Anorexia nervosa (AN), rare in young men, is potentially associated with severe medical complications. Mild liver involvement is common. However, rare cases of severe liver dysfunction associated with AN have been described.

To present a rare, severe case of an adult male with AN.

Describe uncommon, potentially lethal, medical complications associated with liver dysfunction.

Describe medical/psychiatric presentation, course of disease and interventions during hospitalization and follow-up.

Male 35 y.o. with AN for 20 years (purging type with use of diuretics/ laxatives and intensive exercise) was transferred involuntarily to the Psychiatric Department from Gastroenterology because of continuing weight loss, excessive exercise, non-compliance of food/fluid intake recommendations and use of diuretics. The patient on admission had BMI 13.5 kg/m2 (recent weight loss of 20 kg), ascites, ankle edema, severe transaminases elevation (x20), and electrolytes dysregulation. In addition, the patient presented depressive symptoms, hoarding, and obsessive compulsive/avoidant personality traits. Feeding was started with parenteral administration, and then through nasogastric tube. Also, the patient was restricted to his room and energy expenditure was controlled. In addition, behavioral/family/cognitive psychotherapeutic interventions were employed. Patient was treated with S-Citalopram, Olanzapine, and Lorazepam. Weight gradually increased. After 4.5months of hospitalization, liver function was normal, BMI was 21 kg/m2, mood was elevated, and hoarding was diminished. In a 6 months outpatient follow-up the patient's BMI was 23 kg/m2 and he was both socially and personally functional.

Long hospitalization using an integrated approach that combines medical and psychotherapeutic interventions, may reverse severe liver dysfunction in life-threatening NA.

The psychological consequences on the caregivers taking care of mentally ill patients are well known; however, little evidence exists as to whether taking care of a mentally ill patient affects the physical health of the caregiver.

To examine the effect of caregiving on emotional and physical health.

To study the association between caregiving for mentally ill and physical illness.

One hundred twenty-eight caregivers, relatives of patients suffering from schizophrenia or bipolar disorder, who were hospitalized consecutively during the past three years (2011–2013), and 117 controls completed over telephone a structured questionnaire. Eligible patients were all those with duration of illness more than 5 yrs. Data included demographics and detailed information about past or present mental and/or physical illness. Data were analyzed using the Pearson's chi-square test and multivariate binary regression controlling for BMI, age, sex, and smoking.

Significant correlation was found between caregiving and anxiety (OR=4,1, p<0,0001), depression (OR=3,5 p=0,03), sleep disturbances (OR=2,6, p=0,05), arthritis (OR=2,5, p=0,03), rheumatopathy (OR=2,8, p=0.09) and allergies (OR=2,5, p=0,09). The association of caregiving with allergies/ arthritis was independent of anxiety and depression. No correlation was found with diabetes, hypertension and cardiovascular disease.

The stress of taking care of a mentally ill patient appears to affect physical health, specifically increasing the risk for autoimmune disorders (allergy, arthritis), independently of anxiety, depression and sleep disturbances.

Twenty percent of psychiatric inpatients have co-morbid substance abuse/dependence and their management is challening.

To investigate co-morbidity and patterns of substance use among inpatients in a general psychiatric unit.

To examine specific patterns and risk factors associated with substances/alcohol in psychiatric inpatients.

Participants included 487 inpatients consecutively admitted to the Psychiatric Unit, University Hospital of Crete between Nov 2011- Jun 2013. Data were analyzed using the Pearson's chi-square test and multiple regression.

Our sample, mean age 42.7±14.5yrs, consisted of 57.9% males, whereas 51.9% were admitted involuntarily. In addition, 60.3% were unemployed, 24.3% had a spouse and 38.1% had no previous psychiatric hospitalizations. Furthermore, 354 (72.8%) used no substances, while 16.1% used alcohol, 12.3% cannabis, 3.8% opioids, 2.5% cocaine, and 5.5% anxiolytics. Mean age of those abusing alcohol was 41.8yrs, cannabis 34.1yrs, opioids and cocaine 31.6yrs and anxiolytics 36.9yrs. In patients with Major Depression, alcohol (21.1%) and anxiolytics (9.8%) were the most prevalent, whereas, in patients with psychotic disorders and bipolar disorders, alcohol (9.8% and 5.8% respectively) and cannabis (11.9% and 15.2%) were the most frequent. Unemployment, and involuntary admission weren’t significant risk factors for alcohol/substance use.

