A major concern in patients with BIPOLAR Disorder (BD) is the high frequency of suicidality. It is important to determine the subgroup of patients particularly exposed to this risk.

To explore sociodemographic and clinical characteristics of BD patients with a history of suicide attempts and compare them to those who never attempted suicide.

This is a retrospective, cross-sectional, descriptive and comparative study on 100 patients followed in our department and diagnosed with BD type I according to DSM 5. Demographic and clinical data was compared across the groups: suicide+ (S + ) and suicide–(S-).

Overall, 77 patients never attempted suicide (S−), whereas 23 had made at least one suicide attempt (S+). Females represented 61,9% of the S+ group. S+ patients had more relatives with psychiatric illness (82,6% vs. 57.1%) and affective illness (43.5% vs. 33,8%). The mean diagnostic delay was 6.61 years in the S+ group vs. 4.58 in the S− group, with 78,3% of S+ patients first receiving another diagnosis than BD. S+ patients had significantly more depressive episodes and manic episodes with mixed features. Quality of intervals was worse in S+ patients. Anxiety comorbidity was significantly higher in the S+ group (52.2% vs. 13%; P = 0,000). Hyperthymic temperament was significantly associated with the S− group.

Depressive polarity, anxiety comorbidity, as well as diagnostic delay seem to elevate the risk for suicidality in bipolar patients. Suicidality should be closely monitored in patients with these characteristics.

The author has not supplied his declaration of competing interest.

Euthymic patients with bipolar disorder (BD) experience residual symptoms. Interestingly, residual symptoms appear to impact the natural course of BD and represent potential predictors of recurrence and functional impairment.

The study aimed to analyse the relationship between residual depressive symptoms, sleep disturbances and cognitive impairment as determinants of psychosocial functioning in a large sample of euthymic BD patients.

We performed a cross-sectional study of 468 BD outpatients in clinical remission for at least 6 months. Bipolar Depression Rating Scale (BDRS), Pittsburgh Sleep Quality Index (PSQI) scale, Visual Analogic Scales (VAS) evaluated cognitive impairment and functioning assessment short test were used to assess residual symptomatology and functioning of patients. We evaluated functioning with. Structural equation modelling (SEM) was used to describe the relationships among the residual depressive symptoms, sleep disturbances, perceived cognitive performance and functioning.

SEM showed good fit. This model revealed that residual depressive symptoms (path coefficient = 0.37) and perceived cognitive performance (path coefficient = 0.27) were the most important features significantly related to psychosocial functioning. Sleep disturbances were indirectly associated with functioning via residual depressive symptoms and perceived cognitive performance (path coefficient = 0.23).

This study contributes to a better understanding of the determinants of psychosocial functioning during the interepisodic periods of BD patients. These findings should have implications for the improvement of functioning of BD patients in a personalized approach to treatment.

COI: Dr. Samalin reports personal fees and nonfinancial support from Astra-Zeneca, Bristol Myers Squibb, Janssen, Lundbeck, and Otsuka.

The authors L. Boyer, A. Murru, I. Pacchiarotti, M. Reinares, C.M. Bonnin, C. Torrent, V. Norma, P. Corinna, I. de Chazeron, M. Boucekine, P.A. Geoffroy, F. Bellivier, P.M. Llorca, E. Vieta have have not supplied their declaration of competing interest.

Suicidality is a major health concern with as yet unclear neurobiology.

To identify emotional correlates of suicidality in bipolar disorder I (BD-I).

To detect subcortical structural morphology changes associated with suicide attempts.

We enrolled 30 patients with BD-I of which 15 had history of suicide attempts, and 15 healthy controls (HCs) with no such history. Groups were defined according to suicide attempt history and psychopathology. Subcortical gray matter volumes were obtained from 3 T structural MRI scans using FreeSurfer. Intergroup differences were investigated through ANOVAs followed by post hoc Fischer's least significant difference.

HCs had larger left hippocampal and left accumbens volumes than both BD-I attempters and nonattempters. BD-I attempters had smaller left hippocampi and larger left amygdala than both nonattempters and HCs.

