A recent national survey highlighted the considerable treatment gap for depression (59.6%) in modern Singapore. Asians tend to focus on physical features of a disease than the psychological ones, which might contribute to the relative lack of disease pick up by physicians. Literature suggests a distinct clinical entity of depression among the elderly, with a different clinical presentation from adults.

This retrospective case series was undertaken to understand the clinical features and management decisions of elderly patients presenting with depression in Singapore.

To describe the demographics, clinical presentation, psychiatric and medical co-morbidities, and management decisions of depression in the elderly.

Inter-departmental referrals to the Department of Psychological Medicine of Tan Tock Seng Hospital from 1/1/2011 to 31/3/2011 for the management of patients ages above 64 with the diagnosis of depression were collated for case description.

A total of 40 inpatients ages 65 to 104 years (mean 76.2 years) were recruited. 14 (35%) were male and 26 (65%) were female. 70% of them does not have a co-existing psychiatric diagnosis. The highest number of referrals were form the department of General Medicine (42.5%) followed by Geriatric Medicine (25%). Most of the elderly were admitted for infection (20%), followed by equal proportions of those admitted for cardiovascular problems (12.5%), recurrent falls (12.5%), psychiatric issues (12.5%), and orthopedic problems (12.5%).

As the population of Singapore ages, clinicians should be mindful that depression often co-exist with medical co-morbidities, and the complex interaction amongst the two entities.

Quality of life is negatively influenced in various degrees in both bipolar and recurrent depressive disorder, predominantly in the acute episode but also during remission.

To compare the degree of negative influence of the two nosological entities on quality of life of patients during remission.

78 outpatients diagnosed with recurrent depressive disorder, 67 outpatients diagnosed with bipolar affective disorder, according to ICD-10 diagnostic criteria and 73 healthy subjects were selected for this study. The assessment of the subjects took place during remission (euthymia), between june 2009 and june 2012. As work-instruments we used the SF-36 Scale for assessing quality of life and the HAM-D Scale (Hamilton Depression Rating Scale) and YMRS Scale (Young Mania Rating Scale) to confirm remission.

The bipolar group scored lower regarding quality of life than the recurrent depressive group. Both affective disorder groups showed significantly lower quality of life scores when compared to the healthy control group.

Bipolar affective disorder and recurrent depressive disorder have a significant negative impact on quality of life even during remission. Bipolar patients may have a lower quality of life than recurrent depressive patients. To improve quality of life, patients need social and familial support.

In the current study, it was aimed to investigate the correlation between the caregivers of schizophrenia and bipolar disorder (BD) patients in terms of burden, depression, anxiety and hopelessness.

Between March and July 2011, 75 schizophrenia and 50 euthymic BD patients' primary caregivers at the outpatient clinic in Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery participated in this study. Informed consent was obtained from all patients and their caregivers. Sociodemographic data form, PANSS, Beck Depression Scale, Young Mania Scale were applied to the patients. Sociodemographic data form, Zarit Caregiver Burden Scale, Beck Depression Scale, Beck Anxiety Scale and Beck Hopelessness Scale were given to the primary caregivers.

The burden level is found to be severe in the schizophrenia and BD patients’ caregivers. Seventy-two percent of schizophrenia patients’ caregivers and 62% of the bipolar disorder patients’ caregivers had depressive symptoms. The anxiety levels of the caregivers of the bipolar disorder patients were found to be significantly higher than that of the schizophrenia patients’ caregivers (p< 0.05). We found a positive correlation between the scores of the Zarit Caregiver Burden Scale in the caregivers of the schizophrenia patients and PANSS positive, negative, and general psychopathology scores in schizophrenic patients (p< 0.05). There was found a positive correlation between the depression levels of BD patients and their caregivers’ burden scores (p< 0.05).

High level of burden in both groups’ caregivers was found. Therefore, this situation can be making it difficult to cope with these diseases.

Multi-factorial aetiology of schizophrenia has an undeniably large genetic component. Attempts to elucidate its genetics with large case control studies have met with limited success and other approaches are warranted.

In an extended family (pedigree 1) in which two sets of siblings - children of a brother and sister - are intermarried; six members with DSM-IV schizophrenia share a 6MB region of homozygosity on chromosome 13q. One out of twelve genes at this locus shows a sequence change in its promoter region.