Substance/alcohol abuse/dependence is present in 1/3 of our psychiatric population with alcohol, cannabis and anxiolytics the most commonly used. Alcohol was more frequent in older patients with depression, whereas cannabis was more frequent in younger patients with psychotic/bipolar disorder. Development of dual diagnosis centers, very scarce in Greece, are needed for the management of psychiatric patients with substance co-morbidity.

Research focused on the intrafamilial environment of people experiencing their first episode of psychosis (FEP) is limited.

To investigate possible differences in family environment between FEP patients, chronic psychotic patients and healthy controls.

To compare family variables between relatives of FEP patients, chronic patients and healthy controls.

Family cohesion and flexibility (FACES-IV) and psychological well-being (GHQ-28) were evaluated in relatives of 50 FEP patients, 50 chronic patients and 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed between the two clinical groups.

Multivariable linear regression analysis adjusted for several confounding variables revealed statistically significant differences in the total ratio for family cohesion and flexibility between the three groups indicating poorer family functioning for chronic families as compared to FEP families (β coefficient −0.47, 95% CI: −0.77, −0.18) and lower scores for FEP families as compared to controls (β coefficient −0.59, 95% CI: −0.81, −0.37). Chronic families scored significantly higher in critical comments (β coefficient 7.17, 95% CI: 3.45, 10.89), and reported higher subjective (β coefficient 2.85, 95% CI: 0.69, 5.01) and objective burden (β coefficient 8.25, 95% CI: 4.67, 11.84) as compared to FEP families. Non-significant differences were found in psychological well-being between FEP and chronic families, whereas FEP families reported higher levels of psychological distress as compared to controls.

Having a family member with a major psychiatric disorder is a general stressor for families and family interventions should be considered to minimize disruption to family life.

The Family Confusion Assessment Method (FAM-CAM), derived from the original Confusion Assessment Method (CAM), was recently developed to screen for delirium by interviewing family caregivers.

to present the preliminary results of the Portuguese version of FAM-CAM.

The translation process of FAM-CAM was carried out, according to ISPOR guidelines, with trained researchers. After that, a pilot-study was carried out with a sample of families and/or caregivers of elderly patients hospitalized (≥48 hours), in an intermediate care unit of Critical Care Service/CHSJ. Inclusion criteria were: patient knowledge to enable reporting on his/her mental and physical abilities and staying at patient's bedside daily during hospitalization. Families/caregivers aged less than 18 years and who did not speak Portuguese were excluded. All patients were assessed by DSM-IV-TR (reference standard) and by CAM. The FAM-CAM was administered to the families and/or caregivers, by a trained researcher.

The sample included 40 families/caregivers (59% adult children). According to the DSM-IV-TR, 20.5% of patients had delirium. FAMCAM had a moderate sensitivity (75%) and a good specificity (87%) when were assessed against to DSM-IV-TR. Compared with CAM, this instrument presented a better sensitivity (86%) and specificity (90%).

These preliminary results suggested that FAM-CAM appears as a sensitive screening tool for detection of delirium in elderly hospitalized patients, using observations of family caregivers. However, future studies with larger samples will be needed to further validate these results and to analyze other psychometric proprieties.

The present work was supported by Foundation for Science and Technology/FCT (SFRH/BD/63154/2009).

Co-morbidity between depression and diabetes is a common underdiagnosed condition. Individuals with diabetes have about a 2- fold increased risk for major depression, affecting one of every 10 diabetic patients. The association between depression and diabetes may be due to biologic effects of depression on the hypothalamic-pituitary axis, platelet adhesion, inflammation or the autonomic nervous system; alternatively, the association may be due to non-adherence with medication leading to worse control of glycemia.

To investigate the association between diabetes and depression symptoms within a community-based sample with type 2 diabetes mellitus, while controlling for socio-demographic, diabetes-related characteristics and complications, disability, other chronic illness and other health-related variables.

180 patients with diagnosis of diabetes mellitus type 2 were tested to evaluate mood (Montgomery-Asberg Depression Rating Scale, MADRS), health status (Short Form 36, SF-36) and personality (Temperament and Character Inventory, TCI) related to variables (sex, age, education, marital status, socioeconomic status).

