88% of the families complained of high rate of different types of social burden mostly families of patients with negative symptoms, 50% complained of financial burden, 90% of the families felt stigmatized.

Raj L., Kulhara P, Avasthi A, Social burden of positive and negative schizophrenia, Int. J. Soc. Psychiatry, 1991 Winter,37(4),242-50.

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There has been a continued debate in the last decade about the possible role of polyunsaturated fatty acids especially omega-3 fatty acids in attention deficit hyperactivity disorder (ADHD) either as a causative factor - on deficiency - or as a treatment.

To compare omega-3 fatty acids status in children with ADHD to normal children and to study the efficacy of high dose supplementations of fatty acids on symptoms of ADHD.

40 children diagnosed with ADHD combined type and another 40 normally developing as a control group. All patients were subjected to Mini International Neuropsychiatric Interview for Children, IQ assessment,.Conners' Parent Rating Scale-Revised long version (CPRS-R-L), Vigil continuous performance test. The patients were prescribed omega-3 fatty acid supplement daily dose of 900 mg EPA and 600 mg DHA for 3 months. After end of the 3 months these children were assessed again using the Conners' parent rating scale-revised and Vigil continuous performance test.

Significantly lower levels of EPA and DHA in ADHD group compared to normal control inverse correlation between DHA on one side and Conner's ADHD index; inattentive subtest and total DSMIV indexed on the other side Conners’ ADHD index subscale there was a statistically significant improvement following the treatment.

Low levels of omega 3 may contribute to the symptoms of ADHD. Supplementing omega 3 in the treatment of ADHD could be a useful add on tratment specially in cases demonstrating low serum levels.

The frequency of severe adverse drug reactions (ADR) of psychotropic drugs in relation to age is investigated and especially the incidence in hospitalized patients aged up to 60 years is compared with patients aged above 60 years.

The data - prescription rates of psychotropic drugs, reports of severe ADR - are taken from psychiatric hospitals in Switzerland between 2001 to 2010 and stem from the drug surveillance program AMSP.

699 patients exhibited severe ADR: 517 out of 28282 patients up to 60 years (1.8%); 182 out of 11446 elderly patients (1.6%, ns). Linear regression analyses show a significantly decreasing relationship between the incidence of ADR and patients’ age in general and in particular for weight gain, EPMS symptoms, increased liver enzymes and galactorrhoea. Delirium increases with age. A significantly decreasing relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. Comparing age groups, lower frequency of ADR in general was found for antipsychotic drugs and anticonvulsants, in particular also for valproic acid in the elderly. Weight gain was found to be lower in the eldery for antipsychotic drugs, in particular also for olanzapine. For the group of mood stabilizing anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions.

The results suggest that in hospitalized patients the incidence of common severe adverse effects such as weight gain and EPMS symptoms as a consequence to psychotropic medication decreases with age.

Attention Deficit-Hyperactivity Disorder (ADHD) is present in both DSM-IV and ICD-10, with slight differences. For instance, one item is allocated to hyperactivity in DSM-IV and to impulsivity in ICD-10. ADHD is best conceived as a set of core symptoms with some specificity in phenotypal symptomatology. Regarding the specific components, their number remains an open question, the answer oscillating between two (Attention and Hyperactivity-Impulsivity) and three (Attention, Hyperactivity, and Impulsivity).

The aim of this study is to contrast alternative measurement models of instruments assessing ADHD symptoms (2 versus 3 specific factors, hierarchical versus bifactor models) across instruments, and age groups.

We analysed data from the new ChiP-ARD study. Youths (n = 892) aged 5 to 18 years-old were randomly selected and rated by their teachers (ADHD-Rating Scale, and SWAN). Parents (n = 1,171) of these youths rated their own behaviour using the Adult ADHD Symptom Rating Scale (ASRS). The fit of alternative models for ordered-categorical items was tested using the robust Weighted Least Square Estimator (WLSMV).

Results support a bifactor model including one global ADHD factor and two specific Inattention and Hyperactivity- Impulsivity factors. The results also show that the Hyperactivity-Impulsivity factor is improperly defined, and unreliable, calling into question the existence of this subtype. Furthermore, the fit improved when Impulsivity was measured by 4 (ICD-10) versus 3 (DSM-IV) items.

ADHD is a continuous condition from childhood to adulthood, and the “Talk too much” item is best conceived as a measure of Impulsivity than Hyperactivity.

Gamma-Butyrolactone (GBL) is a recreational drug, whose use has increased in recent years. However, it is highly addictive and when consumed in excessive amounts, physical and psychological dependence can develop.

