There are few published studies on the relationship between gender and psychiatric disorders. We assessed sex differences in a sample of first-admission psychiatric inpatients to identify possible risk factors and targets for sex-tailored treatment interventions.

A retrospective study of admissions to the psychiatry department, Coimbra hospital Universitary Centre, Portugal, in 2015 was accomplished (n = 924). The two groups were compared for demographic features, psychiatric diagnoses and medical comorbidities.

Male patients were significantly younger (age average = 47.7 vs. 53.3). Differences in employment, educational, and marital statuses were found between male and female psychiatric patients. Having a degree was a protective factor for males, whereas it was a risk factor for females. Being divorced and single were both risk factors for medical co-morbidity in females. A higher proportion of men among patients hospitalized for schizophrenia (14.9 vs. 5.5%) or substance use disorder (10.3 vs. 2.1%) and a higher proportion of women among those admitted for affective disorders (43.3 vs. 25.9%), including bipolar disorder (13.4 vs. 9.0%), were found. No significant differences in duration of hospitalization between the two groups (22.8 in male vs. 22.2 days in female)

The differences between the two groups of inpatients were very pronounced. A better understanding of these differences may help to establish more effective treatment strategies.

The authors have not supplied their declaration of competing interest.

Suicide-loss survivors (SLSs) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). However, limited data are available concerning the contribution of CG to SI among suicide survivors. Moreover, knowledge about possible psychological processes which may increase SI levels following CG is rare.

In this study, we aim to examine the role of two important emotion regulation variables––mentalization deficits and entrapment––as possible moderators of the association between CG and SI in the aftermath of suicide loss.

Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG, SI, mentalization deficits, and entrapment.

The findings revealed SI to have high and positive associations with CG, entrapment, and metallization deficits. Regression analysis showed mentalization deficits and entrapment contributing to SI beyond the contribution of CG. Notably, a significant interaction was found, indicating that CG and SI became more strongly associated at higher levels of mentalization deficits.

The study’s findings highlight the critical link between complicated grief and suicide ideation among SLSs and the role of metallization deficits as a possible facilitator of this link. Practical implications relating to suicide risk among SLSs are discussed, as well as focused clinical recommendations. The importance of mentalization-based interventions for decreasing SI levels in the aftermath of suicide loss is highlighted.

No significant relationships.

Needs of the elderly are complex and difficult to identify since connected with many different dimensions. The aim was to identify met and unmet needs of patients referred to old age rehabilitation services in Poland (Wroclaw-Wr) and Germany (Hamburg-Ha).

Patients (n=80) over the age of 60 were assessed using the Camberwell Assessment of Need for the Elderly (CANE), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), Good Milieu Index (GMI) and Activities of Daily Living Scale (ADL). Patients were at least 2 weeks under rehabilitation due to orthopedic or neurologic reasons.

Both groups were similar concerning age, gender, education and marital status. Satisfaction of the ward was the same. Wr-patients were significantly more demented (25.1 vs.26.8; p=0.011), depressed (4.12 vs 3.0; p=0.033) and disabled (24.88 vs 76.62; p< 0.0001).

The mean number of total, unmet and met needs before rehabilitation was similar in both centers. However, significantly more needs in accommodation, eyesight /hearing /communication and benefits were reported in Wr, whereas psychological distress and food in Ha.

During rehabilitation program over twice more unmet needs were reported in Wr vs. Ha (1.38 vs. 0.57; p =0,0029) in the areas of eyesight /hearing /communication and benefits, continence, money.

Ha received twice more formal assistance than Wr before (0,0027), but Wr twice more during rehabilitation (p< 0,0001).

Assessing individuals needs may help in creating individual complete rehabilitation program within continuing care post discharge and improve quality of life.

Transcranial direct current stimulation (tDCS) is currently discussed as a therapeutic intervention in various psychiatric disorders. Based on the report about the effectiveness of tDCS in a patient with catatonic schizophrenia, we applied bilateral prefrontal tDCS in a patient with corpus callosum aplasia (CCA) and severe catatonia instead of maintenance electroconvulsive therapy (ECT).

To investigate whether tDCS can replace ECT in a largely treatment-resistant patient.

The 41 year-old male patient showed severe catatonic symptoms since adolescence and was treated by weekly ECT for almost 6 years. Due to cardiac complications and increasing cognitive deficits caused by long-term ECT and weekly anesthesia, tDCS was suggested. The anode was positioned over the left dorsolateral prefrontal cortex (DLPFC), the cathode over the right DLPFC. 2mA tDCS was delivered for 2x 20 minutes (90 minutes break in between), three times a week for the first two weeks, thereafter once to twice weekly. Concomitant medication (clozapine 600 mg/d, aripiprazole 10 mg/d, pirenzepine 50 mg/d, lorazepam 3 mg/d) was continued.

