50 war time cases of criminal homicide and 50 peacetime criminal cases were compared by using Hi square test, Fisher's exact test, Mantel Haenszel test.

The difference in presence of homicide depending on seasonal appearance between war and peacetime varied up to the level of p<0.005. During the winter period 38% of homicide were committed while in summer time mostly 32% homicide were committed. In the peacetime period of 8 years taken as a test (1984-1992) no homicide was committed during the month of August.

During the war the occurance of homicides was balanced in each week day while during the peacetime most homicides took place during the week-end. (p=0.0056). In regard to the period of the day when the homicide was committed, wartime homicides occurred mostly between 11 a.m. and 5 p.m, while during the peacetime they ocurred between 5 p.m. and 11 p.m. (p<0.05). Statistically, there are no significant differences between the two causes pertaining to the psychiatric diagnosis set for those who commit homicide.

In both cases homicides are disturbed persons (II axle), then normal people, i.e. people "without diagnoses" and two categories that represent the majority of 78% in war and 86% in peace. Among homicide with diagnosis in axle I in both samples syndromes that are equally represented are: alchochol dependency, chronical brain syndrome, mental retardation, paranoic psychosis, schizophrenia, epilepsy.

Forensic- psychiatric evaluation of mental soundness is almost identical regarding categories of mentally sound and mentally non sound persons. During the war period the number of the accountable was rather reduced while during the peacetime the number of the accountable was reduced but not significantly.

Aripiprazole is a dopamine partial agonist with a low risk of movement disorder and metabolic adverse effects.

We identified 228 patients consecutively prescribed aripiprazole in our unit and established outcome (continuation with treatment) six months after initiation.

The study cohort consisted of subjects of mean age 36.2 years (17-86) of whom 53.1% were male. Two thirds had a diagnosis of schizophrenia. Overall, 112 (49%) patients completed 6 months' treatment. Reasons for discontinuation were adverse events (n = 61, 53% of those who stopped), lack of effectiveness (n = 45, 39%) and a variety of unconnected reasons (n = 10, 9%). The majority of discontinuations (n = 76, 66%) occurred in the first 60 days of treatment, largely because of adverse effects. Most common adverse events reported were anxiety/agitation (n = 57, 25% of total cohort), insomnia (n = 43, 19%) and movement disorder (n = 24, 11%).

Treatment discontinuation was more likely for in-patients than out-patients (61% vs 42%, p = 0.005) and in those previously prescribed clozapine (p = 0.01). Modal initiation dose was 15mg for patients starting in the first year of the study and 10mg for those starting later. Initiation dose was not associated with outcome.

Aripiprazole showed a degree of effectiveness similar to that shown by other antipsychotics. Early-appearing, trivial adverse events are a major factor in treatment discontinuation. Outcome is best in out-patients and those not formerly treated with clozapine.

The Psychic condition was valued on scale PSE (Present State Examination). 73 patients were examined, passable stationary forensic psychiatric expert operation in The State scientific centre on social and forensic psychiatry to him.V.P.Serbsky, which was installed diagnosis: "Personality disorders". Patients were divided into 3 groups: 1st - incompetent to proceeded (13 persons), 2d - patients, in respect of which is recommended obligatory participation of the attorney in criminal proceedings (36 persons), 3d - competent to proceeded (24 persons).

For revealing factor, influencing upon active participation of defendants in process of protection of their own rights and on entry of the decision on competence to proceed, in all three groups were chose most active in proceeding patients. In process of the called on study beside all patients 1st group of the breach of the thinking existed in psychic condition in the manner of unproductive nesses, circumstantial, absorption on established psychological damage situations, development paranoid ideas or delirium, breach of the volitional checking the behavior, presence of the impulsive forms of the reaction on established situation, uncontrolled persistence in achievement their own integer, breaches of the critical abilities. Their proceeding activity was pathological motivated, not coordinated with attorney and did not bring the result. The Majority the most active patients 2d group was legally literate, agreed the line of protection with attorney, and checked their activity. In ditto time all examined, him were inherent such larval line, as activity and persistence in realization of the significant installation and in achievement desired integer in combination with a certain reassessment of their own possibilities, insufficient volitional checking of its behavior in combination with critical estimation of the situations. In this instance attorney only helped full-fledged and qualitative to protect the right and legal interests its client. Proceeding activity of patients 3d group depended on larval features, such, as striving for action, persistence in achievement their own integer, aptitude to manipulate surrounding, and was more effective.

