With the national redesign of specialist mental health services and its move towards episodic care, community mental health teams in the UK face a challenge in transferring LAI patients to Primary Care. In North Bristol, anecdotal concerns had been raised about this, particularly in the absence of established shared care arrangements (SCAs), and these prompted this service evaluation.

To characterise the use of LAIs by NBRS.

1. 1. To establish the prevalence of LAI prescriptions in NBRS and type of LAI prescribed.

2. 2. To consider the resource implications and distribution of LAI patients by Primary Care surgery.

3. 3. Using aims 1&2 to inform the development of local SCAs.

Use of a cross-sectional caseload survey of 523 out-patients under the care of NBRS on 1 September 2012.

LAIs were prescribed for 15% of the service’s total caseload (both psychotic and non-psyhcotic diagnoses). For those diagnosed with psychosis, flupentixol, risperidone and zuclopenthixol were most commonly prescribed, at mainly fortnightly or weekly injection intervals. The highest concentration of LAI patients were registered with Primary Care surgeries in areas reported as among the 10% most deprived nationally.

1. 1. LAI prescribing practice in NBRS, for those with psychosis, was consistent with national practice.

2. 2. Use of LAIs has particular resource implications for mental health teams.

3. 3. Use of SCAs could facilitate the transfer of care of LAI patients to Primary Care.

An impairment of real-life social functioning has widely been reported in patients with schizophrenia, even when clinical remission has been achieved. Negative symptoms, cognitive deficits and impairment of social cognition are the disease-related variables mainly associated to poor functional out come.

In the present study the above-mentioned disease-related variables were evaluated in a group of patients with schizophrenia and one of healthy controls (HC) in order to investigate their relative weight in affecting functional outcome.

To both patients and HC the Quality of Life Scale and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MATRICS-MCCB) were administered; the factor ’real-life motivation’ was extracted by the Quality of Life Scale.

Patients showed, with respect to HC, a deficit of learning abilities and speed of processing, as well as an impairment of the index of social cognition ’Managing emotions’. Multiple regression analysis showed that speed of processing and avolition explained 40% and 9%, respectively, of the variance for ’Common objects and activities’, as well as 27% and 8%, respectively, of that of ’Interpersonal relationships’.

Our findings indicate that functional outcome in patients with schizophrenia is influenced by cognitive deficit and by avolition but it is not affected by the impairment of social cognition. However, the complexity of this construct suggest to consider further indices of social cognition before to draw definitive conclusions.

Authors thank Compagnia di San Paolo-Neuroscience Call that funded the project Reward system and primary negative symptoms in schizophrenia'.

Some social cognitive subdomains such as emotion processing or theory of mind are impaired in schizophrenia. The relationship between social and general cognition and the development of specific symptomatology is still unresolved. Some authors have hypothesized that an overmentalizing pattern could underlie the development of paranoid symptoms.

1. To compare social cognition between patients with paranoid and non-paranoid schizophrenia; 2. To analyze the influence of general cognition in this result.

To identify a social cognitive error pattern associated with paranoid schizophrenia.

43 patients diagnosed with schizophrenia (24 with paranoid subtype and 19 with other subtypes) were recruited. Mean age of the sample was 43.2 y.o. SD 9.2, 72% were male and mean length of illness was 23 (SD 10.8). Spanish version of the Movie for Assessment of Social Cognition (MASC) and the Screening of Cognitive Impairment in Psychiatry (SCIP) were administered.

While the number of overmentalizing errors was similar between both groups, paranoid patients showed significantly fewer undermentalizing (p < .001) and nonmentalizing errors (p = .029). Overall, they showed better performance in social cognition (p = .03). Paranoid group also showed better performance in verbal fluency and processing speed subscales (p = .04). Finally, a significant correlation was observed between social cognition and cognitive function (r = 0.455, p = .002)

Patients diagnosed with paranoid schizophrenia show better general and social cognitive performance than non-paranoid schizophrenia. A tend to produce more overmentalizing errors was not observed in paranoid patients.

