High rate of depression and suicide found in alcoholics. Low total serum cholesterol is related with suicidal behavior, impulsivity and depression. Alcoholics have elevated serum triglycerides and LDL cholesterol, but lower values of HDL-cholesterol.

To investigate the serum cholesterol levels and differences between secondary depressed and non-depressed alcoholics biochemical blood tests were performed.

A total group of eighty six non-cirrhotic male primary alcoholics, without malnutrition was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the depressive (DA) group and non-depressive NDA group according the Hamilton Depression Rating scale- HAMD cut-off score under 8. Biochemical blood tests were performed for all participants on admission and retrospectively were analyzed. Differences between groups were tested by Student t-test.

There were not significant difference among groups for demographic and biochemical serum parameters. The DA group showed lower level of total serum cholesterol (5,9 ± 1.24) than NDA group (6.4 ± 1.20) on admission, with values between normal rang (3.63-6.7 mmol/l) p = 0.072.

The group of depressive alcoholics showed trend of lower level of total serum cholesterol on admission. It would be useful to investigate low serum cholesterol as possible predictive factor of secondary depression among alcoholics.

Suicide is a major global social and public health problem. Drug abuse is considered a significant risk factor for suicidal behavior. Research evidence suggests that some drug addicts may be more likely to engage in suicidal behavior.

The aim of this study was to describe the characteristics of drug-dependent individuals who committed suicide.

The social and demographic profiles of drug-dependent individuals who committed suicide in Belarus between 1995 and 2010 were investigated.

The use of illicit drugs has increased dramatically during last two decades in Belarus. Suicide is the fifth leading cause of death among drug-dependent population in this country. 92 suicide cases (84 males, mean age 34.9 ± 1.2 and 8 females, mean age 35.6 ± 1.4) among drug addicts in Belarus from 1995 to 2010 were registered. 92.4% of suicide victims used opiates. 53.3% of drug addicts had a criminal record. The majority of suicide victims (68%) suffered comorbid disorders. The most common disorders were viral hepatitis (30%), HIV (20%) and alcohol dependence (18%). 95.7% of drug addicts have committed suicide by hanging.

A number of risk factors for suicide such as opiates use, comorbid disorders and criminal activity among drugdependent individuals have been identified. It is important to identify those individuals with drug dependence that might be at particularly high risk for suicide.

Although the participant number in online role-playing games (MMORPGs) increase significantly, international validated instruments to assess excessive gaming are lacking.

Apart from sociodemographical data and behavioral gamer patterns, 3 different addiction scales were therefore tested in 453 French adult MMORPG gamers recruited during 10 consecutive months to determine characteristics, online habits and problematic overuse. The DSM-IV-TR substance scale (adapted for MMORPG and named DAS), the qualitative Goldberg Internet Addiction Disorder scale (GIAD) and the quantitative Orman Internet Stress Scale (ISS) were analyzed.

The 453 participating adult gamers were typically young adult graduates living alone in urban areas. For all scales, cyberdependence were high (respectively 27.5%, 44.3% and 32.5%). The DAS appeared as a pertinent discriminating instrument as DAS dependent gamers had a 3 times increased tolerance phenomenon, declared significantly more social, financial (OR:4.85), couple (OR:4.61), family (OR:4.69) or work difficulties (OR:4.42) than non-dependent gamers. Furthermore, they were 3 times more irritable, having more daytime sleepiness and more sleep deprivation to play.

The results highlight that the DAS did not overestimate proportion of online video gamers addicted and was associated with several behavioral disorders such as low mood, emotional changes, disturbance of sleep. This study confirms the necessity of setting up a relevant prevention program against MMORPG overuse (Achab et al., 2011, BMC Psychiatry, PMID: 21871089).

Delirium affects 11% to 47% of post-operative cardiac surgery patients and is associated with higher mortality and morbidity rates. However, the pathophysiology of this syndrome is largely unknown.

To investigate whether increased concentration of pre- and postoperative plasma cortisol predicts the development of delirium after coronary artery bypass graft surgery (CABG). Secondly, to assess whether the association between cortisol and delirium is stress-related or mediated by other pathologies, such as major depressive disorder (MDD) or cognitive impairment.

The patients were examined one day preoperatively with Mini International Neuropsychiatric Interview and Montreal Cognitive Assessment to screen for depression and cognitive impairment, respectively. Blood samples for cortisol levels were collected both pre- and post-operatively. The Confusion Assessment Method was used within the first five days postoperatively to screen for a diagnosis of delirium.

