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, Bruno Mario Cesana, Giuseppe Maina, Andreas Conca, Andrea Fagiolini, , A. Carlo Altamura, Bernardo Dell’Osso, on behalf of the ISBD Italian Chapter Epidemiologic Group
European Psychiatry, Volume 62, pp 82-89; https://doi.org/10.1016/j.eurpsy.2019.09.001

Abstract:
Background: we aimed to compare socio-demographic and clinical differences between patients with versus without current RC in order to detect clinical factors that may favor early diagnosis and personalized treatment. Methods: A total of 1675 patients (males: n = 714 and females: n = 961; bipolar 1: n = 1042 and bipolar 2: n = 633) from different psychiatric clinics were grouped and compared according to the current presence of RC in terms of socio-demographic and clinical variables. Chi-squared tests for qualitative variables and Student’s t tests for quantitative variables were executed for group comparison, and multivariable logistic regressions were performed, considering the current presence of RC as dependent variable, and socio-demographic/clinical factors as independent variables. Results: Female gender (male versus female: OR = 0.64, p = 0.04), unidentifiable prevalent polarity (versus depressive polarity: OR = 1.76, p = 0.02; versus manic polarity: OR: 2.86, p < 0.01) and hospitalization in the last year (no versus yes: OR = 0.63, p = 0.02) were found to be associated with RC in the final multivariable regression analysis. Conclusions: RC in BD seems to be more prevalent in female gender and associated with some unfavorable clinical features, such as an increased risk of hospitalization. These aspects should be taken into account in the management and monitoring of RC versus non-RC patients.
Julia Kim, Eric Plitman, Shinichiro Nakajima, Youssef Alshehri, Yusuke Iwata, Jun Ku Chung, Fernando Caravaggio, Mahesh Menon, , Bruce G. Pollock, et al.
European Psychiatry, Volume 61, pp 63-71; https://doi.org/10.1016/j.eurpsy.2019.06.007

Abstract:
Impaired illness awareness or insight into illness (IIA) is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. Neuroimaging studies suggest IIA may arise from interhemispheric imbalance in frontoparietal regions, particularly in the posterior parietal area (PPA) and the dorsolateral prefrontal cortex (dlPFC). In this pilot study, we examined the effects of transcranial direct current stimulation (tDCS) on brain regions implicated in IIA. Eleven patients with schizophrenia with IIA (≥3 PANSS G12) and 10 healthy controls were included. A crossover design was employed where all participants received single-session bi-frontal, bi-parietal, and sham stimulation in random order. For each condition, we measured (i) blood oxygen level-dependent (BOLD) response to an illness awareness task pre- and post-stimulation, (ii) regional cerebral blood-flow (rCBF) prior to and during stimulation, and (iii) changes in illness awareness. At baseline, patients with schizophrenia showed higher BOLD-response to an illness awareness task in the left-PPA compared to healthy controls. Bi-parietal stimulation reduced the interhemispheric imbalance in the PPA compared to sham stimulation. Relatedly, bi-parietal stimulation increased rCBF beneath the anode (21% increase in the right-PPA), but not beneath the cathode (5.6% increase in the left-PPA). Bi-frontal stimulation did not induce changes in rCBF. We found no changes in illness awareness. Although single-session tDCS did not improve illness awareness, this pilot study provides mechanistic justification for future investigations to determine if multi-session bi-parietal tDCS can induce sustained changes in brain activity in the PPA in association with improved illness awareness.
European Psychiatry, Volume 57, pp 26-32; https://doi.org/10.1016/j.eurpsy.2018.12.006

Abstract:
Background: Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years. Methods: A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%). Results: Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days. Conclusions: The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.
, , Steffen Moritz, Anne Karow
European Psychiatry, Volume 56, pp 84-90; https://doi.org/10.1016/j.eurpsy.2018.11.009

Abstract:
Objective: Psychotic-like experiences (PLEs) often occur across different non-psychotic disorders in adolescent and young adult population and are related to early trauma. However, the mechanisms of how exposure to early trauma shapes the risk of PLEs are unclear. In our study, we investigated whether borderline personality features and further non-psychotic symptoms, i.e. factors related to both PLEs and childhood trauma, may mediate the relationship between childhood trauma and PLEs. Methods: Two hundred inpatients aged 16–21 years who were treated due to non-psychotic disorders were included. PLEs were assessed with the Prodromal Questionnaire (PQ-16). Childhood Trauma was assessed with the Adverse Childhood Experience Questionnaire (ACE). Borderline personality features were assessed by using the Borderline-Symptom Checklist (BSL-23). Presence and frequency of depressive symptoms and anxiety were assessed by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7). Table 1 Clinical characteristics (n = 200). Mean (SD) Male/female 67/133 Age 18.72 (1.85) Clinical diagnosis Depressive disorder (F32.1, F32.2, F33.0, F33.1, F33.2) 167 (83.5%) Anxiety disorder (F40.1, F41.0, F41.1, F41.2) 51 (25.5%) Comorbidities PTSD 26 (13.0%) Personality disorders (F60.30, F60.31, F60.4, F60.6, F60.7, F60.8, F61) 124 (66.5%) Eating disorder (F50.0, F50.1, F50.2) 19 (9.5%) Others (F42.1, F42.2, F45.1, F44.5, F90.0) 33 (16.5%) Measures: The Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV) (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders II (SCID-II) were used to identify the clinical diagnoses. Results: A significant relationship between childhood trauma (ACE total score) and PLEs was found (ß = 0.30, 95% CI 0.247--0.659). In particular, emotional neglect (r = 0.298, p < 0.001) and sexual abuse (r = 0.264, p < 0.001) were significantly associated with PLEs. Borderline personality features fully mediated the relationship of childhood trauma and PLEs (ß = 0.12, 95% CI: -0.019--0.370). Anxiety and Depression showed a significant, but partial mediation of the relationship. Conclusion: Borderline personality features seem to be an important mediator of the relationship between childhood trauma and PLEs in adolescent patients with different non-psychotic psychiatric disorders. Theoretical and clinical implications are discussed.
, , Ana López-Villarreal, Ana Isabel Aparicio, Vicente Martínez-Vizcaíno, , ,
European Psychiatry, Volume 56, pp 60-68; https://doi.org/10.1016/j.eurpsy.2018.11.008

Abstract:
Background: Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up. Methods: Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2). Results: The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration. Conclusions: We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.
N. Hallensleben, H. Glaesmer, T. Forkmann, D. Rath, , A. Kersting,
European Psychiatry, Volume 56, pp 43-50; https://doi.org/10.1016/j.eurpsy.2018.11.003

Abstract:
Objective: To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time. Methods: This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%). Results: Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI. Conclusions: This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.
, Ángeles R. Arena, Arnaldo R. Armesto, Demián E. Rodante, Soledad Puppo, Patricia Vidjen, Alicia Portela, Leandro N. Grendas, Andrea E. Errasti
European Psychiatry, Volume 54, pp 19-26; https://doi.org/10.1016/j.eurpsy.2018.07.001

Abstract:
Objective: The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship. Methods: A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months. Results: At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity. Conclusion: The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.
European Psychiatry, Volume 54, pp 35-40; https://doi.org/10.1016/j.eurpsy.2018.07.002

