A significant proportion of elderly patients admitted to the medical wards have psychiatric comorbidities, such as delirium, depression or dementia. Frequently they develop cognitive changes during the hospitalization which constitute an important motive of referral to psychiatric services. The MMSE is considered a useful way to document cognitive impairments.

The aim of this study is to evaluate the capacity of MMSE to detect cognitive changes in elderly subjects referenced for liaison psychiatry service.

Observational study developed between October of 2011 and July of 2013. Included subjects with 65 years and older hospitalized in Internal Medicine service referenced for old age liaison service. Each patient was analyzed according to: social demographic characteristics, medical and psychiatric comorbidities and clinical severity. MMSE was applied to all patients.

Of all 143 patients observed about 30% were referenced because of cognitive changes. Of the total, 46% didn’t collaborate in MMSE. These patients were diagnosed with delirium (52%), delirium superimposed with dementia (17%), depression (12%), adjustment disorder (6%), dementia (3%), psychosis (3%) and others (7%). The main reasons of uncooperativeness, with exception of disturb of conscience and/or attention deficits were: visual difficulties (50%), motor difficulties, physical restraints, distracting environment, duration and extension of the exam and anxiety and/or depressive symptoms.

The cognitive assessment of elderly subjects with MMSE in medical settings is compromised by many aspects, including the inherent characteristics of the clinical environment. A more useful, practical and applicable test is needed to evaluate this specific population.

The Future Excellence International Medical Summer School (FEIMSS) is a 5-day event for medical students held yearly in Manchester, UK. FEIMSS is the largest event of its kind in the world; the 2013 cohort was comprised of 244 students from 40 countries representing 80 universities.

To improve the image of psychiatry with 2 short lectures from a consultant and a trainee psychiatrist.

Feedback forms were distributed to delegates who attended the psychiatry talks. Answers to questions relevant to the talks were on a Likert-type scale. The sample was comprised of participants representing 11 countries from Japan to Kosovo.

25/25 (100%) of the participants responded. The feedback was exceptionally positive. For the,’Did you find the psychiatry talks interesting?’ and,’Does attending FEIMMS improve your understanding and respect for other cultures?’ questions, 23/25 (92%) respondents answered that they agree or strongly agree.

Free-text comments were also positive:

’Overall excellent and made me more inclined to psychiatry than I was before and proved to me that psychiatrists are not the boring stereotype!’

Medical student, Czech Republic

Notwithstanding the limitations of our study (which to our knowledge is the first of its kind on such an ethnically eclectic sample) our results demonstrate that a brief intervention can have positive effects on the perceptions of psychiatry of medical students from diverse cultural backgrounds.

We contend FEIMSS provides a platform to recruit medical students into psychiatry from all over the world and enables them to develop cultural competency.

The NHS introduced Payment by Results (PbR) as a means of classifying mixed cases treated within a hospital. A specific tariff is applied to each healthcare resource group (the unit of currency used). Payment follows the level of activity, according to the tariff. Care Clusters are a currency developed to support PbR for Mental Health Services. There are 21 clusters based upon patient's characteristics. Care Clusters are assigned using a decision tree of algorithm, based on the Person Score from the Mental Health Clustering Tool (MHCT), undertaken by a care professional involved in the patient's care.

A random sample of 30 patients was audited. Patients were allocated care clusters by care professionals at initial assessment. The same patients were re-clustered by Doctor A(Middle Grade) and Doctor B(Consultant Grade). The audit tool was the MHCT.

100% of sample was allocated a care cluster at initial assessment. 70% of cases indicated differences in the care clusters initially allocated. There was a trend towards the Doctor A (middle grade) clustering higher than the care professional. Doctor B (consultant) had a tendency to cluster higher than Doctor B and the care professional.

Clustering relies on subjective views of individuals conducting assessments. The more senior the professional, the higher the care cluster. This raises questions about individual assessment of risk/symptomatology and training provided in using MHCT. This could lead to serious consequences financially.

