Delusion is one of the most characteristic features of all psychotic disorders. It is an essential symptom for both paranoid schizophrenia and persistent delusional disorder. Although delusion in schizophrenia is described as unorganized and organized in persistent delusional disorder, the delusional themes within these psychosis are relatively similar, with the exception of bizarre delusion which is considered as belonging to schizophrenia.

Identifying the types of delusions in long-term evolution of patients with paranoid schizophrenia and persistent delusional disorder and comparing the frequency of their occurrence in the two groups.

Highlighting significant differences in the frequency of delusional themes in long-term evolution of the two groups of subjects with the diagnosis we mentioned above.

We formed a sample of 60 subjects with persistent delusional disorder and a sample of 34 subjects with paranoid schizophrenia. Patients from both groups had an average course of illness of 10 years. We have quantified for each patient the number of hospital admissions during which they tested positive for a certain type of delusion.

Within the persistent delusional disorder group the most frequent type of delusion was of persecution, followed by delusions of reference. Delusions of persecution and delusions of being followed found to be the most common delusional themes in the paranoid schizophrenia group.

We have not found significant differences between the two groups regarding the type of delusions, with the exception of bizarre delusions. The paranoid theme is the most common theme for both types of pathologies.

A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.

To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.

All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.

N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).

Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.

Research suggests that internalized stigma of mental disorder (which reflects the degree to which a person holds internalized stigmatizing beliefs about mental illness) leads to decreased self-esteem, depression, delayed seeking of treatment, prolonged course of illness, poor outcome, social withdrawal, reduced self-efficacy and worsening of quality of life.

On a sample consisting of 40 outpatients with ICD-10 diagnosis of schizophrenia, with average age of 40.73 (SD= 9.168) and mean illness duration of 15.525 (SD=8.202) years, we administered the Internalized Stigma of Mental Illness Scale, the Rosenberg Self-Esteem Scale, the Manchester Short Assessment of Quality of Life and Beck Depression Inventory II. The questionnaire also included several socio-demographic and clinically-related variables.

Schizophrenic patients showed a moderate level of internalized stigma (M= 40.125, SD= 9.946). Patients with higher levels of internalized stigma had significantly poorer quality of life (r= -0.422) and lower self-esteem (r=-0.318). There was a positive correlation between the level of depressive symptomatology and the level of internalized stigma (r=0.385). Correlation with the duration of illness was not statistically significant (r=-0.145).

Our results confirm the data of numerous researches, as well as our earlier findings on the negative effects of internalized stigma of mental disorder on self-esteem and quality of life in panic disorder patients. In order to improve the quality of life of schizophrenic patients, we should increase awareness of the negative effects of internalized stigma and focus interventions on altering stigmatizing attitudes and enhancing coping skills.

Hyponatremia is an antidepressants known adverse effect, ADH secretion has been postulated in its etiology.

To identify risk factors for hyponatremia induced by antidepressants and psychopharmacologic alternatives.

Literature search was performed in PubMed. We report of a case of recurrent hyponatremia treated in our center: woman, 57years old, HIV, HCV; performing 4 episodes of severe hyponatremia in 5 months of treatment involving thiazide, venlafaxine, citalopram, olanzapine,haloperidol, enalapril, escitalopram.

Risk of hyponatremia is higher in patients treated with antidepressants (OR = 2.97), especially serotoninergic antidepressants (OR = 3.96). Elderly and thiazide increment that risk (OR = 6.31 and OR = 8.4 respectively), specially age, thiazide and SSRIs (OR = 148). Higher prevalence in females, lower limit levels of sodium and low body weight. All SSRIs are likely to produce hyponatremia. The effect appears in the first month, it's not dose-dependent and recovers by interrupting treatment. Some cases have been reported following re-exposure to the same or different antidepressant: fluvoxamine and paroxetine (Arizon, 2002), duloxetine and escitalopram (Stovalle, 2009), sertraline and fluoxetine (Raphael, 2010), sertraline and citalopram (Pure, 2011).

