Hyperkeratosis is characterized by abnormal palmoplantar skin thickening. These lesions can extend to other organs and be associated with a multiplicity of pathologies.

This paper aims to describe the features of psychosocial maladjustment in a patient firstly diagnosed as having hyperkeratosis of unknown etiology.

We describe a 14-year-old boy admitted to our outpatient clinic after verbalizing suicidal thoughts to his endocrinologist.

His medical condition had been evolving since he was six, when his palms and specially soles became grossly thickened and painful and he would be found awake at night clawing at his severely scaly and itchy lesions. He was seen by geneticists, dermatologists and plastic surgeons. However, the thickened patches continued to progress over the years, with almost no response to treatment. He was unable to keep up with his friends walking and had to give up on sports. Due to medication he has a reduced stature and low puberty development. On his first appointment he was reported to be unable to manage routine affairs or handle money matters and his scholastic performance was poor. During mental state examination one could assess restricted interests, social and communication defficits, tantrums, self and hetero aggressions and IQ below normal, despite an extraordinary visuo-spatial memory and no suicidal intent. He was medicated with risperidone and structural family therapy was applied, with good response.

Helping individuals and families dealing with behavioural problems improves family dynamics and quality of life even in the presence of such incapacitating diseases.

Maternal depressive risk has been linked to several dysfunctional outcomes. Empirical data indicate that the lack of adequate maternal responses over feeding may affect the quality of the early eating habits of the baby. Such a conclusion, however, is mainly based on cross-sectional research, which does not allow to establish causality.

The aim of the study was to explore in a longitudinal way the link between pre-partum depression and subsequent mother-child feeding interactions.

Participants were 64 women who voluntarily agreed to take part in the study. During their 3rd trimester of pregnancy, all completed a number of self-report instruments, including the CES–Depression scale (CES-D) and Multidimensional Scale for Perceived Social Support (MSPSS). Seven months after the delivery, mother-child dyads were videotaped during a meal session, and the Feeding Observational Scale (FS) was used so as to rate the quality of the feeding interactions.

During pregnancy, the CES-D negatively correlated with the MSPSS, r = -.32, p = .01. For three of the FS scales, the quality of the dyadic feeding interactions at seven months of age of the baby was significantly predicted by the CES-D, β ≥ .30, p < .05, but not by the MSPSS. In contrast, one of the FS scales was significantly predicted only by the MSPSS, β = -.29, p < .05, but not by the CES-D.

Clinical screening during pregnancy may help preventing the establishment of early dysfunctional eating behaviors, by identifying early risk factors for dysfunctional feeding interactions.

To evaluate the initial (3 months) all-cause discontinuation and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, stratified by previous treatment.

These two studies (NCT00705783 & NCT00706654) were double-blind, placebo- or active-controlled assessing the efficacy and safety of AOM-400mg. Detailed study designs have been reported previously (1, 2). This analysis was conducted on the pooled population in the first 3 months after initiating AOM-400mg treatment, on patients who received at least one dose of AOM-400mg. Outcome measures are reported for groups stratified by prior treatment.

During the first 3 months of treatment, discontinuation due to all-causes (except for those who discontinued due to the sponsor stopping the NCT00705783 study early after pre-specified efficacy parameters were met) as well as due to adverse events are presented in Table 1. The rates of insomnia and akathisia are shown in Table 1

Aripiprazole once-monthly 400mg appeared equally safe and effective (as measured by all cause discontinuation) in the first 3 months after initiation, regardless of treatment prior to entering trials.

Medical professionals are exposed to numerous high intensity stressors. This may lead to increased occurrence of signs of burnout syndrome and depression. This phenomenon is further connected to higher probability of serious medical errors, lower attention to patients and other medically serious issues.

We have conducted a national study to assess the level occurrence of burnout syndrome and depression using standardized questionnaires. We have collected data from n=7428 medical doctors cross all specialties and types of medical institutions.

The results of the study confirmed high occurrence of burnout syndrome and depression symptoms among Czech medical doctors. The study also brought information about specific risk factors as the type of specialty, age, marital status or educational level which influence the levels of burnout and depression syndromes at statistically significant levels (p<0,001).

The study supports the hypothesis that medical doctors are highly endangered by development of burnout and depression symptoms and thus should get appropriate care.

The study was supported by the Czech Medical Chamber.

Social-psychological adaptation of war veterans is a practical, scientific and social issue both in CIS countries and abroad. In peaceful life veterans continue to encounter stressful situations triggering their avital activity. This certainly requires rehabilitation measures.

To diagnose psychological constitution of avital behavior, try our rehabilitation program and estimate efficiency of rehabilitation.

