We created an experimental adaptation of the REF scale (Lenzenweger et al., 1997), in a Likert format for discriminate between frequency and intensity of referential thinking (Rodríguez-Testal et al., 2008).

We try to verify if the Likert format of the REF discriminates between controls and patients, and also in patients with different diagnoses. We predict that there will be differences in frequency and intensity between patients and controls.

Participants: 108 subjects, 40 patients from a private center of clinical psychology, 55% women, mean age = 35.70 (SD = 12.42) and 68 controls selected from the normal population, 50% women, mean age = 36.35 (SD = 12.99).

It was applied a cross design for a correlation method of comparison between groups. All the analysis were accepted at p< .05.

No differences in referential thinking between patients and controls with Likert format in frequency (t = 1.496, P = 1.14), although there were differences in intensity (t = 2.30, p =.023). No significant differences in referential thinking between types of diagnoses with the Likert format (X2 = 6.63, p =. 249).

The Likert format of the REF scale adequately discriminates between patients and controls in intensity but not in frequency. This format doesn't discriminate between different diagnoses. The Likert format induces and overestimates the response.

Having been tasked with developing Standards for integrated care pathways for mental health (ICP), successfully publishing in 2007, NHS Quality Improvement Scotland (NHS QIS) now supports NHS Boards in developing and implementing these standards. Support is available via three National ICP Coordinators and local ICP facilitators.

The main objective is for Boards to achieve ICP accreditation, resulting in demonstration of a robust and responsive mental health system through implementation of their local ICPs supporting continuous cycles of quality improvement embedded in a culture that ensures delivery of person-centred care and reflective practice.

A model of and process for accreditation was developed considering: § Developing the project plan§ Reaching consensus on the goal of the accreditation initiative.§ Defining incentives for stakeholders in having ICPs accredited § Reviewing literature on existing accreditation systems in UK and internationally § Developing a range of options§ Carrying out an option appraisal§ Agreeing one preferred option § Obtaining NHS QIS and Scottish Government approval for preferred option§ Further development of support mechanisms and implementation of a longer term accreditation framework

A phased and incremental accreditation system was developed.

The first phase - “foundation level” - focuses on ensuring that appropriate infrastructures are in place to support full ICP development and implementation in NHS Board.

All 14 NHS Boards in Scotland achieved foundation level accreditation.

Reflection on this first phase are helping to inform NHS QIS on how best to structure future levels of accreditation and ongoing support over the next few years.

Alexithymia represents a personality trait construct encompassing difficulty identifying and describing feelings, distinguishing between feelings and the related physical sensations, and an externally oriented cognition. A self-report 20-item Toronto Alexithymia Scale (TAS-20) is a commonly used tool to measure alexithymia. It has been translated into more than 20 different languages, crossing the cultural and language barriers. TAS-20 has a factorial structure: factor 1 assesses difficulty identifying feelings; factor 2 assesses difficulty describing feelings; factor 3 assesses externally oriented thinking.

The objective of the study was to validate a Serbian translation, including the factorial structure, of the TAS-20.

TAS-20 was expertly translated from English to Serbian and given to a bilingual non-clinical sample fluent in both English and Serbian (n=47, age 18-60). The subjects were assigned to complete Serbian version (TAS-20-SRB) at week one, and the English version (TAS-20-ENG) at week two (7-14 days apart). The collected data were analysed using a paired samples correlations and paired samples t-test.

There were no statistically significant differences in paired samples comparisons of means of total score and scores on each of three factors of TAS-20-ENG and TAS-20-SRB (p>0.05). The results of correlations of total scores and scores on factors show the statically significant correlations (p< 0.001), and also that the correlations were very high (from 0.87 to 0.95).

Bilingual subjects showed temporally and quantitatively congruent scores on both TAS-20 and TAS-20-SRB, suggesting that the Serbian translation of TAS-20 was valid, and that the factorial structure remained stable.

There is a considerable body of literature suggesting that standardized rater training is a critical element to achieving inter-rater reliability. With the advance of clinical and research trials to worldwide locations there have been challenges in tailoring instruments not only in terms of language but also culture. In this study we compare different cohorts of raters receiving training from seven different countries. We asked if there was any consistent by-country impact on certain items, factors, or subscales on the instrument.

