We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 1 year efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol dependent patients with high DRL from a randomised controlled trial [NCT00811941].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 187 patients: placebo N=42; nalmefene N=145 (mean age 46.2±11.9 years; 78% men; mean HDDs 19±6.3/month; mean TAC 101±45.0 g/day). Mean number of HDDs decreased to 7 days/month and mean TAC decreased to 33g/day at 1 year in the nalmefene group. At 1 year, there was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.6 [95% CI:-6.5;-0.7]; p=0.0164) and TAC -17.3 [-30.9;-3.8]; p=0.0129). Improvements in clinical status and in liver enzymes from baseline were larger in the nalmefene compared to the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

The theory of gerotranscendence, a developmental theory of positive aging was proposed by Lars Tornstam in 1989. It was based on the empirical researches done by him in late 1970s and early 1980s and work of other theorists. Tornstam began to explore aging with a phenomenological qualitative approach. Tornstam’s earlier work on aging revealed that aging is a natural developmental process towards maturity and wisdom.

To understand the ageing phenomena in terms of growth through cosmic and transcendent means.

Try to present a purely positive prospect on aging to a certain group of people experiencing a change during aging and provide an explanation for the miserable experiences in later life.

We have searched case reports, case series, cohorts and prospective studies, cross sectional data, review articles and research articles from search engines like PubMed, Medline and Google scholar.

The theory of gerotranscendence found that transcendent signs in old provide an interpretative framework to accept these signs as part of normal aging. It helps in development of a positive attitude in approaching older people.

The theory of gerotranscendence presents a positive view on aging. Tornstam has supported his perspective with various qualitative and quantitative research studies. The theory has also been adopted by many scholars and applied in a number of contexts. However, there is a need to further explore this theory in old age people suffering from depression and identify ways to promote gerotranscendence in them.

Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. Persistent neurological signs and symptoms of lithium intoxication gained clinical attention in the 1980s and were named Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT).

To review the long-term neurological sequelae of lithium intoxication (SILENT) to highlight their clinical presentation, assessment, management and preventive measures.

Non-systematic review of literature through search on PubMed/MEDLINE for publications up to 2021, following the terms syndrome of irreversible lithium-effectuated neurotoxicity.

Neurological manifestations of lithium poisoning may persist, even after effective removal of the drug – SILENT. The most frequent sequelae are cerebellum and brain stem dysfunction, extrapyramidal symptoms and dementia. They may last for weeks, months or years. Infection, dehydration, deteriorating renal function or the addition of other drugs may precipitate acute toxicity. Irreversible damage is difficult to treat. Some cases show spontaneous recovery that may be total, but in others, sequelae persist. Helpful measures include the avoidance of acute intoxications with lithium, long-term and continuous dose adjustment and serum level monitoring, stricter exclusion criteria for starting lithium, and aggressive treatment of acute neurotoxicity. Once the long-term neurologic sequelae have set in, the patient should be managed according to the impediment (physical rehabilitation, speech, cognitive training).

It is important to raise the awareness of SILENT so that clinicians are able to avoid it. There should be a low threshold for suspecting the existence of toxicity.

No significant relationships.

Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries.

The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009–2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population.

The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00–3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06–2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08–2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86–2.94).

In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.

Randomised controlled trial.

Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.

Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.

Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.

To analyze lifetime narratives, risk factors, family profiles, internal and external signs of distress and environmental reaction to it, using the method of psychological autopsy and narratives typology analysis in order to better understand and predict suicide in high schools.

The psychological autopsy of 70 high school students suicide victims (54 Jewish, 50 males, 43 born in Israel) were analyzed post mortem using quantitative, qualitative and narrative approach.

We traced two leading narratives: tragic and regressive. Specific risk factors were found including gender, school mal-behavior and truancy, low school grades and learning disorders. Fight with parents and teachers especially with humiliation aspects were a major facilitating factor. Despite the fact that most of the victims gave sings of distress, the adults in their life did not notice it while the peers noticed but refused to believe they are true. Methods of suicide did not differ significantly between genders in this sample. Yet, 20% of the suicide victims were excellent students and fitted the tragic life narratives. They had lower rate of mental disorders (p=0.03), shorter crisis (p=0.006), and less life events (p=0.03) when compared with those with regressive narratives.

We identify two major life narratives in high school students suicides: tragic and regressive. School truancy for the regressive narratives and fight with authority figures and humiliation for the tragic narratives are major risk factors at high school and should be a focus of prevention programs.