Postoperative delirium developed in 36% (41of 113) of participants. Multivariate logistic regression analysis revealed two groups independently associated with an increased risk of developing post-operative delirium:

1. 1) Those with pre-operatively raised cortisol levels and

2. 2) Those with a pre-operative diagnosis of MDD associated with raised levels of cortisol post-operatively. According to ROC

Raised peri-operative plasma cortisol concentrations are associated with delirium after CABG surgery. This may be an important pathophysiological consideration in the increased risk of post-operative delirium seen in patients with a preoperative diagnosis of MDD.

The subclinical behavioral and psychological characteristics of schizophrenic children have not been sufficiently investigated to present specific evidences .To elucidate the picture of them, and to find out indicators which predict later development of schizophrenia, childhood behaviors of the adult schizophrenia subjects were investigated in a questionnairebased retrospective study.

Schizophrenia outpatients (n = 50) in his/her twenties and normal healthy subjects (n = 200) were investigated. All patients are diagnosed according to DSM-IV-TR as schizophrenia, and who present now mainly negative symptoms after passing an acute stage. By modified use of the CBCL (Child Behavior Checklist) as a retrospective assessment questionnaire, the parents of the patients and of control subjects rated their childhood behavior.

Among eight syndrome scales of the CBCL, those of “Withdrawan”, “Anxious/Depressed”, “Social problems” and “Attention problems” were significantly associated with schizophrenia, although any of these scores were not in clinical range. The hit-rate when classifying the schizophrenic and normal subjects by discriminant function using all items of CBCL totaled 94%.

The results suggested that subclinical characteristics of schizophrenia already exist in the patients’ childhood. With some assessment tool using the obtained discriminat function, the quite early detection of schizophrenic children seems possible.

Social anxiety disorder represents a substantial public health problem because is a relative common mental disorder and has a high prevalence and lifelong chronicity. The fact that serotonergic agents is considered to be effective for its treatment suggests that patients may have an abnormal serotonergic neurotransmission. Selective serotonin reuptake inhibitors are effective in the treatment of social anxiety disorder and are currently perceived as the pharmacotherapy of choice.

We investigated the efficacy and tolerability of escitalopram in the treatment of generalised social anxiety disorder.

Patients with generalised social anxiety disorder were randomised to receive placebo (n = 61) or10-20 mg escitalopram (n = 60) in a 12-week, double-blind study. The primary outcome measure was the mean change from baseline to last assessment in the Liebowitz Social Anxiety Scale (LSAS) total score.

The study showed a statistically superior therapeutic effect for escitalopram compared with placebo on the LSAS total score (p = 0.005).There were significantly more responders to treatment for escitalopram than for placebo (68% v. 28%; p < 0.005). The clinical relevance of these findings was supported by significant reduction in the work and social components of the Sheehan Disability Scale and by the good tolerability of escitalopram treatment.

These data suggest that escitalopram was efficacious and well tolerated in the treatment of social anxiety disorder. Further studies are needed on larger groups of patients to certify these results.

Although depression is commonly related to cerebral stroke, mania is a strange but possible consequence of brain ischemia or intracranial hemorrhages. The maniacal episodes in relation to cerebral stroke have an incident, according to the bibliography, 1% in patients with sharp cerebrovascular diseases. So, in larger persons who show the first maniacal episode, it's recommended to perform studies of cerebral image to reject cerebrovascular disease's presence.

Study of the relationship between stroke and the onset of mania/bipolar disorder.

Review of the literature about this subject through Pubmed and report of the patient's medical history.

Let's show the 64-years-old male's case, with a personal record of schizotypal (without having needed previous hospitable admission) and arterial hypertension. The patient shows a set of symptoms, developing one month long, consisting of verbosity, desinhibicion, hipertimia, overheads increasing and conception delirious damage. This symptomatology, completely new in the patient, made suspect an organic origin, so he was admitted in Internal Medicine Unit, the presence of lacunar strokes were objetived in internal capsule. After he was admitted in our Unit of Psychiatric Hospitalization, neuroleptic with Haloperidol treatment is stablished, a rapid response is observed about it. As discharge time, the patient appears euthymic, clear psychomobility and verbalizing an important distance from the delirious clinic.

Despite the rarity of post stroke mania, the appearance of such symptoms in advances ages must be taken into account in every patient without previous affective symptomatology and concomitant neurological lesion.

Fabry disease (FD) is an X- chromosome linked recessive glycolipid storage disease caused by deficient activity of the lysosomal enzyme Alpha Galactosidase A, resulting in progressive accumulation of aberrant catabolites like Globotriaosylsphingosin (lyso-Gb3) in vulnerable cells. The disorder can affect multiple organ systems including the central nervous system. A high proportion of patients with FD are at increased risk of developing neuropsychiatric symptoms.

