Collecting prospective data on medication adherence, course of illness, course of treatment, cost effectiveness and quality of life among patients with schizophrenia under the German health system.

The ELAN study was conducted as a multi-centre, non-interventional observation study. 374 patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-10 F2) who had been discharged with a medication of quetiapine (N=183), olanzapine (N=91) or risperidone (N=100) were included. Follow-up interviews were conducted after 6,12,18 and 24 months. Applied instruments comprised PANSS, MARS-S, EPS-M, AIMS-S, GAF, ZST and a questionnaire for quality of life.

For each follow-up, at least 80% of the original sample could be included. After two years, between 39% and 43% of patients continued to take the drug prescribed at discharge. Only between 4% and 7% of patients received no neuroleptic treatment in the last 6 months, respectively. The variety of drugs used increased during the course. Only small differences could be found regarding the defined outcome measures (PANSS, GAF, rehospitalisation rate) and side effects. Changes in medication were mostly due to insufficient efficacy or side effects. Doctor's recommendations had an important influence on patients’ decisions.

Under conditions of routine treatment, medication adherence was much greater and differences between drugs were smaller than reported in randomised controlled clinical trials. Taking into account the low sample selection bias and the small percentage of lost-to-follow-up subjects, this study provides some new insight into routine clinical treatment and outcomes in patients with schizophrenia.

Apathy is commonly defined as lack of, or diminished, emotion, interest, concern, interest and motivation manifesting as poor engagement with others and loss of pleasure in usual interests. Occurs in various medical condition (stroke, HIV, dementia and Parkinson disease) and other psychiatric disorders. It has been related with thalamus stroke, and seen on clinical practice as a blunted emotional response and indifference.

We have tried to link cases of apathy associated with thalamic stroke and systematically review the literature for similar case reports.

We have searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database until October 2015. Published case reports of apathy in persons who had suffered a brain stroke were selected.

Support the evidence in the literature of the multidimensional nature of apathy and correlate the psychiatric manifestation with the neurological findings. We find similar case reports that could support the anatomical subtract of the apathy and it's also correlated with the previous data reports.

These findings are discussed and interpreted in the seeking of regarding the neurobiological substrate of apathy.

The authors have not supplied their declaration of competing interest.

Brain-derived neurotrophic factor (BDNF) gene may be involved in the pathogenesis of schizophrenia by virtue of its effects on neurotransmitter systems that are dysregulated in psychiatric disorder. The common functional polymorphism Val66Met (or rs6265) within the BDNF gene has been reported to be associated with age of onset in schizophrenia. We investigated the relationship between BDNF polymorphisms rs6265 and rs11030101 and early-onset schizophrenia in the Chinese population.

The tag single nucleotide polymorphisms (tag SNPs) rs11030101 and rs6265 in the BDNF gene were genotyped in 360 early-onset schizophrenics and 399 controls subjects. Single nucleotide polymorphism association and haplotype analysis were performed.

There were significant differences in allele and genotype frequencies between patient and normal control subjects for rs11030101 (χ2 = 5.130407, df = 1, p = 0.023553; χ2 = 6.121, df = 2, p = 0.047). No statistically significant differences were found in allele or genotype between patient and normal control subjects for rs6265. Stratification of the study by gender of the samples yielded significant evidence for an association with the polymorphisms rs11030101 in female population (genotype-wise: χ2 = 7.758, df = 2, p = 0.021).

Our study indicates that the BDNF play major roles in the susceptibility to early-onset and female schizophrenia in the Chinese population.

Schizophrenia has since over a hundred years been associated with autonomic dysregulation, but the prognostic importance of this phenomenon is unclear.

To explore measures in electrocardiograms (ECG) reflecting autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent outcome. Three aspects of routine ECG measures were investigated:

1. 1) differences between patients with first-episode schizophrenia spectrum disorders and healthy controls,

2. 2) relations to early discontinuation of first antipsychotic medication and finally

3. 3) associations to symptomatic remission status five years later.

Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization and left ventricular hypertrophy. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy (hazard ratios 1.3–2.4) and with non-remission five years later (odds ratios 2.9–6.4).

In this longitudinal cohort study, simple ECG measures reflecting autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. However, as this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

To examine the occurrence of suicide in urban and rural regions of Belarus in the post-Soviet period. Design: Unlinked cross-sectional study using data drawn from four time points.

