Current treatments for alcohol dependence, aiming to keep patients abstinent, have shown limited treatment and success rates. Reduction of alcohol consumption is increasingly recognised as a valid and needed option that should be an integrated part of the management of alcohol-dependent patients.

The main objective was to evaluate the efficacy of as-needed use of nalmefene 18 mg (base) versus placebo in reducing the monthly number of heavy drinking days (HDDs) and the monthly total alcohol consumption (TAC; g/day) over 24 weeks in alcohol-dependent patients.

Drinking measures were derived from daily drinking estimates collected with the Timeline Followback method. Safety and additional efficacy data were collected throughout the study.

A total of 604 patients (mean age 51.6 ± 9.6 years, 67% men) were randomised (298 to placebo and 306 to nalmefene). There was a significantly superior effect (mixed model repeated measures) of nalmefene compared to placebo in reducing the number of HDDs (−2.3 ± 0.8 [95% CI −3.8; −0.8]; p = 0.002) and TAC (−11.0 ± 3.0 [95% CI −16.8; −5.1]; p < 0.001). Improvements in Clinical Global Impression - Global Improvement and Severity of Illness scores and reductions in liver enzymes gamma-glutamyltransferase and alanine aminotransferase from baseline were statistically significantly larger in the nalmefene group compared to placebo at week 24. Adverse events (generally transient; most were mild or moderate) and withdrawals were more common with nalmefene than placebo.

Nalmefene was efficacious in reducing alcohol consumption. Nalmefene was safe and well tolerated and dosing on an as-needed basis was feasible.

The majority of studies on the HIP IQ attest a heterogeneity of the IQ profile as specific to HIP. However, the samples are recruited in clinical consultations. Thus, it is important to investigate new samples from schools.

We aimed to analyze the index scores of the IQ profile of children without disorders or specific school assistance.

The WISC-V was conducted and analyzed in 80 healthy children (50 HIP vs. 30 non-HIP), aged 7-to-13 years-old (mean 10y; SD 1.8). All children were recruited in private and public schools in Paris.

All IQ index scores were significantly higher in the HIP vs. non-HIP. In both groups, the Verbal Comprehension Index was the highest index while the Processing Speed Index was the lowest. There are significantly (p=0.02) more heterogeneous IQ profiles in HIP (64%) vs. non-HIP (47%), with a significantly larger gap between the highest and lowest index (respectively: median = 29.5 vs. 21.5). There was a significant-positive correlation between IQ level in general and the heterogeneity of the profile (r = 0.42; p<0.001).

The HIP children show better verbal, visual-spatial, fluid reasoning, working memory, and processing speed index scores. However, the distribution of IQ index scores was similar in both groups. Thus, the heterogeneity of the IQ profile is not specific to HIP children, but rather related to IQ score level. This highlights the importance of considering the IQ as a continuum rather than as a categorical distribution. Moreover, it points to the interest to better understand the IQ profile by completing it with multidimensional assessments.

None Declared

The study attempts to delineate the clinical correlates (suicidal risk, manic, depressive and psychotic symptom severity) and course characteristics (age of onset and details of past affective episodes) of bipolar mixed state and compare with bipolar manic and bipolar depressed state diagnosed according to ICD-10 Diagnostic Criteria for Research(ICD-10 DCR).

The study was carried out in inpatient psychiatry setting of Kasturba Hospital, Manipal, India over a period of 10 months. It was an Open, Non-randomised, Naturalistic study with sequential sampling. The rating scales used were Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Positive and Negative Symptom Scale for Schizophrenia (PANSS) and Beck Scale for suicidal ideation.

A total of 70 subjects were included in the study meeting the criteria of bipolar disorder currently manic, depressed and mixed state according to ICD-10 DCR.

Manic group constituted the majority (n1 = 47) followed by depressed (n2 = 17) and mixed groups (n3 = 6). Mixed group was characterized by preponderance of females, high suicidal intent, high frequency of mood-incongruent psychotic symptoms, illness severity and significant family history.

The study was able to establish some core features that were specific to mixed states. A larger sample size and a prospective follow up study would throw light on the existence of this group as an independent entity.

The purpose of this study was to determine the degree of agreement among parents and teachers with respect to the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF).

A total of 800 randomly selected children (400 boys, 400 girls) aged 7–11 years (mean age 9.28, SD 1.42) were assessed using CBCL and TRF parents completed the Child Behavior Checklist (CBCL) and teachers completed the Teacher's Report Form (TRF). Approximately 98% of the respondents were listed as the mothers and 2% as the fathers. for the TRF, 100% of the respondents were child's teacher. Analyses was included degree of concordance of ratings as a function of informant and child gender. the collected data were analyzed using pearson Coefficient of Correlation.

