Implicit memories like consumption habits and conditioned reactions to drug-related stimuli are operational in addiction and relapse. The affective startle paradigm is an attractive tool for the measurement of the incentive salience of drug-related cues. We tested whether the stronger appetitive valence of drug cues, shown in two recent startle studies in smokers, does persist after prolonged abstinence, and may thus contribute to relapse.

We examined the auditory startle reflex magnitude of mildly deprived (4-6 hours) heavy smokers (n = 24), former smokers (n = 16, mean abstinence interval 18 months), and non-smokers (n = 24) while they viewed smoking-related scenes or standardized unpleasant, neutral and pleasant control scenes from the International Affective Picture System.

As expected, non-smokers showed no appetitive reactions toward smoking-cues. In smokers, smoking-cues had both appetitive implicit (startle suppression) and explicit (ratings for valence and craving) motivational effects, resembling those of pleasant scenes and differing from neutral and unpleasant scenes. This effect was more pronounced in smokers who later relapsed after a smoking cessation program, and in smokers consuming less than 20 cigarettes per day. Former smokers, despite reporting no craving and negative reactions to smoking cues, still showed evidence of implicit appetitive valence of these cues.

Nicotine addiction results in automatic appetitive reactions to drug-cues, which does not vanish after prolonged abstinence and which may thus contribute to relapses. Heavy smoking may result in a progressive internalization of smoking habits and a decline in reactivity towards external smoking-associated cues.

Increasing research interest is focussing also on Quality of Life (QoL) in substance dependent individuals. QoL-assessments have been acknowledged as promising measurements in order to evaluate drug treatment programs.

A prospective, randomized, double-blind, double-dummy, cross-over study design was used in order to compare methadone and slow-release morphine maintenance on patients´ QoL. Sixty-four participants were randomized between two treatment groups receiving either slow-release morphine capsules for 7 weeks followed by methadone oral solution for another 7 weeks (group A), or vice versa (group B). At baseline, week 7 and week 14 QoL status was evaluated using the German version of the Lancashire Quality of Life Profile.

A significant time effect with respect to the domains: general state of health (0.018), mental health (p=0.001), general well-being (p<0.001), leisure time at home (p=0.032) and leisure time out of home (p=0.008). Our findings did not show any statistically significant differences between between the two treatment groups in any Quality of Life scores at week 7 and 14. At the end of study phase (week 14) group A showed significant increases in the domains general well-being (0.010), leisure time at home (p=0.014). Significant improvements for group B were assessed with regard to general well-being (p=0.003), mental health (p=0.003) and general state of health (p=0.017).

The development of treatment programs should focus also on the patients´ subjective perspective. According to our findings agonistic opioid maintenance treatment yields not only to treatment response but also to improvements in patients quality of life.

Many persons with mental disorders smoke cigarettes, while smoking contribute to more frequent occurrences of tobacco diseases, especially coronary heart disease, respiratory diseases and tumours. These diseases can be neglected because of the bad psychical condition of patients. Important are also interactions between nicotine and medicines taken by mentally handicapped persons. It seems very essential to recognize factors favourable smoking, so it can contribute to create effective programs for patients willing quit smoking. The research's aim was to characterize nicotine addiction among mentally ill persons.

The investigated group consisted of 104 smokers with diagnosed mental disorder (schizophrenia or depression disorders). The control group was established from 80 mentally healthy smokers.

In the research one used detailed interview, clinical research and following questionnaire methods: Fagerström Test for Nicotine Dependence, Schneider Test (the test of motivation for smoking cessation), the test of readiness to change (in the basis of the Transtheoretical Model of Behavioral Change, TTM)

Gained results indicate the higher degree of addiction and lower readiness to quit smoking among mentally ill in comparison to the control group. The research reveal negative correlation between the wish of quit smoking and the age of examined and intensification of symptoms of a disease.