Age and sex-specific suicide data for urban and rural regions of Belarus were obtained from the Ministry of Statistics for the years 1990, 1995, 2000 and 2005. The data were recalculated into seven age categories and then directly standardized. Poisson regression models were used to assess changes in urban-rural suicide rate ratios.

Between 1990 and 2000 the suicide rate rose sharply in Belarus and by 2005 it remained much higher than its initial level. After 1995 there was a divergence between sex-specific rates in urban and rural areas. By 2005 although suicide rates had fallen from their 2000 level for both sexes in urban and rural locations, the fall was much smaller in rural areas. These changes resulted in a deteriorating rural/urban suicide ratio across the period 1990 to 2005 with suicide rates among nearly every rural male age group remaining extreme after 1995. Although it is probable that a deteriorating social and economic situation has underpinned increasing suicide rates in all regions, there may be factors that are specific to rural locations such as social isolation, alcohol abuse and the poor provision of medical services.

By 2005 Belarus had one of the highest suicide rates in the world. This now requires urgent intervention by the necessary authorities to ameliorate this situation in urban and especially rural locations.

PTSD and post-traumatic spectrum symptoms represent the most frequently reported psychiatric sequelae of earthquakes and several studies have investigated the role of risk factors1,2. Aim of the present study was to explore PTSD and post-traumatic spectrum symptoms in L’Aquila (Italy) 2009 earthquake survivors and their correlations with age, gender and degree of exposure.

1488 subjects were investigated by means of the TALS-SR5. The total sample was divided, by random extraction, in 8 homogenous subgroups comparable for gender, age (≤40 vs >40 years) and direct/indirect exposure to the earthquake.

41.3% of exposed subjects presented PTSD vs 16.6% of not exposed. Women reported significantly higher PTSD prevalence rates and post-traumatic spectrum symptoms than men. Exposed subjects reported higher PTSD rates both in the whole sample and in all subgroups, with the only exception of younger men.

Our results confirm different vulnerability to PTSD after earthquake on the basis of gender, age and degree of exposure.

Depression is more present among psychiatric disorders in the world, global trends is known that cause high levels of human and social disability. A depression for elderly is not easy, especially to the elderly that are in institutional care without family support.

Measuring level of depression, recognition of characteristics for depression and relation with psychotic symptoms in elderly at the nursing home.

Presentation and description of depression in elderly, without family support at the Nursing Home for Elders in Pristina.

It is a quantitative study. Nursing home residents are assesed with the Beck questionnaire for depression and anxiety, was clinically interviewed and also with the Geriatric Depression scale. Data were analyzed with SPSS 21 and Microsoft Excel 2007.

Number of resident = 85 samples. Residents above 65 years old (the oldest at age of 84). 74 residents have had psychiatric difficulties; in 15 residents were identified psychotic symptoms. A level of depression was found in all cases, the presence of depression with Geriatric scale is confirmed in 83% of cases. Various findings are evident in correlation with socio-demographic data's, gender, somatic diseases, neurological problems. This shows the low level of their involvement in daily activities and rehabilitation.

Institutional, social and mental health care is essential for the category of elderly residents in nursing home. High levels of depression require appropriate therapeutic and psychotherapeutic approach in order to facilitate the quality of their lives.

Patient non-show to clinical appointments is a major component of nonadherence, specifically in mental health institutions, being twice that of non-show in other medical specialties, and is associated with a greater risk of morbidity and mortality.

Our study was conducted to assess the rate and factors associated with missed first appointments in an outpatient mental health clinic, in order to find correlates between the various factors and the probability of non-show among newly referred patients.

This was a retrospective study of 400 consecutive outpatients referred to a single regional mental health clinic in northern Israel during 9 months. Data was collected on sociodemographics, attendance rates, source of referral, the presence of chronic physical illnesses and time elapsed between referral to appointment. The findings were statistically analyzed to identify factors associated with patient non-show rate.

Of the 400 patients included in the study, the non-show rate was 39.6%. Patients who missed appointments were significantly more likely to be younger, to belong to the Arab sector and to wait longer for their appointment. They were less likely to be physically ill. Gender, marital status and source of referral were not significantly associated with the non-show rate.

Given the problematic potential outcome of non-show to mental health clinics, it is important to identify high-risk factors associated with non-show and unique to the population in question, so that interventions can be targeted at them, thus improving treatment outcome and reducing risk to patients.

