Schizophrenia leads to functional deficits. A third of schizophrenia patients have obsessive compulsive symptoms (OCSs). The existing studies, which have investigated the effect of OCSs on social functioning (SF) of schizophrenia patients have produced contradictory findings and, interestingly, they have not adjusted for the role of executive functioning.

To investigate the predictive role of OCSs on SF in schizophrenia controlling for the effects of executive functioning.

In a cross-sectional study of 110 chronic schizophrenia patients we assessed OCSs (Yale-Brown Scale), SF (Strauss Carpenter Scale) and composite executive function (cognitive flexibility: Intra–extra dimensional set shifting task and planning: Stockings of Cambridge task) using the Cambridge Neuropsychological Test Automated Battery (CANTAB). We also measured total symptoms (PANSS total scores) and illness duration. Regression analysis tested the predicting role of OCSs (YBOCS total score) on functioning taking into account executive function (composite score) duration of illness and schizophrenia symptoms.

OCSs were associated with better SF (B = 0.099; 95% CI = 0.019, 0.180; t = 2.449; df = 88; P = 0.016). This result was driven by the association of OCSs with job functioning (B = 0.043; 95% CI = 0.006, 0.081; t = 2.289; df = 88; P = 0.024). Executive functions were not significantly associated with social functioning.

OCSs and not executive functions are associated with social functioning in schizophrenia. Future studies should examine whether OCSs represent a compensatory mechanism aiming at preserving social functioning in the disorder.

The authors have not supplied their declaration of competing interest.

Effective preventive strategies could reduce disability and the long term social and health complications associated with depression, but options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that corrects the attentional and interpretive biases associated with depression.

To determine if CBM decreases the one-year onset of major depression in adults at risk.

This randomised controlled trial will recruit adults with subsyndromal depression living in Australia (parallel design, 1:1 allocation ratio). The intervention will be delivered via the internet over 52 weeks. The primary outcome of interest is the onset of a major depression according to DSM-IV-TR criteria. Secondary outcomes of interest include change in the severity of depressive (Patient Health Questionnaire, PHQ-9) and changes in attention and interpretive biases. Outcomes will be collected 3, 6, 9 and 12 months after randomisation.

Preliminary data on a subsample of 20 participants showed that the mean±SE PHQ-9 score of controls was 7.5±0.9 at study entry and 7.1±1.5 at week 6 (paired t-test=0.29, p=0.779), whereas the mean±SE score of active CBM participants was 7.4±1.0 and 4.4±1.1, respectively (paired t=6.00, p<0.001). The mean PHQ-9 difference between control and active CBM participants over 6 weeks was 2.6±1.5 points (t=1.79, p=0.090). One of 11 controls (9.1%) and 0/9 active CBM participants showed evidence of clinically significant depressive symptoms at week 6 (i.e., PHQ-9≥15).

By March 2015, 6-months preliminary data will be available on 165 participants.

Therapeutic dogs ("pet assisted therapy") have been used in some countries, in cardiology, autism and geriatrics.

It is known that people who own a pet have a smaller incidence of illness, but, except for few sparse studies, this issue has received very little attention in psychiatry.

To study the usage of therapeutic dogs as co-therapy for depression and anxiety in a psychiatric day hospital.

The study consisted of twice weekly sessions of 20 + 10 minutes each, during 6 weeks. First, patients were asked to give instructions and interplay with a dog specifically trained for this activity, under supervision of a psychiatrist. Afterwards, patients walked the dog, giving sets of instructions. Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS) were recorded, for each patient, at the beginning, at the end of the third, and end of the sixth week. A questionnaire was administered at the end.

Ten patients were enrolled. There was a decrease in HDRS and HARS scores (HDRS mean at beginning 26; at 6 weeks: 13,4; HARS at beginning 24,7; at 6 weeks: 15,7). However, results are hard to interpret; Patients were under other therapies (pharmacological, psychotherapy…); the study enrolled a heterogeneous group of patients, with different diagnoses, making interpretation difficult.

Therapeutic dogs can be useful as co-therapy for depression and anxiety, but results must be validated in larger, randomised controlled studies. This approach may improve aspects such as self-confidence, basic affective skills and group cohesion.

The student population seems to be vulnerable to eating disorders (ED) but is this in relation to their ability to express their emotions or alexithymia?

Studying the prevalence of ED and alexithymia among medical students, and establish the relationship between these entities.

It was a cross-sectional study of 97 students in Sfax University Medicine (Tunisia). We used:

– a questionnaire containing demographic and clinical data;

– Eating Attitudes Test (EAT-26): a score ≥ 20 indicates ED;

– Toronto Alexithymia Scale (TAS-20): a score ≥ 61 indicates alexithymia.

