Alzheimer's Disease (AD) surges as a major issue in public health, and so does quality of life of patient's informal caregivers, who are exposed to negative outcomes such as increasing psychological distress and burden, depression and anxiety, which are also often associated to a poor knowledge of the disease, of its symptoms and of patient's needs.

The purpose of the ITINAD project is to demonstrate the effectiveness of a psychoeducational program in reducing the negative impact of caregivers’ coping with an AD patient and in increasing the knowledge.

The study involved 185 caregivers from 10 Italian centers: 89 of them were assigned to the control group, while 96 belonged to the experimental group, which was submitted to a 12 sessions psychoeducational program that developed themes such as clinical aspects of the illness, relatives’ roles and coping strategies. Socio-demographic data for the caregivers were analyzed, while the Hamilton Rating Scales were used to assess the symptoms of anxiety (HRSA) and depression (HRSD); the Psychological General Well-Being Index (PGWBI) measured psychological distress; the QPF (Familiar Issues Questionnaire) was used to evaluate caregivers’ burden and their consciousness towards AD.

Caregivers belonging to experimental group showed a significant decrease in anxiety (p=0,00) and depression (p=0,00); the program led also to a better self control in caregivers as shown by the PGWBI (p=0,04). The QPF demonstrated an improvement in AD's symptoms’ management (p=0,00).

These findings suggest the utility of a psychoeducational group in preventing negative outcomes in AD's caregiver.

Violence is one of the most serious forms of discrimination on account of sex /gender. It is a phenomenon that affects women of different social classes, ethnic and professional groups. Some of these women end up involved with situations that leads them to imprisonment.

To identify histories of gender violence in a feminine jail population; to analyze the relation of this violence with the imprisonment.

Understand the circumstances of gender violence that imprisoned women were exposed.

Thematic oral history research, carried out at the Female Penitentiary in Ribeirão Preto (SP) - Brazil. A semistructured interview was applied to 15 female prisoners.

The analysis of the prisoners’ narratives allowed the identification of two categories: “involvement with criminal partners” and “victimization and violence cycle”. In both, the interviewed women understood that they were dominated by men and considered the violence against them deep-rooted in human culture. They claimed that their involvement in criminal activities, mainly drug trafficking, was under the influence or enticement by companions. Some of them were arrested because they carried drugs to their partners inside male penitentiaries. They said that they had no alternative to the criminal activity as there were no social support and opportunities.

The complexity of violence against women makes necessary the implementation of health, social assistance and education public policies that comprise combat, prevention, assistance and assurance of women’s rights.

A modest body of research has emerged documenting the characteristics of 170 PICU populations in the UK (2006). No specific data is available about Crisis Management of patients diagnosed with Borderline Personality Disorder (BPD) in Female PICUs.

To offer the first service evaluation project in the UK of the BPD group in PICU and to review compliance with the NICE guidelines, ‘Borderline Personality Disorder: Treatment and Management’, 2009.

To measure rates of compliance with NICE guidelines as a gold standard.

Retrospective cross sectional review of patient records.

The project included data of 46 admissions (from 2007 to 2010). Ninety-seven percent of patients were White British. The median length of involvement with mental health services prior to the first admission to ECH was 12 years. Seventy percent of patients showed mixed engagement with services. All patients presented with complex needs, all were detained under the Mental Health Act. The commonest primary reason for admission was self harm or threatening behavior. Seventysix percent of patients were provided with the copy of the multi-disciplinary care plan at the time of admission. Antipsychotic polypharmacy and prescription of antidepressants was reduced during the admission. In 80% of admissions discharge planning was discussed with the patient and documented. In 54% of discharges the care coordinator was involved and at discharge 26% of patients were informal.

Specific target criteria in the NICE guidelines were not complied with fully. For 85% of admissions the initial purpose of admission was fully achieved.

The participation rates in epidemiologic studies have declined in recent decades. Missing data reduce sample size, statistical power, and scientific quality.

To study use of home interviews in recruiting individuals with a psychosis.

To evaluate effect of home-recruitment on non-response bias.

