To describe personality profile of drug users in relation to substance of choice.

To know personality dimension differences according to drug used.

Cloninger's TCI-R was administered to 218 patients in a dual diagnosis unit.

SPSS was applied.

Of the patients, 33.94% had personality disorder. Principal substances used were alcohol, cocaine and cannabis.

Most of drug users had normal scores in each dimension. No high scores were found in reward dependence, self-directedness and cooperativeness with any drug.

High scores were observed for novelty seeking in 42.9% of timulants users; for arm avoidance in a quarter of cocaine, alcohol and methadone users and for persistence in 18.2% of hypnotics users.

Low scores were observed for reward dependence in 45% of heroine and hypnotics users; for persistence in 50% of methadone and 32% of cocaine users; for self-directedness in most of types of drug users and for cooperativeness in up to 50% in heroine, hypnotics, stimulants and cocaine users.

Statistical significant differences were observed for cocaine use and high novelty seeking and low cooperation; for non cannabis use and high harm avoidance; for non anfetamine use and low scores in reward dependence; for opiate use and low self-directedness.

Most of patients had normal scores in the different dimensions.

Presence of comorbid personality disorder led us to consider the results with caution.

The authors have not supplied their declaration of competing interest.

Clinical studies on cognitive effects of second generation antipsychotics produced disappointing findings probably due to the heterogeneity of the clinical populations under investigation, as well as to poor sensitivity of neurocognitive indices. Event-Related Potentials (ERPs) provide a functional measure of electrical brain activity time-locked to discrete stages of information processing. They have been widely used as putative biological markers of cognitive abnormalities in schizophrenia and represent useful indices in the investigation of the cognitive effects of psychotropic drugs.

The present study investigated the effect of risperidone, haloperidol and placebo on N1 and P3 in male healthy subjects.

ERPs were recorded during a three-tone oddball task in which target, standard and rare-nontarget tones were randomly presented. Subjects had to press a button when hearing a target tone. Amplitude and topography of the ERP component maps at peak latencies were compared across conditions. If a significant drug effect was obtained, changes in the cortical sources of the corresponding ERP component were analyzed using Low-Resolution Electromagnetic Tomography (LORETA).

The amplitude of N1 for attended stimuli and of P3 for rare-nontargets (P3a) was significantly increased only by risperidone. No significant change was observed in overall topographic features and in LORETA cortical sources of the same components. No significant drug effect was demonstrated for the latency of all the investigated components and for P3b amplitude.

Our findings suggest that risperidone has a favorable effect on early attention processes and automatic attention allocation.

To alert to apathy as a sub-syndrome in the spectrum dementia-depression.

Review of literature relevant in medline database.

The modern concept of apathy implies a reduced volition. Apathy may occur in depression and dementia and the differential diagnosis is difficult. Symptoms of apathy may constitute a sub-syndrome in the spectrum depression-dementia, that are characterized by lack of interest, psychomotor retardation, loss of energy and loss of appetite. Apathy may occur in dementia without depression and is significantly associated with more severe cognitive deficits. In dementia, depression may primarily result from a combination of symptoms of anxiety and apathy. Most patients with dementia and apathy had concomitant depression, but less depressed patients had concomitant apathy. The key to diagnosis may be the mood symptoms: dysthymia could be a negative emotional reaction to the progressive cognitive decline in dementia, whereas major depression could more strongly related to biological factors.

The nosological position of apathy remains obscure, with some studies suggesting that apathy and depression are independent constructs, and other studies showing a significant overlap between apathy and depression. The major interest to the type of syndrome has therapeutics implications.

Italy has been one of the most affected countries by Covid-19 pandemic. Our University General Hospital, Policlinico of “Tor Vergata” (PTV) in Rome, has become a Covid Hub in order to manage the spread of the epidemic. Thus, our Psychiatric Emergency Service (PES)’s access has been partially limited. Direct indicators of PES activity, as admission rates, can be useful for evaluating the psychological impact of Covid epidemic.

To assess psychiatric admittance rates to PES of PTV before and during Covid-19 global pandemic.

Data from our PES register have been obtained and analyzed. We compared all the psychiatric access during the trimester March – May 2019 and 2020. All patients have been characterized according to clinical features.

