Recent reviews of evidence-based guidelines for the clinical management of Bipolar Disorders (BD) have recommended that “all patients with BD should be offered group or individual psychoeducation” to prevent relapse, improve treatment adherence, quality of life and functioning.

The present study aimed at evaluating the psychoeducation in routine mental health.

One hundred and two outpatients were recruited from two Italian DMHs. Inclusion criteria were a lifetime diagnosis of BD type I or II assessed by SCID-I, being euthymic for at least 3 months. Exclusion criteria were a DSM-IV Axis I comorbidity, mental retardation (IQ < 70), organic brain damage. All subjects received standard psychiatric care, with standard pharmacological treatment; one group received additional 21 weekly sessions of psychoeducation group, according to Colom and Vieta model.

Data show that the number of patients hospitalized during the 1-year follow-up, the mean number of hospitalizations per patient and the mean number of days in hospital were significantly lower for psychoeducated patients.

Our study supports the view that group psychoeducation is an efficacious intervention to prevent patients’ hospitalization and decrease hospital days in pharmacologically treated patients with bipolar disorder, also in routine clinical settings. The results seem to confirm that the psychoeducation promotes an improvement in the course of illness, avoiding acute phases, and producing a greater stabilization of the disease and consequently an improvement in quality of life in people with BD.

ADHD is a common disorder that often presents in childhood and is associated with increased healthcare resource use.

To evaluate ADHD incidence and estimate resource utilization and costs of care in the UK.

The Clinical Practice Research Datalink was searched between 1998 and 2010 for patients aged 6-17 years, newly diagnosed with ADHD. Age- and sex-matched, controls were also identified (ratio 1:3). ADHD incidence was calculated as the number of incident cases/100,000 people (/100k) in the at-risk population. Resource utilization in the first year post-diagnosis was estimated for general practice (GP) contacts, investigations, drug treatments, outpatient appointments, and inpatient admissions. Monetary costs were derived from various sources (at 2011 prices).

2,873 subjects with ADHD and 6,598 matched controls were identified. Mean (standard deviation [SD]) age was 9.8 (2.8) years and most (87%) were boys. The incidence of ADHD amongst boys and girls, respectively, increased from 69/100k and 7/100k in 1998 to 132/100k and 24/100k in 2007, and then fell to 98/100k and 20/100k in 2010. The mean (SD) annual, cost was £1,291 (£2,121) for cases and £315 (£2,345) for controls. For cases and controls, respectively, annual costs comprised GP contacts (£199, £70), investigations (£10, £8), drug treatments (£306, £37), outpatient appointments (£572, £62) and inpatient admissions (£203, £139).

The incidence of ADHD increased between 1998 and 2007, then declined slightly in 2010. Medical costs in the first year post-diagnosis were notably higher in children with ADHD compared with controls

Shire Development LLC.

Metabolic profiles, LEP, LEPR gene polymorphisms and the gene expressions of LEP, LEPR and PPARg2 were studied in SCH patients and controls.

BMI, cholesterol and fasting glucose levels were higher in SCH patients compared to controls. LEP c.-2548 (GA+AA) genotypes were two fold lower in SCH patients versus controls (p< 0.05), and no significant difference was observed in LEPR p.Q223R genotypes. Interestingly, leptin serum levels were lower in SCH patients compared to controls (p< 0.05). Leptin, leptin receptor and PPARg2 gene expressions were found to be decreased in SCH patients compared to controls (p< 0.001, p< 0.001 and p≤0.05, respectively).

Leptin receptor, leptin and PPARg2 genes could be potential risk factors in developing metabolic adversities in SCH.

Persons with severe mental disorders and a history of violent offending are usually seen as a difficult-tomanage population: most have schizophrenia or severe affective disorders, while some suffer from severe personality disorders.

To investigate the sociodemographic, clinical, and treatment-related characteristics of a sample of patients living in RFs with a history of antisocial behaviour (‘violent’ group); to compare the characteristics of the ‘violent’ group with residents never violent; and to compare the rate of violent behaviour in the two groups over two years and to assess the likelihood of discharge in the two groups.