The research showed the need of creation the specific programs of smoking cessation programs for mentally ill persons with particular consideration of the work on motivation to change, reduction depression syndromes and work on the improving live satisfaction.

12 consecutively admitted patients (age 14-15, 6 girls) were assessed regarding to sociodemographic characteristics, familial context, alcohol consumption history and preferred drink.

For all 12 patients, the beverage leading to the intoxication (3 cases of coma) was vodka, in two cases mixed with nonalcoholic drinks. Four patients lived in an unstable familial context (divorce, separation), and one patient was adopted.

While selling Vodka (and other spirits) to persons under 18 is illegal in Switzerland, it was the preferred beverage of adolescents admitted for alcohol intoxication to a Pediatric Emergency Unit, confirming data from other countries. One of the reasons vodka is the preferred alcohol in these patients may be that it has the less telltale odor of the common spirits.

Empirical research on defense mechanisms found a sound support for the relationship of these mechanisms to adaptation. Instruments exploring the defensive operations patients use to help themselves deal with emotional and difficult experiences might assist the psychiatrist in providing treatment.

This study examined the early change in Maladaptive Defense Style (MDS), the development of the Therapeutic Alliance, and the relationship between MDS and alliance, in a short psychodynamic intervention. Outpatients from a psychiatric clinic completed a four-session psychodynamic intervention (Gilliéron, 1989). Defenses were assessed with the Defense Style Questionnaire (DSQ-88) developed by Bond et al (1983). Alliance was measured with the Helping Alliance Questionnaire (Luborsky 2000).

Patients who began the intervention with a poor alliance but ended with a good alliance significantly decreased their use of maladaptive defenses over the course of therapy. Results showed that at the end of the intervention, MDS and alliance were related across all patients, and particularly across patients who developed a good alliance.

Our results suggest that the DSQ is sensitive to acute MDS changes. As a self report instrument it is a practical tool for clinical evaluation. Change in MDS found after such a brief treatment suggests that the psychiatrist's support and exploration may diffuse the sense of threat induced by the crisis and reduce the patient's maladaptive defense activation. This might help develop a psychiatrist-patient working collaboration, fostering their agreement on a treatment plan and its implementation.

We describe the transcultural working method of the Bologna Multiethnic Mental Health Centre (University of Bologna, Italy). The team is composed by psychiatrists, psychologists, anthropologists, social workers and cultural mediators. The main approach is psychotherapy by means of group setting, which is used as for counselling as for longer and more structured psychotherapy.

We carried out a chart review and clinician survey of social, clinical, and service use characteristics of all immigrant patients from 1999 through 2006. We also fulfilled the AMDP -SYSTEM (Manual for the Assessment and Documentation of Psychopathology) for all these patients.

A total of 135 clinic patients was followed up during this period. Most of these patients came from North Africa (32%) and Subsaharian Africa (25%) for financial purposes and 70% were in Italy for less than 10 years. More than ¼ are undocumented. One third of the patients were affected by adjustment disorders, an other third by psychotic disorders and the last third by depression or anxiety disorders. Group setting and helping relation have shown transcultural efficacy, especially during the first period after migration, on psychopathology and adjustment's abilities. This method was effective among every ethnic and diagnostic groups, except for cases in which cultural components, preceding migration, were responsible of suffering.

Starting from therapeutic efficacy of our model, we propose that immigrants psychological distress in Italy is mainly due to cultural shock and role identification loss.

To evaluate the immediate efficacy of a specific group therapy program in improving quality of life and adjustment to body changes due to fat redistribution (lipodistrophy syndrome) in HIV+ patients taking antiretroviral treatment.

