Alexithymia represents a personality construct, characterized by an inability in identifying and verbally describing own and others’ emotions. According to the recent research on emotional dysregulation and the alexithymic construct, it has been described a positive correlation between alcoholism and alexithymia. The present study aims to evaluate the presence of alexithymia in a sample of alcohol dependant patients and, therefore, analyze how the presence of these alexithymic traits may influence/interact with a range of cognitive processes such as the anger rumination, metacognitive capabilities and dissociative experiences.

A sample of 40 alcohol dependant inpatients affected with alcohol dependence and alcohol-related issues were recruited, evaluated and compared with a sample of 40 healthy controls. A clinical evaluation and a complete clinical and psychological assessment were carried out in order to investigate alcohol-related clinical patterns, alexithymia construct, anxiety and depression symptomatology and cognitive pattern.

Subjects with alcohol addiction show higher total scores in all tests except the scale that evaluates anxiety, compared to healthy controls. Finally, a factorial ANOVA analysis demonstrated that alcoholism seems to be determined by the lack of emotional recognition from which derives a dissociative state, which consequently generates a depressive rumination.

According to the recent literature, the present study identifies a significant proportion of alexithymic patients within the sample of subjects affected by alcohol-related disorders. Other clinical variables (i.e. depression, pathological anxiety-related worry, anger rumination, dissociation and metacognitive capabilities) mirror a specific cognitive pattern in the sample of alcoholics rather than the healthy group.

The authors have not supplied their declaration of competing interest.

The goal of value-based healthcare is to improve the quality of care while also lowering healthcare costs. Values may also include societal or research benefits.

To outline the emergence and quality-related concepts of value-based healthcare.

To give a comprehensive overview and critical discussion of quality aspects of value-based mental healthcare including aspects of personal, societal and scientific values.

Review of quality aspects of value-based mental healthcare.

The quality aspect of value-based healthcare includes the implementation of patient-centered care and may include the assessment of societal values or values for research purposes. Current concepts focus on the reduction of disability-adjusted life years to measure the achievement of values, but may need to be broadened to include benefits to society as a whole or the progress of knowledge about mental disorders in research. Conceptually, addressing such broader value issues may lead to increased benefits and a better appraisal of the value of mental healthcare.

The trend towards value-based mental healthcare aims at creating an efficient care delivery model, that strongly focuses on achieving favorable patient outcomes and may in the future also include creating societal values. It includes the development and implementation of suitable mental health policies and comprehensive quality assessment, plus a broad conceptualization of the value-term and its assessment in value-based mental healthcare.

The author has not supplied his declaration of competing interest.

Psychosocial interventions are an essential part of the treatment of schizophrenia and are aimed at promoting the social, family and occupational functioning of the patient and relapse prevention. They are considered proven clinical measures whenever necessary, however they tend to be underused.

Answer the question on psychosocial therapies available today for schizophrenia.

Review through PubMed by entering the following keywords: psychosocial therapy; schizophrenia; cognitive behavioral therapy, and clinical practice guidelines.

There are several psychosocial therapies used in clinical practice. The main points of approach focus on self-management of the disease, everyday problems, education, crisis intervention, and acquiring insight. The cognitive impairment is an important aspect of schizophrenia to consider. It seems that cognitive remediation therapy has been associated with both neurobiological and cognitive improvement.

The combination of different therapies along with psychopharmacological treatment appears to provide better results in the reduction of negative symptoms, positive symptoms and reduced hospital stay.

The authors have not supplied their declaration of competing interest.

The UK General Medical Council highlights the centrality of effective communication, reflective practice and the doctor-patient relationship in medical practice. A decline in empathy has been documented as occurring within clinical and early postgraduate years, potentially affecting diagnostic processes and patient engagement. Access to Balint groups can enhance awareness of the patient beyond the medical model, but remains limited at many UK medical schools. This scheme offered Balint groups to Bristol medical students in their first clinical year, demonstrating that this method is relevant beyond psychiatry.

Initial focus groups with medical students indicated that many felt unable to discuss distressing aspects of clinical encounters. During 2013-2014, a Balint scheme run by psychiatry trainees was started for 150 students in their psychiatry placements. During 2014-15, the scheme was introduced to all third-year medical students on their medicine/surgery placement. Balint leaders have group supervision with a psychoanalytic psychotherapist. Evaluation of the scheme was based on pre-and post-group questionnaires and leaders’ process notes.

Sixteen groups led by 12 trainees were run twice over the year to serve 246 medical students. Two example cases are discussed here. Students appreciated the chance to discuss complex encounters with patients in a supportive peer environment, and work through a range of emotionally challenging issues.