The average age of participants was 24.07 years (± 2.71); the sex ratio (M/W) was 0.4. Their average BMI was 22.85 kg/m2 (± 3.36). They were smoking in 36.1% and sedentary in 43.3% of case. They had a nibbling activity in 57.7%. The average score of the EAT-26 was 11.66 ± 8.66 and prevalence of TCA was 19.6%. The average score of TAS-20 was 50.92, 0.46 and alexithymia was found in 16.5% of students. ED was significantly correlated with nibbling (P = 0.02), BMI or overweight (P = 0.012), smoking (P = 0.006) and physical inactivity (P < 0.00). Also alexithymia was significantly correlated with smoking (P = 0.003) and physical inactivity (P = 0.025). A significant correlation was found between alexithymia and ED (P = 0.008).

It is clear from our study an association between alexithymia and the ED. Psychological support aimed specifically alexithymic dimension is indispensable, not only for decreasing the emergence of ED but also contributing to lower any addictive behavior.

The authors have not supplied their declaration of competing interest.

Despite society argues that all citizens have equal rights and equal opportunities, mentally ill individuals face discrimination, especially in the employment context. Research reported benefits of working and have a job, witch help play social roles and feel useful, key components in social inclusion and recovery of mentally ill individuals.

Employers have an important role in the access of mentally ill individuals into work. They take decisions that affect life opportunities, but, due to their powerful position, their attitudes can influence all enterprise and maintain stereotypes and stigma.

Know perceptions and stereotypes about mental illness in Portuguese employers.

Data were collected using a translation of Attitude Scale for Mental Illness (Hahn, 2002), evaluating dimensions such as separatism, stereotyping, restrictiveness, benevolence, pessimistic prediction and stigmatization. The scale was fulfil using online anonym way, by 50 employers from small (under 250 employees) metallurgic or textile enterprises (60% male, 40% female; mean age 45.9 years).

None of the enterprises have employees with mental illness, neither integration policies. Employers prefer to give a job to people with physical disabilities than to people with mental illness, choosing people with schizophrenia as the last possibility. They have little contact with mentally ill individuals, 96% don’t know governmental policies for job inclusion and only 54% accepts to participate in meetings to understand those policies. Stereotyping, benevolence and pessimistic prediction present highest values.

Employers must be informed about governmental policies using work as a form of social inclusion from mentally ill people.

The professional education can be stressful experience and medical students are exposed to high levels of stress in both theoretical and clinical components of their educational programme. The high level of stress often leads to disruptions in physiological and psychological health.

The purpose of this study was to study stress in medical school students of Semnan university.

This study was a descriptive and cross-sectional research. The sample were 211 students of general physicians (160) and paramedical (51). 206 students filled in a questionnaire.Data were collected using a stress questionnaire (R.S.Eliot). Then data were analyzed by SPSS and mean, frequency distributions. For this study were used chi-square, spearman and pearson correlation coefficient.

The findings showed 9.7% of students under study had high control degree, 82.5% of students had intact life but sometimes stressful situation caused anxiety for them, 6.8% of students feel depress and 1% in their life have mental crisis or conflict.

Teaching to students in order to reduce stress level and provide educational improvement in medical students are recommended.

The aim of the study was to determine the frequency of subtypes of irritable bowel syndrome in positive and negative subtypes of schizophrenia.

Sixty-two drug naïve hospitalized patients between 18 and 65 years (mean age: 33.6) with first episode of schizophrenia based on DSM IV-TR and 69 control subjects matched for age and sex completed this study. A semi-structured clinical interview was used to assess both groups. Clinical data were obtained and basic lab investigations and ultrasonography of abdomen were done in all subjects to exclude any related abdominal pathology. Axis-I disorders of DSM IV-TR were excluded in control subjects. Positive and Negative Syndrome Scale (PANSS) and Rome III Urdu language version scale (cross-validation obtained) for irritable bowel syndrome (IBS) were administered to assess the severity of positive and negative symptoms of schizophrenia and subtypes of irritable bowel syndrome, IBS constipation (IBS-C), IBS Diarrhoea (IBS-D) and IBS Mix (IBS-M) in case and control groups respectively.

Forty-seven patients (75.8%) and 15 patients (24.2%) had positive and negative schizophrenia respectively. Patients with positive and negative schizophrenia had higher rate of IBS-C 6.5% (n = 4), IBS-D 8.1% (n = 5), IBS-M 12.9% (n = 8), non-IBS 72.6% (n = 45) versus healthy subjects IBS-C 1.4% (n = 1), IBS-D 2.9% (n = 2), IBS-M 2.9% (n = 2), and non-IBS 92.8% (n = 64), OR = 4.8; 95% CI.

