Placebo efect has been a controversial and hot topic within psychoneuroinmunology. However recent studies have shed considerable light on the potential mechanisms of placebo responses and their role in health outcomes.

The objective of this study is to analyze the effects of a process of classical conditioning on the evolution of the symptoms present in a case of multiple sclerosis.

Case study in a 40 years woman diagnosed with relapsing-remitting multiple sclerosis treated with natalizumab (Tisabri©).

The results support the consideration of multiple sclerosis as a stress-related disorder.

The role of expectations of improvement in the treatmente of multiple sclerosis is further discussed.

Cognitive symptoms in depression are associated with high distress, poor functional outcome and more relapses. Variability in cognitive deficits in depression is often reported, and may originate from numerous factors; one rarely examined factor is psychiatric history.

To assess the effects of depression and severe psychiatric history on old-age cognitive performance.

From a sample of non-demented participants (60+ years) in a population-based study receiving neuropsychological testing, three groups were formed based on information from the Swedish national inpatient register (1969-2005): current unipolar depression (ICD-10)/no psychiatric history (n=49), current unipolar depression/psychiatric history (n=16; F10-F45, F31-31.9 excluded), remission/history of mood disorders (n=35, F31-31.9 excluded). In addition, a group of healthy controls (n=98) was randomly selected.

Currently depressed participants without psychiatric history performed at a lower level compared to healthy controls in processing speed, attention, executive function, verbal fluency, episodic free recall and vocabulary. However, remitted participants performed at the same level as healthy controls, and outperformed currently depressed with psychiatric history in verbal fluency. No group differences were observed for short term memory, episodic recognition, general knowledge or spatial ability.

Currently depressed without psychiatric history consistently performed at the lowest level. The proportion receiving psychopharmacological treatment in this group was low, 6.1% compared to 56.2% and 37.1%, which may partially account for this finding. Additional factors potentially explaining why remitted participants and healthy controls perform at the same level cognitively will be examined. These findings may have important implications for preventing residual cognitive deficits in depression.

The progressive increase in the prevalence of anxiety disorders in advanced ages advises the extensive use of of screening measurements in this population, that, everywhere in the world, has raised numerically.

The aim of this study was to examine the psychometric properties of a Portuguese version of the Geriatric Anxiety Inventory-Short Form (GAI-SF, 5-item format) in a sample of 932 elders.

Quantitative and cross-sectional study with descriptive and correlational planning. Translation and back-translation was performed by language proficiency experts. The reliability was assessed through Cronbach's alpha coefficient and the factorial validity through Principal Components Analysis. The convergent validity was conducted with the Geriatric Depression Scale (GDS) and the Positive and Negative Affects Scale (PANAS-Negative sub-scale), while discriminant validity was performed with the PANAS-Positive sub-scale and the Satisfaction With Life Scale (SWLS). A Confirmatory Factor Analysis, using a structural equation modeling, was performed to test the fit of the model with the five items.

The GAI-SF showed good internal consistency (α = 0.77), good convergent, and discriminant validity (p < 0.05). The factorial structure presented a single factor that explained 52% of the variance. The model showed a good fit to the data (χ2= 1.233, TLI = 0.997, CFI = 0.999, RMSEA = 0.020).

The GAI-SF, a brief self-report scale, has good validity and reliability, and factorial qualities adequate to measure anxiety symptoms in epidemiological surveys and in geriatric settings.

In the recent years, interest of researchers has been focused on exercise as a possible way to efficiently influence brain functions and plasticity. Several studies concluded that exercise can change brain morphology by affecting synapses, neurogenesis and angiogenesis and improve efficiency in working memory and executive performance. In schizophrenia, white matter integrity is compromised and to what extent exercise affects white matter integrity is unclear.

To investigate the effect of 6 months exercise therapy on white matter integrity in healthy controls and patients with schizophrenia.

A total of 33 patients with schizophrenia and 48 healthy controls, matched for demographic characteristics, were randomized into exercise or occupational therapy/life-as-usual. 3T-DTI data were acquired twice. After susceptibility-artifacts and ECC correction, TBSS was used for registration to standard space and computation of the FA-skeleton. The JHU-ICBM-tract atlas was used to define regions of interest (ROI) for the various fiber tracts. Mean FA values for the FA-skeleton within the separate tract ROIs were calculated. GLM-repeated measures design was done with time as within-subject factor, group and therapy as between-factors, and compliance as covariate.

Significant increases in FA were found for time by randomization in the left corticospinal tract (LCST) (F=4,15, p=0,045), left superior longitudinal fascicle (LSLF)(F=5,092, p=0,027) and forceps major (F=5,687, p=0,02).

