The ageing process is characterized by a high level of complexity, due to theco-occurrence of multiple chronic diseases (comorbidity) that often resultsin the concomitant use of multiple drug therapies (polypharmacy) fortreatment and prophylaxis. Institutionalized elderly may be regarded as theparadigm of this complexity because of their multiple chronic diseases anddecreased functional and cognitive functions.

To explore and characterize the prevalence of comorbidity and polypharmacy ina sample of institutionalized elderly.

A cross-sectional study was conducted with an elderly sample recruited fromthree Portuguese nursing homes. Clinical information was obtained throughinterview and by review of residents’ medical records. The AnatomicalTherapeutic Chemical/ATC classification was used to indicate the main groupof medicines used, and polypharmacy was categorized into minor (2–4medicines) or major (≥ 5). Comorbidities were coded using theindividual body systems of Cumulative Illness Rating Scale forGeriatrics/CIRS-G.

The sample included 175 elderly with a mean age of 81 (sd = 10) years andinstitutionalized for an average of 7 (sd = 11) years. Residents presented amean of 9 (sd = 4) co-morbid medical conditions, mostly psychiatric (80.8%),vascular (76.7%) and endocrine/metabolic (70.3%). Major polypharmacy wasverified for 73.9% of residents. The mean number of medicines was 7 (sd =3), most commonly for cardiovascular (86.0%) and nervous system (79.1%) andfor blood and blood-forming organs (69.2%).

As in other studies in similar settings, polypharmacy was fairly common.These results convey an important message considering that polypharmacy hasbeen associated with negative clinical outcomes that could otherwise bepreventable by reducing the number of prescribed medicines.

The authors have not supplied their declaration of competing interest.

Tramadol, initially introduced in Germany in 1977, is a synthetic analgesic and appears to have a dual mechanism of action; a weak μ-opioid receptor agonism and a reuptake inhibition of serotonin and noradrenaline. It is marketed in Tunisia since 2001. Generally, Tramadol is considered to have a very low risk of dependence and abuse, but rare cases of tramadol dependence have been described in patients without prior substance abuse history. We describe one such case in a relatively young, otherwise healthy patient.

Mr AR, a 47-year-old man, presented to get help with tramadol addiction. He had no previous history of illicit drug use, did not smoke cigarettes or drank alcohol.

Mr AR was started on tramadol treatment about 2 years earlier for back pain. He did have better pain control with tramadol, but he gradually started taking more and more. Ultimately, his pain resolved but he was unable to stop taking tramadol: he was taking up to 1700 mg/d of tramadol and had made multiple efforts to stop. When he stopped taking tramadol, he had dysphoria, muscle cramps, anxiousness, restlessness, and a sensation of insects crawling all over his body. His withdrawal symptoms were severe enough to interfere with his work and family life.

Tramadol dependence is very rare but can happen in a patient without substance abuse history. We, as medical practitioners, should be open to the possibility of tramadol dependence and should resort to optimal and judicious use of such a substance.

In the growing research field of early psychosis detection in patients with an at risk mental state (ARMS), most studies focus on the transition to frank psychosis. However, the majority of ARMS patients do not go on to develop frank psychosis and reported transition rates are declining. Little is known about the long-term outcome of these non-transitioned patients (ARMS-NT).

To investigate in preliminary analyses the long-term outcome of ARMS-NT patients with respect to persistence of ARMS signs and symptoms and the rates of late psychotic transition.

The ongoing study “FePsy-BHS-NT” follows up ARMS-NT without transition during at least the first two years for up to 15 years after their initial assessment. ARMS status is ascertained with the Basel Screening Instrument for Psychosis (BSIP). ARMS remission is defined as the absence of attenuated psychotic symptoms or brief limited intermittent psychotic symptoms for at least 12 consecutive months.

In this preliminary sample of 51 ARMS-NT, the majority of patients (70.6%) have remitted from their at risk mental state, 13.7% remain at risk and 15.7% have made a late psychotic transition during the course of long-term follow up (median = 5.75, range 4–11 years after initial assessment).

The considerable rates of ARMS persistence and late psychotic transition indicate that longer follow-up durations than commonly recommended should be contemplated in ARMS patients. Potential predictors of favorable long-term clinical outcome, as well as psychosocial, neurocognitive and other outcomes of ARMS-NT patients will be further evaluated in the present study.

The authors have not supplied their declaration of competing interest.

Recent findings demonstrated significant overlaps among major psychiatric disorders on multiple neurocognitive domains. However, it is not clear which are the cognitive functions that contribute to this phenomenon.

To find the optimal clustering solution using the two-step cluster analysis on a sample of psychiatric patients.

