In addition to producing antinociception, opioids exert profound effects on body temperature.

This study aimed at comparing antinociceptive and hyperthermic responses between two groups of μ-opioid receptor agonists: fentanyl (4- anilinopiperidine-type) and morphine (phenanthrene-type) derivatives in rats.

Analgesic activity was assessed by tail-immersion test in male Wistar rats (200–250 g). The distal 5 cm of the tail was immersed in a warm water bath (55 + 0.5°C) and the time for tail-withdrawal was measured as a response latency. The body temperature was measured by insertion of a thermometer probe 5 cm into the colon of unrestrained rats.

Fentanyl (F), (±)cis-3-methyl fentanyl (CM), (±)cis-3-carbomethoxy fentanyl (C), (±)trans-3-carbomethoxy fentanyl (T) and (±)cis-3 butyl fentanyl (B) produced dose-dependent increase in antinociception and hyperthermia. The relative order of analgesic potency was: CM(11.27)>F(1)>C(0.35)3T(0.11)3B (0.056). Similar to this, the relative order of hyperthermic potency was: CM(8.43)>F(1)>C(0.46)3T(0.11)3B(0.076). Morphine (M), oxycodone (O), thebacon (T) and 6,14-Ethenomorphinan-7-methanol, 4,5-epoxy-6- fluoro-3-hydroxy-a, a,17-trimethyl-, (5a,7a) (E) also produced dose-dependent increase in antinociception and hyperthermia. Among morphine derivatives the relative order of analgesic potency was: E(56)>O(5)3T(2.6)>M(1), and similar to this, the relative order of hyperthermic potency was: E(37)>O(3)3T(2.3)>M(1).

Morphine (phenanthrene-type) and fentanyl (4-anilinopiperidine-type) derivatives produced hyperthermia in rats at doses about 2 times lower, and 6 to 11 times higher, than their median antinociceptive doses, respectively. This study is first to identify difference between these two classes of opioid drugs in their potencies in producing hyperthermia.

Schizophrenia is a psychiatric disorder which involves chronic or recurrent psychosis and it is commonly associated with impairment in social and occupational functioning. Antipsychotic medications are a first-line treatment, however, most patients experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning and episodes of acute symptomatic relapse.

Systematic literature review in UpToDate and Pubmed.

To identify the most relevant intervention areas of systematic rehabilitation in schizophrenia.

45 years old schizophrenic male who admitted in a Medium Stay Psychiatry Unit with severe behavioural impairment and psychotic symptoms. At least 10 hospitalizations and pronounced disability in basic life skills despite optimal treatment. Poor insight and compliance, frequent relapses, co-morbid substance abuse and difficult family support. Clozapine was added to his treatment with improvement in psychotic symptoms. A multidisciplinary intervention was also done and he was discharged home with important improvement in social skills, better insight and familiar functioning

Despite following an adequate antipsychotic treatment, including Clozapine as the main medication in resistant schizophrenia, it is often partially effective with severe impairments in social and occupational functioning. Family-based interventions, cognitive behavioural therapy and social skills training, added to this medication seem to be essential in the systematic treatment of schizoprenia. It includes a multidisciplinary team and a specific length of time but it is based on the patient's status. Despite evidence of their efectiveness, the availability of these interventions varies widely, as does the availability of clinicians to provide them.

Previously, we reported the clinical efficacy of MPH-LA in adult ADHD evaluated in a 40-week, randomised, double-blind, placebo-controlled, multicentre core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6- month)] (Atten Defic Hyperact Disord. 2013;(5):219–220). Here, we report the long-term efficacy from the 26-week extension phase of the same study.

During the extension phase, patients initiated treatment with MPH-LA 20 mg/day (oral, once daily capsules); uptitrated to optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Change in DSM-IV ADHD rating scale (RS) and SDS total scores at the end of study, were evaluated from the baseline of maintenance of effect phase of the core study and the baseline of extension phase.

At the end of the extension phase, the mean change in DSM-IV ADHD RS and SDS total scores from baseline of the maintenance of effect phase was −0.9 and −1.4 points respectively; and from baseline of extension phase was −7.2 and −4.8 respectively (Table). No new or unexpected safety concerns were observed during the extension phase.

MPH-LA continued to maintain clinical efficacy in adult ADHD patients over long-term.

