To report recent official data of completed suicide in Italy during the time of economic crisis as related to gender and age.

Data for the years between 2006-2007 and 2008-2009 were extracted from the Italian Mortality Database to include all deaths by suicide and to obtain information on their age and gender.

In the last period for which official data are available (2008–2009), there was a ten percent increase in suicide deaths among men 25 to 69 years of age suggesting that suicide rates are on the increase for those involved in the labor force. We also found a decrease in suicides among those aged above 70 years pointing to a lesser impact of the economic crisis on suicide among the elderly who retired from their work.

According to this findings there was an increase in suicide rates among Italian men which is suggestive of a possible contributing role of the economic crisis on such trend.

Previous studies have shown in alcohol dependence patients an attentional bias (AB) under related substance cues which can be a factor of relapse. This AB can be evaluated by the “Alcohol Stroop Test” (AST). The AST is a modified Stroop task while participant have to name the color of the word. This word could be alcohol-related word or a neutral word. AB is the response time's difference between alcohol-related words and neutral words. The goal of the current study was to examine the relation between withdrawal hospitalization and AB.

Individuals with alcohol-dependence disorders (DSM IV) and admitted for withdrawal in addictology unit of CHU Clermont-Ferrand (n=42) and participant with no alcohol or psychiatric disorder recruited from colleagues and friends from the staff performed the AST (n=16) (‘Control Group’) were recruited. For inpatients, one group performed the AST in admission (n=19) (‘Admission Group’), and another group immediately before discharge (n=23) (‘Discharge Group’).

Results show an AB only for patients saw at admission (t(18) =2.12; p< .05). Moreover, we observe that the AB in ‘Admission Group’ (M=34 ms, SD= 70.06) is greater than the AB in ‘Control group’ AB (M = 23 ms, SD = 93.42), itself greater than the AB in ‘Discharge Group’ (M = -12 ms, SD=93.55), (t(55) = -1.71; p =.09).

Although, results are preliminary, the present study provides evidence for the evolution of AB during alcohol addiction treatment and for the value of incorporated method to improve AB during detoxification cure.

To explore tolerability, safety and treatment response with flexible doses of paliperidone palmitate in adult patients with an acute episode of schizophrenia.

Interim analysis of a prospective 6-month, open-label, multicenter study in adult patients with schizophrenia. Outcomes were change in the Positive and Negative Syndrome Scale (PANSS) total score from baseline to endpoint, Clinical Global Impression-Severity Scale (CGI-S), patient functioning (Personal and Social Performance Scale; PSP), weight change and adverse events (AEs).

Of the first 104 patients included (54.8% male, mean age 37.6±11.8 years, 81.7% paranoid schizophrenia, recommended paliperidone palmitate initiation regimen used in 89% of subjects), 65.4% completed the study. Most frequent reasons for discontinuation were AE (13.5%), subject choice (8.7%) and loss to follow-up (5.8%). Mean total PANSS score decreased from 99.5±15.5 at baseline to 71.0±26.9 at endpoint (mean change -28.6±26.2; 95% confidence interval [CI] -33.8; - 23.4; p< 0.0001) with 60.6% of the patients showing improvement of ≥30%. Mean CGI-S score changed from 5.0±0.8 at baseline to 3.6±1.3 at endpoint (95%CI -1.7; -1.1; p< 0.0001). Patient functioning improved from a mean PSP baseline score of 42.7±13.9 to 59.0±18.7 at endpoint (95% CI of change 12.7; 19.9; p< 0.0001). AEs reported in ≥5% were psychotic disorder (15.4%), insomnia (14.4%), injection site pain (13.5%), headache (8.7%), salivary hypersecretion (6.7%) and anxiety (6.7%).

These data support results from recent randomized controlled studies that flexibly dosed paliperidone palmitate is safe, well tolerated and associated with clinically meaningful treatment response in patients suffering from an acute episode of schizophrenia.

Current findings place cognitive and introspection disturbances at the very heart of schizophrenia. In real life, a person is usually free to choose which aspects of an event to relate, how much detail to volunteer, and what degree of confidence to impart. The decision will depend on a variety of situational and personal goals.

To explore whether patients with schizophrenia are able to achieve a compromise between accuracy and informativeness when reporting information from memory, and pave the way for metamemory-based cognitive remediation.