The therapy program consisted of 12 weekly two-hour sessions following a structured cognitive-behavioral group psychotherapy program focused on development of coping strategies, including specific psychoeducational interventions in nutrition and physical exercises. Eight HIV-positive patients with generalized lipodistrophy (affecting face, button and extremities) who referred psychological impairment due to body changes participated in a group therapy. Repeated measures Friedman test was used to analyse changes on the modified version of the Dermatological Quality of Life Inventory (DQLI) administered at three time points: T1 (one month before therapy), T2 (first session), and T3 (last session) Results: All participants (six women, and two men) completed the therapy program. A significant improvement was observed during the intervention time (between T2 and T3). No changes were observed during baseline (between T1 and T2). Issues raised by group participants were problems with dressing, fear of stigmatization, social isolation, and difficulties in sexual relations.

Preliminary data show that our psychotherapy program improves quality of life and psychological adjustment to lipodistrophy body changes in HIV infected patients. Further groups should be performed to confirm its efficacy.

The treatment of Attention Deficit Hyperactivity Disorder (ADHD) should be multimodal. Apart from pharmacological treatment, that is frequently insufficient, psychosocial interventions are considered worthwile. In order to assess the usefulness of a coaching procedure in adult ADHD with respect to symptoms and daily life functioning a pilot study was performed. Beforee and after the coaching symptoms and functioning were rated.

Ten patient (age 25-61, 6 males) with a deiagnosis of ADHD according to DSM-IV criteria were included. They took part in an 8 weeks structured coaching procedure once weekly for two hours. Before and after the coaching patients were assessed with the Rosenberg Self-Esteem Scale, The Attention Deficit Self Rating Scale (ASRS), the Behavioral Assessment of the Dysexecutive Syndrome (BADS), the Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-Les-Q) and the Weiss Adult Functional Impairment Rating Scale. The ratings were done by the patients and a significant other (e.g. spouse)

There were no significant effects on symptoms of ADHD as rated by the patients. The significant other however noted improvement. Functioning in daily life, as measured with the Weiss, showed a significant improvement.

Improvement or not-improvement of ADHD symptoms does not automatically parallel functional outcome in daily life. Psychosocial measures may be of benefit in this respect.

The “telepresence” allows innovative strategies of intervention in psychiatry and new forms of high therapeutic potential in mental healthcare assistance. Within this general framework the authors introduce the “Velletri Intensive Telepsychotherapy Assistance - V.I.T.A. Project”. The project has started four years ago and it consists of psychotherapeutic treatments systematically carried out in videoconference modality. It is aimed at: - defining the feasibility criteria (technical and psychopathological ones) of this kind of treatment; - comparing it with “face to face” psychotherapy; - pinpoint pointing out its elective fields of application in psychotherapy, especially with regards to acute episodes of “crisis”.

Twelve patients have been recruited involved, six for the control group treated by traditional “face to face” cognitive therapy and six for experimental group treated by videoconferencing cognitive therapy. This Psychotherapeutic treatments were carried out by means of regular video connections (ISDN-based, 384 Kb/s) between the research centre and patients who live in towns near Rome. Both the treatments were assessed by: WHO-Quality of Life, HDRS (Hamilton Depression Rating Scale), HRSA (Hamilton Rating Scale for Anxiety), ZDS (Zung Depression Scale), STAI (State-Trait Anxiety Inventory), COPE (Coping Orientation to Problems Experienced), MSPSS (Multidimensional Scale of Perceived Social Support), DES (Dissociative Experiences Scale), BPRS (Brief Psychiatric Rating Scale), GAF (Global Assessment of Functioning scale) and WAI (Working Alliance Inventory); at regular intervals of three months for four years.

A more detailed description of “V.I.T.A. Project” methodology and its preliminary results will be presented.

The new technologies and computer-mediated communication may be used in psychiatric treatment for different type of contacts between patients and therapists including psychotherapy.

Elements of systemic family therapy (under peer supervision) were used by the means of electronic communication with the patient, addicted to alcohol and combined with therapeutic sessions in the therapist's office. E-mail sessions were conducted in a form of “electronic circle” with three family members: the patient, his ex-wife and his sister, each of them representing a part of the family.

