NMS is an infrequent, life-threatening neurologic emergency usually associated with the use of neuroleptics and some other agents that affect central dopaminergic neurotransmission. Because of its low frequency, heterogeneous nature and clinical variability it might be difficult to diagnose.

To identify risk factors to develop a NMS and to set effective treatments.

Literature search was performed in PubMed and UpToDate. Report of a case at our center: 69 year old man with psychotic depression which do not improve with optimal doses of SSRIs, Mirtazapine and Benzodiazepines. Olanzapine (10mg) was added and symptoms compatible with a neuroleptic malignant syndrome were appeared. Supportive care was needed because of medical complications. A treatment with bromocriptine, sertraline, lorazepam and dantrolene was begun with little improvement. It was decided to begin ECT.

It was applied a ECT therapy (12 bifrontotemporal sessions, 380mCu) with a high and effective response. Pshycosis and pshycomotor symptoms disappeared and depression decreased significantly.

Hence a high index of suspicion is needed in the diagnosis of NMS in order to reduce mortality and secuelae. Differential diagnosis must be performed with confusional states due to medical cause, catatonia, serotoninergic syndrome and other neurologic states. As for the treatment, general support meassures and several farmacologic options have been used, though none of them have proved to decrease mortality. ECT remains a good option for improvement of the syndrome as well as the pychiatric condition. No systematic clinical trials evaluating the efficacy of different treatments have been done so far.

Aberrant salience consists of the unusual or incorrect assignment of salience, significance or value to different innocuous stimuli. It has been hypothesized that subjects with an aberrant salience could be proneness to develop psychosis. Despite the importance of this concept in psychosis, only few instruments assess aberrant salience.

To evaluate aberrant salience processing in a clinical trans-diagnostic sample and its relationship with psychotic symptoms.

Thirty-six outpatient subjects attending the Psychiatric Unit of the University of Florence were recruited: 9 with Major Depression Disease (MDD), 8 with Schizophrenia (SC), 19 with Bipolar Disorder (BD). Patients were assessed by means of a clinical interview (SCID-I/P) and several questionnaires, including the Aberrant Salience Inventory (ASI).

The three groups showed significant differences in the lifetime presence of psychotic symptoms, with higher frequency in BD and SC patients (p< 0.01). Significant differences in ASI scores were found between MDD and BD (p< 0.01), and SC and BD (p< 0.01), while any difference between BD and SC was observed. Subjects with positive ASI (cut-off>14) reported more frequently past and lifetime psychotic symptoms (p< 0.01) and constituted a distinct cluster from patients with ASI score < 14.

Aberrant salience is significantly associated to lifetime psychotic symptoms. Thus it represents a relevant psychopathologic dimension that requires a careful investigation in patients with an history of psychotic events. The ASI could represent an useful instrument to evaluate the proneness of clinical and pre-clinical samples to develop psychotic symptoms.

Since 1960, a decade after the introduction of phenothiazine drugs, there were reports of drug related ocular opacities and pigmentation in patients who had been receiving continuous high dose therapy, particularly with chlorpromazine. These ocular effects seem to be related to high doses of phenothiazines and are potentially irreversible. The purpose of our study is to evaluate the pathophysiology of ocular damage, risk factors, treatment and any potential reversibility.

Bibliographic research used PubMed and PsychINFO and conduced to 12 papers.

Analysis of papers has shown that the main pathophysiological mechanism is related to an alteration of excretion of catecholamines, that exposure to sunlight presents a risk factor for the development of corneal deposits and cataract while, as regards the reversibility of these effects, the data are still controversial.

It is necessary, for psychiatrists, the information of the various ocular adverse effects of therapy with phenothiazine so that can be arranged to create a closer and more effective collaboration with an ophthalmologist to prevent and treat this disease.

Moreover, other studies are necessary to lead to an appropriate treatment plan.

Even though 0.3-0.8% percent of the male population are born with hypospadias, it is not known if this is associated with an increased risk for psychiatric morbidity later in life.

The aim of this study was to assess the association between hypospadias and risk of psychiatric disorders in affected individuals.