So far, more than 20 double sessions of tDCS were applied. ECT was needed once after a period of hospitalisation for 10 days due to pneumonia. Since then the patient has solely received tDCS for more than 13 weeks. Catatonic symptoms resolved further under tDCS compared to ECT (Bush-Francis Catatonia Rating Scale: 27/69 points during ECT, 5/69 during tDCS).

tDCS in combination with neuroleptic treatment could be an alternative to ECT in organic catatonia. Further studies are needed to support our hypothesis.

Alcohol dependence and depression are often combined, patients with comorbid pathology have a more severe course of the disease, a high risk of suicide and therapeutic resistance. Enzyme dopamine-beta-hydroxylase (DBH) is a key player in a link between dopamine and norepinephrine neuromediations and may be involved in alcohol dependence and depression comorbidity and genetic markers in DBH gene may be associated with the risk of comorbid state.

To test an association of DBH gene polymorphisms rs161111580 and rs1108580 with depression risk in alcohol-dependent patients.

Our sample consisted of 104 inpatients diagnosed by ICD-10 criteria: 40 with alcohol dependence (AD group) (age 45.6 (SD 10.853), 5% females), 64 with depression and alcoholism comorbidity (AD+D group) (age 41.2 (SD 9.903), 22% females) and 112 healthy controls (age 35.5 (SD 8.286), 15% females). rs1108580 and rs1611115 were detected by RT-PCR.

For rs161111580, frequencies of minor T allele (p=0.031) and ТТ genotype (p=0.017) was higher, СС genotype (p=0.042) was lower in AD group vs. controls. rs161111580 T allele and TT genotype increases the risk of AD (OR=3.715, 95%CI [1.728-7.986], P=0.001 and OR=4.009, 95%CI [1.502-10.699], P=0.006). For rs161111580, frequency of ТТ genotype (p=0.009) was higher in AD+D group vs. controls. For rs1108580, frequency of major А allele (p=0.059, trend) was higher in AD+D, then in AD group. Major А allele rs1108580 increases the risk of depression in alcohol-dependent patients (OR=2.74, 95%CI [1.283-5.855], P=0.001).

It was shown that the DBH rs1108580 increases the risk of depression in patients with alcohol dependence.

No significant relationships.

Psychological stress is associated with accelerated cellular aging and increased risk for aging-related diseases, but the underlying molecular mechanisms are unclear.

We examined the effect of stress on a DNA methylation age predictor that was shown to correlate strongly with chronological age across human tissues (Horvath 2013). Genome-wide DNA methylation was measured in peripheral blood using the 450K Illumina array in three independent cohorts: the Grady Trauma Project/GTP (N=366); a panic disorder case/control sample recruited at the Max Planck Institute of Psychiatry/MPI-P (N=318); and the Conte Center for the Psychobiology of Early-Life Trauma/Conte (N=42). Age acceleration was calculated by subtracting chronological age from age predicted by DNA methylation. Psychiatric symptomatology and stressors were assessed using standard questionnaires.

DNA methylation age strongly correlated with chronological age in all samples (r=0.9, p=2.5x10^-133). Cumulative lifetime stress but not childhood or current stress predicted age acceleration in GTP (p=0.012) and MPI-P (p=0.021). Moreover, epigenetic age acceleration predicted depression (GTP: p=0.002; Conte: p=0.014) and panic disorder (p=0.007). In secondary analyses, we examined the effect of lifetime stress on individual CpGs of the DNA methylation age predictor. After correcting for multiple comparisons, we identified in both GTP and MPI-P a stress-regulated CpG near MCAM, a gene implicated in aging-related diseases, including cardiovascular disease and cancers.

Cumulative lifetime stress, but not childhood or current stress, and psychiatric phenotypes are associated with accelerated epigenetic aging. Our findings may explain the accelerated cellular aging and increased disease risk associated with chronic stress and psychiatric disorders.

Alterations of glutamate, energy and glutathione metabolism contribute to the pathogenesis of psychotic disorders

Revealing clinical-biological correlations in patients with late onset schizophrenia and delusional disorder by determining clinical parameters and activity of platelet enzymes of energy, glutamate, and glutathione metabolism.

27 women of 45-80 years old were studied, with late onset schizophrenia or delusional disorder. Activity of platelet cytochrome c-oxidase (COX), glutamate dehydrogenase (GDH), glutathione reductase (GR) and glutathione-S-transferase (GST), and scores by PANSS, HAMD, MMSE, and CGI-S were evaluated twice: before and after the 28-th day of treatment. Activity of COX, GDH, GR, and GST was measured once in 23 women of 44-81 years old comprising the control group.

