In a European, phase 3 study (SPD489-325), lisdexamfetamine dimesylate (LDX) was more effective than placebo in improving symptoms and global functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

To evaluate the impact of age, sex and baseline disease severity on efficacy outcomes in SPD489- 325.

This 7-week, double-blind, parallel-group, dose-optimized study enrolled patients aged 6-17 years with ADHD. Patients were randomized (1:1:1) to once-daily LDX (30, 50 or 70mg/day), osmotic-release oral system methylphenidate (OROS-MPH; 18, 36 or 54mg/day) or placebo. Efficacy outcomes were analysed in patients dichotomized by age (6-12 years [n=229] or 13-17 years [n=88]), sex (male [n=255] or female [n=62]) and baseline ADHD Rating Scale version IV (ADHD-RSIV) total score (28-41 [n=161] or 42-54 [n=152]). Endpoint was the last on-treatment visit with a valid assessment.

At endpoint, differences (active-placebo) in least-squares mean changes from baseline in ADHD-RS-IV total scores were statistically significant in all age, sex and ADHD-RS-IV total score subgroups for LDX (p< 0.001; effect sizes, 1.68-2.26) and OROS-MPH (p< 0.01; effect sizes, 0.88-1.46). Proportions of patients with a Clinical Global Impressions-Improvement rating of 1 (very much improved) or 2 (much improved) were statistically significantly greater than placebo at endpoint in all subgroups receiving LDX (p< 0.01) and in all subgroups except females receiving OROS-MPH (p< 0.05).

LDX showed greater efficacy than placebo in children and adolescents with ADHD, regardless of their age, sex or baseline disease severity.

Supported by: Funding from Shire Development LLC.

In the diagnosis of functional states of the brain are bursts deviation from the normal pattern EEG. Also used registration of the scalp-recorded direct current (DC) potentials, which in the modern view is characteristic of indirect energy metabolism of the brain.

Studied 25 children 8, 5±3, 3 years of schizophrenia. Aims To assess the significance of electrographic parameters abnormal theta activity with characteristics of energy metabolism of the brain in schizophrenia.

Shifts in scalp-recorded DC potential were studied in relation to the changes of EEG recording such as abnormal prominent theta bursts. Standard EEG recordings were made during wakefulness. “Theta bursts” appeared in two frequency bands: 4-5 cps and 6-7 cps. DC potentials and their topographical distribution were investigated in schizophrenic patients with and without designated electroencephalogram characteristics. The mental state of children assessed psychopathological method and using the scale of PANSS. The obtained data were analyzed using software Statistica-7.

The presence of 6 - 7 Hz in the EEG theta activity, particularly in the temporal areas, combined with a higher level of permanent potentials. Fairly significant differences were observed for the left (p < 0,018) and right (p < 0,012) of the temporal lobes. Were observed higher ratings of positive syndromes scale PANSS (p < 0,014). The presence of 4-5-Hz activity was associated with a decline in constant potentials, and a decrease in mean scores of positive syndromes PANSS.

It was concluded that DC measurement reflects changes in brain state associated with pathophysiology of schizophrenia.

Menopause is characterized by a decline in ovarian function resulting in vasomotor symptoms. Vasomotor symptoms include hot flashes and night sweats.The purpose of this study was to examine the effect of SSRIs on hot flashes in perimenopausal women with depression.

Sixty five perimenopausal women participated in this study. The subjects included 41 perimenopausal women with depression and 24 healthy women. The diagnosis of depression was made by a psychiatric interview and with the help of Hamilton Depression Rating Scale 17 (HAM-D 17). Hot flashes were examined with the use of Menopause Rating Scale (MRS) and they were divided as absent, mild, moderate, severe and very severe.

Perimenopausal women were divided in three groups. The first group consisted of normal controls, the second of depressed perimenopausal women who were taking SSRIs and the third of depressed women not taking SSRIs. The control group had fewer hot flashes than the other two groups (p< 0.0001).The two groups of depressed women did not show any statistically significant difference in the presence and severity of hot flashes in relation to the use of SSRIs.

It was found that depression is associated with the presence of hot flashes in perimenopausal women. On the other hand the use of SSRIs did not relieve perimenopausal women with depression of hot flashes. Therefore, it seems that hormonal replacement therapy has the first role in the treatment of vasomotor symptoms in perimenopausal women.