The association between hypospadias and psychiatric disorders was examined in a population-based cohort study using Swedish registers. Individuals born in Sweden between 1973 and 2009 were included in the study. Among them, 11,156 patients with hypospadias were identified and matched with 1,098,714 distinct controls by year of birth and county. The following outcomes were evaluated: 1- suicide attempt, 2- psychotic, 3- mood, 4-anxiety, 5- eating, 6- personality disorders, 7- disorders due to psychoactive substance use, 8- ADHD, 9- pervasive developmental disorders, 10- intellectual disabilities, and 11- other childhood emotional disorders.

After adjusting for socio-economic and perinatal factors, malformations and/or genetic syndromes, patients with hypospadias were more likely to be diagnosed with pervasive developmental disorders (OR 1.4; 95% CI 1.1-1.6), intellectual disabilities (OR 1.8; 95% CI 1.6-2.1), ADHD (OR 1.2; 95% CI 1.0-1.4) and other childhood emotional disorders (OR 1.3; 95% CI 1.1-1.4) compared to the controls. No relation between other psychiatric diagnosis and hypospadias was found.

Hypospadias is associated with an increased risk of neurodevelopmental disorders.

Restless legs syndrome (RLS) is a sensorimotor disorder characterized of an urge to move the legs during periods of rest or inactivity, such as lying or sitting.

Drug-induced RLS, still remains an under- or misdiagnosed condition.

We present a case of a female patient, who received a combination of low dose of quetiapine in addition to venlafaxine and manifested RLS.

Our patient was admitted because of a mixed episode of bipolar II disorder. At admission she was under valproic (1.5gr/QD, plasma levels: 79mg/litre), topiramate (100mg/QD) and venlafaxine (300mg/BID). Quetiapine 150 mg/QD was started at bed time and within 48 hours the patient showed RLS. The physical, neurological and laboratory examination was normal.

The tapering of venlafaxine resulted in the elimination of RLS within 48 hours. After discharge the patient remained in a normothymic state, without RLS, taking valproate 1,5gr/QD, topiramate 100mg/QD and quetiapine 150mg/QD. After 6 months, because of depression, quetiapine was reduced to 100mg/QD and venlafaxine 75mh/QD was added. The previously described RLS symptoms emerged again within 48 hours. This time the tapering of quetiapine and its substitution by olanzapine 10 mg/QD resulted in a prompt and complete elimination of RLS symptoms.

Neither quetiapine alone, nor venlafaxine alone induced RLS to our patient. Clinicians should not overlook the possibility a RLS to be induced by quetiapine-vanlafaxine combination. The removal of one of the two drugs might be beneficial in the RLS's successful treatment.

The association between depression and metabolic syndrome is becoming more obvious.

We examined the relationship between the number and individual components of metabolic syndrome and late-life depressive symptom clusters.

In 1279 individuals aged 50 through 70 participating in the Nijmegen Biomedical Study (Cross-sectional populationbased survey), we measured all metabolic syndrome components and depressive symptoms using the Beck Depression Inventory (BDI). Principal components analysis of BDI-items yielded two factors, representing a cognitive-affective and a somatic-affective symptom-cluster. Multiple regression analyses adjusted for confounders were conducted with BDI sum score and both depression symptom-clusters as dependent variables, respectively. We explored the differences in this association between men and women.

In fully adjusted models, both presence of the metabolic syndrome as well as number of components was associated with the BDI sumscore(resp. β=0.063;p=0.022 vs. β=0.112;p< 0.001), the latter showing the strongest association. These associations were primarily driven by the somatic-affective symptom-cluster. Testing individual components of the metabolic syndrome, showed that in men waist circumference, triglycerides and HDL cholesterol were significantly associated with depression, whereas in women only the waist circumference.

The specific association somatic-affective symptoms suggest confounding by a (subclinical) somatic condition in stead of a real association with classical depression. The identified sex-differences suggest different pathways between depression and metabolic perturbations in men only. However, as vascular disease develops at higher ages in women and findings were in the same direction but non-significant in women, future research in older women sample should confirm our findings.

PERDOVE study is a prospective observational cohort study, which providing follow-up at one year, aims to investigate the socio-demographic and clinical characteristics of patients in in the 23 medium-long term RFs of the St John of God Order.

