ECT remains as one of the most effective and secure psychiatric treatments for a wide variety of disorders, like depression, bipolar disorder or schizophrenia. Although not fully known, several theories hypothesize about its mechanism of action. To be effective, it has to induce a generalized convulsion of at least 15 seconds.

To analyze and compare convulsion times regarding diagnosis and treatment phase (acute, continuation or maintenance) to discern whether these factors influence convulsion time.

1675 ECT sessions were performed on 117 patients during a year at a universitary hospital. Convulsion times were analyzed comparing them according to main diagnosis (bipolar disorder, major depressive disorder, schizophrenia, schizoaffective disorder), as well as according to treatment phase (acute, continuation, maintenance).

Schizophrenia mean convulsion time was 40,77 seconds (CI95% 39,25-42.28), for schizoaffective disorder it was 34,59 seconds (CI95% 32,74-36,44), for bipolar disorder 35,13 seconds (CI95% 33,83-36,43) and for major depressive disorder 34,90 seconds (CI95% 32,72- 37,07), with a statistical significance between groups of p < 0.001.

According to treatment phase, mean convulsion time in the acute phase was 34,94 seconds (CI95% 33,81-36,19), in the continuation phase it was 39,61 seconds (ICI95% 37,28-42,29), and in the maintenance phase it was 39,00 seconds (CI95% 37,92-40,18), with a statistical significance between groups of p < 0.001.

Although there exist statistically significant differences between groups according to diagnosis and treatment phase, they are not clinically relevant, thus concluding that neither diagnosis nor treatment phase seem to influence convulsion time to a relevant degree.

Women take sick-leave more often than men, in general and especially because of psychiatric disorders.

The aim of the present study was to describe and analyse sick-leave due to psychiatric morbidity and its relation to age and occupation, with a special focus on sex differences.

We conducted a retrospective and descriptive study in external consultation of the psychiatric hospital Razi. We collected the records of patients seen between 01/07/2011 and 30/09/2012 and who received sick leave for psychiatric illness.

92 patients were included (78 female, 14 male) with mean age of 43,6 years. Sick-leave duration was longer for women. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells (86% vs 14%).

Depressive disorders were found among 73% of cases. Highest incidence of sick-leave was found among those with a combination of psychiatric and physical morbidity.

Psychiatric disorder is an important factor in sick-leave among women, especially regarding length of absence. Further studies on the influence of sex integration on sickness absence need to be done.

The utility of Mobile Crisis Unit (MCU) and its target population has been a controversial issue and many scientific articles have been writen about it (1,2).

The aim of this study is to identify the demographic and clinical features of patients diagnosed with psychotic disorder who have been hospitalized and have not required hospitalization in psychiatric unit through a Mobile Crisis Unit (MCU).

We collected retrospectively demographic and clinical variables. These include psychiatric rating scales of severity: Clinical Global Impression Scale (CGI) and Psychiatric Disease Severity (GEP); of functionality as Global Assessment of Functioning Scale (GAF); the aggressive behaviour and violence scale (AVAT) and psychopathology with the Positive and Negative Syndrome Scale (PANSS) of a total of 136 patients between June 2007 and July 2010.

There have been found stadisticaly significative differences between patients who have been hospitalized versus patients who have not in the items of treatment adherence and security staff intervention (Table 1). There is a positive correlation between patients who required hospitalization and the clinical scales CGI, GEP, GAF, AVAT, SUMD, PANSS-P and PANSS-G (Table 2).

We can conclude that patients cared for by the Mobile Crisis Unit (MCU) that require of psychiatric hospitalization have poor adherence to previous treatment. A high frequency of cases require intervention of security staff for having a higher risk of aggressiveness at the moment of hospitalization. The presence of greater psychopathology and functionality severity in patients hospitalized through the Mobile Crisis Unit (MCU) is also considered.

People with schizophrenia and bipolar disorder are more likely to smoke, smoke more cigarettes per day and have greater mortality from smoking-related disease than those in the general population.

To describe the sample and to identify the relationship between the pattern of tobacco use and psychopathology.

Multicenter, observational, prospective, 12-month follow up study to assess the clinical efficacy of a multicomponent smoking cessation program specifically designed for patients with severe mental illness.

65 patients from 3 Mental Health Centers sited in Spain [64.6% males; mean age (SD) = 44.63 (8.93)].

1. (1) Pattern of tobacco use: Fargerstrom Test for Nicotine physical Dependence; Glover-Nilsson Test for Nicotine psychological Dependence; expired carbon monoxide (CO); n° cigarettes/day; n° smoking years.

