In 2007 the Government launched a new Mental Health Plan (MHP), written in the spirit of international principles, including the WHO 2001 Global Mental Health Report and the Helsinki European Declaration. The new MHP includes a special section with guidelines for Child and Adolescent Mental Health Services (CAMHS) development. This is relevant, given that, according to WHO, 2 million young people in Europe suffer from mental disorders, sometimes receiving no care.

Regarding mental health needs of the children and youth, the MHP focus on i. how to develop new CAMHS in public general hospitals, across the country, and ii. how to integrate CAMHS in the general health system (including primary care), in order to promote access and decrease stigma.

A national task force has been empowered by the Government to assure the implementation of the MHP, with external monitoring from WHO. This task force includes a team of child and adolescent mental health experts, belonging to different administrative catchment areas throughout the country.

Relevant advances have been: appraisal of current resources, development of new CAMHS, planning of residential and day unit facilities for adolescents, mental health promotion and domestic violence prevention programmes, advocacy and stigma.

Despite several positive outcomes, CAMHS evaluation detected significant problems (access, equity and quality of care). Special attention should be given to CAMHS, namely through the increase of new services and new teams. Nevertheless, given the present crisis context, broad policies can negatively influence and restraint the mental health plan implementation.

Bad news is ''any news that adversely and seriously affects an individual's view of his or her future and it is usually perceived to be related to incurable diagnosis or diagnosis leading to death. The physicians should not uncover main information especially about the future or present patient's situation, Today more than ever patient's legal and ethical right to understand the reality of his disease is respected This study was carried out to probe Iran community's attitude toward breaking bad news.

This was a cross-sectional study in which 200 patients' companions in various wards of Afzalipour Hospital in Kerman were included. Data were entered in the questionnaires designed to evaluate people's attitude toward giving bad news and its quality.

93 percent preferred to get aware of diagnosis in a supposed cancer situation. The majority agreed with expressing treatment strategies, complications, cure probability and estimated survival. Most agreed that decision making should be based on physician priorities, with having patients' desire in mind.

In terms of giving bad news, physicians ought to build up a more efficacious relationship with patients regarding their individual needs and requests.

Deficits in social cognition are major descriptors of the autism spectrum disorder (ASD). Measurable effects of training methods and psychological treatments have been reported in some psychiatric disorders, but few studies were conducted in the domain of neurodevelopmental disorders.

The aims of the study were:

1. 1) to investigate the use of event-related potentials (ERPs) as valuable markers of neurocognitive basis of emotional face processing in children with and without ASD;

2. 2) to explore whether components of the ERPs can be used as potential markers of enhanced emotional processing in children with ASD who benefited from interactive computer training focused on emotion comprehension.

ERPs were recorded during an implicit emotion recognition task in 19 children with ASD and 11 paired controls, along with other clinical and cognitive measures. Another recording session was conducted after a two-week training with a multisensory video game performed by 12 children from the ASD group.

Preliminary results showed that before the training, children with ASD exhibited abnormal P100 and N170 ERP components which reflect abnormal face perception strategies. After training, some of the children exhibited normalized ERP components and enhanced ERP components’ modulation by emotions.

The results are promising although the training was short and not intensive.

Following the principles and recommendations of international institutions and documents (e.g., WHO, European Union, WHO 2001 Global Mental Health Report and the Helsinki European Declaration), the Portuguese Government launched a new Mental Health Plan (MHP), to be implemented from 2007 to 2016.

1. a) To evaluate the current situation of mental health facilities in Portugal,

2. b) assess the feasibility of national training programmes and

3. c) to ascertain the key obstacles of the execution of the Mental Health Plan.

Level of achievements was appraised by i. A full assessment piloted by the Portuguese National Coordination for Mental Health and ii. a cross-sectional evaluation conducted by a task force from WHO-European Regional Office.

So far the MHP has been moderately executed. Relevant accomplishments include: closing of psychiatric hospitals (40% of chronic patients deinstitutionalized), creation of 20 mental health services for adults, children and adolescents, training of 650 professionals, sponsoring of 46 community mental health projects, launching the residential and supported care network with the Health and Social Affairs Ministries.

Significant challenges persisting are:

1. a) To increase provision of crisis services and residential places,

2. b) To strength the role of primary care services regarding common mental disorders,

3. c) To reinforce the role of non-medical professionals in MHS and

4. d) To change the financing system that has disincentives to establish community based services.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hyponatremia in hospitalized patients. The syndrome is an osmoregulatory disorder, consisting of hyponatremia, decreased serum osmolality, inappropriately elevated urine osmolality, excessive urine sodium in a patient who is euvolemic.