In the Northern Finland 1966 Birth Cohort, field surveys on psychosis were conducted in 1999-2001 and 2008-2010. In order to increase participation in the follow-up sample, cases were offered to be interviewed at home. We studied symptoms, illness severity, functioning, cognition, antipsychotics use, and grey matter (GM) volume between home-recruited and regular participants (RP), and non-participants (NP). Effect sizes (d) were calculated to compare the differences.

Altogether 18 (33%) out of the follow-up sample (n=54) were home-recruited, 27 did not participate. Home-recruited had more symptoms, lower functioning, cognition and GM volume, and they had used more antipsychotics compared to RP and NP in baseline. NP did not differ from RP. The same differences occurred when home-recruited were compared with RP in the follow-up study.

[Selected information from baseline study]

Owing to the home-recruitment we were able to collect data that may be reasonably non-biased in terms of nonresponse bias, which will yield valid estimates in our future studies on change over time in brain and cognitive ability, prevalence and severity of psychotic illnesses, outcome, medication use, and other issues of interest.

Men make up approximately 10% of the diagnoses of specified Eating Disorders (ED), with Bulimia Nervosa more common in men than Anorexia. However, Eating Disorder Not Otherwise Specified (EDNOS) are more prevalent in men than Anorexia and Bulimia combined. Rates of concurrent depression and personality disorders are also high in men with EDNOS, as well as rates of medical co-morbidity.

To describe a sample of male patients attending a Psychiatric Day Hospital.

To understand possible links between the diagnosis of ED and medical and psychiatric co-morbidity among male subjects.

Clinical data about male patients attending the Psychiatric Day Hospital of Modena from 05/01/2009 to 13/06/2012 were collected and analyzed. Psychiatric diagnoses were defined according to DSM IV criteria, medical comorbidities according to ICD10 criteria.

Male patients with ED were on the whole 11 (7.9% of total patients). Nine of them (81.8%) were diagnosed with EDNOS; 7 had medical co-morbidity, namely gastrointestinal (36.4%), respiratory (9.1%), renal (9.1%), rheumatologic (18.2%), cardiac (9.1%) and hypertension (16.6%); 9 had psychiatric co-morbidity, namely personality disorders (46.2%), major depression (30.8%), substance abuse (15.4%) and anxiety disorders (7.7%). Only 1 male patient (9.1%) was suffering from the ED, with no medical or psychiatric co-morbidity.

Male patients suffering from ED are increasing and knowledge on their clinical features are less clear than for female subjects, resulting in a more difficult and less effective clinical management. Despite the small sample size, this study attempts to increase the understanding of this clinical population.

Long duration of untreated psychosis (DUP) has been associated to brain morphological changes in schizophrenia in cross sectional analyses. It is unclear DUP relates to brain volume change over time.

Our aim was to analyze the association between length of DUP and total brain volume change in schizophrenia in a general population based sample.

All members of the Northern Finland 1966 Birth Cohort (NFBC1966) known to have had psychotic illness were invited for a field study at the age 34-years (in average 10 year after onset of psychosis) and follow up nine years later at the age 43-years. DUP was assessed from medical records. The total brain volume scan interval change and the DUP information were available for 32 subjects with DSM III R schizophrenia. We analysed the correlation between length of DUP and the mean annual whole brain reduction, adjusted for age of illness onset and sex.

The mean annual whole brain volume reduction was 0.66%. The reduction was 0.76% among those with shortest DUP, 0.58% among those with median DUP, and 0.63% among those with longest DUP. There was no statistically significant correlation between DUP and annual brain volume change when adjusted for onset age and/or sex.

We did not find an association between long DUP and brain volume decrease in schizophrenia in 9 years follow up. Although long DUP has been associated with differences in brain volume in cross sectional analyses, the significance of DUP on brain morphology in long term is unclear.

Standardised and timely restricted care for anxiety disorders has replaced former treatment in the Mental Health Services in the Capital Region of Denmark. Currently, there is no documentation regarding the impact of treatment standardisation on patient outcome and on service delivery.

The aim is to investigate

1. i) the effect of standardised treatment on patient outcome, and

2. ii) the implementation outcomes of standardised treatment programs for anxiety disorders in clinical practice.

