The career choices of medical students change often during the course of their training. Recent changes to the UK medical training structure force graduates to specialise earlier in their careers. This would make medical school placements even more important in speciality choice. In the UK psychiatry is one of the most undersubscribed specialities.

There are many possible reasons. However, there are very few areas where the profession can exert any influence. Currently, the only available option seems to be to compete with other specialities for the limited number of medical graduates available for postgraduate training.

To assess the influence of placement experience at medical school on student speciality preference and hence subsequent career choice.

50 medical students from a UK university were asked to rank 8 medical specialities from 1–8 (1 = most preferred, 8= least preferred) before and after placements in those respective specialities. The average ranks before and after placements were then compared.

The average specialty ranks before and after placements were: Speciality (before: after), Dermatology (6.2:6.1), Otolaryngology (4.7:4.6), Geriatrics (5.0:4.8), General Practice (3.4:3.5), Obstetrics and Gynaecology (2.7:2.8), Ophthalmology (5.9:5.9), Paediatrics (3.3:3.2) and Psychiatry (4.8:5.1).

The results show that whilst placements in Geriatrics, Paediatrics and Otolaryngology led to an increases in preference +0.2, +0.1, +0.1 respectively. Psychiatry placement led to a large decrease in preference of −0.3. Therefore, specialities such as psychiatry that find it hard to attract medical graduates may benefit from focussing on improving medical student teaching and experience.

To estimate the prevalence of suicidal ideation during gestation and risk factors for depression in postpartum.

712 pregnant women answered the PRIME MD, and reported sociodemographic data, obstetric history and history of violence; 427 women answered the PRIME MD at 4-5th month postpartum. Poisson regression was used to estimate the association between suicidal ideation and sociodemographic, obstetric and violence variables, and to estimate the association between risk factors and depressive symptoms in postpartum.

The prevalence of suicidal ideation during pregnancy was 10.3% (n=73). The prevalence of depression was 36.2% (n=258). Suicidal ideation was associated with: 0 to 4 years of schooling (PR=2.88, CI 95% 1.40-5.91), and 5 to 8 years of schooling (PR=2.63, CI 95% 1.45-4.77), being victim of violence in the current gestation (PR=4.35, CI 95% 2.81-6.74), and anxiety symptoms (PR= 5.49, CI 95% 3.58-8.40).

The prevalence of depression in the postpartum was 28.3% (n=121); 45 were incident cases (37%). The following variables were significantly associated with depression in postpartum: < 19 years of age (RR=1.82, CI 95% 1.03-3.22), 20-29 years of age (RR=2.19, CI 95% 1.30-3.66), lower income (RR= 1.49, CI 95% 1.00-2.23), depressive symptoms during gestation (RR=2.9, CI 95% 2.13- 3.97), anxiety symptoms during gestation (RR= 2.96, CI 95% 2.26-3.88), and being victim of violence during gestation (RR=2.04, CI95% 1.50-2.78).

Gestation is not protective of suicidal ideation and common mental disorders. Treating common mental disorders during pregnancy is essential to prevent depression in post partum and to promote maternal's and infant's health.

Schizophrenia is a mental health disorder associated with high rates of osteoporosis. Studies have suggested antipsychotics as a major cause of accelerated decrease in bone mineral density.

Oestrogen deficiency contributes to osteoporosis and causes increased osteoclast numbers/osteoclastic activity. Prolactin suppresses hypothalamo-pituitary-ovarian axis activity, leading to decreased oestrogen concentrations.

Aripiprazole, an ‘atypical’ antipsychotic, is a partial agonist at dopamine D2-receptors, while other atypical antipsychotics are antagonists at these receptors. Dopamine inhibits prolactin release via these receptors at the anterior pituitary. Aripiprazole has been found to decrease prolactin concentrations in chronic schizophrenics and may be protective against osteoporosis.