The Active participation of the patients with personality disorders with frustration in process of protection of their own rights and legal interest was conditioned paranoiac development to personalities or sharpening in established proceeding such characteristic features, as striving for action, persistence in realization their own integer.

To evaluate the clinical and economic outcomes of treatment with Risperidone Long-Acting Injection (RLAI) in Czech Republic patients.

The electronic -Schizophrenia Treatment Adherence Registry (e-STAR), is a secure web-based, international, observational study of patients with schizophrenia who have been initiated with RLAI. Data are collected both retrospectively and prospectively and include hospitalisations and reasons for treatment initiation and discontinuation; patients are evaluated using the Clinical Global Impression Severity Scale (CGI-S) and Global Assessment of Functioning Scale (GAF).

After 6-months 107 patients (65,4% men) with diagnosis of schizophrenia (76,6%) or schizoaffective disorder (23,4%) were eligible for analysis. The most common reason for switching to RLAI were poor compliance (43,9%) and insufficient response to previous medication (34,6%). At 6-months, 95,3% of patients were still on RLAI treatment. 89,7% of patients were given 25mg of RLAI at baseline and at 6-months 73,5% were still on 25mg. Compared to the 6-month retrospective period, significant decreases were seen in the average length of stay in hospital (21,1 to 5,3 days, p<0,001) and the number of hospitalizations per patient (0,41 to 0,21, p<0,001). Compared to baseline, significant decreases were seen in the occurrence of suicidal ideation (19,2% to 1,9%, p<0,001) and violent behaviour (14,4% to 2,9%, p=0,003). There were significant changes in the average CGI-S score (5,13 to 3,43, p<0,001) and GAF score (47,2 to 64,5, p<0,001) from baseline.

Based on 6-month interim results, treatment with RLAI resulted in significant improvements in disease severity and functioning in patients with schizophrenia.

The AMSP-Project is a prospective multicenter program for continuous assessment of adverse drug reactions of marketed psychotropic drugs in psychiatric inpatients under naturalistic conditions of routine clinical treatment. It corresponds to a dynamic cohort study and currently about 55 German, Swiss and Austrian hospitals are participating, monitoring approximately 30,000 inpatients per year.

to measure the incidence and relative risk ratios of weight gain in association with psychotropic treatment.

All cases of severe weight gain over 10% of initial body weight between the years 2001 through 2005 were reviewed and causality assessment discussed at (inter-)national meetings. Incidence was calculated by number of patients under treatment and relative risks were calculated between the individual treatment regimens.

The risk of severe weight gain is highest under treatment with olanzapine, being responsible for > 40% of the total cases while only 15% of the cohort is treated with olanzapine. The relative risk of olanzapine cases versus the total number of cases was 12 (CI 6.86 – 22.03), taking only those cases into account where only one compound was judged to be responsible (in some cases, drug combinations are imputed.

The AMSP project is a valuable tool in detecting and confirming ADR in a psychiatric hospital setting. The pros and cons of the project are equal to intensive spontaneous monitoring systems. The incidence and relative risk of weight gain is established for psychotropic treatment.

The well known benefits of treatment should be carefully balanced with the problems of weight gain.

Although the mechanisms explaining metabolic impairments observed during antipsychotic treatment are not well known, there are important differences between drugs regarding the possibility of inducing lipidic and glucose impairments.

To assess the effects of atypical and typical antipsychotics -olanzapine, aripiprazole, risperidone and haloperidol over the weight, glucose and HDL-cholesterol levels, during 24 weeks of treatment.