To classify into subgroups a cross-diagnostic sample of psychiatric inpatients on the basis of their neurocognitive profiles.

Seventy-one patients with psychotic, bipolar, depressive and personality disorders hospitalised at Psychiatric Diagnosis and Care Service of Bufalini Hospital of Cesena participated in the study. The symptomatology was assessed using Health of the Nation Outcome Scales-Roma and Brief Psychiatric Rating Scale. Cognitive functions were evaluated using Tower of London, Modified Wisconsin Card Sorting Test, Judgment and Verbal Abstract Tasks test, Raven matrices, Attentional Matrices, Stroop Test and Mini Mental State Examination. Two-step cluster analysis was conducted using the standardized scores of each neurocognitive test.

Two groups were obtained:– group 1, with good cognitive performances;– group 2, with almost all subjects having impaired cognitive performances.

Executive functions and attention are the major determinants of the cluster solution. The clusters did not differ on socio-demographic correlates. Different diagnoses were equally distributed amongst the clusters.

Two-step cluster analysis was useful in identifying subgroups of psychiatric inpatients with different cognitive functioning, overcoming other cluster techniques limitations. According to former literature, these results confirm a continuum of severity in cognitive impairment across different psychiatric disorders.

The authors have not supplied their declaration of competing interest.

Benzodiazepines impair cognitive function, especially in the elderly. The current analysis sought preliminary data on the effect of pregabalin on cognition in elderly patients with GAD.

Patients aged ≥65 years who met DSM-IV criteria for GAD, with HAM-A≥20 and MMSE≥24, were randomized to 8 weeks of treatment with flexible-dosage pregabalin (150-600 mg/d) or placebo. A subgroup (N=89; 81% female; mean age=70.4 years; mean HAM-A=27.3) completed a cognitive battery including the Digit Symbol Substitution Test (DSST) and the Set Test at baseline and endpoint.

At baseline, scores for pregabalin and placebo on the DSST were 13.75±3.51 vs 13.39±3.89 and on the Set Test 37.88±3.25 vs 37.63±3.69. There was significant (P<.05) inverse Pearson correlation between HAM-A item-5 (intellectual) and DSST (-0.32) and Set Test (-0.30) scores. There were also moderate inverse correlations between the DSST and HAM-A total score (-0.35) and age (-0.25). Weaker correlations (with the same directionality) were observed between the Set Test and these variables. At 8-week LOCF-endpoint, scores were comparable on the DSST (13.82 vs 14.54) and the Set Test (38.24 vs 37.95). Endpoint improvement in the HAM-A was moderately correlated with improvement in the Set Test (-0.23, P<.05) but not with DSST. Univariate and multivariate analyses showed treatment with pregabalin had no effect on endpoint cognitive function.

Pregabalin significantly improved the symptoms of GAD in patients aged ≥65 years and caused no impairment of cognitive function. A more extensive cognitive battery is needed to confirm this preliminary finding.

We compared the efficacy and safety of lamotrigine versus placebo for the treatment of acute alcohol hallucinosis comorbid depersonalization disorders.

10 days, randomized, double-blind, parallel study. A total of 40 patients with an ICD-10 diagnosis of acute alcohol hallucinosis comorbid depersonalization disorders were randomized to lamotrigine 300 mg/d (n = 40), or placebo (n = 40). The primary efficacy measure was the PANSS subscale for hallucinosis and Cambridge Depersonalization Scale (CDS).

Iamotrigine treated patients demonstrated a statistically significant greater improvement in PANSS subscale for hallucinosis and CDS than placebo-treated patients.

Lamotrigine demonstrated greater efficacy than placebo in treatment of acute hallucinosis comorbid depersonalization disorders and was generally well tolerated.

The purpose of this study was to investigation the relationship between the dimensions of Family communication patterns (conversation orientation and conformity orientation) with adolescents’ locus of control, self esteem, Shyness and communication patterns.

The participant in this study includes 367 students (232 girls and 135 boys) of first and second graders in high school in the first region of Tehran, that were chosen by available sampling method and filled the Revised family communication patterns questionnaire (RFCP), Levenson locus of control scale (IPC), Rosenberg self esteem questionnaire, shyness questionnaire of Cheeck and Buss and communication skills questionnaire. Regression analysis was used to predict each of the criterion variables by Dimensions of family communication patterns.

The regression analysis result revealed that the Family conversation orientation has a positive and significant relationship with internal locus of control, high self esteem and communication skills and predicts them positively. Also Family conformity orientation has a positive and significant relationship with external locus of control and shyness and predicts them positively. And has a significant negative relationship with self esteem and predicts it negatively.