1. (1) To describe the sociodemographic, clinical, and treatment-related characteristics of RF-patients during an index period in 2010;

2. (2) to identify predictors and characteristics associated with discharge at 1-year follow-up;

3. (3) to evaluate clinicians’ predictions about each patient's likelihood of Home Discharge (HD).

All patients staying in September 2010 with a primary psychiatric diagnosis received a set of standardized assessment instruments, including a “Patient Schedule”, BPRS, HONOS, PSP, PHI, and SLOF. Detailed socio-demographic and clinical data were also collected. Logistic regression analyses were run to identify independent discharge predictors.

The study involved 403 patients. 66,7% is male, mean age is 49 (±10). 70.7% is unmarried. The average duration of illness of these patients is 23 years. Primary diagnosis is represented by schizophrenic spectrum disorders (67.5%). At 1 year follow-up, 104 patients (25.8%) were discharged: 13.6% to home, 8.2% to other RFs, 2.2% to supported housing, and 1.5% to prison.

The main variables associated with a higher likelihood of being discharge to home were: to have an illness duration of less than 15 years and to have an available and effective social support in the last year. Lower severity of psychopathology, and higher working skills were also associated with a significantly higher likelihood to be discharged to home.

Before fulfilling the criteria for anorexia nervosa syndrome, many young females already display symptoms of dysfunctional eating attitudes and behaviour. If also accompanied by increased perfectionism and body shape concerns and dissatisfaction, this can indicate a high-risk group for eating psychopathology.

The study group consisting of 45 randomly selected female students of University of Belgrade, mean age of 22.27 years (min 19, max 27), scored above the cut-off of 30 on the Eating Attitude Test (EAT-40), indicating symptoms of anorexia nervosa.The Frost Multidimensional Perfectionism Scale (FMPS), which measures different dimensions of perfectionism, and the Body Shape Questionnaire (BSQ), which evaluates body concerns and dissatisfaction, were applied, and the Quetelet Index (QI) was calculated.

Descriptive statistics indicate as follows: EAT (M=42.71; SD=13.541), FMPS (M=104.80; SD=14.609), BSQ (M=100.69; SD=29.215), QI (M=21.21; Min 15.64, Max 29.38). Only 24.4% (N=11) of the students were not concerned with body shape. 80% of the study group were of normal weight, 11.1% were underweight, 8.9% were obese, and one member of the group (2.2%) had QI=15.64, indicating anorexia nervosa syndrome. Correlation analysis indicates that there is a positive correlation (r=,393) between perfectionism scores and concerns about body shape (p< 0.01).

Our results confirm previous research on the positive correlation between perfectionism and body shape concerns in females with disturbed eating attitudes and behaviour.This means that these features should be systematically assessed in female students and focus be given to prevention campaigns against eating psychopathology.

Many cross-sectional studies have explored the relationship between subjective QOL of people with schizophrenia and different socio-demographic characteristics, clinical and psychosocial factors. Only few studies tried to identify factors that influence the QOL of these patients using a longitudinal design.

Aim of the present study was to determine influence of clinical factors, socio-demographic variables, spirituality and satisfaction with services on QOL, to identify clinical predictors associated with quality of life at one year follow-up.

Measures at baseline included: demographics, BPRS, PHI, RBANS, FPS, HoNOS, SWBS, VSSS, and the Italian version of the WHOQoL-Brief. Measures at follow up included: HONOS, BPRS, FPS, WHOQoL-Brief. Logistic regression models were adopted to evaluate the association between WHOQoL-Brief scores and patient's sociodemographics, clinical characteristics, spirituality and services’ satisfaction.

The study included 171 patients: 64% males; mean age 48.7 (sd=8.9) with primary diagnosis of schizophrenia. Different domains of QOL were predicted by different indicators at baseline. Younger age, more time spending doing nothing, lower BPRS, lower satisfaction with services were explanatory variables for low quality of life in psychological facet. Spirituality and religiousness were associated with Environmental domain and VSSS was associated to all QOL domains.

Rehabilitation plans for people with schizophrenia living in RFs should pay attention to mediators of change in subjective QOL such as level of activities, social support, spirituality and satisfaction with mental health services. In particular, anxiety and depressive symptoms remain as long-term outcomes of QOL at one year follow up.

