This study evaluated the efficacy and safety of venlafaxine extended-release (XR) in preventing recurrence of depression.

Outpatients with recurrent unipolar depression (N=1096) were randomly assigned in a 3:1 ratio to 10-week treatment with venlafaxine XR (75 mg/d to 300 mg/d) or fluoxetine (20 mg/d to 60 mg/d). Responders (HAM-D17 ≤12 and ≥50% decrease from baseline) entered a 6-month, double-blind, continuation phase on the same medication. Continuation phase responders enrolled into maintenance treatment consisting of 2 consecutive 12-month phases. At the start of each maintenance phase, venlafaxine XR responders were randomized to double-blind treatment with venlafaxine XR or placebo; fluoxetine responders continued on fluoxetine. Time to recurrence (HAM-D17 >12 and <50% reduction from acute phase baseline at 2 consecutive visits or the last valid visit prior to discontinuation) was evaluated using Kaplan-Meier methods and compared between groups using log-rank tests.

In the second maintenance phase, the cumulative probabilities of recurrence through 12 months in the venlafaxine XR (n=43) and placebo (n=40) groups were 8.0% (95% CI: 0.0, 16.8) and 44.8% (95% CI: 27.6, 62.0), respectively (P<0.001). The probabilities of recurrence over 24 months for patients assigned to venlafaxine XR (n=129) or placebo (n=129) for the first maintenance phase were 28.5% (95% CI 18.3, 37.8) and 47.3% (95% CI 36.4, 58.2), respectively (P=0.005).

An additional 12 months of venlafaxine XR maintenance therapy was effective in preventing recurrence in depressed patients who had responded to venlafaxine XR after acute, continuation, and 12 months' initial maintenance therapy.

Hopelessness and self-esteem are evaluated to be linked with psychopathology.

To look for sensitivity of scales who measure these components as premise for use in clinical work.

Measure the level of hopelessness and self-esteem of adolescents referred to clinic and the psychological difficulties;possible correlation with diagnosis, psychological difficulties and suicidality.

Referred adolescents to the clinic have been offered to fill out Hopelessness scale for children, Rosenberg self-esteem scale and SDQ questionnaire. All data has been analyzed by SPSS 14.0.

In the sample of 57 adolescents we found 14 (24,6%) case with high level of hopelessness; 42 (73,7%) cases with low self-esteem and 17 (29,8%) cases with suicidal thinking/behavior. We didn't found any significant association with diagnose.with psychological difficulties based on SDQ (n = 53) resulted 16 (28,3%) cases.We found significant negative association (x2 = 8.857,df = 1,N = 57, Fisher's exact test p < .007) between self-esteem and suicidality (suicidal cases have highest scores at self-esteem scale), where phi=−,394 indicates the strength of association to be medium. A Kruskal-Wallis Test revealed a statistically significant difference where higher hopelessness score correlate with higher means ranks of total difficulties, emotional symptoms, conduct problems, hyperactivity. the same link is with suicidality where we found higher hopelessness score in suicidal cases x2 = 6.578, df = 2,N = 57, p < .037.

Low self-esteem is much presented, but not associated with hopelessness and suicidality. High level of hopelessness and suicidality also are present nearly in third of sample and linked between. High level of hopelessness accompanies other psychological difficulties found (emotional, conduct, hyperactivity) but not with diagnose.

Paraneoplastic cerebellar degeneration (PCD) is a rare disorder, presenting with severe cerebellar dysfunction. In addition to motor deficits, cognitive and behavioural changes can be associated with cerebellar damage. The cerebellar cognitive affective syndrome (CCAS) describes affective disturbances and impairments in executive function, spatial cognition and language.

We describe, using a timeline, a patient who developed a psychiatric disorder following PCD.

A 19-year-old female presented with subacute ataxia, dysarthria and nystagmus. She was diagnosed with Hodgkin's lymphoma and achieved complete remission following chemotherapy. Over the next seven years she experienced recurrent episodes of altered mood. Her depressive symptoms included low mood, crying spells, irritability, apathy, lack of energy and early waking. There were periods when she felt “high”, harboured unrealistic optimism, had reduced attention, increased her alcohol intake and was described as being “reckless” by her family. She was diagnosed with bipolar affective disorder and eventually stabilised on imipramine and lithium.