[Pedigree 1]

Another family (pedigree 2) with two affected brothers has revealed two loci of homozygosity on chromosomes 5 and 9.

[Pedigree 2]

A third family with nine cases of psychosis is being investigated.

An approach which focuses on families with multiple cases in one generation and evidence of consanguinity in parents may be particularly successful for identifying recessive genes.

Longitudinal studies reporting the association between cannabis use and developing depression provide mixed results. The objective of this study was to establish the extent to which different patterns of use of cannabis are associated with the development of depression using meta-analysis of longitudinal studies.

Peer-reviewed publications that compared the risk of development of depression in cannabis users and non-userst were located using searches of EMBASE, MEDLINE, PsychINFO and ISI Web of Science. Data on measures of cannabis use, measures of depression and control variables were extracted. Odds ratios were extracted by age and length of follow-up.

After screening 3,905 articles, 55 articles were selected for full-text review, of which 12 were included in the quantitative analysis. The odds for cannabis users developing depression compared to controls was 1.26 (95%CI=1.10-1.44). The odds for heavy cannabis users developing depression was 1.72 (95%CI=1.27-2.34), compared to non-users or light users. Meta-regression revealed no significant differences in effect based on age of subjects or length of follow-up in the individual studies. There was large heterogeneity in the number and type of control variables in the different studies.

Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. Despite limitations due to heterogeneity in control variables, this study represents the current state of knowledge on this association. In order to establish a more precise dose-response relationship between cannabis use and the risk of developing depression, future longitudinal exploration should take into account cumulative exposure to cannabis.

Pseudocyesis have been crossing several centuries under different terms. Recently there has been an evolution around the factors involved, being recognized a complex relation between psychological mechanisms, neuroendocrine imbalances and sociocultural factors.

To present a clinical case and revisit the literature about pseudocyesis. A reflection about the etiological factors potentially involved and the importance of the cooperation between Psychiatrist, Family Physician and Obstetrician on Somatoform Disorders.

Literary review for understanding the clinical case and diagnosis and treatment discussion.

A woman, followed at Psychiatric appointments for history of drug addiction, presents a clinical chart compatible with pseudocyesis recurrent episode. Several questions are raised about the possible factors associated, considering pathophysiological, neuroendocrine and psychological models. It's also assessed the best therapeutic approach to motivate the patient towards therapeutic compliance, being crucial the coordination between the several health care professionals.

There aren’t many case reports about pseudocyesis, and there is even less data related specifically to patients with an addictive disorder. Besides the psychological factors classically associated with this somatoform disorder, it is necessary to consider endocrine and neurophysiological factors in outlining the etiological mechanisms. It is also acknowledged the crucial importance of a multidisciplinary approach between the several health care professionals, that should be aware to these cases in order to promote the therapeutic compliance by the patients. Early detection and empathic communication with the patient are the most important factors to be valued on an approach which should be socio-familial, biomedical and psychotherapeutic.

Sixty eight patients with epilepsy (mean age 28.1±2.9 years) were studied (DTI MRI, EEG-mapping, neuropsychological tests). Patients of control group (n=32) took AED at therapeutic doses and had side effects at 97%. Patients of experimental group (n=36) treated with low AED doses and 1 Hz rTMS over the temporal lobe with focusing on hippocamp projection.

There were depression at 48.5% and high anxiety level at 40% of examined patients what correlated with position of epileptic focus in left hemisphere (OR=6.7, p=0.045), presenting of “spike-slow wave” complexes (OR=9.6, p=0.0001), female gender (OR=4.2, p=0.04) and focal onset of seizure (OR=2.1, p=0.039). Dynamic monitoring at control group did not reveal any differences at epilepsy course during 12 monthes.

At experimental group significant decreasing of seizure frequency and severity during 12 weeks after rTMS onset was determined. Antidepressive and anxiety effect was obtained at 46% patients to tenth procedure (p=0.004). Increasing of quality of life was registered by QOLIE-31 (p< 0.05). Received effect remained during six monthes in 40% experimental patients (p< 0.05).

Thereby, including of rTMS into combined epilepsy therapy with low doses of anticonvulsants has a determining function and leads to significant antiepileptic effect improves the psychological condition, quality of life of these patients and allows avoiding of psychotropic drugs prescription.

