Hedonic eating refers to the consumption of food uniquely because of its </div><div>gustatory rewarding properties and not for homeostatic needs; so the subject eats also when not in a </div><div>state of energy depletion. Hedonic eating may stimulate powerfully food intake; hence, </div><div>understanding its physiological modulation could improve our knowledge of the pathophysiology of </div><div>obesity. Furthermore, obese people often present binge-eating behaviours, and binge-eating is </div><div>experienced as rewarding. Endocannabinoids, including anandamide (AEA) and 2-</div><div>arachidonoylglycerol (2-AG), and endocannabinoid-related compounds, oleoylethanolamide (OEA) </div><div>and palmitoylethanolamide (PEA), are involved in the modulation of food-related reward. </div><div>

Therefore, in the present study we aimed to investigate the responses </div><div>of endocannabinoids and endocannabinoid-related compounds to hedonic eating in obese patients </div><div>with and without binge eating disorder (BED). </div><div>

Peripheral levels of AEA, 2-AG, OEA and PEA were measured in 7 obese patients </div><div>with BED and 7 obese patients without BED after eating hedonic and non-hedonic food, and </div><div>compared to those of normal weight healthy controls. </div><div>

Peripheral levels of endocannabinoids and endocannabinoid-related compounds </div><div>exhibited different response patterns to hedonic eating among the groups. </div><div>

These data confirm the role of endocannabinoids and endocannabinoid-related </div><div>compounds in food-related reward and suggest a dysregulation of their physiology in obesity and in </div><div>the BED. These findings may have potential relevance to the prevention and treatment of obesity </div><div>and BED.</div>

Childhood trauma exposure is a risk factor for adult psychopathology in general.

The biological mechanisms mediating this increased risk involve the endogenous stress response

system, including the hypothalamus-pituitary-adrenal (HPA) axis, that undergoes trauma-induced

functional changes, which may persist later in life. Since an association between stressful life events

and the onset/course of anorexia nervosa (AN) or bulimia nervosa (BN) has been demonstrated, a

role for the HPA axis in their pathophysiology seems likely.

The cortisol awakening response (CAR) is a useful method to assess

the functioning of HPA axis. Therefore, we conducted an explorative study aiming to examine

possible associations between childhood maltreatments and HPA axis functioning, as assessed by the CAR, in adult patients with AN or BN.

Saliva samples were collected in 24 patients with acute AN, 22 with acute BN and

31 healthy controls at wakening and after 15, 30 and 60 min. They filled in the Childhood Trauma

Questionnaire (CTQ), which assesses five specific forms of childhood maltreatment.

As compared to control group, no-maltreated AN group exhibited an enhanced CAR

whereas no-maltreated BN group showed a normal CAR. Moreover, both AN and BN patients with

childhood maltreatment exhibited a statistically significant blunted CAR as compared to no-maltreated patients.

Present findings suggest that childhood adverse experiences may affect the CAR

in adults with AN or BN and this may represent a functional background of the endogenous stress

response system, which may have relevant implications in the pathophysiology of EDs.

Number of women of reproductive age with obesityhas grown in recent years and represents an important aspect of the overall growthin the number of obese people worldwide. Pregnancy is an ideal moment for healthprofessionals’ intervention.

To understand the emotional experiencesreported by obese pregnant women that had adequate variation in weight during thepre-natal.

Clinical Qualitative Method. The sample of subjects was intentional and closed by the criterion of information saturation with 13 participants. The technique of semi directed interview with open questions in depth was used. After full transcript of interviews. Qualitative Content Analysis has included:free-floating rereading to unveil cores of meanings from interviewees' discourseand categorization in topics for discussion under a psychodynamic theoretical framework.

Data analysis for this work indicates four categories. Three of them show a path of caution with the body that obese women have taken during thepregnancy: 1) The body begins to be thought; 2) The challenge of the diet; 3) The relationship with the prenatal health team. The fourth category reveals a sourceof motivation for changing: 4) Fear as enhancer changes.

