There is substantial evidence indicating that pharmacological treatments targeting glutamatergic transmission are of potential utility in the treatment of drug addiction. The aim of this study was to evaluate the long-term outcome of glutamatergic treatments in patients with pathological gambling.

Fifteen patients fulfilling criteria for pathological gambling and receiving drugs with effects on glutamatergic transmission (amantadine, N-acetylcysteine, gabapentin, pregabalin and topiramate) were enrolled. Gambling craving (Gambling Symptom Assessment Scale, G-SAS, and visual analogue scale, VAS) and relapse (Gambling Timeline Follow Back, G-TLFB) rating scales were administered before and after treatment (1, 3, 6 months follow-up).

Gambling craving and behavior were significantly reduced (p < 0.001) during the study period. Glutamatergic medications also yielded an improvement in treatment retention.

Our results are discussed in the context of the glutamatergic hypothesis of addiction. Our data seem to confirm the utility of targeting the glutamatergic system for the treatment of PG, in particular by acting on craving and increasing treatment retention. in particular, glutamatergic medications may offer some advantages in preventing relapse.

Earthquakes, one of the major natural disasters, tend to be unpredictable, uncontrollable, and highly destructive. They lead to strong initial trauma and significant long-term effects such as posttraumatic stress disorder, depression, anxiety, or other symptoms.

In this research, posttraumatic stress, anxiety and depressive symptoms were studied among adolescents 6 months after Van-Erciş Earthquake 2011.

In the present study a total of 738 Turkish high school students, aged 13-17 years, participated in the study in Van city affected severely by the earthquake. Participants completed a set of questionnaires including the demographic measures, posttraumatic stress reactions, depression, anxiety and dissociation.

The results of the present study showed the presence of probable diagnosis of PTSD in 295 (40.69%), of anxiety in 384 (53.04%) and of depression in 245 (33.70%) of the adolescent examined. Multiple logistic and linear regression analyses were conducted to explore the predictive values of independent variables on development of posttraumatic, anxiety, depressive, and dissociative psychopathology among adolescents experienced Van earthquake.

Our results show high rates of PTSD, anxiety and depression symptoms in adolescents who survived the October 2011 Van-Erciş earthquake. Further, our results highlight the relevance of gender differences, previous psychopathology, trait anxiety, anxiety sensitivity in the response to mass trauma that should be taken into account when facing such events. Our results confirm the pervasive effects of a disaster and risk factors, such as an earthquake, for mental health in adolescents.

High rate of suicidal behavior during adolescence draws the research attention. Numerous motives of suicide attempts were previously described; nevertheless most adolescents reported disturbed relationships with peers and parents. Family background seems to be important, especially the relationship between parents.

To examine suicidality in adolescents and recognize the risk factors, especially adolescents’perceptions of interparental conflict.

To explore risk factors associated with suicidality in adolescents, with regard to relationships within family, with friends and personality characteristics.

The sample consisted of 161 Czech students (14-16 years old) who anonymously completed four questionnaires: CPIC (Children’s Perception of Interparental Conflict Scale), IPPA (The Inventory of Parent and Peer Attachment), PAQ (Personality Assessment Questionnaire), CASPI (Child-Adolescent Suicidal Potential Index).

Very high level of psychosocial distress was found in 45 % of respondents, 25 % admitted suicidal ideation or a history of suicidal attempt. The perceived interparental conflict, not the divorce, was confirmed as the important aspect for higher suicidal risk in adolescents. The perceived threat (higher feelings of danger resulting from the conflict situation and inability to influence the conflict) is the main feature of interparental conflict responsible for child maladjustment. Statistically significant differences between suicidal and non-suicidal adolescents were also found in the level of felt security in relationship with their mother, father and with peers. These groups differed in some personal characteristics too (aggressivity level, negative self-perception, emotional instability, and pessimism).

Results highlight potential targets for intervention among adolescents. Further research is needed to find sensitive predictors.

To study the effect of personal anxiety on relative risk of myocardial infarction (MI) and stroke and its relation with awareness and attitude towards the health in female population of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” program random representative sample of women aged 25–64 years (n=870) were surveyed in Novosibirsk. Levels of personal anxiety were measured at the baseline examination by means of Spilberger’s test. From 1995 to 2010 women were followed for 16 years for the incidence of MI and stroke.