To study efficiency of medical and psychological rehabilitation of people with avital activity after combating stress.

We studied 116 males aged 25 - 43 years who fought at North Caucasus. Sixteen Personality Factor Questionnaire and Hamilton Depression Rating Scale were used. To study avital activity and defence mechanisms, we used Questionnaire for Psychological Diagnostics of Lifestyle Index.

Based on results of diagnostics, we divided respondents into two groups: patients with PTSD and self-injurious behavior who did not have rehabilitation, and patients with PTSD and self-injurious behavior who completed rehabilitation.

Our rehabilitation program included: personality treatment involving person-centered psychotherapy and rational therapy, symptomatic treatment involving neuromuscular relaxation, music therapy, self-regulation, behavior therapy and medication therapy, and social adaptation aimed at formation of adequate behavioral patterns.

The 1st group of patients more frequently demonstrated maximum values of somatic anxiety and depression. The 2d group of patients showed a statistically-valid decrease of somatic anxiety (by 37%), depression (by 34%) and guilt (by 33%).

The results show that our psychotherapeutic rehabilitation program allows to reduce intensity of PTSD and prevent from formation of pathological personality features typical for self-injurious behavior and avital activity.

Avoiding coercive measures is one of the most important aims in emergency psychiatry.

There were far-reaching amendments to the German Civil Code in 2012 (XII ZB 99/12) and the Saxon Law on Aid and Accommodation for Mental Diseases in early 2013 (2 BvR 228/12) concerning the constraint of coerced medication.

To analyze the process of change on our emergency psychiatric ward, we conducted a longitudinal measurement.

We performed a pre-post-comparison (pre: 2010, post: 1st half of 2013) with regard to several patient- and nursing staff-related criteria by using descriptive and test statistics.

Socio-demographic patient data and unit-specific performance data remained unaltered. The distribution regarding the following main diagnoses [ICD 10] changed significantly: F19* (pre 11.0%, post 22.0%; p<0.001), F2*(pre 11.9%, post 17.6; p<0.01) and F1* excl. F19.* (pre 31.2%, post 18.8%; p<0.001). After the amendments a significant reduction of administered medication and a significant increase in the ratio of assaults/property damages/elopements/attempts of absconding per patient (pre 0.007, post 0.021; p<0.001) were measured. Both a significant increase in the ratio of physically restrained patients (pre 22.3%, post 28.7%; p<0.05) and changes regarding involuntary commitment practice impressed. In the course of changing conditions and workload, influences on staff absent time were noticeable. According to these results a partly restructuring of nursing staff was deployed by leadership.

Both nursing management and treatment concepts may have to be reassessed and adapted by discussing several aspects (e.g. safety of staff, professional ethic, staffing structure and levels). Further analyses seem indispensable.

Several studies have pointed to the relevance of a positive attitude and optimism in people's lives. Optimism promotes mental and physical health, especially in coping with stressful situations, and may aid in improving cognitive and contextual resources, and coping that promote better mental health, such as fewer depressive symptoms. Optimists tend to perform better than pessimists in school, sports and work. The satisfaction of life plays an important role in healthy development. The positive affects attenuate the negative aspects of stressful life events and act as protective factors in the development of psychological and behavioral problems.

To investigate mental health indicators in Brazilian children and adolescents.

Investigate differences between boys and girls regarding the positive and negative affect, life satisfaction, satisfaction with school, family, self and friendship, and optimism.

This is a quantitative cross-section study with data collected from 730 children and adolescents with 6-16 years old (mean = 10.6 years, SD = 3.3) from Porto Alegre and Montenegro, southern Brazil. Instruments used: Predictive of Optimism Tasks for Children (TAPOC); Youth Life Orientation Test (YLOT), Multidimensional Scale of Life Satisfaction for Children and Adolescents; Scale Positive and Negative Affects.

The results show good levels of life satisfaction, positive affect and optimism and lower levels of negative affect. The results were substantial even for children under seven.

Young children already have a capacity of expression on their own well-being. The correlations between variables indicate the relevance of indicators of psychological health throughout development.

The use of coercion in emergency psychiatry is discussed controversially.

Concerning the constraint of coerced medication there were changes of the German Civil Code in 2012 (XII ZB 99/12) and the Saxon Law on Aid and Accommodation for Mental Diseases in early 2013 (2 BvR 228/12)

Against the background of the issue ’Coercive Treatment’, we aimed on monitoring the effects of these amendments on our 18-bedded closed psychiatric ward.

We performed a pre-post-comparison (pre: 2010, post: 1st half of 2013) by using descriptive and test statistics.