The data set comes from rater training events held in Russia, India, Singapore, Austria and the United States including participants from seven different countries. Raters (n=221) scored videotaped interviews of schizophrenic patients using the Positive and Negative Syndrome Scale (PANSS). Results were compared across countries and intraclass correlation coefficients (ICC) compared by total score, subscale score and by item.

There were no significant differences between rater cohorts in terms of PANSS total score. Differences emerged in terms of the assessment of negative symptoms in general and the assessment of unusual thought content in particular.

The lack of differences in rater performance across countries indicates that standardized rater training is broadly effective in cohorts selected to participate in clinical trials. By item analysis indicated that there are some important differences in the way that different groups conceptualize items. This suggests a need to tailor training to those items that are less reliable in certain groups to ensure reliability and validity in the use of this instrument.

The importance of rater training for reliability and validity in clinical trials is well documented. In this study the authors examined data from several large training events that used standardized training procedures and raters with similar levels of education and experience to determine if there were any differences between rater performance at baseline (before training) and endpoint (after training) that emerge independent of these factors.

Results from multiple training events held internationally were analyzed to determine if differences between baseline and endpoint scores were significant. Raters scored videotaped interviews of the Positive and Negative Syndrome Scale (PANSS).

Three subgroups of raters emerge based on concordance with gold-standard ratings: raters that score high at baseline and endpoint; raters that score fair at baseline and good at endpoint; raters that do not appear to improve. For the stronger initial raters that continued to perform well after training there was a less substantial change (t(96)=2.953, p< .005) than those raters that did less well at baseline but improved after training (t(160)=4.037, p< .001).

Within training groups there appear to be three groups of raters that emerge independently of rater qualification and training received: those that performed well initially and well at endpoint; another group that performed marginally at the beginning of training and showed improvement by the end; and a third group that did not improve as a result of training. Analysis of ICCs suggests targeted training for individuals that perform less well at baseline could be beneficial.

Functional brain activity has been only studied marginally in schizoaffective disorder (SAD), a disorder whose nosological status is controversial. The present study investigated the prefrontal cortex (PFC) activity of schizomanic patients during performance of a working memory task.

13 schizoaffective patients, with current schizomanic episode (Young> 18); and 26 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups.

During performance of the n-back task, controls showed activation in a cluster of frontal areas and de-activation in the medial orbitofrontal and anterior cingulate cortex. The SAD patients showed significantly less activation in prefrontal areas than the controls. They also showed a marked failure to de-activate in medial frontal cortex. The SAD patients’ impaired task performance was associated with both reduced activation of the dorsolateral PFC and reduced de-activation of the medial frontal areas.

Schizomanic patients show failure of activation in a network of cortical regions, and also a failure to de-activate the ventromedial PFC and anterior cingulate cortex. This latter area corresponds to the one of the components of the 'default mode network´. This pattern of abnormality is similar to that found by our group to characterise schizophrenia (failure to activate and failure to de-activate), but different from that which characterises manic patients (failure to de-activate only).

Functional magnetic resonance imaging (fMRI) is a neuroimaging technique increasingly used for both patient care and clinical research. This techniche provides a space-time high-resolution able to detect small changes in regional brain activation.Ojbectives: the aim of this study was to compare patterns of regional brain activation in patients with eating disorders (ED) and healthy volunteers during emotional stimulation.

A group of 13 young female ED outpatients was selected using DSM-IV criteria and 13 young healthy female volunteers with no significant differences in sociodemographic or environmental data. fMRI was used to examine the neural responses after visual stimulation with neutral and fearful images, taken from the IAPS (International Affective Picture System) and selected a region of interest (ROI) aproach to examine the function of the amygdala in emotional processing.Data processing and higher level analysis were carried out using FSL (fMRI's Software Library).

ED patients showed significantly greater rigth amygdala activation to the fearful images versus neutral images than healthy control subjects (p < 0.02)

A higher right amygdala response to processing of fearful stimuli was observed in ED patients compared to healthy volunteers. This emotional dysregulation in the affective response to unpleasant stimuli would correlate with a maladaptative response and therefore justify disruptive behaviours in this patients.

