Pregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.

To describe the use of pregabalin in adults with intellectual disabilities.

A descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).

Fourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.

Pregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Valproic acid is a psychotropic drug used for several years, due to its properties as a mood stabilizer, being considered as first-line treatment for bipolar disorder. In addition to its teratogenic potential, which prevents its recommendation for the treatment of bipolar disorder in women of childbearing age, valproic acid is associated with some side effects, such as gastrointestinal symptoms, alopecia, weight gain, tremor or hepatotoxicity. Hyperammonemia is a side effect that is little described, but relatively frequent, and may progress to variable encephalopathy.

The authors describe a clinical case of a 48-year-old female patient, hospitalized due to a manic episode, who was prescribed valproic acid, in association with lorazepam and olanzapine.

After three days on a dose of 1000mg of valproic acid, the patient began an acute condition of confusion, psychomotor retardation, temporal-spatial disorientation and ataxia. Infection, electrolyte disturbance and acute cerebral event were excluded. Noteworthy only hyperammonemia. Valproic acid was withdrawn and replaced by lithium, with the patient recovering from the confusional state two days later.

Hyperamonemic encephalopathy secondary to valproic acid was concluded. The mechanisms of valproic acid-linked hyperammonemia are not clear, although it appears to be independent of hepatotoxicity. The most studied hypotheses are related to glutamine reabsorption and serum levels carnitine in patients medicated with valproic acid.

It is essential that there is a high level of suspicion in clinicians for this secondary effect of valproic acid, in order to adequately treat the patient who presents with acute confusional conditions, not explained by other complications.

No significant relationships.

The work presented was funded by the Dutch ministry of Infrastructure and transport and the European Committee.

European data on health-related quality of life (HRQoL) in adults with attention deficit/hyperactivity disorder (ADHD) in the general population is sparse.

To report HRQoL in UK adults with ADHD.

UK residents aged 18–55 years with a diagnosis of adult ADHD completed an online, cross-sectional survey including questions on disease history, the EuroQol Five Dimensions questionnaire with five-levels (EQ-5D-5L) and the Work productivity and activity impairment questionnaire: general health (WPAI:GH). ADHD symptom severity was assessed by telephone using ADHD rating scale version IV with adult prompts (ADHD-RS-IV).

The survey was completed by 233 participants (65.2% women; 77.3% white British), mean age 32.6 years (standard deviation [SD] 9.5), mean ADHD-RS-IV total score 43.46 (SD 7.88). Their mean EQ-5D-5L utility score of 0.74 (SD 0.21) was lower than the UK population norm of 0.86 (SD 0.23).[1] WPAI:GH scores indicated that health problems resulted in impairments of 32.04% in work productivity and 45.79% in regular daily activities. Regression analyses adjusting for gender, age and comorbidities demonstrated associations between EQ-5D-5L utility scores and gender (men had lower scores, P < 0.001), work impairment due to health problems (increasing impairment was associated with lower scores, P = 0.005) and age (for each additional year of age, scores decreased by 0.007, P = 0.010).

These results highlight the impact on health utility, work productivity and regular daily activities, and add to the description of the disease burden of adult ADHD in the UK.

This study was funded by Shire Development LLC.

Kings College London research support account for Asherson received honoraria for consultancy to Shire, Eli-Lilly and Novartis educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech speaker at sponsored events for Shire, Lilly and Novartis.

Haloperidol is one of the first-generation antipsychotics which is used widely around the world and still has its place in psychotic disorders along with his documented antimanic properties.

It acts by blocking essentially dopaminergic receptors but also serotonergic and alpha-adrenergic receptors.

Haloperidol has many side effects, especially extrapyramidal symptoms. Oedema associated with haloperidol is a rare side effect.

The aim of this presentation is to describe the case of a young female who developed a rare side effect of haloperidol.

we conducted a review of literature on different data base about this side effect in order to discuss its potential underlying mechanisms.

Here we report a case of a 24-year-old female with the history of bipolar disorder type 1, and an allergy to chlorpromazine. She was admitted to our psychiatric department for a manic episode with psychotic features and was initially treated with 50 mg of Haloperidol in addition to 30 mg of valium per day. She developed pronounced oedema of the face and upper limbs after two weeks of treatment. All of the paraclinical examinations including blood cell count, liver function tests, renal function tests, serum electrolytes, ECG, urine test didn’t show any abnormalities. We solicited the opinion of both nephrology and pharmacovigilance and concluded to an allergic oedema.