This is prospective observational cohort study involved 23 RFs of the St John of God Order in Northern Italy. The sample was divided into two groups: non-violent patients and ‘violent’ patients. The last included patients at last one time admitted in FMH or arrested for violent crimes or acted violent behaviors against people.

For each inpatient was filled out a “Patient Schedule”: socio-demographic and clinical data were collected, including a specific session to assess aggressive behavior lifetime and in the last year.

The study involved 403 patients: 89 ‘violents’ and 314 non-violent. ‘Violent’ group was mainly male, younger, with a prevalence of personality disorders. Coherently, in the group of ‘violent’ there were more people lifetime arrested and admitted to a FMH.

There are some differences in the monitoring of violent behavior in the two years of assessment. We observed more threatening, slap, punch, inappropriate sexual harassment, etc. in the ‘violents’ group.

Paraneoplastic disorders of the CNS are a heterogeneous group of neurological disorders associated with systemic cancer which cannot be attributed to direct effects of the neoplasm. Although there is extensive literature focusing on the neurological manifestations of these disorders, the initial presentation is psychiatric in many instances and discussion in the psychiatric literature is relatively sparse.

1. - To bolster recognition and enhanced characterization of paraneoplastic disorders from within the psychiatric community.

2. - To explore temporal aspects of symptom presentation in relation to biopsy.

3. - To identify how psychoneuroimmunological factors may contribute to the development of paraneoplastic disorders.

We report the case of a 48 year-old female with no past psychiatric history who presented with neuropsychiatric symptoms immediately subsequent to biopsy and inflammatory breast cancer diagnosis. Patient was initially admitted to the psychiatric unit for suspected acute stress reaction, yet eventually diagnosed with paraneoplastic extra-limbic encephalitis.

1. - As early oncologic treatment and immunotherapies improve outcomes, early diagnosis is paramount for both treating the paraneoplastic syndrome and identifying possible underlying malignancy.

2. - Time course of symptom presentation raises the intriguing possibility that perturbation of tumor tissues during biopsy may accelerate the immune response to onconeuronal auto-antigens and inflammation-mediated neuronal injury.

3. - Given the patient's acute stress state, the rapid time course of symptom onset, and known connection between psychological stress and autoimmunity, we propose that the immune system stress-response may additionally contribute to the paraneoplastic syndrome development. This connection warrants further investigation from within the psychoneuroimmunology community.

Effectiveness studies of therapeutic switching of antipsychotics provide valuable clinical information.

Assess effectiveness of switching patients to lurasidone.

To evaluate 3 dosing strategies when switching patients to lurasidone.

Patients were randomized to three open-label lurasidone dosing strategies: 40mg/day for 14 days (n=74); 40mg/day for 7 days then 80mg/day for 7 days (n=88); and 80mg/day for 14 days (n=82) and stratified by their previous treatment (sedating vs non-sedating). Prior antipsychotic was tapered (50% step-down, day 8, discontinued day 14), followed by 4 weeks of flexible dose treatment (40-120 mg/day). Primary outcome was time to treatment failure (TTF). Of the 198 subjects completing core 6-week study, 149 (75.3%) enrolled in a 6-month extension study.

Switching to lurasidone was well tolerated; 198 (81.1%) of subjects completed core study, 19 (7.9%) subjects experienced treatment failure of which 16 (6.7%) discontinued due to an AE. No clinically relevant differences were noted among the 3 dosing strategies. TTF was earlier in patients previously receiving sedating antipsychotics vs. non-sedating (log rank p=0.101). Core study yielded LS mean (SE) within-group improvement on PANSS total score -5.3 (±0.7), LOCF with further improvement of -1.5 (±0.9), LOCF, at Month 6 from extension baseline. Ninety-eight subjects (65.8%) completed extension phase. Premature discontinuation causes included consent withdrawal (12.1%) and AEs (11.4%). Weight and lipid changes at 6 months were minimal.

Switching to lurasidone was safe and well tolerated regardless of initial dosing strategy. Switched patients maintained or improved symptom control during core and extension treatment.

Postpartum depressive symptomatology is highly prevalent and has negative impact in the entire family.

To identify correlates of postpartum depressive symptomatology.