The authors have not supplied their declaration of competing interest.

Danon disease is an X-linked cardioskeletal myopathy related to a primary deficiency in lysosome-associated membrane protein-2. Danon disease manifests with the triad of hypertrophic cardiomyopathy, myopathy and intellectual disability.Psychiatric symptoms related to the disease have only been studied in a few case reports (Hatz et al, 2010 and Tanidir et al, 2015) and a case series (Yardeni et al, 2016), leaving its pathophysiological mechanisms understudied.

Provide scientific data on psychotic symptoms in patients with Danon disease.

We report an unusual case of a 25-year-old-patient affected by Danon disease that showed an acute psychotic episode.

Mr P is a 25 year-old white male, with past medical history for Danon disease. Mr P presents hypertrophic cardiomyopathy, Wolf Parkinson White arrhythmia and carries an implantable cardioverter-defibrillator. There are previous records of mild intellectual disability and the patient had experienced anxiety symptoms as well as obsessive thoughts in the past without receiving any specific diagnosis or treatment. He was admitted to the Neurology inpatient unit to study behavioural symptoms with atypical visual and auditory hallucinations, accompanied by paranoid delusions during the last 4 days. He was examined by the liaison psychiatric team. Psychosis remitted within 72 hours after introducing risperidone 3mg per day, with good tolerability. Magnetic resonance imaging (MRI) scan was normal.

Danon disease is caused by heterogeneity genetic mutation which means that patients can present different levels of clinical manifestations. The current case report highlights the variety of psychiatric symptoms in patients with Danon disease, and raises awareness towards its identification and treatment.

No significant relationships.

Several studies show, that there exist different diagnosed psychological concomitant diseases with internet addiction. In order to point out the different kinds and frequentness of comorbidities with Internet addiction the Anton Proksch Institut Vienna and the University Mainz - Ambulanz für Spielsucht started a combined, compareable research project, which should show the similarities and differences of comorbidities of the interned addicted patients of both institutions.

In order to become comparable results of both Institutes, the same inquiry methods were used. For the diagnostic of Internet addiction the Scale for the Assessment of Computergame-Addiction (ACA-S), developed by the university medical center of Mainz, is used. In order to be able to cover a broad spectrum on possibly arising concomitant diseases, standardised surveytools are used from different, relevant areas of application. Therefore the Adult Attachement Scale (AAS), the Cambridge Depersonalisation Scale (CDS-9), the d2 (Test of attention), the subscale “Social Insecurity” of EDI-2 (Eating Disorder Inventory-2), the Liebowitz Social Anxiety Scale (LSAS), the NEO Five Factors Inventory (NEO-FFI), the Symptom Checklist 90R (SCL 90-R), the Sensation Seeking Scale V (SSS-V) and the Wender Utah Rating Scale (WURS-k) were used.

First current results of the investigation of comorbidities with internet addiction show a frequent arise of social anxiety, depression and attention deficit hyperactivity disorder (ADHD), which are in both samples remarkably.

The study illustrates, that the patients, which suffer from internet addiction disorder, often show comorbidities, which should be considered in the therapeutic work with Internet-addicted patients.

Obtaining early markers of predictive response in clinical practice has become a need in the management of depression.

To detect early (at week 2) clinical markers predictive of clinical response after 6 weeks of treatment with agomelatine in an open, naturalistic study.

2,780 outpatients were treated by Agomelatine during 6 weeks for MDD. They were assessed at baseline, week 2 and week 6 for the QIDS, a VAS assessing present level of mood, sleep complains (LSEQ), social functioning (SDS), and emotional state (MAThyS). ROC curves were used to assess the best balance between sensitivity and specificity for each parameter.

The patients were 47 years old in average (+/- 12.4), with 67% of females, with, in average, a 10-year course and 2 previous episodes.

The ROC curves showed that 20% improvement of the QIDS at week-2 had the largest area under the curve (AUC = .687). the CGI-EI (AUC = .671), and a simple VAS assessing the level of mood at week-2 (AUC = .659) had results in the same range. Treatment response, improvement of social functioning (SDS) or a decrease of sleep complains (LSEQ) were not significant, confirming that early improvement of sleep is not predictive of later response.

