Schizotypal dimensions are associated with current but not former tobacco consumption

OBJECTIVES

We aimed to study the relationship between tobacco smoking and attenuated psychosis measures taking into account several aspects of tobacco consumption that to date have not been explored and that could help understand this association, such as age of onset, the influence of former consumption and the duration of abstinence.

METHODS

We investigated, in a sample of 580 students, the relationship between schizotypy (using the schizotypal personality questionnaire-brief in a Likert format) and smoking status, nicotine dependence (measured with the Fagerström test for nicotine dependence), age of onset of smoking and in former smokers, duration of smoking abstinence.

RESULTS

35.2% of the students were current smokers and 13.4% were former smokers. We found that current but not former smokers had higher scores of schizotypy (total, positive and disorganized) than non-smokers. We found no association between schizotypy scores and nicotine dependence or earlier age of onset of smoking. The duration of smoking abstinence, in former smokers, was inversely correlated to the score of positive and total schizotypy.

CONCLUSIONS

Our results suggest that tobacco has a reversible effect on schizotypy, but more studies with a different design (controlled, longitudinal) and a more thorough exploration of potential confounders (e.g. cannabis) are needed before a firm conclusion can be reached.

Sick leave duration as a potential marker of functionality and disease severity in depression

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

Changing the Antipsychotic in Early Nonimprovers to Amisulpride or Olanzapine: Randomized, Double-Blind Trial in Patients With Schizophrenia

BACKGROUND AND HYPOTHESIS

Meta-analyses have shown that the majority of patients with schizophrenia who have not improved after 2 weeks of treatment with an antipsychotic drug are unlikely to fully respond later. We hypothesized that switching to another antipsychotic with a different receptor binding profile is an effective strategy in such a situation.

STUDY DESIGN

In total, 327 inpatients with an acute exacerbation of schizophrenia were randomized to double-blind treatment with either olanzapine (5-20 mg/day) or amisulpride (200-800 mg/day). Those patients who had not reached at least 25% Positive-and-Negative-Syndrome-Scale (PANSS) total score reduction from baseline after 2 weeks (the "non-improvers") were rerandomized double-blind to either staying on the same compound ("stayers") or to switching to the other antipsychotic ("switchers") for another 6 weeks. The primary outcome was the difference in the number of patients in symptomatic remission between the combined "switchers" and the "stayers" after 8 weeks of treatment, analyzed by logistic regression.

STUDY RESULTS

A total of 142 nonimprovers were rerandomized at week two. 25 (45.5 %) of the 'stayers' compared to 41 (68.3 %) of the "switchers" reached remission at endpoint (p = .006). Differences in secondary efficacy outcomes were not significant, except for the PANSS negative subscore and the Clinical-Global-Impression-Scale. "Switchers" and "stayers" did not differ in safety outcomes.

CONCLUSIONS

Switching "non-improvers" from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.

Morphopathological changes in obsessive-compulsive disorder

The pathophysiology of the obsessive-compulsive disorder (OCD) has been studied for many years using several structural magnetic resonance imaging, discovering that the anomalies of function and structure of the brain are widespread, they involve different areas, structures and circuits with a complex interconnectivity. More than that, these anomalies cover all the life of a patient, from early childhood, due to variations of developmental stages until adult life. The research is highly important also because OCD has a major hereditary factor, with the phenotype variance between 27–47% due to hereditary factors. Under this paper, that follows last 10 years studies in this area, we will find some relevant findings consisting on neuroanatomic changes, the morphology findings of striatum, globus pallidus and thalamus, the blood flow circuit changes in various regions of the brain, brain connectivity and various correlations of them. Not to forget that OCD must be understand as an emotional disorder but in the same time as a cognitive disorder too. This approach highlights the abnormalities that have been found in brain regions involved in the cognitive and emotional behavior, as for example: extended temporal, parietal, and occipital regions, anterior cingulate, frontal gyrus, amygdala.