This presentation appears to describe a case of CCAS, in which the affective component is bipolar affective disorder, type II. The psychiatric findings are a direct result of the neuropathology, emphasizing the role of the cerebellum in affective illness. While depression, mood instability and psychosis are the possible psychiatric consequences of CCAS, bipolar disorder appears to be a more unusual variant.

This presentation adds to the existing literature suggesting a cerebellar role in the modulation of emotion, and emphasizes the importance of addressing psychiatric sequelae in the treatment and rehabilitation of patients with paraneoplastic cerebellar degeneration.

Current trends that integrate neuroscience, attachement theory and clinical psychiatry suggest that traumatic attachments are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. On the other hand addiction is caused by long lasting changes in brain function as a result of pharmacological insult (repeated drug use), genetic disposition and environmental association made with drug use (learning).

From our clinical work it is known that experience of any sort of attachement abuse is not uncommon in alcohol addiction. Issues of violence and sexual abuse in early personal history deeply influence not only partners' relationship, the capacity for intimacy and mutual trust, but also parental function and cooperation. Attachement traumas in addicted patient were supposed to be very resistant in treatment because of mutual reinforcement of both problems (early trauma experience and addiction): such patients were prone to relapse in addiction treatment either because detached traumatic experiences become a source of long lasting manipulation of addicted patient for retaining the “right for drinking” either because of seriously comorbide disorders without appropriate pharmacological treatment.

In our clinical experience, we found attachement trauma psychotherapeutically accessible only after period of stable sobriety and secondly, that routine combination of intensive psycho- and pharmacotherapy gives an optimistic attitude in treatment which is illustrated by clinical vignettes.

Impulsivity and alcohol drinking are both considered as important predictors of unintentional as well as intentional injuries. However, relationships between impulsivity and risky behaviors have not been investigated in alcohol dependence.

The aim of this study was to analyze relationships between the frequency of risky behaviors and level of behavioral as well as cognitive impulsivity in alcohol-dependent patients.

By means of Barratt's Impulsiveness Scale and stop-signal task the levels of cognitive and behavioral impulsivity among 304 alcohol-dependent patients were measured. Also, patients were asked to answer questions from the Short Inventory of Problems applying to risky behaviors and accidents after alcohol drinking. In addition participants filled in a questionnaire to assess frequency of other behaviors from the analyzed spectrum (suicide attempts, use of other drugs, law problems).

The statistical analysis revealed a significant association between impulsivity and frequency of risky behaviors in alcohol dependent patients. Individuals with higher scores in BIS behaved more frequently in a risky way (p = 0,000001) and had significantly more accidents (p = 0,00067) after alcohol drinking. The association for risky behaviors was strongest for non-planning (p = 0,000075) and attentional (p = 0,000002) impulsivity subscales, whereas frequency of accidents was particularly associated with motor impulsivity (p = 0,001). In addition, a significant association between global impulsivity and risk of suicide attempts, use of other drugs and frequency of law problems was observed. A multivariate analysis revealed that impulsivity and severity of alcohol dependence are the most important predictors of risky behaviors.

Impulsivity increases the frequency of risky behaviors in alcohol-dependent individuals.

The authors have not supplied their declaration of competing interest.

The topic of resilience is obtaining a growing interest in psychiatric research. Resilience refers to positive adaptation or ability to maintain or regain mental health despite experiencing adversity. It is a dynamic, context- and time-specific process, and may vary across all life domains. Pathways to resilience are multiple and reciprocally interacting, and include biological, psychological, social and dispositional attributes. These factors play an important role both in psychiatric and somatic chronic disorders.

Our aim is to evaluate and compare resilience in mood disorder patients and diabetic ones. We also mean to investigate personality features, coping abilities, self-esteem and quality of life, and their possible correlation with resilience in these two populations.

Mood disorder and diabetic patients will be recruited at the Psychiatry Institute (SC Psichiatria) and Endocrinology Ward (SC Endocrinologia), respectively. Socio-demographic data will be gathered and patients will be asked to fill the following self-administered scales: Resilience Scale for Adult (RSA), Coping Orientation to Problems Experienced Inventory – Brief (Brief Cope), Rosenberg Self-Esteem Scale (RSES), Paykel List Of Stressful Events, Temperamental and Character Inventory (TCI), Short Form 36 (SF-36).

Data collection is ongoing. We expect that the findings from this research may allow to develop strategies to support patients with chronic diseases, both as far as outcome and subjective well-being are concerned, according to the World Health Organization definition of 'mental” and 'physical” health.