A marked reduction of the number of patients presenting to PES has been observed (76 patients) in the 57-day period (March 11–May 04, 2020) of lockdown compared to the same period in 2019 (266 patients). The cutback was visible for all diagnostic groups, except for “Borderline Personality Disorder” diagnosis which have slightly increased. On the other hand, hospitalization rates in our psychiatric inpatients unit remained steady.

Although larger study are needed to understand the mental consequences of the lockdown experience, people’s fear of potential infection might explain our results. Interestingly, personality disorder patients represent an exception to it, suggesting the importance of the clinical characteristics of fearless, engagement in dangerous behavior and detachment from reality. These findings might be helpful to improve psychosocial crisis interventions during the pandemic.

A: 1. To develop the urine analysis for exorphins for routine use in blood and cerebrospinal fluid (CSF).

2. Disorders where patient related validation must be carried out: schizophrenia, depression (uni- and bipolar) and autism.

A: HPLC-MS/MS (fragmentation mass spectrometry) technology.

With both a specific HPLC retention time and MS/MS (fragmentation) this method is close to an absolute technique for peptide recognition.

B: ELISA against specific proteins (gliadin, gluten and casein and transglutaminase 6) (Table 1 og 2).

A: schizophrenia: increased opioid peptide levels have been found in Schizophrenia using HPLC, immune assay and behavioral tests. [1–6] as part of a general peptide increase in urine. Since peptides are signaling compounds inhibition of peptidases during transport and work up of samples is critical to prevent break down, which is as expected fast at room temperature.

Strongly supporting is view is the data on postpartum psychoses (a very symptom rich psychosis) where also amino acid sequence of human casomorphin found increased, has been done [7–8]. The opioids can explain most of the symptoms of the psychotic schizophrenic state [6]. It is of paramount importance then to measure these peptides in carefully diagnosed patients on and without medication, in urine, blood and spinal fluid.

As can be seen in Table 1, it is important to measure IgA and IgG antibodies against the precursor proteins for the exorphins, which are found increased by several groups, and also have direct effects on the nervous system [9].

B. In depression increase levels of peptides has been found [18,28,29] and also opioid levels measured as opium receptor binding peptides [28]. In schizoaffective psychosis MS/MS exact detection of exorphins have been published [6]. Also in this syndrome it is critical to be able to measure the exorphins in blood and CSF, especially since the peptidases involved in break down of exorphins are decreased in depressions [30,31]. Inflammatory interleukins are also increased in depressions both uni- and bipolar [32] indicative of inflammatory processes probably in the gut. Inflammatory interleukins increase the permeability of epithelial membranes [33].

C. Autism. Considerable work has been done using HPLC with UV detection and co-chromatography [12,34–40]. However, with HPLC–MS/MS we can ensure that we are measuring only the exorphins and not chromatographically similar peaks that hide inside the main peak [41–43]. We therefore need to validate the new method in autism for both urine, blood and CSF (CSF collected only when spinal tap has to be done in any case).

After extensive testing we have been left with three inhibitors. Citric acid 0.2 M; acetic acid 0.2 M and aprotenine [44,45].

These body fluids will be provided by Prof Dr E. Severance and Prof Dr R. Yolken (Johns Hopkins Univ.) and Prof Dr. Cunningham (Uppsala Univ. Sweden). Lab 1 provides monovettes with citric acid as peptidase inhibitor for urine collection. Blood will be collected in EDTA – aprotenin vacuum test tubes (Vacutainer) as will be CSF.

HPLC and MS/MS detection.

The amount of urine analyzed on the HPLC after work up = 250 nanomles creatinine. To pick out generally active peptides in any one disorder, five and five autistic children or schizophrenic derived and depressive derived urines are mixed, creatinine re-determined and rerun. Peaks that are common to all patients increase or remain the same, while individual peaks of material on the HPLC runs are diluted out.

The complete procedure is published in detail [48]. If we use reporter ions we do not have to match all the peaks as shown in attached figures. On Fig. 1, synthetic bovine β-casomorphine 1-4 (Y-P-F-P) is compared to biologically isolated compound from a batch of five autistic children. On Fig. 2, the faster routine analysis using reporter ions is shown for bovine β-casomorhne 1-4. Top trace is synthetic casomorphin 1-4 and bottom trace is biologically isolated compound. The complete analysis for a series of opioids is published [48].