Schizotypal Personality Questionnaire-Brief: Effect of invalid responding on factor structure analysis and scores of schizotypy

OBJECTIVES

We assessed the effect of invalid responding on factor structure and on scores of schizotypy through the factor analysis of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a sample of 580 Romanian students using 3 validity items and 5 social desirability items.

METHODS

We examined the factor structure of the SPQ-B, we compared the mean SPQ-B scores between reliable and unreliable responders and between high vs. low social desirability responders, and we re-run the factor analysis restricting the sample to the reliable or low social desirability responders.

RESULTS

Factor analysis resulted in a 3-factor solution: Cognitive-perceptual, Interpersonal and Disorganized dimensions. Unreliable responders had lower scores of positive, negative and total schizotypy. Subjects with high social desirability scores had lower scores of disorganized schizotypy. Factor analyses in the samples of "good" responders showed minor differences in reliable responders, whereas, after taking into account the effect of social desirability, 2 items correctly loaded on expected dimensions.

CONCLUSIONS

Random responding and social desirability could influence scores of schizotypy and factor structure. Simple methods could be used to identify invalid responses. The effect of social desirability could be linked to the phrasing of items.

Developing a Platform for Online Psychotherapy Sessions

Introduction

Providing mental health services by real-time videoconferencing has been increasingly adopted as a method of reaching hard-to-serve populations since the early 1990s. There is a growing body of evidence investigating the efficacy of delivering online mental health care. Though studies vary in quality, they generally demonstrate that online mental health care is effective across multiple age groups. Online is generally well accepted by patients and specialists and its implementation is feasible. It is also convenient and cost effective.

Objectives

Due to the fact that almost 75% of Romanian population have internet access and that mental health services are still stigmatized we perceived the opportunity to develop an online platform where patients can easily find and interact with mental health specialists using secured videoconference.

Methods

During a timeframe of two years a multidisciplinary team managed to develop and test an online platform where patients can access psychotherapy sessions. Main design and development targets were usability and confidentiality/security. The platform has an appointment tool, a secure videoconference solution and an integrated online payment service.

Results

The platform can be accessed at https://atlashelp.ro. It was launched in mid July 2016 and it already gathers more than 50 mental health specialists. The feedback was excellent from both specialists and patients.

Conclusions

The solution developed is complaint with most of international standards and offers easy to access and high quality psychotherapeutic services for Romanian patients.

A “Newly Discovered in Romania” atypical antipsychotic prolonged release treatment for patient with schizophrenia. First results of a naturalistic study with recently approved paliperidone palmitate

Introduction

Intramuscular paliperidone palmitate is a long-acting atypical antipsychotic, which has only been marketed in Romania from march 2015 as a free of charge medication/subsidized for the acute and maintenance treatment of schizophrenia in adults.

Objectives and aims

To determine the efficacy and tolerability of paliperidone palmitate in 12 patients with schizophrenia in an outpatient care unit, taking into account the limited clinical experience with this product in Romania.

Methods

The study was performed in an outpatient care unit. Data was collected from medical records of patients started on paliperidone palmitate between March and June 2015. This time period was selected because we wanted to have at least a 6-month period of evaluating these patients. Some of the patients were previously on risperidone long-acting injection (in Romania the advantages of a 1-month injection instead of 2 and the fact that the medication does not need to be held in a refrigerator are 2 important factors that can increase the compliance of the patients). Others were treated with other long-acting antipsychotics (flupentixol). The rest were patients treated before with risperidone, with good response, but with problems of non-compliance.

Results

None of the patients treated with paliperidone palmitate relapsed. Some of them had, at maximum dose, minor extrapyramidal symptoms that disappeared when we lowered the dose. Taking into account the lack of insight and the non-compliance of patients with schizophrenia, this treatment seems to be extremely valuable, maybe more in this kind of cases, in outpatient care units.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The acceptability of web-care for patients with major depressive disorder

Introduction

With the extraordinary rate of development of E-health and widespread internet access in Romania, Inomedica decided to create a platform dedicated primarily to the patients and their families: depresiv.ro. According to Internet Live Stats there were 11,178,477 Internet users in Romania (representing 51.66% of the population) in 2014. Inomedica is a non-governmental organization founded by a multidisciplinary team (psychiatrists, sociologists, IT specialists).

