Psychopathy is characterized by superficial charm, untruthfulness, lack of remorse, antisocial behavior, egocentricity as well as poverty in major affective reactions. This clinical profile has been empirically conceptualized and validated. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. However, no reliable pattern of altered neural activity has been disclosed so far.

To identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology.

First, we used activation likelihood estimation to meta-analyze brain activation changes in psychopaths across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 analyses (P < 0.05, corrected). Second, we functionally characterized the ensuing regions employing meta-data of a large-scale neuroimaging database (P < 0.05, corrected).

Psychopathy was consistently associated with decreased brain activity in the right amygdala, the dorsomedial prefrontal cortex (DMPFC), and bilaterally in the lateral prefrontal cortex (LPFC). Consistently increased activity was observed bilaterally in the fronto-insular cortex (FIC) (Fig. 1). Moreover, we found that the physiological functional role of the candidate regions related to social cognition (DMFPC), cognitive speech and semantic processing (left FIC/LPFC), emotional and cognitive reward processing (right amygdala/FIC) as well as somesthesis and executive functions (RLPFC).

Psychopathy is characterized by abnormal brain activity of bilateral prefrontal cortices and the right amygdala, which mediate psychological functions known to be impaired in psychopaths. Hence, aberrant neural activity can account for pertinent psychopathology in psychopathy.

The authors have not supplied their declaration of competing interest.

To extensively review the European Court of Human Rights (ECHR) case law concerning psychiatric commitment, and to estimate the role of this supranational jurisprudence in the practice of contemporary psychiatry.

Using keywords to search the ECHR computerized database “HUDOC”, we reviewed all cases concerning psychiatric commitment registered between September 1953 and December 31, 2004. Four groups were identified: applications declared inadmissible; applications accepted but not judged by the Court; pending cases; and cases judged by the Court.

Of the almost 118,000 decisions taken by the ECHR in this time frame, we found 108 situations concerning psychiatric commitment. Forty-one of these applications were considered by the Court to be inadmissible. Twenty-four other cases were considered admissible but not judged by the ECHR. Three admissible cases were still pending at the end of 2004. The ECHR judged 40 cases, and found in 35 of them that one or several rights as guaranteed by the Convention had been violated.

The ECHR protects the human rights of persons subjected to involuntary psychiatric commitment by creating supranational law in the following areas: definition of “unsoundness of mind”; conditions of lawfulness of detention; right to a review of detention by a Court; right to information; right to respect for private and family life; and conditions of confinement, which address inhuman and degrading treatment. The respective number of applications submitted to the ECHR did not depend on when the Convention had entered into force in that country.

The possibility of an individual to access the ECHR depends on the degree of democracy in his country and on the access to legal assistance through non-governmental organizations or individual intervening parties.

Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.

Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.

Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.

Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.

Evaluation of non-medical interventions on cognitive and emotional competence in old age is among the goals of research in clinical gerontopsychology.

The goals of our study were to assess the impact of and analyze the differences between a cognitive training program, relaxation training according to Jacobson and a combination of both forms of intervention on cognitive performance, well-being and pain in older people.

26 care home residents (group 1) underwent the Jacobson relaxation training first, followed by a combination of relaxation and cognitive training. 24 participants (group 2) underwent a cognitive training program in the first instance followed by the combined intervention. Various psychological tests were implemented at three time points of measurement.

• - Significant improvement in dementia screening, in visual short-term memory and working memory both after the relaxation training only as also after combination training

• - Relevant improved performance in ultra short-term memory after combination training

• - Significant reduction in depression scores in both study groups

• - Relevant improvement in state of well-being after all training variants

Jacobson relaxation has a markedly stronger positive effect in optimizing the cognitive and emotional status of elderly persons compared to the more frequently propagandized and implemented cognitive training.

The authors aim to identify the main comorbidities in people with schizophrenia and define strategies to prevent it.

Literature review on Medline database.

People with schizophrenia have higher risk to have hepatitis, cardiovascular diseases, diabetes, overweight, sexual dysfunction and obstetric complications. This high vulnerability is associated with higher rates of preventable risk factors, such as smoking, alcohol consumption, use of street drugs, poor dietary habits and lack of exercise. Moreover, some antipsychotic medications used to treat schizophrenia have been associated with higher incidence of physical disease. At last, there are risk factors attributable to patients and healthcare services. Psychiatrists are often not trained in detection and treatment of physical disease. Despite this, there are several attitudes that can reduce the associated morbidity and mortality in people with schizophrenia, such as improving access to healthcare services, integrated healthcare interventions to enable early diagnosis and promotion of healthy habits.

Diagnosis and management of morbidity in people with schizophrenia are more difficult because obstacles related to the patient, the illness, the medical attitudes and the structure of the healthcare services. Regardless these difficulties, the increased frequency of physical disease in people with schizophrenia must be valued due to improved detection and treatment of medical disease will have significant benefits for their psychosocial function and overall quality of life.

The authors have not supplied their declaration of competing interest.

To provide information on the mental health care system in Berlin, Germany.

Using available data we report on the spectrum of mental health care services provided in Berlin, the number of professionalsworking in these sectors, funding arrangements, pathways into care, and user/carer involvement.

The health care system in Berlin consists of a network of inpatient, outpatient, ancillary, and rehabilitative facilities, all of which are meant to work in a synergistic fashion. However, although the individual treatment options are generally well-planned, there is still a lack of co-ordination between them. Currently, the entire network is threatened by cuts in state funding for ancillary and rehabilitative services, by further reductions in the number of hospital beds, and by insurance company cuts in prescription drug budgets, such as those used for atypical antipsychotics in outpatient care.

