A. Feggi

P02-144 - Subjective well-being under neuroleptics (SWN): a predictor of clinical and psychosocial outcome in acute patients. preliminary data

Objectives To evaluate the subjective well-being of a group of patients who were hospitalized at the Institute of Psychiatry (Novara), compared to the severity of illness. Methods Patients are evaluated at admission and discharge through self-administration of the SWN (Subjective Well-being under Neuroleptics) scale, which contains five subscales (emotional regulation; self-control; mental functioning; social integration and physical functioning) assessing patients’ psychophysical and emotional well-being, calculating a value for each subscale and a total score. The clinician fills in the CGI (Clinical Global Impression) for each patient, which provides a global judgement in three areas: severity of illness, global improvement and therapeutic effectiveness. Results From June 2009, 51 patients were evaluated at admission and discharge: 26 diagnosed with psychosis and 25 diagnosed with personality disorders. Preliminary data suggest a meaningful improvement of the physical functioning in the psychotic group, a tendency to improvement of the social integration area in the personality disorders group. Among the psychotic group, the schizophrenic patients (n°=14) have shown an improvement in the self-control subscale. Conclusions Literature suggests that a high SWN score is associated with a better compliance and an early improvement of subjective well-being is a major predictor of the chance of remission. This study will allow to compare the subjective well-being evaluated by SWN with the clinical judgment of the CGI and above all if this can represent a predictor index for the compliance and the chance of remission.

Empathy and Social Cognition: a Comparison of Schizophrenic Patients and Healthy Controls

Introduction Patients affected by schizophrenia have deficits in social cognition, functioning and in properly interpreting facial expression. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian-Network-of-Research-on-Psychosis, headed by Mario Maj and Silvana Galderisi, in our centre;collection went on also after the conclusion of the national project. Aims To compare social inference and facial emotion identification in schizophrenic patients and healthy controls. Material and Methods We recruited 50 patients with Schizophrenia and 50 healthy controls (HCs) matched for sex, age and level of education. Socio-demographic characteristics were gathered;assessment of both patients and HCs included The Awareness of Social Inference Test (TASIT) and the Facial Emotion Identification Test (FEIT);furthermore patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). Results Some differences in socio-demographic variables emerged (patients are more often unemployed and single). Moreover, the preliminary analyses highlight several differences between schizophrenic patients and HCs at TASIT and FEIT:patients performed significantly worse than HCs in both tests, with longer reaction times. Discussion As expected schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. Our preliminary results point out disabilities in understanding social messages and interpreting human behaviour;these features underlie poor and limited social relationships proper to schizophrenia.n 1 Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia;WorldPsychiatry2014,13(3):275-287 2 Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community Schizophr Res.2014Oct;159(1):144-50

Editorial Group: a Long-term Rehabilitation Approach Developed at SC Psichiatria, Maggiore Della Carita Hospital in Novara.

Introduction Our Psychiatry Ward offers several group activities to both inpatients and outpatients. Among these, the Editorial Group involves only outpatients (who had been previously admitted to the Psychiatry Ward as inpatients) in fair psychopathological compensation, carefully selected for this long-term rehabilitation approach. Aims To describe the Editorial Group activity. Methods The Editorial Group meets once a week at the Psychiatry Ward. It involves patients, nurses and a group leader who is a Psychiatrist. The psychiatrists and nurses role is to facilitate the group process and the exploration of the topics discussed. Members are encouraged to discuss their opinions about tales, movies and books; to share poems, paintings, photographs. The aim of this process is to eventually develop a Ward magazine which is published quarterly. Results Members commitment is extended beyond the weekly meeting hour of the group; indeed, we have observed that patients in their free time spontaneously decide to spend time collecting material to share and drawing up the articles, which are assigned according to patients aptitudes and preferences. A continued commitment to share daily life experiences and to express creativity, helps patients get involved in the Group, and eventually leads to something concrete and valuable to share with others, also beyond the Group. Both the leader and the other equipe members help patients listening to each others opinions, ideas and personal experiences. Conclusions The Editorial Group helps patients improving emotional and relational skills, and stimulates cognitive resources. Moreover, it enhances creativity, promotes collaboration and stimulates curiosity.