Exercise positively affects FA of tracts involved in primary motor functions (LCST), regulation of motor behavior, spatial attention, oculomotor functions and transfer of somatosensory information (LSLF) as well as interhemispheric connections (Forceps major) in both groups.

Antidepressants such as SSRI and SNRI are associated to sexual dysfunction (SD). Agomelatine, an antidepressant with an unique and different mechanism of action, didn’t produce SD in patients and healthy volunteeers (Montejo et al, 2010).

To evaluate the effectiveness of switching to agomelatine in patient's experiencing SD related to previous antidepressant treatment (AD-SD).

Observational prospective study of 2-6 months follow-up. Adult sexually active patients presenting AD-SD and switched to agomelatine monotherapy were included. SD was evaluated with the change at endpoint in the validated and specific questionnaire PR-Sex-DQ-SALSEX (Montejo et al, 2001).

51 patients were included. All of them presented moderate to severe SD at inclusion. Previous AD treatment was an SSRI (63.4%) or SNRI (36.6%). Mean time of follow-up was 10.38 weeks (Sd: 5.20). Mean dose of agometine was 28.43 mg/day (Sd: 10.02). Sexual dysfunction (sexual interest, orgasm delay, anorgasmia and arousal problems) improved after switching to agomelatine, as shown by the significant reduction in PR-Sex-DQ-SALSEX score (global and by items) at endpoint (p<0.001, Wilcoxon test). At endpoint 44.9% of the sample had resolved their SD. Moderate-severe SD was present only in 18.4%. 13.9% discontinued agomelatine due to lack of efficacy and 9.7% because tolerability issues, specially associated to discontinuation syndrome.

In our sample global and every domain of SD improved significantly after switching to agomelatine, what makes it an apparent successful option to manage Antidepressant-related Sexual Dysfunction. A gradual switching is suggested in order to avoid treatment failure due to discontinuation syndrome.

Socioeconomic instability might be related to increased suicidality and burden of mental disorders.

To explore the basic implications of the economic crisis from a health policy perspective, according to recent suicide data and unemployment in Greece.

A narrative review in PubMed/Medline and published data from the Greek Statistics Authority (ELSTAT) along with a hand search in selected Greek biomedical journals was undertaken, relevant to suicides, unemployment and mental health policy.

While for the years 2000-2010 the number of completed suicides ranged from 323 (in 2002) to 402 (in 2006), for 2011 the total number is 477 (393 males and 84 females), that is increased by 26,52% in comparison to 2010 (377), while the unemployment rate was approximately 27% during 2012. Although the annual growth rate in 2012 was -6,4, Greece is among the OECD countries with high health expenditure as a share of Gross Domestic Product (9.1 in 2011), but it doesn’t have a specified budget for mental health and is mostly depended in out-of-pocket expenditure (48%). The lack of cost-effectiveness and the informal payments comprise a major source of inequity and inefficiency. Despite the current reorganization of the whole mental health care delivery system, uneven regional distribution of psychiatrists exists. Mental health care facilities as well as extramural mental health units and rehabilitation places mostly uncover rural areas.

Prevention programs concerning mental disorders should be in the first line of Greek mental health policy, focusing in community networking and targeting in systematic assessment of interventions. A clear authority with defined responsibility for overall mental health policy and budgetary matters is needed.

In mental illness, the ability to make choices can be affected by impaired capacity. This study aims to assess the capacity to consent to treatment of patients with a psychosis on initial assessment and during on-going care using validated structured instruments.

To determine the prevalence of incapacity to give consent to treatment in patients admitted with a psychosis using a validated structured assessment tool, the MacArthur Competence Assessment Tool For Treatment (MacCAT –T) on admission and to determine the rate of recovery of capacity with treatment.

All patients who met the ICD-10 criteria and DSM-IV-TR criteria for a psychotic disorder were assessed using the MacCAT –T, PANNS and GAF within 48 hours of admission and again at 6 weeks and 12 weeks after treatment with an antipsychotic.

Out of a total of 56 patients, a siginificant majority showed an improvement in their abilities to give valid consent by 6 weeks following treatment and then again at 12 weeks based on the MacCAT-T. The rate of recovery of capacity was greater in the first 6 weeks than in the weeks after up to 12 weeks. Decreases in PANSS Scales and GAF scores were observed at 6 weeks and again at 12 weeks.

Based on these findings, the writers would advocate for early treatment of patients with psychosis where capacity is impaired as this is in keeping with protecting their rights to treatment during a period of illness and thus restoring their autonomy sooner.

Schizophrenia is a chronic disease; consequently, long-term maintenance of efficacy is an important clinical goal.