Novel aspects of this work include the implementation of Balint groups within medicine and surgery placements; the enrolment of psychiatry trainees as leaders with group supervision and leadership training workshops from the UK Balint Society; and the scale of the scheme.

The authors have not supplied their declaration of competing interest.

Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. Those with schizophrenia and bipolar disorder are at highest risk.

International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions.

This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.

A twice-yearly, multidisciplinary monitoring clinic was established. A protocol was drawn up, following a literature review and inspection of current international guidelines, and a proforma assisted as an aide-mémoire. A self-report questionnaire, the Glasgow Antipsychotic Side Effect Scale, was used to enquire about side effects.

Evaluation took place in descriptive form with audit used to examine outcomes. Full blood test monitoring improved from 9% of patients to 61% in one year, with 78% of patients having had at least one blood test recorded. Prior to the clinic's establishment, only one patient had had any physical parameters recorded, but this improved to 96% recorded after the clinics were run. Side effect documentation also improved.

The clinic was well-received and led to improved teamwork. Future recommendations include organising the clinic so as to include simultaneous blood testing. A similar project is being planned to target all patients attending who are prescribed antipsychotic medication.

The authors have not supplied their declaration of competing interest.

To assess the prevalence of depression during IFN therapy; to test whether a computerized version of the Minnesota Multiphasic Personality Inventory (MMPI) is a sensitive and reliable test for the early identification of patients at risk of depression before IFN therapy is started; and whether and how the depression can be cured. Patients. 185 patients treated with IFN.

Before therapy, all patients underwent an MMPI and a clinical examination for identification of depressive symptoms.

Thirty-one patients developed a psychiatric disorder, 11 of them requiring treatment. Among the 18 patients with MMPI positive tests, 16 developed a psychiatric disorder (sensitivity of 0.58). Among the 154 who did not develop psychiatric side effects, 152 had a negative MMPI (specificity: 0.99). Severe psychiatric disorders (8 patients) were successfully treated with antidepressant drugs.

Psychiatric side effects are easy to see during IFN therapy. An accurate psychiatric evaluation should be considered on all patients before treatment. However, as this specific examination cannot always be performed because of the lack of psychiatrists in liver units, it is necessary to identify tests, that are easy to carry out, reproducible, self-administered and inexpensive in order to screen all patients. If depression develops, it should be treated aggressively, and selective serotonin re-uptake inhibitors are the anti-depressant of choice.

The objective of this family-based whole exome sequencing (WES) is to examine genetic variants of autism spectrum disorder (ASD) in Korean population.

The probands with ASD and their biological parents were recruited in this study. We ascertained diagnosis based on DSM-5™ criteria, using Autism Diagnostic Observation Schedule and Autism Diagnostic Interview–Revised. We selected probands with typical phenotypes of ASD both in social interaction/communication and repetitive behaviour/limited interest domains, with intellectual disability (IQ < 70), for attaining homogeneity of the phenotypes. First, we performed WES minimum 50× for 13 probands and high-coverage pooled sequencing for their parents. We performed additional WES for 38 trio families, at least 100× depth. De novo mutations were confirmed by Sanger sequencing. All the sequence reads were mapped onto the human reference genome (hg19 without Y chromosome). Bioinformatics analyses were performed by BWA-MEM, Picard, GATK, and snpEff for variant annotation. We selected de novo mutation candidates from probands, which are neither detected in two pooled samples nor both parents.

Fifty-one subjects with ASD (5 females, 40∼175 months, mean IQ 42) and their families were included in this study. We discovered 109 de novo variants from 46 families. Twenty-nine variants are expected to be amino acid changing, potentially causing deleterious effects. We assume CELSR3, MYH1, ATXN1, IDUA, NFKB1, and C4A/C4B may have adverse effect on central nerve system.

We observed novel de novo variants which are assumed to contribute to development of ASD with typical phenotypes and low intelligence in WES study.

This work has been supported by Healthcare Technology R&D project (No: A120029) by Ministry of Health and Welfare, Republic of Korea.

The authors have not supplied their declaration of competing interest.

To examine the effectiveness of an Internet Based Therapy (IBT) for Bulimia Nervosa (BN), when compared to a brief psychoeducational group therapy (PET) or a waiting list (WL).

93 female BN patients, diagnosed according to DSM-IV criteria. An experimental group (31 IBT patients) was compared to two groups (31 PET and 31 WL). PET and WL were matched to the IBT group in terms of age, disorder duration, previous treatments and severity. All patients completed assesment, prior and after treatment.