Table DSM-IV ADHD RS, SDS total scores and change from baseline at the end of extension phase

Suicide is a public health problem of the first magnitude for both its costs and its implications for the population. The attention to suicide attempts is itself one of the first reasons for psychiatric consultation, if not the first, in hospitals. Among the risk factors for suicide is the presence of mental disorders on Axis I and II, and the existence of previous attempts.

Studying the behavior of some of the risk factors for suicide known (psychiatric history and previous attempts) in a sample from service Emergency Hospital Juan Ramón Jiménez

Performed a retrospective analysis (for a period of 6 months of 2013) of the risk factors associated with suicidal behavior of patients seen in the emergency department of our hospital for attempted suicide.

In an interim analysis found that up to 50% of patients treated for attempted suicide had made ??previous attempts. Most of them had any axis I disorder (> 75%) and were or had been in outpatient psychiatric follow. Extensive treatment with psychotropic drugs performed most (> 80%)

The high number of cases with previous attempts provides a clear example of the problem of suicidal behavior relapse. The importance of this is increased when you consider that most were receiving or had received psychiatric treatment, reflecting the limitations in our daily clinical practice we have to control this pubic health problem.

Immigration in Spain is from the early ‘90s phenomenon of demographic and economic importance, according to INE, in January 2011 first residing in the country nearly 6.7 million people born outside our borders. In recent years, many immigrants are living in especially difficult circumstances.

Show that these people undergo a series of very specific stressors and duels: precarious and harsh working conditions, poor diet, loneliness and lack of social support… This would enhance the appearance of psychiatric symptoms in various areas, closely related to lifestyles that maintain and in some cases precipitate substance use in this group, primarily those that have a sedative profile.

We will present the clinical case of a 34 year old Nigerian male. No somatic or psychiatric history of interest. Cannabis smoker since adolescence. A year after his arrival in Spain admitted to our inpatient unit due to clinical psychotic. Was a challenge from the point of view of psychopharmacological have many side effects with low doses of typical antipsychotics

Disappearance of psychotic and affective symptoms to approach the case from a pharmacological perspective, social and cultural.

Addressing the relationship between life stressors and cannabis as a trigger or catalyst for psychotic episodes in individuals predisposed. Pathological elaborations of cultural integration of an immigrant (whether by denial of the original culture or over-identification with the host culture) facilitates the use of toxic either for blending with Western consumer culture or cultural consumption radicalization toxic in some East African countries.

We aimed to examine the influence of psychological factors on the adaptation to fibromyalgia (FM). Fibromyalgia is a chronic musculoskeletal pain syndrome of uncertain origin, characterized by widespread pain and abnormal tenderness, associated with body stiffness, fatigue, poor quality sleep, headache, cognitive disturbance. We examined the relationship between personality traits, illness acceptance, strategy of coping with pain, social support and adaptation to fibromyalgia.

Thirty FM patients (28 women and 2 men) completed the NEO Five-Factor Inventory, Acceptance of Illness Scale (AIS), The Pain Coping Strategies Questionnaire (CSQ), Berlin Social Support Scales (BSSS), Visual Analogue Scale (VAS), Fibromyalgia Impact Questionnaire- Revised (FIQ-R).

Regression analysis results indicated that the adaptation to fibromyalgia is differentially associated with personality traits and the subjective level of pain. Especially Extroversion and Agreeableness are significant predictors of the assessment of fibromyalgia impact on everyday life. Neuroticism contributes significantly to vigilance to pain. The strategies to cope with pain correlate with such personality traits like Agreeableness and Openness to experience. The level of illness acceptance highly depends on the subjective intense of pain.

Psychological factors might be involved in triggering, maintaining, exacerbation of the fibromyalgia process and they may influence the adaptation to this illness. Particularly the personality of the patient appeared to play the significant role in this process.

People with psychosis have a deficit in emotion recognition, what has been mainly studied in schizophrenia. However, there are little published data about reactions to emotional facial expression and its relationship with the performance in emotion recognition tasks.

To assess the emotional reactivity to faces and the recognition of emotions in people with an acute psychotic episode.

To determine if there is a relationship between emotional reactivity to faces and emotional perception in people with psychosis.

22 people -14 male (mean age 37,57;SD10,46) and 8 females(49,57;SD13.23)- with an acute psychotic episode (DSM-IV-TR) were asked to assess 20 faces from The Emotion Recognition-40 using the Self Assessment Manikin. Then, faces were projected again, asking the participants identify the emotion expressed in each image.