201 3-months postpartum women completed the Portuguese versions of Postpartum Depression Screening Scale/PDSS, Profile of Mood States, Difficult Infant Temperament Questionnaire/DITQ, Multidimensional Perfectionism Scale and questions on sociodemographic variables (marital status, work status, educational level, parity), Lifetime history of insomnia/LTHD, Lifetime history of depressive symptomatology /LTHDS, Current insomnia, Sleep needs, Health perception/HP, Stress perception/SP, Perceived social support/PSS, Quality of life/QOL, Health problem/complication postpartum, Sensibility to hormonal fluctuations, Type of delivery and Type of feeding.

Total PDSS significantly correlated with LTHDS (rs=.35), LHI (rs=.22), Current insomnia (rs=.37), SP (rs=39), PSS (rs=.25), Perceived QOL (rs=.31), Health perception (rs=.28), Health problem or complication in the postpartum (rs=.16), Negative Affect/NA (r=.59), Positive Affect/PA (r=-.67), Conditional Acceptance/CA(r=.29) and DIT (r=.40) (all p< .01). Mean comparisons revealed that women with vs. without LHDS, with vs. without LTHI, good sleepers vs. with insomnia syndrome, high vs. low SP, bad/very bad vs. good/very good QOL, bad/very bad vs. good very good HP, high (< M+1DP) vs. low (>M-1DP) DIT, CA, NA and low vs. high PA had significantly higher mean scores in AI (all p< .01). Linear regression model composed of all correlated variables explained 53.9% of depressive symptomatology variance and showed that NA, PA, DIT and HP are significant (p< .05) predictors of AI.

These results are in line with previous findings and contribute to the progress on this topic.

Lurasidone has demonstrated efficacy treating adults with schizophrenia, the majority of them with chronic, multi-episode schizophrenia.

To assess baseline characteristics and evaluate efficacy of lurasidone in patients with early-stage schizophrenia (ESS).

Evaluate efficacy of lurasidone in patients with ESS.

A pooled analysis of patients with ESS (defined as onset of illness within 3 years of study entry) from three, 6-week, randomized, placebo-controlled, phase 3 trials was performed. Additional analysis was conducted for patients with onset within 5 years. Efficacy was evaluated using a mixed-model repeated-measures analysis of change in PANSS total score and CGISeverity score. Treatment response was defined as ≥20% improvement in PANSS total score from baseline.

857 subjects were randomized to lurasidone and 366 to placebo of which 102(11.9%) lurasidone and 44(12.0%) placebo subjects had ESS (onset within 3 years). Among 146 ESS subjects, 70.5% were male, mean age was 28.6 years. Baseline PANSS total and CGI-S scores were 96.8 and 5.0 respectively. Lurasidone treatment of early-stage schizophrenia subjects showed significant improvement vs placebo in PANSS total score (-25.9 vs -17.3; p< 0.05, effect size=0.42), PANSS positive (-9.6 vs 6.0; p< 0.01) and negative (-5.6 vs -3.2; p=0.014) subscale scores, and improvement in CGI-S score (-1.7 vs -1.3; p=0.089, effect size=0.36). Responder rates were 69% for lurasidone vs 48% for placebo (NNT=5). Similar results were observed in subjects with within 5 years of onset of illness.

In this subgroup analysis, lurasidone was effective in the treatment of patients with early-stage schizophrenia.

Since 2007, there has been a gradual increase in the total number of the institutionally approved dependency regarding mental disorders (21 596 cases in 2007, 24 317 cases in 2011). The newly proposed criteria of the assessment of the degree of dependence from January 1, 2012 are set according to the principles of the International Classification of Functioning, Disability and Health (ICF). The aim was to take into account the social needs of patients suffering from mental disorders.

The assessment of the degree of dependence includes the evaluation of the functional impact of the longterm unfavourable state of health on the ability to manage the 10 basic needs. The basic needs are further specified by the ICF principles and activities. Prior to the adoption of this method, assessing the degree of dependence had been tested in terms of its functionality, reliability and impact on disabled people. The tests have demonstrated moderate benefits of this method for people suffering from mental disorders.

[The 10 basic needs in the ICF classification].

