Cardiac surgery with cardiopulmonary bypass represents a severe source of stress and has been reported to be associated to the development of Posttraumatic Stress Disorder (PTSD). This disorder leads to a significant disability that might greatly decrease the benefits of surgery. Research rarely focused on the role of attachment styles in the development of PTSD, and no studies addressed this issue in patients undergoing cardiac surgery.

To assess the influence of attachment styles on the development of PTSD.

The identification of specific personological traits predictive of the development of PTSD.

Participants were recruited among patients scheduled for elective cardiac surgery with cardiopulmonary bypass and evaluated through

1. a) Experiences in Close Relationships (ECR)

2. b) Post-traumatic 10 Stress Symptom Inventory - Modified (PTSS-10)

3. c) Perceived Stress Scale (PSS).

Six months after surgery, participants were mailed the PTSS-10 and the PSS. Multiple logistic regression analysis was performed with PTSD as dependent variable, and attachment-related avoidance and anxiety, sex, age and perceived stress as independent variables.

One hundred twenty-one patients (94% of candidates for elective cardiac surgery who met study inclusion criteria) underwent surgery; 61(59%) were assessed after 6 months. Fourteen subjects (19.7%) scored ≥35 on the PTSS-10 at followup and were considered as having a probable diagnosis of PTSD. Attachment related avoidance at baseline predicted the development of PTSD at follow-up (p< 0.017), after controlling for age, sex and perceived stress.

Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery.

Inpatient facilities for people with LD are highly specialised services that are a valuable, but expensive, component of mental health services. Although there are no national data describing these services, commissioners need good quality data to inform their contracting and pricing strategies for LD psychiatric inpatient care. To help fill this information gap, we carried out a review to explore the general characteristic of inpatients population, duration of admission and delays in discharge in the inpatient LD unit.

To analyse admission trends including the reasons for delayed discharges to a LD unit from 2008 to 2011.

A retrospective review of the case records of all inpatient admissions to the LD Unit (Seacole) between 2008-2011.

There were 41 admissions made to the service in the time period from 2008 to 2011. More male patients (76%) were admitted compared to females (24%) (p=0.073). Male patients (55%) were more likely than female patients (20%) to be admitted from a residential home (p = 0.075).There was no statistically significant difference between the male and female sexes regarding diagnosis of challenging behaviour or psychotic or affective disorder. 59% of discharges in 2008–2011 were delayed. The main reason for the delayed discharge was social and was significantly more likely to result from difficulty in finding appropriate placement (p=0.008).

Social problems were the main cause of delayed discharges. Early identification of social issues, better utilization of community resources and robust discharge planning should be done to avoid delay in discharge.

There is evidence that women with breast cancer can develop anxiety and depression, ultimately affecting patients’ compliance and quality of life.

Previous studies investigated psychological distress in women with breast cancer at different stages of the disease. However, few data are available about Italian women in the early steps of their clinical history.

To investigate psychological distress, anxiety and depressive symptoms in a sample of women with a recent diagnosis of breast cancer.

This cross-sectional study involved twenty-five women consecutively attending the oncology outpatient clinic for their first oncology evaluation after surgery. Anxious and depressive symptomatology was assessed through the Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Socio-demographic and clinical characteristics were also collected. Correlations were analyzed using Spearman's correlation coefficient.

The mean values (±SD) of the HADS Anxiety and Depression Subscales were 7.6 (±4.7) and 5.7 (±4.4) respectively. Five patients (24%) scored ≥10 at the HADS Anxiety subscale and 16% scored ≥10 at the HADS Depression subscale, suggesting the presence of clinically relevant symptomatology. DT mean score (±SD) was 5.36 (±3.5), with 48% of patients scoring ≥7, indicative of significant psychological distress. Multivariate analysis showed an inverse correlation between psychological distress severity and time after cancer diagnosis.

These preliminary findings show a prevalence of anxious and depressive symptoms in one out four women with breast cancer. Further prosecution of the study will help to identify women at risk for psychiatric comorbidities, suggesting the development of targeted interventions.