Valence in Anger correlates with Correct Identification (CI) of anger (τ=0.379;p=0.015). Arousal in Anger with CI of anger (τ=0.356;p=0.021) and with False Positive (FP) of anger (τ=-0.415;p=0.012). Valence in fear with CI anger (τ=0.335;p=0.023). Arousal in fear with FP anger (τ=-0.385;p=0.018). Valence in No Emotion with FP Sadness (τ=-0.38;p=0.012), FP anger (τ=-0.479;p=0.004), FP fear (τ=-0.332;p=0.013) and CI no emotion (τ=0.575;p=0.000). Arousal in No Emotion with CI anger (τ=0.50;p=0.002). Every correlation was still significant when controlling diagnosis, except arousal in anger and FP anger.

Results indicate a probable relationship between the way people with psychosis react to a fearful, angry or non emotional face and the emotion they attribute to it.

Delusional disorder has been traditionally thought to be a disorder that does not evolve to defective states. However, little empirical evidence has been obtained so far comparing these patients with other psychotic conditions. Our aim is to characterize delusional disorder patients as compared to other psychotic patients regarding to their psychopathology, neuropsychological performance and general functioning.

A total of 131 psychotic patients were included in this study. 22 patients with delusional disorder, 109 other psychosis. Psychopathology was assessed via PANSS. DKEFS Colour-Word Stroop test was used to assess neuropsychological performance. Functioning was assessed using GAF. Between groups comparisons were performed via ANOVA and post hoc tests using Bonferroni method were subsequently used. Using the inclusive criterion, PANSS's positive and negative subtypes distribution was investigated in the groups using χ2 tests.

Statistically significant differences between patients with schizophrenia and patients with delusional disorder were found for PANSS's negative scale, the scoring was significantly lower for emotional withdrawal, blunted affect, difficulty in abstract thinking and stereotype thinking. There were no statistically significant difference between the groups regarding the rest of scales of PANSS (positive and general psychopathology), neuropsychological performance and functioning.

Even though delusional disorder is considered as a clinical entity more benign than other psychoses, our data show that these patients are only less seriously affected regarding negative symptomatology. In line with the recent nosological progress, these results would support a dimensional conceptualization of psychosis.

To identify and compare the characteristics of symptoms and social functioning of patients with schizophrenia spectrum disorders with substance misuse.

A total of 122 patients admitted to a psychiatric hospital. Inclusion criteria were: age older than 18 years; the presence of’dual’ diagnosis; the appropriate category F2 and F1 ICD-10; a history of at least 10 years of follow-psychiatric service. Depending on the preferred substance, all patients were divided into two groups: 1st group consisted of 76 patients with schizophrenia who abuse alcohol; group 2 included 46 patients with schizophrenia, polydrug abuse. Severity of psychotic symptoms at admission was evaluated on a scale of PANSS, social functioning - on a scale of PSP.

The mean age of patients in the first group was significantly higher (43.0±10.1 vs 34.4±7.4, p<0.05). Drug abuse in patients with second group started in an earlier age than the first alcohol use in patients with the first group (16.5±3.4 vs 21.8±8.1, p<0.05). The age of the first manifestations of mental disorders was significantly lower in the patients group 2 (16.5±6.5 vs 20.4±9.9, p<0.05). Also the age of the first psychotic episode in the second group was lower too (22.0±5.9 vs 26.8±10.2, p<0.05). In a study of the PANSS of the second group, the average score was higher in all subscales. The average score of positive symptoms was 26.2±7.0 against 20.6±7.2, p<0.05, and on the negative symptoms subscale 26.4±4.3 vs 24.6±2.7. Differences between groups tended to significance, p=0.061. The average score on the subscale of general symptoms scores in the second group was also higher (56.4±8.4 vs 51.7±5.5, p<0.05). The level of social functioning was higher in the first group. Average score on a scale of PSP it was 37.8±11.6 vs. 28.8±14.3, p<0.05.

Symptoms of Alcohol-Induced Disorders may resemble characteristic features of Panic Attacks. It is also known that individuals with fears occasionally use alcohol as an anti-anxious agent.

The objective of the study was to investigate the relationship between some common fears and Alcohol-Related Disorders. We have sorted out 61 inpatients with the diagnosis of 'Panic Disorder (PD) with Agoraphobia' according to the DSM-IV criteria.

The rate of Alcohol Dependence among first-degree relatives of the patients was quite high (24, 6%). Approximately 10% had Alcohol Abuse within 5 years prior to PD onset.