Early detection is important, as well as the evaluation of concomitant risk factors in all patients starting antidepressant. Some asymtomatic cases can be unnoticed by clinicians, so risk patients it seems necessary to control ion pretreatment periodically, and to chose safer treatments (bupropion, agomelatine, mirtazapine and reboxetine). In our case, age, sex, concomitant diseases, low sodium and low weight were determinants for the recurrence of the disorder.

In the field of drug abuse treatment, noncompletion and negative outcome is a general problem.

Outcome of hospital treatment of opioid dependence was examined.

The purpose of the present study was examination of a cohort of patients treated at Centre for treatment of drug addiction at the beginning of the treatment, after three and six months.

A group of 113 patients consecutively admitted to a closed detoxification unit between October 2011 and September 2012 were assessed. Positive outcome of the treatment is defined as complete abstinence in the 28 days before review. Baseline data were obtained using The Treatment Outcomes Profile (TOP), The Drug Addiction Treatment Efficacy Scale (DATES), and a semistructured research interview for obtaining information on patient's sociodemographic characteristics. Follow up scores of TOP and DATES have been recorded after three and six months.

Fifty-two patients completed 6 weeks of detoxification program. After 3 months 45 of 84 evaluated subjects (53%) had a positive outcome, 14 patients (12%) abused heroin and 36 patients (32%) abused other drugs. After 6 months 14 of 52 evaluated patients (27%) had a positive outcome and 9 patients (8%) used heroin.

The share of patients with positive outcome peaked at 3 months, however the decreased use of heroin was sustained throughout the observation period.

Psychogenic polydipsia associated with hyponatremia is a potentially dangerous and fatal condition observed on patients with psychiatric illness, specially schizophrenia. This results on a peripheral oedema and can lead to cerebral oedema, mental status deterioration and intracranial hypertension if not identified and treated urgently. We present a case of polydipsia as first signal of psychosis.

20-year-old man without significant past medical or psychiatric history attended to emergency service presenting exuberant lower limbs oedemas. The analytical study stated an hyponatremia and hipo-osmotic urine. A psychiatric evaluation was made after organic illness exclusion. The patient presented serious behaviour changes, delusions and eating disturbances (“eat raw meat to recover the red cells that they had stolen from him”), polydipsia and auditory hallucinations with 2 weeks of evolution. The patient was compulsory hospitalized, treated with risperidone and lorazepam and discharged 28 days after admission without psychotic symptoms.

The recognition and management of the polydipsia as a first signal of psychosis are difficult because sometimes patients are uncooperative and tend to hide their water intake, but is important to be awhare to this signal to prevent the morbidity and mortality associated with this disease.

Many commonly prescribed drugs have anticholinergic properties which can induce side-effects e.g. delirium, especially in an ageing brain with increased sensitivity. Risk-assessment before starting therapy may prevent such sideeffects.

We rated anticholinergic pharmacological properties of prescribed medication and compared the theoretical risk with side-effects in clinical practice.

The scale should improve the safety of pharmacotherapy in gerontopsychiatry.

Based on five publications that considered anticholinergic properties of drugs, a risk-scale was established. Riskpoints for all drugs were summarized to a total score. Patients were selected from TDM-requests and data on patients’ sideeffects obtained from medical files. Reported anticholinergic side-effects including delirium were assessed retrospectively by the UKU-rating scale. Using linear regression and Spearman's correlation-analysis a possible correlation between risk-score points and severity of side-effects was determined.

The screened sample consisted of 53 patients. 38 patients aged from 64 to 89 years (mean 74±6, 63.2% women) could be included for analysis. They had 93 plasma-level determinations (mean 2.4 requests per patient). According to their medication, patients attained by mean 4.51±2.98 risk-points (range 0-16). Mean UKU severity-index of side-effects was 0.81 (±0.99). Risk-points correlated significantly with observed anticholinergic side-effects and delirium (R2=.631, P< 0.001, CI 95%). Spearman correlation-coefficient was 0.731 (P< 0.01, CI 95%).