Abstract:
Background: The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication. Methods: The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders’ representatives. The national recommendations have been subsequently summarized into a European shared document. Results: Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients’ dignity, privacy and safety shall be preserved at all times. Conclusion: The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.
, A. Reichenberg, M. Unenge Hallerback, S. Wikstrom, , B.A. Jonsson, S.H. Swan
European Psychiatry, Volume 51, pp 98-103; https://doi.org/10.1016/j.eurpsy.2017.10.007

Abstract:
Objective: To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age. Method: A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8–13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD). Results: 59.2% of women enrolled in weeks 8–13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P6vs.0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10–31.94). The OR for LD in girls whose mothers’ urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37–77.86). While it cannot be ruled out, our available data do not support confounding by indication. Conclusions: Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.
Hannah Gerwinn, Simone Weiß, Gilian Tenbergen, , Carina Födisch, Alexander Pohl, Claudia Massau, Jonas Kneer, , Christian Kärgel, et al.
European Psychiatry, Volume 51, pp 74-85; https://doi.org/10.1016/j.eurpsy.2018.02.002

Abstract:
Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.
, G. Androsova, O. Bender, D. Boraschi, F. Borchers, , , P. Fletcher, J. Gallinat, D. Hadzidiakos, et al.
European Psychiatry, Volume 50, pp 34-39; https://doi.org/10.1016/j.eurpsy.2017.10.004

Abstract:
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
European Psychiatry, Volume 45, pp 121-128; https://doi.org/10.1016/j.eurpsy.2017.06.003

Abstract:
Objective: Cognitive impairment is a familial and heritable aspect of major psychoses and might be a shared vulnerability marker for schizophrenia and BP. However, it is not clear whether some aspects of cognitive deficits are uniquely associated with risk for specific diagnoses. Methods: A novel meta-analysis of cognitive functions in first-degree relatives of probands with bipolar disorder (BP-Rel) and schizophrenia (Sch-Rel) was conducted. Current meta-analysis included 20 studies and compared cognitive functions of 1341 Sch-Rel, 939 BP-Rel and 1427 healthy controls. Results: Sch-Rel was associated with cognitive deficits in all domains (d = 0.20–0.58) and BP-Rel underperformed healthy controls in processing speed, verbal fluency and speed based executive function tests (d = 0.33–0.41). Sch-Rel underperformed BP-Rel in general intellectual ability, working memory, verbal memory, planning, processing speed and fluency (d = 0.24–0.42). Conclusions: Inefficiency in processing information and impaired processing speed might be common vulnerability factors for major psychoses. On the other hand, low performance in accuracy based tasks and deficits in general intellectual ability, verbal learning, planning and working memory might be more specifically associated with risk for schizophrenia.
D. Pereira, , M. Marinho, R. Fernandes, V. Viveiros
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.748

Abstract:
Introduction Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2]. Objectives We report two cases of antidepressant withdrawal induced mania. Methods Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation. Results Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely. Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic. Conclusion Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon. Disclosure of interest The authors have not supplied their declaration of competing interest.
A. Allen, R. Ansari, J. Thurley, L. Murphy, E. Chan, C. McKinnon, R. Fitzgerald, A. Deeley, R. Wachter, J. Rajewski
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.937

Abstract:
Educational objectives The goal of this poster is to discuss a brief pilot study in which mindfulness – and yoga-based practices were utilized with a group of adult ADHD patients. Methods A sample of 10 adults participated in a pilot group which utilized the use mindfulness-based and yoga practices to address ADHD. This group was a single 2 hour session which was a pilot for a future 6-week psycho-educational group. The participants completed the following questionnaires: the Cognitive and Affective Mindfulness Scale (CAMS-R), the Freiburg mindfulness inventory and the Mindful Attention Awareness Scale (MAAS) in addition to a survey regarding levels of knowledge of yoga and mindfulness prior to the beginning of the session. The participants completed a survey at the end of the session. Results In our small sample group, all respondents reported that they found the session helpful (43% strongly agreed; 57% agreed). When asked if the participants were likely to explore and learn more about ADHD and meditation on their own based on what they learned in the session, most indicated that they were likely to (43% strongly agreed; 43% agreed and 14% were neutral). Conclusions The use of treatment modalities involving the use of meditation and mindfulness-based techniques in a group setting are thought to be helpful in addressing some of the target symptoms of ADHD. Based on the preliminary data collected in our small pilot study, our group intends to further explore the efficacy of meditation-based groups in the form of a 6-week training program in 2017. Disclosure of interest The authors have not supplied their declaration of competing interest.
Z. Mansuri, S. Patel, P. Patel, O. Jayeola, A. Das, J. Shah, M.H. Gul, A. Ganti, K. Karnik, R. Patel
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.02.027

Abstract:
Objective To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD). Background While post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking. Methods We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR). Results We analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD. Conclusions Our study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population. Disclosure of interest The authors have not supplied their declaration of competing interest.
Z. Mansuri, S. Patel, P. Patel, O. Jayeola, A. Das, J. Shah, M.H. Gul, K. Karnik, A. Ganti, K. Shah
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.856

Abstract:
Objective To determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis. Background While post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking. Methods We used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR). Results We analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis. Conclusions Our study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population. Disclosure of interest The authors have not supplied their declaration of competing interest.
I. Sosin, O. Goncharova, Y. Chuev
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.02.454

Abstract:
Introduction Recently scientific attention of Ukrainian narcology was focused on the group of new complex pharmacological preparations with polymodal pathogenic effect option (Cocarnit, World Medicine, Great Britain). Aims and objectives To ground feasibility of Cocarnit application in complex treatment of alcohol withdrawal syndrome (AWS). Method Eleven patients with alcohol addiction were examined. An integrated research of relieving and adjuvant effects of pharmacological preparation Cocarnit in complex with traditional detoxication therapy in clinical course of alcohol dependence at AWS stage was carried out. One to 2 ampoules of Cocarnit were injected intramuscularly once per 24 hrs, № 6. Methods Clinical-psychopathological, clinical-laboratory, consulting of specialists, methods of psychological investigation (CIWA; САН; SF-36) at day 1, 7 and 14 of treatment. Results AWS quantification score on admission was 41. Further therapeutic regress of all AWS components was registered. At day 1 the patient's condition started improving, clinical score was 32; at day 3 – 17; day 5 – the score was 13, insignificant tremor remained. At day 7 of treatment, practically complete relieving effect of the therapy was ascertained. With САН method at day 7 of the treatment, an increase of figures in all scales was registered: state of health 2.7, activity 2.4, mood 2.5. SF-36 method: at day 1 – the score was 24, day 7 – 32, day 14 – 49. Conclusions Thus, the developed by us method of integrated treatment with inclusion of Cocarnit for withdrawal state in alcohol addicts allows to stop acute signs of pathology within 3–5 days. Disclosure of interest The authors have not supplied their declaration of competing interest.
Z. Hou, Z. Wang, W. Jiang, Y. Yin, Y. Yue, Y. Zhang, Y. Yuan
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.2221