High level of anxiety (HLA) in studied cohort revealed in 60% of women. Women with HLA had 1.5-3-fold growth of negative self-rated health (87.5%), about 90% had health complaints, more likely had negative behavioral habits and higher levels of job and family stress compared to those with lower levels of anxiety. Risk of MI development in women with HLA over 16 years of study was higher in 4.2 times (95%CI=1.946-18.583; p=0.05), risk of stroke was higher in 3.5 times (95%CI=1.020-12.015; p< 0.05). MI and stroke incidence rates were higher in married women having HLA with low and high educational level who being in both “middle executives” and “hard manual labor” social classes.

There is high prevalence of HLA in female population aged of 25–64 years. Women with HLA had poor selfrated health and awareness about their health and it associated with higher risk of MI and stroke over 16 years of follow-up.

The proportion of international medical graduates (IMGs) in Ireland has increased from 13.4% in 2000 to over 33% in 2010. Many of their countries of origin have different cultures, expectations of the doctor–patient relationship and communication styles than Ireland. These differences can adversely impact on the quality of care provided by IMGs. There is a lack of research on the impact of cultural differences on communication in the Irish context.

Semi-structured interviews were conducted with 16 IMGs in Drogheda Department of Psychiatry. Transcripts were analysed using nVivo10, a specialised computer programme for conducting qualitative analysis and analysed thematically.

General themes emerged relating to IMG experience of cultural differences in medicine and psychiatry and cultural differences in communication. IMGs did not find their proficiency in English to be a barrier to communication but did find accents, culture-specific sayings and non-verbal cues to be challenging. Differences in doctors’ status relative to patients and different expectations of the doctor–patient relationship were challenging and, at times, frustrating and annoying. It was generally recognised that training in cross-cultural communication skills would be beneficial to new IMGs although a small minority recognised no such issues. Significant differences in attitude to patient confidentiality in Ireland versus the country of origin were identified.

Consideration should be given to providing specific cross-cultural communication skills training for all IMGs training in Ireland focusing not just on verbal and non-verbal communication but also differences in the doctor–patient relationship, patient and relative expectations and medical confidentiality requirements.

The authors have not supplied their declaration of competing interest.

It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature.

We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India.

The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course.

Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness.

Growing up with β-thalassaemic family was analyzed. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.

The current study aims to test the hypothesis: Is suicide predictable? And try to classify the predictive factors in multiple suicide attempts.

A cross-sectional study was administered to 223 multiple attempters, women who came to a medical poison centre after a suicide attempt. The participants were young, poor, and single. A Regression Logistic Test was used to classify the predictive factors of suicide.

Women who had multiple suicide attempts exhibited a significant tendency to attempt suicide again. They had a history for more than two years of multiple suicide attempts, from three to as many as 18 times, plus mental illnesses such as depression and substance abuse. They also had a positive history of mental illnesses.

Results indicate that contributing factors for another suicide attempt include previous suicide attempts, mental illness (depression), or a positive history of mental illnesses in the family affecting them at a young age, and substance abuse.

Loin pain hematuria syndrome (LPHS) is a rare kidney disease with a prevalence of −0.012%. Its clinical features include periods of severe uni-or bilateral lion pain, accompanied by (microscopic) hematuria. It is often misdiagnosed as a psychiatric condition, particularly under the heading of a somatization disorder.

We describe the case of a patient who developed depressive symptoms after decades of suffering from severe intermittent bilateral loin pain.

To report a case-study, describing LPHS as a cause of severe chronic pain and persistent depressive symptoms.

A case-study is presented and discussed, followed by a literature review.

A 55-year-female was referred to a psychiatrist for her depressive symptoms and persistent periods of severe unilateral or bilateral lion pain and intermittent hematuria for over 25 years. There she was diagnosed with a depression and somatization disorder. She received amitriptyline for many years, without any effect. Finally, the patient opted for a second opinion in an academic hospital in Belgium where it was quickly discovered. After surgery, including renal denervation and kidney autotransplantation, her somatic problems and depressive mood disappeared.

The awareness of LPHS is still very limited in medicine. This may lead to incorrect diagnoses, including psychiatric disorders such as somatization disorder. More awareness could lead to earlier diagnosis and prevent the consequences of severe debilitating pain.