Considering IBT, mean scores were lower at the end of treatment for some EDI scales and BITE symptoms scale, while the mean BMI was higher at post-therapy. Main predictors of good IBT outcome were higher scores in EDI perfectionism and higher scores on reward dependence. Drop-out was related to higher SCL-obsessive/compulsive (p=0.045) and novelty seeking (p=0.044) scores and lower reward dependence (p=0.018). At the end of the treatment bingeing and vomiting abstinence rates (22.6% for IBT, 33.3% for PET, and 0.0% for WL; p=0.003) and drop-out rates (35.5% IBT, 12.9% PET and 0% WL; p= 0.001) differed significantly between groups. While the concrete comparison between the two treatments (IBT and PET) did not evidence significant differences for success proportions (p=0.375), statistical differences for drop-out rates (p=0.038) were obtained.

The results of this study suggest that an online self-help approach appears to be a valid treatment option for BN, especially for people who present lower severity of their eating disorder (ED) symptomatology and some specific personality traits.

Subjects with Social Anxiety Disorder (SAD) are characterized by low self-esteem, pessimism, procrastination and also perfectionism.

To examine the link between social anxiety and perfectionism and to evaluate cultural differences on these measures.

To improve our understanding on cultural factors, anxiety disorders and personality features.

Questionnaires on social anxiety, perfectionism and automatic thoughts were administered in a group of 132 students, 58 Israeli-Jewish and 74 Israeli-Arab with an average age of 26.

The rate of SAD in these students according to a score of 60 or more on the Liebowitz Social Anxiety Scale (LSAS) was 16%, a rather high rate in the Western world. the correlation between the total LSAS score and the score of perfectionism was significant (r = 0.31). Also, we will compare data on SAD and perfectionism between our two sub-samples, Jewish and Arab students. Significant differences between the Israeli-Jewish students and Israeli-Arab students appeared on two of the Multidimensional Perfectionism Scales: parental expectations and parental criticism with higher scores in the Arab students.

The linkage between SAD and perfectionism will be discussed and implications for treatment will be suggested.

Systematic assessment of risks is an essential component of care in psychiatric mother baby units. Self-harm, infant neglect and harm or the vulnerable physical health of both mother and infant may all pose risks.

Development of a risk assessment tool and risk assessment among mother-infant dyads at a MBU in Bangalore, India.

Based on data from 200 admissions, doctors and nurses of the unit developed a 15-item tool for risk assessment. Risk was assessed by both nurses and doctors among 58 consecutive mothers admitted to the unit. Risk domains included risks to self, to infant, related to infant health and feeding and violence faced by mother. Frequencies of various risks were calculated. Nurses’ risk assessments were compared to the residents’ risk assessments.

The mean age of the mothers was 25 (±4) years, age of infant 4 (±4) months and duration of episode was 4 (±14) months. Diagnoses included acute polymorphic psychosis (30%), BPAD (27%) and depression (21%). 47% had high suicidal risk and 28% had made an attempt in the current episode. 22% had expressed ideas of infant harm and 24% had physically harmed the infant. 48% of mothers had been physically violent. Multiple risks were seen in 47%. Doctors were able to identify risks more often than nurses.

Risks for self-harm, infant harm and related to infant health were high. Systematic risk assessment by both nurses and doctors is important in an MBU to ensure adequate care for the mother infant dyad.

The authors have not supplied their declaration of competing interest.

Increasing literature suggests the need to explore PTSD and post-traumatic stress symptoms among parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy.

The aim of this study was to estimate full and partial PTSD rates among parents of children with epilepsy according to DSM-5 criteria. Further, aim of this study was to examine eventual gender differences between mothers and fathers.

One hundred and thirty-eight parents, 91 mothers (65.9%) and 47 (34.1%) fathers, of children diagnosed with epilepsy were interviewed using the SCID-5.

Full and partial DSM-5 PTSD were reported by 10.4% and 37.3% of patients, respectively. Significant gender differences, with the mother more affected, emerged in the rates of partial A PTSD rates (P = 0.048) and in the endorsement rates of criterion B (intrusion symptoms) (P = 0.047), criterion D (negative alterations in cognitions and mood) (P = 0.010) and criterion E (alterations in arousal and reactivity) (P < 0.001) too.

This is the first study to identify post-traumatic symptoms in caregivers of pediatric patients with epilepsy with the use of current diagnostic criteria and the relevance of the results suggests the need for further studies on this risk population.

The authors have not supplied their declaration of competing interest.

Many well known studies have defined results and tolerability of stimulants used in school children with ADHD in last period. In our follow-up study from August 2007 to January 2009. will present results of once-daily OROS Methylphenidate therapy including break it for holiday.