The selective serotonin reuptake inhibitors (SSRIs), a frequently prescribed class of antidepressant, have been well reported to cause SIADH. This often poses a clinical challenge to psychiatrists in the consultation liaison and psychogeriatrics setting, where patients are at a higher risk of developing hyponatremia. Other classes of antidepressants should be considered if clinically indicated.

To report an elderly psychiatric patient who was diagnosed with SIADH induced by duloxetine, which belongs to a class of antidepressant known as the serotonin-norepinephrine-reuptake inhibitors (SNRIs).

Patients developing antidepressants induced SIADH present a clinical dilemma to clinicians. Future studies evaluating the incidence of SIADH attributed to the different classes of antidepressants would be helpful to clinicians. Close monitoring of sodium level should be considered when antidepressant therapy is started for patients who are at high risk of developing SIADH.

Agomelatine, a melatonergic agonist and 5-HT2c-antagonist, has demonstrated antidepressant efficacy in clinical trials.

Aim of VITAL was to document treatment with agomelatine non-interventionally in daily practice over 6 months.

Evaluation of the effectiveness of agomelatine on depressive symptoms, daytime activity, tolerability and compliance in depressed patients under routine conditions.

3005 outpatients aged>18 years were observed by 1169 psychiatrists and general practitioners in Germany over 6 months, treated with agomelatine 25-50 mg once daily. Antidepressant effectiveness was evaluated by Beck Depression Inventory (BDI-II), effects on daytime activity by two questions of Circscreen (patient questionnaire), compliance by standardized questions. ADRs were documented every visit.

Included patients (BDI-II total score 31.9) improved during 6 months treatment with agomelatine (BDI-II 9.6). Responder rate (≥50% reduction of BDI-II) rose steadily from 11.7% (2 weeks), 62.0% (12 weeks) to 79.0% (6 months). 55.3% of patients were classified as remitters (BDI ≤9) after 6 months. According to CGI, 20.7% had responded after 2 weeks, 81.6% at study-end (CGI-I≤2). At baseline 53.2% were markedly impaired in normal daily activity compared to 16.1% of patients at the end of study. 64.5% at baseline versus 9.1% after 6 months felt sleepy during daytime (Circscreen). 89.6% of 2511 patients at study-end documented good compliance (regular intake). Adverse drug reactions (mainly headache, dizziness) were reported by 3.6%, 0.6% of patients had reversible ALT/AST>3ULN (n=12).

Antidepressant effectiveness of agomelatine, improvement of daytime activity, good tolerability and good compliance were observed in unselected depressed patients over 6 months.

Since there are clear indications that schizophrenia is a systemic disorder, we sought for a common molecular basis for schizophrenia abnormalities in brain and body. Our hypothesis was that an impaired insulin/ insulin-like growth factor signalling in cells might underlie changes in both brain and body in schizophrenia. In this regard, the intracellular insulin receptor substrates 1-4 proteins might be of interest to study genetically.

In this study, we chose to investigate the insulin receptor substrate-3 (IRS-3) gene as a candidate gene in schizophrenia.

The IRS-3 gene of 93 patients with the diagnosis of schizophrenia according to DSM-IV criteria and 57 healthy control subjects was screened for DNA sequence variations, followed by case-control analyses of total 10 detected polymorphisms.

The A/G genotype of the single nucleotide polymorphism (SNP) at position 100166597 in the IRS-3 gene occurred in 5.3% of the control subjects compared with in 0% of the patients (p=0.05).

Our finding suggests that individuals carrying the A allele of this A/G SNP in the IRS-3 gene have a protection against schizophrenia development.

Systemic sclerosis (SSc) is a chronic connective tissue reaching the skin and blood vessels, responsible for disability and impaired quality of life.

The objective of this study was to evaluate the quality of life and mood in a group of patients with SSc.

Our study was descriptive, conducted between October 2011 and June 2012; Among the 15 women hospitalized with SSc, 10 agreed to participate in the study. Quality of life was assessed by the WHOQOL BREF scale (World Health Quality of Life-Brief Version). Emotional disorders have been evaluated by the “Hospital Anxiety and Depression Scale” (HAD).

