I. Coppola

A case of marchiafava bignami disease with frontal cortex involvement and late onset, long-lasting psychiatric symptoms

Aims To describe the case and management of a patient with marchiafava bignami disease (MBD) with frontal cortical lesions, no specific symptoms at first referral to the emergency room, and late onset of atypical psychiatric symptoms. Methods We report the case of a 44-year-old patient with a history of chronic alcohol abuse, eventually diagnosed with MBD. Results Magnetic resonance showed lesions in the splenium and in the body of corpus callosum and bilateral lesions of the frontal cortex. The patient showed late-onset atypical psychiatric symptoms, which were drug resistant. Conclusions The case we describe seems to support the existing few ones describing cortical involvement in MBD, which suggest that this is associated with a poorer prognosis. Psychiatric symptoms may be challenging to treat because of drug resistance. The involvement of psychiatrists together with neurologists and radiologists, with a consultation–liaison approach has proved important for the achievement of diagnosis and of the most appropriate management and treatment for this patient.

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. 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

Asenapine Effects On Peroxidation and Calcium Movements in HL-1 Cells

Introduction Bipolar patients are at higher risk for cardiovascular morbidity and mortality than their counterparts in the general population. In a recent in vitro study, Asenapine, a new antipsychotic for the treatment of mania/mixed mania, was found to keep physiological endothelial function by activation of eNOS-related NO release and to protect endothelial cells against peroxidation by interference with mitochondria, apoptosis and cell survival. Objective To examine the cardiac protective effects elicited by Asenapine against peroxidation and on the Ca2+ movements. Methods In HL-1 that had undergone oxidative stress by 20 min hydrogen peroxide the effects of 30 min pre-treatment with Asenapine on survival and proliferation will be examined. In Fura-2AM loaded HL-1 we will next analyze the effects of Asenapine on Ca2+ movements and the related involvement of cAMP/PKA and PLC pathways, CaMKII, L and T type Ca2+ channels and 5HT1A receptors. The role of ‘capacitative” Ca2+ entry, plasma-membrane Ca2+ pump inhibitor (PMCA) and Na+/Ca2+ exchanger will be analyzed. Changes of membrane potential caused by interference with K+ channels will be examined, as well. Results We expect to find a proliferative and anti-peroxidative effect of Asenapine in HL-1 cells. Asenapine could also affect Ca2+ movements through cAMP/PKA and PLC-dependent signalling and the involvement of 5HT1A receptors. The effects of Asenapine could also be related to changes of plasma membrane by interference with K+ channels and the modulation of PMCA activity and Na+/Ca2+ exchanger. Conclusions We expect to further confirm the protective effect of Asenapine against peroxidative injuries. Implications will be discussed

Asenapine in Clinical Practice: Responders Vs Non-responders

Introduction Asenapine is a second-generation antipsychotic approved in Europe for the treatment of manic or mixed episodes. Objective To describe the clinical features of Asenapine responders and non-responders. Methods A naturalistic, observational study is ongoing in patients treated with Asenapine. We have already recruited 37 manic patients with a lifetime diagnosis of Bipolar I (BDI) or Schizoaffective Disorder referring to our Psychiatric Ward. Patients are assessed with the Young Mania Rating Scale (YMRS) at baseline (T0), and after 1 (T1) and 4 weeks (T2) of treatment. According to YMRS scores, patients are classified as responders and non-responders. Results The preliminary results highlight a significant improvement of the YMRS score from T0 to T2 in most patients. Asenapine seems particularly effective in patients with less severe manic symptoms, and responders are more likely to have lower baseline YMRS score. No correlation has currently emerged between responder status and diagnosis. Non-responders in our sample are females sharing some clinical features: early onset BDI diagnosis, several previous treatments (antipsychotics, mood stabilizers), initial cognitive impairment confirmed with the Mini Mental State Examination, Alzheimer Disease Assessment Scale and neuroimaging. Conclusions Elderly manic patients with neurological impairment and/or dementia may have poorer therapeutic outcomes and poorer response to pharmacological treatment, which may prove effective in reducing agitation but not mania ratings. Diagnosis (BDI or schizoaffective disorder) does not seem to have a significant impact on Asenapine efficacy. The further recruitment and assessment of patients is expected to support the results described above.

EPA-0757 – Predictors of suicidal behaviours: analysis of four years of emergency room psychiatric consultation

Purpose The annual global suicide mortality rate is 16 per 100,000 and suicide attempts are 20 times more frequent. We aimed at comparing patients referring to the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, in order to assess possible predictors of self-injury. Methods Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2011 at the ‘Maggiore’ Hospital in Novara. A multivariate analysis was performed using a logistic regression in order to assess the potential predictors of self-injury behaviors. Results are expressed as Odds Ratio (OR) with 95% Confidence Intervals (95%CI). Statistical significance was set at p≤0.05. Results In a sample of 1888 psychiatric consultations, 280 (14.8%) were due to self-inflicted injuries . Female gender (OR: 1.51; p=0.005) was found to positively correlate with attempted suicides, whereas unemployment (OR: 0.68; p=0.013) and being in the colder months of the year (OR: 0.75; p=0.043) were found to be negative correlated. A positive trend without statistical significance was observed for foreign nationality, being not married and living with parents/own family vs a negative trend was found for history of psychiatric disorders. Conclusions In accordance with other studies, we observed the female gender positively correlates with attempted suicides and sunlight may act as a trigger. In contrast with literature, individuals with a permanent job would be at higher risk of self-injury behaviours, whereas having a history of psychiatric disorders and being under the care of a psychiatrist might be a protective predictor.

EPA-0704 – Migrant pathway to community mental health center of borgomanero

Background International literature indicates that migrants have highest incidence of mental disorders compared to natives, especially for psychotic disorders. Few studies about mental health of migrants in Italy have been published, although net migration rate grew in the last twenty years. Aims to describe socio-demographic and clinical characteristics of migrants attending Community Mental Health Centre (CMHCs) of Borgomanero (Piedmont, Italy) and to evaluate differences in psychiatric diagnoses and pathway to care among different ethnic groups. Methods Migrants attending CMHCs between 1st January 2012 and 31 August 2013 were included in the study. Data were gathered retrospectively from clinical data sets. Results 97 Migrants attended the CMHCs. The most represented ethnicity is East European (36%), the less one is Asian (4%). Most frequent diagnosis is adjustment disorder (33%). In most cases, access to the service follows the family doctors referral (46%), except for patients with schizophrenia, whose access is most frequently direct (they are usually brought to the service by family members) (33%). The majority of those migrating for working reasons suffers from adjustment disorder, schizophrenia or anxiety. Pathway to care and diagnosis seem to be statistically related (p-value 0,00052), as well as migration reason and diagnosis (p-value 0,0452). Lack of regular residence permit seems to be related to non-medical pathways. Conclusions Pathways to CHMCs are complex and influenced by many factors. Most of the sample received a diagnosis of adjustment reaction. More attention should be paid to developing psychiatric consultation liaison models that encompass the physician and social services.