The authors have not supplied their declaration of competing interest.

Short term benefits of Specialized Early Intervention (SEI) services for treatment of first episode of psychosis (FEP) are not sustained after transfer to regular care. Optimum length of SEI services remains to be determined.

To carry out a randomized controlled trial (RCT) of extending SEI service for an additional three years compared to “regular” care after both groups have received two years of SEI treatment.

The experimental group (extended SEI) will have better clinical (remission length and proportion) and functional outcomes and be cost effective compared to the control group (regular care).

Remission (length and proportion in remission) are the primary outcomes. We aim to randomize a total of 212 patients following two years of SEI service for their FEP. Outcome evaluations to assess symptoms, functioning and service utilization are carried out at entry and every three months. In this presentation we will report only the method and preliminary results (success of urn randomization, drop out and relapse rates) on the sample recruited thus far.

Of the 58 patients approached 50 (86%) agreed to be randomized. Patients were young (mean age 25), mostly male (with a diagnosis of Schizophrenia Spectrum Psychosis (71%). The average length of follow up to date is 13.2 months (s.d. = 5.4). Treatment discontinuation in the experimental and control conditions were 0 and 4 (15%), respectively.

The pilot results show the feasibility for carrying out such a study. The methodological challenges of conducting this long term RCT will be discussed.

There are seldom mental health studies in Portugal about immigrant populations, particularly in groups belonging to non-Portuguese speaking minorities. The recent phenomenon of emergence of new migratory flows coming from Eastern Europe countries, which traditionally had no cultural or linguistic contact with the host country and the implications of this migratory process in the mental health status of this population, is the centre of this investigation.

This study aims to perform a socio-demographic characterization, identify the main health problems and health surveillance patterns of the immigrant population from Eastern Europe countries in Portugal. It also aims to assess the stress vulnerability and ths mental health status of this population.

The study was conducted in immigrant local centres from January 31st 2005 to March 31st 2006 and focused on 566 Eastern Europe immigrants residing in several regions of Portugal, 296 males and 270 females. We used the 23 QVS (Vaz Serra, 2000); GHQ-28 (Goldberg & Hillier, 1979); SSQ6 (Saranson, Saranson & Pierce, 1987) and a Socio-demographic questionnaire.

From the 566 individuals in sample one; we conclude that this population is predominantly male, in active young age, with high academic qualifications.

Regarding mental health status, 10,4% of the inquired immigrants presented psychiatric pathology assessed by the cutting point of GHQ-28 and 54.9% presented stress vulnerability determined by the cutting point of 23QVS. We verified a statistically relevant correlation between stress vulnerability and the levels of mental health of the surveyed population.

Use of the Internet lately has significantly been increased worldwide. The time users spend browsing the Internet is constantly increased resulting to serious consequences incurred in personal, professional and social life.

The purpose was to explore whether the economic crisis is affecting the use and addiction to Internet, whether the economic crisis is a risk factor in the appearance of addiction to the Internet and if the occupation and the existence of extra-curricular activities act as barriers to the development of addiction to the Internet on students.

A questionnaire was prepared based on the diagnostic tool IAT (Internet Addiction Test). The survey was conducted in June of 2014 on 632 students.

It was found that 6.2% of the sample population has moderately addictive behavior and 0.5% has a serious addiction. Addiction levels to the Internet are affected by someone working while studying and his monthly income, by daily time spent by the student in activities besides school, by the time spent daily on the Internet and by the operations mostly used. Also found that the risk of developing Internet addiction is higher among students who said they had difficulty paying their bills and Internet subscription and to those who due to economic crisis would stop all their activities in order to obtain money.

The economic crisis is a factor that affects on Internet addiction and occupation and activities may act as a deterrent to the emergence of the phenomenon.

The authors have not supplied their declaration of competing interest.

We have randomly divide patients into control group(N=45) without antidepressants, and experimental groups in accordance with applied antidepressants: clomipramine(N=48), fluoxetine (N=49), sertraline (N=51), escitalopram (N=49), mirtazepine (N=45), and tianeptine (N=52). We have used HAMD for estimation of depression, QOL scale for quality of life, and UPDRS subscales I(behaviour and mood) and II(daily activities) for PD symptoms at pretrial, and after 3 months scores in all groups. Data were processed with SPSS for Windows.