Differences were observed in emotional processing mediating neural circuitries, with BD-I attempters showing opposite patterns to nonattempters between amygdala and hippocampus.

The authors have not supplied their declaration of competing interest.

Relatives’ coping strategies – an essential element for the recovery of patients with severe mental disorders – are grouped in problem-oriented and emotion-focused. The former include practical strategies to deal with the stressful situation and are associated with a better long-term outcome of patients and relatives; the latter are psychologically driven and are associated with a worse outcome. It has been reported that psychoeducational family intervention (PFI) can improve problem-oriented coping strategies, while few data are available on relatives of patients with bipolar disorder.

To assess the impact of the PFI on promotion of problem-oriented coping strategies adopted by relatives of patients with bipolar I disorder.

This study was conducted in 11 Italian mental health centers. Patients and their relatives were allocated to the experimental group receiving PFI or to the control group (waiting list). Before starting the intervention and at the end of the PFI, coping strategies were assessed using the family coping questionnaire.

Of the 139 recruited families, 72 families were allocated to the experimental group and 67 to the control group. Relatives from the experimental group reported a significant improvement in problem-oriented coping strategies, such as positive communication (P < .01) and searching for information (P < .05). On the other hand, a reduction in collusion (P < .0001), avoidance (P < .01) and resignation (P < .001) were found at the end of the intervention.

PFI is effective in promoting the coping strategies in relatives of patients with bipolar I disorder and it should be given routinely in mental health centers.

The authors have not supplied their declaration of competing interest.

Temperament and mental illnesses are considered to be varying degrees along the same continuum of imbalance in the neurophysiological regulation of behavior. Mental disorders are linked to specific patterns in the relationships between neurotransmitters and between brain structures. Similar links were found for temperament traits. Development of DSM and ICD classifications might benefit therefore from an integration between psychiatry, functional neurochemistry and differential psychology.

To describe the neurochemical systems underlying mental disorders and temperament traits in healthy adults.

Findings in neurochemistry, neuropsychology, differential psychology and psychopathology are compared to the traits described in various temperament models. This analysis is summarized in the perspective of the neurochemical functional ensemble of temperament (FET) model.

Neurochemical correlates for 12 main dynamical aspects of behavior are presented as a systemic framework that follows a universal functional structure of human actions described in kinesiology, neuroanatomy, neurochemistry and clinical neuropsychology. The role of monoamine systems (serotonin, dopamine, noradrenalin), acetylcholine, GABA/glutamate, neuropeptide and opioid receptor systems are linked to regulation of specific dynamical properties of behavior in a systematic way. Several insights for the structure of the classification of mental disorders from the perspective of the FET model are proposed.

An integration of research in neurochemistry and psychopathology of behavior with differential psychology based on healthy samples can bring new insights for future versions of DSM and ICD classifications of mental disorders. Such integration does not follow either dimensionality or categorical approach but instead is based on functional ecology of human behavior.

The author has not supplied his declaration of competing interest.

Bipolar disorder has the highest rates of comorbid substance use disorders. Approximately 60% of patients with bipolar I disorder have a lifetime diagnosis of a substance use disorder (SUD). Excluding tobacco, alcohol is the substance most often abused, followed by cannabis, amphetamines and cocaine.

Determine the prevalence and compare sociodemographic and clinical variables in patients with SUD comorbid diagnoses and patients without this comorbidity.

Charts of all patients with a diagnosis of bipolar disorder admitted in the Coimbra Hospital and Universitary Center over a three-year period (2013–2015) were reviewed to gather data on sociodemographic and clinical data.

During a three-year period, 189 patients were admitted with bipolar disorder, almost half of patients (47,6%) had a SUD comorbid diagnostic. Comorbidity of BD and SUD is characterized by a complicated course with multiple recurrences of bipolar episodes and increased hospitalizations. The risk of suicide attempt is significantly higher when associated with SUD. In addition, BD is associated with pervasive social, family, and employment dysfunction. Poor treatment adherence in this population is also a serious clinical challenge that significantly impacts treatment response and outcome. The authors will analyze all this variables in the population admitted.

According to the most recent literature on SUD and BD, these two problems occur together so frequently that all patients with a bipolar diagnosis should also be assessed for drug and alcohol problems. BD complicated by SUD represents a serious public health problem and a major challenge to treatment providers.