Brexpiprazole is a serotonin-noradrenaline-dopamine agent that binds with high affinity to multiple serotonin, norepinephrine and dopamine receptors. In particular, Brexpiprazole is a partial agonist at dopamine D2/D3 and 5-HT1A receptors and an antagonist at 5-HT2A and norepinephrine alpha1B receptors.

We assessed the efficacy and safety of brexpiprazole versus placebo as adjunctive therapy to anti-depressant therapy (ADT) in subjects with MDD who demonstrated inadequate response to ADT.

This trial had 3 phases: a screening phase (7-28 days); a prospective phase (Phase A): 8-week, single-blind placebo plus an investigator-determined, open-label ADT; a randomized phase (Phase B): 6-week, double-blind, adjunctive brexpiprazole (2 mg/day) vs. placebo in patients with an inadequate response to ADT.

The primary efficacy endpoint was the change from the end of Phase A (Week 8) to the end of Phase B (Week 14) in MADRS Total Score. The key secondary endpoint was the change in mean SDS score. Other secondary endpoints were mean change in CGI-S, IDS-R, HAMD and HAMA.

Of 379 randomized patients, completion rates at Week 14 were high (92.9%). Statistically significant improvements in mean MADRS Total score were observed for subjects receiving adjunctive brexpiprazole 2mg/day compared with placebo (p=0.0001) at endpoint. In addition, on all secondary endpoints Brexpiprazole showed a statistically significant advantage over placebo.

Commonly reported adverse events in the brexpiprazole group (>5% and more than twice placebo) were weight gain (8.0%), akathisia (7.4%).

Brexpiprazole was effective and well tolerated as adjunctive treatment for MDD patients with an inadequate response to ADT.

To evaluate efficacy and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, in obese (BMI =30kg/m2) and non-obese (BMI <30kg/m2) patients with schizophrenia.

Data from a 38-week, double-blind, active-controlled, non-inferiority study (NCT00706654); randomisation (2:2:1) to AOM-400mg, oral aripiprazole (10-30mg/day) (ARI), or aripiprazole once-monthly 50mg (AOM-50mg) assessing the efficacy and safety of AOM in patients requiring chronic antipsychotic treatment were used for this post-hoc analysis. We report the overall relapse rates in the 38-week randomized phase. Comparisons of overall relapse rates were analyzed using the Chi-squared test.

662 patients were randomized to: AOM-400mg (n=265); ARI (n=266); or AOM-50mg (n=131). Of these, the following were obese: AOM- 400mg: n=95; ARI: n=95; AOM-50mg: n=43. In the obese patients, the overall relapse rate was significantly (p=0.0012) lower with AOM-400mg (7.4%) than with AOM-50mg (27.9%). The difference between AOM-400mg and ARI (8.4%) was not significantly different. In the non-obese patients, the overall relapse was significantly (p=0.0153) lower with AOM-400mg (8.8%) than with AOM-50mg (19.3%). The difference between AOM-400mg and ARI (7.6%) was not significantly different. For patients treated with AOM-400mg, the most common TEAEs (>10% in any group) are presented in Table 1.

Table 1.

The efficacy and tolerability of aripiprazole once-monthly 400mg were similar in both the obese and non-obese subgroups.

Supported by Otsuka Pharmaceutical Development & Commercialization, Inc., and H. Lundbeck A/S

Cancer anxiety and depression as a risk factor for reduced survival in cancer patients and is an important factor in the treatment of these patients is not acceptable

This study investigated the impact of cognitive behavioral therapy in reducing anxiety and depression in children that have cancer in Babol.

This research is a kind of pilot with 2 group of test and control group that contains a before test and after test. The sample is including 45 persons that contain children from 7 to 14 years old that suffer from cancer in Babol. These children are divided into two experimental and control groups. We have 22 patients in the experimental group and 23 patients in the control group. This groups were tested in 10 sessions. We use CDS-A depression questionnaire and anxiety questionnaires for collecting information. This group was tested in 10 sessions. We use CDS-A depression questionnaire for collecting information on and anxiety questionnaires were used.