Irritable bowel syndrome is more frequent in patients with schizophrenia than in general population. This functional gastrointestinal disorder associated with psychotic symptoms requires attention and management while managing patients with subtypes of schizophrenia.

The authors have not supplied their declaration of competing interest.

Abortion exerts its effects on psychological wellbeing of a great number of women all over the world. Numerous psychological research deals with describing normative responses to the intervention and determining possible psychopathological outcomes.

Our aim was to justify whether women differ from one another already at the time of the intervention in terms of their level of anxiety and the degree of depression, which might correlate primarily to the difficulties regarding the process of making the decision for abortion and to the nature of their fears.

In our research at the Obstetrics and Gynaecology Clinics at University of Pécs, 112 women (average age: 29.67, ranging 18–44) having had abortion were studied using structured interviews and Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983).

With respect to whether they have reported fear, the research sample could be divided in two groups: 18% have not reported any fear, whereas regarding the remaining 82% some sort of fear was identified by contents analysis, such as fear of later complications (26%), fear of the invasive intervention (22%), fear of both above (15%) and fear of death (19%). The level of anxiety was significantly higher in the group reporting fears at the time of the intervention. The highest anxiety and depression levels were measured in the groups reporting fears of both invasive intervention and later complications, and in the group experiencing fears of death.

Our results draw attention to the significance of the psychological preparation prior to termination.

Antidepressant treatment, although it is effective to improve the manifestations of major depression, may also induce or exacerbate some symptoms of sexual dysfunction. Symptoms such as decreased libido, anorgasmia, delayed ejaculation, erection difficulty or dyspareunia, affect the quality of life of the subject who suffers and the self-esteem, can lead to lack of adherence to treatment and in accordingly, the relapse of depressive symptoms. Serotonergic antidepressants are frequently associated with the onset of sexual dysfunction in sexually active patients exceeding 70%. Clinicians underestimate the actual incidence of dysfunction as the technical specifications of drugs show lower levels than 25% and spontaneous reports of patients do not exceed 20-40%.

Vortioxetina is a reuptake inhibitor of serotonin (5-HT) and is also an agonist of the 5-HT1A partial agonist 5-HT1B and an antagonist of 5-HT3, 5-HT1D and 5-HT7. Apparently, this molecule at doses of between 5 and 15 mg is safe and effective and does not cause sexual dysfunction. It is a well-tolerated and safe, with low incidence of sexual dysfunction.

To evaluate the action we have evaluated sexual dysfunction in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. So we’ve used the SALSex scale (Scale for measuring sexual dysfunction secondary to psychotropic drugs).

The results of this study are still being analyzed.

The authors have not supplied their declaration of competing interest.

Insomnia is a common sleep disorder for patients with depression. This has a major impact on the quality of life for the individual. A randomized controlled trial (RCT) will address the use of music as a non-pharmacological treatment to reduce insomnia in depression.

The aim is to investigate, whether music listening is effective to:

– improve sleep quality;

– reduce symptoms of depression;

– improve quality of life;

– limit or replace medication.

A RCT will address the use of music as a treatment modality in depression using an explanatory mixed methods design. In the first phase of the study, patient data is collected from 3D accelerometer, log files from a new app for iPad called ‘the music star’ and questionnaires (MDI, HAM, PSQI and WHO-QOL). ‘The music star’ is an app for iPad used to select music from special designed playlists developed by Danish music therapists in psychiatry. An exploratory follow-up (semi-structured interviews) aims to explain quantitative results from accelerometer and ‘the music star’ log files. Participants enrolled are registered at the clinic for unipolar and bipolar affective disorders at Aalborg University Hospital – Psychiatry. The participants test whether a sound pillow and special designed playlists is effective to reduce insomnia in depression in a 4 week period.

A feasibility study has been conducted on 11 participants showing positive results in terms of participation and sleep quality.

The authors have not supplied their declaration of competing interest.

Acquired brain injury has been reported to be associated with violence.

To determine whether an association exists between acquired brain injury and violent offending

Study an association between brain injury and crime and identify associated risk factors.

Systematic search of Medline, Embase, PsychInfo, CINAHL, TRIP, using terms, Acquired brain injury, traumatic brain injury (TBI), head injury, frontal lobe, crime, offending, violent offending, sexual offending, prison.

1. A: Multiple studies reported higher life time history of head injury in prison or offender populations in comparison to control groups. Sampling bias and case definition problems have influenced reported prevalence of head injury in offender population ranging from 3.3% to 82%. Reports from secure psychiatric services identify that patients with history of head injury may be more difficult to discharge. Community based studies report cognitive damage as significant risk factor for domestic violence.