This is the first European psychiatric exchange programme and it aims to promote an intercultural professional exchange and cooperation among psychiatric trainees across Europe, with a focus on individual experience.

To provide trainees with the opportunities to:

• promote awareness of intercultural aspects of psychiatry

• engage in clinical, and/or research, and/or teaching activities

• become acquainted with different mental health systems

• gain experience of different illness manifestations and treatment options

• experience a different training programme

• socialise with peer group, promote networking and discuss coping strategies regarding work life balance

The programme was developed by the exchange working group of the EFPT in 2011 and it offers 2-6 weeks in observational placements across Europe in diverse areas.

Feedback from pilot phase (January-July 2012) has shown excellent overall satisfaction of participants in the project. In the 2nd phase (August-December 2012) the programme has expanded offering more observational placements in 8 countries such as: Croatia, Denmark, France, Italy, Portugal, Slovenia, Spain and UK. In the 3rd phase (January-July 2013) it expanded further to include Ireland, Netherlands and Romania in a total of 11 hosting countries. Placements are offered in many subspecialties such as: psychotherapy, emergency psychiatry, child and adolescent psychiatry, eating disorders, family therapy, liaison psychiatry and psychosomatics, drug addictions, learning disabilities, forensic psychiatry and old age psychiatry.

We hope that the diversity of placements offered by this innovative programme will constitute a new approach to the improvement of psychiatric training and practice across Europe.

Previous evidence shows that STON2 was associated with synaptic function and schizophrenia. The aim of this study is to explore the relationship STON2Ser307Pro, Ala851Ser and cortical surface area in schizophrenia patients and healthy volunteers.

MRI whole cortical surface area which was computed by an automated surface-based technique (FreeSurfer) and genotypes were obtained from 74 individuals with first-episode schizophrenia and 55 controls. Multiple regressions analysis was performed using genotype subgroups to effect on cortical surface area.

There was significant genotype-by-diagnosis effect on cortical surface area, Pro-allele-carriers having larger right inferior temporal surface area in schizophrenia patients, but there was no significant on the same area in healthy volunteers, have not detected that Ala851Ser was associati[on with cortical surface area in our subjects.

These data demonstrate that STON2 gene may be alter cortical asymmetry on the right inferior temporal, and that abnormal gene may be a core role that contributes to the pathogenesis of schizophrenia.

The US Drug Enforcement Agency maintains a tight leash on drugs of abuse and has already banned newer designer drugs like Spice and Bath Salts. However, there is increase in the use of a new drug called pump it (PI). There is some evidence that it contains Geranamine Methylhexamine (DMAA). This is a report of a patient who exhibited unusual behavior after using PI.

A 40-yo male was brought to the Emergency Room after he stabbed himself in the abdomen using a knife sustaining laceration to the liver. Psychiatry consult was requested for attempted suicide. The patient had total amnesia surrounding the event. Collateral information from the wife revealed that his pupils were widely dilated and he appeared agitated, paranoid and diaphoretic just before stabbing himself. Six weeks prior, he began snorting to self detoxify himself from opioids. He experienced a 40 lb. weight loss, severe insomnia and impulsive behavior translating into dangerous acts like medication overdose and walking into oncoming traffic. He had no such symptoms prior to using PI.

Geranamine is a stimulant is presumed to act by releasing norepinephrine. It is used as a dietary supplement for weight loss and energy gain. It has been reported to produce paranoia, hallucinations, mood lability and seizures.

Substance induced mood disorder should be considered as a differential diagnosis of suicide attempt and clinicians should be aware about the fact that some “dietary supplements” may pose severe danger to patients.

In the present study, the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adult psychiatric outpatients was investigated. Moreover, co morbid psychiatric diagnoses in adults with ADHD were determined. Patients with and without co morbid ADHD were compared regarding axis I-II co morbidity and socio-demographic characteristics.

The current study included 246 patients admitted for the first time to Numune Hospital psychiatric outpatient clinic in a four months period where they were evaluated for adult ADHD. Diagnosis of ADHD was made by evaluating symptoms of childhood via WURS scale, Turgay's adult ADD / ADHD evaluation scale. For the exact diagnosis DSM-IV criteria were applied to the patients who exceeded the cut of points of both above-mentioned scales. To assess the presence of psychiatric co morbidity a structured clinical interview (SCID-I and II) were applied. Socio demographic characteristics of patients were determined with a semi-structured form. In addition, to grade general psychopathology, Symptom Check List (SCL-90-R), Beck Depression Inventory (BDI) were given.