For data analysis, we use descriptive methods such as frequency and percentage tables, mean and standard deviation, bar charts and analytical methods of Co-variance.

The results have shown that cognitive - behavioral therapy in reducing anxiety and depression in children with cancer are effected.

War stress like other stress has intensity, duration and times and demonstrated differently in society's people and its reaction depends to different factors. Those who are in stress encounter to different problems and it longs so many years on war survivals.

This study investigated the Comparing examination of the type and intensity of P.T.S.D signs in three fighter, self-sacrificing, and imposition war freeman.

The study was descriptive of the event so that the studied groups were subjected to the study of the type and severity of PTSD among various survivor of the war. Iranian Revolutionary Guards personnel are the subjects of the province in the form of veteran groups, militant, prisoner classification and the number 90 was selected as study samples. Data analysis was performed using one-way analysis of variance.

Testimonies shows, the amount of problems in these group of survival is more than other (especially freeman and self-sacrificing).

The important topic in this study is to determine types and intensity of P.T.S.D among war survivals in order to take attention of supporting and medical system support effectively to this category of society. Also take the responsible attention more to these problems.

The study of various psychiatric manifestations of tuberous sclerosis complex (TSC) and psychopharmacologic medications used to treat these disorders through a case of a patient followed for TSC and bipolar disorder, and with a review data from the literature.

In this case report, we present the association of Tuberous sclerosis and bipolar affective disorder in a young man. The literature data were collected by searching PubMed.

We found in the literature various psychiatric manifestations in patients with TSC like behavioral disorders, learning disability, mental retardation, attention-deficit/hyperactivity disorder, autism spectrum disorders, mood disorders, anxiety disorders and thought disorders.

The psychoactive medications most often prescribed for these disorders were antipsychotics essentially second generation (Risperidone, Quetiapine, Aripiprazole, Olanzapine), antidepressants, and anticonvulsants with mood-stabilizing properties (Clonazepam, Valproic acid). In this case report, our patient had TSC, referred to epilepsy, skin lesions(Angiofibromas, Shagreen patches)and confirmed by the neuroimaging(multiple calcified subependymal nod-ules, a thickened gyrus (cortical tuber), an astrocytoma in the right frontal region), with bipolar disorder type I manifested by manic episodes with psychotic features. The patient responded well to treatment with Quetiapine, Valproic acid and Clonazepam after resistance to Risperidone and Haloperidol.

Considering the rarity of bipolar disorder in TSC, the clinical management of these patients should be done on an individ-ual basis. However, the use of anticonvulsant mood stabilizers seems obvious because of the very high incidence of epilepsy in TSC. Quetiapine was one of the most effective antipsychotics in TSC and which showed a positive benefit for our patient at follow-up.

Characteristics can be related to individual driving behavior and traffic much evidence indicates that there is a relationship between personality traits and risky driving behavior.

The goal of recent survey was to identify difference of personality features between risky and ordinary drivers.

Thus the numbers of 120 drivers (60 risky drivers, 60 ordinary drivers) were chosen in a simple random sampling way among Tehran drivers and tested through Neo personality test.

The results indicate the significant difference among personality features of risky and ordinary drivers in all five indexes of neo test including:

1. Neuroticism 2. Extraversion 3. Openness to expense 4. Agreeableness 5. Consciousness.

In fact, indexes average of neuroticism and extraversion were more considerable through risky drivers than ordinary drivers, as well was indexes average of openness to expense, agreeableness and consciousness were less among risky drivers.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that can then face a terrifying event or ordeal in which grave physical harm occurred or was threatened, there is a happen.

