Long acting antipsychotics are an effective option in improving treatment adherence, but tardive dyskinesia can be problem in som cases1

Atypical antipsychotics with long acting formulations offer a safer option for extrapyramidal side effects but it is not clear if they are safer in tardive dyskinesia.

We report a 45 year old male patient with 25 year history of schizophrenia aiming to reveal the effects of paliperidone palmitate on oropharyngeal dyskinesia.

Chlorpromazine, haloperidole, zuclopenthixol, olanzapine and quetiapine were the antipsychotics which were used in the last 12 months. The patient had been using olanzapine 20 mg/day, biperiden 4 mg/day and zuclopenthixol decanoate 200 mg every 2 weeks in the index consultation that the oropharyngeal dyskinesia was observed. Olanzapine was discontinued and since there was need for long acting antipsychotics because of the former history of treatment non-adherence, zuclopenthixol was switched to paliperidone palmitate 150 mg every 4 weeks. Abnormal Involuntary Movement Scale was used weekly to score the dyskinetic movements.

Marked improvement in movement disorder was observed after a switch from zuclopenthixol decanoate to paliperidone palmitate.

Long acting atypical antipsychotics may be a preferable option in patients with tardive dyskinesia if treatment non-adherence is a problem.

The Perinatal period is a time of vulnerability for developing psychiatric disorders of higher prevalence in the female gender - depression and anxiety1. Numerous authors have proposed that maternal psychological factors could influence pregnancy course and the well-being of mother and newborn2.

To explore the relationship between perinatal psychological disorder and physiological parameters evaluated at birth, such as the Apgar Index (AI; 1, 5 and 10 minutes), head circumference, weight, length and age.

533 women answered, in the second trimester of pregnancy (16.98±4.83 weeks of gestation), several questions about psychosocial variables, the Perinatal Depression Screening Scale3 and the Perinatal Anxiety Screening Scale4. Of these, 208 (39.0%) women were interviewed with the Diagnostic Interview for Psychological Distress5. Newborn physiological parameters were obtained from electronic health records.

AI was significantly (p<.01) and moderately (r≈.25) correlated with maternal anxious symptomatology, and with the experience of a stressful event in the last year (only AI 1 minute). Newborns of women with clinically relevant anxious symptomatology (>cutoff point, 14.6%) had significantly lower AI (p<.05), which was also observed in newborns of women who considered having had a stressful event (only AI 1 minute). Women’s newborns with maternal anxiety disorders during pregnancy (5.3%), had significantly lower values in AI, head circumference, weight and age of birth. Regression analyses showed that anxiety in pregnancy (symptoms and/or diagnoses) is a predictor of newborn physiological parameters, explaining significant percentages(r≈22%; p<.05) of its variability.

Early detection of psychological disorders in pregnancy, namely anxiety, is determinant to prevent adverse neonatal outcomes.

No significant relationships.

A considerable amount of data from Western culture suggests that negative family environment can increase the rate of relapse in patients with severe psychiatric disorders. The objective of this study was to explore the effect of family psycho-education intervention on family environment of relatives of patients with severe mental disorders in Iran.

Using an experimental design, with pretest, posttest and a control group, families of 30 patients with severe mental disorders were divided into two groups: six sessions of family psycho-education (intervention group); and no treatment (control group). Family environment was assessed using Family Environment Scale (FES).

Results showed that the family psycho-education program improved cohesion and expressiveness in family members (p< 0.01) but it had no significant influence on conflict (p>0.05).

Family intervention increased cohesion and expressiveness, but it had no significant effect on total family environment score or conflict. One explanation could be that our short- term program focused more on communication skills of family members rather than conflict resolution. Resolving conflict is complex in families of patients and need more time to change. The present study confirmed the need for family psycho-education and availability of resources to offer longer-term family psycho-education program to families of patients.

A 28-year old male patient was admitted involuntarily to the 4th PICU of the Mental Health Hospital of Thessaloniki, due to severe psychotic symptoms and disorganised behaviour. Upon mental health examination the symptoms included auditory hallucinations, tangible speech, delusional ideas of somatic and persecutory type and significant neglect of his personal hygiene. The onset of his psychotic illness was 3 years prior, with two hospitalizations in the UK, and several unsuccessful attempts of outpatient monitoring.