Alcohol-Induced Panic Attacks (13,1%) were accompanied by predominance of somatic symptoms and fear of a life-threatening illness. Most individuals (95,1%) have completely abandoned any experience with alcohol in the first 3 months after manifestation of PD. Some months later, the repeated Panic Attacks could lead to avoidance of a variety of situations. about one-third occasionally used alcohol when they were travelling by public transport. Some patients (9,8%) took alcohol every time they intended being alone out of home which eventually led to Alcohol Dependence (6,5%).

When agoraphobia occurred soon after special treatment (so-called 'coding from alcohol') just only the smell and view of alcohol beverages could provoke panic-like symptoms (8,2%).

Both alcohol consumption and anti-alcohol treatment may immediately precede the onset of Panic Attacks. PD alone is associated with low risk of Alcohol Use Disorders. In contrast, agoraphobic symptoms are very likely to be accompanied with the frequent use of alcohol in fearful situations.

Currently the Eating Behavior Disorders have become a social and health problem of the first kind that requires a specialized and interdisciplinary approach to these disorders. These clinical conditions are characterized by their complexity and diversity symptomatology, which implies a significant interference in their functioning in different areas of life and clinically significant distress.

Given the high burden of care in the USMC that difficult to monitor these patients at appropriate intervals, as well as the seriousness of the clinical and physical complications that can result, ultimately, in death, it seems necessary to implement group interventions to ensure greater continuity of care.

In all forms of group therapy underlying common advantages which advocate their implementation. Recent studies show that group therapy for eating disorders is equally effective as individual treatment. So in the USMC - Huelva conducted a psychotherapeutic group aimed at people with these clinical pictures. The present work is to analyze the impact of the intervention group in the eating disorder symptoms, anxiety and depression, comparing the results obtained in the tests applied before and after treatment.

Psychometric tests used were:

1. - Beck Depression Inventory (BDI)

2. - Inventory of State-Trait Anxiety Inventory (STAI)

3. - Inventory of Eating disorders (EDI)

The results reflect a clinically relevant improvement in both psychometric testing quality indicators (no hospitalizations, no emergency service attendance, adherence, etc.)

We should consider that group psychotherapy has unique properties that offer individual psychotherapy.

Hypothalamic Hamarthoma (HH) is a non-neoplastic nodule resembling the normal gray matter of the hypothalamus. It is usually recognized by its characteristic’gelastic seizures’ and central-type precocious puberty. However, detection of HH in institucionalized people with anti-social and violent behavior has laid some attention in its psychiatric manifestations.

The authors intend to report a clinical case of a patient with rage attacks who was diagnosed with HH, and to make a review of psychiatric symptoms and their treatment in this disorder.

Literature review through Pubmed and report of a clinical case.

Patient aged 39 years old with a 10-year history of epilepsy, under levetiracetam 1000 mg id, was referred to Psychiatry consult due to episodic rage attacks with physical violence. During the diagnostic investigation, the patient made a Magnetic Resonance Imaging which detected a 1cm non pedunculated HH in the III ventricle. The patient Mental State Examination was positive for mild cognitive decline and impulse control disorder with immediate regret and insight. The latter disorder was stabilized with quetiapine 300 mg SR bid and antiepileptic therapy.

This review shows the importance of Magnetic Resonance Imaging in characterization of some psychiatric syndromes. The behavioural abnormalities in patients with HH have not been specifically studied, although typical or atypical antipsychotics plus antiepileptic drugs have a favorable impact. However, aggressiveness is in most cases medically intractable and even with surgery, it can persist at a minor degree.

Mild cognitive impairment (MCI) confers a particularly high annual risk of 10-15% of conversion to Alzheimer's disease (AD). Recent findings suggest that regional brain iron concentration measured by quantitative MR relaxation rate R2' may be useful as a biomarker to evaluate the progression of AD.

In this study, we examined the impact of white matter lesion (WML) pathology measured by visual ratings on the validity of iron concentration in converting and stable MCI patients.

Retrospective magnetic resonance imaging data were collected for 65 MCI patients. All patients underwent 1.5 Tesla MRI: WML were visually rated on T2 images using the Fazekas and the Scheltens scales, iron concentrations of subcortical regions of interest (ROI) were measured on T2* maps by calculating the transverse relaxation rate R2'. Further, volumes of gray matter (GM), withe matter (WM) and cerebrospinal fluid (CSF) were calculated.

