To estimate costs associated with medication non-adherence over a 3-year follow-up period in the treatment of schizophrenia in routine clinical practice in Europe.

SOHO is a 3-year, prospective, observational study of 10972 outpatient participants across 10 European countries. Data were collected at baseline and at 6-month intervals up to 36 months. Medication adherence was assessed at each visit by participating psychiatrists during 4 weeks prior to the visit as: (1) not prescribed medication; (2) always adherent; (3) partially adherent; and (4) never adherent. In this post-hoc analysis, multivariate analyses were performed to compare the costs of resource use (inpatient stay, day care, psychiatrist visits and medication) in patients who were adherent, partially adherent, and non-adherent, using a log-link function. Adherence status was included as a time-varying variable, and other baseline patient characteristics were adjusted for. UK unit costs were applied to resource use.

Out of 5364 patients who were prescribed medication prior to baseline, 5.9% were non-adherent while 77.1% and 17.0% were adherent and partially adherent, respectively, at baseline. The average 6-month cost incurred by non-adherent patients was £2505 while that for adherent and partially adherent patients was £2029 and £2130 respectively. This difference was mainly due to inpatient costs. The inpatient costs incurred by non-adherent patients (£987) were almost double those for adherent patients (£475).

Non-adherence in schizophrenia was likely to incur more inpatient services, which may indicate poorer clinical prognosis. A study limitation is that adherence was assessed by investigators using a single-item measure.

Sleep-wake cycle is one of human biological rhythm highly correlated to well being and general health status.Poor sleep quality, sleep disruption and changes in regular Sleep-wake pattern may cause physical and psychological burden such as impairment in job performance, decreased work efficiency and learning disability.

Health care students trained in medical, nursing and midwifery fields is a population who are at great risk to develop sleep disruption and its subsequent physical and mental morbidity.

The aim of this study was to describe how sleep quality correlated to general health status among 280 health care students.

280 health care students studying in health related fields participated in this cross section study. Pittsburg sleep quality index (PSQI), sleep- wake questionnaire and the general health questionnaire (GHQ) administered to gather data describing sleep quality, sleep wake disruption and the general health status.

Preliminary results showed that 61.4% of subjects defined as poor sleeper. In further co relational analysis there was a significant correlation between sleep quality and general health status (r = .6, p = . 000, n = 280). Regression analysis showed that number of nights with sleep disruption due to shift work or academic needs was a strong predictor for both poor sleep quality and general health status.

In conclusion, Sleep disruption due to shift work or other academic demands is a predictor for poor sleep and its subsequent mental health morbidity, which should be considered as a part of mental health policy for health related college students.

The purpose of this study is to evaluate the psychiatrists' stress factors related to their work in order to find methods that could improve the work environment.

A 30 items questionnaire was designed for the study, based on discussions with the trainees and psychiatrists and reviewing articles related to this topic. Each item was quantified from 0 to 9, 0 meaning “ no stress”, and 9 meaning the highest level of stress. The questionnaire was distributed to 200 psychiatrists (72% response rate) from 5 university centers in Romania. The results were analyzed, using the SPSS medical statistic program.

The majority of the respondents were young psychiatrists, in their first 2 years of practice. Even if most of the fellow psychiatrists do not consider themselves stressed at work, they reported high level of stress at several items. The major causes of stress are: “ the lack of space in the clinic”, “insufficient equipment”, “lack of drugs”. The items with the lowest scores, meaning that there are not stress factors are: ”too much work on emergency room”, “working extra-hours”, “doing somebody else's job”.

All 5 universities reported the same causes of stress as being the most frequent ; these factors are correlated more with economical problems then with medical ones. This reflects the economical status of our country. The stress level can be reduced through economical and administrative measures.

Normal pressure hydrocephalus (NPH) occurs in 0.5% of persons over 65 years old. The etiology of NPH is still unknown. Clinically NPH is characterised by cognitive deterioration, gait impairment and urinary incontinence. NPH is a possible reversible cause of dementia. Neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) allow to assess typical brain changes in this disorder.

The objectives are to present the typical findings of NPH on CT and MRI and to demonstrate differences between NPH and central brain atrophy in neuroimaging.

The imaging features of NPH include: supratentorial ventriculomegaly with callosal angle less than 90o, tight sulci at the vertex and considerable out of proportion enlargement of Sylvian fissures. In case of central brain atrophy there may be a predominance of ventriculomegaly and/or widened sulci without crowding of the gyri at the vertex and callosal angle greater than 90o. In both entities, the decrease of density in periventricular region may be seen: in NPH could be a sign of transependymal oedema or in brain atrophy as an accompanying leukoaraiosis. Additionally, it is possible to assess changes in flow of cerebrospinal fluid (CSF) on MRI: in NPH an increased pulsatile CSF circulation in aqueduct as flow void sign may be observed.

Correct diagnosis of NPH on CT or MRI in relation to clinical data is very important. Treatment with ventriculoperitoneal shunt or third ventriculostomy may partially improve the quality of life in some patients with cognitive impairment due to NPH.

The authors have not supplied their declaration of competing interest.