The study is conducted as a quasi-experimental prospective pre-post study in a naturalistic setting in which patients are referred randomly to the two mental health centres. Patients included in the study are aged above18 years and referred to standardised treatment for anxiety disorders (F40-41). The Conceptual Model of Implementation Research [1] distinguishes between outcomes at three different levels: implementation, service and client (patient), and argues that client outcomes depend on outcomes of the previous levels. This study includes outcomes at all levels. The clinical outcome data include the Symptom Check List-90R, Beck Anxiety Inventory, Global Assessment of Functioning and WHO Wellbeing Index.

The first patient was included in October 2012. The study design will be described in details and preliminary results presented.

From January 2013 standardised and timely restricted care for anxiety disorders are introduced at a national level in Denmark, which further increase the relevance of the present study.

Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient’s life quality.

To investigate the correlation between anxiety, pain and perceived family support in a sample of lung cancer patients.

The sample consists of a total of 101 lung cancer patients hospitalized at the oncology department of a general hospital. Anxiety, pain (severity and interference) and perceived family support were assessed using Spielberger’s State - Trait Anxiety Inventory (SSTAI), the Brief Pain Inventory (BPI) and the Family Support Scale (FSS) respectively.

Analysis showed that there is a correlation between anxiety, pain and family support as perceived by the patients. Pain intensity (severity and interference) has a positive correlation to both state and trait anxiety and a negative correlation to family support. The effects of pain in everyday life also exhibit a positive correlation to state and trait anxiety and a negative correlation to family support. Anxiety (state and trait) has a significant negative correlation to family support.

Pain intensity in lung cancer patients seems to have an effect on patient anxiety and perceived family support. Treating patients’ pain could lead to a decrease in anxiety symptoms as well as an increase in perceived family support.

Lithium remains the gold standard of prophylactic treatment in bipolar disorder. However 10–40% of patients are not responder to lithium and there is still no operational predictive markers of lithium response. Moreover, previous studies relate some conflicting results due to the absence of an unanimous definition and evaluation of prophylactic lithium response. Our objective was to identify clinical factors associated with prophylactic lithium response assessed by Alda questionnaire that includes 6 categories of prophylactic response from no response for at least two years of treatment to no relapse for three years.

To study characteristics associated with lithium response.

All 516 participants met the DSM-IV criteria for bipolar disorder. They all received at least once in their life lithium (for at least two years) and all completed the Alda questionnaire. They were compared on several sociodemographic and clinical factors which were collected using the DIGS. Psychological dimensions were assessed with the ALS and AIS (for affective lability and instability), the BIS (for impulsivity) and the WURS (for ADHD screening) and history of childhood trauma.

Among the 516 subjects, 132 (25,6%) were lithium responders with no relapse during at least two years of treatment; 106 (20,5%) were poor lithium responders. These groups were compared for clinical, dimensional and childhood trauma characteristics, using both univariate and multivariate analyses.

Characteristics associated with lithium response may help to define personalized strategies.

The work purpose was to examine the role physical and sexual abuse during childhood plays as risk factors for committing acts of sexual violence or child abuse once becoming adults.

We selected - from EBM literature published in the last ten years - the most significant studies, no neglecting previous studies also useful for a better comprehension about physical and sexual abuses suffered during childhood and their commission once adults.

To have been victims of physical and sexual violence during childhood predisposes to perpetrate similar behaviors. The family background seems to be the greatest risk factor for the development of such behaviors. This is demonstrated by studies of twins in which only one suffers sexual violence but both experience unfavorable outcomes like the examined. In particular, pedophiles are more exposed to sexual violence during childhood (73%) while rapist to physical and emotional abuse (68%, 70%), especially by parents (78%), but both share models of pathological attachment (anxious for pedophiles and avoiding for rapists).

Even if with different results, we can highlight how to be a victim of violence during childhood, especially in a family context characterized by physical or sexual violence, is one of the greatest risk factors in becoming an abuser. This evidence should be a major impetus to further researches, but mainly to act measures to safeguard the victims from the consequences of the trauma they suffered and from the development of future similar behavior.

Liaison Psychiatry facilitates the management of medical-psychiatric comorbidities.

To describe the activity of the Liaison Service, Maggiore della Carità General Hospital, Novara, Italy, from February 2006 to December 2011.

To evaluate the referral rate among different wards.

