Electroconvulsive therapy is currently used in the management of severe depression, long-term mania and catatonia. Regarding schizophrenia-related psychosis ECT is also an option, but the indication is restrictive to severe cases, drug intolerance or resistant ones. Lack of evidence of cost-effectiveness compared to clozapine, and side effects of ECT techniques before 2003, influenced NICE guidance to not recommend ECT in schizophrenia, but modern ECT machines and procedures are subsequent to 2003. ECT is often performed when clozapine fails to respond in monotherapy or if there is intolerance to antipsychotic side effects. ECT in combination with clozapine seems to have significant results allowing the patients to achieve rapid control of psychotic symptoms with fewer side effects, comparing with antipsychotics-association strategies.

To summarized the latest literature about this field and to present recent data from the Electrovulsivetherapy Unit, in Hospital de Magalhães Lemos, Portugal.

To explore and critically review the controversies of electroconvulsive therapy in the management of drug-resistant schizophrenia.

Retrospective data of an Electroconvulsive Therapy Unit during 2006–2015 was review.

198 ECT treatments in schizophrenic patients were performed in our unit, during 2006–2007, in a total of 647 ECT (30,6%). In 2014–2015, 945 schizophrenic patients received ECT treatment, in a total of 2149 performed ECT (43,9%).

Although guidelines are crucial for the uniform practice of medicine, sometimes is important to be critical about them. The use of ECT in schizophrenia is safe and effective and further research is needed to continue to support this treatment.

The authors have not supplied their declaration of competing interest.

Escitalopram is considered to be more effective than citalopram and to have less side effects. Previous studies have found that common cardiac manifestations of escitalopram overdose are QT prolongation and bradycardia. Some case reports inform about bradycardia without ECG abnormalities with therapeutic doses of escitalopram.

We report of a 29-year-old female patient diagnosed with major depression, hospitalized for 2 weeks. She had no history of any treatment with antidepressive drugs. After administration of 5 mg/day escitalopram the patient's blood pressure and pulse rate were mildly reduced and we observed presyncopal episodes daily. After 1 week of treatment the dose of escitalopram was raised to 10 mg/day and she complained about dizziness. In this case we found that presyncopal episodes lasted longer and both hypotension and bradycardia increased. These symptoms disappeared within 24 hours after escitalopram treatment was discontinuated. Results from routine laboratory tests, ECG, EEG, brain CT were normal. No other farmacologic causes were supposed to induce the above mentioned vegetativ symptoms.

Bradycardia and hypotonia have been previously reported with citalopram, but there are only a few case reports about these side effects induced by a therapeutic dose of escitalopram. Both central and - by directly inhibiting the entry of Ca into vascular smooth muscles resulting in vasodilatation - periferial effects of escitalopram are supposed to be responsible for these rare phenomena. This case report supports the importance of monitoring heart rate and blood pressure when escitalopram treatment is introduced, especially in cases of previously untreated depressive patients.

The increase of immigrants in Canada has set an example for Western countries on how cultural diversity affects health, mental health, and needs. The mental health of elderly immigrants, however, is often forgotten in service delivery system.

This paper examines the socio-cultural determinants of mental health of elderly immigrants in Canada through synthesizing research findings from various studies. The presentation aims to highlight a few key intervention focuses for addressing mental health of this vulnerable immigrant subgroup.

Secondary data analysis was used, using three national surveys and a local community survey, including the Ethnic Diversity Survey, the General Social Survey, the Health and Well Being of Older Chinese in Canada, and the Health and Well Being of Older South Asian in Calgary. Mental health was presented by life satisfaction, self-reported stress, self-reported happiness, self-reported level of trust, sense of belonging, feeling out of place, worrying about hate crime, depressive symptoms, and general mental health measured by SF-36.

Socio-cultural determinants related to a higher level of social support, a higher level of trust, and better financial resources were found to be correlates of more positive mental health. Racial discrimination, culture related beliefs, and barriers often led to negative mental health outcomes.

