Alcohol dependence is seen in approximately 15-20% of hospitalized patients. Delirium tremens is a serious manifestation of alcohol withdrawal. Understanding physicians' knowledge, attitudes and practices is vital to facilitate early recognition and timely management.

Assess knowledge, attitudes and practices of managing alcohol withdrawal in physicians in Tan Tock Seng Hospital, Singapore.

An anonymous self-administered survey assessing demographics, training experience, department of service, knowledge and attitudes was distributed between July to September 2014 to all registered medical practitioners in fifteen departments within the general hospital.

Six hundred and fourty surveys were distributed and 259 responses received with a response rate of 40.5%. Medical disciplines comprised of 55.1% of the responses and surgical 20.9%. Among the physicians surveyed, 61% were male, 39.8% were less than 30 years old, most were junior doctors/trainees (56%) and 71% saw 0-1 case of alcohol withdrawal/delirium tremens per month.

Overall, physicians felt they had been exposed to management of alcohol withdrawal, there was value in learning how to manage (71%) and learning how to manage should be part of core training (73.4%). Only 40.5% felt they were competent in managing and most felt it was not difficult to learn (43.7%). A majority (58.6%) felt they would be more comfortable if there was a protocol available and 36.6% hoped for more education in this area.

There are positive attitudes towards learning how to manage alcohol withdrawal and a protocol driven approach coupled with education as part of core training will be of value.

In our study, we compared the prevalence of alexithymia in diabetic patients with non-diabetic controls and investigated the relationship between Alexithymia and glycaemic control in diabetes.

In this cross-sectional study, TAS-20 scores of 100 diabetic patients and 50 non-diabetic controls were compared.

A structured questionnaire was used to collect socio-demographic data to describe the participants and aspects of their diabetes.

Prevalence of Alexithymia was not significantly higher than in the control (45% Vs 40%;p=0.56).

The diabetic study population was predominantly female (71%) and married (73%).

The average age in diabetic population: 56.21 years (ET=10.58); starting age: 46.8 years; average duration of diabetes: 9.41 years.

Alexithymic diabetic patients have more traumatic events (93.3% Vs 78.2%; p=0.035), especially such as the death of a parent (73.3% Vs 50.9%; p=0.022), than non-alexithymic counterparts. Factors such as comorbidities and presence of diabetic complications were not significantly associated with TAS-20.

Alexithymic diabetic patients were under a worse glycaemic control compared to their non-alexithymic counterparts (84.4% Vs 65.5%; p=0.031).

The high prevalence of alexithymia among diabetic individuals is an indicator of its importance in the approach to diabetic patients. The presence of alexithymia seems to be related to glycaemic control and might be of value in terms of risk stratification of the individual diabetic patient for developing diabetic complications.

It's known that media significantly contribute to the stigmatisation of mental disorders themselves, as well as the people suffering from such ailments. The aim of our study is to provide content analysis of media messages covering the topics of mental health and psychiatry.

The study sample comprises the media messages pertaining to the topic of mental illness collected by using the database of the Newton IT monitoring system. The articles were chosen from 6 printed most widely read daily periodicals, the period under consideration were 5 separate weeks randomly selected from the year 2007.

184 articles with mental illness as main content were found, including 110 in broadsheets and 74 in tabloids. Global impression of the message was negative in 76% of articles in tabloids and in 33% in broadsheets. The most represented diagnosis were Substance use disorders that were mentioned in 22% of all articles, on the other hand the representation of Neurotic disorders was quite low - 2% of all articles, Psychotic disorders were mentioned in 7% of articles.

The results relate to only a short time period, however, suggest that the degree of stigma of mental disorders in the Czech printed media is high and should be further analysed. The main outcome is to formulate the recommendations for media in order to meet anti-stigmatising objectives and thus improve media coverage, minimalize discrimination practises and increase help seeking behavior.

Functional recovery is the contemporary treatment goal in Major Depressive Disorder (MDD). Although consistency among physician and patient expectations may influence the therapeutic result (Demyttenaere K et al, 2011), patients’ perceptions are not always fully captured. Vortioxetine,a multimodal antidepressant, has shown encouraging data in achieving functional recovery, improving both mood and cognitive symptoms (Mahableshwarkar AR et al, 2015).

The aim of the study was to assess the effectiveness of vortioxetine on mood symptoms, cognitive symptoms and functionality, assessed by patient-rated tools, in MDD outpatients in Greece.