Quantitation of specific markers of osteoclastic (cross-linked N-telopeptide (NTX)) and osteoblastic activity (bone alkaline phosphatase (BAP)) can be correlated with bone resorption and bone formation, respectively.

Exploring whether aripiprazole is effective in stabilising bone turnover.

Investigate changes in urinary markers of bone turnover.

We performed 52 week, open-label, intention-to-treat study, offering either a switch to aripiprazole or aripiprazole as add-on to initial antipsychotic medication.

Serial measurements of prolactin, testosterone, 17-β-oestradiol, serum BAP, albumin, urinary creatinine, and urinary NTX concentrations were taken between 0 and 52 weeks.

At the end-point of study, versus the baseline, there were significant decreases in concentrations of urinary markers of bone resorption (P = 0.002 for NTX) and bone formation (P = .026 for BAP). Additionally, a significant decrease in prolactin (P = 0.004) and significant increase in 17-β-oestradiol concentrations (P = 0.015) were found.

Our results show decreased overall bone turnover; and increased long-term bone stability in patients who changed medication.

Japanese universities are required to improve both international and Japanese students' mental health, because the number of international students increases annually. Moreover, mental health data for graduate school students in Japan are lacking. Therefore, the present study attempted to examine differences in graduate school students' mental health according to major, grade, and nationality.

A total of 587 students from a Japanese university, which only offers graduate school education, completed the Japanese version of Kessler 6 (K6) as part of their regular health assessments; 542 students agreed to the use of their data for research purposes.

The K6 scores were analyzed using a 3-way (major × grade × nationality) between-subjects ANOVA, and a significant second-order interaction (F(6, 518) = 2.68, p < .05) was observed. As a subsequent 2-way (major × nationality) ANOVA, performed according to grade, only showed an interaction for first-grade master's degree students (M1; F(2, 167) = 7.88, p < .01), comparisons between Japanese and international students were made according to major. For one major, Japanese students' K6 scores tended to be higher relative to those observed in international students (t(36) = 1.98, p < .10). In contrast, international students' K6 scores for another major were significantly higher than were those of Japanese students (t(86) = 3.31, p < .01).

Japanese and international M1 students' K6 scores differed significantly. University staff should take these differences into account and examine ways to support students.

The Social Distance Scale (SDS) is an established tool in the measurement of discriminatory attitudes towards those with mental illness.

To send an electronic questionnaire incorporating the SDS to both healthcare and nonhealthcare undergraduates.

To compare attitudes using the SDS of both student groups towards vignettes describing active and medically resolved cases of mental illness.

567 first year healthcare and 501 non-healthcare (law and english) university students were sent a questionnaire randomly containing one of six possible vignettes (describing either active or medically resolved depression, schizophrenia or asthma). The SDS as used by Nordt (2006), was then completed, indicating what level of social closeness would be accepted with the person described.

180 responses were received for the healthcare group (31.7% response rate) and 125 for the non-healthcare group (25% response rate). Very good reliability of the Social Distance Scale (Cronbach's a=0.91) was observed in the sample. Statistical analysis was performed using SPSS. A linear regression model was applied which explained 20% of the variance. A significant difference was observed in attitudes between healthcare and non-healthcare students towards both the active and resolved schizophrenia, with the Non-healthcare group expressing higher social distance towards these vignettes (+0.31; P=0.043) compared to the healthcare group. The two groups did not differ significantly in social distance towards the depression and asthma vignettes.

The non-healthcare students were significantly more socially distant towards both active and resolved schizophrenia vignettes. The findings for the remaining vignettes were similar between the two groups.

This study investigated whether a specific planning and evaluation approach called VADO (Skills Assessment and Definition of Goals) resulted in improved personal and social functioning among patients with chronic schizophrenia.

A total of 85 patients with chronic schizophrenia were randomly allocated to the VADO-based intervention or to routine care; 78 completed the program. Interventions were carried out in nine Italian day treatment or residential rehabilitation facilities. Assessment at the beginning of the study and at the one-year follow-up included the Personal and Social Performance scale (PSP) and Brief Psychiatric Rating Scale Version 4.0 (BPRS). Clinically significant improvement was defined as an increase of at least 10 points on the PSP or a decrease of at least 20 percent on the BPRS total score.