A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N=12) 10-20 mg/day, aripiprazole (N=11) 15-30 mg/day, risperidone (N=10) 4-8 mg/day or haloperidol (N=10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity.

Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients.

There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.

To investigate patients double diagnosed with psychosis and substance addiction (especially cannabis) treated with risperidone long-acting injectable (RLAI) for their psychosis: characteristics of treatment and psychosocial reintegration.

Adults with psychosis were changed to RLAI from their previous medication. Starting doses varied but most patients received 50 mg every two weeks. Patients were regularly followed-up by their psychiatrist from 6 months to more than 2 years after starting treatment with RLAI. A reintegration program adapted to the needs of each patient was started as early as possible with support from all available healthcare services of the department. This program focussed on family, social and professional reintegration.

Of 60 psychotic patients, 27 patients (mean age 27.7±6.1 years) had a double diagnosis of psychosis and substance addiction (especially cannabis), and were enrolled in this follow-up study. After six months, 26 out of 27 patients had no relapse of substance addiction. Patients participating in the reintegration program were able to live with their family or at home (10 patients), undertake professional education courses (7 patients), or even return to their jobs (3 patients).

Treatment with RLAI has a positive effect on patients double diagnosed with psychosis and substance addiction (especially cannabis). The association with a reintegration program adapted to the needs of each patient must be started early and maintained for as long as possible in order to have a good clinical outcome, positive impact on the addiction, improve compliance with treatment, and diminish the risk of relapse.

Rhabdomyolysis is a common and potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. The authors report on a case of rhabdomyolysis in a 46-year-old patient with the diagnosis of schizophrenia paranoid type.

The patient was admitted with the symptoms of generalized seizure and vomiting; and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. On the fifth day of his treatment muscle pain and asthenia occurred and creatinine kinase concentration increased to 52090 U/L without any symptoms of neuroleptic malignant syndrome. The course of illness was benignant, clozapine was stopped and during high-volume alkaline diuresis creatinine kinase concentration gradually returned to a normal range. After 6 months follow-up no recurrence of rhabdomyolysis was detected during olanzapine treatment; clinical and laboratory findings were normal.

Rhabdomyolysis was associated with the rapid correction of hyponatremia after water intoxication caused by psychogenic polydipsia and was complicated by clozapine use.

The authors suggest that monitoring creatinine kinase is not necessary routinely by antipsychotic administration, but point at the importance of cautious correction of hyponatremia and of creatinine kinase monitoring beside atypical antipsychotic therapy when patients complain about muscular symptoms and suggest that switch to another atypical antipsychotic after an atypical antipsychotic induced rhabdomyolysis can be a cautious clinical strategy.

Organization of psychiatric services, availability of programs of care and different approaches to treatment influence actual clinical outcome. Psychiatric hospitals usually consist of different wards nad units, to and from which patients are directed inside an episode of inpatient treatment. The aim of the study was to get insight into actual movements of patients betweeen different wards in a large University Psychiatric Hospital and relate these data to clinical outcome.

Hospital database was used as a source of data on patient movements and episodes of hospitalization. 2053 patient records were reviewed for clinical outcome data. Patients with three or more movements were diagnostically rechecked prospectivelly for the purpose of this study using ICD-10 research criteria. Appropriatness of treatment choice was assessed using patient treatment records.

1275 hospitalization episodes were reviewed. 35% of patients were moved between the wards three or more times. Within this group diagnostic discordance was noticed, that influenced changes in the treatment choice after each ward change.

Discordance in diagnostic and treatment choices within same hospital but different wards influenced significantly the course of hospitalization as well as outcome of clinical presentations.

Setting: Two 16-bed inpatient units. Mean length of stay for patients: 10 days. Twenty-four members of the staff responded twice to an interview on cigarettes role in the psychiatric setting, two months before smoking ban implementation, and 3 month after the implementation. Participants' attitudes with regard to the role of cigarettes in the psychiatric setting were investigated.