2. B: Large scale population and military cohorts have reported a higher relative risk for criminal conviction in mild traumatic brain injury (TBI) group. TBI increases the risk of mental disorder by two-folds but also that TBI is significantly related to mental disorder with co-existing criminality.

3. C: Childhood conduct problems, loss of a parent, substance misuse, maternal drug use in pregnancy, impaired executive cognitive functioning, structural damage to orbito-frontal and ventromedial areas, amygdala, and hippocampus are reported as risk factors for violent offending in this population group.

The review provides evidence for an association between brain injury and violent offending and also identifies associated risk factors.

Examine impact of audit and feedback on antipsychotic prescribing in schizophrenia over 4.5-years.

Clinical files in three outpatient psychiatric services in Auckland, New Zealand were reviewed at two time-points (March-2000;October-2004). After the first audit, feedback was provided to all three services. Baseline prescribing variations between services were found for antipsychotic combinations and atypical prescribing, in particular clozapine. In two services audit and feedback continued with two interim reviews (October-2001;March-2003). Specific feedback and interventions targeting clozapine use were introduced in both services. No further audit or feedback occurred in the third service until the final audit. Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each audit.

Three prescribing variables (antipsychotic monotherapy, atypical and clozapine use) were consistent with practice recommendations at the final audit (85.7%, 82.7% and 34.5% respectively) and had changed in the desired direction for all three services over 4.5-years. At baseline there were differences between the three services. One service had baseline prescribing variables closest to recommendations, was actively involved in audit, and improved further. The second service, also actively involved in audit had baseline prescribing variables further from recommendations but improved the most. The service not involved in continuing audit and feedback made smaller changes, and atypical and clozapine use at endpoint were significantly lower despite at baseline being comparable to the service which improved the most.

We found high intensity audit and feedback was an effective intervention in closing the gap between recommended and clinical practice for antipsychotic prescribing.

The authors have not supplied their declaration of competing interest.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioural disorder with considerable costs. Lisdexamfetamine dimesylate (LDX) is approved in the UK for ADHD treatment in children and adolescents.

To perform an economic analysis of LDX for adults with ADHD from the UK National Health Service (NHS) perspective.

To estimate cost-effectiveness of LDX compared with methylphenidate (MPH) and atomoxetine (ATX).

A 1-year decision-analytic model was developed. Health events included response, non-response and unable to tolerate. Efficacy data were taken from a mixed-treatment comparison (MTC) analysis of all clinical trials. Response was defined as a score of 1 or 2 on the Clinical Global Impression–Improvement scale. Tolerability was assessed by discontinuation rates due to adverse events. Utility weights were identified via a systematic literature review. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were based on mean doses reported in the trials used in the MTC. One-way and probabilistic sensitivity analyses were performed.

The comparison of LDX and MPH for 100 people resulted in an increased annual cost of £34 and quality-adjusted life-years (QALYs) of 0.5, with an incremental cost-effectiveness ratio of £64 per QALY. When compared with ATX for 100 people, LDX was a dominant strategy, with lower annual costs (–£26,700) and higher QALYs (1.0). There was a 62% probability of LDX being cost-effective versus MPH-ER at a threshold of £20,000 per QALY.

From the perspective of the UK NHS, LDX provides a cost-effective treatment option for adults with ADHD.

To assess severity of cognitive disturbances during use of individualized therapy.

Study sample included 40 men with diagnosis of alcohol dependence in the period of remission formation. Methods of pictograms, “ten words”, techniques “analogs”, “number square”, “index of functional flexibility of nervous processes” were applied. Measurement was conducted before and after individualized therapy. Depending on structure of cognitive disturbances the individualized therapy included the following: pharmacotherapy, audiovisual, vibrotactile, oxygen-hyperthermic, resonance-acoustic and psychotherapeutic interventions.

Assessment of drawings of the method of pictograms before and after individualized therapy testifies to increase of number of adequate associations in 36.4% of cases, decrease of inadequate symbolic in average from 1.91 scores to 1.77. After therapy part of graphic phenomena-indicators of organic diseases (in 63.64% of patients) and index of severity of organic graphic symptom complex (from 2.14 ± 1.04 to 1.43 ± 0.98, differences are reliable at Р < 0.05) decreased. A set of associations was widened, number of abstractions of high level increased in 31.82% of cases. It was revealed that abilities to generalize and abstract did not change after therapy. Average productivity of mediated remembering after therapy increased from 58,08% to 71.67%. Increase of volume of attention and its switchover capability, increase of average index of functional flexibility of nervous processes from 1.19 ± 0.26 to 1.62 ± 0.16 (differences are reliable at Р < 0.05) were revealed.

Thus, administered with account for structure of disorders individualized therapy allows significant improvement of cognitive functions of alcoholic patients.

The authors have not supplied their declaration of competing interest.