The purpose of this research was to determine the effects of violent Style contact on social problem solving (SPS) and quality of life (QOL) among wives of veterans with PTSD.

population was wives of veterans with and without PTSD. The statistical sample were 80 person that 40 veteran’s wife with history of Domestic violence and 40 veteran’s wife without history of Domestic violence.

selected sample completed two questionnaires Dezurilla’s social problem solving inventory (SPSI-R) and Quality of life (WHOQOL--BREF) Inventory for analyzing of data used that parametric test of MANOVA, the results indicated that are significant differences between QOL and SPS in two groups.

also, the wives of veterans without ptsd had better performance at all levels of quality of life and social problem solving than other groups.

’Heaven has given human beings three things to balance the odds of life: hope, sleep and laughter’ - said Immanuel Kant. Sleep disorders belong to the most common health problems of the modern society and they became one of the first reason for seeking medical attention. Insomnia involves any difficulties related to sleep, including difficulty falling or staying asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors. Sleep disorders occur very often in clinical practice and have major effects on well being and overall health. Among last decades in Poland problem is still increasing. In 1992 - 24 % people in Poland had sleep problems, in 2012 they were present in 55% of population. Furthermore, sleep disorders are commonly associated with other medical problems as a reason, but also as a consequence creating a feedback loop.

An original questionnaire containing 23 questions was created. 49 respondents from the outpatient psychiatric clinic were recruited to the study.

The survey revealed that the number of patients with deteriorated social or work functioning (19%) is lower among patients with mood disturbances (51%). Declared ways to manage sleep disturbances show that patients want to find immediate solutions without participation in long lasting therapy. The large population of respondents des not know the proper way to cope with sleep disturbances. There exist a need for an education campaign in Poland in order to decrease number of medication abuse and to promote behavioral therapy

Major depressive disorder (MDD) is a severe and highly prevalence disease with potentially life threatening illness and high level of morbidity and mortality. Traditional pharmacological strategies are not always sufficiently effective and side effects are not rare and may be the cause of discontinuation, particularly in the long-term treatment.

rTMS could be an alternative strategy for long-term treatment of treatment-resistant depression (TRD).

to evaluate the efficency of maintenance rTMS in a one-year double blind randomized controlled study for TRD patients.

55 TRD patients were involved in a single site trial with two phases: an acute phase (phase I) in which all the participants received active high-frequency stimulation during 4 blocks of five consecutive working days (Monday to Friday) in an open-label design and a maintenance phase (phase II) in which responders (> 49% HDRS-17 reduction from baseline) were randomized in two arms with sham or active highfrequency rTMS maintenance treatment for the eleven following months.

of 55 patients in the acute trials, 33 were responders and 14 accepted to be included in the phase II. Delta HDRS score show a significantly difference for M1-M4 (p=.003), M1-M5 (p=.004) and M1-M6 (p=.043) between the active and the placebo group.

rTMS could be a novel strategy to prevent relapse in TRD patients who respond to an acute rTMS treatment and 1 session per week may be able to prevent relapses. These results need to be confirmed in a larger sample.

Schizophrenia is a devistating disorder which has a genetic component. Recently three reports showed that the IL3 gene, CSF2RA gene are associated with schizophrenia.

The objective of the study was to show whether there was an association between the IL3R gene rs6603272 variant and the CSF2RA rs4129148 variants with schizophrenia.

There was 264 schizophrenia patients and 222 controls from Romania. We utilized a PCR-RFLP method to genotype the subjects.

The genotype frequencies of the IL3RA rs6603272 variant were TT, 54.2; TG, 39.8; and GG,6.1 % in cases and TT, 52.7; TG, 41.9; and GG,5.4 % in controls. The T allele frequency in both controls and cases was 74%. The genotype frequencies of the CSF2RA gene rs4129148 variant were GG, 40.2;GC,51.1; and CC, 8.7 % in cases and GG,39.2; GC,45.5; and CC,15.3 % in controls. The G allele frequency was 66% in cases and 62% in controls.