GLM models with repeated measures revealed that a general progression towards more restrictive attitudes was observed for both smokers and non-smokers. Non-smokers and ex-smokers, who, as could be expected, had in general more prohibitive attitudes than smokers, showed also a larger progression for most items toward more negative attitudes regarding cigarettes role in the treatment setting.

The implementation of a smoking ban reinforced the negative attitudes of non-smoking staff towards cigarettes role in the psychiatric setting, while smokers maintained their attitudes until 3 month after the implementation.

Elevation of serum cortisol is found in many patients with major depressive disorder (MDD) and may be due to a chronic dysfunction in the feedback regulation in the Hypothalamic-Pituitary-Adrenal axis. Saliva cortisol is a valid indicator of serum cortisol. The predictive value of saliva cortisol for remission of depressive symptomatology was investigated.

Saliva cortisol was measured in a sub-sample (N=19) with unipolar MDD according to DSM-IV. Mean score on the Montgomery Aasberg Depression Rating Scale (MADRS) was 26.8 (standard deviation 3.7, range 22-32). At follow-up, two years later, mean MADRS was 13.6 (SD 10.7, range 0-37). In a linear regression model, saliva cortisol at baseline was entered as independent variable and MADRS-score at follow-up as dependent variable.

A significant correlation between the level of saliva cortisol at baseline and MADRS-score at follow-up was found (R=0.33, P=0.036). After adjustment for MADRS at baseline, the level of saliva cortisol explained 21% of the variance in MADRS at follow-up (P=0.018). After further adjustment for age, gender, and use of antidepressant medication, the model still produced significant results (R2=0.50, P=0.026).

Higher level of saliva cortisol is predictive of less improvement in depressive symptomatology over time in unipolar MDD. This finding is in line with a model in which higher secretion of cortisol is associated with a more chronic course in depression. It underlines the importance of biological correlates as predictors of outcome in psychiatric disorders.

We examined the efficacy and safety of flexibly-dosed olanzapine for the treatment of borderline personality disorder (BPD).

In this 12-week double-blind trial, patients 18-65 years of age with a diagnosis of DSM-IV BPD received olanzapine (2.5-20mg/day; N=155) or placebo (N=159). The primary efficacy measure was the change from baseline to last-observation carried forward endpoint (LOCF) on the Zanarini Rating Scale for BPD (ZAN-BPD) total score. Rate of response and time to response were also examined, with response defined as a >=50% reduction in ZAN-BPD total score.

Mean baseline ZAN-BPD total scores were indicative of moderate symptom severity (olanzapine 17.01 vs. placebo 17.70, p=0.156). Both treatment groups showed significant improvements in overall symptom severity, based on mean changes from baseline to LOCF endpoint in ZAN-BPD total score, but did not differ in the magnitude of improvement at endpoint (olanzapine -6.56 vs. placebo -6.25, p=.661). Response rates did not differ between treatment groups (olanzapine 64.7% vs. placebo 53.5%, p=.062); however, time to response was significantly shorter for the olanzapine treatment group (p=.022). Treatment-emergent adverse events reported significantly more frequently among olanzapine-treated patients included somnolence, sedation, increased appetite and weight increase. Mean weight change from baseline to endpoint was significantly different for olanzapine- relative to placebo-treated patients (2.86vs. -0.35kg, p<.001).

Both the olanzapine- and placebo-treated patients showed significant but not statistically different improvement on overall symptoms of borderline personality disorder. The types of adverse events observed with olanzapine treatment were similar to those seen previously in adult populations.

We examined the efficacy and safety of low vs. moderate olanzapine doses for the treatment of borderline personality disorder (BPD) in the largest controlled clinical trial ever conducted in this population.

