are facing ethical problems in their daily practice. MHP usually can rely on their moral competence when dealing with ethical questions. However, in challenging situations doubts may arise concerning the ethical legitimacy of one's decisions. In Clinical Ethics Consultation (CEC), an ethics consultant aims at helping MHP to make ethically sound decisions. In psychiatry, CEC is less common than in somatic medicine. What is the additional benefit of using CEC when dealing with ethical problems in psychiatry?

A conceptual framework of CEC in Psychiatry is presented highlighting its reflective components. Two CEC cases from our service will be evaluated: A) a child psychiatric case where parental conflict split the team on prioritizing values in the care of the child; B) a geronto-psychiatric case with team dissent on the appropriate outpatient follow-up care for an alcohol-addicted patient.

In both cases, consensus was reached; moreover, underlying ethical components were articulated, e.g. A) the importance of a continuous informed consent process with the parents, B) the conflict of respecting the patient's autonomy versus the duty to prevent harm.

While the MHP experienced their difficulties, they benefited from ethics support formulating their own arguments precisely. Intuitive or emotional aspects of disagreement were transformed and entered into a target-oriented discourse on values and norms.

CEC provides the discoursive framework and – in the person of the ethics consultant – the methodological competence to strengthen ethical reflectivity to the clinical setting.

Psychotic depression is widely accepted as a specific subtype of unipolar major depression. Magnetic resonance imaging studies have begun to investigate the neurobiological changes that differentiate this subtype of major depression from non-psychotic depression. Any differences may eventually be useful in aiding diagnosis. This review collates the currently available evidence, with the aim of directing future study.

A systematic search of the Medline, PubMed & Embase databases was used to identify all articles comparing structural or functional magnetic resonance imaging (MRI) differences between psychotic and non-psychotic depression. The results were then collated and organised according to brain region.

Decreased frontal cortex grey matter volumes and, to a lesser degree, insula cortex volumes differentiate psychotic from non-psychotic depression. fMRI studies show associations between altered activity in these two regions and cognitive impairments in patients with psychotic depression.

The volumes of putative emotional processing regions including the amygdala, hippocampus and anterior cingulate show no difference between psychotic and non-psychotic depression.

Structural and functional changes in the higher associative regions of the frontal and insula cortices differentiate between psychotic and nonpsychotic depression to a greater degree than changes in putative emotional processing regions. The numbers of studies available and the sample sizes involved are both small but future studies aimed at understanding the neurobiology of psychotic depression may benefit from a more detailed assessment of these two regions.

Participation is a central requirement of ethical quality in Child Psychiatry. Target criteria are obtaining and maintaining parental informed consent (PIC) and child assent (CA) to hospital admission and treatment. Clinical practice of PIC and CA displays considerable variability and deficits. We report how an innovative implementation strategy through Clinical Ethics Support (CES) impacted on practice.

Approach: explorative, comparative analysis of 10 cases in a Child Psychiatric ward pre and post ‘implementation of ethical target criteria’ in inpatient routine.

Material: patient charts with documented admission, case conference and dismissal.

Research question: evaluating documented changes after the implementation.

CES strategy: a) screening for ethical problems in daily rounds; b) informing case conferences; c) ‘ethics consultations on demand’; d) education; e) ethics policy regarding isolation.

5 pre- and 5 post-implementation cases were analysed (retro-/prospectively) with pairs of cases matched for complexity, severity and patient age.

Analysis shows that daily practice changed after implementation: 1. heterogeneity in PIC and CA reduced; 2. overall quality of documentation raised with voids about ethical aspects of PIC and CA filled; 3. standardized documentation of PIC and CA realized.

The approach is innovative and addresses a research of PIC and CA; results are clinically relevant, let alone their contribution to make the patients’ and their parents’ wishes better heard. Explicit documentation of the target criteria PIC and CA gives clear, fast and consistent information on the ethical status and eventual needs for further intervention, valuable for inpatient care as well as follow-up.