Evaluate the efficacy and long-term safety of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Patients requiring chronic treatment for schizophrenia, not on aripiprazole monotherapy, were cross-titrated from other antipsychotic(s) to aripiprazole in an oral conversion phase (Phase 1). All patients entered an oral aripiprazole stabilization phase (Phase 2). Patients meeting stability criteria entered an ARI-OM stabilization phase (Phase 3), with coadministration of oral aripiprazole for the first 2 weeks. Patients meeting stability criteria were randomized to ARI-OM or placebo once-monthly (placebo-OM) during a 52-week, double-blind maintenance phase (Phase 4). Primary endpoint was time-to-impending relapse. Safety and tolerability were also assessed.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo-OM=134). The study was terminated early because efficacy was demonstrated by a pre-planned interim analysis. Time-to-impending relapse was significantly delayed with ARI-OM vs. placebo-OM (p< 0.0001, log-rank test). Discontinuations due to treatment-emergent adverse events (AEs) were: Phase 1, 3.8% (n=24/632); Phase 2, 3.0% (n=21/709); Phase 3, 4.9% (n=28/576); Phase 4, 7.1% (n=19/269). Most AEs were mild or moderate. Insomnia was the only AE >5% incidence in any phase. Headache, somnolence, and nausea had a peak first onset within the first 4 weeks of treatment. There were no unusual shifts in all phases in laboratory values, fasting metabolic parameters, weight, or objective scales of movement disorders.

ARI-OM significantly delayed time-to-impending relapse compared with placebo-OM and was well tolerated as maintenance treatment in schizophrenia1.

Information processing studies, such as attentional bias, help to distinguish anxious pathologies. If Vigilance and disengagement bias have been widely demonstrated in generalized anxiety and post traumatic stress disorder (PTSD), their existence has not been reported in non clinical sample with or without anxiety and/or PTSD symptoms.

The aim of the present study was to examine the possible presence of specific attentional bias in these populations and compare them with classical bias in PTSD patients.

One hundred and thirty-one students completed a visual search task with a lexical decision component, and anxiety and PTSD scales. We controlled attentional bias: vigilance / disengagement and words valence: neutral / general threat-related / trauma-related. Ten PTSD patients were assessed for PTSD with CAPS and completed the same protocol.

Among non clinical sample, four groups were distinguished: without symptom, anxious, PTSS (Post-Traumatic Stress Symptom) and, anxious and PTSS groups. Analysis of response time and error rate show different pattern of bias in each non clinical group. Considering the PTSS group response times were higher for trauma-related words, while for threat-related words, the anxious group was characterized by lower response times. Without symptom participants showed an attentional bias for negative information. Anxious and PTSS participants were characterized by a generalization of both biases.

These data reveal the existence of different types of information processing between these four non clinical groups. A putative role of anxious symptoms, in anxiety pathologies such as PTSD, on attentional bias is discussed.

Oestrogens may be a protective factor in psychosis. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD).

To evaluate gynaecological variables and psychopathology in women with DD.

To investigate the relationship between age of menarche and onset, and psychopathology in DD.

Forty-five outpatients with DD (DSM-IV-TR) were recruited at the Hospital Clinic of Barcelona, from 2008 to 2012. Twenty-five females underwent a demographic and gynaecological questionnaire. HRSD-17 for depression, PANSS for psychopathology, PSP for functionality and C-SSRS for suicide were assessed. The sample was divided into two groups according to the age of menarche: 12 years or less and more than 12.

Mean age of menarche (SD) was 12.6(1.4) years, mean age of menopause 49.1(3.15), mean age at onset of DD was 49.9(12.58). 33.3% of the sample did not receive gynaecological service in the last 3 years. The group with the earliest age of menarche was older [67.33(11.67) vs.56(9.6); p=0.026], presented an earlier age of menopause [46.80(2.84) vs.50.71(2.29) p=0.018] and latest onset of DD (53.50(14.32) vs.47.44(11.5); p=NS], than those with later age of menarche. No differences were found regarding psychopathology, suicidal behaviour or functionality.

Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. A low compliance rate in gynaecological service use was found. An earlier age of menarche was associated to an earlier age of onset of DD.

Evaluate the effectiveness of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Detailed methodology has been published previously1. Briefly, the study consisted of 4 phases: oral conversion to aripiprazole (Phase 1); oral aripiprazole stabilization (Phase 2); ARI-OM stabilization (Phase 3), with co-administration of oral aripiprazole for the first 2 weeks; and an ARI-OM maintenance phase (Phase 4). Effectiveness assessments included Investigator's Assessment Questionnaire (IAQ) scores, a scale that evaluates effectiveness of current treatment vs. pre-trial medication, where a negative change in score signals improvement, and Personal and Social Performance (PSP) scale scores, where negative change in score signals worsening.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo once-monthly [placebo- OM]=134). Mean IAQ Total scores remained stable in Phase 2 (31.3) and Phase 3 (30.6). During Phase 4, the mean change in IAQ Total score was +1.3 for ARI-OM vs. +3.8 for placebo-OM (p< 0.0001). Mean changes in PSP Total scale scores showed improvement during Phase 2 (3.0) and Phase 3 (2.6). Mean change in PSP scores during Phase 4 showed greater functional stability with ARI-OM (−1.7) compared with placebo-OM (−6.2) (p=0.0002 vs. placebo-OM).