The authors have not supplied their declaration of competing interest.

Lithium is widely used in the treatment of the bipolar disorder. Once introduced, it is necessary to carry out an adequate control of the therapeutic range, since it is potentially toxic, and can affect various organs.

To present the case of a patient suffering from lithium poisoning and to review the symptoms of lithium poisoning.

A descriptive study of a clinical case and review of the literature

49-year-old woman, married. Diagnosed with bipolar disorder. She went to the emergency room due to a low level of consciousness, kidney failure, trembling of the limbs, hyperthermia and leukocytosis. In the last two weeks, the patient has reduced her intake of food, not water, finding herself more and more shaky and less reactive. Lithium in blood at admission 1.71, so conventional dialysis was performed with a progressive decrease into 0.65. On examination, he is practically mutist, bradypsychia with a significant response latency. Clinical judgment: Accidental lithium poisoning.

The primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Severe lithium neurotoxicity occurs almost exclusively in the context of chronic therapeutic administration of lithium and rarely results from acute ingestion of lithium, even in patients currently taking lithium. As such it is an iatrogenic illness, occurring in patients who have identifiable clinical risk factors: nephrogenic diabetes insipidus, older age, abnormal thyroid function and impaired renal function.

No significant relationships.

It has been recognised that poor sleep quantity (i.e. short sleep duration) is associated with an increased risk for physical and mental diseases. However, there have been fewer studies on the associations of poor sleep quality with physical and mental health.

The subjects were 3684 (2471 males and 1213 females) employees aged 20-65 working in local government in Japan. A questionnaire survey was conducted in January 2003. Sleep quality and physical and mental health were evaluated using Pittsburgh Sleep Quality Index (PSQI) and Short Form 36 (SF-36), respectively. Logistic regression analysis was used to evaluate whether each subscale of PSQI was independently associated with poor physical and mental health (the lowest 25 percentile of the Physical and Mental Component Summary (PCS and MCS) Scores of SF-36), after adjustment for potential confounding factors.

Subjective sleep quality, sleep disturbances, use of sleep medication, and daytime dysfunction were significantly associated with poor physical health. Subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction were significantly associated with poor mental health. The associations of subscale scores of poor sleep quality with health were relatively stronger for poor mental health than for poor physical health. Sleep duration (i.e. sleep quantity) was not associated with poor physical and mental health.

Some of the poor sleep quality measures were independently associated with both poor physical and mental health of Japanese civil servants. Longitudinal study is necessary to confirm the causal relationships between sleep quality and health.

There are often substantial delays before diagnosis and initiation of treatment in people bipolar disorder. Increased delays are a source of considerable morbidity among affected individuals.

To investigate the factors associated with delays to diagnosis and treatment in people with bipolar disorder.

Retrospective cohort study using electronic health record data from the South London and Maudsley NHS Foundation Trust (SLaM) from 1364 adults diagnosed with bipolar disorder. The following predictor variables were analysed in a multivariable Cox regression analysis on diagnostic delay and treatment delay from first presentation to SLaM: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder.

The median diagnostic delay was 62 days (interquartile range: 17–243) and median treatment delay was 31 days (4–122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18–3.06) and treatment delay (4.40, 3.63–5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33–0.41) and substance misuse disorders (0.44, 0.31–0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.

Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder, particularly those with alcohol/substance misuse disorders. These findings highlight a need to better identify the symptoms of bipolar disorder and offer appropriate treatment sooner in order to facilitate improved clinical outcomes. This may include the development of specialist early intervention services.

The authors have not supplied their declaration of competing interest.

We aimed is to describe the phenomenology of mental disorders in migrants referred to Bologna West Community Mental Health Centre(CMHC), by analysing the psychopathological dimensions that underlie their clinical diagnoses.

We recruited all migrants who attended the Bologna West CMHC between May 1999 andJuly 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis:(1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlieclinical diagnoses.

We found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism ofthe psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms.

A mixed categorical-dimensional approach adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of migrants patients.

Schizophrenia is a chronic disease; consequently, long-term maintenance of efficacy is an important clinical goal.

To evaluate lurasidone as maintenance treatment for schizophrenia.

To demonstrate maintenance of efficacy with lurasidone.

