DPD is a highly disabling condition for which no efficacious treatment exists. Imaging and neurophysiology findings suggest that the right temporo-parietal junction (RTPJ) plays a crucial role in the conscious experience of the normal embodied self, mediating spatial unity of mind and body, a process impaired in DPD.

We tested the potential therapeutic value of RTPJ rTMS and found that after 3 weeks 6/12 DPD patients responded with 51% reduction on the Cambridge Depersonalization Scale (CDS). After 3 more weeks of RTPJ rTMS responders showed 68% improvement.

Here we present results of 3 and 6 weeks of RTPJ rTMS on each of four cardinal symptom domains of depersonalization, i.e. emotional numbing, anomalous subjective recall, alienation from surroundings, and anomalous body experiences.

In responders we performed a retrospective analysis and applied repeated measures ANOVA on the average scores of each of the four symptom domains derived by the CDS.

Responders to 3 weeks of RTPJ rTMS showed a significant improvement (71% reduction; P= 0.01) in anomalous body experiences. However, after receiving 3 more weeks of RTPJ rTMS they reported further reduction in anomalous body experiences (76% reduction; P= 0.00) and a clinically significant improvement in alienation from surroundings (54% reduction; P= 0.02), emotional numbing (52% reduction; P= 0.05), and anomalous subjective recall (57% reduction; P= 0.11).

This is the first study suggesting that RTPJ rTMS may show therapeutic promise in DPD, and that anomalous body experiences scores might represent an early predictor of response for the remaining symptoms.

The authors have not supplied their declaration of competing interest.

Violation of the functional activity of the nervous and immune systems is an essential link in the pathogenesis of chronic alcohol dependence. The search for new psychopharmacological agents whose action is directed to correction of neuroimmune interaction opens new perspectives for the treatment of alcohol dependence.

(CBAxC57Bl/6) F1 mice with active and passive behavioral types in a state of chronic alcohol dependence owing to 6 month 10% ethanol exposure were undergoing intragastric administration of original anticonvulsant meta-chloro-benzhydryl-urea. Animal's behavioral and immune parameters, brain cytokines synthesis before and after anticonvulsant receiving were estimated.

In the formation of experimental alcohol dependence in animals the most pronounced changes in motor and exploratory activities in open field test, brain cytokines synthesis and suppression of immune response were registered in mice with passive type of behavior. Daily consumption of ethanol solution in mice with chronic alcohol dependence decreased sharply starting from 2 days of anticonvulsant administration and led to the cessation of ethanol consumption by the 5 day. After anticonvulsant administration for 10 days behavioral parameters in mice were comparable with those in the control group of healthy animals. It also restored brain cytokines synthesis and significant stimulated humoral immune response, estimated by the relative number of antibody-forming spleen cells.

Behavior and immune changes following chronic ethanol exposure depended on the behavior status of animals; administration of the original anticonvulsant meta-chloro-benzhydryl-urea may correct both immune and behavior disorders in mice with chronic alcohol dependence, so it has promise in the treatment of alcoholism.

The authors have not supplied their declaration of competing interest.

Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon.

Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study.

The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history.

To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia.

Case report and non-systematic literature review of the current data.

A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia.

Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects.

None Declared

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.

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.

Epilepsy is a public health problem that often affects personal and social patients’ life. Self-esteem, an important factor contributing to psychosocial well-being, is generally disrupted in epilepsy.

The aim of our study was to assess self-esteem and factors associated in patients suffering from epilepsy.

We conducted a cross-sectional, descriptive and analytic study, including 20 patients followed for epilepsy at neurology outpatient department, Habib Bourguiba hospital, Sfax, Tunisia. We collected socio-demographic and clinical characteristics, and used the Rosenberg Self-Esteem Scale (RSES).

The mean age was 35.9 ans. Sex-ratio (M/F) was 3. Hobby practice was noted in 45% of cases. The disease evolves since 19.9 years on average. A worsening of health in the last year was felt in 30% of cases. The stigma was reported in 30% of patients. Self-esteem was: very low 5%, low 40%, average 40%, and high 15%. It was better among married patients, living in family and those with disease evolving since more than 10 years, but without a significant correlation. The factors correlated with good self-esteem were: practicing a hobby (P = 0.006) and absence of stigma (P = 0.001). Poor self-esteem was significantly correlated with perceived health worsened during the last 12 months (P = 0.02). It was poor in unstable patients professionally, but without significant correlation.

Our study confirms the decline of self-esteem in patients with epilepsy. A better education of these patients to accept their illness, as well as raising public awareness on this affection could facilitate social insertion and improve self-esteem.

The authors have not supplied their declaration of competing interest.

Sleep plays a key role in the pathogenesis and clinic of mood disorders. However, few studies have investigated electroencephalographic sleep parameters during the manic phases of Bipolar Disorder (BD).

Sleep management is a priority objective in the treatment of the manic phases of BD and the polysomnographic investigation can be a valid tool both in the diagnostic phase and in monitoring clinical progress.