The symptoms disappeared 10 days after the discontinuation of haloperidol which suggested a potential incrimination of this drug

As far as we know, there are very few reports of allergic oedema with haloperidol in the literature. Potential underlying mechanisms will be discussed.

Through this case study, we aimed to focus attention on this very rare but still possible side effect.

None Declared

Remission and recovery rates for people who have had a first episode psychosis (FEP) remain uncertain.

We conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies and conducted meta regression analyses to investigate potential moderators.

A systematic literature search of major electronic databases without language restrictions was conducted from database inception until July 1, 2016. Longitudinal studies with follow up greater than 1 year reporting data on remission or recovery rates in FEP were included.

Seventy-nine studies were included representing 19,072 FEP patients (mean age = 26.9 years, male = 59.5%). The pooled rate of remission among 12,301 individuals with FEP was 57.9% (95%CI: 52.7–62.9, Q = 1536.3, P< 0.001, n = 60 studies, mean follow up = 5.5 years). Restricting the analysis to studies, which used the remission in schizophrenia working group (RSWG) criteria (n = 25 studies, n = 6909 patients), the pooled remission rate was 56.9% (95%CI: 48.9–64.5, Q = 656.9). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 37.9% (95%CI: 30.0–46.5, Q = 1450.8, studies = 35, P = 0.006, average follow up = 7.2 years). Recovery rates were higher (P< 0.05) in North America compared to other regions.

Our data suggest that remission and recovery rates in FEP may be more favorable than previously thought. We observed stability of recovery rates after the first two years, suggesting that a progressive deteriorating course of illness is not typical. While remission rates have improved over time, recovery rates have not, raising questions about the effectiveness of specialist early intervention services in achieving improved recovery.

The authors have not supplied their declaration of competing interest.

Adolescents with congenital heart disease are at increased risk for developingpsychological distress.

To assess the prevalence of depression and anxiety in adolescents withcongenital heart disease, and to identify the predictors related to thesedisorders.

This is a cross-sectional case-control study. A total of 60 adolescents withCHD aged from 12-18 years and 30 apparently healthy adolescents were recruited. All participants were assessed using a designed questionnaire, the Children'sDepression Inventory (CDI), the Revised Children Manifest Anxiety Scale(RCMAS), and the Mini International Neuropsychiatric Interview for Children andAdolescents (MINI-Kid).

Prevalence of depression was higher in adolescents with CHD compared to healthycontrol (18.3% vs. 3.3%, p= 0.048). Moreover, 30% of adolescents with CHD hadanxiety compared to 10% of the control group (p= 0.03). Multivariate analysisof risk factors showed that level of education and symptomatic cardiacfunctional class were the significant predictors of depression in adolescentswith CHD. Likewise, presence of more than one cardiac defect and having morethan one cardiac catheterization were the significant predictors of anxiety inadolescents with CHD.

Adolescentswith CHD are at increased risk of having depression and anxiety, especiallythose with low level of education, severe cardiac illness and having multiplecardiac catheterizations. Appropriate psychiatric assessment and earlyintervention can improve the quality of life of adolescents with CHD.

To determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.

Cancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.

This cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.

Eighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.

This study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited metabolic disease characterized by mutations in the porphobilinogen deaminase gene. This mutation may provoke neurotoxic levels of delta-aminolevulinic-acid and porphobilinogen, potentially resulting in an acute life-threatening clinical syndrome, characterized by psychiatric, in particular atypical psychotic, symptoms as well as severe neurological and gastrointestinal symptoms. Since the clinical presentation varies and symptoms are nonspecific, diagnosis is often made late.

Naming of alarm symptoms based on a recent case study.

Description of a recent case supplemented with data from the literature.

The patient is a 46 year old woman who was admitted in 2007 with abdominal pain, an epileptic seizure and weakness, interpreted as a Guillain-Barre syndrome. In 2011 she was readmitted with severe abdominal pain, diarrhea, volatile psychotic symptoms and seizures, following a short period of excessive alcohol consumption. During admission she developed progressive weakness in the upper arms, shooting pains in the limbs and a feeling of tightness. Impaired abdominal breathing was suspected. Again, Guillain-Barré syndrome was considered, but additional studies did not support this diagnosis. Because of the recurrent character of symptomatology following alcohol abuse, acute (intermittent) porphyria was considered diagnostically. The dark-colored urine indeed contained significantly increased delta-aminolevulinic-acid and porphobilinogen concentrations. Additional (genetic) diagnosis follows.