The IL3RA gene rs6603272 variant was not associated with schizophrenia(X2=0.271; P=0.873). However The CSF2RA gene rs4129148 variant CC genotype was associated with schizophrenia(X2=5.079; P=0.024). The G allele was agenetic risk factor for schizophrenia (X2=5.079; P=0.024; OR=1.895, 95%CI= 1.080- 3.326). The controls were in Hardy-Weinberg equilibrium. But cases were not.

The progressive aging of the population in contemporary societies leads to the necessary adjustment to the responses of health care services. The project The Oldest Old: Coimbra aging study (PTDC/CS-SOC/114895/2009) assesses an elderly population enrolled in Health Centres of Coimbra - Portugal. The QAFMI/OARS is recognized as the first elderly multidimensional assessment, being one of the areas the mental health.

Assess the use/need of health and social services by the elderly, related with their functional status in five areas (social resources, economic resources, mental health, physical health and activities of daily living).

Assess the use/need felt for health and social services by the elderly, related with the functional status in mental health.

Quantitative methodology using the QAFMI/OARS. The sample consisted of individuals aged 75, or more, randomly selected and representative of Coimbra’s elder residents (N=11279; n=1128). Mental health status was evaluated using the Short Portable Mental Status Questionnaire, the Short Psychiatric Evaluation Schedule and a self-evaluation.

Preliminary results showed that in physical health, ADL and economic resources there are significant differences between age groups. In mental health, there is a significant difference classification between genders, with a tendentiously lower score in women. In social resources, there is a significant difference classification between gender and age group.

The work developed with OARS/QAFMI lead us to consider this instrument very useful to define functional status of the elders in specific evaluation areas as mental health, becoming right to the planning of older care services.

The re-audit was aimed to investigate whether physical health assessment and VTE risk assessment were routinely completed and documented for the inpatients admitted to adult and older adult psychiatric units within Oxford Health NHS Foundation Trust. The results will be used to develop plans around the prevention and management of VTE in inpatients, in conjunction with the Medicines Safety Group committee.

Data collection focussed on assessing evidence that the physical health proforma has been completed and VTE risk identified.

There was a good improvement (target 100%) in the documentation of the physical health assessments, this is clearly seen in 7 out of the 11 wards covered in the audit, compared to 5 wards which achieved the 100% target in 2012 reaudit.

There is a significant improvement in the completion and documentation of VTE risk assessments in Buckinghamshire parts of the trust across general adult and old age wards (90%, and 100% compared to 92% and 94% in 2012 audit).

There is a significant improvement Oxfordshire older adult wards in the completion and documentation of VTE risk assessments in the older adult wards in Oxfordshire (93% compared to 79% in 2012 audit).

1. 1. We should be aiming at having our target of 100% achieved on all wards.

2. 2. Encourage conducting phyyscal health assessment within 24 hours of admission and clearly documenting that.

Lithium is a natural trace element present in drinking water. At the same time it is one of the oldest drugs in neuropsychopharmacology with well-documented antisuicidal effectiveness in bipolar and unipolar depression.

To review the relation between lithium’s levels in drinking (tap) water and suicide rates across various geographical regions.

Literature review on PubMed. Keywords: Lithium, drinking water, suicide mortality, suicide rates.

The majority of the studies show that there is an inverse association between lithium’s levels in drinking water and suicide rates. It has to be mentioned that lithium’s total diurnal intake from drinking (tap) water is submultiple that of the minimum dose used in treating psychiatric disorders. This could imply that lithium’s antisuicidal effectiveness is distinct from its mood-stabilizing or its antidepressant-augmenting actions, being evident even at very low doses. Limitations of the various studies are that they have not controlled for demographic and psychosocial factors or for lithium intake from other sources -e.g. vegetables, dried nuts or bottled water. It is also possible that duration of exposure to a specific level of lithium in drinking water -several years or even tens of years- could have also played a role. However, there are also some studies showing no association between lithium levels in drinking water and suicide mortality.

Primary prevention of suicides is challenging. ’Lithiation’ -enrichment of drinking water with lithium- can provide a valuable help in this direction provided that the limitations of the previous studies will be addressed by further research.