The method in question provides an efficient interconnection within the ICF application in both healthcare and dependence degree assessment. Thus, the reflection of ICF in new medical assessment criteria used to assess the degree of dependence will contribute to a change in how healthcare professionals perceive disabilities, and it will ensure that the areas of healthcare, aftercare or long-term care, and the social area are combined more effectively.

Atypical antipsychotics bind to multiple receptor types and subtypes. Improved outcomes in schizophrenia are linked to activity at D2 and serotonin receptors 5-HT7, 5-HT2A and 5-HT1A.

To characterize the receptor-binding profile of lurasidone and other antipsychotics.

To compare receptor-binding profiles of antipsychotics.

Replicated, side-by-side receptor-binding assays used human recombinant receptors (for 5-HT7, α2A, and α2C) or membrane-fractions of animal CNS tissue. Affinities were determined via Hill plot analysis for IC50values; Ki values were determined using Ki=IC50/(1+ S/Kd) (S=concentration of competing radioligand, Kd=dissociation constant).

Lurasidone displayed potent binding and full antagonism at dopamine D2(Ki, 1.68nM) and serotonin 5-HT2A(Ki, 2.03nM) receptors (the highest D2affinity of all tested agents). Lurasidone's dopamine binding was selective for D2receptors. Unlike other antipsychotics tested, lurasidone had very high affinity and full antagonism at serotonin 5-HT7(Ki, 0.49nM), and nanomolar affinity (Ki=6.75nM) with weak-moderate partial agonism at serotonin 5-HT1Areceptors., Lurasidone showed higher affinity for 5-HT7, 5-HT2A, and 5-HT1Areceptors relative to D2receptor-binding than other agents. Lurasidone displayed moderate affinity for α2C adrenoceptors (Ki, 10.8nM); moderate-weak affinity for α1adrenoceptors (Ki, 48nM); and minimal or unappreciable affinity for receptors associated with undesirable effects (5-HT2C [Ki, 415nM], histamine H1[IC50>1000nM] and muscarinic [cholinergic] M1[IC50>1000nM] receptors).

The unique pharmacological profile of lurasidone is consistent with observed antipsychotic efficacy, low-tomoderate likelihood of EPS, low weight-gain potential, and possible mood, anxiety, and cognitive benefits.

A new approach to health assessment and the rate of working capacity decline of patients suffering from dementia, is based on the results (as of January 1, 2010) of a project entitled: Advances in medical science reflected in functional health state assessment and working incapacity in relation to International Classification of Diseases and International Classification of Functioning, Disability and Health.

The total number of hospitalizations due to dementia (F01, F03, G30) increased by more than one fifth (from 6549 to 7981 hospitalizations) between 2006 and 2010. However, the overall number of disabilities between 2006 and 2009 decreased by one half (from 2998 to 1571), and between 2010 and 2011 dropped to 5% of its original number (190 and 144 cases respectively). Nevertheless, between 2007 and 2011, there was a 50% increase in the number of patients with institutionally confirmed disabilities (from 6270 to 9504).

Conclusion The new approach to incapacity assessment is in accordance with medical experts' opinions and advances in medical science, related to function ability, activity and participation.

The new way of incapacity assessment could be the reason for the dramatic decrease in the number of institutionally confirmed disabilities in 2010 and 2011, despite the growing number of patients suffering from dementia.

Such discrepancy may also be explained by early diagnostics and more effective treatment, which prevent patients with dementia from becoming disabled.

Moreover, this hypothesis corresponds to the increasing number of patients with a certain degree of dependence due to dementia.

Patients with schizophrenia are at high risk for diabetes, dyslipidemia, hypertension, and obesity, which can be exacerbated by some atypical antipsychotics.

To evaluate the effect of lurasidone on weight and metabolic parameters.

To establish the cardiometabolic safety of lurasidone.

Short-term data were pooled from seven, double-blind, 6-week studies of subjects with acute exacerbation of schizophrenia treated with lurasidone 20-160 mg/day (N=1508); haloperidol 10 mg/day (N=72); olanzapine 15 mg/day (N=122); risperidone 4 mg/day (N=65); quetiapine XR 600 mg/day (N=119) or placebo (N=708). Long-term data (6-22 months) were pooled from patients treated with lurasidone 40-120 mg/day (flexibly dosed).

