The etiology of acute and persistent pain is complex, multifactorial and poorly understood. In addition to known factors such as obesity, stress, and inflammation, vitamin D is a potentially important variable.

To examine how vitamin D is linked with pain in a genetically informative sample.

Generalized Estimating Equations were used to estimate the contribution of vitamin D levels to clinical and evoked pain. Within-pair zygosity-stratified correlations were examined to explore the heritability of vitamin D level.

96 female twin pairs (76% monozygotic), some pain-free and some selected for persistent pain, were recruited from a large community-based twin registry. Twins individually provided clinical pain ratings using a validated visual analog scale of the degree of pain experienced over the past 30 days, and evoked pressure pain ratings at threshold using dolorimetry. Serum 25-hydroxyvitamin-D levels (25(OH)D) were assayed in all.

Higher 25(OH)D (>50 ng/mL) was associated with higher clinical pain ratings (B=−.481, p=.02) and higher evoked pressure pain ratings at threshold (B=−.458, p=.05) controlling for age and body mass index. Within-pair correlations suggested low heritability of 25(OH)D.

Vitamin D insufficiency or deficiency was unassociated with pain in this sample, whereas vitamin D sufficiency was associated with greater clinical pain and higher evoked pain ratings, indicating greater pain sensitivity. Given the low heritability of 25(OH)D, these associations are unlikely to be confounded by shared genetics. Differences in vitamin supplementation or outdoor activity and sun exposure between twins with and without pain conditions might partially explain these findings.

Portugal is a country with severe economic difficulties for the last 2 years. Considering the volatile and vulnerable economic social system today, in Portugal, the number of jobs decreased, unemployment increased and, as a consequence, mental illnesses as well. Because of it, and, the request for quicker treatments of mental health by the population are increasing significantly.

Our objective is to evidence in Portugal one of the very first IPT researches as an advisable treatment of acute major depressive disorder, mainly in the current economic scenario, contributing to evidence an effective way to combat mental illness in Portugal.

The ongoing longitudinal study consist of adult outpatients (n=50), diagnosed with acute major depressive episode. The intensity of depression was measured is sessions 1, 6 and 10, with the Center for Epidemiological Studies Depression Rating Scale (CES-D). The procedure is focused in one of four IPT problem areas (role transitions, disputes, grief and loss, and difficulties initiating or sustaining relationships).

The first results show significant trend to identify the Disputes as the main problem-area. The intensity of the depression is significant lower along sessions with same patients. In 8th session, there is a significant decrease of the depressive symptomatology and the patient is more functional and adapted.

Our research evidences the vulnerability to social context amidst the Portuguese economic crisis to depression, as well it evidences the effectiveness of IPT as a brief psychotherapy that responds to the current needs of a population with growing economic difficulties.

To investigate the effect of risperidone and (or) Xiao Huan Tang on activity and preferences behavior of glutamate dysfunction mice model.

70 kunming mice were randomly divided into 5 groups, one group as blank group. Rest groups intraperitoneal injection MK- 801(0.072mg/ml, 5ml/kg/day) continuously 14 day, then randomly numbered: model group, risperidone group, Xiao Huan Tang group and risperidone combined Xiao Huan Tang group. Gavaged corresponding drugs for each group one month, at the same time observe high activities and changes in the preferences of five groups.

Compared with the blank group, activity of model groups was increased (36.8±16.2 vs blank group 11.3±14.5, P<0.05). After gavaged one month, model groups of high activity was decreased, especially risperidone combined Xiao Huan Tang group. There was no statistical meaning in inquiry activity of five groups (P > 0.05). Compared with model group, latent period of step-through test was prolonged 34.1s (P<0.05), of step-down test was prolonged 20.2s in risperidone combined Xiao Huan Tang group.

the combination of Xiao Huan Tang and risperidone can suppress the high activity, prolong harmed memory time, and protect preference behavior of schizophrenia mice.

IDEA project is the outcome of Association for the Improvement of Mental Health programme and coordinated at Institute of Psychiatry, King's College London.