Retrain all staff in use of MHCT, consider clustering in MDT settings and recluster cases to ensure accuracy.

Still unknown and in many aspects controversial the etiology and subsequent psychopathology of depression appears to result from a complex interaction between psychosocial and biological factors.

The aim is to conduct a review of the literature on the neurobiological mechanisms and its relation to the psychopathologic manifestations of depressive disorder.

A literature search was carried out, selecting articles published between 2000 and 2013.

From a biological point of view, the first conceptual hypothesis considered the decrease of brain monoaminergic neurotransmitters as responsible for the occurrence of depressive symptoms. However, subsequent investigation led to models that suggest the existence of more complex neuroregulatory mechanisms. Neuroendocrine systems, specific molecular processes and different brain structures and neural circuits were implicated in mood regulation and stress response. Furthermore, a correlation between the distinct cerebral regions affected and specific depressive symptoms was found.

The current theories attempt to integrate the various etiologic aspects of depression. Although there are still no definitive conclusions, recent research has emphasized the importance of the association between genetic vulnerability, neurodevelopmental factors, environmental events and epigenetic modifications, that lead to neurochemical, neuroendocrine, neurostructural and neurofunctional changes in several brain areas, which in turn are reflected in the psychopathology of depressive disorders.

To investigate the effect of Qing huan ling containing serum on proliferation and morphology of human neuroblastoma SH-SY5Y cells.

7 consecutive days gavaged Qing huan ling or Risperidone to rabbit for preparation of Qing huan ling, or risperidone drug-containing rabbit serum. The morphology of SH-SY5Y cells was observed by inverted microscope after 48 hours drug-containing serum treated, and every 24h proliferation of SH-SY5Y cell was tested by the MTT assay.

Qing huan ling containing serum treated 48h SH-SY5Y cell, were close contact between the cells, have pseudopodia, and promote proliferation. Qing huan ling containing serum compared with the blank serum on proliferation of SH-SY5Y cells not statistically significant (P> 0.05), but risperidone containing serum can be a significant increase in the number of SH-SY5Y cells, showing the logarithmic growth trend (P <0.05).

Qing huan ling containing serum can promote on the normal form of the SH-SY5Y cells, on normal proliferation of SH-SY5Y cells without significant intervention, different from the risperidone role.

164 patients with epilepsy and comorbid psychiatric disorders, aged 18-55 years observed recurrently during a period of 5-9 years. Cognitive disorders were diagnosed in 28% of patients, psychoses – 0.7%, depressive disorders – 3%, personality disorders – 68%. Etiologically epilepsy was symptomatic, associated with brain damage (n=91) and neuroinfections (n=73). Remission for ≥ 2 year period was set in 62% cases.

The survey conducted on EEG’Mizar’ 16 channels. We investigated the alpha-rhythm mean and peak frequency (normal value ≥9.15 Hz both), index of slow-wave activity (<29%), spatial organization of beta- and alpha-activity. Scientifically proved that appearance of anyone abovementioned QEEG characteristic means actuality of brain damage and the reduction is a sign of brain state rehabilitation.

QEEG revealed patterns of organic brain damage in 88% of cases. When remission achieved QEEG patterns exposition decreased from 88% to 9%.

The data obtained fits the hypothesis that activity of epilepsy and comorbid psychiatric disorders defined by mean of Quantitative EEG. These characteristics of the brain's functional state very sensible. Neurologists and psychiatrists have possibility to take into account this information while prescribing or depriving anticonvulsants.

Deficient emotional self-regulation (DESR) have been found to be a very heritable trait that increases susceptibility for later psychopathology, including severe mood problems and aggressive behaviour. A common single nucleotide polymorphism (SNP G-703T, rs 4570625) in the transcriptional control region of TPH2 has been reported to modulate amygdala responsiveness to affective stimuli and has been found to be associated with emotional dysregulation.

we have investigated the moderating role of a TPH2 polymorphism on genesis and stability/instability of DESR during the transition from early to late adolescence, taking also into account the possible interaction with family structure.