This 12-week, double-blind trial involved patients 18-65 years with a diagnosis of DSM-IV BPD randomized to receive 2.5mg/day olanzapine (N=150), 5-10mg/day olanzapine (N=148), or placebo (N=153). The primary efficacy measure was the change from baseline-to-endpoint (last-observation-carried-forward) on the Zanarini Rating Scale for BPD (ZAN-BPD) total score. Rate of response and time-to-response were also examined (response defined as a >=50% reduction in ZAN-BPD total score).

Mean baseline ZAN-BPD total scores ranged from 17.01 to 17.42, indicating moderate symptom severity. Treatment with OLZ5-10 was associated with significantly greater mean change from baseline-to-endpoint in ZAN-BPD total score than placebo (-8.50 vs. -6.79, p=.010). Response rates were significantly higher for OLZ5-10 (73.6%) than for OLZ2.5 (60.1%, p=.018) and placebo (57.8%, p=.006). Time-to-response was significantly shorter for OLZ5-10 than placebo (p=.028). Treatment-emergent adverse events seen more frequently in the olanzapine groups included somnolence, increased appetite, and weight gain. Mean weight change from baseline-to-endpoint was 2.09kg for OLZ 2.5, 3.17kg for OLZ5-10, and 0.02kg for placebo.

The results of this study suggest that moderate doses of olanzapine (5-10mg/day) are effective in the treatment of overall borderline psychopathology. Also, the types of adverse events observed with olanzapine treatment were similar to those seen previously in adult populations.

Personality disorders are common among patients seeking psychiatric care and often coexist with axis I disorders.

This study aimed to determine personality disorders types and their sociodemographic and clinical features in a Tunisian psychiatric population.

A descriptive study in psychiatric outpatient unit of the university hospital Farhat Hached (Sousse, Tunisia). All five years (January 2000 to December 2004) first time attendances to the unit were retrospectively examined in order to identify those with diagnosis of personality disorder (DSM-IV criteria).

148 cases were selected and assessed: sociodemographic features, medical history, personality disorder type and axis I comorbidity. Assessment was based on patients files.

Cluster B types were the most frequent (54,7%), followed by cluster C (21,6%) then cluster A (9,4%). 14,1% of patients had non specified type.

Mean age was 32,84 ± 10,87 years, with predominance of female gender (52,7%)and urban residency (47,7%. 40,5% of patients were married, 60,2% had high school education level or more and 59% had a regular job.

Family history of psychotic disorders was found in 15,5% and of depressive disorder in 10,8%. Personal suicide attempts were noticed in 13,5%.

85,1% of patients had at least one current axis I disorder. The most common were depressive disorders (42,3%), substances abuse (18,5%), anxiety disorders (11,5%) and somatoform disorder (4,6%).

Our findings show sociodemographic and clinical profile of personality disorders in a Tunisian clinical population.

Cluster B personality disorders are common and often correlated with higher rates of axis I comorbidity, increased severity and impaired outcome.

This study aimed to compare sociodemographic and clinical features of patients with cluster B personality disorders to those with cluster A and C.

All five years (January 2000 to December 2004) first time attendances to an outpatient psychiatric unit were retrospectively examined. 127 cases with diagnosis of personality disorders (DSM-IV criteria)were selected: Cluster B (n=81), cluster C (n=32) and cluster A (n=14). Comparaisons were performed for sociodemographic features, medical history and axis I comorbidity.

Patients with cluster B personality disorders were younger(p=0,001), had higher education level (p=0,01) and more regular jobs (p=0,01).

There was less family history of depressive (p=0,011) and anxiety disorders (p=0,021) and more personal history of alcohol abuse (p=0,001). No differences in axis I comorbidity rates were found. However, patients with cluster B personality types had more depressive disorders, addictive disorders and somatoform disorders than those with cluster C (p=0,017) and cluster A (p=0,001). Also, cluster B personality disorders were correlated to earlier onset of addictive disorders (p=0,037) and more frequent follow-up withdrawal (p=0,009).

Clusters B personality disorders were not correlated to higer axis I comorbity rate but to specific comorbid disorders and to follow-up withdrawal.