The abnormal connectivity between brain regions has been proposed to account for the physiopathology of psychoses. But which brains regions or which specific links could play the more important role for psychosis to emerge? This study looked at long range functional connectivity in a large sample of schizophrenic patients during resting state.

Forty-two patients with DSM-IV defined schizophrenia were recruited and compared to 57 controls. Participants took part to a 20 min resting state fMRI scan keeping eyes closed but remaining awake. The signal from the 78 Brodman areas was averaged between which a correlation coefficient was computed as the metric for functional connectivity. Patients and controls were compared using permutation test correcting for multiple testing.

The differences can be better described in terms of hub regions that are more disconnected with others than by specific links. The internal temporal, the temporal pole, the inferior temporal and the anterior cingulate regions were the most disconnected. The sensori-motor frontal and parietal regions were less clearly implicated and were correlated with chlorpromazine equivalent dose. There were no inter-hemispheric difference.

The temporal pole was the most differently connected between the two groups. This region is poorly know as there is no equivalent in the other primates. The internal temporal areas (essentially the enthorhinal cortex) were also much concerned in accordance with the limbic hypothesis of psychosis. Surprisingly the prefrontal regions were not involved probably because of the absence of a outward directed cognitive task.

In personal and in political context, we often evaluate the risk of certain conditions. Therefore, two principal psychological approaches are suggested: the analytical consideration and the intuitive estimation, both with according discriminative brain activation. We investigated the neural basis on which non-experts evaluated high risk of different environmental hazards for the society compared with respective low risk.

Twenty healthy subjects underwent functional magnetic resonance imaging while evaluating the risk of fifty more or less risky conditions presented as written terms. We analyzed brain activations during the individual estimations of ‘high’ against ‘low’ risk. Further, the individual brain activations associated with ‘negative’ versus ‘not negative’ emotional valence of the terms were analyzed.

Estimating hazards to be of high risk was associated with activation in medial thalamus, anterior insula, nucleus caudatus, posterior cingulate cortex and precuneus. These areas were not involved according to the analysis of the emotion ratings.

The results point to a substantial contribution of viscerosensitive areas to signal high risk and supports models of an intuitive “gut” feeling independent of the subjective emotional valence when estimating a high risk of environmental hazards.

The authors evaluated cerebral blood flow response in schizophrenia patients during face perception to test the hypothesis of diminished limbic activation related to emotional relevance of facial stimuli.

Thirteen patients with schizophrenia and 17 comparison subjects viewed facial displays of happiness, sadness, surprise, anger, fear, and disgust as well as neutral faces using the Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces (Matsumoto and Ekman, 1988). Functional magnetic resonance imaging was used to measure blood-oxygen-level-dependent signal changes as the subjects alternated between tasks of discriminating sex with an interleaved reference condition.

The groups did not differ in performance on the task. Healthy participants showed activation in the bilateral fusiform gyrus, medial temporal structures, occipital lobe, and inferior frontal cortex relative to the baseline condition. The increase was greater these regions in the right hemisphere than those in the left hemisphere. In the patients with schizophrenia, minimal focal response in the right fusiform gyrus, medial temporal structures, and occipital lobe was observed for the facial perception task relative to the baseline condition. Contrasting patients and comparison subjects revealed voxels in the left medial temporal structures, occipital lobe in which the healthy comparison subjects had significantly greater activation.

Impaired activation was seen in patients with schizophrenia for detection of facial attributes such as sex. Impairment in the medial temporal structure such as amygdale may lead to misunderstanding of social communication and may underlie difficulties in social adjustment experienced by people with schizophrenia.

There is significant overlap between the cortical network involved in fearful face perception and regional abnormalities identified in patients with bipolar disorder. The primary aim of this study was to measure effective connectivity arising from Dynamic Causal Modelling (DCM) to identify differences within this network in a group of patients with bipolar disorder and controls during an affective processing task.

Functional MRI was used to record brain activations from 52 euthymic patients with bipolar disorder and 44 healthy controls engaged in a fearful versus neutral facial affect recognition task. We used Bayesian model selection to identify the best model of effective connectivity, as well as a random-effects analysis. Additionally, the endogenous connections and modulatory influences were extracted and further analyzed.