The average age was 52.4 ± 8.2 years (38-65 years). Our patients were estimated to have a quality of life overall average with a total score scale WHOQOL BREF close to 60 of 120. The values of the four domains were: physical health 46± 8.8 [31-56], psychological health 50.7± 11.2 [31-69], social relations 57.5 ±15.5 [25-75], environment 52 ± 11 [31-63]. Eight women had a score HAD A >10 defining an anxious states certain. Seven patients had a score HAD D > 10 defining a depression certain. 7 out of 10 women said they needed psychological help and were supported jointly in psychiatry.

Our results underline a high frequency of emotional disorders in patients with SSc. Similarly, the quality of life has been altered. These results suggest a widespread screening for anxiety and depression.

Cardiac surgery with cardiopulmonary bypass represents a severe source of stress and has been reported to be associated to the development of Posttraumatic Stress Disorder (PTSD). This disorder leads to a significant disability that might greatly decrease the benefits of surgery. Research rarely focused on the role of attachment styles in the development of PTSD, and no studies addressed this issue in patients undergoing cardiac surgery.

To assess the influence of attachment styles on the development of PTSD.

The identification of specific personological traits predictive of the development of PTSD.

Participants were recruited among patients scheduled for elective cardiac surgery with cardiopulmonary bypass and evaluated through

1. a) Experiences in Close Relationships (ECR)

2. b) Post-traumatic 10 Stress Symptom Inventory - Modified (PTSS-10)

3. c) Perceived Stress Scale (PSS).

Six months after surgery, participants were mailed the PTSS-10 and the PSS. Multiple logistic regression analysis was performed with PTSD as dependent variable, and attachment-related avoidance and anxiety, sex, age and perceived stress as independent variables.

One hundred twenty-one patients (94% of candidates for elective cardiac surgery who met study inclusion criteria) underwent surgery; 61(59%) were assessed after 6 months. Fourteen subjects (19.7%) scored ≥35 on the PTSS-10 at followup and were considered as having a probable diagnosis of PTSD. Attachment related avoidance at baseline predicted the development of PTSD at follow-up (p< 0.017), after controlling for age, sex and perceived stress.

Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery.

Inpatient facilities for people with LD are highly specialised services that are a valuable, but expensive, component of mental health services. Although there are no national data describing these services, commissioners need good quality data to inform their contracting and pricing strategies for LD psychiatric inpatient care. To help fill this information gap, we carried out a review to explore the general characteristic of inpatients population, duration of admission and delays in discharge in the inpatient LD unit.

To analyse admission trends including the reasons for delayed discharges to a LD unit from 2008 to 2011.

A retrospective review of the case records of all inpatient admissions to the LD Unit (Seacole) between 2008-2011.

There were 41 admissions made to the service in the time period from 2008 to 2011. More male patients (76%) were admitted compared to females (24%) (p=0.073). Male patients (55%) were more likely than female patients (20%) to be admitted from a residential home (p = 0.075).There was no statistically significant difference between the male and female sexes regarding diagnosis of challenging behaviour or psychotic or affective disorder. 59% of discharges in 2008–2011 were delayed. The main reason for the delayed discharge was social and was significantly more likely to result from difficulty in finding appropriate placement (p=0.008).

Social problems were the main cause of delayed discharges. Early identification of social issues, better utilization of community resources and robust discharge planning should be done to avoid delay in discharge.

There is evidence that women with breast cancer can develop anxiety and depression, ultimately affecting patients’ compliance and quality of life.

Previous studies investigated psychological distress in women with breast cancer at different stages of the disease. However, few data are available about Italian women in the early steps of their clinical history.

To investigate psychological distress, anxiety and depressive symptoms in a sample of women with a recent diagnosis of breast cancer.

This cross-sectional study involved twenty-five women consecutively attending the oncology outpatient clinic for their first oncology evaluation after surgery. Anxious and depressive symptomatology was assessed through the Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Socio-demographic and clinical characteristics were also collected. Correlations were analyzed using Spearman's correlation coefficient.

The mean values (±SD) of the HADS Anxiety and Depression Subscales were 7.6 (±4.7) and 5.7 (±4.4) respectively. Five patients (24%) scored ≥10 at the HADS Anxiety subscale and 16% scored ≥10 at the HADS Depression subscale, suggesting the presence of clinically relevant symptomatology. DT mean score (±SD) was 5.36 (±3.5), with 48% of patients scoring ≥7, indicative of significant psychological distress. Multivariate analysis showed an inverse correlation between psychological distress severity and time after cancer diagnosis.