High profile deaths, including the death of a young medical student, have increased the public's awareness of GBL. However, in spite of this and a change in UK law (2009) to make the once legal high a class C drug, the number of patients presenting to emergency departments with GBL overdose has continued to rise. There is significant anxiety amongst professionals working in acute medicine and psychiatry when it comes to managing these difficult presentations, which combine symptoms of a frightening psychosis with marked physical compromise, which can ultimately lead to coma and death. There is also a lack of medical literature concerning GBL.

To discuss a case that presented at Chelsea and Westminster Hospital, highlighting:

1. The signs and symptoms of GBL intoxication and withdrawal.

2. The importance of managing the psychosis alongside the physical symptoms.

3. Where these patients should be managed.

24-year-old patient, brought to A+E after police received reports about a gentleman in an underground station exhibiting ‘erratic, unusual behaviour’.

This case highlights the need for an integrated approach to the management of substance misuse in acute hospital settings. GBL is a substance that most practising doctors have not been taught about. Education on the topic, and other emerging recreational drugs, should be an important part of our continuing professional development.

Attention Deficit-Hyperactivity Disorder (ADHD) is common in childhood (affecting about 5% of children) and persists into adulthood up to 80% of the time. As a result, up to 3.5% of adults may have ADHD, which much higher rates in parents of children referred for ADHD, as heredity plays a role in ADHD. Thus, screening ADHD in adults is relevant in psychiatric and public health practice. The Adult ADHD Symptom Rating Scale (ASRS) was specifically developed for this reason by the World Health Organisation and translated into many languages, including French.

This study aims to estimate the prevalence rates of ADHD in a community sample of French adults, a population where no valid estimates are currently available.

A total of 1,171 adults were asked to rate their behaviours on the ASRS. The total score on the first six items is used as a screener, and the total score of the full set of 18 items is used for adults scoring in the clinically significant zone on the screener (i.e. two-stage algorithm). Maximum-likelihood prevalence rates were estimated in the entire sample and in gender (men vs. women) and age (below and above 43 years-old) subgroups.

The 6-item screener score suggests that 11.27% of participants (10.59% for females, 12.16% for males, 10.66% for younger adults, 12.16% for older ones). The two-stage algorithm suggests that 2.99% of participants (2.57%/3.53% for females/males, 2.16%/4.19% for younger/older adults) present clinical levels of ADHD, which is the rate commonly reported in other countries.

Depressive and anxiety disorders are the most common clinical diagnoses in patients at clinical high-risk (CHR) of psychosis (1).

Clinical disorders and functioning in CHR patients.

To study how depressive and anxiety disorders associate with patients’ functioning at baseline and follow-ups in CHR patients.

In the EPOS project, 245 young help-seeking CHR patients were examined, and their baseline diagnoses were assessed by the SCID-I. The patients were interviewed with the SIPS/SOPS, including assessments of positive and negative symptoms and the Global Assessment of Function (GAF), at baseline and at 9 and 18 months follow-ups.

At baseline and follow-ups, the patients without depressive or anxiety disorders had highest GAF scores. At baseline, the patients with depressive disorders had lower GAF scores than the patients with anxiety disorders. At follow-ups, there were no differences in GAF scores between the patients with depressive or anxiety disorders. In modelling, negative symptoms associated with low GAF scores at baseline and follow-ups, positive symptoms only at baseline and anxiety disorders at 18 months follow-up.

Depressive and anxiety disorders associate with poor functional outcome, and require thus special attention when intervention for the CHR patients is carried out. Positive symptoms predict transition to psychosis (2), but their role in predicting functional outcome is not as great. Instead, negative symptoms associate with poor functional outcome and require intensive intervention.

1. (1) Salokangas RKR et al. Schizophr Res 2012, doi:10.1016/j.schres.2012.03.008.

2. (2) Ruhrmann S et al. Arch Gen Psychiatry 2010;67:241-251.

Sleep quality is a relevant dimension with regards to sleep-wake functioning, and poor sleep quality has been found to be associated with poor academic achievement and health.

Internet use has been identified as having a detrimental effect on sleep patterns. Studies, however, on the relationship between Internet overuse and physical health or sleep problems have been rarely performed (5,6).

The aim of this study was to evaluate Internet addiction among adolescents and to examine the correlation between problematic Internet use and sleep disturbance symptoms.

The study was conducted among 1956 students, aged between 14 and 18 years. Internet Addiction Test (IAT) and a sociodemographic query form were used in the collection of data.

