Neonates born in the winter and those with hypovitaminosis D levels exhibit a higher propensity to develop schizophrenia. Several reports have suggested that adult schizophrenics have lower vitamin D levels.

This study was done to evaluate the presence of hypovitaminosis D in institutionalized schizophrenics.

To compare vitamin D levels in institutionalized patients with schizophrenia.

We retrospectively reviewed the vitamin D results on all schizophrenic patients seen in our office during a period of six months. Vitamin D was measured as 25-hydroxyvitamin D in the blood and reported as ng/ml. The levels were recorded and classified as follows: more than 30 ng/ml: normal; 21 to 30 ng/ml: mild deficiency; 11 to 20 ng/mL: moderate deficiency; 10 ng/ml or less: severe deficiency.

Total of 83 patients, 63 had vitamin D levels measured. 46 (73%) had low Vitamin D levels, while 17 (27%) had normal vitamin D levels. Of the 26 females, 20 (77%) had low vitamin d levels and of the 37 males, 26 (70%) had low vitamin D levels. 10 of the 63 had severe deficiency, 22 of the 63 had moderate deficiency while 14 of the 63 had mild deficiency. No difference was noted between the males and females.

It is estimated that as much as 60% of the adult US population suffers from vitamin D deficiency. Our population of institutionalized schizophrenia patients had a 73% incidence of hypovitaminosis D. It may contribute to the higher morbidity and mortality noted in this population.

Patients with chronic kidney disease (CKD) have more cognitive impairments. However, the etiologies are not fully clear. Plasma homocysteine levels and vascular burden rise in CKD; meanwhile, high homocysteine levels and vascular factors are known risk factors of dementia in non-CKD patients. Thus, we aimed to investigate the association between homocysteine, vascular burden and cognitive impairment in CKD and to see if the effect of elevated homocysteine on cognitive impairment mediated by vascular factor.

146 patients with CKD and 69 normal comparisons were recruited. Cognitive function was evaluated by comprehensive neuropsychological tests assessing processing speed, executive function, language, visuospatial function, memory, and attention domains. Vascular burden was assessed by Framinghan cardiovascular risk scale (FCRS) which indicates risk of atherosclerotic diseases including stroke.

In controlled analysis, patients with CKD had lower scores in all cognitive domains, and had higher homocysteine levels (18.5±6.4 vs. 9.8±2.9, p< 0.0001) and FCRS(17.0±4.7 vs. 14.0±4.7, p< 0.0001). Among patients with CKD, higher homocysteine levels (p=0.026) were associated with lower score on digit symbol task which is related to processing speed and executive function with controlling for age, sex, education and stage of CKD. The association persisted (p=0.047) after controlling for vascular risks.

Patients with CKD had extensive cognitive impairments. Elevated homocysteine levels may be an risk factor, which is independent of vascular burden, of cognitive impairment on processing speed and executive function. Further studies to investigate if normalization of homocysteine can improve cognitive function will be suggested.

High rates of anxiety symptoms among medical students have been observed in many studies. Autonomic symptoms are indications of anxiety somatization. Reports about gender variations in anxiety and autonomic lability are contradictory and require further researches.

To investigate changes of state anxiety, autonomic symptoms among medical students in various study periods and role of gender variations.

54 medical students (28 female and 26 male) of I.M. Sechenov Moscow State Medical University were recruited in this study. Participants were assigned unique identification codes. We used State and Trait Anxiety Inventory (STAI) and Vein’s Autonomic Symptoms Questionnaire (VASQ). State anxiety and autonomic symptoms were defined three times: 2 weeks, one day before the exam and after examination. ANOVA, correlation and t-statistics methods were used to analyze data.