Within the network subserving fearful facial affect recognition, patients with bipolar disorder demonstrated reduced connectivity from the inferior occipital gyrus to the fusiform gyrus compared to healthy controls. Furthermore this connection when modulated by fear showed a reduction in strength in patients with bipolar disorder.

Bipolar disorder was associated with deficits early in the processing of facial affect suggesting the possibility of perceptual abnormalities being associated with the disorder.

Dr Frangou was supported by a NARSAD Independent Investigator Award

It is an unsettled issue in the literature, under which nosological group depersonalization disorder (DPD) should be subsumed.

We measured clinical traits in DPD patients that had previously been implicated in DPD.

Investigated were N = 9 patients with DPD and N = 12 normal controls. To establish the diagnosis of DPD, ICD-10 criteria and cut-off values (CDS > 70) were included. Clinical traits were measured with internationally established psychiatric taxons. Implicit fMRI tasks inducing three steps of happy and sad facial expressions were run, and clinical trait scores were correlated with brain activation in each emotion category.

Significant differences in the regression slopes for the two groups were observed for somatization in the right temporal operculum (happy) and ventral striatum bilaterally (sad). Discriminative regions for depression were the right middle frontal gyrus (happy) and left amygdala (sad). For dissociation, discriminative regions were the left pulvinar (happy) and left parahippocampal gyrus (sad). For state anxiety, discriminative regions were the left ventrolateral prefrontal cortex (happy) and left ventrolateral cortex (sad)(different locations). For trait anxiety, discriminative regions were the right caudate head (happy) and left retrosplenial cortex (sad).

Our results endorse the notion that depersonalization disorder patients show multifaceted clinical traits, but do not justify any bias for a certain nosological category. The differential regions ascertained by regression during emotion processing comparing to normal controls reflect substantial deviations in DPD for clinical trait processing in the brain.

The current study elucidates the relations between alexithymia and brain activation towards happy and sad emotional stimulation in Depersonalization Disorder (DPD). We hypothesized that various facets of the alexithymia construct are differentially related to single neural structures characterizing abnormal emotion processing in DPD.

Investigated were N = 9 patients with DPD and N = 12 normal controls. To establish the diagnosis of DPD, ICD-10 and scale cut-off values (CDS > 70) were included. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). Implicit fMRI tasks inducing three steps of happy and sad facial expressions were run, and clinical trait scores were correlated with brain activation in each emotion category.

Significant positive correlations for alexithymia levels in DPD patients were in the right hypothalamus (happy, r = 0.60, p < 0.00001) and right retrosplenial cortex (sad, r = 0.78, p < 0.00001). The prominent regions for alexithymia levels in normal controls were instead in the left cerebellum (happy, r = 0.71, p < 0.00001) and right ventrolateral cortex (sad, r = 0.89, p < 0.00001). Significant differences in the regression slopes for the two groups were observed in the left putamen (happy, average Δr = 0.86, p < 0.0255) and in the left dorsal ACC (sad, average Δr = 0.87, p < 0.0087).

The present results suggest that the alexithymia trait is related to specific brain regions dependent on emotion. DPD patients recruit different brain regions compared to normal controls in alexithymia.

To identify alterations in neural networks for visual motion perception and pursuit tracking and their interrelationship in schizophrenia, and secondarily to evaluate their comparability to findings in psychotic bipolar disorder.

Untreated first-episode patients with schizophrenia (N=24) and psychotic bipolar disorder (N=13), and 20 matched healthy participants performed a passive visual motion processing task and a pursuit eye tracking task, which patients have been shown to perform as well as healthy subjects, during functional neuroimaging. Available subjects were retested after four weeks, during which both patient groups received second generation antipsychotics.

During the motion processing task, neither patient group showed reduced activation in V5, but activations in its projection fields in posterior parietal cortex were reduced in both groups. Pursuit related neural activation in both patients groups was not reduced in sensorimotor systems, but was enhanced in anterior intraparietal sulcus and insula. In schizophrenia, activation was also enhanced in dorsolateral prefrontal cortex and dorsomedial thalamus. Greater V5 activation during passive motion processing predicted greater activation in posterior parietal cortex during pursuit in healthy individuals but not in patients. The only significant change at follow-up was decreased anterior cingulate activation during pursuit in schizophrenia.