To evaluate lurasidone as maintenance treatment for schizophrenia.

To demonstrate maintenance of efficacy with lurasidone.

Adult patients experiencing an acute exacerbation of schizophrenia received 12–24 weeks of open-label treatment with lurasidone (40–80 mg/d, flexibly dosed). Those who maintained clinical stability for ≥12 weeks were randomized to placebo or lurasidone (40–80 mg/d, flexibly dosed) and entered the 28-week, double-blind withdrawal phase.

Of 676 enrolled patients, 285 met protocol-specified stabilization criteria and were randomized to lurasidone (N=144) or placebo (N=141). Relapse occurred in a greater proportion of patients receiving placebo (41.1%) than lurasidone (29.9%). Time to relapse based on Kaplan-Meier survival analysis was significantly longer for lurasidone compared with placebo (log-rank test, p=0.039). Lurasidone was associated with a 33.7% reduction in risk of relapse versus placebo (Cox hazard ratio [95% confidence interval], 0.663 [0.447, 0.983]; p=0.041). Patients receiving placebo demonstrated significantly greater worsening on PANSS and CGI-S scores compared to lurasidone-treated patients (PANSS mean change, +12.4 vs +8.3, p=0.029; CGI-S mean change, +0.7 vs +0.4, p=0.015; ANCOVA-LOCF). The discontinuation rate due to adverse events was 13.9% for lurasidone and 15.6% for placebo. Minimal changes in weight, prolactin, lipid, and glucose parameters were observed.

This study demonstrated the efficacy of lurasidone for the maintenance treatment of patients with schizophrenia. Lurasidone was generally well tolerated, with minimal effects on weight and other metabolic parameters.

Study sponsored by Sunovion Pharmaceuticals Inc.

ClinicalTrials.gov identifier: NCT01435928

1. 1) To find out the prevalence of ADHD in adults who attend the mental health services in Sligo / Leitrim county.

2. 2) To understand how many cases of ADHD are undiagnosed in the specific adult population

3. 3) To investigate comorbid illness.

All outpatients, aged 18-65 having a minimum of 5 years education, able to speak, read & write English language are included. patients with severe learning disabilities, patients with severe brain injury &with amnesic disorders were excluded.

1. 1) Two screening scales were used (Adult Self -Report scale, Wender Utah Rating Scale)

2. 2) Demographics (Age, Gender, Occupation)

The study is ongoing & preliminary data analysis shows :

184 people were screened

37 excluded (20%)

147 included (80%)

42.1(SD:12.6)

71 males (48.3%), 76 Females (51.7%) In the included category 60 were Positive at ASRS (41%), 46 were positive at WURS (31.5%), 27 were positive for both scales (17%)

The high percentages of ADHD in this particular population can interpreted in two ways. Many cases were missed during the childhood (unlikely) or that there is an overlap of ADHD symptoms with other psychiatric conditions in the adulthood. A third explanation is that both scales over diagnose ADHD but this is not supported from previous research.

in bipolar disorder, psychoeducation has already been shown as a helpful tool to make patients more aware of their disorder and helping them to develop skills towards prevention and early intervention, therefore preventing relapses requiring hospitalization.

to understand if our psychoeducation program helped to prevent new hospitalizations.

analysis of the medical records of all patients who had gone and concluded the program, from 2008 to 2012, measuring new admissions and which type of decompensations they had upon their hospitalizations, prior and after undergoing the program.

57 patients attended the program (48 female, 9 male); average age of 42.7 years old; 41 of them had already had one prior episode requiring hospitalization (70.23% with mania, 19.08% with depression, and 10.69% with a mixed episode). After psychoeducation, none of the patients who had never been hospitalized was admitted; 29.27% of the previously hospitalized (21.05% of the total) required one or more (62.50% with mania, 18.75% with depression, and 18.75% with a mixed episode). Only one new admission was needed to 75% of these patients. 25% of the re-admissions occurred in the same year of the program, all of them related to suspension of the medication.

our results converge with other publications. Psychoeducation does, indeed, seem to be a helpful way to prevent hospitalization, integrated in an individualized therapeutic plan. More efforts must be put to not only to accept more patients, but also to prevent new decompensations, possibly by starting the program right during the patient's hospitalization.

Cognitive distortions play an important role in the onset and maintenance of depressive disorders. It has not been investigated whether these distortions have trait like properties or are dependent on mood states. This study aims to find out this aspect. Our hypothesis is that as depression remits, the frequency of cognitive distortions will lessen.