Improvements in effectiveness, as assessed by the IAQ and PSP Total scale scores, in the Phases 2 & 3 were maintained in Phase 4 for ARI-OM compared with placebo-OM. Treatment with ARI-OM improved symptoms, overall response to treatment and functioning.

Prevalence estimates of childhood and adolescent mental health disorders appear to vary between 20 to 30% worldwide. It is therefore unsurprising that studies have yielded inconsistent findings in regards to the trends of prevalence of mental health disorders. Some reasons for the discrepancy in findings include use of survey data and its associated attrition and selection bias.

First, to determine and compare the prevalence of mental health disorders derived from a survey and a population cohort. Second, to evaluate trends of mental health prevalence over time.

As population data (i.e., linked health records) may be used to overcome the issues presented by survey data, we compared the prevalence estimated from a prospective survey cohort (the Western Australian Pregnancy Cohort (Raine study) to another estimate from a prospective population cohort (linked population data; data from the Hospital Morbidity Records and Mental Health Registration).

As expected, the Raine cohort yielded a larger estimate of prevalence when compared to the linked population data. However each cohort also revealed opposite trends of prevalence, where the Raine cohort showed the prevalence of mental health disorders to decrease as children age.

We therefore recommend that estimates of prevalence be interpreted with the type of cohort in mind, as estimates from survey cohorts will provide different information to that from population cohorts.

Evaluate the safety and tolerability of aripiprazole once-monthly (ARI-OM) initiation in patients stabilized on oral antipsychotics other than aripiprazole. Previous pivotal Phase III trials have evaluated initiating ARI-OM in patients stabilized on oral aripiprazole1.

Eligible patients were treated with oral atypical antipsychotics other than aripiprazole with a history of oral aripiprazole tolerability. The study included a screening phase (30 days) and a treatment phase (28 days). Patients were stabilized per investigator's judgment for ≥14 days on risperidone, olanzapine, quetiapine, or ziprasidone, before administration of ARI-OM (400 mg). Current oral antipsychotic was co-administered with ARI-OM for 2 weeks to determine safety and tolerability of a single ARI-OM dose following treatment initiation. Safety assessments were adverse events (AEs); extrapyramidal symptoms (EPSs) using standard objective rating scales; Columbia-Suicide Severity Rating Scale; clinical laboratory measures; and weight changes.

60 patients initiated ARI-OM, while continuing treatment for ≤2 weeks with oral risperidone (n=24), quetiapine (n=28), ziprasidone (n=5) or olanzapine (n=3). Treatment-emergent (TE) AEs (≥5%) were fatigue, injection-site pain, and restlessness (risperidone); insomnia, dystonia, injection-site pain, and toothache (quetiapine); and muscle spasm, tooth abscess, and toothache (ziprasidone). Prior olanzapine did not cause any AEs. Incidence of TE-EPSs were similar in all groups (< 5%). There were no unusual changes in objective EPS rating scales, suicidality, weight, laboratory values or fasting metabolic parameters across all groups.

The AE profile of patients receiving ARI-OM concomitant with oral atypical antipsychotics other than aripiprazole was consistent with prior reports1.

As German reunification took place in 1990 Eastern Germany as a former socialist country (GDR) became part of democratic Germany. It underwent dramatic changes influencing all parts of society.

Our objective was to analyse all suicides in the Eastern German City Magdeburg based on all relevant police files.

Little is known about the former GDR and its suicide rates since no official data existed. Our aim was to investigate differences in suicide rates by age and sex in one city of the former GDR before and after reunification.

As part of GDR-time the period 1985 - 1989 (A) and as post-reunification time the period 1999 - 2004 (B) were analysed. Basis of our investigation were all police files. Absolute suicide numbers were counted. Suicide rates were calculated per 100.000 persons, sex and year. Different age structures became comparable by using the old standard population of Europe (WHO 1976).

We identified 470 suicides in period A and 206 suicides in period B. For both sexes suicide rates were significantly higher in period A and increased with age. Women had generally lower suicide rates. Age-standardized rates show a reduction for males of about 50% and for females of two thirds in comparison of the two periods.

Suicide rates decreased in our analysed city dramatically. Women in general and particularly elder groups have lower suicide rates and thus benefited most. There are various contributing factors such as positive changes in health care and social support.

The prevalence rate of dementia in older adults with intellectual disability (ID) is comparable with that of the general population and is significantly higher in people with Down Syndrome (DS). It is recommended that diagnosis should be made following history, physical and mental state examination, cognitive assessment, blood tests and, ideally, neuroimaging. However, experience suggests that dementia may be underdiagnosed in this patient group thereby restricting access to appropriate management.