Abstract:
Objective The potential pattern of regional cerebral blood flow (rCBF) in major depressive disorder (MDD) underlies different response to antidepressants medication remain unclear. This study aimed to investigate the differences of rCBF between patients with different treatment response. Methods Eighty MDD patients [(44 treatment-responsive depression (RD) and 36 non-responding depression (NRD)] and 42 healthy controls (HC) underwent pulsed arterial spin labeling (PASL) scans in magnetic resonance imaging and clinical estimates. The exact rCBF values of each groups were obtained via quantification evaluation. Results Compared to NRD, the RD patients showed decreased rCBF values in frontal sensorimotor network (i.e. left paracentral lobule, left medial frontal gyrus, right superior frontal gyrus and right middle frontal gyrus), and further receiver operating curve (ROC) analyses demonstrated that the altered rCBF in these four regions exhibited outstanding performance on distinguishing NRD from RD. The NRD also exhibited reduced rCBF in bilateral cerebellum posterior lobe and right middle occipital gyrus and elevated rCBF in right postcentral gyrus and right middle frontal gyrus as compared to HC. Conclusions The decreased rCBF in frontal sensorimotor network appeared to be distinct characteristics for NRD, and might be severed as promising neuroimaging markers to differentiate depressed patients with weak early response to antidepressant medication. These findings expand our understanding of neural substrate underlying the antidepressant efficacy. Disclosure of interest The authors have not supplied their declaration of competing interest.
Q. Dai, Y. Xuntao, F. Zhengzhi
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.1980

Abstract:
Objective The difficulties in the clinical antidepressant treatment lead to the pursuing of more effective methods such as transcranial magnetic stimulation (TMS). Mixed findings from DLPFC targeted TMS result in the exploration of optimal stimulation location. Disturbed function of obitofrontal cortex (OFC) has been indicated in depression, which is involving in the remission of depression. However, whether it could be a more specific treating target is not tested. Simultaneously, disturbed reward network (RN) has been confirmed in depression, however, whether this could be improved by TMS treatment remains unclear. Methods Fourteen patients with major depressive disorder (MDD) were allocated in a four-week course of OFC targeted TMS. Motivated by the literature, before and after the treatment, the function connectivity of RN with the seed of ventral striatum was conducted. The results were also compared with the data from 33 healthy controls. Results The OFC targeted TMS improved the clinical depression significantly and enhanced the function connectivity within the RN effectively. Specifically, lower baseline dorsolateral striatum connectivity predicted strong therapeutic effect of TMS on depression, while lower baseline insula connectivity predicted weak therapeutic effect on depression. Conclusions The findings offer the first experimental evidence of the therapeutic effect of OFC targeted TMS on clinical depression, enhanced function connectivity within RN might be the potential neural mechanism (Fig. 1). Lower dorsolateral striatum connection might be a reliable neural biomarker of strong responding for TMS treatment, which helps to identify the patients who will be cured by TMS most effectively.
Y. Zakaria, A. Mitchell
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.657

Abstract:
Objective Repeated self-harm is difficult to predict particularly in the long-term. Scales that help identify risk of repetition are widely used, and the most popular is the modified SAD PERSONS scale (mSPS). We aimed to clarify the accuracy of the mSPS in first time and non-first time patients presenting with self-harm with an extended follow-up period of observation. Method We conducted the UK's first long-term prospective risk prediction study of patients to an Accident and Emergency (A&E) department. We followed up 774 patients for a mean period of 7.4 years. At the time of study 429 patients presented with their first episode of self-harm and 345 had a hospital record of past history of self-harm. Results During 7.4 years of follow-up 54.7% of those who initially presented with self-harm represented with a repeat self-harm episode. Four hundred and twenty-one patients had a mSPS score less than 6 (low risk), 260 had a score between 6 and 8 (moderate risk) and 94 scored 9 or higher usually notated as high risk. The clinical utility of the mSPS was “poor” for predicting future self-harm but at cut-offs ≥7 it was “fair” for predicting non-repetition. Of the individual questions in the mSPS, a positive answer to “stated future wishes” was a true positive in 74.0%. Conclusions We found the mSPS was a relatively poor indicator of future self-harm risk in a long term follow-up of patients who self-harmed regardless of hospital record of previous self-harm history. However, mSPS did have modest value in predicting non-repetition. Disclosure of interest The authors have not supplied their declaration of competing interest.
C. Gomez, L. González, M. Anibarro, V. Rodriguez, C. Ortigosa, C. Gomis
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.1275

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Objective The aim of our study is to outline the demographic characteristics of the patients with a diagnosis of personality disorder that come to the ED. A second objective is to find specific risk factor for this type of patients. Methods We selected patients that came to the ED with the diagnosis of personality disorder, between October 2015 and February 2016. Data analysis was conducted using SPSS software. Chi2 test and t-Test were used as appropriate. A P-value < 0.05 was considered statistically significant. Results Sixty-eight of the 402 patients that were attended in the ED met the criteria of personality disorder; 44.92% of these patients presented with suicidal ideation or attempt. We found in the use of drugs, statistically significant differences between men and women, using drugs all the men with a personality disorder that came to the ED except one. The most frequent reason for consult were anxiety, conduct alterations, suicidal ideation, and suicidal attempt, being these consultations the 77%. Conclusion Anxiety and suicide risk are the most common reasons for a personality disorder patient to go to an ED. We have to be even more careful due to the high rate of suicide conducts in these patients. Also, it is important to think of drug use and dual pathology when assessing these patients. Disclosure of interest The authors have not supplied their declaration of competing interest.
R. Shankar, S. Ram
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.930

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DS with aging is associated with greatly increased risk of developing dementia similar to Alzheimer's. Anti-dementia drug discontinuation is recommended when clinical benefit is not determined. In DS it is more complex as medication ill effects of stopping needs to be weighed in balance to extraneous processes such as environment changes, sensory impediments and physical ill health and natural progression of dementia. Aim Can identified risk factors extracted from a comprehensive literature review be developed into an evidence based check list to support risk minimized person centered withdrawal of anti-dementia drugs when considered not to be efficacious in DS? Method A detailed literature review using Medline, PsychInfo, Cinahl and Embase with relevant search terms in various permutations and combinations without any date limit enquiring current evidence base on anti-dementia medication withdrawal was conducted. The review also looked to extract the common risk factors in stopping medication. All risk factors were collated, reviewed by a focus group of experts, developed into a checklist. Results Thirty abstracts were obtained following the search. Six papers were short-listed. No papers identified a structured approach to medication reduction. An 18-factor checklist was applied prospectively to 30 cases. The checklist was sensitive to identify change to guide clinical decision-making. Conclusions Currently, decision to peg medication withdrawal risk is arbitrary and clinical in dementia especially in DS dementia. The evidenced based developed checklist is useful to support and structure clinical decisions. It helps clinicians and patients to focus on promoting safety, reduce harm and guide treatment. Disclosure of interest The authors have not supplied their declaration of competing interest.
B. Motamedi, A. Mahmoudi
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.897

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Objective To determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviours were explored. Methods Data on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. The classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix. Regression analysis was used to calculate relative rates. Results A total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. Conclusions Violent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence. Disclosure of interest The authors have not supplied their declaration of competing interest.
Z. Mansuri, S. Patel, P. Patel, O. Jayeola, A. Das, J. Shah, M.H. Gul, K. Karnik, A. Ganti, R. Patel
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.02.028

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Objective To determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults. Background DA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking. Methods We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR). Results We analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA. Conclusions We demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail. Disclosure of interest The authors have not supplied their declaration of competing interest.
S. Sajith, W. Wong, J. Chiu, P.C. Chiam
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.2036