The finding of present research show that the families with conversation orientation, who have the free, comfortable and rich relationships as a need of joyful family life, lead to the formation of internal locus of control, higher self esteem, less shyness and more communication patterns in children in comparison with the families with conformity orientation.

Previous research has suggested that the consumption of different types of alcoholic beverage may have a differential effect on suicide rates. The aim of this study was to examine the relation between the consumption of different beverage types and suicide rates in Russia across the later-Soviet and post-Soviet periods.

Age-standardised sex- and age-specific suicide rates for the period 1980–2005 and data on beverage-specific alcohol sales were obtained Russian State Statistical Committee (Rosstat). Time-series analytical modelling techniques (ARIMA) were used to examine the relation between the sale of different alcoholic beverages and suicide rates.

Vodka consumption as measured by sales was significantly associated with both male and female suicide rates. The consumption of beer and wine were not associated with suicide rates. The estimates of the age specific models for men were positive (except for the 75+ age group) and ranging from 0.069 (60–74 age group) to 0.123 (30–44 age group). The estimates for women were positive for the 15–29 age group (0.08), 30–44 age group (0.096) and 45–59 age group (0.057).

These findings suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce suicide rates in Russia.

Self-Concealment Scale (SCS) is composed of ten items to measure self-concealment, defined as a tendency to conceal from others personal information that one perceives as distressing or negative (Larson and Chastain, 1990).

To investigate the psychometric properties of the SCS-10 Portuguese version and of an adapted version containing two additional items specifically focused on self-concealment related do health problems (physical and psychological)–SCS-12.

The Portuguese version of the SCS-12 and other validated questionnaires designed to evaluate self-reported health, perfectionism and optimism-pessimism were administered to a convenience sample of 555 adults from the community (60.5% females; mean age = 43.49 ± 10.565).

The SCS-10 and SCS-12 Cronbach's alphas were α < 0.80. In both versions, all the items contribute to the internal consistency. The factor analysis, following the Kaiser and the Cattel's Scree Plot criteria, revealed that SCS-10 is unidimensional and that SCS-12 reliably and validly evaluates two dimensions: F1 Keeping secrets (Explained variance = 48.60%; α = 0.816), F2 Personal concealment including health problems (9.65%; α = 0.797). The pattern of correlations of the SCS dimensional and total scores was as follow: negative low correlations with physical health (@−0.20), negative moderate correlations with psychological health (@–.30), moderate correlations with self-oriented perfectionism, social-prescribed perfectionism, pessimism (@0.25) and optimism (@−0.20).

The Portuguese versions of SCS have good reliability and validity (construct and convergent-divergent). The factorial structure partially overlaps with the original. SCS could be useful for research proposes, namely in an ongoing project on the role of the mentioned personality traits on illness and health behavior.

The authors have not supplied their declaration of competing interest.

There is considerable evidence of cognitive impairment post COVID-19, especially in individuals with long-COVID symptoms, but limited research objectively evaluating whether such impairment attenuates or resolves over time, especially in young and middle-aged adults.

Follow-up assessments (T2) of cognitive function (processing speed, attention, working memory, executive function, memory) and mental health were conducted in 138 adults (18–69 years) who had been assessed 6 months earlier (T1). Of these, 88 had a confirmed history of COVID-19 at T1 assessment (≥20 days post-diagnosis) and were also followed-up on COVID-19-related symptoms (acute and long-COVID); 50 adults had no known COVID-19 history at any point up to their T2 assessment.

From T1 to T2, a trend-level improvement occurred in intra-individual variability in processing speed in the COVID, relative to the non-COVID group. However, longer response/task completion times persisted in participants with COVID-19-related hospitalisation relative to those without COVID-19-related hospitalisation and non-COVID controls. There was a significant reduction in long-COVID symptom load, which correlated with improved executive function in non-hospitalised COVID-19 participants. The COVID group continued to self-report poorer mental health, irrespective of hospitalisation history, relative to non-COVID group.

Although some cognitive improvement has occurred over a 6-month period in young and middle-aged COVID-19 survivors, cognitive impairment persists in those with a history of COVID-19-related hospitalisation and/or long-COVID symptoms. Continuous follow-up assessments are required to determine whether cognitive function improves or possibly worsens, over time in hospitalised and long-COVID participants.

Despite existentialism positing that existential concerns are universal, research into the existential issues related to addiction remains scarce. An existential model of addiction is lacking.

This research aims to develop an existential model of addiction, conceptualising the development of addiction through to authenticity.

A scoping literature review was carried out using PUBMED, reference lists and internet websites.