Are to explore experience of people treated in a mental health setting across nations, determine how inpatient experiences can be improved. Experience gained from interviews will be used to propose questionnaire for routine use, develop versions of interview for other services, inform a possible follow-up study.

30 consecutive patients are interviewed on day of discharge in own language. Semi-structured interview covers physical condition in institutions, experiences of treatments like medication, satisfaction with staff, privacy, dignity and whether rights were respected. Responses are summarized on several visual analogue scales and quantitative analysis were performed. The scale was also be analysed by demographic indices within centres to see whether different groups have different experiences.

Qualitative responses were analysed thematically, both within and between centres, identifying core themes for each domain and core themes for the protocol as a whole.

10 countries are participating, 577 interviews are completed. We followed on visual analogue scale the degree patients felt their stay was beneficial, degree of satisfaction with staff, perceived harm in the hospital, if the right to confidentiality was respected, if individual rights and preferences were respected.

It will be a better understanding of the size, structure and staffing of the institutions included in the study, which will help us with our observations about inpatient experiences by putting them in context and make recommendations to institutions.

Auditory hallucinations are core symptoms of the schizophrenic psychosis, but in some subjects thought process is associated to voice hearing, without the presence of other psychotic-like symptoms. These individuals have the perception of their-own thought as an inner voice.

In the last years, research has provided evidences about neurophysiological correlates of hallucinations, which include alterations in Mismatch negativity, just after the N100, and in P300 (especially the P3a component). However, no study explored subjects with sound thinking.

This paper reports a single-case neurophysiological study performed with a 29 year-old woman, reporting sound thinking and past drug abuse, who came to clinical attention for an anxiety disorder.

Patient's EEG data were compared with EEG data of two control subjects. Electrophysiological data were collected by means of an high-density EEG (Geodesic NetStation), during an active stimulation by Oddball and Go-NoGo Paradigm. EEG data were processed through the EEGLab package for Matlab. An Independent Component Analysis was performed followed by Clusters analysis.

One of the 5 Clusters extracted aggregated two ICs, produced in the scalp central areas, present both in control subjects and in the sound thinking subject: in the last one, the Intertrial Coherence, expecially at Theta frequency band, was much less evident and the P300 appears to be less wide relative to healthy controls.

These results are in line with those found in patients with hallucinations, suggesting the presence of a reduced ability to reorganize the cortical activity in response to external stimuli.

Despite suggestions that chronic stress is involved in the pathogeny of dementias, no systematic studies investigated the possibility of a link between dissociative amnesia and neurodegenerative dementias.

We analyzed data from over a dozen patients with functional dissociative amnesia, whom we investigated with neuropsychological methods, structural and functional neuroimaging. We followed prospectively approximately half of these patients for more than a decade.

We evidenced in a substantial sample of patients with dissociative amnesia with preponderant retrograde memory impairments a hypometabolism during resting state in the right temporo-frontal region, with a decrease in the infero-lateral prefrontal cortex. Additional preliminary data from DTI suggested a decreased integrity of long distance fiber tracts important for conscious mnemonic processing. We found a chronic course of the memory impairments in a substantial number of patients with dissociative amnesic conditions. In some chronic cases of dissociative amnesia we noted a fairly stable course, while in other cases we observed a progressive global cognitive deterioration.

These findings point to a non-homogenous course of dissociative amnesia.

The search for a link between dissociative amnesic conditions and dementia should take into consideration multiple variables, such as the age at the onset of trauma, gender, the recurrence, type and severity of trauma, the presence of psychiatric and medical co-morbidity, pre-morbid personality characteristics (e.g. neuroticism), genetic polymorphisms, educational and occupational attainment, cognitive reserve and the progression of metabolic and microstructural brain changes.

Opioid addiction is a serious mental health problem with substantial impact on society and healthcare. The diagnosis and monitoring of its treatment are almost exclusively clinical tasks and their efficacy is often unsatisfactory. This suggests a need to study potential biomarkers of opiod addiction. In this study, we used functional magnetic resonance imaging (fMRI) and our modification of the Stroop-task to investigate patients’ reactivity to emotionally relevant (drug-related) stimuli and its impact on their cognitive performance as a potential biomarker for opiod dependence syndrome.