Since the established risk-scale correlated well with reported anticholinergic side-effects we recommend to implement this in the planning of psychopharmacological treatment to improve the safety of pharmacotherapy in gerontopsychiatry. For practical reasons it should be amalgamated with therapeutic drug monitoring as Geronto-TDM.

Mild cognitive impairment (MCI) is considered today to be a prodromal stage of Alzheimer's dementia, but without standardized pharmacotherapy.

To follow the outcome of patients diagnosed with MCI treated with nootropics, alternative herbal agents, cholinesterase inhibitors.

To assess the efficacy of early treatment in MCI.

200 patients (over 60 years) diagnosed with MCI were evaluated using the MMSE (Mini Mental State Examination) scale at screening, after 1 and 2 years of treatment. They were divided in four groups:

• A -50 patients treated with Piracetamum 1600mg/day

• B -50 patients treated with Rhodiola-rosea, 2capsules/day

• C -50 patients treated with Galantamine, 16mg/day

• D -50 patients not treated

The improvement of the MMSE score was as following:

[Results].

Comparing the outcome of treated and non-treated groups, we observed that the early treatment of MCI delays the transition to dementia. The outcome of the treated groups after 1 year of treatment was approximately the same. Longtime treatment shows a better improvement in the group treated with cholinesterase inhibitors (Galantamine) compared to the other treated groups, but not statistically significant. Galantamine improves cognitive function. This study proves the necessity of early treatment for MCI to delay the transition to dementia.

We have conducted clinical-immunological examination of 90 patients with adjustment disorder (F 43.2).

From positions of clinical-dynamic approach, adjustment disorders have been differentiated depending on stage of development of disease: neurotic reactions (breakdown of mental adaptation), neurotic states (clinical full-blown states with sufficiently persistent neurotic symptoms and completion of formation of leading syndrome) and protracted states (developments, characterizing transition of the disease into chronic course).

Diagnosis of clinical manifestations of secondary immune deficiency has shown increase of incidence rate of allergic and autoimmune syndromes in persons with adjustment disorder with protracted states as compared with previous stages of development of the illness. At this stage, we have more frequently observed combination of several syndromes of immune deficiency.

Comparative analysis of immune and hormonal statuses has revealed the most informative indices, which characterize stages of development of adjustment disorders, and namely: total number of T-lymphocytes (CD2+-phenotype), level of serum IgM, indices of spontaneous and stimulated variants of NBT-test, level of cortisol and free thyroxin (T4).

Totality of alterations of revealed immunobiological indices is typical for every stage of disease that alongside with clinical signs of immune deficiency allows considering of them as an additional criterion in differential diagnostics of adjustment disorders.

Recently, suicides in Greece, have drawn national and international interest due to the current economic crisis. According to published reports, suicides in Greece have increased up to 40%. Specifically, lay press has highlighted Crete as an area with the sharpest increase of suicides in Greece.

To explore whether the economic crisis is associated with increased suicide rates in Crete.

To investigate the suicide rates in Crete between 1999-2011.

Data on suicides were selected from the Department of Forensic Medicine files of the University Hospital of Heraklion/Crete, as well as from the Forensic Medicine Files of Crete.

Our analysis showed that during the period examined (1) Crete, although has the highest suicide rate in Greece, there is no significant increase between 1999-2011, (2)Deaths due to suicide are four times more frequent in men compared to women, (3) In women there is a significant decrease of suicides, (4) There is a decreasing trend for suicides in Western Crete whereas, there is an increasing trend in Eastern Crete.

Crete has the highest suicide rates in Greece, which however, has not increased during the last 13 yrs. There is a relative increase of suicides in Eastern compared to Western Crete during this period. Our findings do not support the popular belief of increased suicides due to the current economic crisis. The relative increase of suicides in Eastern Crete may be explained by other factors, i.e the lack of community psychiatric services in the area.

To evaluate the long-term outcome of a multidisciplinary rehabilitation program for patients with chronic fatigue syndrome.