Coefficient of correlation showed low to moderate agreement among informants (parent-teacher) (r = 0/39). Furthermore the correlation of scores on the externalizing scale were generally significantly higher (p < 0/01) than the scores on the internalizing scale for parent-teacher correlation. There were no significant effects of gender on concordance among Ratings.

The results indicated that correspondences between parent and teacher ratings of behavioral and emotional problems across home and school settings differ. This difference is at least partly due to the situation specific behavior of children. Externalizing behaviors, in general, are more easily noticeable than internalizing behaviors, which partially explains why there tends to be greater correlation between raters on externalizing behavior. This Results help to gain a greater understanding of how the perception of child behavior varies between raters.

Psychiatric population is characterized by a higher prevalence of cardiovascular events compared to general population. This difference might be due, in part, to the metabolic adverse effects of psychotropic agents, and, in part, to common risk factors such as smoking, sedentary lifestyle and unhealthy diet. Another potential risk factor is represented by the presence of metabolic syndrome (MetS).

We aimed to evaluate the prevalence of MetS and to identify the baseline predictors for the longitudinal development of MetS in a sample of Italian psychiatric inpatients.

Medical records of 343 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.

Prevalence of MetS was 21.5%. MetS appeared directly associated with age and number of medication assumed. ROC curves showed HDL as the best predictor of metabolic syndrome in our sample.

Our results confirm previous data on the association between metabolic syndrome and exposure to complex polytherapy. Additionally, our findings support the notion of psychiatric patients as an at-risk group for metabolic abnormalities, which should be carefully monitored.

The authors have not supplied their declaration of competing interest.

To investigate the behavioral and cognitive effects of memantine in moderate to severe patients with Alzheimer disease receiving donepezil.

Study was a 24 weeks prospective, randomized, parallel group. 43 patients were enrolled in the study, 21 continued treatment with donepezil and 22 were randomized to donepezil and memantine treatment. Patients were at least 50 years old, receiving ongoing therapy with donepezil for at least 6 months (10 mg / day). Average age for both groups was 72.5 years. There were no significant imbalances between the treatment groups in demographic and baseline clinical characteristics. Cognitive, ADL, and global measures were collected at baseline and at the end of weeks 4, 8, 12, 18 and 24. Behavioral measures were obtained at baseline, at the end of week 12 and at week 24. Mean baseline MMSE scores were 15.2 for donepezil group and 14.9 for donepezil – memantine group. Mean baseline NPI scores were of 15.8 for the donepezil group and 16.4 for the donepezil – memantine group.

Patients treated with donepezil – memantine had significantly lower NPI total scores than patients treated only with donepezil. Analyses of the 12 NPI domains revealed significant effects in favor of memantine on agitation / aggression, eating / appetite, and irritability / lability. Memantine - treated patients showed significantly less deterioration in their functionality. The Severe Impairment Battery showed significant differences favoring memantine – donepezil group.

Treatment with memantine was well tolerated and reduced agitation / aggression, irritability, and appetite eating disturbances.

Asperger's Syndrome is a neuro-developmental disorder characterised by social impairment and restricted interests, similar to those found in autism, but with cognitive and linguistic skills preserved. As DSM-5 has eliminated Asperger's Syndrome, will the patients be included in ASD (Autistic Spectrum Disorders)?

The objective of this study is the revaluation of the diagnosis according to the DSM-5 criteria, in a sample of subjects affected by ASD-Asperger's Syndrome.

The secondary aim is to evaluate adaptive skills in order to estimate the probability of the individual's autonomy.

We performed an observational study. Twelve subjects with ASD-Asperger's Syndrome diagnosis with an IQ≥75 were included. An interview to evaluate the existence of ASD, according to the DSM-5 criteria and Vineland adaptive behaviour scales (VABS) to evaluate the adaptive skills, were administered during the sample.

The ASD diagnosis according to DSM-5 is confirmed only in 16.6% of the included subjects. 83.4% were excluded as they did not meet the social communication criteria and the required age for the onset of this specific symptomatology; the VABS subscales of daily skills and socialization are impaired for the entire sample.

Our research shows how the DSM-5 criteria, despite being more specific than DSM-IV, might exclude the subjects affected by Asperger's Syndrome from the Autistic spectrum. Their exclusion would involve the loss of access to specialistic interventions and clinical trials aimed at psychopathological and pharmacological depth

Maternal mental well being influences offspring development. Research suggests that an interplay between genetic and environmental factors underlies this familial transmission of mental disorders.

To explore an interaction between genetic and environmental factors to predict trajectories of maternal mental well being, and to examine whether these trajectories are associated with epigenetic modifications in mothers and their offspring.

We assessed maternal childhood trauma and rearing experiences, prenatal and postnatal symptoms of depression and stress experience from 6 to 72 months postpartum, and genetic and epigenetic variation in a longitudinal birth-cohort study (n = 262) (Maternal adversity, vulnerability and neurodevelopment project). We used latent class modeling to describe trajectories in maternal depressive symptoms, parenting stress, marital stress and general stress, taking polygenetic risk for major depressive disorder (MDD), a composite score for maternal early life adversities, and prenatal depressive symptoms into account.