At baseline, average PSP scores in the experimental group and in the control group were 33.9±8.1 and 34.0±11.2, respectively. (Possible scores range from 1 to 100, with higher scores indicating better functioning.) At six months, the score improved markedly in the experimental group (40.8±10.9) and minimal change was observed in the control group (35.3±11.6); the difference between groups was significant (difference of 6.9 points compared with 1.3 points; t=2.21, df=81, p<.05). At 12 months, the same trend was observed (difference of 12.0 points compared with 3.5 points), and the difference between groups was both statistically and clinically significant (t=2.99, df=75, p<.01).

A statistically and clinically significant improvement in functioning was observed among patients treated with the VADO approach.

Psychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.

To provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.

An English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.

Ms. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.

Parkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.

The authors have not supplied their declaration of competing interest.

Atypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.

Clinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).

Female, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20 mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10 mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1 mg/day.

– Decision of cleaning up aripiprazol during 8 days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600 mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.

– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.

– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.

MAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.

The authors have not supplied their declaration of competing interest.

Studies have indicated antidepressant effects of anti-inflammatory treatment; however, results have been conflicting and side effects may contraindicate anti-inflammatory treatment.

To systematically review the antidepressant and possible side effects of anti-inflammatory interventions.

To include trials published prior to December, 31st 2013, and evaluate depression scores after treatment and side effects.

We identified randomized, placebo-controlled trials assessing efficacy and side effects of pharmacological anti-inflammatory treatment in adults with depressive symptoms including adults fulfilling depression-criteria. We calculated standard mean difference (SMD) and Odds ratios (OR).

10 publications covering 14 trials (n=6,262) were included: 10 on non-steroidal anti-inflammatory drugs (NSAIDs) (n=4,258) and four on cytokine-inhibitors (n=2,004). Anti-inflammatory treatment reduced depression (SMD=−0.54; 95%-CI:-1.08 to −0.01; I2=68%) and depressive symptoms (SMD=−0.27; 95%-CI:−0.53 to −0.01; I2=93%). Sub-analyses particularly emphasized antidepressant properties for the selective cyclooxygenase-2 inhibitor celecoxib in general (SMD=−0.29; 95%-CI: −0.49 to −0.08; I2=73%), on remission (OR=7.89; 95%-CI: 2.94 to 21.17; I2=0%) and response (OR=6.59; 95%-CI: 2.24 to 19.42; I2=0%). Among 6 studies (n=2,523), we found no evidence of an increased number of gastrointestinalor cardiovascular events after 6 weeks nor infections after 12 weeks of anti-inflammatory treatment. All trials were associated with high risk of bias.

Anti-inflammatory treatment, in particular celecoxib, decreased depressive symptoms without increased risks of side effects. However, a high risk of bias and high heterogeneity made the mean estimate uncertain. This study supports a proof-of-concept concerning use of anti-inflammatory treatment in depression. Identification of subgroups that could benefit hereof might be warranted.

Handwriting disorder is considered to be one of the major public health problems among school-aged children worldwide. All the scales in the literature use handwriting tasks but it could be interesting to investigate a more accurate assessment of handwriting difficulties before the development and acquisition of handwriting as such.

The objective of our study is to examine the validity of a prescriptural task consisting of copying a line of cycloid loops in the diagnosis of handwriting disorders.

35 children with handwriting disabilities and 331 typically developing right-handed children in primary school, aged 6-11 years old, were included in the study. They performed a copy of a line of cycloid loops, in an ecological setting, with a paper sheet put on the table. The kinematic measures were recorded with a digital pen. A Receiver Operating Characteristic method (ROC curve) was used to determine whether the loops line copy may be a sensitive test to diagnose handwriting disorders.