Germany is one of the European countries that receive the highest number of refugees for the last years, with around 468 thousand asylum seekers in the first half of 2016. However, the increase in the speed of short-term procedures regarding refugees may at the same time overlook the risks regarding specific populations. Moreover, women and children constitute the most vulnerable groups during war and conflicts and the worst effects, in terms of physical, mental and social consequences, develop on these groups.

To understand deeply the psychosocial situation of female refugees that have arrived in Federal German Republic, to assess their challenges and resources before, during and after the displacement and to propose recommendations for policy changes.

The study consists of two modules, taking place in five states in Federal German Republic, including Berlin, Mecklenburg-Vorpommern, Bayern, Hessen und Mainz. In the first step, a representative stratified sample of female refugees from Syria, Iraq, Iran, Afghanistan, Somali and Eritrea are recruited. The quantitative study instrument include a socio-demographic question form and HSCL-Hopkins checklist, Harvard Trauma questionnaire, Beck depressions inventory, EUROHIS–QOL and SCL-14. In the second step, a qualitative in-depth analysis of focus group meetings is conducted.

There is an urgent need to take action for the mental health problems of refugees. This study constitutes one of the most extensive researches, especially on a subpopulation of refugees that requires specific attention. Challenges faced throughout the protocol and detailed results will be shared as presentation.

The authors have not supplied their declaration of competing interest.

There have been lots of psychological studies on the difference between the West and East; however, it was mainly focused on the cultural and social outlook rather than the personality perspective of the individuals. The difference in personality construct between the West and East needs to be examined with objective and validated instruments.

We used Temperament and Character Inventory (TCI) and NEO Personality Inventory (NEO-PI) along with Sasang Personality Questionnaire (SPQ). SPQ measures the psychological traits with three subscales of behavior (SPQ-B), cognition (SPQ-C) and emotionality (SPQ-E) based on the Yin-Yang and traditional Korean medicine. We analyzed the correlation between TCI, NEO-PI and SPQ with 104 college students in Korea (age, 28.8±4.8; male/female, 52/52).

The personality structure of SPQ showed distinctive features with emotionality (SPQ-E) which generally perceived as concurrent with behavior and cognition. SPQ-B/SPQ-C were correlated negatively with TCI Harm-Avoidance (r=-0.542 and -0.387) and NEO-PI Neuroticism (r=-0.285 and -0.340), however SPQ-E positively with Harm-Avoidance (r=0.283) and NEO-PI Neuroticism (r=0.398). In addition, SPQ-B/SPQ-C were correlated positively with TCI Novelty-Seeking (r=0.355 and 0.369) and NEO-PI Extraversion (r=0.67, 0.283), but SPQ-E not significant with them.

The disparities in personality construct might be originated from difference in the definition of emotionality; the West accentuates the emotional stability, however the East emphasizes the level of emotional activity. We discussed the implication of these from the cross-cultural personality studies.

At the present time, adolescents are in particular vulnerable to feelings of loneliness. They are gradually emancipating from their family and establish relationships with peers. Among the important predictors of loneliness belong genetic and personal variables and factors of social environment.

To examine predictors of adolescents’ loneliness which are located in family environment. To find out how empathy, emotional relationship and control by both of parents contribute to loneliness of adolescent boys and girls.

We examined 206 adolescents in the age from 10 to 18 years through Basic Empathy Scale, Parenting Style Scale and UCLA Loneliness Scale. Stepwise multiple linear regression analysis was used for data analysis.

The significant predictors of boys’ loneliness in family environment are emotional relationship of mother and affective empathy of father. The significant predictors of girls’ loneliness include emotional relationship and cognitive empathy of father. Parental control is not a significant predictor of adolescents’ loneliness.

Adolescents’ loneliness is largely influenced by factors of family environment. Our study highlights the role of emotional relationship provided by the opposite sex parent. Cold behavior of the opposite sex parent could reduce self-esteem and self-confidence of adolescents. Both could help them establish relationships with peers and people outside family, thus protecting them against loneliness. A significant predictor of boys’ and girls’ loneliness is also empathy of father. We recommend to make use of our findings in clinical practice with adolescents, in family therapy as well as in context of attachment.

The authors have not supplied their declaration of competing interest.

The aim was to investigate the dietary status of adults with ADHD. Furthermore, we compared the group with a representative sample of a healthy adult Danish population.