Despite many similarities with the situation in other European capitals, the system of mental health care in Berlin suffersfrom a variety of problems related to co-ordination and costs that are unique to the German capital.

The global burden of depression is high for women in both high income and low-and-middle income countries WHO. Depression is particularly common during pregnancy and in the postnatal period and phenomenology said to be the same as in non-child bearing age. Despite high prevalence of prenatal and postnatal depression in Pakistan, research on the effectiveness of psychological interventions is limited.

This study aimed to assess the feasibility of group interpersonal psychotherapy (IPT) intervention for maternal depression in Karachi, Pakistan.

A total of 50 mothers aged 18 years and above with children below 3 years of age, and experiencing mild to moderate depression were recruited. Assessments were done using Edinburgh Postnatal Depression Scale (EPDS) Rosenberg's Self-Esteem Scale and EuroQol-5D at baseline, 3 months, and 6 months. Rosenberg's Self-Esteem Scale and EQ-5D were also used to measure self-esteem and health related quality of life. Participants were randomly assigned into IPT plus treatment as usual (TAU) and TAU groups. Ten sessions of group IPT were delivered to intervention group.

Results indicated significant difference between intervention and control group on EPDS. The mean score at baseline for the IPT group (mean = 14.76) reduced to (mean = 6.40) (P < 0.000) at 3-month and to (mean = 6.64) (P < 0.001) at 6-month intervals as compared to TAU (mean = 11.44) (P < 0.000) at 3-month and to (mean = 11.08) at 6-month (P < 0.001) after randomisation.

IPT is a successful fit for women with maternal depression in low-income areas and IPT can be the appropriate treatment option as it is time limited, specific, and evidence based.

The authors have not supplied their declaration of competing interest.

At the present time, adolescents are in particular vulnerable to feelings of loneliness. They are gradually emancipating from their family and establish relationships with peers. Among the important predictors of loneliness belong genetic and personal variables and factors of social environment.

To examine predictors of adolescents’ loneliness which are located in family environment. To find out how empathy, emotional relationship and control by both of parents contribute to loneliness of adolescent boys and girls.

We examined 206 adolescents in the age from 10 to 18 years through Basic Empathy Scale, Parenting Style Scale and UCLA Loneliness Scale. Stepwise multiple linear regression analysis was used for data analysis.

The significant predictors of boys’ loneliness in family environment are emotional relationship of mother and affective empathy of father. The significant predictors of girls’ loneliness include emotional relationship and cognitive empathy of father. Parental control is not a significant predictor of adolescents’ loneliness.

Adolescents’ loneliness is largely influenced by factors of family environment. Our study highlights the role of emotional relationship provided by the opposite sex parent. Cold behavior of the opposite sex parent could reduce self-esteem and self-confidence of adolescents. Both could help them establish relationships with peers and people outside family, thus protecting them against loneliness. A significant predictor of boys’ and girls’ loneliness is also empathy of father. We recommend to make use of our findings in clinical practice with adolescents, in family therapy as well as in context of attachment.

The authors have not supplied their declaration of competing interest.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 1 year efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol dependent patients with high DRL from a randomised controlled trial [NCT00811941].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 187 patients: placebo N=42; nalmefene N=145 (mean age 46.2±11.9 years; 78% men; mean HDDs 19±6.3/month; mean TAC 101±45.0 g/day). Mean number of HDDs decreased to 7 days/month and mean TAC decreased to 33g/day at 1 year in the nalmefene group. At 1 year, there was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.6 [95% CI:-6.5;-0.7]; p=0.0164) and TAC -17.3 [-30.9;-3.8]; p=0.0129). Improvements in clinical status and in liver enzymes from baseline were larger in the nalmefene compared to the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

Involuntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.

All patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.

Although psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.

The results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.

The authors have not supplied their declaration of competing interest.

Depression/anxiety disorders and smoking behavior often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional,

To examine both adolescent smoking as a predictor of depression/anxiety disorders, and the effect of these disorders on adolescent smoking.

A representative sample of Catalan adolescents (N = 3008) participating in (PFI) a longitudinal study were interviewed about smoking behavior at baseline (T1) and at two follow-up assessments (T2 and T3). In interviews at baseline (T1) and at T4, the parents were asked whether their daughters/sons had a diagnosis of depression or anxiety. Smoking behavior was defined as smoking at least once a week. Age, sex and household income were included.

Depression/anxiety at T1 increases the risk of smoking behavior at T3 [odds ratio (OR), 1.97, 95% confidence interval (CI) 1.24-3.14] compared with undiagnosed adolescents. After adjusting for age and sex, the risk remains, but after adjusting for sex, age and income, the risk of smoking behavior decreases as household income increases [OR 1.6, 95% CI 0.9-2.85]. Alternatively, smoking behavior at T3 increases the risk of depression/anxiety at T4 [OR 1.7, 95% CI 1.1-2.5] compared with non-smokers. After adjusting for age and sex, the risk remains, but after adjusting for sex, age and income, the risk of depression/anxiety decreases as household income increases [OR 1.48, 95% CI 0.93-2.36].

Our findings provide the first evidence of a two-way relationship between adolescent smoking and depression/anxiety disorders in a community sample in Spain.