98 patients fulfilling chronic fatigue syndrome criteria (Fukuda) participated at a six-month CBT associated with GET based on adaptive pacing strategy in a group therapy and were included in a prospective outcome study at the university outpatient Chronic Fatigue Reference Center.

Multidimensional assessments at baseline, after treatment and at 6 and 12 months follow-up : Checklist Individual Strength; Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index; HADS; Symptom Checklist; Short Form General Health Survey ands Self Efficacy Scale.

After the revalidation program, subjective outcome parameters as fatigue severity, concentration troubles, somatic complaints, sleep disturbances and behavioral consequences of fatigue as activity reduction improve significantly (p< 0,001). The QoL related to health perception, measured in items as vitality, role-physical limitations and social functioning, also improve significantly (p< 0,001). Treatment doesn’t change HADS-scales but the scores don’t differ significantly from a healthy population at baseline. At 6 and 12 months follow-up, we didn’t notice significant decreases in outcome results. Significant improvements correlate significantly with an increase of sense of control of the symptoms (Self Efficacy Scale).

Symptoms, health-related QoL and psychosocial functioning in patients with chronic fatigue syndrome improve after a six-month multidisciplinary rehabilitation program. The one-year follow-up study without any therapeutic intervention proves that outcome can be maintained. The correlation between the persisting outcome results and the increase of Self Efficacy will be discussed.

Pregabalin is indicated for the treatment of GAD in adults in Europe. The efficacy and safety of pregabalin for the treatment of adults and elderly patients with GAD has been demonstrated in 6 of 7 short-term clinical trials of 4 to 8 weeks.

To characterise the long-term efficacy and safety of pregabalin in subjects with GAD.

Subjects were randomised to double-blind treatment with either high-dose pregabalin (450-600 mg/d), low-dose pregabalin (150-300 mg/d), or lorazepam (3-4 mg/d) for 3 months. Treatment was extended with drug or blinded placebo for a further 3 months.

At 3 months, mean change from baseline Hamilton Anxiety Rating Scale (HAM-A) for pregabalin high- and low-dose, and for lorazepam ranged from -16.0 to -17.4. Mean change from baseline Clinical Global Impression-Severity (CGI-S) scores ranged from -2.1 to -2.3 and mean CGI-Improvement (CGI-I) scores were 1.9 for each active treatment group. At 6 months, improvement was retained for all 3 active drug groups, even when switched to placebo. HAM-A and CGI-S change from baseline scores ranged from -14.9 to -19.0 and -2.0 to -2.5, respectively. Mean CGI-I scores ranged from 1.5 to 2.3. The most frequently reported adverse events were insomnia, fatigue, dizziness, headache, and somnolence.

Efficacy was observed at 3 months, with maintained improvement in anxiety symptoms over 6 months of treatment. These results are consistent with previously reported efficacy and safety trials of shorter duration with pregabalin and lorazepam in subjects with GAD.

This study was funded by Pfizer Inc.

Pregabalin is indicated for the treatment of generalised anxiety disorder (GAD) in adults in Europe. When pregabalin is discontinued, a 1-week (minimum) taper is recommended to prevent potential discontinuation symptoms.

To evaluate whether a 1-week pregabalin taper, after 3 or 6 months of treatment, is associated with the development of discontinuation symptoms (including rebound anxiety) in subjects with GAD.

Subjects were randomised to double-blind treatment with low- (150-300 mg/d) or high-dose pregabalin (450-600 mg/d) or lorazepam (3-4 mg/d) for 3 months. After 3 months ~25% of subjects in each group (per the original randomisation) underwent a double-blind, 1-week taper, with substitution of placebo. The remaining subjects continued on active treatment for another 3 months and underwent the 1-week taper at 6 months.

Discontinuation after 3 months was associated with low mean changes in Physician Withdrawal Checklist (PWC) scores (range: +1.4 to +2.3) and Hamilton Anxiety Rating Scale (HAM A) scores (range: +0.9 to +2.3) for each pregabalin dose and lorazepam. Discontinuation after 6 months was associated with low mean changes in PWC scores (range: -1.0 to +3.0) and HAM A scores (range: -0.8 to +3.0) for all active drugs and placebo. Incidence of rebound anxiety during pregabalin taper was low and did not appear related to treatment dose or duration.