Twenty-one patients affected by BD, manic phase, were subjected to sleep monitoring via PSG in the acute phase (at the entrance to the ward) and in the resolution phase (near discharge). All participants were also clinically evaluated using Young Manic Rating Scale (YMRS) Pittsburgh Sleep Quality Index (PSQI), Morningness-eveningness Questionnaire (MEQ) at different timepoints.

Over the hospitalization time frame there was an increase in quantity (Total Sleep Time) and an improvement in the quality and effectiveness of sleep (Sleep Efficiency). In addition, from the point of view of the EEG structure, clinical improvement was accompanied by an increase in the percentage of REM sleep.

Sleep monitoring by PSG can be a valuable tool in the clinical setting both in the diagnostic phase, “objectively” ascertaining the amount of sleep, and in the prognostic phase, identifying electroencephalographic characteristics that can predict the patient’s progress and response to drug therapy. The improvement in effectiveness and continuity of sleep and the change in its structure that accompanies the resolution of manic symptoms also testifies how the regularization of the sleep-wake rhythm is to be considered a priority in treating manic phases.

No significant relationships.

Frontal lobe dysfunction has been considered as a core feature in schizophrenia. To the evaluation of this impairment, time-consuming neuropsychological batteries are needed. Recently, Dubois et al (2000) reported a short battery for assessing frontal lobe function in patients with neurological disorders. To evaluate the clinical efficacy of this frontal assessment battery (FAB) in patients with schizophrenia, we performed both FAB and Stroop Color Word Test (SCWT), which is suggested to be a representative task of executive function.

24 schizophrenic patients and 30 sex and age-matched controls were included. FAB, SCWT and Mini Mental State Examination (MMSE) were performed in both groups. The FAB scores were compared with the performance in SCWT and correlated with education level, age and duration of disease. No difference in the MMSE scores between two groups was found.

The FAB global score was significantly lower in the schizophrenia group compared to controls. In the patients group, the conceptualization and the inhibitory control subscores were negatively correlated with mistakes in color-naming task. The FAB total score, the mental flexibility and the programming subscores were negatively correlated with latencies in color-naming, color-reading and in color-word interference task of SCWT. Negative correlation between the FAB scores and the age and duration of disease was also evident.

The FAB is likely to be a useful and brief battery for assessing frontal lobe function in schizophrenia, as it results from the comparison with SCWT.

Purine metabolism may be affected in major depressive disorder (MDD). Increased enzymatic activity of the purine cycle has been observed in MDD. In MDD patients, purine metabolite levels also react to sertraline treatment.

To compare serum purine metabolites between: 1) MDD patients and non-depressed controls; and 2) remitted and non-remitted MDD patients.

To clarify the role of purine metabolism in MDD during active illness and recovery.

The sample comprised 99 MDD patients (DSM-IV, SCID interview) and 318 non-depressed controls (Beck Depression Inventory scores < 10) aged 20–71 years. Altogether, 78 patients returned for the follow-up; 33 were remitted and 45 non-remitted. Nine purine cycle metabolites were analysed using ultra performance liquid chromatography. Serum metabolite differences between the study groups were examined using logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise and B-HbAC1. The follow-up analyses were adjusted for age, gender and physical exercise.

The participants’ likelihood of belonging to the MDD group increased 1.1-fold for each 1-unit decrease in serum inosine, 3.2-fold for each 1-unit decrease in guanosine levels and 2.2-fold for each 1-unit increase in xanthine levels. The remitted and non-remitted groups displayed no significant metabolite differences, but the remitted group showed a non-significant shift of values towards the values of the non-depressed group.

Increased degradation of purines and accumulation of xanthine may characterise MDD. Alterations in purine metabolism appear to only partially change during recovery. Nevertheless, recovery-related changes require further investigation in larger samples.

Previous studies in other countries have reported that cyberbullying was related to Information and Communication Technology (ICT) use. Helweg-Larsen, (2011) reported that knowledge about safe internet use did not decrease the prevalence of cyberbullying. Less is known about this relationship with family functioning.

To examine the rates of cyberbullying and their relationships with ICT use and family functioning in a sample of secondary students in the UK

To study 1) associations between cyberbullying and ICT use 2) associations between family functioning and parental controls with ICT-use and cyberbullying.

A cross-sectional questionnaire of 2218 secondary students was completed

included demographic data, ICT use (levels and nature), Olweus bullying questionnaire adapted for cyberbullying, General Functioning subscale of the Family Assessment Device and parental controls (type and levels).

Response rate 80%, 45% males, mean (SD) age 14.97 (1.9) years. Cyberbullying seems to be related to the time spent online and to the general family functioning. Bullies or bully-victims spend significantly more time online than those who are not involved. The majority of students have been told how to be safe online; however only a few have parental controls on their computers. There is a significant positive correlation between worse family functioning and time spent online and with being involved in cyberbullying, even after controlling for the time spent online.

Our results suggest that increasing family communication may contribute to reduce children involvement in cyberbullying