Proportions of patients experiencing ≥7% weight gain during short-term treatment were: lurasidone 4.8%, haloperidol 4.2%, olanzapine 34.4%, risperidone 6.2%, quetiapine XR 15.3%, and placebo 3.3%. Median lipid changes were: triglycerides (mg/dL), lurasidone -4.0, haloperidol -3.0, olanzapine +25.0, risperidone +4.0, quetiapine XR +9.5, and placebo -6.0; total cholesterol (mg/dL), lurasidone -5.0, haloperidol -8.0, olanzapine +9.0, risperidone +6.5, quetiapine XR +6.0, and placebo -5.0; trends were similar for LDL. Median changes in glucose (mg/dL) were similar for lurasidone (0.0) and placebo (0.0), and higher for haloperidol (+2.0), olanzapine (+4.0), risperidone (+3.0), and quetiapine XR (+3.0). Minimal-to-no changes in HbA1c were observed. With long-term lurasidone treatment, mean weight change after 12-month exposure was -0.73 kg and median metabolic changes were: -2.0 mg/dL for total cholesterol and -5.0 mg/dL for triglycerides.

Short- and long-term treatment with lurasidone showed minimal changes in weight and decrease in mean total and LDL cholesterol and triglycerides.

Long-term head-to-head studies comparing atypical antipsychotics are important for clinical decision making.

To evaluate long-term treatment of schizophrenia with lurasidone (LUR) vs. quetiapine XR (QXR; Study 234), or risperidone (RIS; Study 237).

To assess efficacy and safety of lurasidone relative to other antipsychotics.

In study 234(efficacy and safety), subjects received 12 months double-blind, flexible-dose lurasidone(40-160 mg/day) or QXR(200-800 mg/day) after completing a 6 week, randomized, double-blind, placebo-controlled trial with LUR or QXR. In Study 237 (safety) clinically stable adult outpatients received 12-months double-blind treatment with flexible-dose LUR 40-120 mg/day or RIS 2-6 mg/day.

Study 234: continued treatment of LUR responders (n=139) reduced relapse risk by 27.2% vs. continued QXR treatment of QXR responders (n=79). Hospitalization risk was 56.7% lower with LUR vs. QXR. More LUR subjects achieved sustained remission vs. QXR (61.9% vs. 46.3%; p=0.043; 12 months, LOCF), and lower all-cause discontinuation (48% vs 61%). Triglycerides were reduced with LUR; total and LDL cholesterol were unchanged or reduced. Median prolactin change was +0.6 for LUR vs. -0.7 ng/mL for QXR. Study 237: clinically significant weight gain was observed with LUR 13%) vs. RIS (19%) with median change in prolactin 0.4 vs. 14.8 ng/mL, respectively. Comparable efficacy was observed for LUR and RIS (change from baseline in PANSS total score:-4.7 vs. -6.5, and CGI-Severity score:-0.4 vs. -0.4, respectively).

The results of these two 12-month trials suggest that lurasidone is safe and well-tolerated with efficacy comparable to quetiapine XR and risperidone for long-term treatment of schizophrenia.

Patient reported outcomes (PROs), i.e. quality of life (QoL), psychosocial functioning and medication adherence are vital assessments of results in schizophrenia treatment.

Quality of life, psychosocial functioning and adherence attitude were evaluated among adult patients with schizophrenia switched from current antipsychotics to lurasidone, using the Personal Evaluation of Transitions in Treatment (PETiT) scale, a PRO measure.

Evaluate PROs after switching to lurasidone.

Stable but symptomatic adult outpatients with schizophrenia were switched from their previous antipsychotics to lurasidone, in a 6-week, open-label trial. Subjective responses to antipsychotic therapy were evaluated at baseline and study endpoint using PETiT (Higher scores=better outcomes). Score change was obtained for all patients and those switched from “sedating” (olanzapine, quetiapine) or “non-sedating” (risperidone, aripriprazole, ziprasidone, others) agents. Change from baseline to endpoint in total (overall QoL) and subscale scores (psychosocial functioning, adherence attitude) were compared using ANCOVA.