In this non-interventional study, vortioxetine was administered as flexible dosing (5-20 mg/d). Mood symptoms, cognitive symptoms and functioning were assessed by the patient-rated scales PHQ-9, PDQ-D and SDS respectively, at baseline, 1 and 3 months. Repeated measures analysis of variance and t-test were used for the statistical analyses.

336 patients participated in the study. PHQ-9 score ±SD decreased from 16.1±5.3, to 10.0±5.7 and 4.6±4.5, PDQ-D score ±SD decreased from 37.3±16.6 to 23.1±14.8 and 12.0±10.6, SDS Score ±SD decreased from 18.7±5.3 to 12.9±5.9 and to 7.8±6.5, at baseline, 1 and 3 months, respectively. The 3 SDS subscales: work/school life improved from 5.8±2.4 to 4.2±2.2 and 2.6±2.2, social life improved from 6.6±2.0 to 4.5±2.2 and 2.7±2.3 and family life improved from 6.3±2.0 to 4.3±2.1 and 2.6±2.3 -baseline, 1 and 3 months, respectively (p<0.001 for all paired comparisons).

MDD patients in Greece treated with vortioxetine significantly improved on mood symptoms, cognitive symptoms and functioning, enriching the already published efficacy data which is mostly based on clinician-rated scales.

A. Galanopoulos and E. Papalexi are full-time employees in Lundbeck Hellas.

The reported lifetime prevalence of depression in adolescents has increased drastically in recent decades. Depression in this population can be particularly damaging and can frequently have a long-lasting adverse impact. The common treatment approach includes psychological therapy and/or anti-depressant medication. However, the efficacy of these approaches, both singularly and combined, is far from conclusive. Recently, there have been an increased number of studies investigating the effect of exercise and physical activity on adolescent depression, however, despite this increased attention, there are no recent reviews and meta-analyses synthesising such studies.

The review examines the treatment effect of exercise on depression symptoms for adolescents aged 13–17 years of age.

A systematic search of seven electronic databases identified relevant randomised controlled trials. Screening, data extraction and trial methodological quality were undertaken by two independent researchers. Standardized mean differences were used for pooling post-intervention depressive symptom scores.

Eleven trials met the inclusion criteria, eight of which provided the necessary data for calculation of standardized effect size. Exercise showed a statistically significant moderate overall effect on depressive symptom reduction. Sensitivity analyses were also conducted and will be presented.

Exercise and physical activity appear to improve depression symptoms in adolescents, especially in clinical samples, suggesting that exercise may be a useful treatment strategy for adolescents with depression.

Despite the positive findings, large clinical trials that adequately minimise bias are required for firmer conclusions on the effectiveness of exercise as an antidepressant treatment.

The authors have not supplied their declaration of competing interest.

In Mental Health inpatient settings, we are working with a population with high levels of physical morbidity. However, this remains an area where Psychiatrists and Mental Health Nurses can lack confidence in the necessary skills. In other disciplines, simulation has provided an opportunity for safe practice of these and other skills. We describe the genesis and regional development of a multidisciplinary clinical simulation course that looks specifically at such ‘medical’ problems.

By the end of this presentation, the audience will: understand the rationale for the RAMPPS course; understand the development of the project; and understand the tangible benefits.

We aim to demonstrate that practising these assessment and initial management skills in a safe, controlled setting can result in improvements in confidence amongst healthcare professionals.

We have constructed a number of scenarios based upon real-life serious untoward incidents from inpatient wards. Using high-fidelity manikins, part-task trainers and actors, we produce realistic scenarios where Health Care Assistants, Staff Nurses and Doctors are all expected to work together. Learning objectives are mapped to relevant professional curricula.

Each professional group reports improvements in confidence across a number of domains. This is borne out in qualitative and quantitative data. Participants appreciate the value of training with colleagues from other disciplines, and feel peers would benefit from similar training.

Simulation is relatively underused in mental health. We demonstrate a way in which this educational approach can lead to improved confidence in managing deterioration in physical health in our inpatient population.

Motivation deficit is a significant aspect of lack of improvement in patients with schizophrenia especially with predominant negative symptoms (PNS). Therefore, improvement depends not only on symptoms reduction and better social functioning but also on patient engagement which is a key but less investigated aspect of successful treatment.

To investigate and compare patient engagement in PNS patients after cariprazine and risperidone treatment characterized by the 11 items of the Positive and Negative Syndrome Scale (PANSS-11).