The students with Internet addiction were more likely to have difficulty in falling asleep (p< 0.001) and night awakenings (p< 0.01). Problematic Internet users and Internet addicts were found to sleep significantly less than avarage Internet users (7.1±1.5 hr/d, 7.0±1.2 hr/d, 7.76±1.5, respectively; p< 0.05). A significant positive correlation between daily sleep duration and IAT (r = -0.132; p < 0.01) and weekly Internet use (r = -0.085; p < 0.01) was found. Linear regression analysis revealed a significant negative and independent association of IAT with daily sleep duration (r = 0.235; p < 0.001).

These results indicate an association between the Internet addiction and impaired sleep. Further studies are needed to describe the causality of this association.

In past years, research in personality disorders has been mainly focused on dimensional models based in statistical methods like factorial analysis. Some different factors have been proposed lately, but most of these developed models seem to accept a model of four or five proposals. However, clinical and research groups disagree in the inclusion of these models in DSM-V.Our aim is to discuss some epistemological questions in dimensional models of personality.

A critical review of dimensional models of personality and their limitations from a hermeneutical perspective is presented.

Three main limitations in dimensional models of personality disorders have been reported:

1. Mental states and behaviour are de-contextualized, so subjectivity (which is responsible for its relevance), is neglected.

2. Temporal dimension of human behaviour is lost, so there is a narrow understanding of subjectivity.

3. An blind epistemological priority is given to first person perspective.

The hermeneutic approach takes into account these limitations and can, certainly, be very helpful with our daily work. Some questions it develops are:

1. The other's subjectivity is out of reach. Our relation with the other is ethical rather than epistemological

2. Subject-Environment interdependence

3. Time as an existential dimension of subjectivity

The epistemological assumptions of dimensional models based on statistical factors have important limitations so they can not be useful for clinical purposes.Using the bases of hermeneutical philosophy of the twentieth century, some psychiatrists (Stanghellini, Ramos and Rejón) re-introduce the subjectivity question and open a broader field to our daily work.

Animal assisted therapy (AAT) is becoming increasingly utilized for psychiatric patients with suboptimal response to traditional therapies. Larger animals, such as horses, may be especially effective therapy enhancers for some patients.

We have introduced AAT at a 500 bed psychiatric hospital in New Jersey. We previously conducted a randomized control trial (n=103) of ten weekly AAT group therapy sessions, comparing canine assisted therapy, equine facilitated therapy (EFT), enhanced psychosocial therapy, and standard treatment in highly regressed and/or violent patients. Initial analyses indicated that the EFT group had fewer violence-related incidents during the 3 months following the intervention compared with the other groups (p< 0.05).

We have initiated a second randomized controlled study comparing EFT with standard hospital treatment in a similar sample.

Based on observations that patients with trauma/abuse histories may find AAT beneficial, this partial replication study is assessing whether trauma history and perceptions relate to symptomatic and functional outcome with EFT.

Preliminary post-session interviews over several weeks for a subgroup of four patients with reported trauma histories (rates comparable to persons with PTSD on the Traumatic Life Events Questionnaire) elicited explicit trauma-related themes (e.g., recollection of past abuse) as well as putative indirect references such as identifying with the horses as understanding their pain and representing “hope.”

The presentation reviews the evolution and refinement of the intervention at our hospital, challenges to implementation, therapeutic course, preliminary outcome assessments, quantitative and qualitative, comparing EFT with standard treatment in the studies.

Compared to the general population, people with schizophrenia have a substantially higher risk of premature mortality which translates into a 10–15 year reduction in life expectancy. The aim of this investigation was to determine if symptoms (including aggression, hallucinations or delusions, and depression) or the environmental and functional status of people with schizophrenia contribute to the high mortality risk observed in this patient group.

We identified cases of schizophrenia, aged ≥15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of specific symptoms, activities of daily living (ADLs), living conditions, occupational and recreational activities (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007-10) using Cox regression.

We identified 4270 schizophrenia cases (170 deaths) in the observation period. After controlling for a broad range of covariates, mortality was not significantly associated with hallucinations and delusions or overactive-aggressive behaviour, but was associated with subclinical depression (adjusted HR 1.5; 95% CI 1.1-2.2) and ADL impairment (adjusted HR 1.8; 95% CI 1.2-2.9).

Severity of symptoms, such as delusions and hallucinations, was less important in predicting mortality than subclinical depression and difficulties carrying out activities of daily living. The overall picture appears to be one where the highest all-cause mortality risk is in service users who are least visible to clinical teams.