Promoting a better mental health should expand beyond the use of individual interventions and treatments. Socio-cultural determinants have to be addressed through creating a more positive social and structural environment for the elderly immigrants.

The excess cardiovascular mortality associated with bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors such as obesity. Antipsychotic medication can induce weight gain or worsen other metabolic cardiovascular risk factors.

We presented two case exemples illustrating weight gain induced by atypical antipsychotics, and discuss therapeutic managements according to litterature data.

Case report 1 Mr H.D is a 23 year-old university student, with medical history of seizures treated by Valproic Acid, stopped three years ago. He was diagnosed with schizoaffective disorder since 2008, treated by Olanzapine 15 mg/day. Treatment by mood stabilizers was hampered by liver cytolisis. Within three months after introducing Olanzapine, the patient experienced considerable weight gain amounting to 10 kilograms. Therefore, treatment doses were decreased.

Case report 2: Mrs I.T is a 31-year old female patient with medical history of asthma, anemia and herniated disc worsened by obesity. She was diagnosed with bipolar disorder and received Carbamazepine and Fluoxetine. But increased gamma-GT level induced by Carbamazepine led us to achieve a swith to Quetiapine, to which the patient showed weight gain amounting four Kilograms within three months (body mass index=34.5). A switch to Aripiprazole was achieved.

Psychiatrics must pay attention to concomitant medications and individual factors underlying overweight and obesity. Although several management options of weight gain are available, the best approach seems to attempt to prevent this weight gain.

The early intervention service (EIS) approach is based on therapeutic interactions, which promote service user recovery from first episode psychosis. Collaborative therapeutic work between the service user and case manager depends on good communication. This can be a challenge for people with psychosis as the process of thought can be disrupted or stimulus misinterpreted leading to communication errors.

The objective is to develop an interactive tool that can assist service user's communication of distress, whilst employing a psychoeducational approach to the use of an informal therapeutic measurement scale; subjective units of distress (SUDs) and early warning signs (EWS). The ApTiC mobile intervention will include ten numerically graded emoticons from low to extreme distress. Each emoticon is associated with specific individualised service user descriptors and linked to an individually agreed action plan and level of response to be offered by a staff member.

The aim of the present study will be to examine the feasibility and acceptability of the ApTic mobile intervention in preparation for a larger randomised controlled trial.

Phase one: qualitative research to inform the development of the complimentary tool and mobile app (qualitative). Phase two: a 12-week rater-blinded randomized control trial of ApTiC compared to routine EIS case management (quantitative).

The qualitative data will be presented.

It is expected that once validated, the SUDs based ApTiC will enhance rapport and understanding thus improving the recovery approach to well-being and hopefully preventing relapse or the involvement of the crisis team or hospital admissions.

The authors have not supplied their declaration of competing interest.

Psychopathology rating scales have been widely used. Studies evaluating the congruence between self and observer-reported ratings show inconsistent results.

Determine whether there was consistency between psychopathology as assessed by patients and clinicians’ assessment in outpatients observed in the Young Adult Unit of our Psychiatry Department (Coimbra Hospital and University Centre-Portugal).

Socio-demographic characterization was undertaken with young adult outpatients observed during nineteen months (1st January 2015–31st July 2016). Brief Symptom Inventory–53 items (BSI-53) and Brief Psychiatric Rating Scale (BPRS) were applied at the first clinical evaluation. Spearman correlation coefficient between General Severity Index (GSI) of BSI-53 and BPRS total score was calculated.

During the mentioned interval 255 outpatients were observed: 64.3% females and 35.7% males; aged between 17 and 39 years old (average: 20.56; median: 20). Fifty percent were diagnosed with neurotic, stress-related and somatoform disorders (ICD-10 F40-48) and 14.1% with mood disorders (ICD-10 F30-39). BPRS and BSI-53 rating scales were administered to 55 patients: 72.5% females and 27.5% males; average age 21.2. A statistical significant correlation was found between BPRS total and GSI score.