The authors have not supplied their declaration of competing interest.

Both major depressive disorder (MDD) and alcohol use disorder are highly prevalent, often comorbid and cause significant socioeconomic burden. At CAMH, we have developed and integrated care pathway (ICP) to treat these disorders and evaluated its effectiveness in comparison to treatment as usual (TAU)

Chart review; descriptive statistics, c2 and t-tests, linear mixed effects models, Kaplan–Meier and log-rank analyses.

Overall, 81 patients were enrolled into ICP. Comparisons of treatment retention rates between ICP patients and matched historical controls (n = 81) showed significantly lower dropout rate in ICP cohort (18.5% vs. 69.1%, P < 0.001, Fig. 1). The ICP patients demonstrated significant reduction in depressive symptoms severity (QIDS: 14.6 vs. 10.0, P < 0.001; BDI 26.3 vs. 16.2, P < 0.001), reduction in the amount of alcohol consumed weekly from 44.6 standard drinks at baseline to 12.6 (P < 0.001) by the end of treatment, which was significantly better compared to controls (56.9 vs. 25.2, P < 0.001), P = 0.014 (Fig. 2).

The ICP is a feasible approach to treatment of concurrent AUD and MDD with significantly higher retention rates than TAU. Patients demonstrate improvements on several levels including depressive symptoms, and changes in alcohol drinking patterns.

The authors have not supplied their declaration of competing interest.

Illicit drug use is well known as an important contributor to the global burden of diseases, but the physical and psychopathological risks of recreational drugs misuse are often underestimated and drug-related fatalities in specific settings are under-investigated.

In the framework of the EU-funded project “EU-Madness”, we collected and analysed all the reports of drug-related fatalities in Ibiza from January 2010 to September 2016, with the aim of characterising the sample, and identifying the involved substances and the nature of deaths associated with their consumption.

Overall, 58 drug-related fatalities were registered from 2010 to September 2016 (87.9% males, 12.1% females, mean age 33.16; females were significantly younger than males). Most of the deceased were Britons (36.2%), followed by Spanish (22.4%), Italians (6.9%) and Germans (5.2%). In half the cases, the substance identified in post-mortem analyses was a stimulant; in 24.1% of the sample it was a depressor a prescription drug or more than two substances in 22.4%. Most of the fatalities were due to cardiovascular accidents (62%); 22.4% were deaths by drowning, 12% by fall from heights and 3.4% were due to mechanical asphyxia.

According to the results from our sample, stimulants (mainly MDMA and cocaine) are the substances of abuse involved in most drug-caused fatalities. The number of fatalities per year has been steadily increasing, but the growing diffusion of novel psychoactive substances (NPS) does not seem to be a direct cause (although better methods of their analysis in post-mortem samples should be designed).

The authors have not supplied their declaration of competing interest.

The abnormal bodily phenomena questionnaire (ABPq) originates from the analysis of clinical files of more than 350 patients with schizophrenia. It consists in a semi-structured interview created to evaluate the subjective anomalies in feelings, sensations, perceptions and cognition in the domain of the lived body.

The present study is aimed at providing preliminary data for the validation of the Italian version of the ABPq.

The ABPq was translated and adapted into Italian. ABPq scores were correlated to those obtained by the schizophrenia proneness instrument, Adult version–body perception disturbances (SPI-A E, body) that evaluates the same kind of phenomena, in order to examine its convergent validity. Moreover, ABPq was correlated to psychopathological domains assessed by the Positive and Negative Syndrome Scale (PANSS) and by the Brief Negative Symptom Scale (BNSS).

The experimental sample included 40 clinically stable patients. Our findings showed a strong correlation between ABPq and SPI-A E, body. An association of ABPq total score with the positive and disorganized dimensions was also observed.

Our preliminary data suggest that the Italian version of ABPq has a good convergent validity. The presence of abnormal bodily phenomena resulted to be associated to a greater severity of the disease and therefore it could be hypothesized that they represent an indicator of clinical severity.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The Maudsley obsessional-compulsive inventory (MOCI) is a widely used self-report measure of obsessive-compulsive symptoms in clinical and non-clinical populations, both in research and clinical settings. Nogueira et al. confirmed in 2011 that the MOCI Portuguese version has good psychometric properties, having a factorial structure that is in accordance with those reported by other groups.