Reduced transfer of visual motion information to parietal association cortex may compromise information about target speed and tracking error needed for sensorimotor transformations during pursuit tracking in psychotic disorders. Enhanced activation of a prefrontal-thalamo-parietal network during pursuit tracking in schizophrenia may represent compensation for this deficit.

The diagnostic boundaries of social anxiety disorder (SAD) are still controversial and recent evidence suggests that the condition could be better understood as a continuum of severity, rather than a strictly circumscribed entity. Current neuroanatomical theories on SAD support the involvement of limbic structures in its pathophysiology, with an emphasis on the amygdala. Thus, the objective of this study was to investigate the hypothesis of volumetric alterations in the amygdala of subjects in different points of the social anxiety spectrum.

The sample consisted of patients with generalized SAD (n=17), subthreshold SAD (increased social anxiety without avoidance; n=13), and healthy controls (n=15). Participants underwent structural magnetic resonance scans and the volume of the bilateral amygdala was manually determined.

Significantly greater volumes of bilateral amygdala were found in socially anxious individuals. Amygdala volumes of subthreshold SAD participants fell between the values found for generalized SAD and healthy controls.

Individuals suffering from SAD have greater amygdala volumes compared to controls and this difference seems to be in agreement with the theoretical conception of SAD as a severity continuum and not as a circumscribed nosological entity.

Recent studies have identified DAAO as a probable susceptibility gene for schizophrenia and bipolar disorder. However, little is known about how this gene may affect brain function to increase vulnerability to these disorders.

The present investigation examined the impact of DAAO genotype on brain function in patients with schizophrenia, patients with bipolar I disorder and healthy volunteers.

We tested the hypotheses that the high-risk variant of DAAO would be associated with altered prefrontal function and functional connectivity in schizophrenic and bipolar patients.

We used functional magnetic resonance imaging to measure brain responses during a verbal fluency task in a total of 121 subjects comprising 40 patients with schizophrenia, 33 patients with bipolar I disorder and 48 healthy volunteers. We then used statistical parametric mapping (SPM) and psycho-physiological interaction (PPI) analyses to estimate the main effects of diagnostic group, the main effect of genotype and their interaction on brain activation and functional connectivity.

In schizophrenic patients relative to bipolar patients and controls, the high-risk variant of DAAO was associated with lower deactivation in the left precuneus and greater activation in the right calcarine and posterior cingulate gyrus during task performance. In addiction, these areas expressed altered functional connectivity with the rest of the brain in schizophrenic patients relative to bipolar patients and controls.

Our results suggest that genetic variation in DAAO has a significant impact on brain function and provide preliminary evidence for a disease-specific pattern of gene action in specific brain regions.

Deficits of social cognition are a relevant predictor of functioning and outcome. Several studies have found that euthymic bipolar patients perform worse in social cognition tasks than healthy controls. Some data show a higher relapse risk in bipolar patients with concomitant mentalization deficits. However, relatively little is known about the neurobiological base of these deficits.

12 euthymic bipolar I patients and 14 age- and IQ-matched healthy controls underwent event-related functional MRI study while performing 15 irony, and 15 control tasks (auditory stimulus) in the scanner. Both within group (irony versus control task) and random effects between group analyses were performed on fMRI data.

Bipolar patients were significantly compromised in their ability to appropriately answer irony tasks. Bipolar patients showed a reduced activation in right cingulate, right anterior paracingulate cortex, right precuneus, left superior parietal lobule, left hippocampus, left insula in comparison to healthy controls. However, bipolar patients brain activation was significantly increased in the left inferior frontal gyrus, left superior temporal gyrus, and left secondary somatosensory cortex.

The findings of this neuroimaging study suggest that euthymic bipolar patients are restricted in their ability to mentalize fully. They show less activation in brain regions involved in mental imaginery, emotional processing and self-representation. Therefore, bipolar patients have difficulties in understanding others’ intentions and emotions, which impacts on interpersonal relationships and the functional outcome.