Genetic risk for MDD associated with trajectories of maternal well being in the postpartum, conditional on the experience of early life adversities and prenatal symptoms of depression. We will explore whether these trajectories are also linked to DNA methylation patterns in mothers and their offspring. Preliminary analyses suggest that maternal early life adversities associate with offspring DNA methylation age estimates, which is mediated through maternal mental well being and maternal DNA methylation age estimates.

We found relevant gene-environment interactions associated with trajectories of maternal well being. Our findings inform research on mechanisms underlying familial transmission of vulnerability for psychopathology and might thus be relevant to prevention and early intervention programs.

The authors have not supplied their declaration of competing interest.

In general, the large body of research for children with autism spectrum disorder (ASD) indicates that autistic children show profound impairment in socio-cognitive functions. So, strategies should be considered in intervention programs in order to decrease the socio-cognitive impairments in individuals with ASD.

Although exercise activities can be presented in conjunction with social activities, there is few works examining a multilayer group exercise targeting a wide range of characteristics of ASD such as social and cognitive deficits as well as behavioral problems.

The purpose of this study was to investigate the effect of a 10 week social group exercise program (SGEP) on social abilities, attentional function and clinical character of children with ASD.

In a randomized, controlled trial, 30 high functioning autistic children and adolescents aged 7 to 14 years old were randomly allocated to either an experimental group that received SGEP or to a control group. Participants were evaluated for level of social skill (Autism Social Skill Profile), cognitive and attentional functions (Wisconsin Card Sorting Test) and clinical features (Autism Treatment Evaluation Checklist) before and after the intervention period.

Results indicated that participants in experimental group showed significant improvement in social, attentional skills and clinical character but those in control group remained unchanged.

We concluded that physical exercise particularly those with social content have the potential for improving main problems of children with ASD and can be added as an essential part of their treatments alongside the conventional and behavioral intervention programs.

Internet addiction has become a harmful behavioral problem found to be highly prevalent in high school and college students. Many studies demonstrated significantly association between Internet addiction and depression.

To study the prevalence of Internet addiction and the association between internet addiction and depression in medical students, faculty of medicine, Ramathibodi hospital.

A cross-sectional study was conducted. Participants were the first to fifth-year medical students who agreed to participate in this study. Demographic characteristics were derived from self-rated questionnaire and were analyzed by descriptive statistics. Thai version of Young's Internet Addiction Diagnostic Questionnaire and Thai version of Patient Health Questionnaire (PHQ-9) were used to assess internet addiction and depression, then Chi2 test and logistic regression were used to analyze the associations between internet addiction, depression and associated factors.

From 705 participants, 24.5% had internet addiction and 29.0% had depression. There was statistically significant association between Internet addiction and depression (odd ratio: 1.92; 95% confidence interval [CI]: 1.34–2.77, P-value < 0.000). Logistic regression analysis illustrated that the Internet addiction group had risk of depression 1.58 times higher than the group without Internet addiction (95% CI: 1.04-2.38; P-value < 0.031). Academic problem was found to be a significant predictor of both Internet addiction and depression. Furthermore, Internet addiction, relationship problems with friend and lover, and health problem were also significant predictors of depression.

Internet addiction was common psychiatric problem which associated with depression among medical students. We suggest that surveillance of Internet addiction should be considered in medical schools.

The authors have not supplied their declaration of competing interest.

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.

Nutritional rehabilitation in anorexia nervosa (AN) is impeded by fear of food, eating and change leading to treatment resistance. Oxytocin exerts prosocial effects on anxiolysis, fear modulation, trust and brain plasticity.

A placebo-controlled RCT examined the effects of self-administered intranasal oxytocin (IN-OT) in AN patients.

To ascertain whether single and repeated doses of IN-OT enhance treatment in AN.

Female AN patients self-administered twice daily 18IU IN-OT (n = 21) or placebo (n = 21) for 4–6 weeks during hospital treatment. Weight and BMI were measured at baseline and after treatment. The Eating Disorders Examination (EDE) was the primary outcome measure. Cognitive rigidity was compared between groups after four weeks repeated dosing. The effects of the first and last doses of IN-OT versus placebo, on salivary cortisol before a high-energy afternoon snack, were compared.