The study of persistent hiccup as an adverse effect of antipsychotic medication.

Monitoring for adverse effects during admission.

On the 8th day of admission, oral olanzapine 10 mg was commenced at night. On the 9th day, olanzapine was increased to 20 mg per day. Discontinuation of intramuscular medication occurred on the 16th day. After presenting no clinical improvement for 27 days with the administration of olanzapine as monotherapy, amisulpride at 2ml per day was initiated alongside the Olanzapine. In the context of medication titration, amisulpride reached 8ml per day, equivalent to 800mg per day after 2 months of hospitalisation.

Apart from minor constipation, no other gastrointestinal health problems were reported in his records. The onset of the hiccups occurred along the dosages of 800mg/day of amisulpride and 20mg/day of olanzapine.

There was a satisfactory response to treatment evidenced by a 30% reduction on the Positive scale of the PANSS, however, the hiccups did not recede.

None Declared

Parkinson’s disease has long been considered as a neurodegenerative disorder of pure motor expression. Motor dysfunction in Parkinson’s disease and other parkinsonian disorders is frequently accompanied by nonmotor signs and symptoms, including cognitive impairment, apathy, anxiety, and depression. Among psychiatric disorders comorbid with Parkinson’s disease, depression is probably the most important in terms of frequency and impact.

The aim of this presentation was to illustrate the importance of considering depressive symptoms in patients with Parkinson’s disease.

A case report describing a patient with depressive symptoms in a patient with Parkinson’s disease and literature review.

We report a case of a 57-year-old woman who presented symptoms of Parkinson’s disease for two years. She was treated with Benserazide (Madopar). She was referred to our department for depressive symptomatology. The patient suffered from fatigue, insomnia, loss of sexual desire, sadness, anhedonia, and social withdrawal during the last three months. The diagnosis of depression was not immediately retained. Finally, a major depressive episode was diagnosed. Fluoxetine (20mg per day) was prescribed with clinical improvement.

The diagnosis of a depressive episode is most often complex, due to an overlap symptomatic of both disorders. The depression comorbid to Parkinson’s disease because of its frequency and impact, requires specific identification and management early.

Treatment adherence plays an importance role in the field of Mental Health, as therapeutic failure increases the number of relapses as well as hospital admissions.

To know if treatment failure is related to the type of mental illness suffered by the patient.

An interview was constructed to collect clinical data (diagnosis, prescribed drug group and drug group which has been altered, how this modifies the treatment and the reasons reported to alter the prescription)

-Marital status: 48,9% married/consensual union, 30,5% widowed, 19.1% single and 0.7% separated or divorced.

-Coexistence: no statistically significant differences were found in compliance among those living alone and those living together.

Group-diagnosis: Psychosis 12,9%, Affective disorders 39,3%, Anxiety disorders 5,0%, Personality disorders 0,7%, secondary to organic disease 15,7%, dementia 21,4%, Other 4,3%.

Compliance depending on diagnosis: Psychosis (83,3% Yes - No16,7%), Affective disorders (67,3% Yes - No 32,7%), Anxiety disorders (42,9% Yes - No 57,1%), Organic disorders (59,1% Yes - No 40,9%), dementia (56,7% Yes - No 43,3%), Other (Yes 50% - 50% No) Conclusions: A prioiri, cohabitation is an interesting factor in adherence, because living with relatives can lead to greater supervision, and hence greater compliance with treatment.

However,only diagnostic group seems to have a role in compliance. Of the analized sample, the group with greater adherence to treatment was “psychosis”.

Despite the emphasis that needs to be done in compliance with treatment of psychotic disorders, it is also necessary to enforce compliance in other disorders.

The Changsha study identifies adult, non-psychotic relatives of patients with schizophrenia who show deficits in neurocognitive, social, clinical and other dimensions, and who meet proposed diagnostic criteria for a liability syndrome for schizophrenia (’schizotaxia’).

To define and validate schizotaxia.