Thepregnancy is an opportune moment for women to come into greater contact with themselvesand to notice their emotional conflicts. Through the changes in the body, the woman can start a more refined process of self-care and the experience of body-mind unit. The relationship with the professional health team plays an important role in motivational support to pregnant obese women.

Anorexia nervosa (AN) is a complex and severe psychiatricdisorder. Currently, treatment has limited effecttiveness.

Articles in Pubmed and TripDatabase, using 'anorexia nervosaand therapeutics'. Also activated filters: publication date from2013/09/01 to 2014/09/31.

The update of the lastest publications on treatment of anorexia nervosa.

We select six studies (two reviews and five clinical trial)because of the topic relation and the high leve of evidence.

One review is about Neuromodulation effects and the other aboutDeep-brain stimulation on AN. Two of the clinical trials are about psycotherapyand two about pharmacological treatment.

Psycotherapy is the treatment of choice, although in that momentwe can found studies about alternative treatment for specific cases.

Neuromodulation tools havepotencial for reducing eating disorderssymtomatology and realted behaviours. Preliminary results about Deep-brainstimulation showed that may be is a option for weight restoration inotherwise-refractory and life-threatening cases. Both reviews required morereserch to evaluated the long-term outcomes in eating disorders.

Focal Psychodynamic therapy proved advantages in terms of recovery at 12-month follow up, and enhanced Cognitivebehaviour therapy was more effective with respect to speed of weighgain and improvements in eating disorders psychppathology.

Cognitive Remediation therapy study confirms the feasibility for anorexia nervosa.

Relative to pharmacological treatment, Dronabinol insevere AN induce a smal but signoficant weight gain. And Lamotrigina studyshow that maybe is useful in patients who binge eat and purge.

To examine the factors that can predict the likelihood that a patient presenting to the Emergency Room will have impaired insight.

Twenty-two independent demographic and clinical factors contained on data assessment tools for 337 patients assessed by the crisis team in the ER over 6 months were compiled and analysed using SPSS Version 20 with univariate analyses and logistic regression.

Only four (employment status, history of self-harm, reason for presenting to the ER and psychotic symptoms present) of the twelfth-predictor variables on univariate analysis made unique statistically significant contributions to a logistic regression model. Patients who were unemployed or had a history of self-harm were about two and three times respectively more likely to have impaired insight compared with those who were employed or had no history of self-harm, controlling for other factors in the model. Patients who had psychotic symptoms on mental state examination were about six times more likely to have impaired insight compared to those who did not have psychotic symptoms, controlling for other factors in the model. Patients presenting to the ER with psychotic symptoms or drug/alcohol problems as chief complaints were 25 times and four times respectively more likely to present with impaired insight compared to patients presenting with a medical complaint, controlling for other factors in the model.

Patients presenting to the ER with a psychotic symptom and those with psychotic symptoms on metal state examination as well as those presenting with drug/alcohol problems are candidates for an insight-oriented psychotherapy.

having a dedicated psychiatric team embedded in a busy emergency department is conducive to providing a higher quality of mental health care, decrease the adverse occurences associated with boarding the severely mentally ill.

Aggression is common in children and adolescents on psychiatric units. Rates ofaggression are 27% to 78% on forensic adolescent units, and similar onnon-forensic units. Sometimes rapid tranquilization is needed for managing thisproblem – but no good quality systematic reviews exist for this population.

Weplanned to do a systematic review of psychotropics compared to placebo or otherpsychotropics by any route used as rapid tranquilization in aggression in childrenand adolescents with any mental disorder.

The aimis to provide evidence based and generalisable knowledge.