Adult patients experiencing an acute exacerbation of schizophrenia received 12–24 weeks of open-label treatment with lurasidone (40–80 mg/d, flexibly dosed). Those who maintained clinical stability for ≥12 weeks were randomized to placebo or lurasidone (40–80 mg/d, flexibly dosed) and entered the 28-week, double-blind withdrawal phase.

Of 676 enrolled patients, 285 met protocol-specified stabilization criteria and were randomized to lurasidone (N=144) or placebo (N=141). Relapse occurred in a greater proportion of patients receiving placebo (41.1%) than lurasidone (29.9%). Time to relapse based on Kaplan-Meier survival analysis was significantly longer for lurasidone compared with placebo (log-rank test, p=0.039). Lurasidone was associated with a 33.7% reduction in risk of relapse versus placebo (Cox hazard ratio [95% confidence interval], 0.663 [0.447, 0.983]; p=0.041). Patients receiving placebo demonstrated significantly greater worsening on PANSS and CGI-S scores compared to lurasidone-treated patients (PANSS mean change, +12.4 vs +8.3, p=0.029; CGI-S mean change, +0.7 vs +0.4, p=0.015; ANCOVA-LOCF). The discontinuation rate due to adverse events was 13.9% for lurasidone and 15.6% for placebo. Minimal changes in weight, prolactin, lipid, and glucose parameters were observed.

This study demonstrated the efficacy of lurasidone for the maintenance treatment of patients with schizophrenia. Lurasidone was generally well tolerated, with minimal effects on weight and other metabolic parameters.

Study sponsored by Sunovion Pharmaceuticals Inc.

ClinicalTrials.gov identifier: NCT01435928

The efficacy of venlafaxine extended-release (XR) at doses between 75 mg/d and 300 mg/d has been demonstrated in patients with recurrent major depressive disorder (MDD) over 2.5 years. This analysis evaluated the long-term efficacy of venlafaxine XR ≤225 mg/d, the approved dosage in many countries.

In the primary multicenter, double-blind trial, outpatients with recurrent MDD (N=1096) were randomized to receive 10-week acute-phase treatment with venlafaxine XR (75 mg/d to 300 mg/d) or fluoxetine (20 mg/d to 60 mg/d), followed by a 6-month continuation phase. Subsequently, at the start of 2 consecutive, double-blind, 12-month maintenance phases, venlafaxine XR responders were randomized to receive venlafaxine XR or placebo. Data from the 24 months of maintenance treatment were analyzed for the combined end point of maintenance of response (ie, no recurrence of depression and no dose increase above 225 mg/d), and each component individually. Time to each outcome was evaluated with Kaplan-Meier methods using log-rank tests for venlafaxine XR-placebo comparisons.

The analysis population included 114 patients who had received venlafaxine XR doses less than or equal to 225 mg/d prior to maintenance phase baseline (venlafaxine XR: n=55; placebo: n=59). Probability estimates for maintaining response were 70% for venlafaxine XR and 38% for placebo (P=0.007), for no dose increase were 76% and 58%, respectively (P=0.019), and for no recurrence were 87% vs 65%, respectively (P=.099).

These data confirm venlafaxine XR is effective maintaining response at doses ≤225 mg/d for up to 2.5 years in patients with MDD.

Lurasidone has demonstrated efficacy in the treatment of schizophrenia in a series of short-term placebo-controlled trials.

To evaluate the safety, tolerability and effectiveness of lurasidone in the long-term treatment of patients with a DSM-IV-TR diagnosis of schizophrenia.

Patients who completed a 6 week, double-blind, placebo-controlled trial received once-daily, flexible-doses of lurasidone, 40–120 mg in a 22 month open-label extension study. An observed case analysis was performed on change from pre-treatment baseline in safety and efficacy parameters.