To develop and validate diagnostic criteria for schizoaxia, and to reduce its symptoms using risperidone.

We investigated whether a low dose (2.0 mg) of risperidone, a second generation antipsychotic medication, could attenuate negative symptoms, neurocognitive deficits, and other measures of clinical and social function in subjects who met our research criteria for schizotaxia. One hundred eighty nine relatives were assessed at the Mental Health Institute, Second Xiangya Hospital, in Changsha, China. Eighty six of these individuals met criteria for schizotaxia, and 36 agreed to enter a 6-week, double-blind, placebo-controlled protocol.

ANCOVAs using age and gender as covariates showed significant improvement in the risperidone group (n = 20) on neurocognitive function (Wisconsin Card Sorting Test Total Errors and Perseverative Errors) and on a self-report measure of social function (Social Adjustment Scale), compared to the placebo-control group (n = 16). Effect sizes were small to medium. Notably, risperidone effect sizes were larger (medium to large) in a subset of subjects (risperidone = 15; placebo = 10) whose membership in the schizotaxic group was confirmed by cluster analysis.

The results are generally consistent with previous open-label investigations of risperidone administration in subjects with schizotaxia, and provide evidence that significant neurocognitive and clinical problems are amenable to remediation in non-psychotic relatives of people with schizophrenia.

There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). ToM impairment has been also reported in euthymic bipolar disorder (BD). However, data from direct comparisons of patients with schizophrenia and BD on ToM abilities are limited.

It has been suggested that different aspects of mentalizing processing, such as epistemic and emotional mental representations, i.e. cognitive and affective ToM, must be separately examined.

The aim of the study was to compare ToM ability and both its cognitive and affective components between schizophrenic and euthymic BD patients.

Fifty three BD type I euthymic patients, 54 patients with schizophrenia and 53 healthy controls (HC) completed a multi-facet battery of ToM tasks, including False belief task, Hinting task and Faux Pas Recognition Test (FP). Besides the overall ability to recognize Faux Pas, two specific components of ToM – cognitive and affective – were assessed with FP. The three groups were matched for gender, age and education.

BD and schizophrenia patients showed no impairment in the False belief task. Schizophrenia patients performed significantly lower than HC and BD patients in Hinting task, FP recognition and affective ToM. Both patient groups were impaired in cognitive ToM. However, only BD patients with a history of psychosis performed significantly lower than HC in affective ToM.

In contrast to schizophrenia patients, euthymic BD patients show a specific deficit only in cognitive but not in affective ToM. Further research on the impact of these deficits on social and occupational functioning is warranted.

The main description of alexithymia is a personality construct characterized by difficulties in experiencing and verbalizing emotions, and a poor capacity for symbolic thought reflected as a tendency toward externally oriented thinking.

The aim of the present study is to investigate the effects of alexithymia on tendency of somatization and sleep quality in depressive patients.

Eighty-five major depression patientswere included in the study. the Beck Depression Inventory (BDI), Toronto Alexithmia Scale, Symptom Interpretation Questionairre (SIQ) and Pittsburgh Sleep Quality Index (PSQI) were used for assesments and measurements.

Patients with major depression were divided into two groups that alexithymic and non-alexithymic according to the aim of the study. there were significant differences in the BDI scores, the number of somatizating symptoms and psychologizing and somatizing scale scores in the SIQ, and daytime functionality scores in PSQI between alexithmic and non-alexithymic depressive patients.

Alexithymia seems to be related with depressive symptomatology. Depressive patients with alexithymia may display abnormal health belief and difficulty in expressing their complaints. Therefore, alexithymia is a feature that affects the pattern of depressive symptoms. This present study confirmed that depressive patients have high prevalence of alexithymia, somatization and difficulty in expressing the feelings. Because of the loss of daytime functionality in the alexithymic depressive patients, clinicians should consider alexithymia in clinical practices.

We aimed to explore the expert perspective on relevant issues of individuals with bipolar disorder. The specific aims are to identify problems in functioning important to individuals with BD and to quantify these using the ICF.