Several factors can determine the accuracy of psychopathology self-assessment, including diagnosis and severity of illness. In fact, studies show strong correlation between self and observer assessment of depressive and anxious psychopathology, but no correlation in psychotic psychopathological dimensions. Therefore, the correlation found in this population can be explained by the fact that the majority of patients were diagnosed with neurotic, stress-related and somatoform and mood disorders.

The authors have not supplied their declaration of competing interest.

We examined the effects of affect and emotional suppression (ES) on short-term life satisfaction (LS). In doing so, we considered the dimension of activation for positive affect (PA) and negative affect (NA).

The final sample included the data collected from 398 students (184 men and 214 women). The mean ages were 19.15 yrs for men and 19.84 yrs for women. Participants answered six questionnaires two of which were used for another study. The Positive and Negative Affect Schedule was utilized for assessing activated PA and NA, two subscales of the Multiple Mood Scale to measure deactivated PA and NA, respectively, one subscale of the Emotion Regulation Questionnaire for gauzing ES, and the Short-term Life Satisfaction Scale for LS. All of them were Japanese versions, answered on the past week.

Results showed that LS was positively associated with PA and negatively with NA, but that its positive association was stronger in activated PA than deactivated PA while its negative association was stronger in deactivated NA than activated NA. The interaction between deactivated NA and ES was significant in men, whose post-hoc tests suggested that deactivated NA was more negatively associated with LS when ES was higher.

This study suggested that activated and deactivated affect differ in their relations to life satisfaction. Moreover, it is likely that the detrimental effect of NA on life satisfaction is larger when the expression of NA is more strongly suppressed.

Child psychiatric service is a novel approach in Bangladesh but has proved its efficacy within a short time.

To describe how a developing country has established sustainable child psychiatric services by using limited resources effectively.

Discuss the service delivery model and recent achievements in child psychiatry in Bangladesh as well as the limitations and strengths.

Effective policy making, capacity building and community based survey are the turning point of the development of child psychiatry in Bangladesh. The prevalence of child mental disorders found 18.4% in a community based survey. By the efforts of few visionary psychiatrists the wing of child psychiatry has established in Bangabandhu Sheikh Mujib Medical University (BSMMU) and separate department named ‘Child Adolescent and Family Psychiatry’ has formed in National Institute of Mental Health (NIMH), Dhaka. Center for Neurodevelopment and Autism in Children (CNAC) also established in BSMMU with the mission to serve the children with neurodevelopmental disabilities, to increase awareness and to train the professionals. From 2008 the Child Guidance Clinic of national Institute of Mental Health Dhaka served more than three thousand children with any mental disorders.

According to the current scenario we can comment that the future prospect of child psychiatry in Bangladesh is promising. In spite of very limited resources the child psychiatry is going ahead to set an example for other developing countries in the context of sustainable service delivery model.

Risky sexual behaviors are typically seen in patients with bipolar disorder, especially during the manic phases.

Disinhibition, impulsivity and risk taking expose these patients to unplanned pregnancies and sexually transmitted infections.

However, there is a lack of studies regarding these behaviors in stabilized bipolar patients during euthymia.

The objective of this study was to look for a risky sexual behavior by evaluating sexual knowledge and sexual behavior of patients with bipolar disorder in the euthymic phase.

We conducted a descriptive cross-sectional study including 30 patients diagnosed with bipolar disorder I or II (DSM-IV).

Data were obtained through a semi-structured interview evaluating the following: sexually transmitted infections, condom use, multiple sexual partners, sex under the influence of drugs or alcohol, and prostitution.

The Young Mania Scale and the Hamilton Depression Scale were used for clinical assessment.

The preliminary results suggest a lack of knowledge leading to a tendency to risky sexual behavior in both male and female, married and unmarried patients.

Patients with bipolar disorder are exposed to risky and unsafe sex because of the clinical features of their disease and associated comorbidities.

Prevention and awareness of sexual risks are unavoidable in the management of these patients.

The author has not supplied his declaration of competing interest.