Based on the previous results of exploratory factor analysis with a Portuguese students sample, the present study aimed to perform a confirmatory factor analyses (using Mplus software) to verify if the three dimensions’ structure fitted the data.

The sample comprised 234 students on their first three years of college education (78.2% female), between 18–26 years old (M = 20.55; SD = 1.66). Participants filled the Portuguese version of the MOCI.

Our results showed that the MOCI Portuguese version with original 3-factor structure has a good fit (χ2(227) = 386.987, P < .05; RMSEA = 0.053, 90%CI = 0.044–0.062; CFI = 0.928; TLI = 0.920; WRMR = 1.089). Good reliability was found for all subscales (Cronbach alpha < .80).

The MOCI Portuguese version reliably and validly assesses three OC symptom dimensions in young adults. Further research is needed to confirm this structure in Portuguese clinical samples.

The authors have not supplied their declaration of competing interest.

Early stages after a first psychotic episode (FEP) are crucial for the prognosis of the disease. Those patients who drop out of treatment after a FEP show a significant increase in their vulnerability to relapse. Relapses associated a greater risk of neurotoxicity, chronicity, hospitalization, decrease of response to the treatment, increase of burden and functional decline.

To determine what antipsychotic is more effective in the prevention of relapse after a first psychotic episode.

PAFIP is an assistance program focused on early intervention in psychosis. Between January 2001 and January 2011, 255 patients were recruited and randomly assigned to treatment with haloperidol (n = 48), olanzapine (n = 41), risperidone (n = 44), quetiapine (n = 34), ziprasidone (n = 38) and aripiprazole (n = 50). We compared the rates of relapse and remission reached by haloperidol, olanzapine, risperidone, aripiprazole, ziprasidone and quetiapine during a 3-year follow-up. All of the patients were antipsychotic naives at the beginning of the treatment.

There were no statistically significant differences in regard to the rate of clinical remission. Patients assigned to the groups of aripiprazole, olanzapine and risperidone presented a solid trend to a significantly inferior rate of discontinuation for any reason since the beginning of the treatment.

These data point to a greater protection against relapse and a likely better prognosis related to the use of aripiprazole, Olanzapine and risperidone.

The authors have not supplied their declaration of competing interest.

College students are known for their variable sleep schedules. Such schedules, along with other common student practices are associated with poor sleep hygiene. The persistence of the precipitating stressor is one of the factors involved in the persistence of insomnia.

To examine the role of the perceived stress, perseverative thinking, strategies of cognitive emotion regulation and negative affect as predictors of sleep difficulties.

The sample comprises 549 college students.

PSS-10, PTQ, CERQ and POMS-58. Three questions were used to access difficulties in initiating sleep (DIS), maintaining sleep (DMS) and early morning wakening (EMA). A Sleep Difficulties Index (SDI) was calculated by summing DIS, DMS and EMA scores.

In total sample, the multiple linear regression explained 27.7% of the SDI total variance (R2 = .277, F(9, 375) = 15,942, P < .0001). The significant predictors of the total variance of SDI were perceived distress (B = .246, P = .0001), repetitive thought (B = .189, P = .005), cognitive interference and unproductiveness (B = −.188, P = .006), rumination (B = .130, P = .044) and negative affect (B = .156, P = .018).

Preventive interventions focused on predictor factors (perceived stress, perseverative thinking, rumination and negative affect) should be considered in order to promote better mental health in college students.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

At the present time, adolescents are in particular vulnerable to feelings of loneliness. They are gradually emancipating from their family and establish relationships with peers. Among the important predictors of loneliness belong genetic and personal variables and factors of social environment.

To examine predictors of adolescents’ loneliness which are located in family environment. To find out how empathy, emotional relationship and control by both of parents contribute to loneliness of adolescent boys and girls.