A 1-week taper following 3 or 6 months of pregabalin treatment was not associated with clinically meaningful discontinuation symptoms as evaluated by changes in the PWC and HAM A rating scales.

This study was funded by Pfizer Inc.

To measure changes in causal attribution in chronic fatigue syndrome. The cause of chronic fatigue syndrome (CFS) is still unknown. Behavioral, cognitive and affective factors may play a major role in perpetuating fatigue.

175 patients fulfilling Fukuda CFS criteria participated in a six-month CBT associated with GET based on adaptive pacing strategy, in a group setting. Causal attribution was measured with the Causal Attribution List (CAL). Therapy didn’t aim change in causal attribution. All patients were included in a prospective outcome study at the university outpatient Chronic Fatigue Reference Center (UCL), with multidimensional assessments at baseline and after treatment: Checklist Individual Strength (CIS); Short Form General Health Survey (SF36), Causal Attribution List (CAL).

At baseline, SFC patients were more likely to attribute their fatigue to physical than psychosocial causes (p< 0.001). After treatment, fatigue severity and behavioural consequences (CIS) and the most factors of health-related quality of live (SF36) improved significantly (p< 0,001). After treatment, patients had more causal attributions (CAL) than at baseline (p< 0,001). Correlation analyses indicated that improvement of subjective fatigue (CIS-severity, SF36-vitality) was not correlated significantly neither with physical or psychosocial causal attributions scores at baseline, nor with individual changes of physical or psychosocial causal attributions after treatment.

Causal reattribution is not necessary in chronic fatigue syndrome CBT. In our study (n=175) improvement of subjective fatigue is not correlated with changes in causal attribution. The advantages of abstention from causal reattribution in psychosomatics will be discussed.

Epistatic effects between gene variants of 5-HTTLPR (L=long, S=short), MAOA-VNTR (L=long, S=short), and BDNF Val/Met have been found with regard to behaviour in experimental animals as well as indicated in human samples in relation to neuroticism and depression. In the present study we studied epistatic effects of the above gene variations in an interaction with environmental adversity on adolescent criminality.

Family maltreatment, sexual abuse and criminality were measured by self-reports in a Swedish adolescent population-based sample (n=1819). Genomic DNA was isolated from saliva and used for genotyping of the BDNF, the 5-HTT and MAOA genes.

BDNF genotype showed a main effect on adolescent criminality. BDNF also showed a two-way interaction with 5- HTT and Family maltreatment. 5HTT showed two-way interactions with MAOA and Family maltreatment. MAOA also showed a two-way interaction with Family maltreatment. Significant three-way interactions were found for; BDNF-5-HTT-Family maltreatment; BDNF-MAOA-Family maltreatment; BDNF-MAOA-Sexual abuse; and 5HTT-MAOA-Family maltreatment. Significant four-way (G*G*G*E) interactions were found for BDNF-5-HTT-MAOA-Family maltreatment and BDNF-5-HTTMAOA- Sexual abuse, respectively.

Boys showed a stronger effect of environmental adversity compared to girls. However, there were no significant sex-gene interactions. Furthermore, the two most genotypically divergent groups, according to expression levels, showed the highest criminality scores (MAOA-LL + 5-HTT-LL + BDNF Val-Val vs. MAOA S/LS + 5-HTT-S/LS + BDNF Val-Met/Met-Met), when exposed to environmental adversity.

There are significant epistatic effects between 5-HTT, MAOA and BDNF genotypes and environmental adversity for criminal behavior. Two distinct “types” can be recognized with regard to genotype.

Therapeutic Drug-Monitoring (TDM) for bupropion is limited by bupropion's instability at room temperature and by the absence of a well-defined therapeutic reference range. Further it is unclear to what extent bupropion and its metabolites contribute to therapeutic effects, though hydroxybupropion seems to account for the major antidepressant effects.