The‘PICO’ is as follows: Populationis children and adolescents up to the age18 with aggression and a mentaldisorder; Interventionsare psychotropics by any route; Comparisonsare placebo or other psychotropics by any route; and Outcomes are efficacyand safety. Only RCTs are eligible. A comprehensive search is carried outof Medline, Embase, Psychinfo and other databases. Articles selection anddata extraction is carried out by two reviewers independently for reliability. Articles are assessed for quality. Meta-analysis is preferred if warranted byheterogeneity assessment; otherwise narrative synthesis will be done usingGRADE evaluation.

Thereview is underway. The effect sizes would be as follows: for dichotomousoutcomes relative risk, absolute risk change and numbers needed; and forcontinuous outcomes mean difference or standardized mean difference. Thesewould be sensitivity analyzed. If meta-analysis were not warranted, thennarrative synthesis will be presented.

Conclusions will be drawn for relative efficacy and safety of thepsychotropics.

Suicide is a serious public health problem in Western countries. In Spain, suicide is the leading cause of unnatural death in front of traffic accidents. The presence of a mental disorder is referred to as a risk factor of great interest both for its presence in suicides and the possibility of being treated and thus to reduce the risk of suicide.

Study the presence of psychiatric diagnoses in subjects entering the treble unit of Huelva for attempted suicide.

We conducted a retrospective study comparing the data obtained with this material in the literature. Statistical analysis was performed using the statistical package SSPS.

In the process of data analysis.

1. - Presence of diagnosis and prevention opportunities

2. - Differences between sexes.

3. - Further exploration and increasing the sample compared to suicides

Home treatment Team deals with high turnover of patients with significant risks on daily basis. There have been complaints by General Practitioner’s that discharge letters have inconsistent information regarding medications, risks and diagnosis.

To standardise the content of discharge letter, improve the communication between primary and secondary care and to reduce medication errors eventually maintaining remission.

It is a retrospective audit done in May 2014 looking at the discharge letters to primary care in the month of October 2013. As there were no standards to compare, internal standards were set up for the purpose of audit based on the discussions with various General Practitioners.

Discharge letters were scrutinised based on the Primary and Secondary diagnosis with ICD 10 category, clear documentation of risk and details of medication including name, dose, frequency and duration. Audit tool was devised looking into this and 54 out of 108 patients were selected randomly and audited.

Although majority had diagnosis stated quality of discharge summaries were variable with lot of psychiatric jargons. Risks were documented in an unstructured manner with inconsistent management plans. Most of the letters had medications with some had no dosage or frequency documented clearly.

Results were discussed and presented in academic programme in the trust. New template was devised with all the relevant information and implemented successfully. Re audit to done after 6 months with the view of replicating trustwide.

Agitation is a broadly defined phenomenon that is associated with many physical and mental illnesses. The core features of agitation generally include: irritability, excessive or semi purposeful motor activity, heighted responsiveness to internal and external stimuli and an unstable course. Inhaled Loxapine is recently available as a new approach in the management of these episodes.

To present case reports of Inhaled Loxapine in the treatment of agitated patients in our clinic.

We have selected representative case reports form our acute unit characterizing the patients´ history and the circumstances of present admission, the evolution and the management of these episodes during the admission.

Inhaled loxapine as a new treatment option allows rapid control of agitation in these unstable patients who can suddenly turn into aggression or violence, facilitating the therapeutic alliance between the patient and physician without resorting to mechanical or physical restraint.

The financial crisis that began in 2008 affecting many European countries and mainly Greece has an ongoing impact on public mental health and quality of life. The aim of this study was to investigate the potential impact of the financial crisis on criminality verifying differences in crime rates between the years 2008 and 2011 in Greece.

Data on crime in Greece for 2008 and 2011 were provided by the Crime Analysis Section of the Public Security Department of the Hellenic Police Headquarters. In order to create a comprehensive global index of criminality we calculated an overall crime rate including the following crimes committed: homicides, financial crimes (fraud, extortion), drug-related crimes, illegal weapon possession, sex-related crimes (rape, sexual exploitation), thefts/ burglaries and robberies. The overall and the aforementioned specific crude crime rates were calculated per 100,000 residents. Paired samples t-test was used to examine the differences in the rates between 2008 and 2011.