Patients referred for psychiatric consultation were analysed by means of a logistic regression model.

1794 patients overall were involved. The referral rate was 1,60%, with a decrease in 2011. The highest frequency was in Radiotherapy and Hematology (14.71%). Reasons for consulting were: management problems (38%), assessment of a positive psychiatric history (37%), depression (32%), differential diagnosis between organic and psychiatric diseases (19%). Interventions for differential diagnosis and management problems significantly increased in 2010 and 2011 respectively. Radiotherapy and Haematology Wards were characterised by a higher referral rate for psychiatric history or depression (53%; 55%), Surgery showed fewer requests for depression (20%). The consultant suggested interviews or drug administration to 91% and 69% of patients respectively; interventions on the hospital staff and on the family in 34% and in 16% of cases. We observed an increase in interventions on hospital staff (49%) since 2006 and the use of interviews increased (96%) since 2010. Radiotherapy and Hematology were characterized by a greater use of interviews (95%), interventions on staff (43%) and family members (22%).

The referral rate is consistent with literature. Differences among Wards as far as the use of liaison psychiatry is concerned are discussed.

Physical abuse means the non-accidental infliction of physical injury on or physical mistreatment of a child. Incidence, forms and degree of child physical abuse vary greatly depending on many variables such as geographical area, general awareness, culture, religion, economic status and others factors.

This study highlights occurrences of child physical abuses in Kurdish families from to medical students’ reports.

To know the rate of phsycial abuse in Kurdish families and address the related characteristics.

The total of 432 medical students in Kurdistan Region/Erbil/Iraq, anonymously answered a set questions about the occurrence of child abuse in their families, their attitudes and opinions towards the issue, the perpetrators and their motives, with physical, psychological, and low sequelae etc.

Two-thirds of students believed that child physical abuse is a real concern in Kurdish families.

One-thirds of students reported occurrence of child physical abuses sometime in their families.

To them, most perpetrators of the abuse were from paternal more than maternal side; from other males, rather than other females in the extended family. And they were associated with subsequent adult victimization (both psychological and physical).

Childhood physical abuse is relatively common in Kurdish families, and is associated with a wide variety of psychological symptoms.

More emphasis on raising the public awareness about impact of child abuse is crucial, in terms of demonstrating its psychological consequences like building a more fragile adult personality, and a lot of other untoward consequences.

To explore safety, tolerability, treatment response and hospitalizations in adult patients with schizophrenia treated with long-acting injectable risperidone (RLAI) or oral antipsychotic standard of care (oAP) in routine clinical practice.

Prospective one-year open-label non-interventional study exploring flexible doses of RLAI and oAPs. Primary outcome was the number of hospitalizations from baseline to endpoint. Additional outcomes were changes in the Clinical Global Impression of Schizophrenia (CGI-SCH), patient functioning (Global Assessment of Functioning) and treatmentemergent adverse events (TEAEs).

The intent-to-treat analysis included 561 patients on RLAI and 522 patients on oAPs (44% female gender, mean age (±SD) 42.2±13.1 years). Demographics and baseline characteristics were comparable, yet RLAI-treated patients had higher disease severity, lower baseline functioning and more substance abuse. The number of hospitalizations did not differ between the two groups while median duration of hospitalization was significantly shorter with RLAI (12.3 vs 20.6 days). Positive, negative, cognitive symptoms, disease severity, patient functioning and medication satisfaction improved significantly better with RLAI than oAPs. The most frequently reported TEAEs (=2% in any group) for RLAI and oral APs were increase of body weight (5.0%; 5.6%), psychotic disorder (2.7%; 4.0%), schizophrenia (2.5%; 3.1%), anxiety (2.3%; 2.7%), insomnia (0.9%; 3.1%) and somnolence (0.4%; 2.5%), respectively.

This one-year non-interventional study supports results of recent randomized controlled trials that treatment with RLAI is associated with less days spent in hospital, better symptomatic and functional outcomes and higher patient satisfaction with medication compared to oral APs.

Delirium is a common complex syndrome with serious outcomes such as increased mortality, physical morbidity and length of hospitalization. There are similarities with symptoms of mental illnesses, which may lead to under-diagnosis of delirium in psychiatric patients. Thus in spite of the severity of delirium, it frequently goes unrecognised and hence is inadequately managed.