The platforms provide rigorous and quality online information about depression as well as self-assessment tools and Q&A section.

The presentation will explore the development and effects of the first 16 months of operation of a web platform about depression.

Methods

The depresiv.ro platform design is simple and user friendly. Mental health specialists contributed to the development of the content, which is easy to access and understand.

The platform also provides access to a self-evaluation tool, the Hospital Anxiety and Depression Scale (HADS), and thus helps the users identify possible problems and encourage them to seek professional help. The web application also included a demographic questionnaire, and a medical history questionnaire. A native iOS version of the application is available to download free on AppStore. The platform is supported by a Google grant program.

Results

The platform traffic increased from a few users per day at launch to more than 1000 unique visitors per day. Since 1st January 2015, about 178,000 unique visitors accessed the platform. All the metrics improved significantly during the last months: bounce rate (66.3%), average session duration (02:17 minutes), number of pages per session (2.4).

About 25,000 users accessed the HADS application since its release, from August 2014 until September 2015, showing the increasing need for free online self-evaluation tools.

The Q&A section is one of the most visited on the platform since many users try to find answers for their questions regarding depressive or anxiety symptoms.

Conclusions

As new technologies are introduced and become more accessible, mental health specialists are developing new ways of providing services and collecting data. The traffic data/usage for both the depresiv.ro platform and the app are evidence for the widespread acceptability of web-based delivery methods.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Neurosyphilis and early-onset major neurocognitive disorder – Case reports

Introduction

Neurosyphilis has been called “the great imitator” because of its atypical clinical presentation ranging from motor dysfunctions to psychotic episodes to dementia. This, and the fact that it has become a rare disease, makes diagnosis challenging.

Objective

This work will present three early onset Major Neurocognitive Disorder cases for which neurosyphilis was considered as a possible cause.

Aims

In this presentation, we underline clinical characteristics that should raise the suspicion of neurosyphilis and the importance of an adequate diagnosis.

Methods

The three patients presented as case-reports were admitted to an acute psychiatric ward, presenting with psychomotor agitation and aggression. The initial clinical evaluation (including the patient's medical history) did not suggest the presence of syphilis. Subsequent blood-tests were performed, including RPR (Rapid Plasma Reagin) or VDRL (Venereal Disease Research Laboratory) which were positive in all three cases. Other tests were performed in order to confirm the presence of neurosyphilis.

Results

All three patients had positive treponemal and nontreponemal test results. For only one of the three patients, imagistic abnormalities of the brain were present. For two of the patients, a positive diagnosis of Major Neurocognitive Disorder due to neurosyphilis was established.

Conclusions

Neurosyphilis can be a cause for Major Neurocognitive Disorder. The diagnosis of this pathology is important because cognitive function can be improved by adequate treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Comparison Of The Improving In Major Depressive Symptoms As Reported By Romanian Physicians And Patients In a Prospective, Multicenter, Observational Study

Introduction

Depression leads to substantial suffering for the patients, their families and becomes an economic burden for system [1,2]. Patients and clinicians tend to rate the remission differently [3].

Objectives and methods

We investigate if clinicians and patients rate different the treatment response. This study assed the evolution of major depressive episode (MDE) in patients treated with Agomelatine, in Romania. It was designed as a multicentre, observational study that included 1213 adult patients evaluated in 75 sites in 2014. The design included 3 visits (baseline (V1); visit at 2/3 weeks (V2); visit 6/8 weeks (V3)). The scales used were: MADRS, SHAPS, CGI-I, CGI-S, PGI-I, PGI-S.