We found 1) mild depressive symptoms in 73% of patients (6≤ MADRS score ≤20), with a greater prevalence in female gender (94% females vs 53% males) and in older age (58% males vs 94% females); 2) a poor quality perception of health status in 68,7% of diabetics/depressed patients (subthreshold ISM, mental health index); 3) frequency methodical type personality (low NS, high HA, low RD) in 53% of sample (48% males, 71% females).

Diabetic population has increased risk of developing depression. Early identification of depressive symptoms may occur through the study of risk factors.

Assessment of neuropsychiatric symptoms is crucial to the management of dementia. In this context, the Neuropsychiatric Inventory (NPI) is the most widely used comprehensive tool, assessing twelve domains (delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, aberrant motor activity, night-time behaviour and appetite/eating abnormalities). NPI records severity, frequency and caregiver distress. It has been translated and validated into a number of languages and shown to be reliable in cross-cultural studies.

To present preliminary results of the NPI Portuguese validation study.

A cross-sectional study was conducted with a convenience sample of institutionalized elderly (≥ 60 years old) in three Nursing Homes in Portugal. All patients were also assessed with MMSE (cognition) and GDS (depression). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected elderly.

The sample included 166 elderly, with a mean age of 80.9 (10.2sd). Three out of the NPI behavioural items had significant negative correlations with MMSE: delusions (r=−0.177, p=0.024), disinhibition (r=−0.174, p=0.026) and aberrant motor activity (r=−0.182, p=0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (r=0.166, p=0.038). NPI showed good internal consistency (overall α=0.766; frequency α=0.737; severity α=0.734). The inter-rater reliability was excellent (ICC=1.00, CI95% 1.00–1.00), as well as test-retest reliability (ICC=0.91, CI95%0.80–0.96).

These results suggested that the Portuguese version is a valid and reliable instrument for the evaluation of neuropsychiatric symptoms in elderly people.

Major depressive disorder (MDD) is a complex disorder and recent research suggests that muliple genetic and environmental factors seem to underly MDD criteria as well as seem to influence brain structure and function.

Aim of the study was to investigate whether epigenetic regulation and mRNA expression of glucocorticoid inducible genes (SGK-1, GILZ) are associated with structural alterations in hippocampal subfields and functional brain changes. Moreover, we investigated whether there are interactive effects between the genetic variant of the BICC1 gene and ELA.

Patients with MDD and healthy controls were investigated using structural magnetic resonance imaging (MRI) and functional MRI with an emotion inhibition task. Analysis of a single nucleotide polymorphism in the BICC1-1 (rs999845) gene as well as mRNA expression and methylation of DNA was performed.

Hippocampal subfield volumes of dendate gyrus and CA2 were reduced in patients with MDD. These were associated with reduced mRNA expression of glucocorticoid inducible genes and with DNA methylation. Moreover, MDD patients with a history of ELA, who carry the protective T-allele, had smaller hippocampal head volumes compared to MDD patients without ELA. FMRI showed that patients and controls carrying the protective T-allele of BICC1 activate the emotion regulation system significantly more compared to those participants homozygous for the major C-allele (p<0.05, family wise error corrected).

These results are suggestive for environment x gene interactions in MDD and for the impact of epigenetic regulation on brain structure and function.

Spherocytosis is an inherited hemolytic anemia, most common on northern Europe, that causes variable degrees of anemia, jaundice, splenomegaly and in severe cases adolescents are transfusion-dependent prior to esplenectomy.

Chronic illnesses are known to provoke psychosocial dysfunction in affected children and their families. The risk of psychiatric disorder increases with the number of such family's adverse factors as marital discord, low social status and parental psychiatric disorders. It has been reported that children with two family risk factors have a fourfold increase in rate of disorder.

This paper aims to describe the features of psychiatric and psychosocial maladjustment in a patient firstly diagnosed as having sickle cell disease.

We describe a 16-year-old girl with homozygous hereditary spherocytosis admitted to the outpatient Child and Adolescent Psychiatry Department who developed progressive social isolation.

Her psychiatric condition had been evolving since fifth grade, when she started blood transfusions and stricter clinical surveillance. A favorable trend was observed after strategic family therapy and individual cognitive-behavioural therapy focusing on anxiety and shyness desensitization intending to overcome friendship difficulties and improve social assertiveness.

In psychosocial management of physical illnesses, assessment and care should include a focus on families besides the affected individual only. This study suggests that the bio psychosocial approach to health care and consultation-liaison psychiatry should be emphasized.

Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost.

1. - To establish the course of the first major depressive episode (MDE) in a population of students.

2. - To identify the various factors involved in this process.

Retrospective and descriptive study on 40 students followed in Psychopedagogie’ consultation in the department of Psychiatry B, Hedi chaker hospital in Sfax Tunisia from 2009 to 2013. The statistical analysis was performed by the SPSS (version 18).

The average age of the group was 22,8 years. Twenty-three women (57,5%) were included. All of patients were single. The socioeconomic level of the group was fair in 62,5% of cases. Twelve subjects had a family history of psychiatric illness. Prevalence of unipolar depression was 82,5%. Majority of patients were treated with only pharmacological means (77,5%). The general evolutif course in our subjects tends to improvement (37,5%). Six patients had a complete recovery. The persistence of residual symptoms was found in 12 patients. Deterioration in social and professional functioning was reported in12 patients. Six patients have had relapse. The recurrence of MDE was reported in 2 patients. Chronicity was founded in 4 patients. Two patients had a new suicide risk. One patient had an emergence of mood episode. No patient had spontaneous improvement. Nine patients have stopped the follow. The main reason of worsening was the emergence of an intercurrent stress factor (52,5%).

The negative impact of depression in our patients explains the necessity of a well adapted management.

We used British national survey data to test specific hypotheses that mood instability 1) is associated with psychosis and individual psychotic phenomena, 2) predicts the later emergence of auditory hallucinations and paranoid ideation, and 3) mediates the link between child sexual abuse and psychosis.

We analysed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N=8580 and 7403 respectively). The 2000 survey included an 18-month follow-up of a subsample (N=2406). Mood instability was assessed from the Structured Clinical Interview for DSMIV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale

Mood Instability was strongly associated in cross-sectional analyses with psychosis (2000 OR: 7.5; 95% CI: I 4.1–13.8; 2007: OR 21.4; CI 9.7–41.2), paranoid ideation (2000: OR: 4.7; CI 4.1–5.4; 2007: OR 5.7; CI 4.9–6.7), auditory hallucinations (2000: OR: 3.4; CI 2.6–4.4; 2007: OR 3.5; CI 2.7–4.7) and paranoia total score (2000: Coefficient: 3.6;CI 3.3–3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3;CI 1.6–3.3) and of auditory hallucinations (OR: 2.6;CI 1.5–4.4). Finally it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation, and a quarter of that with auditory hallucinations.

Mood instability is a prominent feature of psychotic experience, and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.

Methylphenidate (MPH) abuse is well established especially among young people in USA. In France, MPH is indicated in treatment for attention deficit/hyperactivity disorder (ADHD) in children and narcolepsy in children and adults. Since its release onto the market, MPH abuse has been progressively increasing by individuals close to children treated with MPH and especially by patients to whom MPH is prescribed offlabel or obtained in black market.

We report the results of a national survey on abuse and off-label use of methylphenidate.

Assessment of data collected between 2000 and 2011 from the Nots, OPPIDUM and OPEMA databases (tools for monitoring psychoactive substance misuse).

MPH abuse and misuse were identified in 245 patients (168 in NotS, 68 in Oppidum and 9 in Opema). In NotS database, subjects were predominantly males (65%), aged between 12 and 74 years. When specified (122 cases), the sustained release form was used in 83% of cases and maximum daily MPH intake reached 2520 mg. MPH was injected (20%) or snorted (4%). Polydrug use was noted in 77% of cases. Regarding Oppidum and Opema databases, patients were exclusively adults and supported for drug addiction. In these cases, MPH was obtained by medical prescription (61%) and/or in black market (36%).

The medical practice of off-label prescription of MPH to treat ADHD or drug addiction in adults is the main problem in France. Another new aspect is that MPH is also diverted by teenagers, with or without ADH, for its stimulant and concentration-enhancing properties.

Cognitive impairment is often characterized as trait features of bipolar disorder.

To evaluate possible impairment of attention and executive function in bipolar patients.

Improving life quality of bipolar patients with cognitive deficits.

75bipolar (depressive: Hamilton Depression Rating Scale score>=17, manic/hippomanic: Young Mania Rating Scale score >=12, euthymic:6month of remission, HAMDscore<=8, YMRSscore<=6) patients (DSMIVTR). All the patients were free of psychotic symptoms at the moment of neurocognitive evaluation. Comparison group consisted of 25 healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery included standardized test of IQ, attention, working memory, visual memory, verbal memory and executive functioning. Demographic data, data about family history, information about psychiatric history, past and current treatment, history of psychosis, duration of illness, age of onset were collected. We analyzed statistically these data and evaluate impairment of attention and executive dysfunction.