Changing of study situation influenced lability of state anxiety (ANOVA, F= 3,23; p= 0,04). We found gender differences in autonomic symptoms’ penetration in 1st (p= 0.05), 2nd (p< 0.05) and 3rd (p< 0.01) periods; state anxiety varied in 2nd period (p< 0,05) only. Correlation between autonomic symptoms and gender was found in 1st (r= 0,46; p= 0,003) and 2nd (r= 0,901; p< 0.001) periods; correlation between state anxiety and gender was moderate in 2nd period (r= 0,55; p< 0.001).

Statistical significance was achieved between a level of anxiety and various studying situations. Correlation between gender and both state anxiety and rate of autonomic symptoms was found. State anxiety and degree of autonomic symptoms was significantly higher in female.

Donepezil, a centrally acting acetylcholinesterase inhibitor (AChEI), is approved for symptomatic relief of cognitive impairment in patients with Alzheimer's disease and Vascular Dementia (VD). Several adverse effects were reported and the most common are gastrointestinal disturbances. Others include bradycardia, agitation and confusion. Although epileptic seizures are listed as a side effect, there are few reports.

To present a case-report of donepezil-induced epileptic seizures and a review study regarding the theme available in Medline.

Brief literature review.

A case report is presented and literature of this theme shortly reviewed.

The case involves a 62-year-old female diagnosed with VD 6 months previously. Her medical history included a cerebrovascular accident 24 months earlier. She started the treatment with donepezil 5 mg and 48 hours later she was admitted in the Emergency with convulsions. She was unconscious for 20 minutes with urinary incontinence and bitten tongue. Normal blood analyses. A contrast brain CT showed a mild degree of cortical atrophy without new structural lesions. EEG showed mild and diffuse neuronal dysfunction with no grafoelements indicative of epilepsy. Donepezil was discontinued, no therapy was instituted and the patient has been convulsion free.

The mechanism of convulsive action of AChEIs isn’t clear. There are reports about centrally acting AChEIs inducing convulsions in patients with Dementia without any underlying neurological condition. Further research is needed to delineate the frequency of this effect and to extend our knowledge of the underlying pathophysiological mechanism in order to determinate the safety profile of AChEIs.

Cerebral activity during can be approached by the measurement of functional activity in healthy young people. Functional activity reflects the statistical dependencies among near and distant brain regions by generalized partial directed coherence (GPDC).

Sleep stages of 9 healthy young subjects without somatic, psychiatric and sleep disorders were defined in accordance with the Rechtschaffen and Kales criteria (Wake, stages 1 to 4 and REM sleep). In regard of specific sleep EEG frequencies (delta, theta, alpha, sigma and beta), the first 20 epochs of each sleep stage were used for analysis. GPDC was applied between each electrode and each other of the 19 EEG electrodes.

In comparison to wake and REM sleep, GPDC showed increased interdependencies across each NREM sleep stage. Lower sleep EEG frequencies increased these changes. Moreover, during slow EEG rhythms, differences observed across stages were more pronounced. In addition, differences between bands were more marked during wake and sleep stages 1 and 2. None differences were observed for GPDC values between both sides of human brain. In the right hemisphere as well as in the left one, GPDC is similar between sleep stages in delta frequency while GPDC differed from wake to other sleep stages in theta, alpha, sigma and beta EEG frequencies.

A different mapping in the three classical sleep states (Wake, NREM and REM sleep) is showed by generalized partial directed coherence in sleep EEG frequencies. Additional studies investigating the directional information flow should be performed to complete our results.

Some patients have a chronic and/or recurrent form of the disorder. Reasons of treatment resistance have been described, but the neurobiological basis of disorder gravity is unclear.

Examine if the hyperactivity of right and left amygdala, left posterior cingulate cortex or left dorsolateral prefrontal cortex predict the treatment effect of Cognitive Behavioral Therapy (CBT).

The aim of our study is to test the hypothesis of treatment predictability in panic disorder patients in fMRI.

24 patients meeting the ICD-10 criteria for panic disorder with or without agoraphobia. Patients were studied in fMRI during the exposition of threat-related words compared with neutral words and emotional faces compared with fixation points. Patients were studied in fMRI scanner before and after CBT treatment. Psychopathology was assessed using Clinical Global Impression rating scale (CGI) and Beck Anxiety Inventory (BAI). Patients were divided into responders and non-responders groups by the 25% reduction in BAI scale.