2. (2) Psychopathology: PANSS; Hamilton; Young; CGI-G.

Schizophrenia 64.6% and bipolar 26.2%; suicide attempts 36.9% (2.83 mean of suicide attemps); economically active 7.7%. There is no differences: in psychopatology severity between “heavy smokers” (ppm ≥ 26 or n° cigarettes/day ≥ 30) and “non heavy smokers” (ppm < 26 or n° cigarettes/day < 30) and in the pattern of tobacco use between schizophrenia and bipolar patients. There is no relationship between psychopatology severity and the pattern of tobacco use in schizophrenia patients. Finally, there is relationship between depressive symptoms (Hamilton) and nicotine psychological dependence (Glover-Nilsson Test) in bipolar disorder patients (r = 0.72, p = 0.004).

In bipolar disorder patients, there is relationship between the severity of depressive symptoms and the dependence of nicotine.

Wernicke-Korsakoff (W-K) syndrome is a neuropsychiatric disorder resulting from thiamine deficiency, which is associated with significant morbidity and mortality. According to autopsy-based studies, it is still greatly underdiagnosed. In this case study and review, we focus on late diagnosed W-K related with alcohol misuse, and we give a short review about the topic focusing on its prompt diagnosis and adequate treatment.

We intend to underline that W-K syndrome, a preventable neurological condition and even treatable in its early phase if suspected, is underdiagnosed, with critical consequences for the patient's prognosis.

Using a case-report format, we describe three cases of W-K syndrome which were initially misdiagnosed in different general hospitals. We summarize complementary explorations, therapeutic management and evolution, and after that we shortly review the topic.

The three patients were diagnosed of W-K syndrome in the psychiatry unit, weeks after being visited in the emergency facilities, where it was not suspected nor detected or prevented. All of them ended up with cognitive disabilities of a different degree, always with a remarkable impact in their functioning. One of them achieved some amelioration with thiamine in high doses, despite its late detection.

W-K can be prevented and treated if early detected, but it is underdiagnosed, with severe consequences for the patients. We suggest some measures that could enhance its detection and prevention, like modifying emergency room protocols, both diagnostic and therapeutic.

This study presents the first results of a project on alexythymia and emotional connections in a sample of 8 patients with EDs. The project aims to evaluate changes in emotional expressions through the language used, by means of the Italian measure of the referential process. Changes in the alexithymic condition will be examined through the outcome and qualitative analysis of the psychotherapeutic process.

25 verbatim transcribed psychotherapeutic sessions were analyzed and correlated with TAS20, EDI-2, PBI, BUT, SWAP200, and between these and the narrative indices of the IDAAP.

The relation between TAS20 and PBI supports a link between alexythymia and parenting styles: neglect and overprotection seem to contribute to difficulties in forming emotional connections. The positive correlation found between the TAS20 and some EDI2 subscales indicates a tendency to express misunderstood stimuli by means of the body. A positive correlation between MHIWRAD2 and TAS20 may suggest strong phases of emotional activation due to emotional dysregulation. The analysis of the significant correlations between the PBI and the RA measures indicate that parenting styles are related to language. A positive correlation between the IWRAD indices and maternal overprotectiveness was found: maternal overprotectiveness may be associated to strong emotional activation which is in turn characterized by emotional dysregulation. The associations between the narrative indices and the high functioning measure of the SWAP200 suggest that the reflexive components is related to high functioning; emotional dysregulation, as expressed by the variability in RA peaks, seems to be connected to low functioning.

During the 6 months of recruitment, the patients admitted for depressive symptom complaints were screened with a medical history and socio-demographic inventory, the SCID II, the Hamilton Depression Rating Scale (HAM-D), the Beck Anxiety Interview (BAI), and the Beck Depression Interview (BDI). The patients will be retested through a follow-up after 3 and 6 months with HAM-D, BDI and BAI. Only the feminine part of the sample was considered (n = 60) and divided by SCID II results in Borderline Personality Disorder [B] (n = 33), Other PD [O] (n = 14) and negative [N](n = 9); 4 patients refused to complete the tests [R].

Statistically, there were no significant differences among the groups, if the same test is compared at the same moment; however, during follow-up B improves in a statistically significant way compared to others. Moreover, those of B who underwent psychotherapy statistically had significantly lower scores than those of B who did not.

Research clearly demonstrates the importance of PD, and in particular borderline, in determining admissions due to depressive symptomathology. Moreover, Borderline PD patients improve more than other patients after an admission, particularly if they underwent psychotherapy.