The aim of this examination was to check if measurement of only hydroxybupropion is useful to guide the antidepressant therapy with bupropion.

Hydroxybupropion plasma levels were measured by high performance liquid chromatography with ultra violet detection and related to therapeutic effects measured by the Clinical Global Impression Scale for improvement.

The study included 52 patients (50% female). Patients who were very much improved according to CGI had significantly (p=0.042) higher hydroxybupropion serum levels than patients with moderate or minimal improvement (mean±SD, 1113±576 ng/ml, 825±398 ng/ml and 475±331 ng/ml, respectively). Receiver operating characteristics analysis revealed significant predictive properties of hydroxybupropion serum levels (p=0.002) for improvement with a lower threshold level of 858 ng/ml. Women attained significantly higher serum levels than men and also exhibited a better therapeutic effect (p= 0.018), though they did not receive significantly higher doses.

Measurement of hydroxybupropion plasma levels can be used to optimize the therapeutic outcome of patients treated with bupropion. Plasma levels between 850 and 1500 ng/ml can be regarded as optimal. Potential sex differences in bupropion pharmacokinetics, probably due to differential activities of CYP2B6, should be taken into account.

We investigate, in 36 STN DBS PD patients, depression, anxiety and mania at baseline, 3-mounth post-surgery and 6-mounth post-surgery. At baseline, demographic data and clinical characteristics (duration of disease, PD medication, past psychiatric history were also collected. Scores at motor section of the unified Parkinson disease rating scale and PD medication were evaluated at baseline, 3-mounth post-surgery and 6-mounth post-surgery. A multivariate analysis and a factorial discriminant analysis (FDA) were considered to study differences between surgical outcomes considering an adjustment on disease duration.

Thirty six patients with Parkinson's disease treated with STN-DBS were analyzed considering stimulating electrodes localization (‘in’, ‘frontier’, ‘out’ of STN).

Concerning the pre-surgical parameters, no configuration was found.

Considering only 3-mounth post-surgery parameters (electrodes localization, motor scores, psychiatric data, PD medication) patients differ according to surgical positioning: ‘frontier’/’out’ and ‘in’ but the best separation between the 3 groups of localization was obtain including pre-surgical post-surgery parameters. This segregation was maintained at 6-mounth postsurgery.

Our work provides preliminary answer to the question of impact of the exact electrode position on neuropsychological side effects of STN-DBS and enhances the importance of combining pychiatrico-neuro-surgical data.

The aim of the study was to identify sociodemographic, clinical and service delivery risk factors for suicide in the population of service-users (SUs) and non-service users (NSUs) plus gender-related characteristics of suicidal behaviour; in a limited geographic region.

Data were collected on 68 cases of suicide (ICD-10 X60-X84) for residents on the Isle of Wight between January 2006 and December 2009.

Significantly (p=0.0006) more men than women (male/female ratio 3:1) died by suicide. Relatively (p=0.07) more women (56.2%) than men (32.7%), and significantly more (p=0.05) SUs (45.3%) than NSUs (13.3%) were unemployed. Significantly more (p=0.0006) SUs (64%) than NSUs (20%) had a history of suicide and relatively (p=0.06) more (50.9%) SUs than NSUs (20%) had attended the A & E prior to their death. 69% had an adverse life event within a year prior to their suicide. Depression was significantly (p=0.008) more frequent in women (66.6%) than men (23.7%). Suicide by hanging was the commonest cause acounting for death of 71% of men and 50% of women. 57.3% of deaths occurred at their place of residence and 75% of on weekdays. 50% of women died in autumn, compared to 28.8% of men. There were three inpatient deaths (4.4%). Relatively (p=0.08) more women (56.2%) than men (32.7%) have contactacted serivces before their death.

80% suicides were conducted by people suffering from a mental disorder. Men are at a significant risk of suicide. Anxiety disorders in men and depression in women are the most common mental disorders.