We examined 206 adolescents in the age from 10 to 18 years through Basic Empathy Scale, Parenting Style Scale and UCLA Loneliness Scale. Stepwise multiple linear regression analysis was used for data analysis.

The significant predictors of boys’ loneliness in family environment are emotional relationship of mother and affective empathy of father. The significant predictors of girls’ loneliness include emotional relationship and cognitive empathy of father. Parental control is not a significant predictor of adolescents’ loneliness.

Adolescents’ loneliness is largely influenced by factors of family environment. Our study highlights the role of emotional relationship provided by the opposite sex parent. Cold behavior of the opposite sex parent could reduce self-esteem and self-confidence of adolescents. Both could help them establish relationships with peers and people outside family, thus protecting them against loneliness. A significant predictor of boys’ and girls’ loneliness is also empathy of father. We recommend to make use of our findings in clinical practice with adolescents, in family therapy as well as in context of attachment.

The authors have not supplied their declaration of competing interest.

To describe the mental disorders and social function of the hard to reach young people (HTRYP) from the innovations project (IP) and compare to a matched sample from a community mental health team (CMHT).

IP was a new multidisciplinary team based within an inner city, walk-in health centre, North East England (throughout 2011).

Phase 1 and 2: retrospective review of clinical case notes of YP who attended the IP and CMHT. Phase 3: 24-months follow-up evaluation of the mental state and social function, using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children's Global Assessment Scale (CGAS).

Overall, 36 referrals accepted by the IP, 31 met criteria for HTRYP, 15 were offered individually tailored therapy. IP group experienced more deprivation compared to the CMHT matched sample (n = 115). At baseline, the HTRYP had more mental disorders, higher severity scores and lower levels of social function (HTRYP HoNOSCA mean: 19.1 and CMHT mean: 11.2 P = < 0.001 and HTRYP CGAS mean: 51.0, CMHT mean: 58.9, P = 0.05). The HTRYP made significantly greater improvement compared to CMHTYP; (HoNOSCA P = < 0.001 and CGAS P = < 0.002). Thirteen HTRYP attended the follow-up review at 24 months compared with nine of CMHTYP. There was great variability in terms of social function between the YP within each sample.

The term “HTR” describes a state, which the YP may be at a particular point their lives. A service, which utilises a developmental theoretical framework, offers regular reviews and an individualised care plan, could reduce longer-term morbidity and mortality suffered by HTRYP.

The authors have not supplied their declaration of competing interest.

22q11.2 deletion syndrome (22q11.2DS) results from a hemizygous microdeletion on chromosome 22 and is characterized by phenotypic variability. Several studies have been conducted on the impact of COMT functional polymorphism in 22q11DS, suggesting that attenuated psychotic manifestations are frequent in children and adolescents and represent one of the strongest predictors for the onset of psychotic disorder.

We explored possible interaction between COMT polymorphism and subclinical psychiatric symptoms in a 22q11.2DS cohort of 42 participants aged 6 to 26 years: 17 hemizygosity for COMT-Met and 25 hemizygosity for COMT-Val.

To analyse impact of COMT gene in 22q11DS and its related psychiatric correlates.

Each participant, genotyped for the catechol O-methyltransferase (COMT) Met/Val polymorphism, underwent structured psychiatric and cognitive assessment. Analysis of positive and negative symptoms was performed by the structured interview for prodromal syndromes (SIPS). Finally, longitudinal data available in a subsample of 24 individuals were used to explore the developmental trajectories of psychotic symptoms one year later.

There was a significant positive correlation between COMT Val polymorphism and positive symptoms; at follow-up, no significant correlation were found between COMT polymorphism and psychiatric symptoms. No other significant differences were found between groups (Comt/Met-Comt/Val) on any other CBCL or QI score.

COMT and additional genes microdeleted might interact in the susceptibility to schizophrenia in 22q11.2DS: psychotic symptoms might result from an epistatic interaction with other genes. Moreover, gene-environment, in presence of genetic vulnerability could increase the risk of schizophrenia in 22q11DS.

The authors have not supplied their declaration of competing interest.

Bullying at school and victimization problems in adolescence have a negative impact in personal identity development specifically in mental health field.

To analyze coping profiles used in a communitarian adolescents sample in relation to victimization among peers and controlling the other victimization subtypes.