Recent reviews of evidence-based guidelines for the clinical management of Bipolar Disorders (BD) have recommended that “all patients with BD should be offered group or individual psychoeducation” to prevent relapse, improve treatment adherence, quality of life and functioning.

The present study aimed at evaluating the psychoeducation in routine mental health.

One hundred and two outpatients were recruited from two Italian DMHs. Inclusion criteria were a lifetime diagnosis of BD type I or II assessed by SCID-I, being euthymic for at least 3 months. Exclusion criteria were a DSM-IV Axis I comorbidity, mental retardation (IQ < 70), organic brain damage. All subjects received standard psychiatric care, with standard pharmacological treatment; one group received additional 21 weekly sessions of psychoeducation group, according to Colom and Vieta model.

Data show that the number of patients hospitalized during the 1-year follow-up, the mean number of hospitalizations per patient and the mean number of days in hospital were significantly lower for psychoeducated patients.

Our study supports the view that group psychoeducation is an efficacious intervention to prevent patients’ hospitalization and decrease hospital days in pharmacologically treated patients with bipolar disorder, also in routine clinical settings. The results seem to confirm that the psychoeducation promotes an improvement in the course of illness, avoiding acute phases, and producing a greater stabilization of the disease and consequently an improvement in quality of life in people with BD.

ADHD is a common disorder that often presents in childhood and is associated with increased healthcare resource use.

To evaluate ADHD incidence and estimate resource utilization and costs of care in the UK.

The Clinical Practice Research Datalink was searched between 1998 and 2010 for patients aged 6-17 years, newly diagnosed with ADHD. Age- and sex-matched, controls were also identified (ratio 1:3). ADHD incidence was calculated as the number of incident cases/100,000 people (/100k) in the at-risk population. Resource utilization in the first year post-diagnosis was estimated for general practice (GP) contacts, investigations, drug treatments, outpatient appointments, and inpatient admissions. Monetary costs were derived from various sources (at 2011 prices).

2,873 subjects with ADHD and 6,598 matched controls were identified. Mean (standard deviation [SD]) age was 9.8 (2.8) years and most (87%) were boys. The incidence of ADHD amongst boys and girls, respectively, increased from 69/100k and 7/100k in 1998 to 132/100k and 24/100k in 2007, and then fell to 98/100k and 20/100k in 2010. The mean (SD) annual, cost was £1,291 (£2,121) for cases and £315 (£2,345) for controls. For cases and controls, respectively, annual costs comprised GP contacts (£199, £70), investigations (£10, £8), drug treatments (£306, £37), outpatient appointments (£572, £62) and inpatient admissions (£203, £139).

The incidence of ADHD increased between 1998 and 2007, then declined slightly in 2010. Medical costs in the first year post-diagnosis were notably higher in children with ADHD compared with controls

Shire Development LLC.

Metabolic profiles, LEP, LEPR gene polymorphisms and the gene expressions of LEP, LEPR and PPARg2 were studied in SCH patients and controls.

BMI, cholesterol and fasting glucose levels were higher in SCH patients compared to controls. LEP c.-2548 (GA+AA) genotypes were two fold lower in SCH patients versus controls (p< 0.05), and no significant difference was observed in LEPR p.Q223R genotypes. Interestingly, leptin serum levels were lower in SCH patients compared to controls (p< 0.05). Leptin, leptin receptor and PPARg2 gene expressions were found to be decreased in SCH patients compared to controls (p< 0.001, p< 0.001 and p≤0.05, respectively).

Leptin receptor, leptin and PPARg2 genes could be potential risk factors in developing metabolic adversities in SCH.

Persons with severe mental disorders and a history of violent offending are usually seen as a difficult-tomanage population: most have schizophrenia or severe affective disorders, while some suffer from severe personality disorders.

To investigate the sociodemographic, clinical, and treatment-related characteristics of a sample of patients living in RFs with a history of antisocial behaviour (‘violent’ group); to compare the characteristics of the ‘violent’ group with residents never violent; and to compare the rate of violent behaviour in the two groups over two years and to assess the likelihood of discharge in the two groups.

This is prospective observational cohort study involved 23 RFs of the St John of God Order in Northern Italy. The sample was divided into two groups: non-violent patients and ‘violent’ patients. The last included patients at last one time admitted in FMH or arrested for violent crimes or acted violent behaviors against people.