Significant reduction of activity was observed in responders on the right amygdala, while the left amygdala decreased activity is lower, and could be the effect of habituation. Incresed activation of left Broca’s area 46, and 45 was negative treatment effect predictor.

Negative treatment effect predictor is hyperactivity in left dorsolateral prefrontal cortex BA 46 and 45. Positive predictors are higher reactivity of right amygdala for anxious faces, activation of right angular gyrus, right insula, right temporal pole.

Supported by the project IGA MZ CR NT 11047-4/2010

Some studies showed that nicotine withdrawal may increase the likelihood to develop anxiety or distress.

Nicotine withdrawal symptoms (NWS) may specifically provide an opportunity to learn that physical sensations can be aversive, thus anxiety or distress-provoking.

We evaluated whether NWS predict the responding to a test inducing distress, the so called Breath Holding (BH) test, in regular smokers evaluated under nicotine withdrawal conditions or under non withdrawal conditions. Specifically, we studied if fear or discomfort are felt as a response to the test inducing distress.

We run a cross-over design study on current smokers. Each subject received either nicotine and placebo in two different test days according to a randomized, double-blind order. Four hours after the administration of nicotine or placebo, each subject underwent the BH test. Fear and Discomfort were evaluated by means of a Visual Analogue Scale (VAS-F for Fear and VAS-D for Discomfort).

20 subjects (10 females and 10 males) with a mean age of 32,05 ± 10,13 years were studied. At baseline the two conditions did not differ. No statistically significant results were found for VAS-F and VAS-D in terms of response to the BH test.

NWS seem not to affect the response to a distress test in current smokers at least when fear or discomfort are taken into account.

To report a case of isoniazid-induced delirium.

A 56-year-old man affected by alcoholism and hepatic cirrhosis was admitted to hospital for a suspected pneumonia with pleural effusion and thickenings. A Mantoux skin test was positive. A core biopsy of the pleural nodules revealed a tubercular granulomatous pleuritis. An isoniazid, ethambutol and rifampicin therapy was then started. Subsequently the patient developed a state of delirium. A diagnostic work-up was carried out considering different hypothesis: hepatic encephalopathy was ruled out because of lack of response to appropriate treatment; negative encephalic CT scan, liquor examination and EEG excluded a tubercular involvement of the central nervous system or other neurologic etiologies. Haloperidol and delorazepam were administered under the suspicion of Wernicke-Korsakoff syndrome, without any benefit. Finally a toxic etiology was considered. Among isoniazid side effects psychosis is described, though rare. Isoniazid therapy was then stopped and substituted by moxifloxacin, with progressive improvement of the state of consciousness.

Cases of isoniazid-related psychiatric disorders reported include psychosis, obsessive-compulsive disorder and mood alterations. Two mechanisms are generally considered as responsible: pyridoxin deficiency and isoniazid toxicity, a molecule chemically near to iproniazid, a powerful monoamineoxidase inhibitors. This is the first report of a case of isoniazidinduced pure delirium, with all clinical features according to DSM-IV criteria. We also confirmed successful resolutions of symptoms only by discontinuation of therapy.

In the work-up of a state of delirium, when investigating the toxic hypothesis, clinicians should consider neuropsychiatric side effects of isoniazid.

Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways.

Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether.

To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran.

A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding.

Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence.

Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family.

The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.

Over the last decades, acupuncture has been seen as an acceptable primary detoxification treatment for opiate dependence, and currently used to relieve the severity of opiate withdrawal symptoms among MMT patient.

To investigate the effectiveness of electroacupuncture treatment in reducing opiate withdrawal symptoms among MMT patient.