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Background and Objective Psychiatric assessment and care of people with Intellectual Disability (ID) is complex due to their cognitive and communication impairments. Demand for further training in this area by trainees in psychiatry has been well documented. The main of aims of this study were to explore the attitudes and perceptions of psychiatry residents and non-residents (non-trainees) with regards to care of patients with ID as well as their knowledge and training in this area. Method The study was conducted as an anonymous survey at the Institute of Mental Health, Singapore. A survey questionnaire developed by the study team was sent to residents and non-residents in psychiatry. Results Forty-eight out of the 76 questionnaires were returned with a response rate of 63.16%. Twenty-eight participants described themselves as non-residents and the rest were residents. All participants responded that postgraduate training was required in the area of ID and mental health and majority reported that available training was inadequate. Ninety percent of respondents believed that people with ID were vulnerable to exploitation by other patients in the inpatient unit and 94% of respondents believed that people with ID should be managed by a specialist team. Conclusion Currently residents and non-residents in psychiatry see that training in ID and mental health as well as services for people with ID as inadequate. Efforts should be made to include specialist training in psychiatry of ID in the Singapore psychiatry curriculum to enhance the confidence and expertise of psychiatrists in this field.
K. Mann, T. Leménager, , M. Fauth-Bühler
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.134

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Objective The reclassification of PG as an addictive disorder is under debate for ICD-11. Data on psychiatric comorbidity and family history might provide the basis for a well-informed decision. Methods We compared 515 male pathological gamblers from inpatient treatment units with 269 matched controls. Patients were diagnosed by experienced clinicians. In a random sample of 58 patients clinical diagnoses were validated through SKID 1 interviews [1]. Results 88% had a comorbid diagnosis of substance dependence (nicotine dependence 80%, alcohol dependence 28%). Only 1% of the gamblers had an impulse control disorder diagnosis. Compared with controls first degree relatives were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), PG (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Conclusions In addition to recent papers on the neurobiology (Fauth-Bühler et al., 2016) and genetics of gambling [2,3], our findings support the classification of PG as behavioural addiction in the ICD-11 [4]. Disclosure of interest The authors have not supplied their declaration of competing interest.
Z. Mansuri, S. Patel, P. Patel, O. Jayeola, A. Das, J. Shah, M.H. Gul, K. Karnik, A. Ganti, K. Shah
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.02.029

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Objective To determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis. Background While post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking. Methods We used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project(HCUP) from 2002 to 2012. We identified AMI and psychosis as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR). Results We analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis. Conclusions Our study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population. Disclosure of interest The authors have not supplied their declaration of competing interest.
S. Mehta, A. Baruah, D. Chetia, S. Das, P. Avinash
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.02.443

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Introduction Association between leptin and ghrelin plasma levels and alcohol craving have been found in few studies but they have failed to differentiate this correlation with alcohol withdrawal state. Objectives To research this correlation in a different population and to study this correlation with respect to hyper-excitable state of alcohol withdrawal. Aim To study levels of leptin and ghrelin in relation with alcohol withdrawal and craving. Methods Twenty-five indoor patients fulfilling the alcohol dependence criteria were assessed for alcohol withdrawal symptoms and craving. Leptin and ghrelin levels were measured on 1st day, @ the end of 1st week, @ the end of 3rd week of stopping alcohol. Withdrawal was assessed using CIWA-A at day 1 and day 7, craving was assessed using PENN's scale of craving at the end of week 1 and week 3. Control group consisted of 15 first-degree relatives not taking alcohol. Results It was found that leptin [t (38) = 2.95, P = 0.005] and ghrelin [t (38) = 2.56, P = 0.015] were significantly higher in alcohol-dependent patients. Levels of hormones had no significant correlation with alcohol withdrawal scores but had positive correlation with craving scores after abstinence. Conclusions Leptin and ghrelin, known for balancing the energy homeostasis of body, also seem to play a role in pathways of drug dependence and craving. This relation is independent of stress hormone axis as leptin and ghrelin levels are not correlated with withdrawal scores, which is an indicator of stress hormone axis activation during alcohol withdrawal. Disclosure of interest The authors have not supplied their declaration of competing interest.
, L. Zouari, M. Maâlej-Bouali, , N. Zouari, J. Ben Thabet,
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.754

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Objective To identify predictive variables of chronic benzodiazepine use among elderly patients with depressive disorder. Methods This was a cross-sectional, descriptive and analytical study, including 41 patients suffering from depressive disorders, aged 65 years or more, treated with benzodiazepine (BZD) and followed-up in outpatient psychiatry unit at Hedi Chaker university hospital in Sfax in Tunisia. We used a standardized questionnaire including socio-demographic and clinical data. Chronic BZD use was defined as BZD availability at least 50% of the days between day 181 and day 365 following initiation. Results The average age of patients was 69.29 ± 5.7 years. The sex ratio (M/F) was 0.5. The majority of them were married (78%), unemployed (82.9%) and living in urban area (61%). They had at most a primary degree (90.2%) and a low socioeconomic level (63.4%). The average time of BZD consumption was 4 years and 5 months. The prevalence of chronic BZD use in our sample was 56.1%. Duration of benzodiazepine use was greater than 1 year for all chronic BZD users. The mean dose of Benzodiazepine (Lorazepam) consumed was 3.87 ± 2.8 mg per day. Chronic BZD use was correlated with low socioeconomic level (86.3% vs 36.8%; P = 0.000), psychiatric comorbidity (72.7% vs 26.3%; P = 0.004) and recent hospitalization (59% vs 15.7%; P = 0.023). Conclusion There is a high prevalence of chronic BZD use in our study. For the 65 years and older patients with depressive disorder, significant predictors of chronic BZD use were low socioeconomic level, psychiatric comorbidity and recent hospitalization. Disclosure of interest The authors have not supplied their declaration of competing interest.
H. Jiang, R. Quan, Y. Yuan
European Psychiatry, Volume 41; https://doi.org/10.1016/j.eurpsy.2017.01.387

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Objectives The diagnosis of major depressive disorder (MDD) is symptom based due to the lack of biological biomarker. p11 protein was recently found to be an important factor mediating depression-like states and antidepressant responses. The aim of the study was to assess whether p11 protein in urine can serve as a potential biomarker for major depression, and the relationship of its levels among urine, serum and cerebrospinal fluid (CSF). Methods We obtained urine samples from 13 drug-free MDD patients and 13 age- and gender-matched healthy controls. We also collected urine, serum and cerebrospinal fluid samples from 13 of fracture patients or cesarean section patients in the spinal anesthesia. The concentrations of p11 protein were measured using ELISA. Results In MDD patients, urine levels of p11 protein were all less than the minimum detectable concentration of the ELISA kit. The urine levels of p11 were detectable only in one healthy control. In the spinal anesthesia patients, we can detect p11 concentrations in both serum and urine in only two patients. Besides, levels of p11 were detectable in the serum of one patient and urine of another patient. We were unable to measure CSF levels of p11 in all patients. Conclusions Concentrations of p11 protein in the body fluids are very low and unstable. The sensitivity of the current p11 ELISA kit is currently unsatisfactory, requiring the development of an ELISA kit of higher sensitivity to determine whether p11 in body fluids can serve as biomarker for depression. Disclosure of interest The authors have not supplied their declaration of competing interest.
, K. Palmér, L.M. Johansson
European Psychiatry, Volume 43, pp 19-27; https://doi.org/10.1016/j.eurpsy.2017.01.328

