Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT.

There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS.

Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway.

All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers.

We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments.

This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.

Excellence ix xedical training xnd specializatxon is nx xonger restricted tonxtional perspectixes. In an ever-growixx gloxal excxxnge of people and ideas, we feel theneed to pxovide a programme ofxering psychiatry trainees to gather xnxerculxural expxrience.

The EFPT (Xxxxxxxx Federation of Psychiatry Trainees) Exchxnge Programmeaims to promote an intercultural xrofessional exchange and cooxeratxon among psychiatrytrainees, giving the opportunitx xo engage xn local activities, gainixg experxence with diversemental health systems, with different illness xanifxstations and treatment options, xlus toexperiexce a distinct traxnxnx programxe.

To sxt up the first European Psychiatry Exchange Programme.

Thx EFPT Exchange has, so far, the participation of 7 countries offerinx hoxtinstitutions: Crxatia, Denmark, France, Ireland, Portugal, Spain and United Kingdom. It offers2-6 weeks obserxational pxacxxexts. There are 2 main application periods each year: winxerand summer. Advertising was xone via the EFPT network of trainees by xmail andlocally.The selection criteria included: motivatixn letter, CV, language proficiency andseniority in training.

This first applicatxon period had 36 applications, and candidates were trainees in11 differext countries: Croatia, Finland, Franxe, Ireland, Italy, Portugal, Romaxia, Serbia,Spain, Turkey and United Kingdom.

Taking xnto account the high impact of an ever-growing mobility of patxentsand doctors, xhx XXXX promotes intercultural learning for improving the mental health caresexxice for xhe next generation of psychiatrists. In xhe future, we expxct to haxe moreplacements and mxre xarticipating countries.

Sham-controlled studies of neurofeedback are aimed to provide evidence-based data regarding its efficacy. However, a sophisticated sham procedure may turn out to be an intervention rather that a neutral control.

Data from a single-case cross-over sham-controlled study of NF in migraine were analyzed to access the effects of sham-NF. The study included 5 females with chronic migraine and was divided into 4 phases: pre-evaluation (≥ 2 weeks), treatment 1 (5 weeks), treatment 2 (5 weeks), post-evaluation (≥ 2 weeks), where treatment 1 and 2 included 10 infra-low frequency NF and 10 sham-NF sessions at T3T4 site in randomized order. Participants filled out a computerized diary about headache and emotions.

Sham-NF resulted in some reduction of the level of tension (0.8 ± 0.7 vs. 1.1 ± 0.5, P = 0.1) and anxiety (0.56 ± 0.5 vs. 0.95 ± 0.4, P = 0.07) as measured by the mean value in the diary (rating from 0 - no emotion, to 3 - very intense). While the total frequency of headache was not influenced by sham-NF (40 ± 11% vs. 40 ± 7% days, P = 1), a tendency towards an increase in quantity of severe headaches (42 ± 18% vs. 20 ± 18% days, P = 0.07) and in the need for drug intake (74 ± 27% vs. 44 ± 30% days, P = 0.07) was observed. We supposed that expectation of feedback and failure to receive it during sham sessions may have possible negative effects, while frequent visits to the clinic and contact with the therapist may explain reduction in anxiety.

Sham-NF seems to have both placebo and nocebo effects, which should be considered during interpretation of results of the studies.

The authors have not supplied their declaration of competing interest.

The education and training of doctors specialising in Child and Adolescent Psychiatry (CAP) varies substantially across Europe. There is a paucity of information available about training quality. This prompted an initial training survey led by Dr E Barrett (2010) which was expanded upon by the CAP working group in the 2010 EFPT international forum in Dubrovnik to create ‘country reports’ for 2010–2011.

The objectives of this study were to collect information relating to key aspects of CAP training programmes in Europe in a systematic way in order to start a ‘Training Database’ that can be held centrally by the EFPT. Information will be added to the database every year following EFPT annual international meetings.

We aim to better understand the training structures in CAP across europe to help inform best practice standards for training.

A pro-forma word document was emailed to all EFPT CAP contacts: there were 20 contacts emailed.

So far we have a response rate of over 60% and we are continuing to collect and collate relevant data. This survey highlighted a large variation in CAP training across Europe. It represents the basis for systematic data collection on an international level, and will help focus on areas where CAP training could be improved.