Despite important progress, the results of pharmacological treatment of schizophrenia are frequently unsatisfactory. Therefore some patients use natural medicines although it is unclear whether natural medicines are effective and safe. We assessed the evidence for natural medicines with and without antipsychotics in treating symptoms or reducing side effects of antipsychotics in schizophrenia.

A systematic review until April 2013. Only RCTs with a Jadad score of 3 or higher, were included.

105 RCTs were identified. Evidence was found for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6 for improving symptoms of schizophrenia when added to antipsychotics. Inconclusive or no evidence was found for omega-3, Dserine, D-alanine, D-cycloserine, B vitamins, vitamin C, dehydroepiandrosteron (DHEA), pregnenolone (PREG), inositol, gamma-hydroxybutyrate (GHB) and des-tyr-gamma-endorphin when added to antipsychotics. Omega-3 without antipsychotics might be beneficial in the prevention of schizophrenia. Only ayurvedic herbs (in one study), no other agents, seemed effective without antipsychotics. Ginkgo and vitamin B6 seemed to be effective in reducing side effects of antipsychotics. All natural agents produced only mild or no side-effects.

High quality research on natural medicines for schizophrenia is scarce. However, there is emerging evidence for improved outcome for glycine, sarcosine, NAC, some Chinese and ayurvedic herbs, ginkgo biloba, estradiol and vitamin B6, all with only mild or no side effects. Most study samples are small, the study periods are generally short, the studies only cover a modest part of the world's population and most results need replication.

60% of older people admitted to general hospital will have or develop a mental disorder (Department of Health, 2001). Mental disorder in this population is an independent predictor of poor outcome and is associated with increased mortality, greater length of stay, loss of independent function and higher rates of institutionalisation (The Royal College of Psychiatrists, 2005).

To examine if the liaison psychiatric intervention has improved the outcome for the patients and to introduce measures to improve quality, safety and efficiency within the service practice in the future

A total of 128 patients were referred to the geriatric liaison psychiatry service in a 6 months period between from an acute general hospital .50 patients were randomly selected from these referrals. Data's were collected from both the case notes as well as clinical information system using an audit data collection tool.

Majority (62%) were seen within 24 hours and 82% were seen within 48 hours. The main diagnosis was depression closely followed by dementia. Only a small minority (8%) of the patient needed inpatient psychiatric admission. 50% of the patients were discharged within a week of the Liaison assessment and majority of the cases (70%) patients were able to go back home.

Identification of mental illness in the acute hospital settings remains low. In spite of dementia being extremely common diagnosis, very few did appear to have been referred to the specialist memory service. Liaison Psychiatry intervention possibly improved outcomes for patients and the services.

The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes.

To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal.

Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA.

675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = −.26; p = .05) and heart rate (r = .33; p = .01).

Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.

Identifying schizophrenia vulnerability factors requires testing specific hypotheses concerning etiopathogenic models, candidate genes, and environmental factors involved. We hypothesized that patients developing schizophrenia after using regularly cannabis represent an homogenous phenotypic entity which could result from a specific interaction between genetic polymorphisms (SNPs) of CNR1, CNR2 and COMT genes and cannabis use (an environmental factor intervening lately in the neurodevelopment).

The main objective was to confirm that patients using cannabis before the onset of schizophrenia had fewer markers of early-neurodevelopmental impairment. The secondary objective was to identify a gene environment interaction in this subset of patients.

Patients were prospectively included and underwent a standardized interview and an evaluation of cognitive functions and neurological soft signs. Blood and saliva samples were collected. For the case-case genetic study, those patients were pooled with patients included in a cannabisdependent schizophrenic-patients cohort. Eight CNR1, CNR2 and COMT SNPs were analyzed.

We included 61 patients in the clinical part. Regular cannabis users before the onset of the disorder had fewer neurological soft signs, less cognitive impairment and a different clinical symptomatology. For the genetic part 26 patients were added to the 57 patients from the clinical part (4 non Caucasian patients excluded). Results were in favor of a gene environment interaction for rs1049353 of CNR1.