Feeling Through the Body: Alexithymia and Eating Disorders

Introduction Alexithymia is characterized by difficulties identifying and communicating feelings, and problems differentiating between feelings and bodily sensations; its concrete cognitive style focused on the external environment is typical of psychosomatic patients. Patients with eating disorders (EDs) have high levels of alexithymia, particularly difficulties identifying and describing their feelings. Objective The aims of our study are (1) to assess the alexythimia, emotional empathy, facial emotion identification skills and social inference abilities in a sample of ED patients; (2) to compare these variables between ED patients and healthy controls (HC); and (3) to correlate levels of alexithymia with the severity of the ED as measured by the Eating Disorder Inventory-3 (EDI-3) EDRC score in the ED group. Methods ED (N=42) and HC (N=42) were tested with the Toronto Alexithymia Scale (TAS-20), Eating Disorder Inventory (EDI-3), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT) and Interpersonal Reactivity Index (IRI). Results Data collection is being completed and the results’ analysis is ongoing. We expect the ED sample to show greater alexythimia and a poorer performance at FEIT and TASIT than HCs. We expect to find a linear correlation between the TAS-20 and EDRC score. Conclusion A better understanding of the role of alexithymia in ED etiology and maintenance might allow the development of targeted treatment approaches to help patients improve their skills in identifying and expressing emotions.

EPA-0777 – Alexithymia, facial emotion identification and social inference in ed patients: a case-control study

Introduction Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions. Objectives To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age. Aims To describe a specific pattern of emotional dysregulation in ED patients. Methods ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP). All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20). Results The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples. Conclusions Clinical implications will be discussed.

EPA-0722 – The effectiveness of a new approach using movies in the training of medical students.

Introduction According to Torres approach, dynamic images from movies may help to reflect on empathy-related issues, to develop a compassionate approach to patients and their sufferance, and to enhance awareness about stigmatizing attitudes. Since its development this method has been used by the Psychiatric Institute of the Universita del Piemonte Orientale Amedeo Avogadro, Novara, for the education and training of medical students and, broadly speaking, of people involved in helping professions. Aims To describe the preliminary results about the impact of this intervention in a sample of medical students. Methods cinemeducation seminars lasted 6 months, and included 12 meetings. Movies were discussed from a psychological perspective in a group setting and experiences were integrated with the help of the group-leader. Data were collected anonymously via self-report questionnaires from 40 randomly selected participants. Assessment scales (Attitudes Towards Psychiatry, ATP-30; Social Distance Scale, SDS; Interpersonal Reactivity Index, IRI; Rosenberg Self-Esteem Scale, RSES; Toronto Alexithymia Scale, TAS) were administered both before and after the workshops. Results a significant increase was found in the ATP-30 score (pxa0=xa0.034), and a reduction of the SDS (pxa0=xa0.022) and IRI-PD (pxa0=xa0.010) scores. Conclusions although these results are preliminary, an improvement in students’ attitudes towards psychiatry was found, together with an increased ability of students to tolerate their own anxiety when experiencing others’ distress. This approach to movies allows developing both cognitive and emotional knowledge, which should be considered particularly important in medical education.

1693 – A pilot project of cinemeducation for medical students: focus on psychiatry, stigma, and empathy

Introduction Stigma on psychiatric patients is frequent not only among common people but also in healthcare professionals. Cinema might be useful tool for medical educational purposes and might help reduce negative attitudes towards mental illness. Objectives In the first place, to develop a pilot project of cinemeducation aimed at enhancing awareness and thinking over about psychiatry and stigma in medical students; secondly, to investigate students’ stigmatizing attitudes, empathy, personality and self-esteem and the impact of the cinemeducation intervention on some of these variables. Methods From October 2012 to January 2013, students will attend six cinemeducation lectures focused on helping relationships. Sociodemographic data will be collected at baseline only, and so will the Temperament and Character Inventory. In order to investigate attitudes towards psychiatry, self-esteem, alexithtymia and empathy, students will be asked to fill in some self-administered scales, both at baseline and at the end of the six lectures. These scales will include: Attitudes Towards Psychiatry Scale, Social Distance Scale, Dangerousness Scale, Mental Illness: Clinicians’ Attitudes Scale, Interpersonal Reactivity Index, Rosenberg Self-Esteem Scale, Toronto Alexithymia Scale. Results/conclusions The correlation among the variables assessed will be investigated in order to understand whether certain personality traits, self-esteem and empathic attitude influence students’ beliefs about psychiatry. The impact of the cinemeducation lectures on stigmatizing attitudes will be investigated as well.