Despite advances in the last decade, people with schizophrenia remain disabled by negative symptoms and function poorly in community settings. Until recently negative symptoms were neglected as a treatment target despite apparent recognition of their importance among clinicians.

To examine the impact of negative symptoms on psychosocial functioning in order to assess the importance of such symptoms as a potential treatment target.

295 community based participants with DSM4R schizophrenia were recruited in 11 different European centres and assessed using the following scales: PANSS, GAF, Personal and Social Performance (PSP), Quality of Life Scale (QLS), Functional Recovery Scale in Schizophrenia (FRSS) and PsychoSocial Remission in Schizophrenia (PSRS). Relationships between and negative symptoms and functionality were examined using standard statistical approaches.

In this European cohort negative symptom scores were highly correlated with poor psychosocial functioning in participants living in the community. This significant trend occurred across different scales for measuring functional assessment.

The pharmacological treatment of schizophrenia appears rather becalmed at present. First and second generation antipsychotics appear to have similar efficacy for positive symptoms, different side effect profiles, but little impact on negative symptoms. This study shows a close relationship between negative symptoms and psychosocial functioning: high negative symptom scores are associated with poor functioning. This work supports the view that negative symptoms are a key target for drug development with significant potential benefit for the functioning of individuals. Drug development will increasingly focus on negative symptoms and develop effective adjunctive medication used with existing antipsychotics.

Varenicline is an alpha 4 beta 2 nicotinic receptor partial agonist with dopaminergic effects, approved for smoking cessation. The complex interactions and modulations of serotonin and nicotine receptors caused by varenicline may cause mania by its serotonin agonist activity and by its release of dopamine in the striatum. We report a case of a varenicline-induced mania with the history of depression.

A 38-year-old female, with the history of depression and have been using sertraline 50 mg/day for a year, admitted for grandiose delusions, decreased need for sleep, increased amount and rapid speech, and agitation. These symptoms began 1 week after she started taking varenicline as prescribed for smoking cessation. Young Mania Score (YMS) was 32. She discontinued sertraline and varenicline after 1 week of use but symptoms of mania continued. The patient smoked about 20 cigarettes a day for more than 10 years. She had a positive history of depression in her family. Her lab work up was unremarkable; including negative urine toxicology and brain CT scan. The patient met DSM-5 criteria for a manic episode and was started on olanzapine 10 mg/day and quetiapine 100 mg/day. The patient's symptoms gradually improved within 1 week with attainment of euthymic mood, improved sleep, and resolution of grandiosity. YMS was 7.

Based on this case it might be suggested that patient's and family's psychiatric history should be assessed cautiously before prescribing varenicline for smoking cessation due to development of mood symptoms.

The authors have not supplied their declaration of competing interest.

To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental disorder, as compared to matched acute voluntary hospitalized patients (VHP). To evaluate the effect of psychopathology severity and cognitive dysfunction on decisional capacity.

Cases were recruited among ICP at the Umberto I Hospital, ‘Sapienza’ University of Rome; controls were age- and sex-matched VHP, in the same ward and time period. Subjects were diagnosed according to DSM-IV-TR criteria and further evaluated through a) MacArthur Competence Assessment Tool for Treatment (MacCAT-T) b) Brief Psychiatric Rating Scale-24 (BPRS) c) Raven's Colored Progressive Matrices (CPM) d) Mini Mental State Examination (MMSE).

Eighteen cases were enrolled (67% women), mean age was 25.1 ± 2.8 years. There were no differences between groups in: diagnostic distribution (40% schizophrenic spectrum disorders, 40% mood disorders, 20% other diagnosis), disease duration, MMSE. ICP had higher BPRS total scores (mean difference ± S.D.= 10.3 ± 19.4; [95% C.I.= 0.6 ÷ -20.0]), and performed worse than VHP in MacCAT-T comprehension (-1.0 ± 1.3; [95% C.I.= -1.6 ÷ -0.3]), appreciation (-1,7 ± 2.0; [95% C.I.= -3.0 ÷ -0.7]), reasoning (-2.1 ± 2.9; [95% C.I.= -3.6 ÷ -0.7]) and expression of a choice (-0.8 ± 1.0 [95% C.I.= -1.3 ÷ -0.3]). Competence to give informed consent was associated with psychopathological dimensions but not with MMSE and CPM scores, in the sample overall.

Competence to consent to treatment was reduced in ICP compared to VHP. Involuntary commitment was not necessarily associated with incapability of making treatment decisions.

Recent years have seen a particular attention towards the research of particularities of cognitive processes in schizophrenia.

This study aims to investigate neuropsychological impairment in schizophrenia patients and their siblings.

Cognitive functioning in 30 schizophrenia patients, 30 unaffected siblings and 30 unrelated healthy controls was assessed using verbal fluency tests (letters and categories) and several computerized memory and executive function tests.

The patients performed significantly poorer than controls on all cognitive tests. Unaffected siblings demonstrated better performance than patients on some measures of spatial memory and executive function, but the performance was worse then controls. Patients and siblings demonstrated impaired verbal fluency performance.