Psychopathology, from an existential point of view, occurs as a result of the avoidance of the existential givens which are death, freedom, existential isolation and meaninglessness. In this model, addiction is positioned as a coping mechanism to deal with the existential or neurotic anxiety which arises from facing or avoiding the existential givens. Addiction is defined as being-with-drug; a state in which our inherent relation to others is replaced by a relation with a substance. This state is understood from the ontological, axiological, ethical and praxeological levels, shedding light on the phenomenological experience of addiction. The existential dilemmas around meaning, loneliness, death, freedom, guilt and control while living with addiction are discussed. Finally, existential crises, boundary situations and secondary suffering are seen as the main motivators to overcome addiction.

Phenomenological and existential research support the fact that existential issues are relevant to addiction. This model explains the relationships between existential concepts and addiction, while providing a framework for clinicians to explore and address these issues with patients.

Auditory Processing Disorder (APD) is defined as a disorder in recognition, discrimination, separation, grouping, localisation or ordering of sounds.AP evaluation of children with learning disorders has two goals:1) to rule out an auditory processing disorder (APD) as a contributing factor for impaired cognition and 2) to diagnose APD in children with learning disabilities, in order to ensure appropriate remediation.

46 children were evaluated for Auditory Processing Disorders. 40 of them were fully assessed in 2 sessions each. 6 were lost to follow-up. We applied the: a) Peripheral hearing testing: Otoscopy, PTA, Speech audiometry b) AP battery:, Speech in noise, Duration Pattern Sequence (DPS), Pitch Pattern Sequence (PPS), Random GAP. C) Speech in noise: normative data from our lab. D) DPS,PPS, Random GAP: Standardized tests (Auditec, St. Louis). E) Learning Disability battery: WISC-III, Language tests (phonemic synthesis, non-words).

22 (of 40) 55% are diagnosed with Auditory Processing Disorders (at least 1 of the AP tests is pathological.) All 22 children with APD are already receiving appropriate treatment according to their auditory processing deficits and are being followed up for their progress. APD management strategies include: 1. Signal enhancement strategies 2. Specific Auditory Training 3.Linguistic, cognitive, metacognitive and educational strategies

Identification of underlying specific auditory deficits in the heterogeneous group of LD children may indicate what remedial action is appropriate, since appropriate management of the auditory processing deficits may lead to improved auditory as well as reading skills.

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.

To evaluate the 6 month 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 [NCT00812461].

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 317 patients: placebo N=162; nalmefene N=155 (mean age 44.8±10.3 years; 69% men; mean HDDs: 22±6.2/month; mean TAC 111±47.9g/day). Mean number of HDDs decreased to 10 days/month and mean TAC decreased to 43g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-2.7 [95% CI: -5.0;-0.3];p=0.0253) and TAC -10.3 [-20.2;-0.5];p=0.0404). Improvements in clinical status and alanine amino transferase were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events were more common with nalmefene; incidence of adverse events leading to dropout was at the placebo level.

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

The authors have not supplied their declaration of competing interest.

To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

Cognitive deficit is a significant problem in schizophrenic patients. It cannot be attenuated by any antipsychotic drugs. It has been known that changes of neuronal density is correlated with learning and memory deficits. Bacopa monnieri (Brahmi), popularly known as a cognitive enhancer, might be a novel therapeutic agent for cognitive deficit in schizophrenia by changing cerebral neuronal density.

To determine the effects of Brahmi on attenuation at cognitive deficit and on the neuronal density in the prefrontal cortex, striatum and cornu ammonis subfield 1 (CA1) and 2/3 (CA2/3) of hippocampus in sub-chronic phencyclidine (PCP) rat model of schizophrenia.

Rats were assigned to three groups; Group-1: Control, Group-2: PCP administration and Group-3: PCP + Brahmi. Rats were tested for cognitive ability by using novel object recognition test. Neuronal density from a serial Nissl stain sections of the prefrontal cortex, striatum and CA1-3 of all rats were measured by using Image ProPlus software and manual counting.

Sub-chronic PCP administration resulted in cognitive deficits in novel object recognition task. This occurred alongside significantly increased neuronal density in CA1. The cognitive deficit was recovery to normal in PCP + Brahmi group and this occurred alongside significantly decreased neuronal density in CA1.

Brahmi can be a potential cognitive enhancer against Schizophrenia. It reduces density of neuron in CA1. The reduced neuron is possibly glutamatergic neuron, which results in neuronal toxicity and cognitive deficit. Therefore, Brahmi eliminates glutamatergic excitotoxicity in CA1 and cognitive function is then recovery.