Data were collected from the ADHD database operated by the ADHD outpatient clinic at Aarhus university hospital. We used data from newly referred patients in a seven months period from April 2014 through October 2014. The collected data include weight, height, blood pressure, somatic or psychiatric co-morbidity, blood sample, physical activity scale. Concerning the diagnosis of ADHD: DIVA, ASRS, BRIEF-V. Inter99 was used to assess the dietary status. The representative sample was obtained as a part of a public health survey from 2010 called “how are you” conducted in the same region of Denmark as the location of the psychiatric hospital. Preliminary results, one hundred and forty-three patients were included in the study, 52% males. The mean age was 30.9 years. A larger proportion of ADHD patients fall in the category “unhealthy dietary pattern” compared to the representative sample population (26% vs. 12%), while the proportion in the “healthy dietary pattern” category is markedly lower (14% vs. 24%). The differences seem to be explained by lower than recommended intakes of fruits and vegetables.

Our findings suggest a general shift towards more unhealthy dietary patterns among patients with ADHD. This exposes them to higher risk of somatic diseases, notably diabetes mellitus and cardiovascular disease. Lifestyle interventions could be a necessary part of standard treatment for patients with ADHD.

The authors have not supplied their declaration of competing interest.

The assessment and management of psychomotor agitation may result in the use of coercive or sedative treatments. In the absence of conclusive evidence, the consensus of experts can guide clinical decisions.

To seek consensus recommendations on the assessment and management of psychomotor agitation.

An international expert task force in this field developed consensus using the Delphi method. Twenty-seven experts were invited to participate and 91% of them agreed. Initial survey items were gathered from the content of literature search (systematic review). This included open-ended questions inviting participants to add suggestions by e-mail correspondence. After this initial first round, the Delphi study was conducted online using Google Forms. Survey items were rated on a 5-point scale. Items rated by at least 80% of experts as essential or important were included. Items rated as essential or important by 65–79% of experts were included in the next survey for re-rating. Items with consensus below to 65% were rejected and excluded.

The initial survey included 52 items. The second web-based survey included 33 items. The briefer third survey consisted of 6 items that needed rerating. Twenty-two of the initial 33 items were endorsed and formed the clinical recommendations on the assessment and management of the psychomotor agitation. The endorsed items were categorized into 5 domains forming the clinical recommendations.

The panel expert generated 22 recommendations on the assessment and management of agitation. The Delphi method is a suitable formal iterative process for reaching consensus on relevant and controversial issues.

The authors have not supplied their declaration of competing interest.

Psychopathy is characterized by superficial charm, untruthfulness, lack of remorse, antisocial behavior, egocentricity as well as poverty in major affective reactions. This clinical profile has been empirically conceptualized and validated. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. However, no reliable pattern of altered neural activity has been disclosed so far.

To identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology.

First, we used activation likelihood estimation to meta-analyze brain activation changes in psychopaths across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 analyses (P < 0.05, corrected). Second, we functionally characterized the ensuing regions employing meta-data of a large-scale neuroimaging database (P < 0.05, corrected).

Psychopathy was consistently associated with decreased brain activity in the right amygdala, the dorsomedial prefrontal cortex (DMPFC), and bilaterally in the lateral prefrontal cortex (LPFC). Consistently increased activity was observed bilaterally in the fronto-insular cortex (FIC) (Fig. 1). Moreover, we found that the physiological functional role of the candidate regions related to social cognition (DMFPC), cognitive speech and semantic processing (left FIC/LPFC), emotional and cognitive reward processing (right amygdala/FIC) as well as somesthesis and executive functions (RLPFC).

Psychopathy is characterized by abnormal brain activity of bilateral prefrontal cortices and the right amygdala, which mediate psychological functions known to be impaired in psychopaths. Hence, aberrant neural activity can account for pertinent psychopathology in psychopathy.

The authors have not supplied their declaration of competing interest.

Evaluation of non-medical interventions on cognitive and emotional competence in old age is among the goals of research in clinical gerontopsychology.

The goals of our study were to assess the impact of and analyze the differences between a cognitive training program, relaxation training according to Jacobson and a combination of both forms of intervention on cognitive performance, well-being and pain in older people.

26 care home residents (group 1) underwent the Jacobson relaxation training first, followed by a combination of relaxation and cognitive training. 24 participants (group 2) underwent a cognitive training program in the first instance followed by the combined intervention. Various psychological tests were implemented at three time points of measurement.

• - Significant improvement in dementia screening, in visual short-term memory and working memory both after the relaxation training only as also after combination training

• - Relevant improved performance in ultra short-term memory after combination training

• - Significant reduction in depression scores in both study groups

• - Relevant improvement in state of well-being after all training variants

Jacobson relaxation has a markedly stronger positive effect in optimizing the cognitive and emotional status of elderly persons compared to the more frequently propagandized and implemented cognitive training.