We are enrolling 32 children in study, 7-14 years old, and all of them were team-diagnosed according DSM IV/psychiatrist, psychologist, neurologist. Children with ADHD symptoms are treating with OROSMPH (18-54mg), with adjustments based on clinical symptoms, and all ADHD symptoms measures, vital signs, EEG and laboratory results also will be included through our study period.

Effects of OROS MPH therapy will be presented only in children who completed the study, looking for adverse events, clinically significant effects on vital sings, EEG, laboratory test parameters, and also, improvement academic functions, before and after breaking therapy.

Besides our expecting on reduction of ADHD symptoms with minimal effects on vital sings,values on growth, tick, laboratory test, it considers too, better academic functioning, social relationship with continual therapy.

Metabolic syndrome (MS), which consists of several metabolic abnormalities, is highly prevalent in patients with schizophrenia. According to some studies, MS is characterized by a mild chronic inflammatory state, while for the elevated white blood cell (WBC) and neutrophil counts are considered to be positively associated with MS.

To determine the WBC and neutrophil counts and to establish their possible association with MS and its components in schizophrenic patients.

We conducted a cross-sectional study. The study group consisted of schizophrenic patients from the University Clinical Hospital Mostar (n=100), while the control group consisted of healthy subjects who came to the systematic medical examinations in the Health Center Mostar (n=100). The diagnosis of MS was made according to ATP III criteria, and on that basis the subjects from both groups were divided into two subgroups, one with and one without MS.

Schizophrenic subjects had significantly higher average WBC (p<0,001) and neutrophil (p<0,001) counts compared to the control group. Schizophrenic subjects with MS had significantly higher WBC and neutrophil counts compared to both control subgroups. WBC and neutrophil counts correlated positively with fasting blood glucose level and MS prevalence. There were no significant correlations between WBC or neutrophil counts with the number of MS components.

WBC and neutrophil counts are positively associated with MS prevalence and fasting glucose level. Routine monitoring of these inflamatory indicators might have an important role in predicting MS development in schizophrenic patients.

Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in the industrialized world. Recent research evidence suggests that psychosocial distress has been implicated as both a precursor to IHD and significant risk factor for death in those with established IHD. According to WHO, psychosocial distress will be the most harmful risk factors for the development of IHD in the near future. High IHD mortality in Russia and its profound fluctuation over the past decades have attracted considerable interest. Some experts have underlined the importance of the psychosocial distress of economic and political reforms as the main reason for the IHD mortality crisis in Russia in the 1990s.

The aim of the present study was to estimate the effect of psychosocial distress on IHD mortality rate in Russia.

Trends in age-adjusted, sex-specific suicide (as an integral indicator for psychosocial distress) and IHD mortality rate in Russia from 1965 to 2005 were analyzed employing a distributed lags analysis in order to asses bivariate relationship between the two time series.

Time series analysis indicates the presence of statistically significant association between the two time series both for males (r = 0.73; SE = 0.17) and females (r = 0.35; SE = 0.17).

These findings suggest that the Russian IHD mortality crisis is most likely to have been precipitated by the psychosocial distress imposed by rapid societal transformation. The experience of Russia should serve as an example of how societal-level change can influence the health of a population.

To examine psychological distress and quality of life in patients with medically unexplained symptoms (MUS) compared to those with medically explained symptoms (MES) in a primary care setting in Karachi, Pakistan.

472 patients attending a GP clinic in Karachi completed questionnaires to assess somatic symptoms, anxiety, depression, and quality of life. The patients’ GP recorded whether the complaint was medically unexplained or medically explained.

Patients with MUS were more likely to be employed (p=0.01) educated to a higher level (p<0.001), have less difficulty meeting day-today need (p=0.05) and have a higher percentage of people showing concern and interest in what they are doing (p<0.001). In addition, they have fewer problems with mobility (p=0.001), with usual activities (p=0.05), with pain/discomfort (p=0.004) and with anxiety/depression (p<0.001). They have a smaller number of family members (p=0.05), a higher income (p=0.019), a lower level of depression (p=0.05) and a lower number of life events (p<0.001). In terms of significant independent risk factors for medically unexplained symptoms, there were three such risk factors, the number of life events (OR 0.88, p<0.001), problems with anxiety/depression as measured on the EQ-5D (OR 0.53, p=0.003) and the amount of concern shown by people (OR 1.82, p=0.006).

Compared to people with MES, those with MUS had experienced less psychological distress and better health-related quality of life. Furthermore, those with MES had higher scores on the life events checklist and were more likely to come from larger families, be illiterate, unemployed and to have financial problems.