We aimed to elucidate the barriers to a timely diagnosis of dementia in the ID population attending a specialised ID memory clinic in London, UK.

We conducted a service review of the Clinic, retrospectively reviewing the records of all patients seen in 2011 to assess attendance and diagnosis rate, co-morbid physical and mental illness and the completion of neuroimaging and blood tests.

32 patients were seen at least once during 2011 in the memory clinic, of whom 11 (34%) received a diagnosis of dementia. 22 (69%) of those seen had DS and 18 (56%) were male. 12 (38%) patients have thyroid dysfunction and 8 (25%) have epilepsy. 23 patients had completed a DLD in the past year and 14 (44%) had completed more than one DLD. 12 (38%) patients had a previous brain scan and 27 (84%) patients had had blood tests in the previous year.

Comorbid physical illnesses, consistent attendance at appointments, access to psychological assessment and willingness to undergo neuroimaging and phlebotomy are significant barriers to diagnosis of dementia in patients with ID.

Negative feelings towards the body and body size misperception have long been associated with disordered eating behaviour. Over recent years the perceptual flexibility of the human body representation has been consistently demonstrated using multisensory perceptual illusions. Whether such perceptual changes can impact the emotional experience of our body, however, has yet to be explored.

The current study exploits well-established perceptual body illusions to induce illusory ownership over slimmer and wider body shapes whilst measuring changes in body satisfaction.

To identify a direct causal link between perceptual and affective body representations.

Participants were presented with video images of both a slimmer and wider mannequin body viewed through head mounted displays from a first person perspective. Illusory ownership was induced by synchronously stroking the seen mannequin body with the unseen real body. Pre and post illusion affective and perceptual measures captured changes in perceive body size and body satisfaction as a result of the illusion.

Illusory ownership of a slimmer body significantly increased feelings of body satisfaction as well as significantly decreasing perceived actual body width. Change in body satisfaction following illusory ownership of a wider body, however, was modulated by degree of sub clinical eating disorder pathology and did not induce a systematic change in perceived body width.

These findings suggest a link between perceived body size and body satisfaction, which may be modulated by eating disorder pathology. The results could have implications for future treatments of eating disorders.

Evaluate the efficacy of aripiprazole combination with lithium/valproate vs. placebo combination in bipolar mania using a titration regimen with a low starting dose (5 mg/day).

Eligible adult patients with bipolar mania receiving lithium/valproate and a Young Mania Rating Scale (YMRS) Total score ≥16 who might benefit from combination treatment with aripiprazole, were randomized to aripiprazole (n=181) or placebo (n=189) with lithium/valproate. Primary endpoint was mean change from baseline to Week 12 in YMRS. Secondary endpoints were Clinical Global Impressions-Bipolar Version (CGI-BP) severity of illness score, response rate (≥50% improvement in YMRS Total score), and remission rate (YMRS ≤12). Safety and tolerability were also assessed. Enrolment yielded a 77% power to detect a 2.6-point change in YMRS Total score at endpoint.

At endpoint, the mean change in YMRS Total Score (last-observation-carried-forward [LOCF]) for aripiprazole vs. placebo was not significant (treatment difference [-2.04] in favour of aripiprazole (95% CI: -4.14, 0.07; p=0.058). Mean change from baseline to endpoint in CGI-BP showed a treatment difference (-0.30) in favour of aripiprazole vs. placebo (95% CI: - 0.59, -0.01; p=0.044). Response rates were 68.8% vs. 61.3% (p=0.128) and remission rates were 69.9% vs. 64.0% (p=0.211) for aripiprazole and placebo, respectively. No unexpected adverse events (AEs) occurred. Treatment-emergent AEs (≥5% and twice the rate of placebo) were akathisia, depression, and nausea.

The target sample size of 388 patients was not achieved in this study and the primary outcome did not reach statistical significance. Now new or unexpected AEs occurred.

One of the problems of the contemporary psychiatry is, certainly, hospitalization, because the freedom of an individual, altogether with the right to life and personal safety, is a basic human right. Hospitalization of patients with schizophrenia interferes with their psychological and social integrity, which is of high importance for their lives.

Is to determine whether the socio-demographic characteristics (gender, age, education, work and marital status) influence the decision making regarding the form of hospitalization.

In purpose of the investigation, we used the closed-type questionnaires that were composed for the needs of this paper. In order to fill the questionnaires, we used the case records of hospitalized patients with schizophrenia during 2010. In order to analyze the obtained data we used the methods of descriptive statistics.