A recurrent disease course with severe gastrointestinal, neurological and psychiatric symptoms, following alcoholabuse, is suspect for AIP.

Long-term care for the elderly by their family members represents a serious burden in Italy. The physical and psychological health of informal caregivers is a growing public health issue. Old patients often seek urgent medical attention in the Emergency Department (ED) and hospitalisation is frequent event among the elderly.

Aim of the study was (1) to investigate the burden of care among the caregivers of old patients; (2) to examine the influence of the burden experienced by the caregivers on ED and hospital admissions of the elderly.

We conducted a descriptive study of patients aged 75 years or older and their caregiver admitted to the ED from 10/1/15 to 6/10/15 (77 patient-caregiver pairs). The caregivers were evaluated using the Caregiver Burden Inventory (CBI). A case manager collected the patient's data.

CBI score is the highest among patients seeking ED evaluation due to caregiver's concern. The majority of the elderly admitted to the ED whose caregiver shows elevated emotional burden at the CBI do not present with serious or urgent medical condition and are not hospitalised. Emotional burden is the highest among the caregivers of demented subjects who share the same house.

Our findings indicate that the burden experienced by caregiving family members plays a role in elderly people avoidable ED visits.

The authors have not supplied their declaration of competing interest.

Alcohol and other substance use contribute to a major, preventable, international healthcare burden. The evidentiary bases for screening, brief intervention, and referral to treatment (SBIRT) for alcohol are well-established, while research on SBIRT for other substance use is ongoing. In the United States, funding for SBIRT education among medical professionals recently has expanded beyond physicians to include other healthcare providers such as nurses and social workers.

This brief study measured characteristics of nurses, social workers, and physicians at the beginning of the first year of graduate education (nurses, social workers) or post-graduate year 1 (physician residents) to assess potential baseline differences in knowledge, attitudes, beliefs, and behaviors related to SBIRT.

The aim of this study was to inform targeted modification of SBIRT education programs based on baseline differences between professions.

Participants (n = 81 [16 physicians, 27 nurses, 38 social workers]) completed a 36-item assessment of baseline behaviors (modified from Hettema et al., 2012) and knowledge, beliefs, and attitudes predictive of SBIRT performance (Gassman et al., 2003). Differences between groups were assessed using ANOVA and the Tukey or Games-Howell post-hoc test (contingent on homogeneity of variance).

The study identified differences among professionals for 13 of 36 measured variables across several domains: SBIRT behaviors, beliefs about time utilization, satisfaction working with at-risk clients, self-efficacy, and perceived organizational resources.

Preliminary data suggest that SBIRT training for medical professionals might be improved by attending to specific differences among nurses, physicians, and social workers in several key areas.

E-learning may be a cost-efficient alternative or addition to traditional continuous medical education (CME) face-to-face courses. Even though some data are available regarding views on e-learning of general medicine physicians, preferences of psychiatrists have not been systematically assessed as yet.

To assess early career psychiatrists' (ECPs) preferences on e-learning.

To explore: 1) What do early career psychiatrists want to learn via e-learning? 2) How should e-learning be provided?

Online focus groups were conducted via skype. Participants were purposively sampled for professional qualification (trainees/newly-qualified psychiatrists) and recruited in 14 European countries. Qualitative analysis of the data is in progress. Preliminary findings are presented.

Four focus groups with in total 20 early career psychiatrists from different countries were conducted. The number of participants to focus groups varied from four to seven.

ECPs would use e-learning to learn about topics not normally thaught during standard psychiatric training, and to have contact with experts in the field. E-learning courses on general basic knowledge (psychotherapy theories, psycho-pharmacology) need to be related to clinical practice.

ECPs suggested that e-learning courses should be interactive, user-friendly and accredited by national authorities. Cost of e-learning courses and lack of awareness of e-learning opportunities are significant barriers to access, particularly for trainees.

Access of ECPs to e-learning may be increased by offering information on courses and affordable fees. Content-wise, e-learning should provide specialist knowledge or training in generic skills closely related to practice. E-learning courses should be delivered by renowned international experts.