Comparison between live and e-mail sessions shows similar patterns in communication, roles and behavior of family members.

E-mail contacts in the form of “electronic circle” could be used as addition to the live family therapy session, when regular meetings could not be conveyed. E-mail communication gives new tool for psychiatric and psychotherapeutic treatment and represents new type of patient-therapist relationship.

The Living Life to the Full college and free online courses are based on the Cognitive Behaviour Therapy (CBT) approach and is offered at Further Education Colleges and free of charge online (www.livinglifetothefull.com). The classes teaches key skills such as identifying and challenging unhelpful thoughts, problem solving etc.

In the college course, total mean scores at baseline for knowledge questions was 8.20 increasing to 11.07 gain 2.87 p=.042). Self assessed skills were 24.00 at baseline, increasing to 34.20 at session 8 (mean difference = 10.20 p=.001). The Training Acceptability Rating scale showed content scores at session 1 of 77% rising to 91% at session 8. Process scores were 73% at session 1 rising to 89%, showing training acceptability throughout the course. The online course has over 15,000 registered users. 70% are clinical cases of anxiety (HAD scale), and 55% depression. 24% of users are clinical cases and are not receiving any support from a practitioner. The site has had over 4 million hits in 10 months and an average of 1000 hits/hour.

Delivering CBT in this way seems to lead to gains in mental health literacy. Such courses may provide another useful option for helping people access CBT for mild to moderate problems of distress. A RCT of the core course materials has just been completed.

There are many factors which cause soldier's crisis during the military duty: problems in adjustment to military environment or some problems in relationship with his parents or a girlfriend. If those problems are enormous, soldier has to inerrupt military duty in that moment for a period. But problems can be continued and existed furthermore.

Aim of our study was to show the application of short term psychotherapy for the soldier in crisis following estimation for military duty who couldn't overcome his problems during the military duty that preserve him to adapt to civilian environment successfully.

In three phases of short term psychotherapy: initial, when the therapist makes the diagnosis of the disorder and also the interpersonal problematic is pointed out; intermediary when the focus is treated, and the final phase when the therapist encourages the patient to recognize and consolidate gains and prepare the patient to use it in the future, the therapist aims to enable patient to identify, understand and give a meaning to his conflicts; still aiming to correct the distortions in the perceptions that patient has about himself and his environment, as well to improve his interpersonal relationships.

The final result of short term psychotherapy for the soldier in crisis following estimation for military duty is decreasing patient's anxiety and depression and increasing his self-confidence. All of that provides him to come back to the level of functioning that existed before the beginning of the crisis and to continue his life successfully.

M.A female 30 years old, second born after her brother. Her parental family was overprotective. Her mother's or father's family were free of mental illness.

At 1998 she met a young man. Three years later they decided to get married. They both had stigma of b-thalassaimia. Those days she had her first stroke of paranoid schizophrenia (according DSM IV). She had been hospitalized for 40 days. Six months after her discharge note, continued to have symptoms (such as less concentration and side effects of antipsychotics). Then we met her. We changed her treatment into atypical antispsychotics and at the same time we psychotherapize her. We changed the treatment into aripiprazole because she gained weight. Her figure was improved more and more. At February of 2005 she has got pregnant, she had never stopped her treatment. According to her personality and psychopathology, it was sure that if we had stopped the medicine or psychotherapy she would had an abortion. Then, we continued aripiprazole.

During her pregnancy nothing psychopathological happened. So she continued to work till the 36 week of her pregnancy. Her sexual and family life was very good and she gained only 7 kilogramms in her pregnancy. At the amniocentesis the fetus was negative for b-thallassaimia. After 40 weeks of pregnancy she gave birth to a healthy (goodlooking) male. After all these, the couple is very functionable and this was the aim of our trial.

Patients presenting with multiple unexplained physical symptoms such as somatization disorder (SD) and abridged somatization (AS) pose significant challenges in mental health and primary care settings. Until recently, no intervention had been found to produce meaningful improvement in these patients. We present here results of two studies one on SD the other on AS.