25 Patients and their healthy matched controls answered general knowledge questions whose answers are numerical first freely, and second through a metamemory-based control. In the second step participants gave their answers with respect to two predefined intervals, one narrow and one large, then made a confidence level judgment for both answers, and had afterwards to select one of the two answers.

Patients were less accurate than healthy participants when reporting information at a self-paced level of precision. However, they benefited remarkably firstly from the framing of the responding, and secondly from the metamemory processes of monitoring and control to improve their memory reporting and to equate healthy subjects' accuracy.

In spite of their memory deficit in the free report, following accurate monitoring, patients strategically regulated the grain size of their memory reporting and proved to be able to manage the competing goals of accuracy and informativeness. These results lead to some optimism regarding the patients' possible adaptation to everyday life situations.

The diagnosis of Posttraumatic Stress Disorder (PTSD) and the experience of childhood maltreatment have been independently associated with a higher risk for suicide attempts.

To investigate if PTSD diagnoses following childhood abuse are correlated with markers of suicide severity, such as the age at the first suicide attempt, the number of attempts or the suicidal intent.

We studied a sample of 726 suicide attempters. Lifetime clinical diagnoses and history of childhood abuse were registered. The association of PTSD and childhood abuse dimensions with age at first suicide attempt, number of suicide attempts and suicide intent was studied. An adjusted multinomial logistic regression was performed to ascertain if combined childhood abuse and PTSD increased the severity of the suicidal behavior.

Several types of childhood abuse (emotional, physical and sexual abuse) when combined with a lifetime diagnosis of PTSD showed an increased risk for more suicide attempts and a higher level of suicidal intent compared with the absence of any or both risk factors.

The combination of PTSD and childhood abuse should be investigated in clinical settings due to an augmented risk for more severe suicidal behavior.

[Suicide intent associated with PTSD and/or abuse]

Experimental evidence indicates that patients with severe mental illness such as schizophrenia or mood disorders have a higher incidence of overweight and obesity (Daumit et al., 2003).

This review describes the neuropsychological functioning and therapeutical approaches (psychotherapeutic, pharmacological, surgical) in obese patients with psychiatric disorders.

To provide suggestions for good clinical practice in obese subjects with psychopathology, based on data found in the literature.

MEDLINE and PubMed databases (1962-2012) were searched for English-language articles.

Most of the literature says that the best treatment for these patients should use an integrated approach, starting from an assessment of the psychological and cognitive resources to set up a more effective and personalized therapeutic path.

Obese patients who have psychiatric disorders represent a population that requires specific treatment measures; in fact, the development, the maintenance and the outcome of the problem of weight are influenced not only by physical and life style factors, but also by specific factors related to psychopathology, neuropsycology, and side effects of certain drugs.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 1 year efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol dependent patients with high DRL from a randomised controlled trial [NCT00811941].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 187 patients: placebo N=42; nalmefene N=145 (mean age 46.2±11.9 years; 78% men; mean HDDs 19±6.3/month; mean TAC 101±45.0 g/day). Mean number of HDDs decreased to 7 days/month and mean TAC decreased to 33g/day at 1 year in the nalmefene group. At 1 year, there was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.6 [95% CI:-6.5;-0.7]; p=0.0164) and TAC -17.3 [-30.9;-3.8]; p=0.0129). Improvements in clinical status and in liver enzymes from baseline were larger in the nalmefene compared to the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for treatment.

To evaluate the 6 month efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol-dependent patients with high DRL from a randomised controlled trial [NCT00811720].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 350 patients: placebo N=170; nalmefene N=180 (mean age 51.9±9.4 years; 63% men; mean HDDs: 23±5.7/month; mean TAC: 101±41.7g/day). Mean number of HDDs decreased to 11 days/month and mean TAC decreased to 44g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-3.7 [95% CI: -5.9;-1.5];p=0.0010) and TAC (-18.3 [-26.9;-9.7];p< 0.0001) at month 6. Improvements in clinical status and liver parameters were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

We describe the efficacy and safety of as-needed use of nalmefene in the subgroup of patients with a high drinking risk level (DRL; men:>60g/day; women:>40g/day); i.e. a group of patients with a great unmet medical need for.