This is a five year follow-up study of the genetic section of the PrISMA project (Progetto Italiano Salute Mentale Adolescenti) The final study population included 287 subjects (50.9% boys, 49.1% girls, aged 15-19). To test for hypothesized influences and moderation effect of TPH2 genotype we performed a path analysis using Mplus 6.11 and the bootstrapping procedure describe by Preacher et al. (2007)

The effect of family structure on early-adolescence DESR is moderated by TPH2 genotype: subjects living in monoparental families which are also homozygous for G-allele show higher scores on DESR index. Otherwise, the effect of family structure on late-adolescence DESR is mediated by the same symptoms in early-adolescence and this mediation is moderated by TPH2 G-703T polymorphism

Future models of the developmental link between environmental adversities and dysregulation problems therefore need to consider that a more ‘dynamic’ G×E perspective.

Fantasies, despite their constant presence in the human being, are a phenomenon which has a scarce interest in academic psychology (Kinsey y cols, 1948; 1953). Unlike sexual fantasies, where there are systematized studies from the 1940s, in relation to latent aggressiveness there is an important vacuum.

This study will try to throw evidences about the relation between different types of personality and the level of sadism and/or latent aggressiveness that prevails in each one of them, as well as the modus operandi that can be attributed to them. It also aims at check the evolution of the latent aggressiveness in relation to age.

Have been applied in the evaluation of the sadistic fantasies and aggressiveness the test MCMI (Millon, 1983), the test MACI and the Questionnaire of Sadism and Criminality (CSyC, 2013) which allows to predict certain criminal behaviors as well as know their modus operandi if they are carried out. The sample was formed by a group of adolescents aged between 13 and 18 years old and another group of adults from 40.

Latent aggressiveness levels seem to point a normal curve, being established the maximum peak in adolescence. Further, the qualitative study reflects relations between certain psychopathological profiles of personality and particular modus operandi.

The results of this study show the evolution of the levels of sadistic fantasies according to the age and the role that personality has in different criminal acts.

Transcranial direct current stimulation (tDCS) is currently investigated for the treatmentof various neuropsychiatric disorders. Neuroplastic effects may be achieved by prolonged neuronal depolarization/hyperpolarization.

Schizophrenia studies revealed a neuroplasticity deficit of cortical areas. Promising results of anodal/cathodal tDCS for acute and chronic symptoms were shown in one randomized clinical trial and several case reports.

To improve negative symptoms, anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) and cathodal tDCS above the supraorbital region was used. Clinical scores were assessed with Positive and Negative Symptoms Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS).

20 patients with predominant negative symptoms and stable medication (>3 weeks) were randomized to active or sham group. Anode was placed over the left DLPFC, cathode over right orbit. 2 mA tDCS was delivered 10 times within weeks 1 and 2. Concomitant medication was continued. Functional connectivity MRI (fcMRI) was performed before and after tDCS.

Post-hoc test (least significant difference, factor ‘group’) showed significant PANSS amelioration in the active group (p = 0.014) for the follow-up, two weeks after the end of stimulation. SANS revealed significant improvement in the active group in week 1 (p = 0.047), week 2 (p = 0.005), and follow-up (p = 0.011). In the active group, fcMRI showed a significant deactivated cluster (corrected p< 0.05) in the anatomical regions of ncl. accumbens, subgenual cortex and striatum.

tDCS is a promising tool to improve various schizophrenic symptoms that are otherwise often difficult to treat.

Apathy is defined as lack of motivation that occurs in various neuropsychological disorders. Apathy frequently co-occurs in patients with late-life depression, and previous studies have shown that apathy is associated with frontal cognitive impairment that constitutes the distinct depressive syndrome in late-life depression. Here we tested elderly patients with mild to moderate depression on behavioral tasks requiring executive and non-executive functions.