For each inpatient was filled out a “Patient Schedule”: socio-demographic and clinical data were collected, including a specific session to assess aggressive behavior lifetime and in the last year.

The study involved 403 patients: 89 ‘violents’ and 314 non-violent. ‘Violent’ group was mainly male, younger, with a prevalence of personality disorders. Coherently, in the group of ‘violent’ there were more people lifetime arrested and admitted to a FMH.

There are some differences in the monitoring of violent behavior in the two years of assessment. We observed more threatening, slap, punch, inappropriate sexual harassment, etc. in the ‘violents’ group.

Paraneoplastic disorders of the CNS are a heterogeneous group of neurological disorders associated with systemic cancer which cannot be attributed to direct effects of the neoplasm. Although there is extensive literature focusing on the neurological manifestations of these disorders, the initial presentation is psychiatric in many instances and discussion in the psychiatric literature is relatively sparse.

1. - To bolster recognition and enhanced characterization of paraneoplastic disorders from within the psychiatric community.

2. - To explore temporal aspects of symptom presentation in relation to biopsy.

3. - To identify how psychoneuroimmunological factors may contribute to the development of paraneoplastic disorders.

We report the case of a 48 year-old female with no past psychiatric history who presented with neuropsychiatric symptoms immediately subsequent to biopsy and inflammatory breast cancer diagnosis. Patient was initially admitted to the psychiatric unit for suspected acute stress reaction, yet eventually diagnosed with paraneoplastic extra-limbic encephalitis.

1. - As early oncologic treatment and immunotherapies improve outcomes, early diagnosis is paramount for both treating the paraneoplastic syndrome and identifying possible underlying malignancy.

2. - Time course of symptom presentation raises the intriguing possibility that perturbation of tumor tissues during biopsy may accelerate the immune response to onconeuronal auto-antigens and inflammation-mediated neuronal injury.

3. - Given the patient's acute stress state, the rapid time course of symptom onset, and known connection between psychological stress and autoimmunity, we propose that the immune system stress-response may additionally contribute to the paraneoplastic syndrome development. This connection warrants further investigation from within the psychoneuroimmunology community.

Effectiveness studies of therapeutic switching of antipsychotics provide valuable clinical information.

Assess effectiveness of switching patients to lurasidone.

To evaluate 3 dosing strategies when switching patients to lurasidone.

Patients were randomized to three open-label lurasidone dosing strategies: 40mg/day for 14 days (n=74); 40mg/day for 7 days then 80mg/day for 7 days (n=88); and 80mg/day for 14 days (n=82) and stratified by their previous treatment (sedating vs non-sedating). Prior antipsychotic was tapered (50% step-down, day 8, discontinued day 14), followed by 4 weeks of flexible dose treatment (40-120 mg/day). Primary outcome was time to treatment failure (TTF). Of the 198 subjects completing core 6-week study, 149 (75.3%) enrolled in a 6-month extension study.

Switching to lurasidone was well tolerated; 198 (81.1%) of subjects completed core study, 19 (7.9%) subjects experienced treatment failure of which 16 (6.7%) discontinued due to an AE. No clinically relevant differences were noted among the 3 dosing strategies. TTF was earlier in patients previously receiving sedating antipsychotics vs. non-sedating (log rank p=0.101). Core study yielded LS mean (SE) within-group improvement on PANSS total score -5.3 (±0.7), LOCF with further improvement of -1.5 (±0.9), LOCF, at Month 6 from extension baseline. Ninety-eight subjects (65.8%) completed extension phase. Premature discontinuation causes included consent withdrawal (12.1%) and AEs (11.4%). Weight and lipid changes at 6 months were minimal.

Switching to lurasidone was safe and well tolerated regardless of initial dosing strategy. Switched patients maintained or improved symptom control during core and extension treatment.

Postpartum depressive symptomatology is highly prevalent and has negative impact in the entire family.

To identify correlates of postpartum depressive symptomatology.