For this study female outpatients (178 acutely depressed & 168 in remission) and their healthy female relatives (177 controls) presenting to the psychiatry clinics of three hospitals in Turkey were recruited. The participants were diagnosed according to DSM criteria by MINI. The participants were evaluated by IDS-C, and they filled out the Cognitive Distortions Questionnaire. The groups were compared with each other on these scales by appropriate statistical methods.

Except for the self-blame subscale scores, the highest scores were found in the acutely depressed patients, and the lowest scores in the healthy controls. The same subscales also managed to differentiate the patients in remission from the controls. Self-blame scores were found to be mood state dependent.

These results suggest that cognitive distortions, except for the self-blame subscale, remain activated even after depression remits. Therefore, cognitive distortions related to self-criticism, helplessness, hopelessness and preoccupation with danger should be continuously monitored, and targeted for therapeutic interventions, even after remission is achieved. Yet, the content analysis of these distortions highlight the fact that the most important depressive distortions may be related to self-criticism, which is a component of the classical cognitive triad.

transsexual populations seem to present specificities in brain structure, function and psychometrics, which may play an important role in adapting to the sex transition process.

to find neurobiological and psychometric features determining the adjustment to gender transition.

we assessed gender identity disorder diagnosed patients of our unit clinically and through MMPI-2, and secondly, we reviewed the literature on differential brain characteristics of this population.

some aspects of brain functioning may be changed by several factors, including early development and the effect of hormones in several stages of life; psychometric features may correlate with psychological adjustment and neurobiological changes, depending on psychosocial resources of the transsexual person.

clinical protocols in gender identity disorder management may benefit from longitudinal tailoring, taking into account neurobiological and psychometric aspects, as well as their interplay.

The treatment of tobacco dependence during the acute or withdrawal treatment of addiction patients remains a controversial topic, despite the positive data on its effectiveness.

Treatment objectives are not only tobacco abstinence but also a reduction in smoking in the sense of ‘harm reduction’.

During a six-month data collection period, all tobacco-dependent patients on an acute addiction ward were included in the treatment approach. The open programme lasted for two weeks (two group sessions and an optional individual consultation). Patients (treatment and placebo group) were assessed at four points in time (a pre-test, a post-test and a 3- and 6-month follow-up). A standardized questionnaire was assessed with focus on acceptance of the programme, motivation and changes in smoking behaviour.

A sample of n = 70 participants was studied (control group: n = 82). Although participation was mandatory, acceptance of the programme was good to very good. A total of 11.9% of the participants participated in the voluntary, manualised individual therapy sessions in addition to the group programme. Compared to the control group (brief information about tobacco dependence and nicotine replacement therapy), all participants showed a change in smoking behaviour and motivation to quit. During the acute treatment, 24.3% of the patients reduced their smoking and 4.3% even quit smoking. Data will be presented from the 3- and 6-month follow-ups.

The results indicate good acceptance, very good practicability and positive effects on smoking behaviour of early counselling and tobacco withdrawal in patients with comorbid addiction disorder.

Somatoform-type disorders or’medically unexplained’ symptoms (MUS) represent variable group of psychopathological syndromes. It is considered that sensory, emotional, cognitive and personality mechanisms play role in the genesis of MUS.

of the study was to analyze the relationship among personality types, clinical manifestations, and cognitive disturbances that occur in patients with MUS.

106 patients with different MUS were studied with the help of clinical and psychological tests - Minnesota Multiphase Personality Inventory (MMPI), 16 Personality Factors Questionnaire, Temperament and Character Inventory, Giessen Subjective Complaints List, Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale, Toronto Alexithymia Scale, Somatosensory Amplification Scale, Addenbrooke's Gognitive Examination, Frontal Assessment Battery, Dissociation Scale.

Five types of behavior patterns of patients with MUS were revealed with the help of MMPI profile analysis – schizotypical hypochondria (SH), hysterical hypochondria (HYH),’organic’ hypochondria (OH), depressive hypochondria (DH) and pshychovegetative subdepressive hypochondria (PVH). Patients with HYH, DH, PVH were characterized by alexithymia, high dissociation and amplification. Patients with OH had disturbances of memory and spatial gnosis. SH had high hypochondriac concerns (irrational health believes), subdepressive affect, disturbances of process of conceptualization.

MUS have complex psychopathological structure, which includes not only quantity of somatic complaints, intensity of hypochondriac concerns, evidence of anxiety and depressive symptoms. Important components of MUS are represented by cognitive style disturbances (alexithymia, dissociation, sensory amplification) and neurocognitive deficit (insufficient spatial gnosis, constructive and conceptualization abilities, memory, dynamic praxis). Different personality and behavior styles evidently integrate this continuum of disturbances in several superordinate somatoform-type syndromes.

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.