The benefit-risk ratio of a long duration of antidepressant drug treatment (ADT) may not be favourable. A pragmatic way to study the consequences of ADT duration in accordance with practice guidelines is to assess its impact on health care use.

To assess the economic impact of ADT duration in a real-life setting through the changes in direct health care costs.

A historical fixed cohort study included 27,134 patients aged 18 and over with a new ADT registered in the national insurance database. The economic impact concerned health care expenditure in the first three months after treatment discontinuation. Generalized linear models compared two groups of treatment duration: less than six months and six months and over.

After adjustment for care costs before and during ADT, gender, age, chronic diseases, welfare entitlement and prescriber specialty, total health care costs (in log) [-0.06 (-0.14;0.01) p = 0.11] and psychiatric care costs (in square root) [-0.08 (-0.41;0.25) p = 0.6] were similar in both groups after ADT discontinuation. Non-psychiatric care costs were significantly lower in the “long treatment duration” group compared with the “short treatment duration” group [-11.4 (-15.8;-7.0) p < 0.0001]. The decreases in total and non-psychiatric care costs after the ADT episode were larger in the “long treatment duration” group compared with the “short treatment duration” group.

With regard to health care costs and global health, ADT of short duration appear less effective than treatment of recommended duration.

Bipolar disorder (BD) is strongly associated with suicidal behaviors. Suicidal behavior is based on a stress/vulnerability model. Several factors have been identified, including clinical features (such as impulsivity) and cognitive deficits (such as impaired decision making or problem solving). Identifying specific factors in BD patients is needed to better prevent suicidal behaviors.

1. 1) To identify clinical and cognitive characteristics associated with suicidal behaviors in euthymic BD patients.

2. 2) To determine a correlation between neuropsychological variables and the number and characteristics of suicidal attempts.

214 euthymic BD patients from the national network of “Centres Experts Bipolaires” were included and divided into two groups based on the personal history of suicide attempts. Socio-demographic and clinical variables were collected and neuropsychological functions were assessed (attention, memory and executive functions).

We found an association between suicidal behavior and gender, employment status. Suicidal attempters had significantly more mixed episodes and hospitalizations. There was no difference between the two groups concerning neuropsychological measures. The number of suicide attempts and verbal fluency scores were negatively correlated.

The lack of significant differences in neuropsychological scores may be due to a common vulnerability between suicidal behaviors and BD. Further studies, especially prospective ones, are needed in order to characterize high risk BD patients in order to develop effective specific preventive strategies.

There are above 170 PICUs in the UK, most of them being gender mix or male only. There is no specific data available about management of patients diagnosed with Borderline Personality Disorder (BPD) in PICUs.

Review of sociodemographic, clinical, outcome characteristics, care pathways and financial implications when managing BPD population in Female PICU.

To measure rates of compliance with NICE guidelines using such criteria as: comprehensive care plan provided on admission to PICU and at discharge from PICU; patient being involved in discussion about discharge plans; specialist assessment / treatment started before admission to Female PICU was continued during the admission; referral for psychological therapies was considered/made during stay in Female PICU; prescribing practice by referring and admitting teams; availability of specialist Personality Disorders (PD) services locally.

Retrospective cross sectional review of patient records.

76% of patients are admitted to Female PICU with a comprehensive multi-disciplinary care plan. 80% of patients transition from ECH was discussed carefully with the patient beforehand. Specialist assessment/treatment started before admission to ECH was continued during the admission 100%. Most of the patients would receive treatment by various psychotropic meds prior and during the admission. Referrals to psychological therapies were considered for 19% of patients. There is a lack of specialist PD services.

BPD is the most costly population in comparison with other patient groups in Female PICU which requires multidisciplinary team input, specialist services involvement, better adherence to NICE guidelines, support and training for MDT.

Set shifting provokes gender related alterations of rapid cerebral hemodynamics in large basal cerebral arteries. However, no information on frequency patterns has been reported, especially when comparing phases of set shifting and set maintenance.

In the following functional transcranial Doppler study (fTCD), we introduced spectral analysis to rapid cerebral hemodynamic changes.

To investigate signal characteristics during both phases and its correlate with sociodemographic and performance variables.

Male and female participants performed the Wisconsin Card Sorting Test during measurement of the middle cerebral arteries. Cerebral hemodynamics underwent spectral transformation during set maintenance and set shifting. Correlation analyses examined the linkage with sociodemographic and performance variables.