A 56 year old female inpatient suffering from treatment resistant recurring depression with psychotic symptoms for a period of over two decades was diagnosed with asymptomatic hypertrophic cardiomyopathy in a routine health checkup. The incidental finding lead to an elaborate diagnostic work-up including genetic testing for FD as a possible cause.

A novel, hitherto undescribed mutation in the Alpha Galactosidase Gene (c.1025.1027delGAC) affecting enzyme activity was detected. In addition, lyso-GB3 concentration was increased above the normal level, in concordance with the diagnosis of FD.

In this patient, undiagnosed FD associated with a novel mutation of the Alpha Galctosidase Gene may have caused predominantly psychiatric symptoms and contributed to therapy resistance.

Previous studies suggested that cognitive enhancement associated with nicotine may be a form of “selfmedication” explaining high rates of smokers among patients with Schizophrenia or Mood Disorders. On the contrary, patients with Obsessive-Compulsive Disorder (OCD), though are characterized by cognitive impairment, do not show a higher tendency to smoking than general population and show a lower tendency to smoking than other psychiatric patients.

Our pilot study aims to investigate the effect of cigarette smoking on cognitive performance in patients with OCD. No published studies investigated this issue.

Fifty-nine inpatients suffering from OCD (22 smokers and 37 non-smokers) were recruited. At the beginning of the hospitalization, we assessed different cognitive domains using a standard non-computerized neuropsychological battery (memory, attention and verbal fluency). In addition, 28 patients out of the 59 (12 smokers and 16 non-smokers) underwent a computerized neuropsychological evaluation specific for executive functions (CANTAB software). OCD-clinical symptoms were evaluated by Y-BOCS.

Smokers and non-smokers did not differ for demographic (age, schooling) and clinical variables (Y-BOCS scores). Compared to non-smokers, smokers showed worse performances on the phonemic fluency test (non-computerized battery) and a tendency to risk higher amount of money on a decision making task (CANTAB).

Smoking does not seem to improve cognitive performances of patients with OCD, whereas it seems to affect impulsivity, thus worsening decision making ability and flexibility, possibly by an effect of nicotine on dopaminergic neurotransmission in orbito-frontal cortex. This may explain the low rate of smokers in patients with OCD.

The aim of the study is to provide information about lithium effectiveness and safety in the treatment of very old patients with mood disorders.

All patients aged ≥75 years attending our private practice in the past 10 years.

We treated 183 subjects aged ≥75 years. 25 were in the lithium group and 138 in the no-lithium group. Bipolar disorder diagnosis and history of previous suicide attempts were more frequent in the Li group. Mean duration of lithium treatment was 31.3 ± 35.0 months. Mean daily dose of lithium was 390 (± 178.5) mg. Treatment with lithium was associated with better Clinical General Impression-Improvement scores than other psychopharmacological treatments. Rates of discontinuation were not significantly different between lithium and other treatments. In no patient, hypothyroidism or renal failure were major clinical problems.T4 treatment (a proxy for hypothyroidism) was prescribed to 8 (32%) of lithium-treated patients. Lithium was withdrawn in 6 (24%) patients.

The reasons for the suspension of lithium were:

1. 1) Unproven effectiveness of the drug for the individual patient.

2. 2) Occurrence of serious cardiac or renal disease, independent of the use of lithium.

3. 3) Erratic and unpredictable metabolism of lithium in the very elderly.

4. 4) Poor compliance (two cases).

5. 5) Age related spontaneous mitigation of the disease.

Lithium can be valuable in the treatment of elderly patients, with adequate precautions. Elderly patients require lithium dosages that are 25 to 50% lower than those used in younger individuals. A single bedtime dosing regimen is recommended.

The aim of the study is to assess the epidemiology of psychiatric symptoms in patients with Huntington Disease (HD).

All patients affected by HD attending our Movement Disorder Clinic in a 3-year period were evaluated by the Unified Huntington’ Disease Rating Scale and by the BPRS.

Among 70 patients, 61 (87.1%) presented depressive symptoms in the course of illness, 56 (80.0%) anxiety, 36 (51.4%) manic symptoms, 47 (67.1%) irritability, 15 (21.4%) delusions, 9 (12.4%) hallucinations, 23 (32.9%) obsessivecompulsive symptoms, 57 (83.7%) apathy, 28 (40%) aggressiveness/violence, 26 (37.1%) suicidality, and 29 (41.4%) dementia.