There is no statistical significance in pretrial scores between groups. After 3 months there is: significant increase in control and significant discrease(p=0.000) of HAMD scores in all experimental groups, in favour of antidepressant with higher mediana(escitalopram 9; sertralin 8; tianeptin 6;clompramin 3; mirtazapin 3;fluoxetine 1; control -2); significant increase of QOL scores in favour of antidepressant with higher mediana(escitalopram 1.24; sertraline 1.12; tianeptine 0.65; clomipramine 0.40; mirtazapine 0.27; fluoxetine 0.27), and significant difference in UPDRS II pretrial and after 3 months subscores(p=0.016), in favour of escitalopram.

All tested antidepressant are efficient in reducing HAMD score, but only escitalopram,sertraline,and tianeptine improved HAMD, QOL, UPDRS I, and II scores without side effects.

Cognitive functions have a decisive influence and prognostic value for functional recovery. The NIMH MATRICS initiative established a consensus on neuro-cognitive and social cognitive domains relevant for the treatment of schizophrenia. Against this background we developed the Integrated Neurocognitive Therapy (INT) covering all MATRICS domains. INT is strongly based on therapeutic principles of the Integrated Psychological Therapy (IPT) designed by our research team several years ago. INT is partly computer based and intends to restitute and compensate neuro-cognitive and social cognitive functions.

INT was evaluated in an international multi-cite RCT with centers in Switzerland, Germany, and Austria. The Swiss National Science Foundation supported this study. INT was compared with a treatment as usual control condition (TAU). INT patients received 30 therapy sessions twice a week. 169 schizophrenia outpatients participated in the study.

Using an ANOVA model, INT groups show superior effects after therapy and 1-year follow-up in proximal outcomes of neuro- and social cognition. Significant effects are evident in most of the MATRICS-domains. Additionally, significant effects in more distal outcomes are evident for INT patients in psychosocial functioning and negative symptoms after therapy and at follow-up. A low drop-out rate of 12% of the INT patients indicates a high acceptance by the patients.

Results support evidence for the efficacy of INT in proximal and distal outcome dimensions. Further evaluations on INT have to investigate its relevance for different psychotic populations such as young early psychotics and more chronic older patients.

Compassion can be defined as an intentional sensitivity to the suffering, with a motivation and commitment to try to relieve it, which can have a positive impact on individuals’ emotional and psychological well-being. The relevance of compassion focused therapies is well established and this makes the development of reliable instruments for the assessment of the different facets of compassion targeting different age groups crucial for research and clinical practice. The Compassionate Attributes and Actions Scale (CAAS) aims to assess compassion on three directions: self-compassion, compassion for others or compassion received from others. Each of the scales assesses one's compassionate attributes and compassionate actions separately when dealing with difficult or painful situations.

This study aimed to adapt the CAAS for adolescents and to explore its factor structure and psychometric properties in a sample of Portuguese adolescents.

A total of 336 Portuguese adolescents with ages ranging from 12 to 19 years old participated in the study. Several exploratory factor analyses were conducted.

Exploratory factor analysis showed that, except for the attributes section of the self-compassion scale (that showed to be bi-factorial), all the other scales (and their sections) presented a single-factor structure. The three scales, and its sections, demonstrated a good reliability and excellent test-retest reliability and good convergent and discriminant validity.

Results were in line with the factor structure found in the adults’ version. The scales and its sections have shown good psychometric characteristics and constitute a useful instrument to assess and investigate the three directions of the compassion.

The authors have not supplied their declaration of competing interest.

An integrated program (Institutional Psychiatric Open Light Treatment) for psychosis and personality disorder was enriched with audiovisual functions provided through a dedicated website.

The aim of the present study was to observe how and if these added functions support the patients in their daily living, influencing the quality of the recovery process.

Recent studies highlighted how telemental health services are effective to provide access, improve basic outcome, facilitate empowerment of patients and be well-accepted (Hilty, 2013; Hailey, 2008) and how integrated community-based treatment, such as Community-Based Psychodynamic Treatment Program (Chiesa and Fonagy, 2009) or Assertive Community Treatment (Veldhuizen and Bahler, 2013) are effective in SMI.

Telemental health services may become factors improving real-life functioning, integrating community-based treatment for psychosis and bettering social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services, so positively affecting outcomes of psychosis treatment.

All patients admitted (May 2010–April 2015) were included. Aged between 18 and 65, with schizophrenia, psychosis, schizoaffective disorder, bipolar disorder, personality disorder.

Some troubles with the website use (Voice2Voice) led to a second version, more friendly and simple to use (app2gether).