Results

The MDE improvement was significant (P < 0.001) for all aspects evaluated. At baseline, more clinicians vs. patients considered the moderately or markedly ill as best descriptors of the state. The difference between the two assessments was even higher for V2 and V3. During V2 clinicians reported “minimally improvement” while patients reported “much improvement” in higher percentage. During V3, both, clinicians and patients reported a “very much improved” clinical status. Of the patients 42.60% reported at V3 “normal”, not at all ill’ in comparison to 34.81% of clinicians who reported the same (P < 0.001).

Conclusions

This could mean that patients are not aware of the severity of their disease. This data could be interpreted in the way that patients are more prone to rate higher the improvements as response to treatment and the clinicians to rate as response a more than 50% decrease of symptomatology.

References not available.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychiatric comorbidities in patients with brain tumors after radiotherapy – An intermediate report

Introduction

Primary or secondary CNS tumors are among the most difficult to manage forms of cancer. Treatment of these tumors remains a challenge in oncology and the success rates for treatment of brain tumors are much lower than in extracerebral localizations. Because most chemotherapeutic agents do not cross the blood-brain barrier effectively and surgery is sometimes only palliative, radiotherapy remains the main method of treatment of these lesions. Both localized and generalized brain radiotherapy have numerous psychiatric complications.

Objectives

The objective of the study was to assess the psychiatric comorbidities in patients with brain tumors receiving radiotherapy.

Aims

This is an intermediate report of a larger study that assesses comorbidities in patients with brain tumors after radiotherapy.

Methods

Twenty-five patients with different localization brain tumors were included in this observational study before receiving radiotherapy. All patients were assessed using Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Montreal Cognitive Assessment (MOCA) for cognitive impairment and Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form (Q-LES-Q-SF) at inclusion and after 3 months from finishing the radiotherapy sessions.

Results

Twenty-two patients completed the study. Nine patients received antidepressant treatment (sertraline, tianeptine) during the study for depressive symptoms or anxiety. Patients receiving antidepressants showed better scores on HADS, MOCA and Q-LES-Q-SF scales.

Conclusions

Antidepressant use in patients receiving radiotherapy for brain tumors could be neuroprotective and could improve quality of life.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treatment effectiveness in patients with schizophrenia as measured by the ASSESS battery - first longitudinal data

BACKGROUND

Effective pharmacological treatment with a favorable side-effect profile increases treatment adherence and is therefore very important for patients with schizophrenia. Psychiatrists need easy to use and reliable assessments instruments to evaluate treatment effectiveness in their patients.

SUBJECTS AND METHODS

A group of European leading psychiatrists have proposed a framework for the assessment of treatment effectiveness in patients with schizophrenia - the ASSESS battery (The ASseSsment of EffectivenesS in Schizophrenia Battery) which evaluates the effectiveness of treatment during both the remission and the relapse periods. ASSESS includes: 10 items of Positive and Negative Symptoms Scale (PANSS), Brief Assessment of Cognition in Schizophrenia (BACS), Medication Satisfaction Questionnaire (MSQ), and Personal and Social Performance Scale (PSP). The battery assesses five domains: symptomatic remission and retention of treatment, affective symptoms, cognitive functioning, treatment satisfaction and personal and social functioning. The aim of the present study was to evaluate the applicability of ASSESS in real world practice.

RESULTS

The variations of the PANSS items rated during the study indicate a significant improvement of psychopathology. A similar improvement was observed in cognition, social functioning and treatment satisfaction as shown by BACS, PSP and MSQ scales. Cognitive impairment, personal and social functioning, and treatment satisfaction were correlated with the remission or augmentation of positive symptoms.

CONCLUSIONS

This pilot study revealed that ASSESS is easy to apply in clinical practice and is a suitable tool for psychiatrists since it covers all the relevant aspects of the course of schizophrenia in a compact form.