Program is then in sequence:

– A: further validation of method for urine in the different disorders;

– B: validation of method for blood in the same disorders;

– C: validation of method for CSF (spinal fluid) in schizophrenics and depressive patients.

NB.

To avoid overlooking new compounds a complete HPLC run with UV 215 nm (peptide bonds); 280 nm (aromatic groups) and 325 nm (Indolyl-acryloid) shall be run for urines. If sufficient serum is available and spinal fluid these will also be run on HPLC in addition to MS/MS detection.

Antibody assays will be done at Johns Hopkins using ELISA, Transglutaminase 6 antibodies at Lab 1 also using ELISA assay.

Figures and references not available in the abstract.

The authors have not supplied their declaration of competing interest.

Serotonin systems play a key role in the pathogenesis of major depression, SSRIs drugs are the first step in its treatment. Serotonin transporter (5HTT) gene is known as the responsible gene for Major Depression Disorder. Deletion or insertion in the 5-HTTLPR creates short and long alleles. Detecting the genotype regulatory region in (5HTT) can be useful and individual for everybody antidepressant treatment.

Western reports have demonstrated that l allele is associated with better SSRIs anti depressive effects than the s allele. Study of a Korea had contrasting finding.

There is association between treatment outcome phenotypes and HTTLPR in Iranian Major Depressive Population.

In this study, 105 patients with MDD (according by DSM-IV-TR) treated by Citalopram. on the other hand genotyping for alles of 5HTT and level of drug serum was obtained. Beck depression test was done in the first, 4th and 8th week. Dose Citalopram was 20–60 mg/D. Lack of clinical response was studied with mental state and Beck Depression test, then if there was no response the drug changed.(after 4 weeks).

In Iranian patients frequency of each allele base on the population study is near to 0.5 (L: 0.48 and S: 0.52). 69% of the patients with allele L (L/L or L/S) respond to Citalopram, while just 44% of the S/S patients did not need to change the drug.

Our study confirms the hypothesis that the L allele is associated with better response to antidepressant drug (P value=0.033. CI: 95%).

According to contemporary phenomenological literature, dysphoria is the background mood characterizing patients with borderline personality disorders (BPD). In particular circumstances, it can take the form of a state of pressure, urge to act, and quasi-explosion, which is very dependent on situational triggers. There are currently no instruments able to measure this situational form of dysphoria.

To develop and analyze psychometric properties of the Situational Dysphoria Scale (SITDS), a self-report questionnaire that measures situational dysphoria.

To validate the SITDS for a future use in routine clinical practice and, more generally, to assess different forms of dysphoria in BPD in a more precise way.

The preliminary 58-item SITDS was administered to 105 BPD patients, along with other conceptually similar (Nepean Dysphoria Scale) and conceptually distinct (Cynical Distrust Scale, Inventory of Interpersonal Problems-47, empathy quotient, and borderline personality severity Index-IV) instruments. The psychometric characteristics (reliability, internal structure, convergent and divergent validity) of the SITDS were then examined.

The final 24-item SITDS (with each item rated on three subscales: internal pressure, urge to act, and quasi-explosion) demonstrated excellent internal consistency (alpha = .91). A three-cluster solution was found, with clusters pertaining to personal events, interpersonal events, and environmental events. There were medium to strong correlations with NDS, and weaker but still significant correlations with CynDis, IIP-47, EQ, and BPDSI-IV.

The SITDS is a useful and easy-to-handle instrument for measuring situational dysphoria. Further research in clinical samples is needed.

The authors have not supplied their declaration of competing interest.

Desipte the effective symptomatic treatment of schizophrenia, poor functional outcomes are still a challenge. Neurocognition has been identified for a long time as a main background factor of these. According to the findings the neurocognitive aspects are not suitable to explain all the functional deficits of patients with schizophrenia. For this reason an other aspect of the cognition need to be investigated to understand our patients: the social cognition. The developement of social cognitive interventions has also recieved growing attention in schizophrenia research in the recent years.

We reviewed the literature and collected information about the theoretical background of social cognitive impairments and social cognitive treatments.

Our aim was to produce an integrative overview of the above mentioned theories and present new treatment possibilities.

PubMED suggested relevant studies, exploring the role of social cognitive impairments and efficacy of remediation programmes aimed at improving social cognition.