To evaluate the 6 month efficacy and safety of as-needed use of nalmefene 18mg versus placebo in a subgroup of alcohol-dependent patients with high DRL from a randomised controlled trial [NCT00812461].

All patients received a motivational and adherence-enhancing intervention (BRENDA) in combination with either nalmefene or placebo. Number of heavy drinking days (HDDs) and total alcohol consumption (TAC) were measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The study population consisted of 317 patients: placebo N=162; nalmefene N=155 (mean age 44.8±10.3 years; 69% men; mean HDDs: 22±6.2/month; mean TAC 111±47.9g/day). Mean number of HDDs decreased to 10 days/month and mean TAC decreased to 43g/day at month 6 in the nalmefene group. There was a superior effect of nalmefene compared to placebo in reducing the number of HDDs (-2.7 [95% CI: -5.0;-0.3];p=0.0253) and TAC -10.3 [-20.2;-0.5];p=0.0404). Improvements in clinical status and alanine amino transferase were greater in the nalmefene group compared to the placebo group (p< 0.05). Adverse events were more common with nalmefene; incidence of adverse events leading to dropout was at the placebo level.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with high risk for alcoholrelated harm.

Patients with sleep disorders have a significant increase in suicidal ideation and suicide attempts, at the assessment and lifetime (Goodwin et al, 2008; Chellappa et al, 2007; Wojnar et al, 2009; Li et al, 2010).

To evaluate the relationship between sleep disorders and suicidal behavior.

To study factors associated with a diagnosis of insomnia in patients admitted to the Emergency Department.

Participants were 843 patients consecutively admitted to the Emergency Department of the Sant’Andrea University Hospital in Rome, Italy, between January and December 2010. All patients admitted were referred to a psychiatrist. A clinical interview based on the MINI and a semi structured interview were performed. Patients were asked about “ongoing” suicidal ideation or plans for suicide. Clinical diagnoses were assigned according to ICD-10 criteria.

48% received a diagnosis of a mood disorders (BD and MDD) or anxiety disorders, 17.1% Schizophrenia or other non-affective psychosis. Patients with insomnia had more frequently a diagnosis of BD (23.9% vs. 12.4%) or MDD (13.3% vs. 9.5%; P< 0.001). Patients with insomnia less frequently had attempted suicide in the past 24 hours (5.3% vs. 9.5%; P< 0.05) than other patients, but suicide attempters with insomnia more frequently used violent methods (64.3% vs. 23.6%; P< 0.01) than suicide attempters without insomnia.

Our results support a relationship between sleep disorders and suicidal behavior. Clinicians should pay attention to sleep disorders when assessing suicide attempters; in fact, such conditions may have important clinical implications.

Low assertiveness and difficulties in emotion's regulation can perpetuate symptoms and worsen the outcome in patients with eating disorders (ED).

Cognitive-behavioral-therapy (CBT) is the most effective treatment for bulimia nervosa (BN) and binge eating disorders (BED). Group training helps patients to cope with interpersonal difficulties.

To examine the effects of a CBT-group-training on assertiveness, emotion's regulation and binge behaviors in patients with ED.

Scale for Interpersonal Behavior (Arrindell et al, 1984; Sanavio, 2002), Difficulties in Emotion Regulation Scale (Gratz et al, 2004; Sighinolfi et al, 2010), Bulimic Investigatory Test of Edinburgh (BITE) were administered at baseline and one and three months after a CBT-training to 20 patients with ED (BED, NES, BN, EDNOS) (90% women, age 25-69 years).

Patients who took part in the training improves assertiveness and emotion's regulation.

[SIB]

[DERS]

CBT-group-training increases assertiveness, improves emotion's regulation, has little effects on binge behaviors severity.

Patients with severe mental illness have significantly reduced lifespans. Excepting suicide, cardiovascular risk is the biggest cause. The problem is exacerbated by psychotropic medication and poor primary care engagement. Therefore psychiatrists should maximise every opportunity to promote physical health.

We audited physical examination, investigations, and documentation of past medical history (PMH) & assessments in inpatients. We used the Royal College of Psychiatrist's Physical Health in Mental Health Scoping Group 2009 guidelines as our standard.