The literature about the incidence of delirium in psychiatric patients is sparse.

A description of the pattern of admission will help understand the clinical features of delirium.

To estimate the diagnostic incidence and describe the pattern of admission (inpatient, outpatient and emergency) of delirium in Danish psychiatric patients from 1994–2011.

Using a nationwide population-based mental health register to examine diagnoses of delirium from 1994–2011, where ICD-10 diagnostic criteria have been used. The delirium diagnoses include delirium unspecified, delirium superimposed on dementia and delirium due to alcohol or drug use or in a withdrawal state. The incidence rates were age-standardized and the statistical analyses performed with STATA.

Males dominate in all three groups of delirium diagnoses. The incidence rates of delirium unspecified in hospitalized patients have increased markedly, graph 1. The incidence rates of delirium in hospitalized dementia do not show the same increase.

Fig. 1

[graph 1]

The incidence rates of delirium unspecified in hospitalized psychiatric patients have increased.

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction of delayed onset. It is characterized by a severe skin eruption, fever, hematologic abnormalities, and internal organ involvement, potentially life-threatening. His incidence ranges from 1 in 1000 to 1 in 10,000 drug exposures. More than 50 drugs have been reported to induce DRESS, however anticonvulsants account for one third of the drugs causing DRESS.

To Highlight to the knowledge of potential adverse effects of psychiatric drugs.

To describe and discuss a case report of DRESS Syndrome induced by Lamotrigine in a patient with bipolar disorder, using medline database.

The pathogenesis of DRESS syndrome is not fully understood. However, his death rate is up to 10%, what makes his recognition very important. From all the drugs that can cause DRESS, lamotrigine, used in psychiatry as mood stabilizer, is the second principal drug related to it, next to carbamazepine.

Although, this syndrome is mainly managed in non-psychiatric units, a psychiatrist must know the potential reactions to the drugs he uses. The psychiatrist must be able to warn the patient and to suspect of this clinical identity, in to order to a quicker and better managing of these cases. This subject is an example how psychiatry and medicine are linked and how important is a multidisciplinary approach of a psychiatric patient.

Obsessive compulsive disorder (OCD) is relatively more frequent in pregnancy (third trimester) -3,5%- and post partum - 4 to 9%. Puerperium is at risk for onset of OC disorder and OC personality disorder. Most common obsession are contamination (75%), aggressive (33.3%), and symmetry/exactness (33.3%), and the most common compulsions are cleaning/ washing (66.7%) and checking (58.3%). OC personality disorder is a risk factor for post partum onset of OCD.

We selected women during their admission for delivery (n = 61) and analyzed: sociodemographically and through administration of EPDS, BDI, BAI, WHOQOL and SCID II (comparing Obsessive-Compulsive patients [OC=32] with negative patients [NEG=11]). Time of recruitment: 2 weeks

Labor: Emergency cesarian OC (21,4%) vn NEG (10,3%)

Previous treatment: OC (outpatient department+ private psychiatrist+ psychologist) 11,1% vs NEG 0%; only Psychologist OC 16,7% vs NEG 6,3%

Past drug intake: Antidepressant OC 11,1% vs NEG 0%

Miscarriage: OC (22,2%) vs NEG (31,3%)

Previous Oestroprogestinic intake : OC (66,7%) vs NEG (81,3%)

Complication during pregnancy: OC (38,9%) vs NEG (21,9%)

Whoqol psychological: OC (22,05) vs NEG (23,66) p = 0,46; environment: OC (28,32) vs NEG (31,09) p=0,015; physical: OC (23,37) vs NEG (26,72) p=0,011

BAI: OC (14,58) vs NEG (5,75) p=0,0005

BDI: OC (5,63) vs NEG (1,72) p< 0,0001

The groups clearly differ. From a test analysis we can underline that OC feels less confident in their environment and perceives less Physical wellness. BAI and BDI are statistically different, even if OC scores small level of anxiety or depression.

The Night Eating Questionnaire (NEQ; Allison et al, 2008) is the only validated instrument to assess the Night Eating Syndrome. It is composed of 14 Likert items and it enables to rule out for sleep-related eating disorder.