This survey highlights a large variation in CAP training across Europe. It represents the basis for systematic data collection on an international level, and will help focus on areas where CAP training could be improved.

N-acetylcystein (NAC), a precursor to the amino acid cysteine, has been emerging as an interesting add-on treatment in several psychiatric conditions and especially in Obsessive Compulsive Disorder (OCD). These results may be linked to its metabolic profile: antioxidant properties through glutathione production; anti-inflammatory properties; and modulation of the glutamatergic and dopaminergic systems of neurotransmission.

Review the potential therapeutic effects of NAC in psychiatry, with main focus on syndromes of the obsessive-impulsive spectrum with report of a clinical case.

Case report of a patient with OCD and Hoarding disorder, with complete clinical remission after treatment with NAC; bibliographic search using PubMed/MedLine database with the following keywords: n-acetylcysteine; OCD; hoarding.

We report and discuss the case of a 44-year-old man with a diagnosis of Obsessive Compulsive Disorder with orderliness and contamination themes, coupled with Hoarding disorder. The patient experienced gradual though slight improvement with Paroxetine (60 mg/day) to which was subsequently added Risperidone (2 mg/day) with further slight improvement. In combination with the previously given pharmacological agents, NAC (1800 mg/day) was introduced with subsequent complete remission of all symptoms.

Studies suggest that NAC may be useful in the treatment of several psychiatric conditions. Our case report suggests direct relation between treatment with NAC and remission of obsessive and hoarding symptoms. Although encouraging, additional controlled research will be required to ascertain NAC clinical usefulness.

Domestic violence against women has increasingly been recognized nationally and internationally as a serious problem. Violence against women is a troubling phenomenon in Russia. Meanwhile domestic abuse against women often results in long-term mental health problems.

The main aim of the study was to find out the psychological and psychiatric consequences of violence against women and to determine the origins of crimes committed by abused females.

A cohort of 18 females was examined by forensic psychiatrists. All women had committed crimes of violence (murders, attempted murders). Details of background, psychiatric and offending history were extracted. Each item was assessed with the help of descriptive statistics.

A research has been carried out on the basis of psychiatric and forensic psychiatric assessment of two groups of women who had a long history of violence by their husbands or partners. Clinical assessment has revealed depression, anxiety, low self-esteem, post-traumatic stress disorder, drug abuse. All women underwent forensic psychiatric assessment as they had committed serious crimes of violence. The research has revealed two types of homicides. Women of the first subgroup displayed pathological altruistic motivation of their children. Women of the second subgroup had committed homicides of their husbands and partners whose violence towards women escalated in severity.

The research shows the necessity of domestic violence prevention by legal provisions and multidisciplinary research with participation of psychiatrists, psychologists, sociologists, human rights advocates and feminist societies.

The authors have not supplied their declaration of competing interest.

Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England.

We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis.

Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, −786;31) to £599 (−1,321;−156) (in 2020–2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [−0.03;0.05] to 0.01 QALY, [−0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving.

Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.

Approximately one-third of patients with psychotic disorders does not respond to standard antipsychotic treatments. Consensus criteria for treatment resistance (TR) may aid the identification of non-response and subsequent tailoring of treatments. Since consensus criteria require stability of clinical status, they are challenging to apply in first-episode psychosis (FEP). This study aims to investigate (a) if an adaptation of consensus criteria can be used to identify FEP patients with early signs of TR (no early clinical recovery—no-ECR) after 1 year in treatment and (b) to what extent differences in antipsychotic treatments differentiate between outcome groups.

Participants with FEP DSM-IV schizophrenia spectrum disorders were recruited during their first treatment. A total of 207 participated in the 1-year follow-up. Remission and recovery definitions were based on adaptations of the “Remission in Schizophrenia Working Group” criteria and TR on adaptations of the “Treatment Response and Resistance in Psychosis” (TRRIP) working group criteria.

97 participants (47%) could be classified as no-ECR, 61 (30%) as ECR, and 49 (23%) as with partial ECR (P-ECR). Statistically significant baseline predictors of no-ECR matched previously identified predictors of long-term TR. Only 35 no-ECR participants had two adequate treatment trials and met the full TRRIP criteria. 21 no-ECR participants were using the same medication over the follow-up year despite the lack of significant effects.

The difference in the percentage of FEP participants classified as no-ECR versus TR indicates that we may underestimate the prevalence of early TR when using consensus criteria.