597 schizophrenic patients with diagnosis F20.0 - F20.9 hospitalized during 2010, of which 472 (79.6%) voluntarily, and 125 (20.4%) involuntarily. Among socio-demographic characteristics, the differences between the voluntarily and involuntarily admitted patients are observed by: occupation, working status, number and cause of hospitalization (first and repeated), while there are no differences regarding the level of education and marital status. By gender, there are no differences in type of hospitalization.Voluntarily admitted patients are the predominant in the group of age 41-50, and the involuntary in the group of 31-40.

According to the presented analyses of results of socio-demographic characteristics of involuntarily and voluntarily hospitalized patients with schizophrenia, we came to a conclusion that the specified characteristics influence the form of hospitalization.

Important reciprocal relationships exist between the central nervous, the endocrine and the immune systems.

The main objective was the quantitative determination of prolactin levels in acute and remitted psychotic patients receiving conventional and atypical antipsychotic treatment. Possible correlations between prolactin levels and psychotic, endocrine or immune disorders in patients' medical history or family history were checked.

58 patients (42 women and 16 men) receiving antipsychotic treatment were included in the study in order of their presentation to control visits or admission in the psychiatric hospital. They were classified into the following ICD 10 diagnostic categories: acute and transient psychotic disorders, schizophrenia, persistent delusional disorder, schizoaffective disorder and bipolar disorder. The following data were collected: prolactinemia (chemiluminescence method), ASAT, ALAT liver enzymes, glycemia, serum creatinine, thyroid hormones, sexual hormones, the intensity of psychiatric symptoms measured with BPRS, personal and family history of psychiatric, endocrine, immune disorders or treatments.

47 patients (81%) presented hyperprolactinemia (33 women and 14 men). 9 patients (16%) presented a history of autoimmune disorders, 4 (7%) having also a family history of autoimmune disorders. 9 women had amenorrhea or irregular menstrual cycle. 5 patients were on long acting antipsychotic treatment.

Regardless of the antipsychotic treatment received, the majority of the patients presented hyperprolactinemia. Women presented a higher increase in prolactin levels than men. The results were interpreted according to the thyroid and sexual hormonal status. A positive correlation between prolactin levels and BPRS scores was found (r = 0.2628 P= 0.0463, 95% CI).

To complete an up-to-date meta-analysis of studies investigating the correlation between insight and various measures of neurocognition in psychosis.

We completed a comprehensive literature search using Pubmed and ‘Web of Science’. After applying inclusion and exclusion criteria we isolated 34 papers published on this topic since 2004. This list was then added to those published prior to 2004 that had been found in an earlier meta-analysis performed by our group to give a complete collection of 69 papers. Metaanalysis of data was performed in the Comprehensive Meta-Analysis software using random effects models.

Overall our sample included 5127 patients with psychosis across 69 studies. We performed analyses for overall cognition, IQ, memory, executive function and specifically the Wisconsin Card Sorting Test (WCST). We found a small but highly significant correlation between insight and each measure of neurocognition in all patients with psychosis (mean weighted r = 0.13–0.16 across domains, p < 0.001). When restricted to those patients with diagnosis of schizophrenia (n = 1708) the strength of correlation in each domain increased slightly (mean weighted r = 0.14–0.18, p < 0.01). We found no evidence of significant publication bias.

In this comprehensive meta-analysis we found a small but robust correlation between insight and a variety of neurocognitive domains in patients with psychosis. We believe that this data supports the role of neurocognitive processes in some aspects of insight but believe that a more precise experimental approach is required to elucidate the exact mechanisms of this relationship.

The endogenous opioid system (EOS) plays a critical role in addictive processes. Molecular dysregulations in this system may be specific for different stages of addiction cycle and neurocircuitries involved, and therefore may differentially contribute to the initiation and maintenance of addiction.

We here evaluated whether the EOS is altered in brain areas involved in cognitive control of addiction including the dorsolateral prefrontal cortex (dl-PFC), orbitofrontal cortex (OFC), anterior insula (AI) and hippocampus, in human alcohol dependent subjects.

Levels of EOS mRNAs were measured by qRT-PCR, and levels of dynorphins by radioimmunoassay in postmortem human specimens.

Prodynorphin kappa-opioid receptor mRNAs and dynorphins were upregulated or demonstrated higher dispersion in alcoholics.

Dysregulation in the kappa-opioid receptor/dynorphin system in alcoholics may contribute to alcohol craving and neurocognitive dysfunctions relevant for addiction and disrupted inhibitory control.

We are grateful to the NSW Tissue Resource Centre for providing human brain samples. Supported by the Swedish VR and FAS.