Study 1 included 84 patients with SD seen in a mental health setting and Study 2, 172 patients with AS seen in primary care. In both studies, patients were randomly assigned to either a “standard care” or an “experimental treatment” consisting of a 10 session CBT designed for patients with unexplained symptoms. The Clinical Global Scale (CGI) for Somatic Symptoms was the key outcome measure.

In Study 1, CBT-treated SD patients were significantly more likely to be rated as “much/very much improved” than “control” patients (39.5% vs. 4.9%). CBT also led to a decrease in health care costs. In Study 2, CBT-treated AS patients were significantly more likely to be rated more “much/very much improved” in the CGI than those in the control group (60% vs. 25.8%). Depressive symptoms also improved more under CBT but the effect on physical symptoms was independent from that on depression.

For patients diagnosed with SD and AS in primary and specialty care, CBT produced clinical benefits beyond those that result from current state of the art treatments. CBT may be the treatment of choice for most of these patients.

Stubbornness, disobedience and, talking back to parents may cause parents to be anxious and defiant about their children.

In order to study during 20 months, 24 subjects (13 girls and 11 boys) less than 5 years age children with Stubbornness evaluated with Child Behavior Check List and clinical interview. Parents with psychiatric disorders and impaired household interpersonal relationship received at least 3 sessions of counseling, individual skills training, and in some cases they received drugs. Results estimated after one and three months and the reported stubbornness by parents evaluated.

Six subjects, two girls and four boys, had at least one concomitant psychiatric disorder and excluded from the study (three of them had ADHD). In the 13 of children both of parents participated in the evaluation and treatment processes. In the 87.1% of parents (27 of 31 each parents) at least one of them had psychiatric problem or dissatisfaction of marriage of subjects and the most frequent symptoms in decreasing ordinary were depressive symptoms and complaining about non-participation of another parent in the child nurturing. In three month survey 77.8% of children (6 boys and 8 girls) were free symptom. ANOVA showed that sex of children hasn't any effect on treatment results (P > 0.05).

The findings of this study provide some support for the use of Parent-oriented treatment for less than 5 years age children with stubbornness. Review of literatures reveals that

Stubbornness has a powerful stem in parent's behaviors.

The objetive of this study is to examine the efficacy of group psychoeducational therapy for inpatients with DSM-IV schizophrenia.

Fourteen in-patients with DSM-IV schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also recibed a two-months course of psychoeducational psychotherapy. Outcome was evaluated using Clinical Global Impression-Schizophrenia Scale.

Patients who attended psychoeducational group showed a improvement in CGI-SCH score.

The results suggest that psychoeducational psychotherapy can improve the treatment of schizophrenia.

Psychoeducational psychotherapy has no side-effects and is relatively inexpensive.

To carry out a three year randomised controlled trial of a specialist behaviour therapy service for adults with learning disabilities compared with treatment as usual, within South Essex Partnership NHS Trust. The study is funded by the South Essex Partnership NHS Trust (ISRCTN62134865).

Challenging behaviour is common in people with intellectual disabilities, but there is a paucity of specialist services in most areas. Currently, most of the care is provided by local community based intellectual disabilities teams whilst specialist care is usually hospital based and situated away from the clients' residence. South Essex Partnership NHS Trust provides such a specialist service to people with intellectual disabilities and challenging behaviour within a five sector locality.

68 participants will be randomly assigned either to specialist intervention or treatment as usual group. Structured interviews are conducted with clients and their carers at baseline and at three and six month follow-up. Main outcome is reduction in challenging behaviour. Secondary outcomes are reduction in carer burden and costs.

Will report on the first 2 years of a 3-year trial.

Intervention research is very scarce if not completely lacking in the field of intellectual disabilities mental health. We anticipate that the data from this study will provide evidence not only for further research but also for service developments and improvement in patient care.