To analyze the effect of adjunctive therapy with pregabalin versus usual care (UC) on healthcare costs and clinical consequences in generalized anxiety disorder (GAD) patients with partial response (PR) to previous SSRI.

Post-hoc analysis of patients enrolled in a prospective 6-month observational study. Patients with a PR [CGI score >3 and insufficient response with persistence of anxiety symptoms (HAM-A score ≥16)] to SSRI monotherapy were considered eligible for inclusion. Two groups (based on psychiatrist judgment) were analyzed 1) adding pregabalin (150-600 mg/day) to existing therapy; or 2) UC (switching to a different SSRI or adding another anxiolytic. Costs estimation used year-2009 prices for GAD related healthcare resources utilization. Measures of clinical consequences were, changes in total scores of anxiety in HAM-A (primary outcome) and GAD co-morbid depressive symptoms in MADRS (secondary outcome) scales.

Four-hundred-eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher adjusted mean changes (95% CI) vs. UC in HAM-A [-11.2 (-12.2;-10.2) vs. -14.9 (-15.6;-14.2), respectively; p< 0.001] and MADRS [-7.8 (-8.7;-6.8) vs. -11.6 (- 12.2;-10.9), respectively; p< 0.001]. Adjusted mean baseline healthcare costs were significantly reduced in both cohorts; -€487 (-652;-317) and -€531 (-648;-413), respectively (both p< 0.001), yielding to similar 6-month costs; €1543 (1375;1711) UC and €1497 (1380;1614) pregabalin, p=0.661.

In this post-hoc analysis, GAD patients with PR to SSRI experienced greater symptom improvement with adjunctive therapy with pregabalin versus UC without increasing healthcare cost.

The mortality among homeless people is linked to the presence of psychiatric disorders.

We compared the risk of specific death causes among clients of the Public Mental Health care (PMHc) in Utrecht with that of the general population, and assessed whether treatment at a local psychiatric service is associated with this risk.

To clarify the association between the presence of a mental disorder and mortality among the socially marginalized.

Out of 8,741 clients in the PMHc register, the records of 6,724 could be linked to the registries of Statistics Netherlands (CBS). Controls (N=66,247) from the population register were personally matched to a PMHc client. A Cox regression analysis was used to estimate hazard ratios (HR) of death.

An increased all-cause mortality among PMHc clients compared to controls was found (HR=2.99, 95%-CI: 2.63- 3.41), associated with a broad range of death causes.PMHc clients with record linkage to the Psychiatric Case Registry Middle Netherlands (’PMHc+’) had an increased risk of suicide (HR=2.63, 0.99-7.02), but a lower risk of death from natural causes (HR=0.71, 0.54-0.92), compared to PMHc clients without (‘PMHc-’). Compared to controls, however, ‘PMHc-’ clients experienced increased risks of suicide (HR=3.63, 1.42-9.26) and death due to mental & behavioural disorders (HR=7.85, 3.54- 17.43).

Among PMHc clients, a registered diagnosis at a local psychiatric service appears to be favourably associated with lower mortality due to natural death causes. The high risk of suicide among ‘PMHc-’ clients probably indicates a high prevalence of undiagnosed mental disorders among PMHc clients.

ADHD in adults is associated with a significant impairment in many life activities increasing the risk of chronic stress in everyday life. Previous studies reported normal cortisol awakening response (CAR) in children with ADHD without comorbidities, nevertheless there is a lack of studies in adults.

The aim of the present research is to examine CAR in adults with ADHD and to assess possible differences between the combine and inattentive subtypes.

Patients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample consisted of 50 adults, age between 18 and 51 years (mean 35.24 ± 9.21) fulfilling current diagnostic criteria for ADHD (DSM-IV criteria). All patients were naïve to stimulant medication. Psychiatric and organic comorbid disorders were excluded. To assess CAR, four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening.

The mean increase in CAR for the whole group of patients was 10.34±8.79 nmols/l. T-test comparisons showed no significant differences in the mean increase of CAR between the inattentive (mean: 9.47±9.04 nmols/l) and combine (mean: 11.25±8.67 nmols/l) subtypes (t=0.610; z=0.546).