Prevalence of ADHD in adult psychiatric clinic was 15.9%. Adults with ADHD usually referred due to co morbid psychiatric problems. It was determined that they had deficits in education and social functions. Substance abuse and suicide were among the most prevalent psychiatric problems.

ADHD was common in adult psychiatric outpatients and axis I-II co morbidity was highly prevalent among these patients.

Hyponatremia due to antidepressant-induced SIADH can cause significant morbidity and serious complications. It is commonly associated with SSRIs, but the frequency and class-specificity are unclear.

To determine the relationship between hyponatremia and antidepressants, defining incidence and odds ratios for antidepressant classes, along with patient risk factors.

A review of the literature was performed in Web of Science and Pubmed until April 2012, using combinations of search strings “antidepressants” and antidepressant class and generic drug names with “hyponatr(a)emia”, “SIADH” or “inappropriate antidiuretic hormone secretion”.

19 effect studies and over 50 case reports were considered, the majority concerning SSRIs. Variation in study design, population and cut-off values caused divergence of hyponatremia incidences of 0.06-40% for SSRIs and 0.08-70% for venlafaxine. Incidence numbers for mirtazapine and TCAs were tenfold lower. Odds ratios for SSRIs (1.5 -4.0) were consistently higher than for TCAs (1.1-1.9). The risk associated with MAO-inhibitors, reboxetine and bupropion could not be established due to insufficient information. Patient risk factors included older age (OR 6.3) and concommitant use of (thiazide) diuretics (OR 11.2-13.5).

Hyponatremia is an underdiagnosed and potentially dangerous side-effect of antidepressants and this risk is not exclusive to SSRIs. Current evidence suggests a relatively high risk for hyponatremia with the use of SSRIs or venlafaxine, especially combined with patient risk factors, in which cases clinicians should actively screen for this complication. Mirtazapine and TCAs entail a moderate risk and can be considered as alternative treatment for patients with increased risk or history of hyponatremia.

Type 2 Diabetes mellitus (T2DM) is a chronic disease that requires long-term medical care and lifestyle change. Many patients find it challenging to implement required behaviour changes and consequently, do not achieve glycaemic control. It is essential to research social cognitive factors that impact self care in T2DM.

To study the impact of barriers and illness perceptions on self care in T2DM

To explore barriers to self care and illness perception and examine their relationship with self care, metabolic control and quality of life in T2DM.

A cross-sectional design was employed. The sample consisted of 60 patients with type 2 DM, meeting specified inclusion and exclusion criteria, recruited from the out-patient services of a hospital at Bangalore. The Barriers of self care questionnaire (Glasgow, 1994), The Revised Illness Perception Questionnaire (Morris et. al, 2002), The Summary of Diabetes Self Care Activities (Toobert & Glasgow, 1994) and The Diabetes Quality of Life Questionnaire Brief Clinical Inventory (Burroughs, Desikan, Waterman, Gilin & McGill, 2004) were administered. Metabolic control was assessed using glycosylated haemoglobin levels (HbA1c).

Findings revealed that barriers to self care, negative perceptions of consequences of the illness and negative emotional representations were associated with poorer self care. Adherence was associated with better metabolic control and quality of life.

Barriers to self care and maladaptive illness representations pose a challenge in achieving self-care goals. Understanding barriers is the first step in facilitating practitioners to identify their role in enabling patients to overcome them.

There is good evidence from epidemiological studies that the diagnosis of schizophrenia is associated with an increased risk of violence.Some studies have linked the presence of positive symptoms, first psychotic episode, duration of untreated psychosis and lack of insight with violent behavior.

The primary objective was to identify factors related to violent behavior in patients diagnosed with psychotic disorder attended by our group, a multidisciplinary mobile outreach team (EMSE).

We evaluated a total of 249 patients diagnosed with psychotic disorder between 2007 and 2012. We administered the following scales: PANSS, GAF (Global Assessment of Functioning), CGI (Clinical Global Impression), GEP (Severity of psychiatric illness scale, AVAT (Instrument to assess violent behavior in mental illness) and SUMD (Scale unawareness of mental disorders). To study the correlation between the scales and the score of the AVAT instrument we used the Pearson correlation. Clinical variables were also compared between aggressive and non-aggressive patients using Chisquare and Student's.