We audited notes of all 125 patients admitted to four wards at Ladywell unit over two months (01/07/2011- 31/08/2011). We surveyed trainees to identify training and resource needs and facilitate focussed interventions.

Physical Examination: 102/125(82%) received physical examination, 60/125(48%) on admission. Average delay before examination 12 days.

Blood tests/Investigations: 89/125(71%) received blood tests: 50/125(40%) thyroid function, 67/125(54%) liver function, 28/125(22%) glucose, 1/125(0.8%) HbA1c, 38/125(30%) lipid profile. 48/125(38%) had urine drug screening, 55/125(44%) ECG.

Documentation: The following was documented: 102/125(82%) PMH, 82/125(66%) allergies, 90/125(72%) smoking status. The following was scanned into records: 23/55(42%) ECG, 72/125(58%) physical observation chart.

Survey: The trainee survey highlighted need for training updates on physical health and problems in equipment provision.

Physical assessment is inconsistent, neglecting metabolic screening. Admission is a vital window for screening/modifying physical health.

Focussed assessment guidelines should be formulated. Following the survey, teaching led by consultant physicians has been organised on identified topics including metabolic syndrome. Lack of equipment will be addressed by creation of comprehensive equipment lists, to be distributed to ward administrators.

Cognitive and Behavioural Therapy (CBT) is a successful treatment of obsessive-compulsive disorder (OCD). It is known to induce changes in cerebral metabolism, but the dynamics of these changes and their relation to clinical evolution remain largely unknown, precluding the identification of individualized response biomarkers.

We performed systematic clinical and fMRI evaluation of 35 OCD patients immediately before a three-month course of CBT, halfway through and at its end, as well as 6 months after in order to study the dynamics of treatment response. To sensitize fMRI probing, we used an original exposition task using neutral, generic and personalised obsession-inducing images.

CBT produced a significant improvement in OCD, already predicted by response at midtherapy (r2=0.67, p< .001). Initially, patients were more sensitive to personalised than generic or neutral images and had stronger related activations in the anterior cingulate, orbitofrontal and parietal cortices. In the high responder group (ΔYBOCS>45%), behavioural sensitivity to generic stimuli was reduced, even more so for personalised ones. Clinical improvement was markedly concomitant to a decrease of activity in the anterior cingulate and left but not right orbitofrontal cortices.

Using an innovative and highly sensitive exposition paradigm in fMRI, we show that clinical and metabolic phenotypes have parallel evolutions during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the earlier stages of the therapy.

Cocaine dependence has been associated with emotional dysfunction as well as social inhibition. Given the drug's powerful effect on emotional state, chronic use may impact the neural networks used for emotional processing, and this impact may manifest in altered behaviour.

To test the hypothesis that stimulant-dependent individuals less accurately identify expressions intended to elicit inhibitory or avoidant responses (ie fear, anger, disgust), and that this behaviour may, in part, be related to differences in the underlying neural networks for processing these emotions.

To detect differences in facial expression classification and corresponding neural networks in cocaine-dependent individuals versus healthy controls.

Cocaine-dependent men (N=32) and age-matched, healthy men (N=29) completed two computerized facial classification tasks (Benton Facial Recognition test and Emotion Hexagon task) and underwent structural MRI scanning.

Performance on the Benton task did not differ between groups. There were significant differences between cocainedependent individuals and controls in accurately classifying fear and anger as well as differences in misclassifications of these two ‘inhibitory’ emotions. No group differences were observed when classifying facial expressions of happy, surprise, sad, and disgust. A multivoxel analysis method (Partial Least Squares) confirmed the involvement of neural networks implicated in fear and anger perception, but showed significant differences between the groups.

The Benton task confirmed that differences in facial expression classification are not attributable to differences in facial processing. Cocaine-dependent individuals were less accurate at identifying ‘inhibition’ emotions and showed significant abnormalities in the brain systems implicated in fear and anger.

The aim of this prospective study was to gain a complete picture of the biopsychosocial effects of interferon-α treatment of patients with chronic hepatitis C. The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability would be measured with the inclusion of the social context. Furthermore, the effects of interferon treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites, and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with interferon-α were examined over the entire period of treatment as well as three months later, applying a holistic biopsychosocial model.

Psychiatric and biological assessments were carried out at six different times: before, during (at one, three, six and nine months), and after the end of interferon-α treatment.

