Young adult woman was admitted to our department with symptoms of depression. The patient had a history of sexual abuse in her childhood. After her admission she received antidepressive treatment with a selective serotonin reuptake inhibitor (sertraline) as well as supportive therapy.

After a four months treatment the patient suddenly disappeared from her hometown. Some days later she was found by the police in a city hundreds of miles away. She had no memory of her previous life and identity and named herself with a new name. The patient was diagnosed as having dissociative fugue. For five months after the diagnosis was made the patient remained amnesic for her identity and autobiographical memory. No pharmaceutical medication was administered; only psychotherapy. The patient begun to have suicidal thoughts which led to her hospitalization.

A course of electroconvulsive therapy (ECT) as well as SSRI medication (venlafaxine, initially 75mg and then 150 mg) was administered. Following the fifth course of ECT the patient recalled all of her past memory.

The electroconvulsive therapy has not been shown to be an effective or appropriate treatment for dissociative disorders; some authors have indicated that it may be important in relieving an associated depression.

There are no reports on the use of ECT for dissociative fugue.

This patients paradoxal recall of memory following a course of ECT treatment forced us to this announcement.

The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up.

Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models.

The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure.

Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.

Catatonia is a psychomotor syndrome frequently observed in disorders with neurodevelopmental impairments, including psychiatric disorders such as schizophrenia. The orbitofrontal cortex (OFC) has been repeatedly associated with catatonia. It presents with an important interindividual morphological variability, with three distinct H-shaped sulcal patterns, types I, II, and III, based on the continuity of the medial and lateral orbital sulci. Types II and III have been identified as neurodevelopmental risk factors for schizophrenia. The sulcal pattern of the OFC has never been investigated in catatonia despite the role of the OFC in the pathophysiology and the neurodevelopmental component of catatonia.

In this context, we performed a retrospective analysis of the OFC sulcal pattern in carefully selected homogeneous and matched subgroups of schizophrenia patients with catatonia (N = 58) or without catatonia (N = 65), and healthy controls (N = 82).

Logistic regression analyses revealed a group effect on OFC sulcal pattern in the left (χ2 = 18.1; p < .001) and right (χ2 = 28.3; p < .001) hemispheres. Catatonia patients were found to have more type III and less type I in both hemispheres compared to healthy controls and more type III on the left hemisphere compared to schizophrenia patients without catatonia.

Because the sulcal patterns are indirect markers of early brain development, our findings support a neurodevelopmental origin of catatonia and may shed light on the pathophysiology of this syndrome.

To identify the different factors associated with postpartum blues and its association with postpartum depression, from a large French cohort.

We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter cohort including 3310 women. Their personal (according to the Diagnostic and Statistical Manual, fifth edition [DSM-5]) and family psychiatric history, stressful life events during childhood, pregnancy, and delivery were collected. Likewise, the French version of the Maternity Blues Scale questionnaire was administered at the maternity department. Finally, these women were assessed at 8 weeks and 1 year postpartum by a clinician for postpartum depression according to DSM-5 criteria.

The prevalence of postpartum blues in this population was 33%, and significant factors associated with postpartum blues were found as personal (aOR = 1.2) and family psychiatric history (aOR = 1.2), childhood trauma (aOR = 1.3), obstetrical factors, or events related to the newborn, as well as an experience of stressful life events during pregnancy (aOR = 1.5). These factors had a cumulative effect, with each additional factor increasing the risk of postpartum blues by 31%. Furthermore, adjustment for sociodemographic measures and history of major depressive episode revealed a significant association between postpartum blues and postpartum depression, mainly at early onset, within 8 weeks after delivery (aOR = 2.1; 95% CI = 1.6–2.7), but also at late onset (aOR = 1.4; 95% CI = 1.1–1.9), and mainly if the postpartum blues is severe.

These results justify raising awareness among women with postpartum blues, including reassurance and information about postpartum depression, its symptomatology, and the need for management in case of worsening or prolongation of postpartum blues.

The sense of self-agency, i.e., experiencing oneself as the cause of one's own actions, is impaired in patients with schizophrenia. Normally, inferences of self-agency are enhanced when actual outcomes match with pre-activated outcome information, where this pre-activation can result from explicitly set goals (i.e., goal-based route) or implicitly primed outcome information (i.e., prime-based route). Previous research suggests that patients show specific impairments in the prime-based route, implicating that they do not rely on matches between implicitly available outcome information and actual action-outcomes when inferring self-agency. The question remains: Why? Here, we examine whether neurocognitive functioning and self-serving bias (SSB) may explain abnormalities in patients’ agency inferences.

Thirty-six patients and 36 healthy controls performed a commonly used agency inference task to measure goal- and prime-based self-agency inferences. Neurocognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) and the SSB was assessed with the Internal Personal and Situational Attributions Questionnaire.