Scattering of frequencies was significantly increased during set shifting as compared to set maintenance (P = 0.006). Increasing age was significantly associated with increasing variability of spectral frequencies during set maintenance (P < 0.002). In males, but not in females, higher age predicted increased variability of spectral frequencies during set shifting on the right hemisphere (P = 0.002). During that phase, males showed a frequency peak near 0.1 Hz (trend level).

This study provides evidence that spectral analysis of cerebral hemodynamics is a fruitful strategy to characterize gender differences and brain behavior relationships during higher cognitive functioning. Further covariates such as age, performance and hemisphere have to be considered. In other words, signal frequency of cerebral hemodynamics may be an underreported neurobiological marker in addition to signal strength, with special relevance for psychiatric diseases with cognitive dysfunction and/or gender differences, such as schizophrenia or major depression.

Sexual dysfunction is the inability to perform satisfactory sexual activity. It is estimated that 80% of men have erectile dysfunction in dialysis and 55% of women, difficulty in sexual arousal. Men may have decreased libido, erectile dysfunction and difficulty reaching orgasm. Women have difficulty in sexual arousal, decreased vaginal lubrication, dyspareunia, and difficulty achieving orgasm.

Assess sexual dysfunction in hemodialysis patients.

A Cross-sectional analysis conducted with a randomized sample of 100 subjects from a total of 521 hemodialysis patients (20%) of both genders. Data were collected through Kidney Disease Quality of Life - Short Form (KDQOL-SF).

Most patients were female (52%), mean age 55 ± 14 years. After KDQOL-SF, the most common complaint was lack of sexual activity (82.81%). Most patients are dissatisfied with sexual performance (59%). Among them, the more dissatisfied were women, 61% (36/59), p < 0.02, and patients under 65 years, 61% (36/59) p < 0.007. Among those who report being sexually satisfied, the majority were male (58.33%). We found that sexual dissatisfaction is more common in women. Among 52 female patients, 37 were dissatisfied (71.15%), whereas among men, we have 56.25% (27/48) of sexual dissatisfaction.

There is evidence of high prevalence of dissatisfaction in the hemodialysis patients sexual performances. Further studies are needed on their sexual function, as well as therapeutic interventions that may offer improvement in this negative scenario.

Nicotine addiction is common among people with schizophrenia and is associated with significant morbidity and mortality. This rate is a much higher than among the general population, where the percentage of smokers varies between 25-47%.

This study aims to characterize nicotine dependence in schizophrenics compared to smokers not having mental health problems. The research was also to determine whether the affective psychological factors (anxiety and depression) and the level of distress are important predictors of smoking in a group of psychotic patients.

204 smokers participated in the research, including 104 people with schizophrenia and 100 healthy persons. Participants were interviewed and asked to complete five questionnaires: Fagerström Test for Nicotine Dependence, Test of Motivation for Smoking Cessation, Hospital Anxiety and Depression Scale and Distress Thermometer.

The study has shown that the schizophrenics smoked more, took a greater number of puffs, showed a higher level of dependence and were less motivated to give up smoking than the mentally healthy persons. The results show the important role of affective factors and feeling of distress in nicotine dependence. The study also confirmed a significant relationship between distress and the number of cigarettes smoked. Affective factors and distress explain 34% of variance of the number of cigarettes in the group of schizophrenics and 56% in the control group.

This study showed that psychological treatment should be implemented into programs for nicotine dependence to improve the functioning schizophrenics in terms of coping with stress and maintaining good mood.

In adolescents, Socially Prescribed Perfectionism/SPP has been consistently associated with depression. Findings on Self-Oriented-Perfectionism/SOP and depression are equivocal. Self esteem/SE has been found to play a significant role between SPP and depression.

To analyse the relationship between perfectionism, SE and depression in a Portuguese adolescents sample.

963 adolescents (59.2% girls), aged 15.80 ± 1.510 answered the Portuguese versions of the Children Depression Inventory/CDI, Rosenberg Self-Esteem Scale and Child and Adolescent Perfectionism Scale.