We report a case of a 27-year-old Iraq War veteran with no previous psychiatric history who sustained severe traumatic brain injury (TBI) following a blast injury from an improvised explosive device. The patient subsequently suffered severe anxiety symptoms controlled only with combined therapy with benzodiazepines and venlafaxine. Even more disabling, the patient also experienced intractable headache and shoulder pain unresponsive to non-steroidal anti-inflammatory agents, tramadol, gabapentin, or NMDA-receptor antagonists. Given the risk of respiratory depression with his current medications, opioid analgesics were not favored for the management of his pain. The patient was started on sublingual buprenorphine at a dose of 8mg three times daily with significant improvement. This dose was maintained and the patient was able to function relatively pain-free.

Chronic pain is a significant complication in patients with TBI and is reported by a majority of patients with TBI, regardless of the severity of the injury. The treatment of chronic pain among individuals can be challenging. Patients with TBI may be on other medications for impulse control, such as anticonvulsants and benzodiazepines. Further treatment with narcotic analgesics may therefore increase the risk of respiratory depression. Buprenorphine is a partial mu agonist whose effects plateau at higher doses, at which time it begins to act like an antagonist. It is this property at higher doses that limits its dose-dependent respiratory depression. Buprenorphine thus has the advantage of effective analgesia with minimal sedation and may be useful to treat chronic pain among TBI patients already taking benzodiazepines.

H&F Multidimensional Perfectionism Scale is a widely used measure of perfectionism developed to measure Self-oriented perfectionism (SOP), Socially-prescribed perfectionism (SPP) and Other-oriented perfectionism (OOP) dimensions. The original scale comprises 45-likert items. We have previously developed a short version of The H&F-MPS, with 13 items, showing adequate validity in a sample of university students, using principal component analyses method with factors varimax rotation.

To examine the factor structure of the H&F-MPS13 with confirmatory factor analysis (CFA), using a different sample of Portuguese university students.

The sample comprises 245 university students (68.9% females), with a mean age of 20.95 years (SD= 2.19; range= 17–33) who completed the H&F-MPS13. CFA was used to test the model suggested by prior exploratory factor analyses of H&F-MPS13.

After correlated errors, we obtained a good fit for the second-order factor (X2/d= 2.577; CFI= 0.928; GFI= 0.915, RMSEA= 0.080; P[rmsea ≤ 0.05] = 0.001). The H&F-MPS13 showed acceptable internal consistency (α= 0.77) and the three dimensions presented Cronbach's alphas ranging between acceptable and good (α OOP = 0.67; SPP = 0.73; SOP = 0.89).

The H&F-MPS13 obtained through CFA is a reliable and valid measure to assess perfectionism in Portuguese university students.

The authors have not supplied their declaration of competing interest.

Previous studies have found association between several schizophrenia candidate genes and neurocognition in schizophrenia patients and healthy individuals. Both brain-derived neurotrophic factor (BDNF) and disrupted in schizophrenia 1 (DISC1) are important for neurodevelopmental processes and have been implicated as schizophrenia candidate genes, as well as genes influencing neurocognition.

To test for the previously described association of these genes with schizophrenia and neurocognition.

DNA samples from a homogeneous sample of 280 schizophrenia patients and 230 healthy controls were genotyped for polymorphisms in schizophrenia candidate genes DISC1 (rs821597 and rs821616) and BDNF (rs6265). Clinical assessment was performed using the Schedule for Deficit Syndrome and the Positive and Negative Symptom Scale. Neurocognitive functioning was assessed in a subsample of 263 patients and 135 healthy controls by a comprehensive neuropsychological test-battery. Based on the raw neuropsychological measures we calculated a global index of cognitive impairment and domain-specific composite z-scores. Association between the above composite scores and the SNPs was examined using GLM and GENMOD analysis.

The investigated SNPs were not associated with schizophrenia, nor with the deficit or non-deficit subgroups. However we found significant association between global cognitive impairment and rs821616 in DISC1 (F = 3.02, p = 0.05) and rs6265 in BDNF (F = 4.47, p = 0.01); moreover rs6265 was associated with working memory (F = 6.22, p = 0.002) and attention (F = 7.27, p = 0.0074)

Using neurocognition as an endophenotype for psychotic disorders in genetic studies has the potential to determine common and separate genetic factors influencing disease risk and neurocognition.