In many European countries including France, awareness for Attention Deficit-Hyperactivity Disorder (ADHD) is increasing. Unfortunately, estimates of prevalence based on validated instruments and reasonably large and representative samples are still lacking in many of these countries.

This study aims to estimate the prevalence rates of ADHD in school-aged children based on teacher ratings of the ADHD rating scale (ADHD-RS-IV) and of the Strengths and Weaknesses of ADHD-Symptoms scale of the Normal-Behavior (SWAN). These scales differ in item wording and scoring, and have both been extensively validated.

892 youths aged from 5 to 18 are included in the present study. Maximum-likelihood prevalence rates were estimated (based on recommended scoring criteria) in the entire sample and in gender (boys vs. girls) and age (below and above 12 years-old) subgroups.

Using the ADHD-RS, 10.65% of youths might have ADHD (4.37% Predominantly Inattentive subtype, 3.36% Combined subtype and 2.91% Predominantly Hyperactive-Impulsive subtype). Boys were more affected than girls (sex ratio 1.4:1), children were more affected than adolescents, and ADHD girls were more likely to be of the Inattentive subtype. Using the SWAN, 2.25% of youths might have ADHD (1.13% Combined subtype, .90% Predominantly Hyperactive-Impulsive subtype, .34% Predominantly Inattentive subtype). No overall differences between genders were observed, children were more affected than adolescents, and ADHD boys were more likely to be of hyperactive-impulsive subtype.

There are true differences according to the rating scales. Teacher ratings provide useful information that also has to be combined with parental and clinical ratings.

It is well known that mental illneses are associated with higher prevalence of somatic disorders when compared to the general population. We observed that, at the time of admission to the Acute Psychiatric Unit (APU) at our Hospital, many patients have associated urinary tract infection.

To determine the characteristics of patients that present with urinary tract infection on admission to the APU

From all admissions to the APU during 2011, patients with urinalysis, sediment and culture suggesting urinary tract infection were recruited for this study.

83 out of the 229 patients admitted to the APU had urinary tract infection at the moment of admission. Most common psychiatric diagnoses in patients with urinary tract infection were: mood disorders (37.35%), psychotic disorders (22.89%) and personality disorders (14.46%) Of these 83 patients, 72.29% had a history of previous psychiatric admissions and 91.67% had a new admission with an associated urinary tract infection.

Figure

[readmissions]

A high percentage of patients admitted to our APU have recurrent urinary tract infections. Urinary tract infections may play a negative impact on their psychopathological evolution and may be associated with the need for hospital admission.

Violence gender has caused considerable social alarm. Better awareness of the characteristics and problems of the female victims is necessary to be able to provide adequate psychological attention.

To identify the specific characteristics of PTSD in female victims of gender violence, stating what are the symptoms of this disorder are usually present, identify some of the most important variables that characterize women seeking assistance this problem.

The goal of this study is examining PTSD in battered women.

Participants: 100 Chilean and 170 Spanish battered women.

Instruments:

1. - Semi-structured interview for victims of abuse: assesses sociodemographic characteristics of victims and circumstances of abuse, it was designed for this research.

2. - The PTSD Symptoms Severity Scale (Echeburúa et al., 1997): assesses the severity and intensity of the symptoms of this disorder according to the diagnostic criteria of the DSM-IV-TR in victims of different traumatic events.

The results show that the most typical symptoms of PTSD are: re-experiencing (the presence of unpleasant and recurring memories about the abuse and psychological and physiological distress on recalling the events); avoidance symptoms (avoidance of thoughts, feelings or conversations related to what has been experienced, loss of interest in significant activities and restriction of emotional life); and hyperactivation symptoms (permanent state of hypervigilance and startle response).

This data will be useful to understand the problems and consequences of abuse and to target interventions to be made to alleviate the plight of these women in cases where it appears PTSD.

Prescription and sale of Methylphenidate (MPD) has increased sharply in Iceland in recent years as it has done worldwide. MPD is known to have abuse potential but significant i.v. use of prescription stimulants has not been reported in the literature. Clinical experience however has indicated that such i.v. use has now become very prevalent in Iceland.

To investigate the prevalence, pattern and symptoms of i.v. MPD abuse in Iceland.

The study is cross-sectional in design. The study tool is a semi-structured interview designed especially for the purpose of this study. All substance abusers admitted to drug treatment in Iceland who have used substances i.v. in the past 30 days, are offered to participate in the study. The aim is to include 150 individuals.