Of the 244 patients switched to lurasidone, 213 had available data. Changes from baseline in mean total PETiT score (3.2, P< 0.0001) and subscale scores of psychosocial functioning (2.5) and adherence attitude (0.7) were reported in all patient groups (p< 0.001). Improvement in mean total PETiT score was observed in patients switched from non-sedating (3.5, n=139) and sedating (2.7, n=74) antipsychotics and was statistically significant (P< 0.0001) in the non-sedating group. Differences in statistical significance (sedating vs non-sedating) may arise from smaller changes, not sample size.

In this study, patients switching to lurasidone experienced improvement in QoL, psychosocial functioning and adherence attitude.

During the past three decades psychiatry has suffered from a decline in the recruitment of young physicians across Europe. The challenges for clinical psychiatric research are even worse. After psychiatry has declared itself a medical (neuro) speciality the situation is now shifting towards the better.

Active innovation programs are however needed to accelerate this recent positive trend.

To introduce and train medical students in clinical psychiatric research methodology by practical research work supported by theoretical teaching.

To describe a local initiative done by AUH Risskov, Department M in Denmark implementing a clinical research teaching program for medical students.

We invited students of medicine known as dedicated and pro-active and posted the program on our website. Students responding positively to our invitation were interviewed by the first and senior author before being accepted into the program.

The group consists of 8 medical students and one psychology student in their third to the tenth term (of 12) at university. They are all given minor research questions relevant to the clinical department. The trainees are supervised in groups and individually parallel to systematic teaching. Further details will be given at the presentation.

We have deliberately sought out the most qualified students with an elitist approach. The participants commit themselves to act in an active, independent and disciplined way when accepted into the program.

The participants will be present at the Nice congress ready for discussion and with answers to any questions about the program.

Major depressive disorder, the most prevalent psychiatric disorder in general population, raises a series of clinical challenges, chronic medical comorbidity being regular one.

Our main objective was to analyze the weight of anxiety and depressive symptoms levels, and that of premorbid personality traits, in co-occurrence of medical diseases in subjects with major depressive disorder.

A cross-sectional research was performed on 32 inpatient subjects admitted in Timisoara Psychiatric Clinic during 2010 - 2012 with major depressive disorder. Anxiety symptoms level were self-assessed with Beck Anxiety Inventory and depressive symptoms level were self-assessed with Beck Depression Inventory. Temperament and character personality traits were self-assessed using Cloninger TCI tool, which was administrated once that clinical remission has occurred.

Majority of studied subjects (71%) have had at least one comorbid chronic medical diseases. Despite the results of other studies, the level of depressive and anxiety symptoms has no significant impact in medical comorbidity occurrence. Major depressive subjects with medical comorbidity, have had significant higher scores in Harm Avoidance, more exactly in Shyness with Strangers (p = 0.007) and Fatigability (p = 0.013). Significant higher total scores were revealed, in the same subjects, for all three character dimensions like as Self-Directedness (p = 0.004), Cooperativeness (p = 0.039) and Self-Transcendence (p = 0.030).

According to our research results, rather than temporary clinical symptoms constituting clinical picture of subjects with major depression there is possible that premorbid personality traits could weigh more significant to the appearance of medical comorbid conditions.

The aim of this study is identifying the predictors of major depression and anxiety disorders and the predictors of the remission of these disorders.

A longitudinal study under the form of a community survey includes a randomly selected sample of 2,434 individuals between 15 and 65 years of age (T1); 1,815 agreed to be re-interviewed two years later (T2). Mental disorders were identified with the Composite International Diagnostic Interview, including mood disorders (major depression, and mania), and some anxiety disorders: panic disorder (PD), social phobia (SP), and agoraphobia (AG). Logistic regression was used to identify predictors (T1) of remission of mood disoders and anxiety disorders at T2 and predictor of new cases at T2.

The prevalence of mental disorders for the two waves of the research program will be presented. For major depression (MD), among the 145 subjects who had MD at T1, 69% recovered at T2 and among the 1553 that did not have MD at T1, 5.7% developed MD at T2. For anxiety disorders, among the 93 subjects who had these disorders at T1, 78.4% recovered at T2 and among the 1635 subjects who were free of an anxiety disorder at T1, 1.8% developed it at T2. Predictors identified for remission of disorders and for developing new disorders at T2 will be presented.