Early improvement at week 2 with agomelatine may be used to detect later responders. This improvement can be perceived both by clinicians (QIDS or CGI-EI) or patients (level of mood according to a simple VAS). to our knowledge, this positive predictivity has not been previously observed in a naturalistic study on MDD.

To assess the prevalence and gender characteristics of psychological health problems of raped individuals during the Bosnia-Herzegovina (BH) 1992–1995 war sixteen years after war quitted.

The study was carried out in BH, in January 2011. We assessed 95 (81 females) Bosniac (Muslim) war survivors who experienced raping as a tool of genocide, aged 50 ± 10.1 years (min. 32, max. 73 years), without gender significant differences for presence of posttraumatic stress disorder (PTSD), anxiety disorder, depression, somatic symptoms, anxiety and insomnia, social dysfunction, severe depression, prevalence of smoking and alcohol drinking. We used Harvard Trauma Questionnaire (HTQ), Hopkins Symptom Checklist (HSCL-25) and General Health Questionnaire (GHQ-28).

Respecting the DSM-IV criteria, in the whole sample of 95 raped victims, 90 (94.7%) met criteria for PTSD, 94 (98.9%) for anxious disorder, 93 (97.9%) for depression, 73 (76.8%) for somatic symptoms, 75 (78.9%) for anxiety and insomnia, 55 (57.9%) for social dysfunction, 53 (55.8%) for severe depression, 53 (55.8%) were cigarette smokers and 8 (8.4%) drunk alcohol. Women significantly more frequent presented anxious disorder 81 (100%) than amongst men 13 (92.9%), while men significantly more drunk alcohol than women (Chi-Square=5.847, P = 0.016; Chi-Square=15.635, P < 0.001, respectively).

Raped women were significantly more often anxious than men and raped men significantly more often drunk alcohol than women. There were no significant gender differences in the prevalence of PTSD, depression, somatic symptoms, anxiety and insomnia, social dysfunction, severe depression and smoking cigarettes amongst raped war survivors.

Researches on female offenders have indicated a high degree of psychiatric morbidity amongst women. Since the rates of female criminality are rising it would appear important to conduct the study of the relationship between criminal behaviour and psychiatric diagnoses in female offenders.

The main purpose of this investigation is to find out origins of crimes in women and to reveal the influence of child and adolescent maltreatment on personality disorders in adult women.

Clinical psychopathological, psychological, statistical.

A cohort of 24 females with diagnosis of personality disorders was examined. All of them had committed crimes of violence. In the majority of the sample women had a previous history of psychiatric admissions (child psychiatric hospitals, adolescent units). The retrospective review revealed that the majority of women in their childhood were exposed to emotional, physical and sexual abuse in their families. Our results point that maltreatment may distort personality formation and social adjustment and contribute to behavior problems, negative relation to socialization and criminal behavior in adulthood.

The study revealed that psychiatric disorders in childhood and adolescence are predictive of adult criminality in females. This findings may be used as prognostic indicators of development of aggression in female forensic patients.

The study is supported by the Russian Fund of Fundamental Investigations 6-06-00314

The authors have not supplied their declaration of competing interest.

To explore association of family stress with other psychosocial factors in female population aged of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” program random representative sample of women aged 25–64 years (n = 870) were surveyed in Novosibirsk. Questionnaire “Awareness and attitude towards the health” was used to estimate levels of family stress. Chi-square (χ2) was used for assessment of statistical significance.

The prevalence of high family stress level in women aged 25–64 years was 20.9%.

High family stress was higher in age groups 25–34 years and 45–54 years: 27.6% and 30.5%, respectively. Among women with family stress, 58.7% had high level of trait's anxiety. Women with stress at family had high rate of major depression (11%). There were tendencies of higher prevalence of hostility and vital exhaustion in those with stress (41.1% and 27.4%, respectively). Among those in female population with stress at family, 60.6% had sleep disturbances. Social support like close contacts and social network tended to be lower in women with family stress: 59.1% and 80.3%, respectively. Rates of serious conflicts in family were more often in younger age groups and reached 48.6%. In women aged 25–34 years, 54.9% have no possibilities to have a rest at home after usual working day (P < 0.001).

The prevalence of high stress in family in female population aged 25–64 years is more than 20% in Russia. High family stress closely associated with anxiety, major depression, high hostility and vital exhaustion, poor sleep and low social support.

The authors have not supplied their declaration of competing interest.