To investigate the psychometric properties of the NEQ and to investigate its pattern of correlation with related variables in a sample of Portuguese overweight women.

The NEQ and the other self-report validated instruments to assess disordered eating, insomnia, daytime sleepiness, depressive symptoms and affect were administered to an outpatient sample of 276 women (Mean age=43.85±11.88; Mean BMI=32.82Kg/m2±5.43) attending a weight loss treatment consultation in a public hospital.

The NEQ Coronach a was .60. A four factors structure (variance explained=57.62%) was selected: Factor (F)1 “Nocturnal ingestions” (α=.81); F2 “Evening hiperfagia” (α=.57); F3 “Mood/Sleep” (α=.42) and F4 “Morning anorexia” (α=.24). From the 23 participants (8.6%) who snacks when get up in the middle of the night, 6 (26.1%) had “not at all/a little” awareness of their eating; 3 (13.0%) had “none at all/a little” control over their eating while up at the night. NEQ total score significantly (p< .01) correlated with disordered eating behaviors (r=.28), insomnia (.50), daytime sleepiness (.27), depressive symptoms (.40), negative affect (.39) and positive affect (-.16).

The Portuguese version of NEQ presents reasonable internal consistency. The factorial structure overlaps with the original almost completely. The pattern of correlations with relevant variables was as expected. The NEQ could be very useful to clinical and epidemiological purposes.

Co-occurring impairments of episodic-autobiographical memory and theory of mind were described in several psychiatric and neuropsychiatric disorders. Despite sophisticated elaborations in theoretical domains, the relationship between episodic-autobiographical memory and social cognition remains unelucidated.

This work’s objectives are establishing greater recognition of the possible contribution of episodic - autobiographical memory to social cognition, by resorting to data from developmental amnesia (a condition with onset in early childhood, caused by relatively selective bilateral damage to hippocampi).

We describe a young adult with amnesia with neurodevelopmental mechanisms.

The patient was investigated medically, psychiatrically, with extensive neuropsychological methods and with neuroimaging.

Neuroimaging revealed grossly reduced hippocampi volumes bilaterally. There was no evidence of pathology in the underlying parahippocampal region or other areas. Performance on tasks that tapped on various aspects of social cognition was non-uniform, ranging from within normal limits to moderate impairment.

According to our knowledge, this is among the first case reports about a comprehensive evaluation of social information processing in a patient with amnesia with neurodevelopmental mechanisms. This patient showed impairments in performance in some laboratory tasks for social cognition, but not in others. This suggests that various components of social cognition may have different neural correlates; their unraveling may aid understanding of when and how episodicautobiographical memory contributes to social cognition. This study also emphasizes the need to employ various tasks to assess social cognition in patients with amnesia, which go beyond traditional laboratory paradigms.

Cocaine users often experience transient psychotic symptoms following cocaine use (Smith et al. 2009). The severity of such psychotic symptoms is influenced by cocaine dose (Vorspan et al. 2011). Several authors observed a higher prevalence of childhood trauma in cocaine addicts than control subjects (Enoch et al. 2010).

Describe cocaine induced psychosis and evaluate if it is associated with childhood trauma.

Define the population of cocaine users who experiment cocaine induced psychotic symptoms.

We did a transversal retrospective study. 100 outpatient cocaine users were evaluated with Scale for the Assessment of Positive Symptoms of Crack Induced Psychosis (SAPS-CIP) and Childhood Trauma Questionnaire (CTQ). Informations were obtained about lifetime cocaine use (age of onset, DSM IV dependence criteria, route of administration, daily dose, days of use per month).

We did not observe any link between SAPS-CIP and CTQ or CTQ and cocaine consumption. About cocaine consumption, more often patients took cocaine during the worst period, higher is the SAPS-CIP score. If patients are (or were) dependent to cocaine, they have higher scores on SAPS-CIP. Moreover, if patients took cocaine intravenously, they have higher scores on SAPS-CIP than if they took it by snorting, or smoking.

In the conditions of our study, childhood trauma isn’t a mediator for cocaine induced psychosis. About psychotic symptoms, they seem to be more severe among daily cocaine dependents who take it intravenously.