Despite there were no significant differences in salivary CAR between ADHD subtypes in adults, the mean increase of CAR was higher in combine than in the inattentive subtype. Salivary CAR needs to be further explored as an index of vulnerability to stress in these patients.

There is a large mortality gap between patients with a non-affective psychotic disorder (NAPD) and the general population.

To assess whether mortality risks vary for different death causes according to duration since diagnosis and age in a large sample of NAPD patients.

To get insight into the risk of specific death causes along the treatment trajectory, important for interventions that are tailored to the patients' risk profile.

Data of NAPD patients (n=12,580) from three Dutch psychiatric registers were linked to the registers of Statistics Netherlands and compared to personally matched controls (n=124,143). Death rates were analysed by duration since the date of diagnosis of the (matched) patient and age using Poisson regression.

Among patients, the rates of all-cause death decreased with longer duration. This was explained by lower suicide rates. E.g., among those aged 40-60 years, the rate ratios (RRs) of suicide during 2-5 and >5 years compared to the early years after diagnosis were 0.52 and 0.46 (P=0.002). Compared with controls, patients experienced higher rates of natural death causes during all stages and in all age categories: RRs 2.35-5.04, P < 0.05. No increase in these RRs for patients compared to controls with increasing duration or increasing age was found.

The high risk of natural death causes among NAPD patients is not (only) an effect of accumulating risks induced by the chronic nature of the disorder and/or antipsychotic treatment, but is already present during the early stages of the treatment and at young age.

Findings regarding impairments in quality of life of children and adolescents with short stature are not unequivocal. The present paper examines prevalence of such impairments, their mutual relationship, potential determinants and differences between patient self-report and parent report.

Children and adolescents (n=218) with short stature (idiopathic short stature and growth hormone deficit) and their parents provided assessments of psychological health (Strengths and Difficulties Questionnaire - SDQ) and health related quality of life (KIDSCREEN Questionnaire). Variance and regression analysis were used to identify group differences and potential determinants of quality of life.

Child-reported SDQ total score was in the normal range in over 80% of cases, while 7.8% were identified as borderline impaired and 8.2% were classified as abnormal. Parents ratings were 76% normal, 8.6% borderline and 17.8% abnormal. Impairments were found for young children, for boys and for very short patients. Analysis of variance showed higher KIDSCREEN scores in the SDQ normal group. SDQ and KIDSCREEN correlated significantly. Half of the variance in KIDSCREEN scores was explained by a combination of SDQ scores, clinical status and sociodemographic data in child and parent samples.

Parents reported higher impairments in psychological health than children. SDQ related differences in KIDSCREEN scores and the proportion of variance in QoL explained by the SDQ suggest that mental health should be routinely assessed in children with short stature as a part of the diagnostic process. Psychological interventions should be considered when clinically indicated.

Art and Religion have accompanied the history of human kind since primordial times, undergoing changes with evolution, being interconnected or separated in antithesis in some historical periods. Nevertheless both are eliciting the idea of “Sublime” affecting in a greater or lesser degree the life of individuals in our society. A curious interconnection with psychosis is seen in two peculiar conditions: Stendhal and Jerusalem syndromes.

Starting from the consideration of Art and Religion in the Idealistic philosophy the relationship between Stendhal and Jerusalem syndromes, which lead to acute transient psychotic episodes in tourists with psychic and somatic symptoms, is examined.

This work aims to spread the knowledge about the two syndromes, to highlight analogies between them, and finally to summarize and show a possible connection between the modern findings in neuroaesthetics and Stendhal syndrome.

The work is of qualitative type and mainly descriptive: all the existing evidence on the topic and with possible connections to it was brought together, summarised, and compared leading to new possible ideas for the future.

A hypothetical psycho-pathophysiological mechanism is proposed, based on the psychoanalysis, psychology, genetic, and the new findings in neuroaesthetic (especially connected to Stendhal syndrome), but more research is needed.

The influence of Art and Religion culminating in Stendhal syndrome and Jerusalem syndrome, based on their comparison, could be regarded as “tourist syndromes” or as a “tourist's transient psychotic episode” differentiating the object of psychosis as Art in the first and Religion in the second.

Of this study were to analyze the frequency of involuntary admission into psychiatric hospitals in Moscow through the Emergency Medical Service during a 2 -year period. As well as distinguish clinical, social and legal particularities associated with compulsory hospitalization.