We found that regular cannabis users before the onset of schizophrenia had less neurodevelopmental impairment. In this subset of patients, cannabis could play a causal role in a gene environment interaction leading to schizophrenia.

Administration of psychoactive drugs increases dopaminergic receptor stimulation, improves mood and stimulates motor activity. Structural and functional changes can be observed in particular structures of the central nervous system (CNS).

This study aims to assess the saccadic refixation parameters in opioid addicted subjects treated with methadone compared to control group.

Eighty-six patients from the substitution program were examined. The study included 36 subject of the control group. The trial was conducted twice: before and about 1.5 hours after the administration of therapeutic dose of methadone. Performed Latency Test(LT) with Saccadometr diagnostic system.

The statistical analysis showed that the mean duration before and after the administration of methadone was a statistically significant increases (p=0,0001) in the subjects from substitution program compared of the control group but after administration of methadone the value greatly increased in experimental group (before 52ms, after 56ms). It was observed that the mean amplitude after the administration of methadone increased statistically significantly in experimental group compared of the control group (p=0,02). Mean peak velocity of latency after the administration of a therapeutic dose of methadone was statistically significant decreased in experimental group compared of the control group (p=0,0004).

The results indicate a change in the dynamics of saccade after methadone administration. The observed changes in values for eye movements may be due to the inhibitory effect of methadone on CNS.

Schizophrenia evolution have negative effects on social functioning, with substance abuse, low coping capacity and social-economic losses for patients and their families. Identifying and assessing the impact of social factors can create the preconditions to improve the evolution of the disease.

Determining the correlation between social functions and quality of life in schizophrenic outpatients.

Study on 81 patients diagnosed with schizophrenia and hospitalized in Craiova Mental Health Center (July 1st, 2007–June 30th, 2012) using Personal and Social Performance Scale and WHOQOL–BREF.

Social-demographic data revealed the dominance of female (59.26%), average age 45.36±8.50 years, urban residence (85.18%), average educational level (49.38%), and unemployment (92.59%). There is a high incidence of paranoid schizophrenia (74.09%) with insidious onset (67.90%) between 20-29 years (50.62%) and aggressive behavior (69.14%), with 2 admissions in the last 5 years (60.50%), and poor level of social functioning (95.06%). Moderate-severe social and personal inabilities were significantly correlated with the aggressive behavior, the poor social adjustment, stationary or worsened evolution and unemployment. The assessment of the quality of life was influenced by several clinical and social-demographic variables: the number of readmissions, the patient's condition upon discharge, the patient's gender, educational level and level of social adjustment.

These correlations demonstrating the influence that social stress elements have on the schizophrenic outpatient's quality of life representing the genuine risk factors for unfavorable evolution.

The urgent children and adolescent psychiatric consultations have increased recently[1] and may be the first contact with the mental health network[2].

To describe and analyze the population<18 years old admitted at the psychiatry emergency department(ED) of Hospital Clínic of Barcelona between june/12-may/13.

Demographic and clinical data were collected, using SPSSv.19.0 for statistical analysis.

596 emergency visits from out of 420 patients were recorded[46.3% male, mean age 14.52(6-17)years]. The most frequent consultation reason was behavior disorder(54.4%), being the most common diagnosis externalizing disorder(51.2%). 44.8% had been previously attended an average of 3(1-17)times in our ED. 85.6% were already under psychiatric follow-up and 67.8% had been psychopharmacologically treated. Prior psychiatric hospitalizations occurred in 35.1%[average 1-3times]. 27.4% required acute hospitalization at the ED discharge.

Most of consultations were between 12:00–13:00PM and 18:00–20:00PM, maximal activity was detected on Monday(17.6%) and minimal on Sunday(9.1%). Holiday periods coincided with a consultation decrease while April-May-June period accumulated a third of them. The stay time average in ED was 6.41 hours(15min-3days) and a 32.6% required pharmacological treatment.

Since 2009 a reduction of 14.16% of the total psychiatric emergencies has been detected in our ED, but children and adolescents consultations have increased an 18%.Data obtained of the most common diagnosis and circadian and weekly distribution of visits are consistent with previous studies[1]. Greater prevalence of behavioral disorder was found in frequenters (3emergent consultations/year), which calls for further studies to optimize the approach to this problem.