Depression is one of the main causes of incapacity worldwide. Research has shown that mindfulness practice, self-compassion promotion, and spiritual well-being are beneficial for depressed individuals.

Analyze the associations between compassion, mindfulness, and spiritual well-being, during and after a therapeutic intervention (concluded less than a year ago).

To determine if mindfulness, self-compassion, and spiritual well-being are predictors of depression.

Patients diagnosed with chronic depression were treated in a residential therapeutic community for a period of six to eight months. The 63 participants (M = 32.84, SD = 10.24, range = 15–50 years old; 32 during treatment; 31 after treatment) were assessed with the Beck Depression Inventory, the Questionnaire of the Five Facets of Mindfulness, the Self-Compassion Scale, and the Spiritual Well-Being Questionnaire.

There were differences in mindfulness, self-compassion, spiritual well-being and depression by sex, existence of previous psychiatric treatment, moment of the study (during versus after intervention), and depression levels. After intervention the group had higher levels of mindfulness and self-compassion (common humanity) and lower levels of over-identification, compared with group during treatment. The predictors of depression were the self-judgment dimension of the self-compassion scale and, negatively, the mindfulness dimensions of non-reactivity and non-judging, and the spiritual well-being dimension of personal well-being.

Results confirm the relationship between the study variables and depression. This reinforces the importance of intervention based on positive psychology enhancing positive areas of human experience, rather than focusing on psychological pain, weaknesses, and disabilities.

The authors have not supplied their declaration of competing interest.

A negative attitude towards the body supposed to lead to eating disorders and to increase the level of social anxiety.

The research aim is to study the characteristics of eating behavior and social anxiety in women who have negative attitude towards their body.

The following methods have been used: Multidimensional Body-Self Relations Questionnaire (MBSRQ); Eating Attitudes Test (EAT-26); Brief Fear of Negative Evaluation (BFNE); Iowa–Netherlands Comparison Orientation Measure (INCOM), Social avoidance and distress scale (SADS). The sample consists of 98 women in the age from 18 to 60 years belonged to three age groups: Group 1: N=41, mean age 21.0+3.1; Group 2: N=29, mean age 29,5+4,9; Group 3: N=28, mean age 47,5+12,5.

We have found out a statistically significant correlation between the negative attitude towards the body and the social anxiety. The more a woman dislike her appearance the higher is the level of social anxiety and the higher is the risk of eating disorders. It should be mentioned that all the negative tendencies are more prounouced in the youngest age group.

The research results can be implemented when designing prevention programs. Such programs are extremely important for young women in the age from 18 to 24 years as they have the highest risk of forming an eatind disorder as well as the social anxiety disorder.

The author has not supplied his declaration of competing interest.

Metabolic dysregulation is currently considered a major risk factor for hippocampal pathology. The aim of the present study was to characterize the influence of key metabolic drivers on functional connectivity of the hippocampus in healthy adults.

Insulin resistance was directly quantified by measuring steady-state plasma glucose (SSPG) concentration during the insulin suppression test and fasting levels of insulin, glucose, leptin, and cortisol, and measurements of body mass index and waist circumference were obtained in a sample of healthy cognitively intact adults (n = 104). Resting-state neuroimaging data were also acquired for the quantification of hippocampal functional cohesiveness and integration with the major resting-state networks (RSNs). Data-driven analysis using unsupervised machine learning (k-means clustering) was then employed to identify clusters of individuals based on their metabolic and functional connectivity profiles.

K-means clustering identified two clusters of increasing metabolic deviance evidenced by cluster differences in the plasma levels of leptin (40.36 (29.97) vs. 27.59 (25.58) μg/L) and the degree of insulin resistance (SSPG concentration: 161.63 (65.27) vs. 125.72 (66.81) mg/dL). Individuals in the cluster with higher metabolic deviance showed lower functional cohesiveness within each hippocampus and lower integration of posterior and anterior components of the left and right hippocampus with the major RSNs. The two clusters did not differ in general intellectual ability or episodic memory.

We identified two clusters of individuals differentiated by abnormalities in insulin resistance, leptin levels, and hippocampal connectivity, with one of the clusters showing greater deviance. These findings support the link between metabolic dysregulation and hippocampal function even in nonclinical samples.