This was a pilot study with randomized, single-blinded, and parallel. Recruitment of 22 subjects, 11 in methadone treatment + acupuncture and 11 in methadone treatment without acupuncture. The severity of withdrawal reaction was assessed by Objective Opiate Withdrawal Scale (OOWS) and Subjective Opiate Withdrawal Scale (SOWS) at baseline, third, fifth, seventh, tenth and fourteenth day of treatment.

One way Analysis of Variance (ANOVA) comparing the mean scores of the OOWS between treatment and control group has shown at tenth day of treatment p value is 0.026 and at fourteenth day p value is 0.022. One way ANOVA comparing the mean scores of the SOWS between treatment and control groups has shown at tenth day of treatment, p value is 0.015 and at fourteenth day, p value is 0.009.

The study has shown the promising results, where electroacupuncture treatment had an effectiveness in relieving opiate withdrawal symptoms among MMT patient.

Gender differences in psychopathological symptoms have frequently been found in chronic schizophrenia and first-episode psychosis (FEP) patients. However, many of the existing studies suffer from methodological problems. Furthermore, very few studies have investigated gender differences in at-risk mental state (ARMS) individuals.

To investigate whether male and female ARMS and FEP patients differ in self- and observer-rated psychopathological symptoms when adjusted for potential confounders.

Psychopathological symptoms were assessed in 117 ARMS and 87 FEP patients by two observer-rated scales:the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and one self-report scale,the Frankfurt Complaint Questionnaire (FCQ). Gender differences were investigated by applying Analyses of Variance using the BPRS, SANS and FCQ subscales as dependent variables and, group and sex as between-subject factors. Furthermore, Analyses of Covariance were conducted by including age, antipsychotic, antidepressant and cannabis use as covariates.

No significant gender × patient group interactions were found, suggesting that gender effects did not differ between patient groups. Women showed higher scores in positive psychotic symptoms (BPRS Psychosis/Thought Disturbance) while men had higher scores in negative symptoms (BPRS negative symptoms, SANS total score, and subscales Affective Flattening, Avolition-Apathy and Asociality-Anhedonia). However, the differences did not withstand correction for multiple testing. Furthermore, these results did not change when corrected for potential confounders.

Our findings suggest that male and female ARMS and FEP patients do neither differ in self-report nor in observer-rated psychopathological symptoms when corrected for multiple testing and potential confounders.

Premenstrual dysphoric disorder is a premenstrual syndrome comprising physical and psychic symptoms. Bipolar disorders, particularly “soft” forms, share symptoms such as depressive mood, irritability or mood reactivity with premenstrual dysphoric disorder, posing challenges on differential diagnosis. In the present work a case of a woman suffering from cyclothymia is reported, with mood episodes confined in the luteal phase of the menstrual cycle.

Case Report.

A 42-year-old married Caucasian woman is presented, suffering from mood disorder episodes lasting for 10-12 days each, during the luteal phase of the menstrual cycle, and remitting after the beginning of her menses. The mood episodes occurred since the age of 20, in almost every menstrual cycle. The patient described hypomanic symptoms during the first 4-5 days of the luteal phase, reporting irritable mood, pressured speech, increased libido as well as vividness of her perceptions and excessive goal-directed activity. The hypomanic symptoms were followed by irritable and depressive mood, fatigue, hypersomnia, tearfulness, decreased self-esteem and pessimism, lasting for another 6-7 days. The patient also reported migraine and binge-eating episodes during each depressive phase. A full range of examinations, including blood and hormonal tests, yielded normal results. Lamotrigine was titrated at 200 mg/day, with subsequent amelioration of symptoms.

The exact relationship between premenstrual dysphoric disorder and other disturbances, which either coexist, or deteriorate premenstrually, or even synchronize with the menstrual cycle, has not been elucidated yet. Studies aiming at a better understanding of this relationship could aid at accurate diagnosis and treatment.

Professional guidelines for forensic interviews of children have emphasized cognitive factors associated with children's memory retrieval and paid less attention to the emotional factors that may inhibit the cooperativeness of reluctant interviewees.