These preliminary findings show a prevalence of anxious and depressive symptoms in one out four women with breast cancer. Further prosecution of the study will help to identify women at risk for psychiatric comorbidities, suggesting the development of targeted interventions.

Evaluate the efficacy and long-term safety of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Patients requiring chronic treatment for schizophrenia, not on aripiprazole monotherapy, were cross-titrated from other antipsychotic(s) to aripiprazole in an oral conversion phase (Phase 1). All patients entered an oral aripiprazole stabilization phase (Phase 2). Patients meeting stability criteria entered an ARI-OM stabilization phase (Phase 3), with coadministration of oral aripiprazole for the first 2 weeks. Patients meeting stability criteria were randomized to ARI-OM or placebo once-monthly (placebo-OM) during a 52-week, double-blind maintenance phase (Phase 4). Primary endpoint was time-to-impending relapse. Safety and tolerability were also assessed.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo-OM=134). The study was terminated early because efficacy was demonstrated by a pre-planned interim analysis. Time-to-impending relapse was significantly delayed with ARI-OM vs. placebo-OM (p< 0.0001, log-rank test). Discontinuations due to treatment-emergent adverse events (AEs) were: Phase 1, 3.8% (n=24/632); Phase 2, 3.0% (n=21/709); Phase 3, 4.9% (n=28/576); Phase 4, 7.1% (n=19/269). Most AEs were mild or moderate. Insomnia was the only AE >5% incidence in any phase. Headache, somnolence, and nausea had a peak first onset within the first 4 weeks of treatment. There were no unusual shifts in all phases in laboratory values, fasting metabolic parameters, weight, or objective scales of movement disorders.

ARI-OM significantly delayed time-to-impending relapse compared with placebo-OM and was well tolerated as maintenance treatment in schizophrenia1.

Information processing studies, such as attentional bias, help to distinguish anxious pathologies. If Vigilance and disengagement bias have been widely demonstrated in generalized anxiety and post traumatic stress disorder (PTSD), their existence has not been reported in non clinical sample with or without anxiety and/or PTSD symptoms.

The aim of the present study was to examine the possible presence of specific attentional bias in these populations and compare them with classical bias in PTSD patients.

One hundred and thirty-one students completed a visual search task with a lexical decision component, and anxiety and PTSD scales. We controlled attentional bias: vigilance / disengagement and words valence: neutral / general threat-related / trauma-related. Ten PTSD patients were assessed for PTSD with CAPS and completed the same protocol.

Among non clinical sample, four groups were distinguished: without symptom, anxious, PTSS (Post-Traumatic Stress Symptom) and, anxious and PTSS groups. Analysis of response time and error rate show different pattern of bias in each non clinical group. Considering the PTSS group response times were higher for trauma-related words, while for threat-related words, the anxious group was characterized by lower response times. Without symptom participants showed an attentional bias for negative information. Anxious and PTSS participants were characterized by a generalization of both biases.

These data reveal the existence of different types of information processing between these four non clinical groups. A putative role of anxious symptoms, in anxiety pathologies such as PTSD, on attentional bias is discussed.

Oestrogens may be a protective factor in psychosis. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD).

To evaluate gynaecological variables and psychopathology in women with DD.

To investigate the relationship between age of menarche and onset, and psychopathology in DD.

Forty-five outpatients with DD (DSM-IV-TR) were recruited at the Hospital Clinic of Barcelona, from 2008 to 2012. Twenty-five females underwent a demographic and gynaecological questionnaire. HRSD-17 for depression, PANSS for psychopathology, PSP for functionality and C-SSRS for suicide were assessed. The sample was divided into two groups according to the age of menarche: 12 years or less and more than 12.

Mean age of menarche (SD) was 12.6(1.4) years, mean age of menopause 49.1(3.15), mean age at onset of DD was 49.9(12.58). 33.3% of the sample did not receive gynaecological service in the last 3 years. The group with the earliest age of menarche was older [67.33(11.67) vs.56(9.6); p=0.026], presented an earlier age of menopause [46.80(2.84) vs.50.71(2.29) p=0.018] and latest onset of DD (53.50(14.32) vs.47.44(11.5); p=NS], than those with later age of menarche. No differences were found regarding psychopathology, suicidal behaviour or functionality.

Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. A low compliance rate in gynaecological service use was found. An earlier age of menarche was associated to an earlier age of onset of DD.

Evaluate the effectiveness of investigational aripiprazole once-monthly (ARI-OM) for maintenance treatment in schizophrenia.