The results show that the nature of psychiatric manifestations cannot be generalized across all patients with HD for several reasons:

1. 1) in the course of HD, symptoms change spontaneously reflecting the degenerative pathogenesis of the disease;

2. 2) the phenomenology of symptoms depends on age of onset, patient's gender, number of CAG triplets, gender of the affected parent;

3. 3) drugs used to improve motor symptoms have psychiatric side effects which superimpose and merge with the mental abnormalities of the disease;

4. 4) Huntington’ gene is just one of the 30,000 expressed in the brain.

Therefore, the symptoms induced by the disease depend not only on the specific abnormal gene causing the disease but also on patient's general genetic background of both paternal and maternal origin, and on personal non genetic factors.

Rather than standardized approaches, the continuous re-evaluation of psychopathological dimensions in the individual patient with HD is essential for the proper management.

A recent meta-analyses by our team found baseline respiratory abnormalities in subjects with Panic Disorder (PD) compared to subjects without PD. However, it is still open the question whether these abnormalities are intrinsic to pathophysiology of PD or may be shared with other psychiatric populations with high trait and state anxiety levels, such as subjects suffering from other anxiety disorders.

To meta-analyze the results from all of the studies that compared baseline respiratory parameters between subjects with PD and subjects with other anxiety disorders.

A literature research in bibliographic databases was performed. Only fixed-effects models were applied due to the small number of studies available for each parameter. Several moderator analyses and publication bias diagnostics were performed.

Subjects with PD showed a lower end-tidal CO2 pressure and a higher mean respiration rate at baseline compared to patients with both Generalized Anxiety Disorders and Social Phobia. Furthermore, also a significantly lower venous CO2 pressure and a higher venous HCO3- (bicarbonate ion) concentrations in PD than Social Phobia was found. Moderator analyses suggested that these differences between groups are not explained by differences in the state anxiety levels experienced during the assessment procedure. No evidence of publication bias was found.

Results suggest that peculiar baseline respiratory abnormalities and particularly a chronic hyperventilation may be specific of PD pathophysiology also when compared to other anxiety disorders.

In 2007 the Mental Health Act in England and Wales was amended and the definition of Mental Disorder was broadened. This change affected people with Personality Disorders who now can be admitted for hospital treatment without consent, often for prolonged period of time.

This poster reviews clinicians’ attitudes towards the new legislation and its consequences and also presents the research on the different perspectives about the new law.

To review clinicians’ attitudes with regard to interfaces between Personality Disorders and the new law.

Use of the specifically designed questionnaire for clinicians providing hospital care for patients with Borderline Personality Disorders. MEDLINE and PsycINFO databases were also searched for all English-language articles published between 2008 and 2012 containing the keywords “rsonality Disorder”, “Mental Health Act” and “clinicians view on compulsory treatment of persons with Borderline Personality Disorder”. Additional key articles published before 2008 were reviewed. The most relevant articles were selected for the review.

There is still no common consensus in regard to the benefit of compulsory hospital admission of persons with Borderline Personality Disorders. Results from questionnaires are under review.

Although neuroimaging studies suggest brain regional abnormalities in depressive disorders, it remains unclear whether abnormalities are present at illness onset or reflect disease progression.

We hypothesized that cerebral variations were present in adolescents with subthreshold depression known to be at high risk for later full-blown depression.

We examined brain structural and diffusion-weighted magnetic resonance images of adolescents with subthreshold depression.

The participants were extracted from the European IMAGEN study cohort of healthy adolescents recruited at age 14. Subthreshold depression was defined as a distinct period of abnormally depressed or irritable mood, or loss of interest, plus two or more depressive symptoms but without diagnosis of Major Depressive Episode. Comparisons were performed between adolescents meeting these criteria and control adolescents within the T1-weighted imaging modality (118 and 475 adolescents respectively) using voxel-based morphometry and the diffusion tensor imaging modality (89 ad 422 adolescents respectively) using tract-based spatial statistics. Whole brain analyses were performed with a statistical threshold set to p< 0.05 corrected for multiple comparisons.

Compared with controls, adolescents with subthreshold depression had smaller gray matter volume in caudate nuclei, medial frontal and cingulate cortices; smaller white matter volume in anterior limb of internal capsules, left forceps minor and right cingulum; and lower fractional anisotropy and higher radial diffusivity in the genu of corpus callosum.

The findings suggest that adolescents with subthreshold depression have volumetric and microstructural gray and white matter changes in the emotion regulation frontal-striatal-limbic network.