The aim of this study was to examine that apathy, not depression, is associated with executive function in patients with late-life depression.

We enrolled 83 patients (67.9 ± 6.4 years of age; 51 women) with major depressive disorder from the geriatric psychiatric clinic of the Chang Gung Memorial Hospital. The inclusion criteria included a diagnosis of non-demented major depressive disorder. Patients with a history of any psychiatric disorders other than major depression, or major medical illness including neurological disorders such as Parkinson's disease, were also excluded. All participants were administered the 17-item Hamilton Depression Scale. The apathy-related items of the Ham-D are diminished work/interest, anergy, lack of insight, and psychomotor retardation.

We employed pairs of behavioral task to assess whether apathy has a distinct effect on executive control functions. Each test pair consisted of an executive and a non-executive task.

We showed that the extent of apathy significantly accounted for variances in performance in the frontal executive but not non-executive cognitive tasks.

These results extend previous studies by relating apathy to deficits in executive function in patients with late-life depression and suggest the importance of assessing the ‘apathetic syndrome’ in the clinical evaluation of patients with late-life depression

Over the last years, the bavarian population, which was relatively homogeneous, has become increasingly culturally diverse. Many migrants to Bavaria have been exposed to extreme stress before, during, and after migration, with potential effects on their physical and mental health. Health problems and suicide rates are of great public health concern. This study compares descriptively frequencies of attempted suicide among native germans and immigrants in Bavaria.

We investigated official data on completed suicide in Bavaria in relation to nationality (german/non-german), age, gender and administrative district. Data were extracted from the Bavarian Police Mortality Database (2009–2010) and were analysed using multilevel models to investigate individual and regional factors and the relevance of nonspecific regional heterogeneity.

After adjustments for age, sex and year, nationality (German vs. non-German) was significant associated with completed suicide in most models considered. We could not find significant regional heterogeneity.

Further research is needed regarding the influence of nationality and migration status on suicidal behaviour using multilevel models.

Transcranial direct current stimulation (tDCS) is currently discussed as a therapeutic intervention in various psychiatric disorders. Based on the report about the effectiveness of tDCS in a patient with catatonic schizophrenia, we applied bilateral prefrontal tDCS in a patient with corpus callosum aplasia (CCA) and severe catatonia instead of maintenance electroconvulsive therapy (ECT).

To investigate whether tDCS can replace ECT in a largely treatment-resistant patient.

The 41 year-old male patient showed severe catatonic symptoms since adolescence and was treated by weekly ECT for almost 6 years. Due to cardiac complications and increasing cognitive deficits caused by long-term ECT and weekly anesthesia, tDCS was suggested. The anode was positioned over the left dorsolateral prefrontal cortex (DLPFC), the cathode over the right DLPFC. 2mA tDCS was delivered for 2x 20 minutes (90 minutes break in between), three times a week for the first two weeks, thereafter once to twice weekly. Concomitant medication (clozapine 600 mg/d, aripiprazole 10 mg/d, pirenzepine 50 mg/d, lorazepam 3 mg/d) was continued.

So far, more than 20 double sessions of tDCS were applied. ECT was needed once after a period of hospitalisation for 10 days due to pneumonia. Since then the patient has solely received tDCS for more than 13 weeks. Catatonic symptoms resolved further under tDCS compared to ECT (Bush-Francis Catatonia Rating Scale: 27/69 points during ECT, 5/69 during tDCS).

tDCS in combination with neuroleptic treatment could be an alternative to ECT in organic catatonia. Further studies are needed to support our hypothesis.

Asperger's Syndrome is a neuro-developmental disorder characterised by social impairment and restricted interests, similar to those found in autism, but with cognitive and linguistic skills preserved. As DSM-5 has eliminated Asperger's Syndrome, will the patients be included in ASD (Autistic Spectrum Disorders)?