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Background: The need for psychotherapy in primary health care is on the increase but individual-based treatment is costly. The main aim of this randomised controlled trial (RCT) was to compare the effect of mindfulness-based group therapy (MGT) with treatment as usual (TAU), mainly individual-based cognitive behavioural therapy (CBT), on a broad range of psychiatric symptoms in primary care patients diagnosed with depressive, anxiety and/or stress and adjustment disorders. An additional aim was to compare the effect of MGT with TAU on mindful attention awareness. Methods: This 8-week RCT took place in 2012 at 16 primary care centres in southern Sweden. The study population included both men and women, aged 20–64 years (n = 215). A broad range of psychiatric symptoms were evaluated at baseline and at the 8-week follow-up using the Symptom Checklist-90 (SCL-90). Mindful attention awareness was also evaluated using the Mindful Attention Awareness Scale (MAAS). Results: In both groups, the scores decreased significantly for all subscales and indexes in SCL-90, while the MAAS scores increased significantly. There were no significant differences in the change in psychiatric symptoms between the two groups. The mindfulness group had a somewhat larger change in scores than the control group on the MAAS (P = 0.06, non-significant). Conclusions: No significant differences between MGT and TAU, mainly individual-based CBT, were found in treatment effect. Both types of therapies could be used in primary care patients with depressive, anxiety and/or stress and adjustment disorders, where MGT has a potential to save limited resources. Trial registration: ClinicalTrials.gov identifier: NCT01476371.
, J.J. Anderson, , ,
European Psychiatry, Volume 39, pp 33-39; https://doi.org/10.1016/j.eurpsy.2016.06.001

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Objectives Using data from a prospective birth cohort, we aimed to test for an association between exposure to tobacco smoke in utero or during early development and the experience of hypomania assessed in young adulthood. Methods We used data on 2957 participants from a large birth cohort (Avon longitudinal study of parents and children [ALSPAC]). The primary outcome of interest was hypomania, and the secondary outcome was “hypomania plus previous psychotic experiences (PE)”. Maternally-reported smoking during pregnancy, paternal smoking and exposure to environmental tobacco smoke (ETS) in childhood were the exposures of interest. Multivariable logistic regression was used and estimates of association were adjusted for socio-economic, lifestyle and obstetric factors. Results There was weak evidence of an association between exposure to maternal smoking in utero and lifetime hypomania. However, there was a strong association of maternal smoking during pregnancy within the sub-group of individuals with hypomania who had also experienced psychotic symptoms (OR = 3.45; 95% CI: 1.49–7.98; P = 0.004). There was no association between paternal smoking, or exposure to ETS during childhood, and hypomania outcomes. Conclusions Exposure to smoking in utero may be a risk factor for more severe forms of psychopathology on the mood-psychosis spectrum, rather than DSM-defined bipolar disorder.
Q. Dai, G. Yang, C. Hu, L. Wang, K. Liu, Y. Guang, R. Zhang, S. Xu, B. Liu, Y. Yang, et al.
European Psychiatry, Volume 39, pp 114-122; https://doi.org/10.1016/j.eurpsy.2016.07.008

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Objective Although alienation toward parents is important for children (for current mental health status or later interpersonal relationships in adulthood), it is undervalued and even lacks a standardized tool of assessment. Moreover, the large number of left-behind children in China is a cause of public concern. However, their experienced alienation toward their parents remains unclear, which may be important for early detection or intervention for behavioral problems in this population. Hence, the current study aimed to develop an alienation inventory for children and then use it to investigate the experienced alienation toward parents in Chinese left-behind children. Methods Two studies were carried out. Study 1 was designed to develop a standard inventory of alienation toward parents (IAP). In study 2, 8361 children and adolescents (6704 of them were left-behind status) of the Chongqing area, aged between 8 and 19 years old, were recruited for investigation. All participants were surveyed with a standard sociodemographic questionnaire, children's cognitive style questionnaire, children's depression inventory, adolescent self-rating life events checklist, and newly built IAP in study 1. Results In study 1, we developed a two-component (communication and emotional distance) and 18-item (9 items for maternal or paternal form, respectively) IAP questionnaire. In study 2, exploratory factor analysis indicated an expected two-factor structure of IAP, which was confirmed by confirmatory factor analysis. The Cronbach's alpha coefficients showed a good reliability (0.887 and 0.821 for maternal and paternal form, respectively). Children with absent mother experienced the highest alienation toward parents. Boys as well as children aged 8–10 years old experienced higher alienation toward parents. Poor communication with parents (sparse or no connection), level of left-behind condition (parents divorced, been far away from parents), and psychosocial vulnerability (stressful life events, negative cognitive style) were risk factors of alienation toward parents. Conclusions The current study develops a two-factor (communication and emotional distance) IAP, which offers a reliable tool to assess experienced alienation of affection toward parents in children aged between 8 and 19 years old. Our result is the first investigation of experienced alienation and potential influential factors in Chinese left-behind children. The findings that children with absent mother experience higher alienation toward parents, as well as three recognized risk factors for alienation of affection toward parents (poor communication with absent parents, worse left-behind condition, and psychosocial vulnerability), give valuable guidance for parents who intend to leave or who are already leaving as well as for government policymaking.
, M. Sellbom, S. Bo,
European Psychiatry, Volume 37, pp 22-27; https://doi.org/10.1016/j.eurpsy.2016.04.006

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Objective Borderline Personality Disorder (BPD) is a highly prevalent diagnosis in mental health care and includes a heterogeneous constellation of symptoms. As the field of personality disorder (PD) research moves to emphasize dimensional traits in its operationalization, it is important to determine how the alternative DSM-5 Section III personality trait dimensions differentiates such features in BPD patients versus comparison groups. To date, no study has attempted such validation. Method The current study examined the utility of the DSM-5 trait dimensions in differentiating patients with the categorical DSM-IV/5 diagnosis of BPD (n = 101) from systematically matched samples of other PD patients (n = 101) and healthy controls (n = 101). This was investigated using one-way ANOVA and multinomial logistic regression analyses. Results Results indicated that Emotional Lability, Risk Taking, and Suspiciousness uniquely differentiated BPD patients from other PD patients, whereas Emotional Lability, Depressivity, and Suspiciousness uniquely differentiated BPD patients from healthy controls. Conclusion Emotional Lability is in particular a key BPD feature of the proposed Section III model, whereas Suspiciousness also augments essential BPD features. Provided that these findings are replicated cross-culturally in forthcoming research, a more parsimonious traits operationalization of BPD features is warranted.
Adrian Scott Hickin, Olav B. Lian, Victor M. Levson
Quaternary Research, Volume 85, pp 409-429; https://doi.org/10.1016/j.yqres.2016.02.005