We got a comprehensive view of psychopathological, neuroanatomical and theoretical aspects. Our findings supported the determinig role of social cognitive impairments in schizophrenia and the importance of new treatment approaches. The overview revealed significant effects of treatments on ToM, emotional recognition, social perception and attributional style.

The social cognition is a notable field of the cognition in schizophrenia. Remediation programs are promising approaches to improve social functioning in schizophrenia, and probably a useful strategy for early treatment in psychosis, however according to our overview more researches are neccessary to elaborate definitional and methodological inaccuracies and eliminate uncertanity of effecacy.

To examine the relationship of traumatic experiences and PTSD among a representative population sample of 1,456 German elderly (60 years and above). Several studies have suggested that PTSD, but also traumatic experiences are related to adverse health outcomes. However, many past studies are based on selected samples like combat veterans, or survivors of natural disasters. To our knowledge this is the first representative population study in the elderly.

Based on self-report data and using regression analyses, we investigated the association of traumatic experiences and PTSD with several medical conditions.

Traumatized subjects had a significantly increased risk for all the medical conditions under study compared to those participants without a traumatic exposure (OR = 1.37 for hypertension up to 5.12 (CI = 2.25–11.6) for cancer). There are significant associations of current PTSD with cardiovascular diseases (Angina pectoris/coronary artery disease; congestive heart failure, peripheral vascular disease) and cardiovascular risk factors (hypertension, elevated cholesterol) (OR = 1.94 for peripheral vascular disease up to 3.76 for elevated cholesterol), as well as with asthma, cancer, back pain, hard of hearing, osteoporosis, stomach problems and thyroid disorders.

Our study delivers additional evidence for the association of traumatic stress and PTSD with impaired physical health in a general population sample in the German elderly. It underpins the importance of traumatic experiences and PTSD not only for mental health, but also for physical health as a long-term consequence.

Depressive/dysphoric personality (DP) is common in clinical settings, particularly among individuals with clinical depression.

The purpose of this research was to examine DP in two treatment settings (Study 1 and Study 2, respectively), and to determine whether those with comorbid DP would respond differentially to antidepressant medication, psychotherapy, or their combination as compared to those without DP.

The specific aim of the study was to evaluate pre- to post-treatment changes in depression severity levels between those with and without DP.

Study 1: Six hundred eighty (N=680) psychiatric outpatients with chronic depression were randomized to receive antidepressant medication, cognitive behavioral psychotherapy, or their combination for 12 weeks. Patients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment. Study 2: One hundred fifty-nine (N=159) psychotherapy clients were naturalistically followed from pre-to post treatment (average 6.5 months). Clients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment.

Thirty six percent (36%) of psychiatric outpatients and 44% of psychotherapy clients presented with DP at pre-treatment. There were no signficiant differences between those with and without DP on levels of depression severity in any treatment modality. In fact, among psychotherapy clients, those with DP made greater treatment gains than those without DP.

These findings suggest that in routine clinical situations, comorbid DP at pre-treatment should not be seen as an obstacle to successful treatment outcomes.

Van Os et al. (2009) have proposed a Proneness-Persistence-lmpairment model to explain the psychosis continuum, and cognitive models of psychosis have suggested that appraisals of anomalous experiences may be key in determining ‘need for care’.

The present study investigated the interaction between appraisals and safety behaviours in the maintenance of impairing psychotic symptoms.

It was predicted that individuals with psychotic symptoms without a need for care would display fewer threat appraisals and safety behaviours than their clinical counterparts, and that these variables would predict distress.

The study recruited people with persistent psychotic experiences but who had no-need-for-care (Persistence group; n = 39) and individuals diagnosed with a psychotic disorder who were receiving current treatment (Impairment group; n = 28). The participants were assessed on semi-structured interviews of appraisals and safety behaviours in relation to their psychotic experiences and on anxiety and depression questionnaires.

Both groups had similar levels of psychotic symptoms in the last month, including first rank symptoms. However there was a large significant difference between Impairment and Persistence groups in threat appraisals and safety behaviours, with the Persistence group reporting higher levels of both. A mediation analysis found that threat appraisals mediated the relationship between safety behaviours and anomaly-related distress, suggesting that threat appraisals may maintain anomaly-related distress, a defining feature of Impairment status.