Stable and lasting cognitive impairments involving attention and executive functioning (working memory, executive control, verbal fluency, mental manipulation and cognitive flexibility) are evident across all phases of illness. Longer durations of mood disturbance and higher number of hospitalization are negatively correlated with executive function.

Deterioration of executive functioning is related of hospitalization for mania. Attention and executive function are deteriorated by the recurrence of episodes. Sustained attention is impaired during mania, depression, euthymia. Selective attention deficits during acute episodes don’t normalize during euthymia.

Bipolar patients exhibit widespread neurocognitive dysfunctions during their lives, and attention and executive function are important impaired domains regardless illness phases.

Intimate partner violence (IPV) accounted for 62.4% of the total interpersonal violence burden in women. Various studies have identified the mental health consequences of intimate partner violence, with PTSD and depression as the most commonly identified disorders, but less have analysed the role of different type of violence.

The aim of this study was to assess the contributions of different forms of intimate partner violence (physical violence, sexual violence, psychological abuse, and stalking) on symptoms of posttraumatic stress disorder (PTSD) and depression.

In all 160 women consecutively receiving a protection order in the South of Italy were assessed by an external interviewer. Hierarchical regressions tested the unique effects of different types of intimate partner violence on PTSD and depression.

In terms of PTSD symptoms, more than half (68.2%) of the sample reported PTSD and 77.4% reported severe depression symptoms. Two types of intimate partner violence (physical and sexual) were significantly associated with depressive symptoms, while only psychological violence was moderately correlated with PTSD symptoms. Physical abuse contributed to the prediction of depression and psychological abuse to PTSD.

A significant number of women with protection orders suffer from PTSD and depression. The results confirm a relationship between severity of intimate partner violence and mental health problems (PTSD and depression). Assessment of intimate partner violence should incorporate the multiple dimensions that have been identified as contributing to poor mental health.

The special mental states such as hallucination and confusion in schizophrenia have been creating obstacles in research in spirituality in this population. Although primary treatment should focus on symptom management, psychosocial and spiritual care should not be neglected. This study aimed to understand spirituality from the perspectives of both the patients and the healthcare professionals and its role in different stages of disease and rehabilitation.

Schizophrenic patients (n=22) and healthcare professionals including psychiatric doctors, nurses, and social workers (n=19) were recruited from an out-patient clinic of a hospital and a mental health rehabilitation complex. Semi-structured interviews on the meaning and experiences of spirituality, and its role in rehabilitation were conducted, with follow-up interviews when further clarification was needed. Interviews were transcribed into verbatim and analyzed with the assistance of computer software based on Ground theory. Trustworthiness was assured through member checking and peer scrutiny.

Both patients and professionals regarded spirituality as an inherent part of the patients’ well-being. Spirituality could be a practice, a way of thinking, sense of peace and fulfillment, and connectedness towards oneself, others, and a higher power. Spiritual experiences were helpful in the rehabilitation phase. However, some patients considered spirituality as apparitional experiences, thus hindered their recovery.

This study demonstrated that the spirituality played a part in patients’ lives and rehabilitation. Findings suggest the importance of spiritual care in this population and provide insights and roadmap for developing spiritual assessments and holistic care in psychiatric context.

This study is supported by RGCGRF/HKU745511H.

Previous studies have presented different factorial structures using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The core elements of burnout include emotional exhaustion, depersonalization, and a lack of personal accomplishment. The MBI-HSS is the most widely used questionnaire to evaluate burnout, and has been applied to various healthcare providers.

To investigate the factorial structure of a Portuguese version of the MBI-HSS for nurses in Portugal.

Secondary data analysis was implemented to explore the factor structure of MBI-HSS using exploratory factor analysis (EFA). Confirmatory factor analysis was then performed to verify the modified structure for nurses in Portugal. The data provided for this study were obtained from nurses (n = 146) from 15 surgical and medical units.

The EFA found that three factors explaining 59% of the variance were extracted, and 20 out of 22 items were retained. The goodness-of-fit test was the performed using the CFA approach, and verified that the modified version of MBI-HSS is a suitable instrument for measuring burnout for nurses in Portugal.