Socio-demographic patient data and performance data remained stable. Regarding the main diagnoses [ICD 10] F19* (pre11.0%, post 22.0%; p<0.001), F2*(pre 11.9%, post 17.6; p<0.01) and F10.* -F18.* (pre 31.2%, post 18.8%; p<0.001) there were significant changes in distribution. We measured a significant reduction of the administration of emergency medication, except for the intramuscular injection of Zuclopenthixol, Olanzapin and Diazepam, and for the oral application of benzodiazepines and antipsychotics after acute crisis. At the same time the ratios of assaults/self-injuries/property damages per patient day (pre 0.005, post 0.018; p<0.001), physically restrained (pre 22.3%, post 28.7%; p<0.05) and involuntary committed patients (pre 15.5%, post 24.1%, p<0.01) augmented significantly. The average duration of involuntary commitment (excl. outliers) remained unaltered, but the variance of average duration increased (p<0.001).

The reduction of administered benzodiazepines and antipsychotics seems to correlate with an increase of aggressive behaviour and alternative use of other coercive measures. Further research and a social discussion on this issue are required.

The rapid emergence of New Psychoactive Substances (NPSs), combined with the ability of the Internet to disseminate information quickly, represents a serious issue from both a clinical and a public health point of view.

Aim of our research project is to assess the knowledge of NPSs and the extent of their diffusion amongst Italian young people.

A questionnaire has been administered to a youth population (2700 subjects, 16-24 year old) randomly selected from a representative group, to evaluate their knowledge/use of a group of NPSs. Other items evaluate possible alcoholic abuse, use of other drugs, smoking habit, consumption of energy drinks/caffeinate beverages, time spent over the Internet per day.

In the sample a partial knowledge of NPSs has been reported. The use of Cannabis in form of ’Spices’, ’Bath Salts’ including mephedrone, and Salvia divinorum was found in 1,4%, 2.2%, and 0.8% respectively. Relevant is the consumption of alcoholic beverages, with an important prevalence of binge drinking habits (98% of alcohol drinkers, 48,4% of total sample).

The results evidence a partial, but presumably significant compared to the general population, knowledge of use of New Psychoactive Substances among selected Italian adolescents and young adults. Peculiar is the percentage of subjects with Binge Drinking habits (98%) among alcohol consumers (50,8% of total sample). We aim to widen the data with further questionnaire collection, in order to present more significant results

Postcentral gyus (PoCG) has received little attention in brain imaging literature compared to others brain regions. In spite of that, some structural magnetic resonance (sMRI) studies have detected the presence of structural and functional abnormalities in schizophrenia.

1 year longitudinal study assessing PoCG morphometry in First Episode Schizophrenia (FES) patients and in healthy comparison (HC)

We aimed to assess PoCG volumes differences and to explore possible changes over time, by means of sMRI. Also, we aimed to investigate the relationships between PoCG morphometry and clinical and cognitive variables.

56 FES patients, selected through the PAFIP Program, carefully assessed for dimensional psychopathology and cognitive functioning, and matched HC (n=56), underwent two sMRI at 1,5 T (interscan interval=1 year). PoCG grey matter (GM) volumes were measured.

We found a significant reduction in right PoCG GM volume in patients at follow up (Tab.1) and a trend of interaction time x group in male right PoCG. We found positive correlations between right PoCG and SAPS total scores and disorganized symptoms. Finally, we observed inverse correlations between left PoCG and WAIS BD at baseline and between bilateral PoCG and CPT scores at follow up.

Table 1

Results about volume comparions at baseline, at follow up and the interaction time for group.

this is the first study focusing on PoCG in FES patients. Our results suggest a greater decrease of right PoCG, at a trend level, in male patients than in HC, sustaining that PoCG morphometry change in the first year of the illness, possibly sustaining the symptomatology and the cognitive impairment.

The SEYLE (’Saving and Empowering Young Lives in Europe’) randomized clinical trial is funded by the European Union (FP7). Its aims were to collect baseline and follow-up data on health and well-being among European adolescents and to test three different suicidepreventive interventions, in comparison with a control group, in order to recommend culturally adjusted models for promoting mental health and preventing suicidal behaviors. The present ancillary study presents results of the French Prof-Screen cohort.

1: to describe the psychopathological profile of ’at risk’ students. 2: to compare the profiles of students referred vs. not referred to mental health services. 3: to analyse judgment criteria of the professional for referring pupils.

The questionnaire was a composite of psychopathology scales: Beck Depression Inventory (BDI-II); Zung Self-Assessment Anxiety Scale (SAS), Paykel Scale, Delibarate Self-Harm Inventory (DSHI) and other questions addressing issues of substances use, social relationships...