There is a positive correlation between AVAT and PANSS-P (r = 0.544), ICG (r = 0.472), GEP (r = 0.515) and a negative correlation between AVAT and GAF (r = -0357). The correlation between AVAT and SUMD is positive (r = 0.119) but not statistically significant.

The presence of positive symptoms and clinical severity has been linked to increased aggressiveness and to predict the occurrence of violent behavior in the course of psychotic disorder. Unlike other studies, no correlation was observed with the lack of insight.

86 PD patients and 51 SCZ were evaluated by using the PSAS scale. Data from correlational analyses supported the construct and discriminant validity of the scale in all hallucinatory modalities were related to both gold-standard (PANSS P3 and UPDRS I Item2). Test-retest reliability (33 SCZ and 50 PD) over a 1-week interval determined 2 patients groups :stable : there's no significant (p>.05) differences between before and after measurements in each domainand unstable: all sub-scale and total score significantly (in the range .045 to .002) changed.Inter-rater reliability (18 SCZ and 17 PD) varied by subscale sense hallucinations and domain-specific κs ranged from .56 to .94.

The results suggest that the usefulness of PSAS as a clinical tool is for initial detailed evaluation and monitoring changes in hallucinations, in SCZ and PD. The next step will be to compare all modality hallucinatory manifestations in PD and schizophrenia.

Fear of crime is a kind of unpleasant and often intense emotion caused by perceived risk of being victimized. It is evidenced that fear of crime has tremendous impacts on the mental health of older people who resort to avoidance behaviors for self-protection.

This study examined the impact of fear of crime on the mental health and avoidance behavior of the communitydwelling older adults living in urban China.

For the present study, data were collected from a representative sample of 453 older persons aged 60 years and above from Kunming, Yunnan province using face-to-face interview. Associations between fear of crime and mental health, and avoidance behavior were measured using linear regression.

The final sample ranged from 60 to 100 years of age (Mean = 72.29, SD = 8.27) and included 198 (43.7%) males and 255 females. Preliminary results showed that 258 participants (57.0%) reported fear of one or more types of depicted crimes; 397 (87.6%) carried on one or more kinds of avoidance behaviors; and 234 (51.7%) presented deteriorating mental health. Results of hierarchical regression analyses indicated that fear of crime was a significant predictor of both poorer mental health (p < .05) and more avoidance behaviors (p < .001), independent of gender, age, education, household finance, length of residence in neighborhood, household size, living arrangement, physical health and social networks.

Fear of crime had detrimental impacts on mental health of older Chinese and resulted in reduced social participation due to their avoidance behaviors.

Existential anxiety (EA) has been described as the anxiety about the meaning of life, death and the necessity to make choices (Tillich, 1953).Although recent research found EA to be associated with trauma and general psychological symptoms in community samples (Weems et al. 2004), to date, no study has investigated its relationship with trauma exposure and posttraumatic stress disorder (PTSD) symptoms in psychiatric outpatients.

To examine the association between EA and self-reported trauma history and PTSD symptoms in psychiatric outpatients.

Seventy-two stable psychiatric outpatients (mean(SD) age=46.1(14), 55% females) were assessed with the Existential Anxiety Questionnaire (EAQ; score ranging 0-39), the Trauma History Questionnaire which reports on criminal experiences, natural disasters, death exposure and questioning about physical and sexual experiences, and the PTSD Checklist (PCL; score ranging 17-85).

Mean(SD) EAQ and PCL scores were 20.0(7.8) and 40.0(15), respectively. A majority of participants (93%) reported at least one lifetime trauma exposure. Results revealed a positive correlation between existential anxiety and lifetime trauma exposure (r=.28, p< .05).Furthermore, in patients with lifetime trauma exposure, increased EA was associated with increased PCL total score (r=.57, p< .001) as well as with all PTSD symptom clusters: re-experiencing (r=0.45, p < 0.001), hyperarousal (r=.51, p< .001) and avoidance (r=.53, p < .01).

Our findings suggest that EA might be an interesting construct to examine further in the assessment and treatment of PTSD and paves the way for empirical investigations of existential therapies.