A significant increase in the overall crime rate between 2008 and 2011 (t=5.01, p=0.001) was found. Moreover, between 2008 and 2011 there was significant increase in the crude rates of homicide (t=2.41, p=0.03), fraud (t=7.35, p=0.001), extortion (t=3.22, p=0.009), illegal weapon possession (t=5.27, p=0.001), theft/burglary (t=4.62, p=0.001) and robbery (t=3.23, p=0.007). There were not statistical differences in the crude rates of sex-related and drug-related crime.

According to the results of this study criminality in Greece shows significant increase during the current financial crisis as reflected in many crime indicators.

The term ‘revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments.

Continued readmissions require a large portion of Mental Health Departments’ resources.

To analyze the RD phenomenon in an acute psychiatric ward during a 5-year period.

We retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed.

In the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was ‘worsening of psychiatric symptomatology” (55.27%). The most frequent diagnoses at discharge were ‘Schizophrenia” (41.26%) and ‘Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001).

Our RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

In the last years in Greece, one the most controversial issues has been the probable increased rate of suicides in the middle of a financial and social crisis. The purpose of this study was to see the change of the profile (type and frequency) of suicide attempts referred to a big General Hospital in the years before and during the financial crisis.

Data were collected both from the Emergency and the Outpatient Departments of the Psychiatric Sector of our Hospital between the years 2008 and 2013. Data were analyzed with a SSPS package using t-test, ANOVA and Multiple Regression analyses.

The number of suicide attempts recorded didn’t differ significantly in the years before i.e. 2008 and 2009 and during the financial crisis, between 2010 to 2013. During the deepening of the crisis (2012), a statistical difference was found as for the reason stated. This has been,as reported by the patient, financial difficulties, correlating (p<0.01) with the degree of GDP decline . In the half of 2013 there was no correlation of the attempts with the financial difficulties.

The suicide rate change in Greece has been a topic for an ongoing discussion. These results are inconclusive regarding the change in the profile or in the number of suicide attempts before and after the 2010 debt crisis. The yearly number in suicide attempts didn’t differ significantly between 2008 and 2013 . The patients’ reason of the suicide attempt was financial insecurity during the worst year of the crisis, i.e. 2012.

Social support networks, with greater support from families, friends and communities are linked to better health. Also, due to the present economic condition they might be the only solution for rehabilitation in patients with lower income.

Aim: To investigate the way that social support network can help patients with rehabilitation after hospitalization.

All patients that were referred to the social workers network from 2012-2013 were assessed in order to find those who seek rehabilitation programmes. Analysis was performed with SPSS21.

143 patients, 100(69.9%) males, 81(71.7%) with lower education were referred for rehabilitation and poverty reasons. 117(81.8%) were Greeks 75(52.4%) single, 99(69.2%) had no insurance and 125(87.4%) unemployed. The referrals were made mostly from social hospices (N=71) and the hospital clinics(N=59), while the amount of patients was almost identical for the two years(47.6% for 2013 and 50.4% for 2012 respectively). The main reason for the referral was poverty(N=117 81.8%), poverty and health problems(N=22 18.4%), psychiatric problems(N=2 1.4%) and HIV(N=2 1.4%). In the majority of the cases(N=106 74.1%) there was a successful result in finding a rehabilitation hospice. Finally, there was a statistical significant difference between those that had family-support(N=47) and those that didn't(N=96) in the referrals amount (x2=10.894 p=.02).

Results indicates that family is a protective factor against social support need, but due to the economic condition and new family bonds, a growing number of people still needing help, even if they have a family that could support them, something that should be further investigated.