In the Prof-Screen arm, when critical scores were reached in the baseline questionnaire, the pupil was considered ’at risk’ and was examined by a professional who had to decide, based on a semi-structured interview and his/her clinical global impression, whether the pupil had to be referred to mental health services.

among the 235 pupils in the Prof-Screen arm, 168 (71,5 %) were considered ’at risk’. 156 (92,9 %) were evaluated in the clinical interview, among which 38 cases (24,4 %) were referred to mental health facilities.

major predictors for referral were depression, alcohol misuse and non suicidal self-injury.

Anhedonia has been regarded as a core deficit of schizophrenia and has been assigned a central role in the pathogenetic models of the syndrome as well as in the disability associated to it. Current research suggests that schizophrenia patients do not have a deficit in hedonic experience but, instead, a reduced ability to anticipate reward that might underlie other aspects of schizophrenia, such as avolition and lack of initiative.

The present study was aimed at characterizing these aspects in a sample of 35 patients with schizophrenia stabilized on second generation antipsychotics by comparing them to a group of 26 healthy controls (HC).

In both patients and HC, instruments specifically designed to assess the experience of consummatory and anticipatory pleasure as well as trait social and physical anhedonia were used; the factor ’real-life motivation’ was extracted by the Quality of Life Scale.

Patients showed, with respect to HC, higher trait social anhedonia, as well as reduced real-life motivation, but similar scores for trait physical anhedonia and the experience of consummatory or anticipatory pleasure.

In our sample of patients with schizophrenia the preserved experience of both consummatory and anticipatory pleasure in the presence of a significant deficit of motivation suggests a poor ability to translate pleasurable experiences into motivational states.

Authors thank Compagnia di San Paolo-Neuroscience Call that funded the project 'Reward system and primary negative symptoms in schizophrenia'.

With the national redesign of specialist mental health services and its move towards episodic care, community mental health teams in the UK face a challenge in transferring LAI patients to Primary Care. In North Bristol, anecdotal concerns had been raised about this, particularly in the absence of established shared care arrangements (SCAs), and these prompted this service evaluation.

To characterise the use of LAIs by NBRS.

1. 1. To establish the prevalence of LAI prescriptions in NBRS and type of LAI prescribed.

2. 2. To consider the resource implications and distribution of LAI patients by Primary Care surgery.

3. 3. Using aims 1&2 to inform the development of local SCAs.

Use of a cross-sectional caseload survey of 523 out-patients under the care of NBRS on 1 September 2012.

LAIs were prescribed for 15% of the service’s total caseload (both psychotic and non-psyhcotic diagnoses). For those diagnosed with psychosis, flupentixol, risperidone and zuclopenthixol were most commonly prescribed, at mainly fortnightly or weekly injection intervals. The highest concentration of LAI patients were registered with Primary Care surgeries in areas reported as among the 10% most deprived nationally.

1. 1. LAI prescribing practice in NBRS, for those with psychosis, was consistent with national practice.

2. 2. Use of LAIs has particular resource implications for mental health teams.

3. 3. Use of SCAs could facilitate the transfer of care of LAI patients to Primary Care.

An impairment of real-life social functioning has widely been reported in patients with schizophrenia, even when clinical remission has been achieved. Negative symptoms, cognitive deficits and impairment of social cognition are the disease-related variables mainly associated to poor functional out come.

In the present study the above-mentioned disease-related variables were evaluated in a group of patients with schizophrenia and one of healthy controls (HC) in order to investigate their relative weight in affecting functional outcome.

To both patients and HC the Quality of Life Scale and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MATRICS-MCCB) were administered; the factor ’real-life motivation’ was extracted by the Quality of Life Scale.

Patients showed, with respect to HC, a deficit of learning abilities and speed of processing, as well as an impairment of the index of social cognition ’Managing emotions’. Multiple regression analysis showed that speed of processing and avolition explained 40% and 9%, respectively, of the variance for ’Common objects and activities’, as well as 27% and 8%, respectively, of that of ’Interpersonal relationships’.

Our findings indicate that functional outcome in patients with schizophrenia is influenced by cognitive deficit and by avolition but it is not affected by the impairment of social cognition. However, the complexity of this construct suggest to consider further indices of social cognition before to draw definitive conclusions.

Authors thank Compagnia di San Paolo-Neuroscience Call that funded the project Reward system and primary negative symptoms in schizophrenia'.