The current study explored whether an additional focus on rapport-building altered the dynamics of interviews with alleged victims of intra-familial abuse, and increased abuse disclosures.

426 4- to 13-year-old suspected victims of intra-familial abuse were interviewed using either the NICHD Investigative Interview Standard Protocol (SP) or a Revised Protocol (RP) designed to enhance rapport between the child and interviewer.

Children were more likely to make valid (corroborated) allegations of abuse when the RP was employed, with variation according to age, gender and prior disclosure. Similar patterns were evident in a larger sample of 1424 which included non-corroborated cases.

Subsequent analyses focusing on a subset of interviews (n=200) were designed to explore differences in the dynamics of the interviews using the SP or RP which may account for the increase of allegation rates using the RP.

The interviews were coded to identify expressions of the interviewers’ support and the children's reluctance and uncooperativeness in the pre-substantive portions of the interviews.

As expected, RP interviews contained more supportive comments and fewer unsupportive comments. Children interviewed in this way showed reduced reluctance, with remarkably fewer expressions of resistance and denial but also fewer omissions.

Focus on rapport-building altered the interview dynamics, rendering reluctant children more cooperative and more likely to disclose their abuse.

Fear of crime is a kind of unpleasant and often intense emotion caused by perceived risk of being victimized. It is evidenced that fear of crime has tremendous impacts on the mental health of older people who resort to avoidance behaviors for self-protection.

This study examined the impact of fear of crime on the mental health and avoidance behavior of the communitydwelling older adults living in urban China.

For the present study, data were collected from a representative sample of 453 older persons aged 60 years and above from Kunming, Yunnan province using face-to-face interview. Associations between fear of crime and mental health, and avoidance behavior were measured using linear regression.

The final sample ranged from 60 to 100 years of age (Mean = 72.29, SD = 8.27) and included 198 (43.7%) males and 255 females. Preliminary results showed that 258 participants (57.0%) reported fear of one or more types of depicted crimes; 397 (87.6%) carried on one or more kinds of avoidance behaviors; and 234 (51.7%) presented deteriorating mental health. Results of hierarchical regression analyses indicated that fear of crime was a significant predictor of both poorer mental health (p < .05) and more avoidance behaviors (p < .001), independent of gender, age, education, household finance, length of residence in neighborhood, household size, living arrangement, physical health and social networks.

Fear of crime had detrimental impacts on mental health of older Chinese and resulted in reduced social participation due to their avoidance behaviors.

Insulin-dependent diabetes, obesity and gestational diabetes are factors associated with macrosomia. Some psychiatric medications have well established side effects of weight changes in exposed pregnants. However, very few studies have investigated about the effects of lithium in fetal and neonatal anthropometry.

To investigate the effects of maternal use of lithium during pregnancy on fetal and neonatal growth.

A case-control study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA. Case group consisted of 18 pregnant women on maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=5) during pregnancy; control group involves 49 healthy women selected from an initial sample of 309. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, fetal and neonatal anthropometry.

Women did not diabetes or obesity criteria pre-pregnancy and during pregnancy. Mean maternal age (SD) in lithium exposed cases was 33.5 (3.8) and 32.5 (4.1) in non-exposed pregnant. No statistically significant differences were found regarding sociodemographic variables and pre-pregnancy BMI. Caesarean section was required in 91.8% of lithium exposed mothers, whereas 8.2% of non-exposed women did not need it (p= 0.000). Fetuses exposed to lithium had greater abdominal circumference (p= 0.018) and femur length (p= 0.010) compared to non-exposed group. There were no differences in umbilical cord/maternal plasma lithium ratio between women treated with lithium monotherapy or polytherapy (1.11vs.1.03).

The fetuses exposed to lithium had a greater abdominal circumference, greater femur length and more caesarean section in comparison to non-exposed group. Fetal growth surveillance is recommended in pregnant treated with lithium.