Interpersonal sensitivity can be explained as a personality trait in which there is an excessive and expanded awareness of the behavior and emotions of others. Individuals having high interpersonal sensitivity are sensitive to interpersonal relationships and self-deficiencies in comparison to others. Studies report that high interpersonal sensitivity can cause low self-esteem and feelings of insecurity.

The objective of this study was to examine the level of interpersonal sensitivity in individuals with an at-risk mental state (ARMS) for psychosis compared to the individuals not at risk for psychosis.

A total sample of 50 individuals was recruited from Bahria University, Karwan-e-Hayat and Karachi Psychiatric Hospital: 25 with ARMS for psychosis and 25 participants who were not ARMS, according to scores on Schizophrenia Proneness Inventory-Adult (SPI-A). All of the participants then responded to self-report questionnaire on Interpersonal Sensitivity Measure.

Results showed that the group with ARMS had a significantly higher interpersonal sensitivity on average (112.5) as compared to healthy individuals (91.8). Results show significant difference in both of the groups (t = –5.049; P < .0001) indicating that interpersonal sensitivity in people with ARMS was relatively high compared to those who were not at risk.

This study suggests that being ‘hypersensitive’ to interpersonal interactions is a psychological feature of the potentially prodromal phase of psychosis. Addressing difficulties in interpersonal relationships and offering early psychotherapeutic interventions can be beneficial, not only in averting serious illness, but preventing loss to individual and national productivity.

The authors have not supplied their declaration of competing interest.

Olanzapine is an atypical antipsychotic medication, previously expected to be safe in terms of hematological side effects and an alternative choice to clozapine in patients who develop hematotoxicities. However, since olanzapine was introduced to the market, a lot of cases reports have been published revealing it could cause hematoxicity. Some of them indicate that olanzapine induces agranulocytosis. Because of that, it raises the concerns about hematological safety of olanzapine.

To date, no review discusses this topic specifically, so we conducted a systemic review to explore and address this issue.

We searched Pubmed, Google Scholar, Ovid and Medline databases for articles between 1998 and 2015 that include keywords olanzapine, leukopenia, neutropenia, and agranulocytosis.

A total of 38 publications were identified. The case reports included patients aged 16 to 83 years. Doses ranged from 2.5 to 30 mg. After starting treatment, onset of hematotoxicity varied from the first day to 2–3 years, but most commonly within the first month. Also, olanzapine could induce leukopenia in patients who have never developed drug-related leukopenia.

Among antipsychotic medications, olanzapine is the third leading cause of neutropenia and the second leading cause of atypical antipsychotic medication. Because of the small body of literature regarding the hematotoxic side effects of olanzapine, we encourage further research to understand the mechanism by which olanzapine causes granulocytopenia. The identification of risk factors could facilitate the development of new surveillance guidelines in patients taking olanzapine. We recommend that the guidelines of using and monitoring olanzapine need to be reconsidered.

The authors have not supplied their declaration of competing interest.

Explore the neurocognitive and temperament profile of borderline personality disorder (BPD) and schizotypal personality disorder (SPD) to better understand their underlying neurobiology for improved treatment.

17 BPD, 16 SPD, and 15 healthy controls (HCs) were given a comprehensive neuropsychological battery (CANTAB), the Iowa Gambling Task, a time perception task, and questionnaires of impulsivity, temperament, emotion, and frontal behavior (measures orbitofrontal cortex (OFC) dysfunction).

BPD and SPD patients performed significantly worse on the delayed match to sample (DMS) task compared to HCs, but had preserved function on decision-making, planning, time perception and attention tasks. SPD patients performed significantly worse on spatial working memory (SWM) tasks, and had higher religious commitment scores than HC and BPD groups, which correlated with their SWM deficits. BPD patients had significantly more frontal behaviors and emotions than both groups, which correlated with their emotionality, impulsivity, BPD symptoms, and temperament traits.

Both BPD and SPD groups had a deficit on the DMS task, sensitive to medial temporal lobe (MTL) dysfunction, but only SPD patients had SWM deficits, indicative of dorsolateral frontal cortex (DLFC) dysfunction, which correlated with their high religious commitment in line with their odd beliefs and magical thinking. Only BPD patients had frontal behavior deficits, related to OFC dysfunction, which positively correlated with their emotionality, impulsivity, and temperament traits. While both disorders may have a deficit in MTL function, DLFC dysfunction may contribute to SPD symptoms, and OFC dysfunction to BPD symptoms, suggesting treatment should target unique prefrontal cortex regions respectively.