An online survey on functioning in BD was conduced. For each ICF domain one question was presented. Recruited participants were psychiatrists, general physicians, psychologists, nurses and social workers worldwide. Answers were linked to the ICF according to predefined rules (Cieza, 2001). Data analyses include frequencies of ICF categories named by experts.

Health professionals from all WHO-world regions and from different professional backgrounds accepted our invitation to participate. The Americas was the highest represented region (36%) and a significant part of the professionals involved were psychiatrists. From all the concepts contained in the answers, body functions categories with highest frequency of appearance were emotional functions (3,5%), mentioned by 62% of the experts and sleep functions (2,4%) mentioned by 58%. The body structure brain corresponds to 2% of the total categories obtained and was included by 56% of the experts. Maintaining one's health was the most mentioned activity and participation (2,8%), referred by 36% of the participants and important environmental factors include health services (4,8%) and immediate family(3,8%), which appeared in 82% of the questionnaires.

The present study is an important step in applying of the ICF to BD. It also shows an important level of agreement between experts around the world regarding central issues of the disorder.

Funded by MURINET-MRTN-CT-2006-035794

Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. There has been extensive and growing interest in its application to long-term illnesses but surprisingly not in severe psychiatric disorders, such as schizophrenia. However, the great majority of schizophrenics are capable of understanding treatment choices and making rational decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.

Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge.

Of the oral presentation: to present the study design; to make an interim report of the data obtained at the moment of the congress.

Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: Inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.

Currently in the recruiting phase with 55 patients included in the study. An interim analysis of at least half of the target sample size.

We will show the study design and decision tools employed. Conclusions in relation to the effectiveness (adherence and readmissions) and subjective perception.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Biochemical bases of interaction between monoaminergic systems and cortisol as one of the main component of hypothalamic-pituitary-adrenal axis in pathogenesis of anxious depression are investigated poorly.

Elucidate some biochemical aspects of interaction of monoaminergic systems and cortisol in pathogenetic mechanisms of anxious depression.

Patient's state (61 patients) according to ICD-10 criteria was defined as a depressive episode as an independent disease (F32.1) and in the structure of recurrent depressive disorder (F33.1). The anxiety in the structure of the depression was the main indication to inclusion in the investigation. According to Hamilton rating scale for depression and Hamilton rating scale for anxiety the total points were 21.83 and 18.00, respectively, that corresponded to severe depressive disorder and severe anxiety. 43 of 61 patients were investigated biochemically.

There were revealed significant increase of platelet monoamine oxidase activity and cortisol level. It means that patients with anxious depression are characterized by profound disturbances of monoamine metabolism and hormonal status that are the reflection of disturbed homeostasis as a whole.

There are revealed tight interaction between monoamines and cortisol. We hypothesize about biochemical mechanisms of disturbed balance between serotonergic and noradrenergic systems and cortisol in anxious depression.

Drop-out from treatment for Eating Disorders is increasing (Campbell; 2007), and it is a risk factor for relapse and more chronic and severe course of the illness (Fassino et al.; 2009). Drop-out can be caused by interaction of concurrent, individual, familiar ad environmental factors (Sly; 2009).

To examine possible risk factors of drop-out from inpatient treatment for eating disorders.

The sample included 41 patients who voluntarily left the treatment before completion (’droppers’) and 88 patients who completed it (’completers’), in the period between 1st January 2006 and 31st December 2009 at Villa Maria Luigia Hospital (Monticelli Terme, PR, Italy). Patients were administered 2 self-report questionnaires and 3 psychometric tests: Eating Disorders Questionnaire, Predisposing, bringing on and maintaining risk factors for eating disorders, EDI-II, BUT, SCL-90.

Droppers appear to be more aggressive (p = 0.022), get worse scholastic results (p = 0.016) and have less friendships and less social interaction (p = 0.021). Parental break-up (p = 0.015), moving house (p = 0.006), father's death (p = 0.005), abortition (p = 0.040), father's alcohol abuse (p = 0.011) and a mother who suffers of eating disorder (p = 0.008) are more frequent in droppers than completers. Catholic religion seems to be a protective factor from drop-out (p = 0.005).

Drop-out is a multifactor phenomenon; identification of risk factors can improve treatment strategies and outcome.