201 3-months postpartum women completed the Portuguese versions of Postpartum Depression Screening Scale/PDSS, Profile of Mood States, Difficult Infant Temperament Questionnaire/DITQ, Multidimensional Perfectionism Scale and questions on sociodemographic variables (marital status, work status, educational level, parity), Lifetime history of insomnia/LTHD, Lifetime history of depressive symptomatology /LTHDS, Current insomnia, Sleep needs, Health perception/HP, Stress perception/SP, Perceived social support/PSS, Quality of life/QOL, Health problem/complication postpartum, Sensibility to hormonal fluctuations, Type of delivery and Type of feeding.

Total PDSS significantly correlated with LTHDS (rs=.35), LHI (rs=.22), Current insomnia (rs=.37), SP (rs=39), PSS (rs=.25), Perceived QOL (rs=.31), Health perception (rs=.28), Health problem or complication in the postpartum (rs=.16), Negative Affect/NA (r=.59), Positive Affect/PA (r=-.67), Conditional Acceptance/CA(r=.29) and DIT (r=.40) (all p< .01). Mean comparisons revealed that women with vs. without LHDS, with vs. without LTHI, good sleepers vs. with insomnia syndrome, high vs. low SP, bad/very bad vs. good/very good QOL, bad/very bad vs. good very good HP, high (< M+1DP) vs. low (>M-1DP) DIT, CA, NA and low vs. high PA had significantly higher mean scores in AI (all p< .01). Linear regression model composed of all correlated variables explained 53.9% of depressive symptomatology variance and showed that NA, PA, DIT and HP are significant (p< .05) predictors of AI.

These results are in line with previous findings and contribute to the progress on this topic.

Lurasidone has demonstrated efficacy treating adults with schizophrenia, the majority of them with chronic, multi-episode schizophrenia.

To assess baseline characteristics and evaluate efficacy of lurasidone in patients with early-stage schizophrenia (ESS).

Evaluate efficacy of lurasidone in patients with ESS.

A pooled analysis of patients with ESS (defined as onset of illness within 3 years of study entry) from three, 6-week, randomized, placebo-controlled, phase 3 trials was performed. Additional analysis was conducted for patients with onset within 5 years. Efficacy was evaluated using a mixed-model repeated-measures analysis of change in PANSS total score and CGISeverity score. Treatment response was defined as ≥20% improvement in PANSS total score from baseline.

857 subjects were randomized to lurasidone and 366 to placebo of which 102(11.9%) lurasidone and 44(12.0%) placebo subjects had ESS (onset within 3 years). Among 146 ESS subjects, 70.5% were male, mean age was 28.6 years. Baseline PANSS total and CGI-S scores were 96.8 and 5.0 respectively. Lurasidone treatment of early-stage schizophrenia subjects showed significant improvement vs placebo in PANSS total score (-25.9 vs -17.3; p< 0.05, effect size=0.42), PANSS positive (-9.6 vs 6.0; p< 0.01) and negative (-5.6 vs -3.2; p=0.014) subscale scores, and improvement in CGI-S score (-1.7 vs -1.3; p=0.089, effect size=0.36). Responder rates were 69% for lurasidone vs 48% for placebo (NNT=5). Similar results were observed in subjects with within 5 years of onset of illness.

In this subgroup analysis, lurasidone was effective in the treatment of patients with early-stage schizophrenia.

Since 2007, there has been a gradual increase in the total number of the institutionally approved dependency regarding mental disorders (21 596 cases in 2007, 24 317 cases in 2011). The newly proposed criteria of the assessment of the degree of dependence from January 1, 2012 are set according to the principles of the International Classification of Functioning, Disability and Health (ICF). The aim was to take into account the social needs of patients suffering from mental disorders.

The assessment of the degree of dependence includes the evaluation of the functional impact of the longterm unfavourable state of health on the ability to manage the 10 basic needs. The basic needs are further specified by the ICF principles and activities. Prior to the adoption of this method, assessing the degree of dependence had been tested in terms of its functionality, reliability and impact on disabled people. The tests have demonstrated moderate benefits of this method for people suffering from mental disorders.

[The 10 basic needs in the ICF classification].

The method in question provides an efficient interconnection within the ICF application in both healthcare and dependence degree assessment. Thus, the reflection of ICF in new medical assessment criteria used to assess the degree of dependence will contribute to a change in how healthcare professionals perceive disabilities, and it will ensure that the areas of healthcare, aftercare or long-term care, and the social area are combined more effectively.