As compared with controls, only GDH activity was found significantly decreased (before and after treatment, p<0.001). Clusterisation of patients by enzymatic activities resulted in 3 clusters significantly different by COX, GDH and GST. Significant correlations were found between enzymatic activities and scores by psychometric scales: in the cluster 1 (n=9) baseline COX activity correlated with scores by PANSS positive subscale (R=0.9, p=0.001) and with scores by MMSE (R=-0.9, p=0.002); in the cluster 2 (n=12) GR activity after treatment negatively correlated with scores by PANSS (R=-0.9, p=0.001), PANSS negative subscale (R=-0.8, p=0.004), and CGI-S (R=-0.9, p=0.001).

The revealed correlations between enzymatic activities and clinical parameters give hope on detection of useful biochemical markers which, after enlargement of patients’ group with late onset psychotic disorders, would be validated for prediction of the pharmacotherapy efficiency and outcome of treatment.

No significant relationships.

The PANSS is utilized in clinical trials for assessment of psychopathology. In order to determine the status of a patient, comparisons within a general population are necessary. If several groups of patients are to be compared, gender, age, co-morbid diagnoses, and other factors affecting clinical status are not identically distributed.

1) Phase 1: To establish the initial psychometric properties of the PANSS-Ru. 2) Phase 2: To establish normed-reference data for the PANSS-Ru.

Phase 1: 40 patients with schizophrenia and other psychotic disorders. Phase 2: 375 individuals (n = 250 patients; n = 125 controls). Responses were assessed for internal consistency, stability, reliability, discriminative validity, and construct validity. Fifth percentile norms are presented as step functions. Data were compared to US norms.

40 subjects enrolled for Phase 1. Alpha coefficient of 0.88 verified good internal consistency. Test-retest comparisons verified time stability (r = 0.67 to 0.92). Correlation between subscale and the total scores ranged from 0.76 to 0.86, compared to > 0.83 for US norm studies. Internal consistencies were α > 0.745. Mean subscale/ total score were equivalent to US population norms within 13%. However, there was a difference of > 5 norm-based points for mean general psychopathology subscale. Norms had a sensitivity of 85% and specificity of 89%.

Preliminary results show that different dimensions of symptom presentations in the Russian population may help to improve symptom-specific treatments, and will also provide comparison data for a Russian population. Further normative studies are warranted in other populations.

Alcohol use disorder is a pressing problem in our society. However, only a small percentage of patients with alcohol use disorder are ever treated. Nalmefene acts as an antagonist of mu opioid receptors preventing the pleasurable sensation that often accompanies alcohol consumption, while its modulation of kappa opioid receptors can decrease the dysphoria associated with alcohol withdrawal.

Studying the effect of nalmefene on patients with alcohol use disorder who are trying to reduce their daily alcohol consumption.

This is a descriptive study that pretends to assess the effect of nalmefene 18 mg/day on alcohol intake in a sample of five patients (3 men and 2 women) that came to our psychiatric consultation from March to September 2016. They all had tried in the past to stop or reduce their alcohol consumption but were unable to do so. We initiate follow-up with the patients in psychiatric consultation for the next three months with a monthly frequency.

Out of the 5 patients, 4 reported to have reduced their alcohol consumption over the observation time, going from 32 drinks per week to 18 drinks per week on average. The fifth patient abandoned prematurely the treatment due to the appearance of side effects (nausea). No other relevant side effects were detected.

Nalmefene appears to be effective and safe reducing abusive alcohol intake and avoiding alcohol withdrawal syndrome. Therefore, nalmefene can be considered a good therapeutic option helping reduce alcohol consumption in patients with alcohol use disorder.

The authors have not supplied their declaration of competing interest.

Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery.

To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD.

A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used.

Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma.

Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

Over the last decades, antipsychotic plasma levels have been used to evaluate therapeutic response, adherence and safety of antipsychotics in schizophrenia. Their clinical utility in delusional disorder (DD) has been poorly studied.

To investigate the relationship between plasma concentrations of risperidone (R), 9-OH-risperidone (9-OH-R) and olanzapine (OLZ), and clinical outcomes in DD.

Case-series of inpatients and outpatients with DD receiving treatment with risperidone (n=19) or olanzapine (n=2). Determination of R, 9-OH-R (active metabolite) and OLZ levels were obtained by high-performance liquid chromatography with electrochemical detection. Clinical variables such as treatment response or adverse events were recorded for all patients. These variables were correlated with two plasmatic ratios in patients treated with R: R:9-OH-R concentration ratio and total concentration-to-dose (C: D) ratio, indicating CYP2D6 activity and R elimination respectively.