250 subjects entered the study; 39.8% completed 12 months and 26.8% completed 22 months of treatment. Lurasidone treatment was associated with a mean endpoint change in weight of +0.7 kg. Median endpoint change at Month 12 and Month 24, respectively, was -1.0 and −9.0 mg/dL for total cholesterol; 0.0 and −1.0 mg/dL for LDL; +1.0 and −11.0 mg/dL for triglycerides; +4.0 and +2.0 mg/dL for glucose; 0.0 and +0.1% for HbA1c; and −1.3 and −1.1 ng/mL for prolactin. The mean PANSS total score was 69.5 at extension baseline. The mean (95% CI) endpoint change from extension baseline in PANSS total score was −0.5 (95%-CI: −0.7, −0.3). Overall, 14.7% of patients discontinued due to an adverse event. Adverse events occurring with an incidence ≥10% were schizophrenia (12.4%), akathisia (10.8%) and somnolence (10.8%).

In this 22 month extension study, treatment with lurasidone was associated with minimal effects on weight, glucose, and lipids. Subjects demonstrated sustained improvement in the PANSS total score for up to 24 months of lurasidone treatment.

Correction of the syndrome of hyperprolactinemia is very important problem of psychopharmacotherapy.

Comparative assessment of efficacy by bromocriptin and cabergolin action in syndrome of hyperprolactinemia in patients with schizophrenia and schizoaffective disorder.

120 female patients with diagnosis of schizophrenia (86) and schizoaffective disorder (34) were treated for a long period with risperidon; all of them suffered of hyperprolactinemia. Bromocriptin and cabergolin were used for the treatment of hyperprolactinemia. All patients were separated for 2 groups: patients of the 1st group (n = 64) were treated with bromocriptin (5 mg daily/2 months), patients of the 2nd group (n = 56) - with cabergolin (5 mg weekly/2 months). The level of prolactin was estimated in blood serum using immunoenzyme method.

In the 1st group 48 patients (75%) were responders: prolactin level decreased from 1997 ± 504 m ME/I to 1125 ± 293 m ME/I (p ≤ 0.05) and in 16 (25%) nonresponders prolactin level did not change - 2165 ± 606 m ME/I before and 2190 ± 441 m ME/I after the treatment (p ≥ 0.05). In the 2nd group 48 patients were responders (85.7%) and serum prolactin level was reduced in the range of 30-75% from 2294 ± 634 mME/l to 1109 ± 240 mME/l (p ≤ 0.05). In the nonresponders (8 patients; 14.3%) changes of serum prolactin were insignificant (2514 ± 578 mME/l/ before and 2084 ± 451 mME/l after the therapy; p ≥ 0.05).

Investigation has shown a high level of efficiency of cabergolin (dostinex) and bromocriptin in correction of hyperprolactinemia.

The authors have not supplied their declaration of competing interest.

Cariprazine is a potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors.

Summarize data from 2 Phase III, randomized, double-blind (6-week), placebo-controlled trials of fixed-dose cariprazine (3mg/d and 6mg/d, NCT01104766) and flexible-dose cariprazine (3–6mg/d and 6–9mg/d, NCT01104779) in adults with acute exacerbation of schizophrenia.

Evaluate the efficacy, safety, and tolerability of cariprazine in schizophrenia.

Primary and secondary efficacy parameters were change from baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S), respectively, and were analyzed using a mixed-effects model for repeated measures.

Randomized patient populations: 617 (NCT01104766; 153 placebo, 155 cariprazine 3mg/d, 157 cariprazine 6mg/d, 152 aripiprazole) and 446 (NCT01104779; 147 placebo, 151 cariprazine 3–6mg/d, 148 cariprazine 6–9mg/d). Improvement from baseline to Week 6 on PANSS total scores was significantly greater with cariprazine vs placebo: least square mean difference (LSMD) was −6.0 (3mg/d, P=.0044), −6.8 (3–6mg/d, P=.0029), −8.8 (6mg/d, P<.0001), and −9.9 (6–9mg/d, P<.0001). Cariprazine was significantly superior to placebo on CGI-S: LSMD was −0.4 (3mg/d, P=.0044), −0.3 (3–6mg/d, P=.0115), −0.5 (6mg/d, P<.0001), and −0.5 (6–9mg/d, P=.0002). Aripiprazole (active control, NCT01104766) was superior to placebo on both measures (LSMD: PANSS=−7.0, P=.0008; CGI-S=−0.4, P=.0001). The only common cariprazine-related TEAE (≥5% and twice rate of placebo) that occurred in both studies was akathisia. Changes in metabolic parameters were small and similar to placebo in both studies.

Cariprazine was effective and generally well tolerated in the treatment of schizophrenia.