The vulnerability-stress model assumes that psychotic symptoms emerge from the interaction between stress, basic symptoms and information processing deficits. Despite the large amount of data on first episode psychosis, this particular topic has been investigated to a minor extent in patients readmitted to acute psychiatric wards.

To assess the association between basic symptoms and subjective stress, life events, and executive functions.

To identify the factors associated to basic symptoms during relapses.

Patients affected by schizophrenia, schizoaffective and bipolar disorder according to DSM-IV TR were recruited from the acute psychiatric wards of two University Hospitals in Rome. They were evaluated through: a) Frankfurt Complaint Questionnaire (FCQ); b) Stress-related Vulnerability Scale (SVS); c) Paykel Interview for Recent Life Events (IRLE); d) Wisconsin Card Sorting Test (WCST).

Forty-nine patients were enrolled (65% women; mean age 42.7 ± 10.5 years; education 12.4 ± 3.2 years; disease duration 17.6 ± 11.4; 63% affected by bipolar disorder). Basic symptoms were positively associated to SVS total score (rho = 0.66, p < 0.01), IRLE marital subscale (rho = 0.3, p < 0.05), while negatively associated to WCST number of completed categories (rho = −0.32, p < 0.05).

Preliminary results of this study show that basic symptoms are positively associated to perceived stress and marital life events, while negatively associated to executive functions, during psychotic relapses.

Adults with Attention-deficit hyperactivity disorder (ADHD) often suffer from serious education, occupational and interpersonal impairments that can induce stress in these patients. The aim of the present study is to evaluate stress responses in adults with ADHD using the Trier Social Stress Test (TSST).

Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample included adults with ADHD, naïve to medication, fulfilling current DSM-IV criteria. Psychiatric and organic comorbid disorders were excluded. Maximum cortisol increase and’Area Under the Curve’ with respect to the ground (AUCG), were calculated. Subjective stress was also studied using the Perceived Stress Scale (PSS).

The sample of ADHD patients included 28 men and 22 women. Maximum cortisol increase compared to baseline was statistically significant in the group of men (t=2,62; p= 0,014) but not in the group of women (t= 0,965; p=0.347). TSST-AUCG was 43,78±22,29 nmols/l for men and 36,50±30,99 nmols/l for women. T-test comparisons revealed no significant differences between men and women in TSST-AUCG (t=,948; p= 0,348) or in the PSS (t=,454; p=0,652).

Compared to women, men with ADHD showed a higher peak of cortisol after stress induction. Nevertheless, no differences were found in the whole cortisol response (AUCG). There were no differences between men and women with ADHD in the subjective stress measures. The influence of ADHD subtype (Inatentive vs. Combine) on stress responses cannot be excluded.

The ROAMER project, funded by the European Commission, has been designed to develop a comprehensive, consensus-based roadmap to promote research on mental health in Europe. It has been repeatedly affirmed that the different people involved in the mental health field hold different views about the desirability of clinical outcomes and the general principle is that research agenda should reflect the needs and values of the people who use health services.

To involve different stakeholders in the development of the agenda for mental health research.

To identify priorities in mental health research in Europe for the next ten years.

An online survey was conducted with national associations/organizations of psychiatrists, other mental health professionals, users and/or carers, and psychiatric trainees in the 27countries of the European Union.

One hundred and eight associations/organizations out of the 154 contacted returned the questionnaire(response rate:70%). According to all categories of stakeholders, the five most frequently selected research priorities were early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and new medications for mental disorders. The top five research areas in terms of importance were quality of mental health services, suicide prevention, early detection and management of mental disorders, rehabilitation and social inclusion, prevention of mental disorders. The least developed research areas in each country were molecular bases of mental disorders, environmental risk/protective factors for mental disorders, resilience and mental health, prevention of mental disorders, health and well-being of carers.

These results show that some rebalancing in favour of psychosocial and health service research is needed.