P03-129 - Atypical neuroleptics and glucose metabolism: A study project

Introduction Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with mental illness. Atypical antipsychotics are more associated with obesity, metabolic syndrome, abnormal glucose and lipid metabolism than first generation antipsychotics. Objectives To identify risk factors related to glucose metabolism in short, medium and long time treatment and find out which are related to neuroleptic therapy and which depends on genetic background and lifestyle. To follow up clinical and self-rated variations of the psychiatric symptoms. Methods We included psychotic or bipolar patients in treatment with only one typical (haloperidol) or atypical (clozapine, olanzapine, risperidon, aripiprazole, paliperidon) neuroleptic, drug-naive or after a wash-out from previous therapy. Patients will be evaluated five times (at baseline and after 1, 3, 6, 12 months) with a blood sample (haemocrome, glucose, insulin, Hb A1C, thyroid hormones, liver and pancreatic function), BMI, Basal Metabolic Rate (BMR), OGTT, HOMA index, familiar and pharmacological history, SIDE and CGI. Results From blood exams and OGTT we will obtain data regarding variations of glucose metabolism and the possible relationship with neuroleptic medications. From SIDE questionnaire we will assess the impact of side-effects by the patients perspective and with CGI the variations of symptom severity. Conclusions Our study will allow us to identify risk factors concerning glucose metabolism alterations related to antipsychotic medications.

P01-585 - Dual diagnosis (DD) at first admission (FA) in three different periods: An epidemiological study

Introduction DD represents a common issue in clinical practice, with relevant effects on symptoms, course and treatment of disease. Its often associated with negative outcome as a greater severity of symptoms and resistance to drug treatment. Objectives To assess how the characteristics (sociodemographic, clinical and related to substance abuse) of patients discharged with DD have changed taking into account the FA occurred in three different five-year periods (1990–1994, 2000–2004, 2005–2009). We also compared the characteristics of patients discharged with only psychiatric diagnosis with those of patients with DD to look for possible risk factors for abuse among people with psychiatric illness. Methods We conducted a retrospective study of medical records of patients at FA to our Institute in three different periods. We divided the patients discharged with DD from those discharged with only psychiatric diagnosis. Results Among the FA occurred in the periods examined we noticed an increase of DD cases (12% from 1990 to 1994, 21% 2000–2004, 28% 2005–2009). The incidence of each diagnosis was changed in several years, but each time the diseases more represented remain schizophrenic or affective psychosis and personality disorders. Alcohol is the most widely used psychotropic drug in each period. There is also a progressive increase in the abuse of cannabis, cocaine and in the incidence of multi-drug abusers. Compared with patients discharged with only a psychiatric diagnosis, patients with DD were more frequently:male, younger, unmarried, unemployed, with legal issues, grown up in a family with serious problems, and history of etero-aggressive episodes. Conclusions Due to continued increase in cases of DD, we want to highlight the importance of early identification of cases of comorbidity in order to provide adequate treatment and support.

P03-50 - Creutzfeldt-jacob disease with psychiatric presentation (CJD) : A case report

Introduction CJD is a neurodegenerative disease with a rapid onset characterized by progressive dementia, myoclonus and also cerebellar, pyramidal and extrapyramidal signs. It is caused by an increased loss of neurons due to the abnormal conformation of a membrane protein. Case report A 69 year-old woman was admitted to Psychiatry with a clinical picture characterized by psychomotor agitation, disorientation, confusion, confabulation, false ricognition, circumstantiality, perseveration, logorrhea and dysphoria. She presented no alterations of sense-perception. Her psychiatric history was silent. The neurological examination showed no focal neurological deficits and the first EEG was nonspecific. She became progressively more confused, with subsequent drowsiness with psychomotor agitation, aimless buste, disorganization and visual hallucinations. She started treatment with quetiapine (200xa0mg/die) and lorazepam (4xa0mg/die) without benefit. The second EEG was characterized by triphasic waves with diffuse projection. MRI angiography revealed the presence of diffuse cortical ribbon hyperintensity of gray matter. CSF examination showed positivity of 14/3/3 protein and a TAU protein value greater than 16000xa0pq/ml allowing diagnosis of CJD. Conclusions We emphasize the importance of a correct differential diagnosis in patients with psychiatric symptoms and rapidly progressive dementia unresponsive to therapy.