During IFN-α treatment 22 (53.7%) patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired role physical, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and role emotional.

The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

Delirium is a frequently under-recognized finding in post-cardiopulmonary bypass patients that is potentially reversible but often associated with short-term complications, increased mortality and prolonged hospitalisation.

In this prospective study the frequency of delirium after cardiac surgery with cardiopulmonary bypass (CPB) was determined. Furthermore, we investigated the impact of intra- and postoperative levels of albumin as a biomarker of delirium.

34 patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enrolled in this prospective study. During the Intensive Care Unit (ICU) stay and shortly after discharge from the ICU, delirious state was evaluated daily using the Delirium-Rating-Scale. Albumin was assayed preanaesthesia, immediately after induction of anaesthesia, at the beginning of the heart-lung-apparatus period, immediately before the opening and 5 minutes after the opening of the aortic clamp, 24h and 48h postoperatively and on the day before discharge.

After CPB, a clinical significant delirious state was observed in 11 patients (32.4%). The albumin level decreased during the surgical intervention and increased postoperatively with a maximum level at the time of discharge. CPB patients with delirious state showed a significantly lower albumin level 24h and 48h postoperatively than those without delirium.

A postoperative delirium is a frequently observed finding in post-CPB patients. A low levels of postoperative albumin seems to be an useful biomarker to identify patients with high risk of delirious state after CPB.

Much speaks in favour of searches for biomarkers that might help to predict the emergence of delirium. Advance warning of the threats of this condition could potentially reduce significant morbidity, mortality, and costs of hospitalising patients.

Our prospective study investigates for the first time the impact of soluble interleukin-2 receptor (sIL-2R) as a biomarker of delirium after cardiac surgery with cardiopulmonary bypass (CPB).

34 patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enrolled. During the ICU stay and after discharge from the ICU, the delirious state was evaluated daily using the Delirium-Rating-Scale (DRS) by P. T. Trzepacz. sIL-2R was assayed before CPB, 24 h postoperatively and on the day before discharge.

After the CPB, 11 patients (32.4%) developed delirium. During the study period the sIL-2R level decreased at 24h postoperatively and increased afterwards. In the subgroup of patients with a postoperative delirious state longer than 24 hours the sIL-2R level is statistically significantly elevated 24h postoperatively in comparison with CPB-patients without a postoperative delirious state. Furthermore, as shown by a Spearman's rank correlation, CPB patients with higher Delirium-Rating-Scale scores 72h, 96h and 120h postoperatively had significant higher sIL-2R levels 24h postoperatively.

High levels of sIL-2R appear to be a useful biomarker to identify patients with high risk of delirious state.

Structural Analysis of Social Behaviour by L.S. Benjamin as revised by Scilligo represents self image by two axes: affiliation with love and hate as extreme points; interdependence with freedom and control as extreme points. Axes define a circumplex with 4 quadrants: loving freedom; hostile freedom; hostile control, loving control. Psychic wellness consists of high loving control and freedom and low hostile control and freedom. Quadrants are divided into 12 clusters: self-emancipation, self-affirmation, self-exploration, self-acceptance, self-protection, self-regulation, self-limitation, self-blame, self-attack, self-rejection, self-neglect, self-isolation.

The present study aims to enrich knowledge about intrapsychic world of people with Eating Disorders by analyzing self image of diagnostic subtypes.

Differentiating diagnostic subtypes self image in order to have a new key to choose therapeutic interventions.

250 women with ED, outpatients of the ED Unit of an Italian General Hospital, were administered the Intrex questionnaire, the operational definition of the 12 clusters. One-way ANOVA and post-hoc comparisons between diagnostic subtypes were performed.

Results indicate that ED patients have negative self-image. Bulimics show the highest level of self-blame, self-attack and self-rejection and the lowest of self-affirmation, self-exploration, self-acceptance, self-protection; anorexics show the highest level of self-regulation and self-limitation together with poor self-affirmation, self-exploration, self-acceptance. BED and EDNOS profiles appear less self attacking and more self acceptant.

Eating disorder diagnostic subtypes seem to have distinct intrapsychic profiles that can be reflected in different interpersonal behaviours. Such knowledge may help the therapist to choose the better interpersonal position to support therapeutic change.