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Geomorphic, stratigraphic and geochronological evidence from northeast British Columbia (Canada) indicates that, during the late Wisconsinan (approximately equivalent to marine oxygen isotope stage [MIS] 2), a major lobe of western-sourced ice coalesced with the northeastern-sourced Laurentide Ice Sheet (LIS). High-resolution digital elevation models reveal a continuous 75 km-long field of streamlined landforms that indicate the ice flow direction of a major northeast-flowing lobe of the Cordilleran Ice Sheet (CIS) or a montane glacier (>200 km wide) was deflected to a north-northwest trajectory as it coalesced with the retreating LIS. The streamlined landforms are composed of till containing clasts of eastern provenance that imply that the LIS reached its maximum extent before the western-sourced ice flow crossed the area. Since the LIS only reached this region in the late Wisconsinan, the CIS/montane ice responsible for the streamlined landforms must have occupied the area after the LIS withdrew. Stratigraphy from the Murray and Pine river valleys supports a late Wisconsinan age for the surface landforms and records two glacial events separated by a non-glacial interval that was dated to be of middle Wisconsinan (MIS 3) age.
M. Serrano Villar, P. Barga, A. Coronado, M. Alcami, A. Ortiz, S. Ares, F. Omenaca,
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.1284

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Objective This study examined the emotional and behavioral functioning among 10–14 year-old children who were born with very low birth weight (VLBW, <1500). Method Prospective and cross-sectional study of 90 VLBW (<1500 g) survivors born at the Hospital Universitario la Paz in Madrid, Spain, from 2000 to 2005 who were assessed by interviewers using the Strengths and Difficulties Questionnaire (SDQ). Parents also reported on their children's functioning. Children who showed an abnormal SDQ score on the total difficulties subscale or who had psychiatric history were also assessed using the K-SADS-PL. Results The proportion of children with abnormal-self-rated-SDQ scores was as follows: almost 25% of children showed an abnormal score on hyperactivity, nearly 15% on emotional problems, 15% on conduct problems and 10% on peer problems. Overall, 15% of children showed an abnormal score on the total difficulties subscale. Most children (99%) showed a normal score on the prosocial subscale. These proportions were higher when the questionnaire was rated by parents. Thirty-eight percent of children were assessed using the K-SADS and very few of them meet the criteria for at least one psychiatric disorder. Biomedical variables were associated in the expected direction to children's SDQ scores such as birth weight, head circumference and Apgar scores. Conclusion To conclude, being born with very low birth weight seems to be related to the emotional and behavioral functioning that these children appear to show between 10 and 15 years later. Disclosure of interest The authors have not supplied their declaration of competing interest.
Y. Zhang, F. Liu, Z. Dai, B. Wu, Q. Wu
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.780

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Objective To observe the effect of Qing Huan Ling and (or) risperidone on locomotor activity and explorative behavior of schizophrenia mice model by open field test. Methods Seventy kunming mice were randomly divided into 5 groups, one group as blank group. The rest groups ip MK-801 continuously 14 day, then randomly numbered: model group, risperidone group, Qing Huan Ling group and risperidone combined Qing Huan Ling group. Ig give corresponding drugs for each group 4 weeks, observe the change of locomotor activity and explorative behavior by open field test. Results After Ig 4 weeks, compared with the blank group, there were no obvious difference in locomotor activity and explorative behavior between risperidone group, Qing Huan Ling group and the combined group. Compared with the model group, risperidone had statistics meaning in the repression of explorative behavior (P < 0.05),the combined group has statistics meaning in the repression of locomotor activity and explorative behavior (78.92 ± 36.18 m vs. 186.92 ± 41.08 m, P < 0.01). Conclusion Qing Huan Ling regulate the central nervous system of schizophrenia mice model; when combined with risperidone, it restrain the central nervous system of schizophrenia mice model and the effect is stronger than risperidone alone. Disclosure of interest The authors have not supplied their declaration of competing interest.
S. Egger, S. Vetter, S. Prinz, G. Weniger, M. Müller
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.626

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Introduction Subjective perceptions of clinical change in patients with schizophrenia are often not congruent to the objective evidence of the same, especially since a lack of insight is part of the symptomatology. However, the exploration of the relationship between clinical judgments from mental health experts and the patients’ perception of symptom change is fairly understudied. Aims and objectives This study aimed to investigate the performance of the Positive and Negative Syndrome Scale (PANSS) as a tool for clinical outcome monitoring in schizophrenia in concordance with the change of self-reported psychopathology assessed with the Frankfurt Complaint Questionnaire (FCQ) in patients with a schizophrenia. Methods A consecutive sample of patients admitted to a Swiss psychiatric hospital for schizophrenia was assessed with the FCQ at admission and discharge. The PANSS was rated by the responsible clinicians at admission and discharge. Complete data of admission and discharge were available from approximately 60 cases. Reliable change index (RCI) was calculated to determine a clinically meaningful change based on the PANSS scores. Logistic regression models were conducted to explore the link between RCI levels and the change of self-reported perceptions of psychopathology. Results and xonclusions Our study found no relationship between the change of PANSS and FCQ from admission to discharge in a sample of patients treated for schizophrenia. Therefore, our findings provide evidence for a large discrepancy between the observed clinical severity and the subjective perception of symptoms in individuals with schizophrenia. Disclosure of interest The authors have not supplied their declaration of competing interest.
L. Picco, E. Abdin, S.A. Chong, S. Pang, S. Shafie, J. Vaingankar, M. Subramaniam
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.1929

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Introduction Various socio-demographic variables have been shown to influence attitudes towards seeking professional psychological help (ATSPPH), while negative ATSPPH can act as a barrier to mental healthcare, resulting in under-utilization of psychological services. Aims and objectives To explore the factor structure of the ATSPPH scale and determine whether any significant socio-demographic differences exist in relation to ATSPPH among a nationally representative sample. Methods Data was extracted from a population-based, cross-sectional survey conducted between March 2014 and March 2015 among Singapore Residents aged 18-65 years (n = 3006). Respondents completed the 10-item ATSPPH scale and also provided socio-demographic information. Exploratory factor analysis (EFA) was performed to establish the factor structure of the ATSPPH scale. Multivariable linear regression analyses were conducted to examine socio-demographic factors associated with ATSPPH. Results EFA revealed that the ATSPPH scale formed three distinct dimensions comprising “Openness to seeking professional help”, “Value in seeking professional help” and “Preference to cope on your own”. Higher “Openness to seeking professional help” scores were significantly associated with 18-34-year-olds and unmarried respondents, whilst Malay ethnicity and lower education were significantly associated with lower openness scores. Malays, Indians and lower education were significantly associated with lower “Value in seeking professional help” scores, whereas higher “Preference to cope on your own” scores were significantly associated with lower education. Conclusion Population subgroups including those with lower educational levels and different ethnic groups have more negative ATSPPH. Tailored, culturally appropriate educational interventions which reduce negative ATSPPH are needed, which effectively target these populations. Disclosure of interest The authors have not supplied their declaration of competing interest.
M. Müller, V. Stefan, W. Godehard, S. Prinz, S. Egger
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.595

Abstract:
Introduction Research into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups. Aims and objectives This study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission. Methods A consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups. Results and conclusions According to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems. Disclosure of interest The authors have not supplied their declaration of competing interest.
A. Bener
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.136