There is a growing evidence for clinical effectiveness of Home Treatment for <a name="OLE_LINK2"></a><a name="OLE_LINK1">patients with severe psychotic disorders</a>. Here we present the development and implementation of a manualised assessment-based Home Treatment in Germany.

We compared the 6-month effectiveness of an assessment-based Home Treatment in patients with schizophrenia spectrum disorder to standard care in a catchment area design.

The primary outcome criteria was the rehospitalisation rate. Secondary outcomes comprised improvement of symptoms, functioning, quality of life, medication adherence and satisfaction with care.

Assessments were carried out at baseline and at 3 and 6 month. Inpatient admission and treatment contacts were assessed from the hospital database.

We visited 20 patients with severe psychotic disorder (ICD10: F2.x) almost 400 times in twelve months. The median was 15.5 visits per patient. The intervention resulted in a highly significant reduction of the rehospitalisation rate (−51%, P<.01) and we found a significant improvement in Medication Adherence within the first 3 months using the Morisky-Score (P<.01). There wasn´t any significant change in clinical outcome regarding variables from Psychopathology with the Positive and Negative Syndrom Scale (PANNS), Global Assessment of Functioning (GAF), Quality of Life (The World Health Organization Quality of Life, WHO-QUOL) and client satisfaction (ZUF-8).

Applying assessment-based Home Treatment for patients with severe psychotic disorders is an alternative treatment compared with standard care resulting in a significant lower rehospitalisation rate with an equivalent clinical outcome.

Endorsing self-stigmatizing thought per se needs not produce chronic distress. Only when it occurs frequently and automatically as a mental habit does this create constant mental turmoil. The cognitive content and the habitual process of self-stigma should be assessed independently among people with mental illness. Although existing measures can assess the content of self-stigma (i.e., the extent of self-concurrence with negative stereotypes of mental illness), none of them assesses the process (i.e., the habitual quality of self-stigmatizing thinking).

The present study aims to develop and validate a measure of the habitual process of self-stigma, that is, the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale.

Ninety five people with mental illness completed an initial version of the STAR together with a measure of the cognitive content of self-stigma (i.e., the Self-Stigma Scale—Short Form [SSS-SF]).

Exploratory factor analysis suggested a 2-factor structure of the STAR (i.e., repetition and automaticity of self-stigmatization). The four highest-loading items on each factor were selected to constitute the final version of the STAR. The 8-item STAR and its subscales demonstrated excellent internal consistency. The STAR showed significant but moderate correlation with the SSS-SF.

With the validation of the STAR, the time is ripe to move beyond a global evaluation of self-stigma as a content-oriented construct and to understand both the content and process of self-stigma, so that the diversity and complexity of its impact on people with mental illness can be more fully captured.

One in three people detained in Italian Penal Institutions suffer from mental disease. The rate of suicide among prisons’ population is higher than among general population. The high prevalence of mental disturbs and the comorbidity with infectious diseases and drug addiction is well recognized. The conditions of Judicial Psychiatric Hospitals, institutions for criminals judged social dangerous and unable to understand and act, are even more critical. Therefore, the Right to Health in jails is constantly questioned.

The aim of this work is to analyse Italian penitentiary situation in order to understand the causes of these inequalities in Health, with the perspective to promote mental health and to ensure the Right to Health.

This paper is the result of the first step of the International Project ‘Caught From Inside – The Other Side Of Life”: a one-year research led by the Research Group of SISM – Segretariato Italiano Studenti in Medicina, Italian Member of IFMSA (International Federation of Medical Students’ Association), starting from a bibliography provided by Academic Supervisors.

It results that mental health and illness, as well as health and illness in general, are determined by multiple social, biological and psychological factors. In order to obtain significant gains in prisoners’ mental well-being may be useful to forge interdisciplinary collaborations between those working in socio-political and health domains.

Virtuous examples are those Countries where Penitentiary System is not merely custodialistic and the Institutions are closer to inmates, much more customised, targeted, linked to outside healthcare facilities, preventive.