App2gether provided several functions: audio/video conference rooms for patients or family (synchronous virtual space to interact, at scheduled time, with a psychologist, a psychiatrist or a peer support worker, in free groups); chat (asynchronous virtual space for any question or information).

We considered primary outcomes proposed by Cochrane Collaboration (Shek, 2010): hospital admissions, days of hospitalization, day-hospital admissions, day-program attendance (e.g. weekly), treatment compliance (voluntary discharge or missing scheduled date).

We considered, as secondary outcomes, variables closely associated with real-life functioning (Galderisi, 2015): global functioning (Italian translation of Global Assessment of Functioning Scale), quality of life (Short Form 36 item), social relationships (Personal and Social Performance), internalized stigma (Internalized Stigma Mental Illness Inventory), empowerment (Empowerment Scale).

Patients were divided into four cohorts:

– 1-using “app2gether” functions in the follow-up, attending day treatment program (n = 35);

– 2-attending day treatment program (n = 52);

– 3-attending transitional day-hospital program (n = 171);

– 4-not included in the IPOLT-program (n = 188).

Patients were included in the first group only based on their basic computer skills and fast Internet availability.

At first, we compared (2) and (3) with (4), as control group. For each patient, we considered an identical observation period before and after day-hospital admission (ANOVA, P < 0.05).

We found a significant improvement in primary outcomes and global functioning, but not in other secondary outcomes, for the groups (2) and (3) compared with (4).

Over 6-months observation, patients using “app2gether” functions in the follow-up showed:

– a significantly decrease in hospital admissions and hospitalization length, compared to non-IPOLT-program group;

– a reduction in day-hospital admissions and day-hospital attendance, compared to (2) and (3) groups;

– a notable effect on secondary outcomes, compared to all other groups.

A dedicated website in the IPOLT-program supports patients in their living's place, does not interfere with daily activities, decreases social costs, encourages community integration and reduces stigma.

Synchronous telepsychiatry allow a professionally modulated intervention in “here and now”; asynchronous contacts with specialists combine professional intervention with chances of autonomy and autoregulation. These services reduce costs, in terms of FTE (Full Time Equivalent), but not the efficacy.

Future advances in the websites should be designed, simplifying the contact surface with the treating-team and reducing the social impact of therapeutic practice.

A better understanding of the complex variables influencing real-life functioning and new sensitive tools to detect it are needed.

The authors have not supplied their declaration of competing interest.

The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus.

In this study, the altereration of the ARC neuropeptide/hormone levels in rats were determined as one of the weight gain mechanism. To examine olanzapine's weight gain effects, olanzapine was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides.

Food consumption was found to be increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and α-MSH decreased significantly but CART levels were also reduced unexpectedly. in conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain due to olanzapine therapy.

To assess effect of pelvic tilt by birth ball, sacrum-perinea heat therapy and combination use of them on active phase of physiologic labor.

In this randomized control trial, 120 primiparous volunteer with age 18-35 years, gestational age of 38–40 weeks, in one of hospitals of Iran university of medical sciences were randomly selected and divided in four groups: Pelvic tilt by using birth ball, sacrum perinea heat therapy, combined use of two mentioned methods and control group. Tools had 3 main parts of personal characteristic, client examination form and pain visual analogue scale (VAS). All ethical points were considered.

Equality of four groups had been checked before intervention. Lowest pain score first belong to pelvic tilt by birth ball then combined group and finally in heat therapy, which all were significantly less than control group. Significant decrease of pain had been seen in birth ball group and combined group during after 30 minutes intervention, but in the heat therapy group, it was seen after 60 minutes intervention (P-value < 0.05).

All three interventions of this study had significant effect and decreased labor pain during active phase, but highest decrease was in pelvic tilt by birth ball group and its effect started after 30 minutes intervention. It is suggested that that Obstetrics and Midwives consider these safe methods for labor pain management.

The authors have not supplied their declaration of competing interest.

Though Focus of mental health care is negative emotional state, positive psychology appeals to masses. Because troubled person not only wants relief but also wants a life of meaning & purpose (National Mental health plan 2003-2004, Australian Govt.). and purposeful life without mentally healthy family is difficult. So family's transformation's imperative (Welsh Assembly Govt. 2005 a).

To strengthen Family members to transform Dysfunctional family.

1. 1) Preserve family mental health & Prevent mental illness among family-members of mentally ill patient.

2. 2) Prevent deterioration of mentally ill patient.

Discussion -for therapeutic alliance.