Weight gain was similar in IN-OT and placebo groups. Only the EDE eating concern subscale score was significantly lower after 4–6 weeks (mean 35 days) of IN-OT (p = 0.006). Anticipatory levels of salivary cortisol fell from baseline after the initial dose in contrast to the placebo group where levels increased. After four weeks IN-OT, salivary cortisol was significantly lower (p = 0.023) overall with little anticipatory increase compared to placebo. There were no differences in anxiety scores. Cognitive rigidity was significantly lower in the IN-OT group (p= 0.043)

Self-administered IN-OT might enhance nutritional rehabilitation in AN by reducing eating concern and cognitive rigidity. Lower salivary cortisol before a high-energy snack, suggests reduction of fear rather than anxiety.

The authors have not supplied their declaration of competing interest.

This given study was designed to qualitatively and quantitatively examine the Psychosocial – emotional consequences of infertility on female infertile patients . Suicidal risk amongst infertile patients was a incidental yet significant finding with 25 percent of the study population reporting a positive result by the MINI scale. There are very few studies conducted in the Indian context that analyses the psychosocial aspects of infertility and the impact of ART treatment on the quality of life.

The finding in our study indicates that both infertility and stress associated with ART treatment contributes to psychological turmoil namely depression , anxiety, psychopathology and quality of life impairment in addition to suicidal ideation and suicidal risk.

Aims

To assess the psychosocial impact of infertility amongst female infertile patients including suicidal risk/ suicidal ideation in the given study population.

A total of 300 women attending the Obstetrics and Gynecology out patients department of a tertiary hospital in Kolkata, India were selected by simple random sampling. 100 fertile women attending the routine ante natal clinic were selected as cases and 100 infertile women seeking fertility treatment were selected as controls. 100 women didn’t follow up with the study. The following questionnaires were administered to both case and control group- BAI, BDI, SCL-90-R, SF-36, MINI and socio demographic proforma ; by trained clinic psychologist .

The raw scores & adjusted scores were analysed statistically by SPSS using the following tests, independent t test, chi square test and Z test.

The results of the MINI scale indicate that up to 25% of the infertile cohort suffer from suicidal risk/ suicidal ideation which is statistically significant in comparison to the control group.

The other psychosocial parameters are also statistically significant in the case in comparison to the control population.

Although the psychosocial impact of infertility has been well researched and documented. Few studies have been conducted globally which assess suicidal risk amongst infertile patients.

Our results corroborate earlier studies such as the Danish administrative population-based registry study by Trille Kristina Kjaer et al which found a causative link between infertility and suicidal risk.

Further research is needed in this direction

None Declared

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a serious condition associated with persistently high ADH with water retention despite sufficient vascular volume. Sodium valproate (VPA), an antiepileptic indicated to treat bipolar disorder, blocks sodium (Na) and calcium ions. Few studies have examined the association between VPA and SIADH.

This abstract has two interrelated objectives: (1) to describe a VPA-associated SIADH case study we encountered in our clinical setting; and (2) to review literature for other VPA-associated SIADH cases to illuminate associations and possible risk factors.

After recording a case from clinical experiences, we completed a literature review of other cases of hyponatremia associated with VPA.

We reviewed resulting artticles from searches in PubMed and in the aggregate Dartmouth Biomedical Library indices with no date or language parameters. We then searched those articles’ bibliographies.

Ms. A is a 63-year-old woman with schizoaffective disorder, bipolar type, hospitalized for the resurgence of visual hallucinations (VH) of “monsters” asking her to hurt herself and others. She had been adherent to VPA (500mg twice daily) and non-adherent to prescribed Olanzapine (25mg). On Day 1 (D1), her labs were concerning for serum Na 119mEq/L (n=135-145), serum osmolality (SOsm) 264mEq/L (n=275-295), and inappropriately high urine osmolality 111mOsm/kg (n <100 mosmol/kg in hyponatremia) and urine Na 34mEq/L (n <20 mosmol/kg in hypovolemic hyponatremia). Her VPA level was 73.6 mcg/mL.

She was restarted on her home psychiatric medications for VH, and her hyponatremia responded to water restriction, with serum osmolality at 292mEq/L by D4 (see Figure). She was admitted to the inpatient psychiatric unit for concerns of persistent VH. On D13, her SOsm worsened to 267mEq/L and VPA was discontinued at that time. On D19, SOsm improved to 283mEq/L. Her VH responded well to discontinuing VPA and adding Risperidone (titrated to 6mg) and on D22 she was discharged home. Given the chronological sequence of her newly developed VH, the patient’s hallucinations were likely multifactorial, with contribution from hyponatremic encephalopathy-related psychosis.

Our literature review found ten articles reporting thirteen other cases of VPA-associated SIADH (see Table). Our patient shared demographics with most previously reported cases: being older in age and having polytherapy and a low baseline Na. None of the previous case reports showed specific drug interactions to be particularly likely causes of hyponatremia.

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Although VPA-associated SIADH is a rare phenomenon, caution is warranted when evaluating patients with VPA use presenting acutely with psychosis and hyponatremia. These symptoms could be the manifestation of hyponatremic encephalopathy-related psychosis.

None Declared