The predictors of new cases identified will allow to develop more effective prevention program and those associated to remissions will help to improve mental health services.

Self-harm is a major public health problem, being a frequent condition among youth and young adults. Psychiatric conditions, like borderline personality, depression, substance misuse and anxiety disorders, are commonly associated with self-harm. The effects of media and contagion are also important and the internet has an important role in divulging and sharing self-harm behaviors.

We pretend to study the role the internet in potentiating or preventing self-harm behaviors.

We used combined literature searches in PubMed and B-on using the terms “self-harm”, “self injury”, “self mutilation” and “internet” and we also present a clinical case from our service.

Most of the individuals that have self-harm behaviors may never present in psychiatric ward. Today, there is more information about self-harm available to the public domain than ever and web sites about self-harm include personal pages, forums, blogs, communities and even video-sharing sites. These web sites have supportive content that allow the users feeling that they are not alone, sharing feelings and narratives. However, most of them have potentially harmful material, including self-injury related tips, reinforcing messages and triggering material, normalizing or even glamorizing self-injury.

Most of the websites normalize and promote self-harm behaviors. Only the better knowledge of these phenomena would allow the use of internet as an effective tool for self-harm prevention, especially for socially-isolated and vulnerable individuals.

The study of the relationship between insight, psychopathology and executive functions has revealed contradictory results, which seems to demonstrate the complex and multidisciplinary nature of insight. Several studies in psychotic patients confirmed the association between lower insight and poor prognosis, emphasizing the impact of poor adherence to treatment in greater symptom severity and greater likelihood of aggressive behavior.

To study the relationship between insight, psychopathology and executive functions. Analyze the association between these variables and the type of crime committed in a sample of forensic patients.

The sample is comprised by patients hospitalized for more than 6 months in the Department of Forensic Psychiatry of the Centro Hospitalar e Universitário de Coimbra, diagnosed as measured by DSM-IV-TR, in the category “Schizophrenia and other Psychotic Disorders”. Of these, we excluded those that according to DSM-IV-TR had a diagnosis of “Mental Retardation” (IQ as measured by WASI - Wechsler Abbreviated Scale of Intelligence) or “Substance Dependence”. Patients were evaluated using PANSS (Positive and Negative Syndrome Scale), SUMD (Scale to Assess Unawareness of Mental Disorders) and TMT (Trail Making Test). Biographical data, type of crime that led to the hospitalization and the security measure applied, was gathered through the review of patient's clinical files.

Data will be analyzed using the Statistical Package for Social Sciences (SPSS - 19th version) and the results will be interpreted according to the current literature.

Comorbidity between ED and depression is high. Causal relation between two is bidirectional. Person with ED can have MDD because of psychological factors. MDD symptoms and associated hypogonadism affect on libido and erectile function. Diseases like ankolysing spondolysis, asthma, rheumatoid arthritis, coronary heart disease, psoriasis, diabetes, and multiple sclerosis have strong co morbid ED and MDD. Inflammation is common overlapping factor in these illnesses.

An internet search was made on pubmed, and psychiatrist.com, using key words, major depression, endothelial dysfunction, inflammation, erectile dysfunction, and cytokines. This was followed by study of relevant martial in different journal and books.

Men with ED had high levels of depressive, somatic, and anxious symptoms. Approximately one-third of people with MDD had higher levels of peripheral inflammatory marker. Incidences of ED are two fold higher in depressed people as compared with nondepressed.

Levels of pro inflammatory cytokine like IL-1,I patient L-6,TNF,CRP, interferon-gamma and homosystien are raised in MDD. Cytokines effect on the HPA axis, glucocorticoid resistance, neurotransmission and hippocampal neurogenesis. Patients treated with interferon have higher risk of developing MDD .Antidepressant therapy results in decreased inflammatory response.

Erectile function depends on integrity of endothelium which is target of inflammation. Endothelial dysfunction is linked to ED as they share a common pathway through the release of nitric oxide. Proinflammatory cytokines and homosystien play role, both in ED and MDD.

Inflammation and its markers need to be considered in cases of co morbid ED and MDD.