Some social cognitive subdomains such as emotion processing or theory of mind are impaired in schizophrenia. The relationship between social and general cognition and the development of specific symptomatology is still unresolved. Some authors have hypothesized that an overmentalizing pattern could underlie the development of paranoid symptoms.

1. To compare social cognition between patients with paranoid and non-paranoid schizophrenia; 2. To analyze the influence of general cognition in this result.

To identify a social cognitive error pattern associated with paranoid schizophrenia.

43 patients diagnosed with schizophrenia (24 with paranoid subtype and 19 with other subtypes) were recruited. Mean age of the sample was 43.2 y.o. SD 9.2, 72% were male and mean length of illness was 23 (SD 10.8). Spanish version of the Movie for Assessment of Social Cognition (MASC) and the Screening of Cognitive Impairment in Psychiatry (SCIP) were administered.

While the number of overmentalizing errors was similar between both groups, paranoid patients showed significantly fewer undermentalizing (p < .001) and nonmentalizing errors (p = .029). Overall, they showed better performance in social cognition (p = .03). Paranoid group also showed better performance in verbal fluency and processing speed subscales (p = .04). Finally, a significant correlation was observed between social cognition and cognitive function (r = 0.455, p = .002)

Patients diagnosed with paranoid schizophrenia show better general and social cognitive performance than non-paranoid schizophrenia. A tend to produce more overmentalizing errors was not observed in paranoid patients.

Brexpiprazole is a serotonin-noradrenaline-dopamine agent that binds with high affinity to multiple serotonin, norepinephrine and dopamine receptors. In particular, Brexpiprazole is a partial agonist at dopamine D2/D3 and 5-HT1A receptors and an antagonist at 5-HT2A and norepinephrine alpha1B receptors.

We assessed the efficacy and safety of brexpiprazole versus placebo as adjunctive therapy to anti-depressant therapy (ADT) in subjects with MDD who demonstrated inadequate response to ADT.

This trial had 3 phases: a screening phase (7-28 days); a prospective phase (Phase A): 8-week, single-blind placebo plus an investigator-determined, open-label ADT; a randomized phase (Phase B): 6-week, double-blind, adjunctive brexpiprazole (2 mg/day) vs. placebo in patients with an inadequate response to ADT.

The primary efficacy endpoint was the change from the end of Phase A (Week 8) to the end of Phase B (Week 14) in MADRS Total Score. The key secondary endpoint was the change in mean SDS score. Other secondary endpoints were mean change in CGI-S, IDS-R, HAMD and HAMA.

Of 379 randomized patients, completion rates at Week 14 were high (92.9%). Statistically significant improvements in mean MADRS Total score were observed for subjects receiving adjunctive brexpiprazole 2mg/day compared with placebo (p=0.0001) at endpoint. In addition, on all secondary endpoints Brexpiprazole showed a statistically significant advantage over placebo.

Commonly reported adverse events in the brexpiprazole group (>5% and more than twice placebo) were weight gain (8.0%), akathisia (7.4%).

Brexpiprazole was effective and well tolerated as adjunctive treatment for MDD patients with an inadequate response to ADT.

To evaluate efficacy and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, in obese (BMI =30kg/m2) and non-obese (BMI <30kg/m2) patients with schizophrenia.

Data from a 38-week, double-blind, active-controlled, non-inferiority study (NCT00706654); randomisation (2:2:1) to AOM-400mg, oral aripiprazole (10-30mg/day) (ARI), or aripiprazole once-monthly 50mg (AOM-50mg) assessing the efficacy and safety of AOM in patients requiring chronic antipsychotic treatment were used for this post-hoc analysis. We report the overall relapse rates in the 38-week randomized phase. Comparisons of overall relapse rates were analyzed using the Chi-squared test.

662 patients were randomized to: AOM-400mg (n=265); ARI (n=266); or AOM-50mg (n=131). Of these, the following were obese: AOM- 400mg: n=95; ARI: n=95; AOM-50mg: n=43. In the obese patients, the overall relapse rate was significantly (p=0.0012) lower with AOM-400mg (7.4%) than with AOM-50mg (27.9%). The difference between AOM-400mg and ARI (8.4%) was not significantly different. In the non-obese patients, the overall relapse was significantly (p=0.0153) lower with AOM-400mg (8.8%) than with AOM-50mg (19.3%). The difference between AOM-400mg and ARI (7.6%) was not significantly different. For patients treated with AOM-400mg, the most common TEAEs (>10% in any group) are presented in Table 1.

Table 1.

The efficacy and tolerability of aripiprazole once-monthly 400mg were similar in both the obese and non-obese subgroups.

Supported by Otsuka Pharmaceutical Development & Commercialization, Inc., and H. Lundbeck A/S