The study is in its preliminary stage. First results show that MPD is now the most commonly abused i.v. drug in Iceland, 85% of the sample admitted to using MPD i.v. in the past 30 days. Methylphenidate is preferred by i.v. substance abusers over illegal stimulants.

Our preliminary data shows that MPD abuse is a very prevalent problem in Iceland. It is the most commonly abused i.v. drug in Iceland at present. It is important to objectively verify and characterize the pattern of MPD abuse as to evaluate the complications associated with i.v. use of MPD. Increased knowledge of this problem is necessary both for Iceland as well as other countries.

Several authors made important contributions to the evolution of psychopathological concepts that we now often gather under the topic of formal thought disorders (FTD).

Our objectives were to describe the interpretation of concepts - including FTD and related concepts - by authors that had a major impact in the field and in defining trends nowadays.

In general we aimed to reach a comprehensive understanding of the evolution of the above mentioned.

We reviewed the literature by searching PUBMED and a library database using the terms thought and language and association and schizophrenia and course interchangeably. We used article and book references to increase our search.

Throughout the years - from the first observations suggesting a primary pathology of the ability to coordinate ideas of Esquirol and Guislain to the current DSM-IV Schizophrenia criteria - and considering authors from all over the world - including Fish (UK), Kurt Goldstein, Carl Schneider, Emil Kraepelin (Germany), Eugen Bleuler (Switzerland), Jules Séglas (France), Nancy C. Andreasen (USA), Pio de Abreu (Portugal), Elie Cheniaux (Brazil), among others - terms have been given approximate meanings and different symptoms/signs have been considered to that purpose.

Using precise concepts of formal thought and related disorders is crucial when considering diagnostic hypothesis and passing information on to colleagues. Thus, it is of utmost importance having a better understanding of the above.

VIH/AIDS infection is frequently associated with psychiatric disorders. Psychiatric comorbidities may interfere in adherence to antiretroviral treatment. Therefore, diagnosis and treatment of these conditions are essential. However, the administration of a new drug to the HAART therapy can result in drug interactions.

Our objectives were to describe the relationship between mental disorders and HIV and to analyze the interactions and adverse reactions when combining psychotropic drugs and antiretrovirals.

We aimed to review the literature of the association of mental disorders and HIV focusing mainly on the pharmacological aspects.

We reviewed the English literature from 1993 until 2011 searching MEDLINE using interchangeably the key-words HIV, AIDS, psychosis, depression, anxiety, secondary mania, antidepressive agents, antipsychotics, benzodiazepines, and HAART.

Patients with mental illnesses may be more prone to acquire infectious diseases by taking risk behaviors. Also, HIVinfected patients are more likely to present with psychiatric symptoms than the general population. Adding pharmacotherapy may improve adhesion to the antiretroviral treatment. We highlight the use of antipsychotics, antidepressants, benzodiazepines and mood stabilizers in patients diagnosed with HIV. We include interactions between pharmacotherapy and antiretroviraltherapy. Some of these drugs (e.g. Ritonavir) have shown important interactions, while others have shown any or no information was found available.

Choosing the best therapeutic intervention in each case, particularly considering those drugs with the least interactions and adverse effects, is crucial for a therapeutic success and in the combat to infection.

First case report of paediatric obsessive compulsive disorder (OCD) was presented by Janet in 1903. Since then many more reports of OCD in children and adolescents have been published. OCD in adult patients has been studied in the last decades but studies for pediatric OCD only began in the last 20 years.

To review the most recent knowledge on the characteristics, epidemiology, pathophysiology and treatment of pediatric OCD.

Review literature published on MEDLINE/Pubmed database in English language using “obsessive compulsive disorder in childhood”, “obsessive compulsive disorder in children and adolescents”, “OCD in childhood”, “OCD in children and adolescents” and “pediatric OCD” as key-words.

OCD is common among children and adolescents, with prevalence of 1-3% that often becomes a chronic condition. OCD onset has a bimodal age distribution with one peak at age 11 and other peak in early adulthood. There is a male preponderance in affected children, high comorbidity with psychiatric disorders mainly with tic disorders and attention deficit hyperactivity disorder, higher familiality and higher rates of aggressive/harm obsessions and religious obsessions. The current etiologic model most commonly accepted points to a dysfunction of cortico-striato-thalamic loops. Cognitive behavioural therapy (CBT) and a combination of CBT with a selective serotonin reuptake inhibitor are the treatments of choice for pediatric OCD.

Pediatric OCD seems to be an OCD subtype with similarities but also with important differences from adultonset OCD. Further research is still needed to better elucidate the genetics and the exact pathophysiology of pediatric OCD.