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Objective To determine correlation between depression, anxiety and stress in menopausal and post-menopausal women and shedding more light on a complex relationship. Methods A cross-sectional descriptive study was used and 1468 women aged 45–65 years were included and 1101 women agreed to participate (75.0%). Depression, anxiety and stress were measured using the Depression Anxiety Stress Scales (DASS-21). Data on body mass index (BMI), clinical and other parameters was used. Results A total of 1101 women agreed to participate after informed consent was obtained. The mean age and SD of the menopausal age was 49.55 ± 3.12, the mean and SD of postmenopausal age was 58.08 ± 3.26 (P < 0.001). There were statistically significant differences between menopausal stages with regards to age, ethnicity, educational status, occupation status, and place of living. Also, there were statistically significant differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, and diseases. Depression and anxiety were more common among post-menopause women. Also, there were no differences between the groups regarding the frequency of certain levels of stress among menopause and post-menopause. Multivariate regression analyses revealed that age in years, diastolic BP, consanguinity, regular exercise were predictor for depression. Meanwhile, diastolic BP, occupation and physical activity considered the main risk factors for anxiety. Furthermore, age in years, occupation and sheesha smoking habits were considered as the main risk factors associated with stress. Conclusion A large number of factors were associated with experiencing menopausal and psychosocial problems which had negative effects on the quality of life among Arabian women. Disclosure of interest The author has not supplied his/her declaration of competing interest.
A. Joseph, K. Davis, M. Fridman, P. Gustafsson, J. Quintero, V. Sikirica, T. Banaschewski
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.561

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Objective To document patient characteristics and treatment patterns in a real-world population diagnosed with attention-deficit/hyperactivity disorder (ADHD). Methods This was a retrospective chart review of children/adolescents (6–17 years) diagnosed with ADHD in the UK, Germany and Netherlands who initiated stimulant monotherapy (SM), non-stimulant (atomoxetine) monotherapy (NSM) or polypharmacy (SM/NSM ± SM/NSM or other psychotropics) on/after 1-1-2012. To facilitate descriptive comparisons, cohort quotas were imposed: ∼50% SM; ∼25% NSM; ∼25% polypharmacy. Index date was first SM, NSM or polypharmacy treatment on/after 1-1-2012. Patients were required to have ≥ 6 months’ pre-index (baseline) history and ≥ 12 months’ post-index follow-up. Analyses were descriptive. Results In total, 497 patients were included (mean [SD] age: 10.8 [2.9] years; 77% male); 65% (SM), 63% (NSM) and 83% (polypharmacy) had at least marked baseline ADHD severity based on Clinical Global Impressions scale (P < 0.05 SM/NSM vs polypharmacy). Ninety percent (SM), 75% (NSM) and 73% (polypharmacy) were pharmacotherapy naïve at index (all P < 0.10); 61% (SM), 65% (NSM) and 72% (polypharmacy) received previous behavioural therapy. In SM patients, methylphenidate was predominant (most frequent brands: Concerta® [29%], Medikinet® [28%]); in polypharmacy patients, methylphenidate plus atomoxetine (22%) or other psychotropic (19%) was most common. Index therapy switch was common, particularly in polypharmacy patients (25%) (P < 0.05 vs SM [14%] and NSM [13%]). Switches were precipitated by poor response in 75% of cases overall. Conclusions Polypharmacy patients generally presented a more complicated history (including higher ADHD severity) and treatment pathway versus monotherapy patients. Index therapy switches were commonplace and more frequent in polypharmacy patients, often due to poor response. Disclosure of interest The authors have not supplied their declaration of competing interest.
E.M. Barranco, D. de la Vega, Á. Arcenegui, A. Rico, M. Blanco, R. Martín, J.A. Guija, L. Giner
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.715

Abstract:
Introduction It has been suggested that there is a relationship between BMI and suicide. Thus, BMI of subjects who commit suicide would be lower than the BMI of other unnatural deaths (Flaig 2013). Objectives Explore the possible relationship between BMI and suicide. Material and methods A total of 1197 suicides and 473 unnatural deaths (not by suicide) were collected systematically for 60 months at the Institute of Legal Medicine of Seville. Age, sex, weight, height and cause of death were recorded. Statistical analysis was performed using SPSS v19.0. Results (Figure 1) Discussion In our study we found that suicide (of all age groups and both sexes) have a lower BMI than controls. However, the relationship between these two variables is complex and not all studies support it. Moreover, the relationships between depression, suicide and overweight point in different directions. More and more studies indicate the existence of a relationship between depression and overweight, suggesting that perhaps the “epidemic” of depression and overweight that we see in Western societies has some connection. In addition, depression is a risk factor for suicide well established. Our results indicate that suicide group tends to have lower BMI (less weight in relation to its size) than the controls. Disclosure of interest The authors have not supplied their declaration of competing interest.
K. Jucys, A. Leleikiene, D. Jokuboonis
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.1032

Abstract:
Gamma-hydroxybutyrate (GHB) is a γ-aminobutyric acid (GABA) precursor and metabolite that naturally occurs in the human body. Initially, GHB was used as an anaesthetic agent but was later also found to have anabolic, hypnotic, antidepressant, anxiolytic as well as cholesterol lowering effects. Recently though, research into GHB has been carried out primarily in assessing its effectiveness in treating alcohol and opioid withdrawal syndrome. There are no epidemiological data about GHB consumption in Lithuania, however during last decade there were observed many fatal cases of GHB users due to GHB intoxication or withdrawal abroad. In this article we will present the clinical case and problems which face the patient of 2-year daily GHB consumption. There were observed mild to moderate abstinence state presented with its clinical course and peculiarities. Whereas using GHB is becoming more popular in Lithuania, it is very important to pay attention to this substance and problems related to its usage. Disclosure of interest The authors have not supplied their declaration of competing interest.
A. Bener
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.135

Abstract:
Objective The objective of current study was to investigate whether associaction exist between depression and low BMD during menopausal and post-menopausal period. Methods A cross-sectional descriptive study and 1650 women aged 45–65 years were included during 1182 women agreed to participate (71.6%). Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes. Results A total of 1182 women agreed to participate and responded to the study. The mean age and SD of the menopausal age were 48.71 ± 2.96 with depressed and 50.20 ± 3.22 without depressed (P < 0.001). Also, the mean and SD of postmenopausal age were 58.55 ± 3.27 depressed and 57.78 ± 3.20 without depressed (P < 0.001). There were statistically significance differences between menopausal stages with regards to number of parity, and place of living. There were statistically significance differences between menopausal stages with regards to BMI, systolic and diastolic blood pressure, vitamin D deficiency, calcium deficiency and sheesha smoking habits. Overall, osteopenia and osteoporosis and bone loss were significantly lower in post-menopausal women than in menopausal women (P < 0.001). Similarly, T-score and z-score were lower with depressed menopause and postmenopausal women (P < 0.001). Conclusion The multivariate logistic regression analyses revealed that the depression, the mean serum vitamin D deficiency, calcium level deficiency, less physical activity, co-morbidity, number of parity, systolic and diastolic blood pressure and sheesha smoking habits were considered as the main risk factors associated with bone mineral loss after adjusting for age, BMI and other variables. Disclosure of interest The author has not supplied his/her declaration of competing interest.
A. Malagon, D. Córcoles, E. Pérez, L. Mollà, D. Bergé, A. González, M. Bellsolà, L.M. Martín, , V. Pérez
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.372