From Barcelona Metropolitan area, 1031 adolescents between 12 and 20 years old participated (37.5% boys; 15.7% foreigners). The different coping strategies were assessed with adolescent coping orientation for problem experiences test and the victimization types with juvenile victimization questionnaire.

A 46.2% of adolescents suffered a victimization event by peers in the last year. As victimization level by peers advance, it presents an increase of unproductive coping strategies (P < .001; d-Cohen = 0.92). Regularly women score higher than men in low and moderate victimization groups (P < .05). However, when it reaches the highest expression (higher risk profile), unproductive strategies use in both genders is very similar and significant differences disappear. The results show that avoidant coping type is associated with a higher rate of victimization by peers. Positive relationship between previous victimization in other areas and peer victimization rate was found.

It is of high importance to develop and strengthen coping psychoeducation programs centered in solving this problem and struggling against victimization consequences by peers in adolescence. Due to that, increase of this victimization type is very related to the use of unproductive strategies use and therefore a coping by avoiding the problem.

The authors have not supplied their declaration of competing interest.

There is no consensus of the relationship between early childcare and later psychological development.

We studied 1428 children participating in the French EDEN cohort. Childcare was reported prospectively between ages 4 months and 3 years: childminder, collective care, informal care. Children's behavior was assessed by mother-reported strength and difficulty questionnaire (SDQ) scores at ages 3.5, 5.5 and 8 years. Trajectories of children's behavioral difficulties (emotional difficulties, behavioral problems, peer-relations difficulties, symptoms of hyperactivity and inattention, prosocial behavior) were identified using group-based trajectory modelling (PROC TRAJ, SAS). To control for selection and confounding factors, we used propensity scores based on over 30 covariates, included in multinomial regression models as inverse probability weights of exposure.

Compared to children in informal care, those who were cared for by a childminder or in collective care were less likely to have peer problems (respectively, ORs for the intermediate level trajectory = 0.67 [95% IC: 0.47–0.95] and 0.49 [95% IC: 0.34–0.72]; ORs for the high level trajectory = 0.47 [0.27–0.82] and 0.33 [0.17–0.62]). Collective care was also associated with a reduced likelihood of intermediate (OR = 0.71 [0.52–0.98]) and high trajectories of hyperactivity and inattention (OR = 0.50 [0.35–0.81]), intermediate (OR = 0.58 [0.39–0.88]) and high trajectories of emotional symptoms (OR = 0.54 [0.32–0.92]) and intermediate (OR = 0.72 [0.51–1.01]) and high behavioral problems trajectories (OR = 0.54 [0.34–0.85]).

Childcare attendance prior to school entry – particularly collective childcare – may have beneficial effects for children's psychological development and peer relations.

The author has not supplied his declaration of competing interest.

In adolescence, help-seeking is affected by different actors. The influence of each actor on help-seeking is often studied in isolation, or, if multiple informants are included, using only few assessments of adolescents’ mental health.

The aim of this study is to determine the extent to which self-, parent- and teacher-reported problem behavior predict secondary care in adolescence and to what extent the informants’ relative importance changes over time.

Data from the Dutch community-based cohort study tracking adolescents’ individual lives survey (TRAILS) were linked to administrative records of secondary care from 2000 (age 9) to 2011 (age 21). Internalizing and externalizing problems were assessed using the youth self-report, child behavior checklist and teacher checklist of psychopathology at ages 11, 13 and 16, and the adult self-report at age 19.

The annual incidence of secondary care fluctuated between 1.3% and 2.4%. In Cox regression analyses that adjusted for sociodemographic covariates and problem behavior, internalizing problems but not externalizing problems predicted secondary care. Secondary care between the ages 11 to 13 years was predicted best by teachers, between the ages 13 to 16 by parents, and between the ages 16 to 21 by adolescents.

The relative importance of informants for predicting secondary care shifts over time, which suggests that each informant is the driving force behind secondary care at a different phase of adolescence. The treatment gap may be reduced by improving problem recognition of teachers in secondary education and by educating young adults about mental health problems.

The authors have not supplied their declaration of competing interest.