The assessment and diagnosis of personality disorders (PDs) has been of great interest to researchers and clinicians. PDs are related with poorer therapy outcomes and increased health service costs. Interviews are quite lengthy and require specialized training, leading to a very high cost of administration. An initial screening with good properties would eliminate the need for detailed assessment in most noncases. We reviewed papers that analyze screening instruments for PDs.

Medline, PsycINFO, and Academic Search Premier were computer-searched for relevant studies. The key words used were screen* and personality disorder*. The references of the obtained journal articles were also examined. Inclusion criterion was providing the necessary information to calculate hit rates and kappas related to gold standards interviews.

26 studies met inclusion criteria. Considerable variation in predictive ability existed among studies Hit rates ranged from 0.53 to 0.94. Kappas ranged from 0.20 to 0.89. Performed analyses showed differences between questionnaires and interviews.

We discuss different options according to the context of application, feasibility, number of items and psychometric properties.

Frequently it is relatively easy to establish prevalent clinical syndrome in treated patients, yet influence of personality is frequently neglected. Professional approach towards personality pathology might help to avoid misunderstandings and achieve better treatment results. This case presents 35-year-old woman, treated in different psychiatric hospitals 9 times in 5 years. She was diagnosed with several disorders (moderate or severe depressive episode with or without psychotic symptoms; anxious or mixed personality disorder; schizotypal disorder; schizoaffective disorder; harmful use of alcohol etc) and treated by many psychiatrists, psychotherapists using both medication (typical and atypical antipsychotics, tryciclic and other antidepressant drugs, including SSRI, SNRI, NDRI,NARI, SARI, NaSSA, anxiolytics, antimanic drugs) and psychotherapy. Treatment was unsuccessful and provoked helplessness, frustration, rage, hopelessness for the staff. Patient's behavior was demonstrative, manipulative, focused on communication with young male inpatients. She exhibited dramatization, exaggerated expression, continuous seeking for attention (often by inappropriate sexually provocative behavior), overwhelming separation anxiety when abandoned by love objects.

Description of treatment peculiarities of histrionic personality

Case analysis

During last hospitalization, the patient received a diagnosis of histrionic personality disorder at borderline personality organization level (identity diffusion, sufficient reality testing, primitive defenses). Treatment results were better after discontinuing medication.

This case description:

1. 1. Illustrates the powerful feelings of the staff during treatment of histrionic disorders.

2. 2. Reveals the amount of health care resources demanded for treatment of this type of patients (both material and immaterial) because of frequent hospitalizations, frequent shifting of diagnoses and treatment.

This study was aimed to depict some psychological features characteristic for children suffering from stomach pain.

Two projective tests “House – Tree - Person” and “Kinetic Family Drawing” were used. 60 children suffering from stomach pain were tested. The control group consisted of 30 basically healthy children.

Analysis of collected data has shown that unsociability, poverty of emotions, very high level of anxiety are characteristic for children suffering from stomach pain. Ill children show high level of insecurity, hostility and antagonism to the family. Also difficulties in communication, complicated family situation were characteristic for the group of sic children.

Electroconvulsive treatment (ECT) is an effective treatment option for patients with a major depressive disorder. Despite a lot of research efforts the exact mechanism of action of ECT is still not clear.

Nitric oxide (NO) is a gaseous compound, synthesized out of arginine with citrulline as concomitant product. In the endothelium NO production leads to vasodilatation and in the central nervous system it acts as neuromodulating agent. NO is increasingly thought to be related to neuropsychiatric disorders.

In 20 severely depressed, medication free patients, we measured the ratio of citrulline to arginine (Cit-Arg ratio) in plasma, before and after treatment with ECT. This ratio could be regarded as a reflection of the synthesis of NO.

The Cit-Arg ratio in the depressed patients was not different from healthy controls. After treatment a significant increase of the Cit-Arg ratio was found.

Treatment with ECT was associated with an increase of the synthesis of NO. The exact role of NO in the mechanism of action of ECT deserves further study.