Abstract:
Introduction Social withdrawal is a major health problem that has been related with higher morbidity and mortality rates. There are few studies about the relationship between suicidal behavior and social isolation. Aim To describe the existence of suicidal risk in subjects with social isolation. Method Participants were 187 subjects referred to a Crisis Resolution Home Treatment because of social isolation. The inclusion criteria were: home isolation, avoiding of social situations and relationships, for at least 6 months. Suicide risk was assessed by the item of the Severity of Psychiatric Illness, dividing in four groups (from absence to high suicide risk). Socio-demographic and clinical data were also analysed. Results Most cases (n = 132, 70.5%) had absence of suicide risk. They were predominantly young males in all groups. There were no statistically significant differences in sociodemographic or clinical variables. The mean age at onset of social isolation was lower in the high suicide risk group, having lower socially withdrawn period. This group had also lower rates of child abuse and suicide attempt history. The more frequent diagnosis in all groups was psychotic, affective and anxiety disorders. Those cases with mild and high suicide risk needed more frequently hospitalization. Conclusions Social isolated people attended by CRHT do not have high frequency of suicide risk. Cases with higher suicide risk are younger and have a shorter period of isolation. The absence of child abuse history or previous suicide attempts contrasts with previous suicidal behavior research. These data can be influenced by the characteristics of functioning of CRHT and the small sample size. Disclosure of interest The authors have not supplied their declaration of competing interest.
Y. Kikuchi, T. Kanbayashi, T. Shimizu
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.2008

Abstract:
Objective Dementia with lewy bodies (DLB) is commonly considered the second most common form of dementia. The purpose of this study is to investigate the treatment effects of aripiprazole in patients with DLB. Methods Eleven patients who had meet the criteria for DLB participated in this study. The presence of psychotic symptoms was confirmed by scores of either the delusions or hallucinations items of the Neuropsychiatric Inventory (NPI) score. Patients who had 25 or more on the Mini-mental State Examination Scale (MMSE) at the entry or having brain damage were excluded. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-weeks intervals or more rapidly based on investigator's judgment. Previous medications prior to aripiprazole administration were not changed through this trial. Patient's clinical status was assessed at baseline, then 2 weeks during the study by using NPI, Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale (BPRS) to measure psychotic behavioral symptoms, and Simpson-Angus Scale (SAS) to measure parkinsonism symptoms. Clinical Dementia Rating (CDR) and MMSE were carried out at screening and end point to evaluate cognitive function. Results The mean scores of the SAS and CDR were significantly decreased at the study endpoint compared to baseline. The mean scores of the NPI and BPRS improved up until 4 weeks after having started aripiprazole. After 4 weeks, improvements slowed. The mean score of the CGI-S was decreased up until 8 weeks. Conclusion This study shows that aripiprazole may be effective for the treatment of psychotic symptoms in patients with DLB. Disclosure of interest The authors have not supplied their declaration of competing interest.
A. Bener
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.1109

Abstract:
Objective The objective of current study was conducted to determine whether low vitamin D level and BMD are associated with depressive symptoms as burden in Arab women during the menopausal and post-menopausal period. Design and setting A cross-sectional descriptive study. Subjects A multi-stage sampling design was used and a representative sample of 1436 women aged 45–65 years were included. Methods Bone mineral densitometry measurements [BMD] (g/m2) was assessed at the BMD unit using. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The Beck Depression Inventory (BDI) was administered for depression purposes. Results Of the 1436 women living in urban and rural areas, 1106 women agreed to participate (77.0%). There were statistically significance differences between menopausal stages with regards to ethnicity, education level, systolic and diastolic blood pressure, parity, sheesha smoking and depressive symptoms. Overall, 30.4% of women were affected with osteopenia/osteoporosis in menopause and postmenopausal (24.4% vs. 35.7%; P = 0.0442). Osteopenia in menopause and postmenopausal (18.7% vs. 29.3%; P = 0.030) and osteoporosis (9.9% vs. 15.9%; P = 0.049) were significantly higher in post-menopausal women than in pre-menopausal women (P = 0.046). Similarly, vitamin D deficiency was more prevalent among postmenopausal women than menopausal women. The study revealed that vitamin D level, hemoglobin level, serum iron fasting plasma glucose, calcium, triglycerides, HDL cholesterol, LDL cholesterol, alkaline phosphate and magnesium were considerably lower in postmenopausal compared to menopause women (P < 0.001). Conclusion The study confirmed strong association between vitamin D level and BMD in Arab women during the menopausal and post-menopausal period. Disclosure of interest The author has not supplied his declaration of competing interest.
A.R. Teo
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.836

Abstract:
Introduction Since the 1990s the term “Hikikomori” has emerged as a way to describe a modern form of severe social withdrawal first described in Japan. Recently, there have been increasing reports of Hikikomori around the globe. Objectives To describe operationalized research criteria for Hikikomori, as well as epidemiologic, diagnostic, and psychosocial features of the Hikikomori in international settings. Methods Participants were recruited from sites in India, Japan, Korea, and the US. Hikikomori was defined as a six-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Lifetime history of psychiatric diagnosis was determined by the Structured Clinical Interview for the DSM-IV Axis-I and Axis-II Disorders. Additional measures included the Internet Addiction Test, UCLA Loneliness Scale, Lubben Social Network Scale (LSNS-6), and Sheehan Disability Scale (SDS). Results Thirty-six participants meeting diagnostic criteria for Hikikomori were identified, with cases detected in all four countries. Avoidant personality disorder (41%), major depressive disorder (32%), paranoid personality disorder (32%), social anxiety disorder (27%), posttraumatic stress disorder (27%), and depressive personality disorder (27%) were the most common diagnoses. Sixty-eight percent had at least two psychiatric diagnoses. Individuals with Hikikomori had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5), and moderate functional impairment (SDS M = 16.5, SD = 7.9). Conclusions Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with Hikikomori have substantial psychosocial impairment and disability, and a history of multiple psychiatric disorders is common. Disclosure of interest The author has not supplied his declaration of competing interest.
D. Denzel, L.R. Demenescu, L. Colic, F. von Düring, H. Nießen, M. Walter
European Psychiatry, Volume 33; https://doi.org/10.1016/j.eurpsy.2016.01.047

Abstract:
Objective To investigate how brain metabolites, especially glutamate and glutamate to glutamine ratio of pgACC modulate the neural response within these areas and how this affects their function during emotion facial expression matching task. Methods Seventy healthy volunteers underwent magnetic resonance spectroscopy (MRS) and task functional magnetic resonance imaging (fMRI) in 7 Tesla scanner. PgACC MRS data were obtained using STEAM sequence and analyzed using LCModel. Angry, fearful, and happy facial expressions were presented in an affect-matching block where one of the two facial expressions presented matched the target facial expression. The control condition was form matching. Data were preprocessed and analyzed in SPM 8. Results Glutamate to Creatine ratio measured in pgACC positively correlated with BOLD response in the right DLPFC during negative emotional perception (FWE = 0.05) Glutamate to glutamine ratio indicating on-off mechanisms in pgACC positively correlated with BOLD responses in FFA extending to cerebellum cluster (FWE < 0.05). Conclusion This study indicate that pgACC, baseline metabolism predicts neural response to emotional processing. We conclude that individuals with higher glutamate ratios, an excitatory neurotransmitter, in pgACC during rest might have a better coping mechanism to potential danger indicated by perception of angry or afraid faces. The higher glutamate to glutamine ratio in pgACC indicates a higher turnover of excitatory metabolite glutamate. This mechanism is associated with higher emotional response in fusiform area and cerebellum suggesting higher visual attention towards negative emotions. Disclosure of interest The authors have not supplied their declaration of competing interest.
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