Results showed a substantial smaller effect of primed outcome information on agency experiences in patients compared with healthy controls. Whereas patients and controls differed on BACS and marginally on SSB scores, these differences were not related to patients’ impairments in prime-based agency inferences.

Patients showed impairments in prime-based agency inferences, thereby replicating previous studies. This finding could not be explained by cognitive dysfunction or SSB. Results are discussed in the context of the recent surge to understand and examine deficits in agency experiences in schizophrenia.

Nalmefene may be helpful in the treatment of several other addictions by blocking the positive reinforcements of the drugs.

The authors have not supplied their declaration of competing interest.

Both major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)

Chart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.

Overall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).

The ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.

The authors have not supplied their declaration of competing interest.

The use of drugs to improve cognitive performance (pharmacological enhancement) is a practice that increases in frequency, especially in individuals with a high degree of academic education, university students, and workforce with high responsibilities. Legal substances such as alcohol and caffeine, prescription drugs such as modafinil or methylphenidate and some illegal drugs such as amphetamines or cannabis are utilized to improve cognitive performance, maintain wakefulness, or induce sleep. Perception of risk is low in many cases. Internet has facilitated the illicit access to prescription drugs with astonishing ease.

We want to exemplify through a clinical case, how the access to some of these substances through internet is very easy, and how, in this case, the use of Modafinil (drug indicated for narcolepsy) with the objective of maintaining academic performance aggravates symptoms of anxiety in a 22-year universitary patient.

Exposition of clinical case in the poster.

The use of substances (“smart drugs”) presents risks for both physical and psychological health that sometimes are not perceived by the user. It is surprising that a highly educated individual has taken Modafinil without researching for a deep understanding of the side effects of the drug.

Internet access of regulated substances that should only be prescribed by a physician to be used on very concrete symptoms is extremely easy. In the case of the Modafinil, it is possible to access its purchase by simply searching the words “purchase/buy Modafinil” in any internet browser.

The authors have not supplied their declaration of competing interest.

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 review epidemiology, pathogenesis, risk factors, consequences and current recommendations for therapeutic intervention.

Medline/Pubmed database search using the terms poststroke depression, depression and stroke, depression and cerebral vascular accident, stroke patients, published in the last 16 years.

The treatment of PSD has been shown effective in improving the evolution and prognosis of these patients, therefore it is very important early diagnosis.

The authors have not supplied their declaration of competing interest.

There are many controlled studies of Psychoeducation and Psychotherapy with differing type and length of treatment.

To find out the effects of a cognitive-psychoeducative group intervention

The aim of the study is to investigate the effects of a cognitive-psychoeducative group therapy (CPT) vs Treatment as usual (TAU) with additional information group in patients with ongoing stable pharmacotherapy on relapse prevention, compliance, coping-behaviour, illness concepts and quality of life.

Patients with BP I or BP II were diagnosed with MINI and treated either with 14 sessions of group-CPT (with 8 hours separate sessions for significant others) or got an information book for patients on bipolar disorder and 3 group-sessions of information and discussion with patients and relatives. Booster sessions were given for both groups after 6 and 9 months.Follow-up after 12 and 24 months. Evaluation was carried through on number and type of relapses, duration of inpatient episodes, with scales for mania and depression, WHO-QoL-BREV, Ilness-concept scale,Medication Attitude questionnaire (LAQ), Medication Compliance Questionnaire (MCQ), Coping (SVF-120).

100 patients with Bipolar disorder (76 BP I and 24 BP II) were treated (52 with CPT and 48 with TAU plus information group). After 14 weeks treatment there was an improvement in illness concepts and compliance in both groups.At 12-month follow-up there was a significant decrease in number of manic episodes in both groups, but for depressive episodes only in the cognitive-psychoeducative group.

CPT effective in relapse prevention, TAU+info effective against manic but not depressive relapses.

Proper recognition of facial expressions of emotion is crucial for human social relationships. Impairments in the capacity to process facial information may play an important role in the etiology and maintenance of certain mental disorders, especially music performance anxiety (MPA).

To assess the recognition of facial expressions of emotion in musicians compared to a group of subjects from the general population, considering also the presence/absence of MPA.

Hundred and fifty amateur and/or professional musicians who regularly take part in public performances (GM) and 150 subjects from the general population (GP) completed a task of facial emotion recognition and were assessed in terms of accuracy and reaction time. The group of musicians was subdivided between subjects with and without MPA indicators. Data were analyzed using Student's t test (P < 0.05) within the statistical package for the social sciences.

GM were less accurate and had a longer reaction time in the recognition of facial happiness (P < 0.001, effect size: 0.25–0.44) compared to GP. Musicians with MPA had a still lower accuracy in the recognition of happiness, as well as longer reaction times for emotions as a whole (P < 0.04; effect size: 0.32–0.40) compared to musicians without MPA.

The poorer performance of musicians in the recognition of happiness suggests difficulties to recognize indicators of social approval, which may negatively affect performance through increased anxiety and negative thoughts that can favor the onset of MPA.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.