The objective of this study is the revaluation of the diagnosis according to the DSM-5 criteria, in a sample of subjects affected by ASD-Asperger's Syndrome.

The secondary aim is to evaluate adaptive skills in order to estimate the probability of the individual's autonomy.

We performed an observational study. Twelve subjects with ASD-Asperger's Syndrome diagnosis with an IQ≥75 were included. An interview to evaluate the existence of ASD, according to the DSM-5 criteria and Vineland adaptive behaviour scales (VABS) to evaluate the adaptive skills, were administered during the sample.

The ASD diagnosis according to DSM-5 is confirmed only in 16.6% of the included subjects. 83.4% were excluded as they did not meet the social communication criteria and the required age for the onset of this specific symptomatology; the VABS subscales of daily skills and socialization are impaired for the entire sample.

Our research shows how the DSM-5 criteria, despite being more specific than DSM-IV, might exclude the subjects affected by Asperger's Syndrome from the Autistic spectrum. Their exclusion would involve the loss of access to specialistic interventions and clinical trials aimed at psychopathological and pharmacological depth

Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs.

We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures.

Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions.

These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.

Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs.

We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures.

Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions.

These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.

Several brain circuits are relevant in the neurobiology of addiction. Here we want to highlight symptoms related to the domains of mood, anhedonia and anxiety that may precede drug abuse and represent a specific risk factor for addiction. The mood regulation circuit that contributes to regulation of stress reactivity and the interoception circuit that contributes to awareness of drug craving and mood also participate in addiction but their involvement in the human brain has been much less investigated.

Here we aim to investigate mood and anxiety in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypothesis of regional grey matter reduction correlating with mood and anxiety.

Cambridge Gambling Task (CGT) data were acquired from 30 patients receiving MMT and 23 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities in the clinical rating scales BDI, Anhedonia, HAD-Anxiety, IDS and Snaith Hamilton. Increased BDI, HAD-Anxiety and IDS correlated with grey matter reductions in the hippocampus, amygdala, bed nucleus of stria terminalis and insula. Increased Snaith Hamilton correlated with grey matter reductions in periaqueductal gray, ventral tegmental area and nucleus caudate.

These findings support an interpretation of a neurobiological underpinning of mood and addiction. However, the anatomically restricted correlates with mood and anxiety suggest that a rationale for adopting a mood addiction model should be further investigated.

Familial liability to both severe and common mental disorder predicts psychotic disorder, psychotic symptoms and psychotic-like experiences (PLe). However, the relation between familial liability and psychosis outcome may be associated with genetic variation. We investigated the influence of familial liability on PLe in a nonpsychotic, general population based group, and the potential moderating effect of the BDNFVal 66Met polymorphism.

PLe and familial liability were assessed in 313 individuals (mean age 38.6±13.3; gender: 43% males). Familial liability was obtained using the questions from Family Interview for Genetic Studies and dichotomized to none or at least one mental disorder in the first degree relatives (parents and siblings). PLe (visual and auditory hallucinations) were assessed through relevant questions in CIDI 2.1 G section on psychotic disorders. The sample undergone clinical reinterviews with the Structured Clinical Interview for DSMIV. BDNF val66met (rs6265) was genotyped using standardized procedures.

Familial liability was associated with PLe (OR= 1.8; CI: 1.1–3.0; p: 0.012). The association between familial liability and PLe was significant in individuals with Val/Val allele (OR= 2.2; CI: 1.2-4.1; p: 0.009) whereas there was no evidence for an association between familial liability and PLe in Met carrier individuals.

Individuals with a familial liability for mental disorders are more likely to report PLe. Val/Val genotype reported more PLe when exposed to familial liability than did individuals carrying Met allele. Therefore, the observed gene-environment interaction effect may be partially responsible for individual variation in response to familial liability.