These data provide support for the cognitive model of psychosis, with threat appraisals potentially playing a major role in the transition from non-clinical anomalous experiences to clinical psychotic status.

Compared to the general population, mentally ill patients might have additional risk factors for thrombembolism that can lead to sudden deaths. Several studies suggest a significant relationship between mental illness and death due to pulmonary embolism.

Our study evaluates the causal part that might have mental illness and different physical and medical treatments in the sudden deaths due to pulmonary embolism in mentally ill patients.

We conducted a retrospective study on the autopsies of patients admitted to Razi Hospital for psychiatric illness and who died during their stay in hospital from January 2000 to December 2010.

38 patients died during their stay at Razi Hospital during the studied period and had the origin of death identified by autopsy. Average age at the moment of death was 42,31 years, 58% were male, 40,5% suffered from physical illness before their admission to psychiatric hospital, 65% were tobacco-smokers. The most frequently found psychiatric diagnosis (41,7%) was Schizophrenia. First generation antipsychotics were mostly prescribed to patients (87,5%). Pulmonary embolism was the cause of death of 6 of our patients which equals 15,78%. Amongst these 6 patients, two suffered from Major Depressive episode with psychotic features, the remaining suffered from schizophrenia.

Several of the modifiable and non modifiable risk factors for thromembolism found in psychiatric patients and mentioned in literature are also found in our study. Identification of these risk factors is necessary to avoid premature death of mentally ill patients.

Alopecia areata is a frequently encountered hair disorder characterized by the rapid hair loss, usually from the scalp. It has few physically harmful effects, but may lead to psychological consequences, including high levels of anxiety and depression.

This case-control study was undertaken to determine the psychiatric morbidity among patients with alopecia areata.

The study included 50 patients diagnosed with alopecia areata and 50 age-sex matched individuals selected from a general population without any hair loss (control group). For evaluating psychological distress, we used Hospital Anxiety and Depression Scale (HADS). Severity of the disease was evaluated by Severity of Alopecia Tool (SALT).

Patient's mean age was 32.92 years. Fifty-two percent of patients were females. Patients were single in 52% of cases, divorced in 2% of cases and married in 46% of cases. Depression and anxiety were detected respectively in 38% and 62% of patients. There was statistically significant difference between the patients and control group in terms of depression (p = 0.047) and anxiety (p = 0.005). Depression was statistically higher in women with alopecia areata (p = 0.016). Disease severity was higher in psychiatric morbidity cases.

The results of this study indicate that alopecia areata is associated with psychiatric morbidity. Dermatologists should be aware of the psychological impact of alopecia areata, especially as current treatments have limited effectiveness.

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and is a major public health problem in Morocco. The World Health Organization (WHO) recommends a four-drug combination therapy for two months (isoniazid (INH), rifampicin, pyrazinamide and ethambutol), followed by two drugs (INH and rifampicin) for 4 months, as first-line treatment for newly diagnosed pulmonary TB in children and adults. This regimen is generally considered effective, safe, and cost-effective. However, adverse effects and drug interactions often complicate the treatment of TB. Isoniazid is associated with 32% of adverse events, of which 1.9% are psychiatric.

focus on drug-induced etiologies of acute psychotic symptoms make the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition. focus on drug-induced etiologies of acute psychotic symptomsmake the diagnosis of isoniazid-induced psychosis report the literature on the management of this condition.

The patient and guardians were interviewed to obtain information after their consent. Data from the patient profile forms and laboratory test reports were evaluated. Causality assessment was done by the WHO scale and the Naranjo scale. Oral informed consent was obtained from the patient and parents.

We report a case of acute psychosis in a child with a temporal sequence strongly in favor of INH-induced psychosis. Treatment with risperidone at an appropriate dose improved the symptomatology while waiting for the end of the antituberculosis protocol. As soon as the isoniazid was stopped, there was a clear return to the child’s premorbid state.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.

As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

The acute onset of psychotic symptoms in a patient taking isoniazid should lead to suspicion of this psychiatric side effect and prompt intervention, involving discontinuation of isoniazid and/or a trial of an antipsychotic.As protective measures, the authors suggest adjusting the dose of isoniazid to weight, possibly performing a genetic test if slow acetylation is suspected, and closely monitoring patients with a favourable background.

None Declared