The analysis of the database records of Psychiatric Department of the Station of Emergency Medical Service named after A.S. Puchkov for the period from July 2010 till June 2012.

General population of Moscow city consists of 11,5 millions people. 200 thousands individuals receive psychiatric care. Every year about 42,000 mentally ill people get admitted to the psychiatric hospitals in Moscow through emergency medical service. Around 60% (25 000) of the patients went through involuntary hospitalization. 82% of them were due to the autoagressive or aggressive behavior, including suicidal behavior and suicide attempts. 18% of involuntary hospitalization happened due to the psychiatric helplessness and risk for the health and well being of an individual in case of absence of psychiatric help. The numbers of involuntary admission remained stable over the two-year period. The most common entry diagnoses were unspecified schizophrenia and delirium tremens.

The primary Sjögren's Syndrome (SS) - a chronic, systemic autoimmune disease, characterized by lymphocytic infiltration of endocrine glands, functional impairment of the salivary and lachrymal glands, which has some common pathogenic links with stress-related mental disorders (MD).

To evaluate the occurrence rate/severity of MD and the influence of stress factors in SS patients.

50 inpatient women (mean age 46+13.16 yrs) suffering SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression, anxiety and stress load were measured with MADRS, HAM-A and PSS.

MD were diagnosed in 42 (84%) of SS patients: depressive episode (mild/moderate; single/recurrent, n=9;18%); dysthymia (n=9;18%); generalized anxiety disorder (n=7;14%); adjustment disorder (n=8;16%); schizotypal disorder (n=9;18%). Mean severity levels of anxiety, depression and stress were 16.5+6.5; 17.2+7.9 and 16.9+6.0 accordingly. The acute stress factors and reactions were preceded the SS symptoms in most cases (n= 27, 54%). MD had the significant precipitating chronic stress factors in 36 (72%) patients. The adverse experience in childhood (parental deprivation mostly) had 32 (64%) of SS patients (recurrent events - 48%).

The study revealed high occurrence rate of MD, precipitating stress factors and childhood adverse experience in SS patients. The results support the stress-diathesis model of mental disorders in patients suffering rheumatic disease.

Patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. Additionally the patients have high level of obesity which is a contributing factor to increased physical morbidities and premature death.

Quantify the use of psychotropic medicine in patients with severe mental illness. Measure the effect of an intervention to reduce psychotropic medicine.

Intervention study with six facilities for patients diagnosed with mental illnesses. The intervention period was one year.

At index many patients had obesity and waist circumference were in average 109 cm. Mean values of antipsychotic daily doses/ defined daily doses PDD/DDD was 2.5. The rate of antipsychotic excessive dosing was 65% and 88% of the patients were treated with psychotropic poly-pharmacy. The intervention didn’t show any effect as there were no difference between the changes in the intervention group and the control group.

The patients were treated with antipsychotic poly-pharmacy in high dosages. The intervention did not show any effect. We must think of new ways to restrict the treatment with psychotropics to this group of patients.

Despite growing interest in internet addiction (IA), there is still no consensus in perceiving it as a distinct clinical disorder. Proposals of including IA in the DSM-V and possibly also ICD-11 have strengthened the notion that it has a lot of features justifying its nosological classification as a primary disorder.

Besides a large number of epidemiological surveys, clinical examinations investigating psychopathological symptoms and co-morbidity in a standardized way are still missing. Hence, clinical data is very important in the research on IA as it might support data gained in representative studies.

The purpose of the study was to provide further clinical characterisation of IA.

A clinical sample from a specialized outpatient clinic in Germany was examined by clinical ratings (GAF; psychiatric co-morbidity) and questionnaires (SCL-90R, PHQ). Two clinical groups were included: Patients meeting criteria for IA (n=80) and patients with pathological gambling (n=80). For further statistical comparison, healthy controls (n=80) were recruited too.

Both clinical groups scored significantly higher in SCL-90R and PHQ than the controls. Patients with IA showed similar profiles in SCL-90R as pathological gamblers with no significant differences in any sub-scale. Also, scores of GAF were similar. Expert ratings on co-morbidity indicate that depression is associated with both disorders. In IA also social phobia is common.

Patients with IA and pathological gamblers display comparable levels of psychopathological symptoms and impairment. IA seems to cause significant psychopathological strain similar to pathological gambling that is accepted as a clinical disorder since the 1980ies.