Detailed methodology has been published previously1. Briefly, the study consisted of 4 phases: oral conversion to aripiprazole (Phase 1); oral aripiprazole stabilization (Phase 2); ARI-OM stabilization (Phase 3), with co-administration of oral aripiprazole for the first 2 weeks; and an ARI-OM maintenance phase (Phase 4). Effectiveness assessments included Investigator's Assessment Questionnaire (IAQ) scores, a scale that evaluates effectiveness of current treatment vs. pre-trial medication, where a negative change in score signals improvement, and Personal and Social Performance (PSP) scale scores, where negative change in score signals worsening.

710 patients entered Phase 2, 576 Phase 3 and 403 Phase 4 (ARI-OM=269, placebo once-monthly [placebo- OM]=134). Mean IAQ Total scores remained stable in Phase 2 (31.3) and Phase 3 (30.6). During Phase 4, the mean change in IAQ Total score was +1.3 for ARI-OM vs. +3.8 for placebo-OM (p< 0.0001). Mean changes in PSP Total scale scores showed improvement during Phase 2 (3.0) and Phase 3 (2.6). Mean change in PSP scores during Phase 4 showed greater functional stability with ARI-OM (−1.7) compared with placebo-OM (−6.2) (p=0.0002 vs. placebo-OM).

Improvements in effectiveness, as assessed by the IAQ and PSP Total scale scores, in the Phases 2 & 3 were maintained in Phase 4 for ARI-OM compared with placebo-OM. Treatment with ARI-OM improved symptoms, overall response to treatment and functioning.

Prevalence estimates of childhood and adolescent mental health disorders appear to vary between 20 to 30% worldwide. It is therefore unsurprising that studies have yielded inconsistent findings in regards to the trends of prevalence of mental health disorders. Some reasons for the discrepancy in findings include use of survey data and its associated attrition and selection bias.

First, to determine and compare the prevalence of mental health disorders derived from a survey and a population cohort. Second, to evaluate trends of mental health prevalence over time.

As population data (i.e., linked health records) may be used to overcome the issues presented by survey data, we compared the prevalence estimated from a prospective survey cohort (the Western Australian Pregnancy Cohort (Raine study) to another estimate from a prospective population cohort (linked population data; data from the Hospital Morbidity Records and Mental Health Registration).

As expected, the Raine cohort yielded a larger estimate of prevalence when compared to the linked population data. However each cohort also revealed opposite trends of prevalence, where the Raine cohort showed the prevalence of mental health disorders to decrease as children age.

We therefore recommend that estimates of prevalence be interpreted with the type of cohort in mind, as estimates from survey cohorts will provide different information to that from population cohorts.

Evaluate the safety and tolerability of aripiprazole once-monthly (ARI-OM) initiation in patients stabilized on oral antipsychotics other than aripiprazole. Previous pivotal Phase III trials have evaluated initiating ARI-OM in patients stabilized on oral aripiprazole1.

Eligible patients were treated with oral atypical antipsychotics other than aripiprazole with a history of oral aripiprazole tolerability. The study included a screening phase (30 days) and a treatment phase (28 days). Patients were stabilized per investigator's judgment for ≥14 days on risperidone, olanzapine, quetiapine, or ziprasidone, before administration of ARI-OM (400 mg). Current oral antipsychotic was co-administered with ARI-OM for 2 weeks to determine safety and tolerability of a single ARI-OM dose following treatment initiation. Safety assessments were adverse events (AEs); extrapyramidal symptoms (EPSs) using standard objective rating scales; Columbia-Suicide Severity Rating Scale; clinical laboratory measures; and weight changes.

60 patients initiated ARI-OM, while continuing treatment for ≤2 weeks with oral risperidone (n=24), quetiapine (n=28), ziprasidone (n=5) or olanzapine (n=3). Treatment-emergent (TE) AEs (≥5%) were fatigue, injection-site pain, and restlessness (risperidone); insomnia, dystonia, injection-site pain, and toothache (quetiapine); and muscle spasm, tooth abscess, and toothache (ziprasidone). Prior olanzapine did not cause any AEs. Incidence of TE-EPSs were similar in all groups (< 5%). There were no unusual changes in objective EPS rating scales, suicidality, weight, laboratory values or fasting metabolic parameters across all groups.

The AE profile of patients receiving ARI-OM concomitant with oral atypical antipsychotics other than aripiprazole was consistent with prior reports1.