40 patients with opioid addiction aged 25.9±2.6 years with mean narcotization period of 9±3.4 years were included. The control group consisted of 25 age- and gender-matched healthy subjects. fMRI was performed on 1.5T scanner Toshiba Vantage Titan. The original Strooptask was modified to investigate the effect of emotionally relevant distractor on the task performance by changing the background of the stimuli: emotionally neutral (furniture and everyday objects) and relevant (pictures of drugs, and drug paraphernalia). Group comparison of the activation maps was performed using two-sample T-test.

In comparison to the control group, patients with opioid addiction showed worse task performance, accompanied by the increased response of the left insula, dorsolateral prefrontal cortex, right amygdala and hippocampus.

We found that emotionally relevant stimuli worsen Stroop-task performance in drug addicts, which is accompanied by the increased activation of structures involved in emotional reactivity and cognitive control. The applicability of this combined imaging-neuropsychological task in practice is the matter of our future research.

Atypical antipsychotics and some other psychotropic drugs such as valproate, lithium or mirtazapine are known to induce several metabolic complications. However there is an inter-individual variability in developing metabolic features which may be explained by clinical and genetic factors.

To determine whether weight gain and/or appetite change after one month are predictors for a weight gain after 3 and 12 months of treatment.

A longitudinal clinical and pharmacogenetic study is presently ongoing in the Department of Psychiatry-CHUV. Several clinical data have been recorded over one year following the introduction of psychotropic treatment. 406 patients with weight at baseline, after one month and with at least a third weight measure during the first year of treatment were included in the present study.

Using Receiver Operating Characteristic (ROC) analyses, an initial weight increase of 5% was found to be a good predictor for a consequent weight gain at 3 months (ROCAUC=77) and one year (ROCAUC=68). By using a generalized linear mixed model corrected by several confounders, this weight change of 5% was found to be significantly associated (p-value<0.0001) with an important weight change (10 to 20% increase from baseline value) over one year. Appetite was not found to be good a predictor of weight gain over one year.

An initial weight gain of 5% during the first month following an introduction of atypical antipsychotics, lithium, valproate and/or mirtazapine is a predictor for further weight gain and should be a warning sign to introduce weight lowering strategies.

Weight gain and obesity are serious problems associated with psychiatric diseases, in which psychotropic treatments play an important role. The CREB-regulated transcription coactivator 3 (CRTC3) gene was linked to energy balance in animal models, and in humans CRTC3 rs8033595 polymorphism was associated with obesity markers only in Mexican-Americans, a population with a high prevalence of obesity.

To determine whether polymorphisms within the CRTC3 gene are associated with adiposity markers in Caucasian psychiatric patients, a population with also a high prevalence of obesity.

The association of the CRTC3 rs8033595 and 2 other selected CRTC3 polymorphisms (rs3743401 and rs3902286) was investigated in three independent groups of Caucasian psychiatric patients taking weight gain-inducing psychotropic drugs such as atypical antipsychotics, lithium and valproate (n1=168, n2=188, and n3=448). Body mass index (BMI) was chosen as a marker for obesity. Generalized Additive Mixed Model (GAMM) was used to test the association of CRTC3 polymorphisms with BMI.

Obesity prevalence was high in the three psychiatric populations (n1:40%, n2:28% and n3:19%). The three CRTC3 polymorphisms did not deviate from Hardy-Weinberg equilibrium and the minor allelic frequency (MAF) was 44%, 25% and 19% for CRTC3 rs8033595, rs3743401 and rs3902286, respectively. None of the CRTC3 polymorphisms were found to be associated with BMI in any of the three psychiatric samples and when analyzing the combined samples together.

CRTC3 polymorphisms seem not to have an influence on adiposity markers (BMI) in Caucasian psychiatric patients receiving drugs inducing weight gain.

Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease. Although it is commonly accepted that abstinence influences long-term survival, no studies have specifically investigated the impact and predicting factors of prolonged abstinence after an episode of AH. Here, we aimed at investigated which are the clinical, psicosocial, alcoologic parameters associated with long-term abstinence and its impact on survival.

A series of 102 patients with biopsy-proven AH seen at the Hospital Clinic of Barcelona from 2000 to 2007 were included in the study. Patients were hospitalized and received standard medical care. We describe the independent association between amount of alcohol consumed and long-term abstinence. We evaluated the effect of short term and long-term abstinence on survival.

67.4% were male, and median age was 50 years. 50.5% of the study cohort remained abstinent during the follow up period, while 49.5% of the patients admitted alcohol use at some degree during follow up. A higher score on the High-Risk Alcoholism Relapse Scale increased risk of active drinking at follow-up. When stratified by amount of alcohol consumed after admission of acute alcoholic hepatitis, those with moderate survival had median survival time of 38.2 months compared to 26.4 months in patients with severe consumption.

Early alcohol consumption after an episode of AH negatively impacts survival. The High risk Alcoholism Relapse Scale is a good predictor of long-term abstinence. Short-terms interventions in patients with AH are strongly recommended in this patient population.

Some 25%–30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. transcranial directcurrent stimulation (tDCS) is a novel somatic treatment proposed for hallucinations and negative symptoms (Brunelin et al. 2012).

We aimed to assess the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms in patients with schizophrenia.

Six patients (aged 41–66 year) with schizophrenia and medication-refractory auditory verbal hallucinations were enrolled. Positive and Negative Syndrome Scale (PANSS) and Cardiff Anomalous Perceptions Scale (CAPS) were administered as outcome measure, before (T0) and after tDCS (T1), to assess treatment response. tDCS delivered by a HDCstim (Newronika, Milano, Italy) (2mA, twenty minutes, twice a day for 5 consecutive days) with the anodal electrode over the left dorsolateral prefrontal cortex and cathodal electrode on the left temporo parietal cortex.

The patients tolerated well the procedure and there was no side effect. After tDCS auditory verbal hallucinations improved by 33% in frequency (T0 vs T1 p=0.03) and by 40% in distress (T0 vs T1 p=0.02), for up to one month. Negative symptoms as measured by the PANSS also decreased by 24% (T0 vs T1, p=0.02).

The results of this small, open tDCS trial prompt the further studies with controlled, double blind design in a larger sample size of schizophrenic patients. Nonetheless, our findings are in line with available data reporting a beneficial effects of tDCS in schizophrenia (Brunelin et al. 2012).

Studies demonstrate higher rates of cardiovascular death among psychiatric patients. Psychotropic medication can prolong the QT interval, increasing the risk of potentially fatal torsade de pointes. Guidelines recommend monitoring QT intervals for patients on psychotropic medication. The QT interval needs to be corrected for heart rate using a correction formula. The most commonly used is Bazett's. However, it becomes less accurate at lower and higher heart rates. Different formulae should be used in such cases. We noted that different formulae gave different QTc intervals for the same ECG posing a clinical management dilemma.

To evaluate different QTc correction formulae.

To find out if using different QTc correction formulae produces consistently different intervals, according to the formula, for a cohort of patients’ ECGs.

We reviewed 36 ECGs from a cross section of forensic female patients on psychotropic medication.

For each ECG we recorded the ECG calculated QTc and heart rate.

We manually calculated the QTc using Bazett, Fridericia, Hodges and Framingham formulas.

Different formulae produced consistently variable QTc intervals. The discrepancy was greatest at lower and higher heart rates. Many patients had high heart rates making the discrepancy pertinent to our patient cohort.

Psychotropic medication is adjusted according to QTc thresholds which are stipulated in guidelines. At present guidelines do not recommend which QT correction formula to use. Different formulae give different QTc intervals. Our results demonstrate the need for a consensus to be reached and included in guidelines to ensure consistent and safe practice.