Patients with schizophrenia and theirs unaffected siblings shared a deficit in verbal fluency.

One of the most important attitudes which can affect personal, professional and social operation of individual, especially medical students is assertiveness.

The samples of this research consist of 412 students of Jahrom University who are studying in Doctoral, Nursing, Technician of operation room and technician of Narcosis. Ratus Assertiveness test was used for gathering data.

The score of assertiveness was between 73/8-173.82.3% of students were unassertive and 17/7% was assertive. The highest rate of assertiveness was observed in the students of Narcosis (121.44±19.19) and the lowest rate was seen among doctoral students (113.30±14.64).

The results reveal the prevalence of unassertiveness in the students of Jahrom University. The low assertiveness score in the male students is clear. Also students whose fathers are highly educated and also students who have better economic situation, have higher score.

Internet addiction can have important consequences in adolescents. Many adolescents have to live apart from their families for their education during high school. Some of these students stay in dormitories. Despite the many studies on Internet addiction, none of them clarify the Internet addiction status and quality of life of dormitory residents.

Our aim in this study was to determine the internet addiction scores of dormitory residents and evaluate whether a difference was present with students who lived at home.

The subject group consisted of randomly chosen dormitory students. The control group consisted of another randomly chosen student at the same class who was staying at home. The sociodemographic data forms the pediatric quality of life inventory (PedsQL), children's depression inventory (CDI) and internet addiction test (IAT) were administered.

We found lower Internet addiction scores and total psychosocial scores in dormitory students compared to students who lived at home. There was no difference between the groups regarding depression score, physical health total score and quality of life total score.

Our results indicate that dormitory students suffer less from Internet addiction than those staying at home while the quality of life is similar. Staying at a dormitory may be protective against and therapeutic for Internet addiction without decreasing the quality of life and missing school for internet addict adolescents as it makes it more difficult for them to access the internet.

The authors have not supplied their declaration of competing interest.

A 21-year-old man was admitted to our clinic due to treatment resistant cervical dystonia attributed to neuroleptics. During the last five years he had been treated for depressed mood, somatic delusions and aggressive behaviour. He had been given SSRIs and atypical antipsychotics at low doses; six months prior to his admission he had been switched to risperidone.

Present clinical examination revealed torticollis, motor stereotypies, vocal tics (sniffing, repetition of words), mental koprolalia and obsessive-compulsive symptoms. He complained of repetitive intrusive thoughts of harming his sister and thoughts of a ‘delusional’ nature regarding somatic complaints were also present. The patient was diagnosed as TS and was successfully treated accordingly.

TS can mimic many hyperkinetic states. Whether patients with TS are at higher risk of developing dystonia, or tics and dystonia share a common pathophysiological mechanism (dopamine-inhibiting processes are probably involved in both conditions) is still debatable.

One of the current concerns in the research on schizophrenia is the relationship between social functioning and emotion recognition abilities, more specifically of the role that this can have, as a potential pathway for building subsequent psychosocial intervention methods.

To establish the precise role that the ability to recognize emotions has on social functioning in subjects with a diagnosis of Schizophrenia.

To help develop psychotherapeutic intervention programs that will increase social functioning.

This paper analyzed a sample of subjects (N=31) with a diagnosis of Schizophrenia (according to the WHO ICD 10), who were selected based on inclusion/exclusion criteria. The following parameters were assessed: socio-demographic (gender, age of onset, level of education, family and professional status), social functioning (SFS scale) and the ability to identify emotions in the eyes (‘Reading the Mind in the Eyes’ test).

The ability of recognizing the emotion ‘anger’ is directly correlated with the ability to communicate and keep interpersonal relations (Spearman R = 0.310, p <0.05), the ability of independence/performance (Spearman R = 0.471, p <0.05), as well as the ability to relax (Spearman R = 0.456, p <0.05) and to engage in social activities (Spearman R = 0.473, p <0.05).

We noted that ‘anger’ is the only emotion that was correlated with social functioning. Anger must be understood beyond its negative connotation, also as a positive element, in the sense of positioning the individual in the society and of taking action in regard to personal needs.

Studies from Pakistan reveal a high prevalence of depression in women. Evidence based and effective treatments are available, yet there is a significant gap between the number of women in need of treatment for depression and those who receive the services. This qualitative study identifies the barriers in access to mental health services for women with depression in Karachi from key informants' perspectives.

19 key-informant interviews were conducted with psychiatrists, psychologists, general health practitioners, pharmaceutical representatives, a government health department official and NGO workers working on women health issues.

Key-informants reported lack of awareness, misconceptions, self-medication, being young and unmarried and financial status as barriers for women in accessing mental health services. In addition, provider's lack of medical education about depression, mismanagement of cases by GPs, opposing mental health care and lack of referral system are also considered barriers to mental health services. Larger societal issues are stigma, gender bias, as well as poor resource allocation and management.

Key-informants considered women's education, mental health literacy and referrals as facilitators for women.

The study highlights the need for multipronged and multi-sector approach for increasing the access to mental health services for women in an urban context of developing country where mental health services are present but not accessed by women.