Six kinematic variables recorded during the prescriptural task were found to be relevant markers of handwriting disorders with a sensibility between 0.743 and 0.880: strokes number, total and effective drawing time, in-air pauses times, loops number, number of peaks velocity.

The graphomotor task of copying a line of cycloid loops showed a good sensitivity to diagnose handwriting disorders and appeared to be a good predictor test, more particularly with the variables reflecting the strokes temporal organization.Drawing loops is a rapid graphomotor task, useful for exploring prerequisites of handwriting in screening for handwriting disorders.

There is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.

We aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.

A total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).

Our study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.

The authors have not supplied their declaration of competing interest.

Schizophrenia (SCH) is considered the most serious psychiatric disorder with complex pathogenetic and pathophysiological mechanisms and inadequate treatments.

Given the association of psychotropic medication and cognitive, functional, and neuropsychiatric symptoms (NPS), the use of certain measuring instruments among patients who suffer from schizophrenia is important because the quantification of treatment effects is crucial for optimizing the management of patients with schizophrenia.

To assess the efficacy of antipsychotic therapy in schizophrenic patients with predominantly negative and positive symptoms, cognitive impairment and social, occupational and psychological dysfunction.

Two main groups were selected for analysis: (N=34) included patients taking first-generation antipsychotics (FGAs) and (N=16) included patients taking second generation antipsychotics (SGAs). We used the Positive and Negative Syndrome Scale (PANNS), Global Assessment Functioning (GAF) and Montreal Cognitive Assessment Scale (MOCA).

Out of the total number of examinees (n=50), 15/50 (30%) were males and 35/50 (70%) were females; the age of onset was 38.4±1.77; duration of illness (mean±SD) 32.5±5.00; SANS-Total (mean±SD) (23.82±9.962); SAPS-Total (mean ±SD) (28.6±9.74). Analysis of the PANSS scale bipolar index shows that patients on SGA, on average, had lower scores (2.37±12.5) compared to patients on FGA (5.91 ±9.61).

Preliminary evidence showed that there are no significant advantages in the use of atypical antipsychotics compared with typical ones in a group of patients suffering from schizophrenia. It is important to realize what role the advancement of antipsychotics has played and what still needs to be accomplished to further improve the outcome of sch patients.

The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) introduced severity indices for Eating Disorders (ED).

This study assessed in a male ED sample the DSM-5 severity indices for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) and compared them to an alternative transdiagnostic drive for thinness (DT) severity category and a combined DSM-5/DT severity categorization

178 males with EDs were classified using: a.) a DT categorisation based on the EDI-2 DT subscale; b.) the DSM-5 severity categories for AN, BN and BED and c.) a combination of the DT and the DSM-5 severity categorisation. These severity classifications were then compared based on psychopathology and personality.

For the DSM-5 severity indices, the “mild” category was most prevalent for AN and BN, and the “moderate to extreme” group for BED. For the EDI-2 DT severity classification, the “mild” category was overrepresented in all subtypes. For the combined DSM-5/DT categorization, the “mild combined” severity group was the most prevalent for AN, while for BN and BED the “severe/extreme” combined group was most prevalent. Clinically significant findings were strongest for the DT categorization followed by the combined DSM-5/DT approach. Almost non-significant findings were revealed for the DSM-5 severity categories for all ED subtypes. These findings were most pronounced for AN and BN and almost non-existent for BED.

Our findings provide support for DT as an alternative transdiagnostic severity category for EDs in males that may be more meaningful than the DSM-5 severity indices for AN and BN, but not BED.

No significant relationships.

The Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.

To examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.

To propose amendments to the legislation, based on the experiences elicited.

This cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.

317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.

Nursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.

Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patiens in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission.

Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication).

Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1- lie down 5 minutes, 2 - stand up 5 minutes, 3 - lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission.

We found highly statistically significant negative correlations between level of dissociation measured by DES and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder.

Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patiens and age of onset and duration of disorder.

By grant IGA MZ ČR NT11047.