Therapeutic Transformation of dysfunctional family -

1. (a) Family Therapy: Why? Because family therapy focuses on well-being which is over & above the absence of depression-anxiety etc. Family therapy addresses problem and not individual unlike other therapies (NIMH, EFTA).

2. (b) Psycho-education: To build positive emotions which facilitate skills & resources needed for recovery (Fredrickson). It includes (i) Transactional-analysis (ii) Proactive behavior (iii) Social maturity (Robert Kegan).

3. (c) Positive Psychotherapy (PPT): Recovery rate was 85% (30%-single therapy) when psychotherapy was clubbed with pharmacotherapy. Positive emotions promote psychological resilience & positive emotional granularity. PPT focuses on pleasant, engaged & meaningful life (Seligman 2002).

4. (d) Spiritual Psychotherapy: Inevitable to future Psychiatry, because meditation alters levels of Melatonin, Serotonin, boosts immune response. Contents: (i) Meditation – changes brain (Dr Zedel, 2010) (ii) Spiritually-augmented CBT (SACBT), (iii) IBMT (Tang Y Y)/Yog-Nigra.

Family mental health is achieved.

Thus attained family mental health will facilitate family's transformation.

The authors have not supplied their declaration of competing interest.

The Burnout Syndrome Study screened for burnout in psychiatric trainees in 22 countries, along with associated factors. This paper reports the results of the PHQ-9 depression screen that formed part of the study.

It is well documented that physicians have higher rates of mental illness compared to the general population. Post-graduate medical trainees may work long hours and be exposed to stressful or saddening situations regularly. Their environment and workload means they may not exhibit appropriate help-seeking behaviours and be at significant risk of depression.

The study used a cross sectional, multi-country online survey. Participants were asked to participate via an email invitation. The participants were asked to complete the PHQ-9 questionnaire, which is validated as a primary care self-administered screen for depression. Mixed methodology was used when recruiting trainees to obtain the most representative sample possible from each country. Statistical analysis was performed using SPSS.

Complete data was obtained from 1980 trainees with an average age of 31.9 years and with 2.8 years of training. The prevalence of depression in psychiatric trainees varied by country from 50% in Latvia to 7.1% in Belarus. The average rate of depression was 20.8%.

Prevalence of depression in the US general population is estimated at 6.7%, making the prevalence of depression in trainees of 20.8% a sign that action needs to be taken to reduce depression rates in trainees.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a multifactorial disease requiring treatment that manages a broad spectrum of symptoms. Cariprazine is a dopamine D3 and D2 receptor partial agonist antipsychotic candidate with preferential D3 receptor binding.

Evaluate the pharmacological/behavioral profile of cariprazine in animal models.

To determine the activity and receptor occupancy of cariprazine in rat models at doses that confer antipsychotic-like efficacy.

Cariprazine was evaluated in rat paradigms that model symptoms of schizophrenia, mania, and depression. Occupancy of cariprazine, aripiprazole, and risperidone at D3 and D2 receptors was also compared.

Cariprazine showed antipsychotic-like efficacy on conditioned avoidance response and amphetamine-induced motor activity tests (ED50: 0.8 and 0.1 mg/kg) with potencies similar to risperidone (ED50: 0.9 and 0.2 mg/kg) and greater than aripiprazole (ED50: 18 and 3.9 mg/kg). While all 3 compounds displayed high in vivo occupancy of D2 receptors, only cariprazine displayed potent in vivo occupancy of D3 receptors at antipsychotic-like doses (ED50 [% inhibition]: cariprazine, 0.43 mg/kg [99.3]; aripiprazole, >30 mg/kg [26.4]; risperidone: ~2.3 mg/kg [53.4]). At or below antipsychotic-like doses, cariprazine demonstrated antimanic-like, antidepressant-like, anxiolytic-like, and procognitive effects in rats. As determined using D3 receptor knockout mice, procognitive and antidepressant-like effects of cariprazine were shown to be mediated via the D3 receptor.

At antipsychotic-like effective doses in rats, cariprazine demonstrated balanced and significant occupancy at both dopamine D2 and D3 receptors; other antipsychotics displayed relatively low D3 receptor occupancy. Additionally, at antipsychotic-like doses cariprazine demonstrated efficacy in different rat models of mania, mood, anxiety, and cognition.

These findings demonstrate a lower autonomic power in panic disorder patients and tendency to increase it during the treatment.

Supported by: Project IGA MZ ČR NS10301-3/2009