CDI and SE mean scores were significantly different between genders (CDI-Girls:10.84 ± 6.025 vs. Boys:8.90 ± 6.477; SE- Girls:20.11 ± 4.953 vs. Boys:20.48 ± 4.856; p < .001). SOP was not significantly correlated with CDI and SE in both genders. In both genders SPP was positive correlated with CDI and negatively correlated with RSES (r = .20, p < .01). RSES was negative correlated with CDI (Girls, r = -.70; Boys, r = -.63; p < .01). Girls with high SPP (>M+1SD) had CDI total mean scores significantly higher than girls with low SPP ( < M-1SD) (12.61 ± 6.79 vs9.75 ± 5.24, p=.003). Gils and boys with high SE vs. low SE had significantly higher CDI total mean scores (Girls:18.49 ± 5.98 vs. 4.91 ± 3.05; Boys:17.02 ± 7.65 vs.5.80 ± 5.62; p < .001). Linear regression showed that the model composed by SPP and RSES explained 49.5% of the CDI variance in girls and 40.0% in boys (p < .001). In both genders, SPP and SE were significant CDI predictors (p < .05). The mediation analysis revealed that in the Girls sub-sample SE partially mediated the relationship between SPP and CDI (IC 95% .036-.126).

High SPP and low SE are associated with depression in adolescence.

The ongoing global economic recession has impacted most severely on the more vulnerable sections of society. The policy of economic austerity being pursued by the British government - 2011-2012 saw the first decline in spending on mental health in 10 years - has placed further strain on the underprivileged.

This paper will examine the impact of the recession and British government policy on gender mental health inequality and recommend corrective action as appropriate.

Examine impact of recession and British government policy on

1. a) negative social determinants of mental health of women

2. b) how they contribute to mental health inequity and

3. c) what measures might be adopted to tackle these negative social determinants.

1. 1/ Analyse arguments on impact of social determinants on mental health inequities.

2. 2/ Review available hardcopy and internet literature on recession and government policies as they pertain to women and mental health inequalities.

3. 3/ Determine optimal approach on behalf of government to prevent gender mental health inequalities.

Current British government policies risk adversely impacting upon the social determinants of mental health of women in Britain, with negative consequences in terms of gender mental health equity. This is particularly true for women in economically disadvantaged circumstances.

Urgent action is required to address this situation by

1. a) reversing policies that negatively impact upon women and risk provoking mental health inequalities and

2. b) introducing gender-proofed policies that will not negatively impact upon the social determinants of mental health of women in Britain.

Two parameters for assessment compliance in HD patients are interdialytic weight gain (IWG) and absences, both influenced by psychological and nutritional aspects.

Achieve greater compliance by using Water Control Dynamic (Bucket Dynamic - BD) to clarify risks of excessive IWG.

BD was performed during HD session by nutritionist and psychologist in 48 HD patients to show that HD doesn’t eliminate fluids as a healthy kidney. Two buckets (B) are presented; one filled with water (B1) another empty (B2). Professional holds an 250 mL glass (represents fluids someone ingests), the other holds a 50 mL glass (represents HD fluid removal capacity). The 250 mL glass, one professional takes water from B1 and places it in the B2. Meanwhile, the other uses the 50 mL glass to take water from B2. This analogy demonstrates that HD doesn’t remove all liquid someone can drink. Hence, water intake control necessity. Nutritionist clarifies patients’ nutritional concerns, while the psychologist addresses emotional issues. We compared percentage of IWG and absences in two months before and after BD.

After BD, we observed decreases in absences (7,2% X 5,7%) p < 0,05 and IWG (4,9% X 4.1%) p < 0,05. IWG was within recommended levels (3.5% to 5% of dry weight) before and after BD, but, before BD, IWG was at the upper limit of the recommendation.

We believe this experience fostered self-control, resulting in better compliance, and allowed us to benefit from an innovative work interaction between health professionals from different areas.

An antidepressant drug treatment (ADT) may be associated with adverse effects such as manic switch or chronic irritable dysphoria. These adverse effects have been highlighted in patients with bipolar disorder but never in the general population. They may lead to prescription of sedative treatment, particularly antipsychotic drugs.

To assess whether the prescription of ADT is subsequently associated with an increased probability of prescription of an antipsychotic treatment, in the general population.

A nested case-control study was carried out in a cohort of subjects initiating a new ADT registered in the national insurance database (n = 28,145). Cases were defined as subjects receiving a new antipsychotic drug treatment. Controls did not receive any antipsychotic drug until the index date. They were compared for the probability of receiving an ADT during at least two weeks in the four weeks prior to antipsychotic initiation.

2558 subjects received an new antipsychotic drug over the follow up. After adjustment for gender, age, chronic disease status, welfare benefit, specialty of the ADT prescriber, co-prescription of other psychotropic drugs, a new antipsychotic dispensing was associated with exposure to ADT during at least two weeks in the four weeks (OR 1,42 ; IC95% 1,29-1,58 ; p < 0,0001).

The dispensing of ADT increases the risk of receiving an antipsychotic treatment, which may be a proxy for manic switch, in the general population.