Scarce studies have reported a relationship between Attention Deficit-Hyperactivity Disorder (ADHD) and atopic symptoms (i.e. rhinitis, eczema), food allergy and asthma in children and adults. Results of the studies show a trend toward a positive relationship.

This study aims to explore the relationship between ADHD and atopy in treatment-naïve children referred to an ADHD consultation.

For 12 consecutive months, all children diagnosed with impairing ADHD and for who a psychopharmacological treatment was indicated were blood tested for the presence of a mixture of specific IgE (PHADIATOP® test). An allergist subsequently performed prick-tests on only those with positive tests.

63 children out of 102 included (61.8%) had a positive blood test. Age, gender and Body Mass Index did not differ between positive and negative groups. Children were more likely to have ADHD Combined (66/102). Rates of Opponent Defiant Disorder (ODD, 40/102) and Conduct Disorder (CD, 14/102) were similar between groups. Atopy is not with ODD or CD. Familial history of ADHD (36/102) or atopy (39/102) is significant. Prick tests confirmed the blood test in all cases. Rhinitis was most frequent (40/63) with moderate to severe intensity in 23 cases (67.7%), associated with a history of conjunctivitis in 21 cases (61.8%). Most youths had never been referred to an allergist although some of them had a persistent and severe symptomatology.

This is the larger study reporting a strong relationship between ADHD and atopy. All children referred for ADHD shall be screened for atopy and vice versa.

The aim of this study was to understand the early stage of illness recovery experiences and related needs of patients who underwent emergency cardiac surgery.

A qualitative approach was used. Patients who had been transferred from intensive care units to a general ward for least 6 days and were expecting to be discharged within one week were interviewed at a medical center in northern Taiwan.

A total of 9 patients participated in this study. Two themes emerged from the analysis related to their illness experiences. Patients felt ‘shock’ when they were informed to have emergency surgery or when they woke up to know surgery had been done on them, including unbelieving and suspicious. They also described various degree of ‘psychiatric symptoms’, such as fragment of memory or memory loss related to the medical procedure, nightmares, insomnia,hallucinations, derealization, daze, sluggish response, and attention deficit. Three themes emerged from the analysis looking at their needs. Patients described the needs for ‘reassurances,’ ‘support,’ and ‘more information about subsequent treatment and care’ to rebuild their new life in the future.

This study has shown that these patients had many of symptoms related to acute stress and their related needs in the early recovery stage. The findings would enhance the health professions can design early interventions to treat acute stress symptoms in critical care units. It would help patients in the restore their social and occupational functions, and prevent the development of PTSD. It is suggested integrated interdisciplinary care and support are crucial helping patients recovery.

Burning mouth syndrome (BMS) is an unremitting oral burning in the absence of detectable changes of the oral mucosa, whose prevalence ranges from 3.7% to 18% in the older age groups, particularly among postmenopausal women. This condition is often under-diagnosed, and rarely treated when diagnosed.

1. (i) To make a synthesis of clinical and pathophysiological data

2. (ii) to provide a review on therapeutic evaluated in BMS.

We conducted a systematic review of the literature using the criteria according to the PRISMA research paradigm “glossodynia OR burning mouth syndrome OR stomatodynia OR stomadynia OR stomatopyrosis OR glossodynia OR oral dysesthesia OR persistent idiopathic orofacial pain”.

(i) BMS is described as burning pain, tingling or numbness sensations in the oral mucosa, most often affecting the tongue, anterior palate and/or lips. The pain increases during the day, is relieved when the patient is eating or drinking, and is exacerbated by speeching.

BMS has a multifactorial origin, involving peripheral nerve dysfunction (peripheral small fibre neuropathy of intraoral mucosa ; subclinical lingual, mandibular, or trigeminal neuropathy) and central (striatal dopaminergic dysfunction); hormonal dysfunction (impaired production of neuroactive steroids in the skin) and psychological (neuroticiste personality with somatization).

(ii) Literature can recommend systemic alpha-lipoic acid, topical or systemic clonazepam, and psychotherapy. Efficacy data and the risk / benefit ratio of the tongue protectors allow to recommend their use.

We have explained current clinical, physiopathologic, and therapeutic data of BMS whose understanding is necessary to improve these patients’management.