In this phase 3 study patients suffering from PNS of schizophrenia (PANSS-FSNS≥24) were randomized to 26 weeks of treatment with either cariprazine or risperidone (target dose 4.5 and 4 mg/day, respectively). To compare the effects of the two drugs on patient engagement the PANSS-11 scale was used. Change from baseline (CfB) on the selected items and PANSS-11 total score were analyzed using mixed model of repeated measures approach without correction for multiplicity.

PANSS-11 total score mean CfB were -11.20 (SD=0.43) for cariprazine-, and -9.44 (SD=0.45) for risperidone-treated patients with a -1.79 (95% CI=-3.01, -0.56) mean difference (p=0.004) in favor of cariprazine. Most item differences were statistically significant (N1, N2, N3, N4, N5, G16) or numerically higher (N6, G7, G13) for cariprazine versus risperidone.

Cariprazine significantly improved patient engagement in patients with PNS of schizophrenia compared to risperidone based on the PANSS-11 post-hoc analysis. These results suggest that cariprazine treatment may improve not only the symptoms and everyday functioning of PNS patients but their engagement with life.

Studies were funded by Gedeon Richter Plc. and Allergan Plc (prior to its acquisition by AbbVie). Dr. Laszlovszky, Dombi, Balogh, Dr Barabassy, Dr Vass, Dr. Szatmári and Dr. Németh are employees of Gedeon Richter Plc.

Cluster B personality disorders (i.e., Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders), is characterized by a dramatic pattern of relating to others, with symptoms characterized by a difficulty regulating emotional states and behavior (APA, 2000). The desire to cause pain often characterized these disorders (i.e. borderline) involving vindictively harming another with serious and often negative interpersonal consequences. Nevertheless, there is a paucity of research about the nature of relationships between spitefulness and personality disorders.

This study aims to investigate the association between spitefulness and personality disorders in an offenders samples (N = 305).

To investigate the associations among spitefulness and personality disorders. We hypothesized that spitefulness would be differently associated with emotional and impulsive personality disorders (cluster B: antisocial, borderline, histrionic and narcissistic).

As expected, spitefulness and some personality, disorders were positively associated. Specifically, ASPD and Borderline are strongly associated with high levels of spitefulness.

Such results confirm the theorization that the assessment of spitefulness improve the accuracy of diagnosing of these personality disorders.

The authors have not supplied their declaration of competing interest.

Affecting over 120 million people, major depressive disorder (MDD) is characterized by low mood, lack of interest and a cluster of other vegetative and cognitive symptoms causing significant distress of functioning. It has a relapsing and recurring course and frequently becomes chronic. Thus, there is a need to further develop therapeutic techniques to improve the course and the prognosis of depressive disorders. Recent clinical trials suggest that botulinum toxin (BTX) treatment may also have an antidepressant effect.

The authors aim to conduct a non-systematic review in order to understand the relationship between MDD and BTX treatment.

To assess whether current evidence supports the BTX to treat major depressive patients.

A non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “botulinum toxin” and “depression”.

There is a small but growing body of evidence suggesting that botulinum toxin may be useful for the treatment of depression. The main hypothesis for the proposed beneficial effects of botulinum toxin is through the facial feedback. Low mood and depression are often associated with a sad facial expression. Injecting botulinum toxin and improving facial expression would lead to the improvement of depression symptoms.

Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin. It supports the concept that the facial musculature not only expresses, but also regulates mood states.

The authors have not supplied their declaration of competing interest.

Depression is a significant problem of our civilization. It is said that 10–20% of basic health care patients have depressive disorder. Its etiology is complex and multifactorial. Guilt feeling is one of accessory symptoms, but only small part of psychiatric literature is concerned with this problem.

The aim of the study was to find the correlation between guilt feeling and the level of depression and anxiety.

The study group involved 20 patients with depression diagnosed with ICD-10 criteria (14 females and 6 men aged 40–69 years). The depression level was determined using Beck Depression Inventory (BDI). The anxiety was assessed using State-Trait Anxiety Inventory (STAI) and guilt feeling using Interpersonal Guilt Questionnaire-67 (IGQ-67).

The results were statistically analyzed using Microsoft Excel. 5 patients didn’t have symptoms of depression in last week, 11 have mild-moderate and 4 moderate-severe depression. Weak, but not statistically significant correlations between interpersonal guilt feeling and the level of depression (r = 0,319), anxiety as state (r = -0,395) and anxiety as trait (r = 0,298) were found. Statistically significant was correlation between age and state anxiety (r = 0,138; p = 0,037).

There is no evidence of relationship between interpersonal guilt feeling and the severity of depression and anxiety. In elderly patients with depressive disorder the level of state anxiety is higher. It may be significant to the effectiveness of applied therapy.