The results confirmed the factorial structure of MBI-HSS for nurses in Portugal with a three-dimension, 20-item assessment, and the variance was not diminished in this sample. These findings demonstrate that the modified version of MBI-HSS provides a suitable instrument for measuring burnout for Portuguese nurses. Similar to other cultures, our population retained each of the items based on the theoretical structure.

Globally there is apprehension about a nursing workforce shortage. To date, no studies have connected quality of work life with other contributing and co-existing factors such as depression, anxiety and stress.

This study explores the association of the quality of compassion fatigue and compassion satisfaction with anxiety, depression and stress and builds a portrait of nursing profiles to identify the factors/triggers that move a nurse from normally functioning, to at risk or very distressed levels.

Exploratory cross sectional survey of 112 registered nurses working in several departments of a Portuguese tertiary hospital using a self-report survey tool to collect data.

Burnout and secondary traumatic stress were significantly related to higher levels of anxiety and depression. Higher anxiety levels were correlated with nurses that were younger in age, working 40 h per week, and without a postgraduate qualification. Older and more experienced nurses exhibited higher levels of compassion satisfaction. Twenty percent had elevated levels of compassion fatigue, with 7.6% of the sample having a very distressed profile. At risk nurses stress and depression scores were significantly higher than nurses with higher compassion satisfaction scores.

In recognition of the importance of continuing professional education and in line with previous studies into burnout in preregistration nurses, educators should advocate including strategies in undergraduate and postgraduate nursing programs that facilitate students identifying and managing compassion fatigue and build personal resilience through the development of positive coping strategies.

Bipolar patients show broad cognitive deficits during entire course of the illness.

To evaluate a possible relationship between a severe course of illness and cognitive impairment in bipolars.

Improving life quality of bipolar patients with cognitive deficits.

75bipolar (depressive:Hamilton Depression Rating Scale score>=17, manic/hippomanic: Young Mania Rating Scale score>=12, euthymic:6month of remission, HAMDscore<=8, YMRSscore<=6) patients (DSMIVTR). All the patients were free of psychotic symptoms. Comparison group consisted of 25healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery included standardized test of IQ, attention, executive functioning, memory (working, visual, verbal). Demographic data, data about family history, psychiatric history, past/current treatment, psychosis history, duration of illness, age of onset were collected. We analyzed statistically these data and evaluate relationship between severe course of illness and cognitive impairment.

Cgnitive deficits are more frequent in bipolars with more severe course of illness, as indicated by: longer durations of mood disturbance (negatively correlated with executive function, psychomotor speed, attention, concentration and verbal memory-associated with a higher number of past manic episodes too), younger age at onset, history of multiple and frequent episodes (with manic episodes impacting neuropsychological impairment most extensively; attention and executive function deteriorated by the recurrence of episodes) and higher number of hospitalization (negatively correlated with visual and verbal memory, verbal fluency, spatial memory, psychomotor speed, executive function).

Svere course of illness influence cognitive status of bipolars. There's need for further clarification regarding the magnitude, clinical relevance and confounding variables of cognitive deficits in bipolars.

The annual global suicide mortality rate is 16 per 100,000 and suicide attempts are 20 times more frequent. We aimed at comparing patients referring to the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, in order to assess possible predictors of self-injury.

Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2011 at the ‘Maggiore’ Hospital in Novara. A multivariate analysis was performed using a logistic regression in order to assess the potential predictors of self-injury behaviors. Results are expressed as Odds Ratio (OR) with 95% Confidence Intervals (95%CI). Statistical significance was set at p≤0.05.

In a sample of 1888 psychiatric consultations, 280 (14.8%) were due to self-inflicted injuries. Female gender (OR: 1.51; p=0.005) was found to positively correlate with attempted suicides, whereas unemployment (OR: 0.68; p=0.013) and being in the colder months of the year (OR: 0.75; p=0.043) were found to be negative correlated. A positive trend without statistical significance was observed for foreign nationality, being not married and living with parents/own family vs a negative trend was found for history of psychiatric disorders.

In accordance with other studies, we observed the female gender positively correlates with attempted suicides and sunlight may act as a trigger. In contrast with literature, individuals with a permanent job would be at higher risk of self-injury behaviours, whereas having a history of psychiatric disorders and being under the care of a psychiatrist might be a protective predictor.