Of 65 subjects, 25 converted to AD during a follow-up of 19.2±7.4 months and 40 remained stable. Converters had significantly more WML in periventricular regions and the temporal lobe as well as lower volume of WM and a higher volume of CSF. In contrast, ROI analysis of iron deposits showed higher iron concentration in the globus pallidus, the insula, the hippocampus and the substantia nigra in non-converters compared to converters.

Our results suggest that the validity of the measurement of iron deposits as a biomarker for the imminent conversion from MCI to AD may be limited by the presents of WML pathology.

Early detection of cognitive change is essential for the diagnosis and timely onset of treatment in a variety of neuropsychiatric disorders. Since changes in executive function (EF) are contingent upon age and may compromise assessment accuracy, psychiatric patients and normal controls were compared in terms of cognitive decline rates. EF is measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB), that has adapted several standard cognitive tests for computerized administration and scoring.

Specification of the relation between psychopathology, cognition and aging.

Cross sectional examination of the age related executive changes in a sample of adults with a history of psychiatric illness using the CANTAB.

A total of 406 patients (18-72 years), diagnosed with (a) affective disorders (N=153), (b) substance related disorders (N=112), (c) personality disorders (N=82), or (d) pervasive developmental disorders (N=59), completed CANTAB executive function tests of working memory (SWM), strategic planning (SOC) and set shifting (IED). Test performances were compared with those of 52 healthy adults.

Both in the patient groups and the healthy participants, similar rates of executive decline were found.

The present research indicates that the decline of executive skills in populations with psychiatric conditions does not exceed the age related executive changes typically seen in healthy aging adults. Still, compared with the latter, patients seem to earlier reach the critical threshold at which functional deficits emerge, notwithstanding the comparable decline rates. Understanding aging and its interaction with cognition in later life may refine treatment design for the elderly patient.

Hedonic eating is characterized by the consumption of food uniquely for its gustatory rewarding properties and not for the occurrence of short-term energy depletion. Eating a piece of cake after a satiating meal is a typical example of hedonic eating. It is intuitive that hedonic eating may stimulate powerfully food intake; hence, understanding its physiological modulation could help to contrast obesity and other eating disorders.

To explore the role of endogenous appetite and/or reward modulators in hedonic eating.

We measured plasma levels of ghrelin, endocannabinoids, colecystokinin-33 (CCK) and peptide YY3-36 (PYY3-36), in 8 satiated healthy subjects after ad libitum consumption of high palatable food as compared to the consumption of isoenergetic non-palatable food.

Hedonic eating was characterized by increased levels of ghrelin and the endocannabinoid 2-arachidonoyl glycerol (2-AG) but a decreased secretion of the satiety hormone CCK. Levels of other endocannabinoids and PYY3-36 did not significantly differ between hedonic and non-hedonic eating.

Present findings suggest that, when motivation to eat is generated by the availability of high palatable food and not by food deprivation, the increased levels of the hunger hormone ghrelin and the reduced secretion of the satiety hormone CCK could promote eating in spite of no energy need. Otherwise, the increased secretion of ghrelin and 2-AG could promote the ingestion of high palatable food via the activation of the endogenous rewarding system.

Sloppiness refers to the indeterminate, untidy or approximate qualities of the exchange of meaning between patient and psychotherapeutics (Boston Change Process Study Group, 2005). In an institutional’good-enough’ Day-Hospital, patients move around psychiatry, physicians, phychotherapists, rehabilitation groups giving arise a relational field where something happens. Beyond known therapeutic factors,’something else’ arises from intrinsic indeterminancy of the relationship among minds.

Our work is an attempt to elaborate and explore the idea of sloppiness and co-creativity as a model of therapeutic teamwork organization in an institutional Day-Hospital.

The sloppiness as a model of teamwork organization may permit to individuate features relevant in a co-creation process among teamwork members and patient in severe psychiatric disorder.

We present four case reports belonging to different diagnostic classes: psychosis, affective disorder, personality disorder and anxiety disorder.

Long time clinical observation suggests that different features significantly affect clinical outcome in different patients. So, sloppiness has a pivotal role in the therapeutic process leading to a change because,’playing’ among teamwork in a unstructured relational space, patients drawn on what they authentically need.

Sloppiness and co-creativity might represent’something else’ which allow patient to create his personal therapeutic pathway, and teamwork to fine-tune dynamically therapeutic act on patient. So sloppiness, as a tool of encounter between patient and teamwork in an institutional Day- Hospital, might advance co-creativity process leading to an individual care pathway good-fitted on patient.