The endogenous opiate system (EOS) has been linked to social attachment in classical animal experiments, to addictive disorders (AD) and, more recently, to specific traits of personality through research in genetic polymorphisms and neuroimaging techniques.

To expose the relation between social bonding and AD, via the latest neurobiological findings in the EOS. To propose a theoretical framework which may allow a clinical approach based upon respect and no stigmatization.

Literature review in MEDLINE database with the keywords “opioid”, “polymorphism”, “object attachment”, “addictive behavior”, “personality”.

Polymorphisms in the mu-opioid receptor gene lead to different attachment behaviors in primates. The EOS in humans has been related to pain and placebo effect and recently, to social rejection and acceptance. Thus, some authors talk about “social pain”. Interestingly, the EOS has a role in harm avoidance and in the reward system. These traits of personality (harm avoidance and reward dependence) predispose to AD, and likely, pathological models of social bonding may drive to a need of palliating excessive discomfort originated by an altered opioid function through addictive behaviors. The origin of AD must be focused on the individual vulnerability rather than in the addictive substance/behavior.

The latest findings in the EOS yield concrete evidences that support the classical hypothesis of an opioid nexus between social attachment and AD, and shift the spotlight from the addictive object to the vulnerable subject. This theoretical framework may ease a clinical approach based upon respect and no stigmatization.

The authors have not supplied their declaration of competing interest.

The aim of this paper was to review literature concerning the relationship between suicide and substance abuse behaviours among adolescents, focusing on epidemiology, comorbidity and prevention programs.

we performed a Pubmed/Medline, Scopus, PsycLit, and PsycInfo search to identify to identify all papers and book chapters during the period between 1980 and 2013.

Adolescents with substance abuse disorder who attempt or complete suicide can be characterized as having mood disorders, stressful life events, interpersonal problems, poor social support, lonely lives, and feelings of hopelessness. The research supports the existence of a strong relationship between suicide and substance abuse.

Preventive programs should be based on risk factors associated with both suicide and substance abuse disorder. Management programs should combine different therapeutic strategies such as peer-to-peer education, school-based programs, psychotherapy and pharmacological treatment. Evidence suggests that targeted suicide prevention programs can be delivered which reduce the burden associated with substance abuse and suicide in youths.

One of the major challenges in clinical psychiatry remains the absence of well established objective measures of symptoms’ severity. Clinical insights are mainly provided through keen behavioral observation and subjective questionnaires and scales.

The aim of this paper is to predict depression severity through speech using the features extracted from the speech as provided by participants during a semi-structured dialogue with a virtual avatar.

We use data from a subset of the DAICWOZ dataset consisting in 142 dialogues between participants and a virtual avatar during which the avatar uses several prompts to maintain a conversation with the participant. The avatar uses prompts involving the topics of travel, dream jobs, and memorable experiences. From the speech generated from the dialogue, we extract participant utterances separated by prompt and extract features from the three sets of transcripts. We extract content features from the transcript and acoustic features from the excerpt corresponding to the speech from the participant for the prompt in question.We perform regression experiments on the PHQ8 items using the features extracted from each set of transcripts. Furthermore, we combine the features extracted from each set of transcripts and compute partial spearman correlations between them and the PHQ8 items using gender as a covariate.

With our best regression model we obtain an R2 of 0.1, explaining 10% of the variance in the PHQ total score. Additionally, we obtain a mean absolute error of 1.25, suggesting that the regressor can detect with more or less precision clinically meaningful differences in depression severity between participants. Partial correlations between the total score and the features show significant correlations between features dependent on the amount of speech generated by each participant, along with the complexity of syntactic structures used.

Automatic analysis of spontaneous speech could help with the detection and monitoring of signs of depression. By combining the use of this technology with timely intervention strategies for instance provided by a virtual agent it could contribute to timely prevention.

A. König: None Declared, M. Mina Employee of: ki:elements GmbH, S. Schäfer Employee of: ki:elements GmbH, N. Linz Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH, J. Tröger Shareolder of: ki:elements GmbH, Employee of: ki:elements GmbH