Brain derived neurotrophic factor (BDNF) levels in depressed women treated with open-label escitalopram

BACKGROUND

Recent studies suggest the important role of brain derived neurotrophic factor (BDNF) in the etiopathogenesis of major depressive disorder (MDD) and the mechanism of action of antidepressants. This study aimed to correlate serum levels of BDNF and clinical symptoms in patients with MDD before and after 6 months treatment with escitalopram.

SUBJECTS AND METHODS

Twenty women diagnosed with MDD and 20 aged-matched healthy female controls were recruited. The patients received escitalopram 10-20 mg/day. BDNF serum levels were measured at inclusion, week 4, week 12 and week 24. The Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess the severity of depressive symptoms and the clinical evolution of patients. Statistical analysis was performed using both observed cases and last observation carried forward.

RESULTS

At baseline, low serum levels of BDNF were associated with MDD. In women with MDD, escitalopram seems to have a positive effect on BDNF serum levels in parallel with the clinical response.

CONCLUSIONS

This study suggests that a good clinical evolution under treatment with escitalopram might be associated with increases of BDNF levels in female patients.

Nutrition and depression at the forefront of progress

Depression is a debilitating disorder estimated to become the second cause of morbidity worldwide by the year 2020. The limited efficacy of antidepressant therapy, as well as the major negative consequences of this disorder, has stimulated additional research in order to determine possible adjunctive treatments. There is mounting evidence linking dietary patterns to major depression development. This article presents some of the most significant findings concerning the role of nutrition in major depressive disorder. Although more focused and clear results are needed, the correlation between nutrition and mental health is gaining attention. Now, there is evidence supporting the importance of nutrition in maintaining good mental health. We emphasize multiple findings that support adherence to healthy dietary patterns, taking into account that the production of neurotransmitters need, among others, right amounts of nutrients, a lot of which can only be supplied through diet. Not only certain nutrients are needed for proper brain functioning, but also others can be harmful, promoting depression. The Mediterranean diet has been linked to a low prevalence of depression while fast-food consumption has been found to increase the risk of developing and aggravating this disorder, hence the need for nutritional interventions. From the perspective of discovering modifiable risk factors, the role of nutrition in psychiatry could be more important than it was initially considered.

Social impact of behavioral disorders in psychiatric patients

Background: Violent behavior is often met in patients with mental health disorders. An important area of research studied different factors that can influence aggressive behavior in psychiatric patients. Objectives: The paper's aim was to compare different characteristics between two groups of patients, who presented with psychiatric disorders and aggressive behavior. Demographic characteristics, diagnosis, use of alcohol, history of brain injury, physical and verbal aggression were analyzed in both groups. Methods: The first group was formed of 23 mentally ill patients framed into the Article 114 Criminal Code who presented aggressive behavior and committed various offences. In the second group, 45 patients admitted at psychiatry without their consent were included, after having committed different acts of aggression. Results: The patients from the first group had significantly more psychiatric admissions in their history than the patients from the second group. A higher percentage of alcohol users was registered in the first group, compared to the second one. More patients with personality disorders and concomitant use of alcohol were present in the first group, compared to the second group. In both groups, aggressive behavior was more frequent in patients having psychotic disorders, compared to other diagnosis. Even if overall aggression was more frequent in the second group, when alcohol use (with or without brain injury) was present, aggressive behavior became more frequent in the first group. Conclusions: Results of the study suggest that when certain conditions are met, they can significantly influence the behavior of psychiatric patients, with notable differences in each group.

A randomized controlled trial of allopurinol vs. placebo added on to antipsychotics in patients with schizophrenia or schizoaffective disorder

Adenosine agonists produce behavioral effects similar to dopamine antagonists, hence increasing adenosine levels might improve symptoms of schizophrenia. This hypothesis is supported by three single-site studies indicating that allopurinol, which increases adenosine levels, improved symptoms in patients with schizophrenia. We performed a multi-center, 8-week RCT of allopurinol vs. placebo added to anti-psychotic medications in 248 patients with schizophrenia or schizoaffective disorder. Both groups showed improvement in the PANSS (effect size 1.13) and in clinical and cognitive measures. No difference was observed between groups in primary (t=0.01, p=0.992) or secondary outcome measures. These findings do not support allopurinol as a treatment for schizophrenia.

Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative

CONTEXT

There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods.

OBJECTIVES

To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview.

MAIN OUTCOME MEASURES

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment.

RESULTS

The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system.

CONCLUSIONS

Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.

Erectile dysfunction in psychiatric patients

Introduction

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual activity.

Objectives

ED is a common condition in psychiatric patients, which can modify their quality of life.

Aims

The aim of this study is to assess the prevalence and the severity of ED in psychiatric patients.

Methods

This naturalistic, observational study was conducted during a six months period. The International Index of Erectile Function (IIEF) 15-item questionnaire was used to assess 144 male inpatients with different psychiatric disorders. IIEF is a brief, cross-culturally valid, self-administered scale for detecting treatment-related changes in patients with erectile dysfunction and addresses the relevant domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The patients were analyzed by age, psychiatric diagnosis, medication, IIEF scores at admission.

Results

Then mean age was 36.4 years. The lot included 44 patients with Psychotic Disorders, 68 with Mood Disorders, 21 with Alcohol Dependence, 11 with Personality Disorders. Severe ED was registered in 38% of investigated patients, which determined abandon of sexual attempts in 57% of cases; 12% had moderate ED, 15% had mild to moderate ED, 18% had mild ED and 17% had normal sexual function. No orgasm was reported in 32% of patients and 37% had no sexual desire. Under treatment with antipsychotic medication 78% had severe or moderate ED.

Conclusions

Severe ED was correlated with age, also being seen in young patients. ED was correlated with depression, schizophrenia and antipsychotic medication.

Therapeutic effect and tolerability of quetiapine XR in patients with manic episode, bipolar disorder I

Introduction

Agitation and aggressive behavior are common symptoms in patients with an acute relapse of bipolar mania.

Objectives

Quetiapine XR is an effective treatment in agitated patients with an acute relapse of bipolar disorder.

Aims

The aim of this study was to assess the efficacy and tolerability of Quetiapine XR in patients with manic episode.

Methods

This naturalistic, observational study evaluated 45 patients diagnosed with manic episode, bipolar disorder I (DSM IV-TR) for a period of 4 weeks, during which the patients received Quetiapine XR, in doses between 800 mg and 1000 mg per day, using a rapid titration scheme.

Efficacy of the treatment was measured using Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI), performed at baseline, and then weekly. The Overt Aggression Scale-Modified (OAS-M) was used daily until day 4 and then once per week. Extrapyramidal symptoms were assessed with Barnes Akathisia Rating Scale and Abnormal Involuntary Movement Scale.

Results

Important improvement of OAS-M total score was observed from the second day of treatment. After 4 weeks, more than a half of the patients presented a decrease of YMRS score with more than 50%. The CGI score also significantly improved. The treatment was well tolerated, mild to moderated adverse reactions being registered, without extrapyramidal symptoms.

Conclusions

These results confirm that Quetiapine XR is an effective and safe treatment for patients with an acute relapse of bipolar disorder I, the rapid titration scheme of the doses leading to a good control of aggressive behavior.

Markers of vulnerability in schizophrenia

Vulnerability in schizophrenia is an integrative concept, which tries to explain the development of schizophrenia as an interaction between different individual susceptibility factors and environmental risk factors. Vulnerability markers used in genetic studies include biochemical indicators, neuroanatomical, neurophysiologic, and cognitive abnormalities. Among those, the most extensive studied markers were: evoked potentials, smooth pursuit eye movements, and attentional deficits. Some of the potential indicators presented in this paper satisfy most of the criteria necessary for a vulnerability marker, but none meets all of them. Nevertheless, they represent important markers of risk to schizophrenia.