Twenty-one patients were included: inpatients (n=10) and outpatients (n=11). Dose range: R, 1-6 mg/day; OLZ, 5-10 mg/day. Three outpatients (R, n=2; OLZ, n=1) presented antipsychotic levels under the detection limit (non-adherence). All R patients showed CYP2D6 activity (R: 9-OH-R ratio <1). Eight patients presented C: D > 14, indicating a reduction of R elimination, which was associated with poor clinical response (n=3), adverse events (n=3) and no clinical relevance (n=2). OLZ (n=2), no association between levels and clinical outcomes.

The determination of antipsychotic plasma levels may be of clinical utility in the assessment of treatment resistance, antipsychotic-adverse events or non-adherence in inpatients or outpatients with DD. Therapeutic drug monitoring should be further studied in future works.

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

The association between economic crises and mental health problems can be attributed to a number of factors. Among these, age seems to be an important determinant.

The aim of this study was to assess whether mental health of the Portuguese population following the onset of the 2008 recession, differs by age groups.

A follow-up study (2015) on the population aged 18 to > 65 years old, using the National Mental Health Survey (n = 911). The age-group prevalence of mental health distress assessed by the ten-item Kessler's Psychological Distress Scale (K10) was calculated using Chi2 statistics and mental distress as a categorical variable (P < 0.05).

Mean mental distress score differed significantly according to age group, χ2(3) = 10.684, P < = 0.05. The results showed that the older groups (50–64 and 65 = years old) were more frequently under mental distress (17–19%) compared to younger people (18–49 = years old), which were less likely to report being distressed (8–12%).

Age seems to be an important determinant of distress levels during the economic crisis in Portugal. Older adults reported to be more distressed compared to younger individuals. There are several hypotheses for a differential expression of psychological distress between age groups such as working status and retirement, which can express differential access to coping resources under such contextual negative pressure of economic recession. Further research on age groups is thus needed to better understand how recession generates adverse effects on mental well-being.

The authors have not supplied their declaration of competing interest.

A challenging medicine dissertation: to design a psychiatric therapeutic community.

A medical student winning a grant addressed to architects and farm laborers aimed to convert a rural area through Social Innovation programmes, a group of young enthusiastic psychiatrists and a donor involved in psychiatric circumstances are the actors of the project for turning a rural building located in the small village of “Villa San Bartolomeo” (Reggio Emilia, Italy) into a psychiatric social-rehabilitation community.

The project started reviewing the literature concerning community-based psychiatry residential facilities. Later, a structured interview has been carried out with the village's inhabitants in order to investigate both their perception of stigma towards mental illness and the perceived needs of their city. The answers have then been used to organize the activities within the psychiatric community, ranging from recreational through sportive until occupational ones, such as farming vegetable gardens, breeding domestic animals, producing handiworks. These labors are intended both to satisfy the village demands and realize a greater integration of the community itself within the surrounding social network.

The therapeutic interventions that are going to be realized within the residential home will be aimed to promote patients’ personal growth and adapting capacity. These interventions are intended to allow the accomplishment of a greater housing independence of the hosts by restructuring their affective, relational and social backgrounds.

This is an ambitious project, started by chance, representing the desire and the hope for curing mental illness by establishing a contact with the natural environment.

Schizophrenia (SCZ) is a common and disabling psychiatric condition. Its diagnosis is entirely clinical. Many researchers have looked into electroencephalogram (EEG) power spectrum analysis for SCZ to find specific abnormalities.

The objective of this study was to analyze the EEG of patients with SCZ using power spectral density and to compare them with those of healthy controls, in order to look for specificities.

This was a cross-sectional, descriptive, and analytical case-control study conducted with patients followed for SCZ in the psychiatry "C" department at the Hedi Chaker hospital in Sfax. Healthy controls were included. Patients were assessed by the Positive and Negative schizophrenia scale (PANSS). All participants benefited from an EEG at rest condition at the service of the functional exploration at the Habib Bourguiba hospital in Sfax. We have measured the powers of each band using Welch power spectral density method called absolute power (AP). Statistical analyses were carried out.

Fifteen schizophrenics and 15 controls, all male, were included. The average age of schizophrenics and healthy controls was 40 years ±12.72 years and 47.93 ± 15.61 years respectively. There were no significant differences in age between patients and controls. Schizophrenics had a mean PANSS of 64.6±22.7.

At the quantitative EEG, differences appeared to be insignificant. There was an overall decrease in AP for the alpha band particularly in the parietal and occipital lobes in schizophrenics (53,16 ± 48,83 μV2 and 75,17 ± 56,28 μV2 respectively) compared to controls (335,15 ± 994,73 μV2 and 400,24 ± 1109,95 μV2 respectively). There was also an overall decrease in AP for the different frequency bands in schizophrenics compared to controls. However, values persisted high in the temporal lobe for all frequency bands.

In conclusion, this decrease in AP for the alpha band in the parietal and occipital lobes in schizophrenics can be a sensitive biomarker for diagnosing SCZ.

None Declared