Poor patient-rated health status is associated with increased mortality among patients with heart failure. In some patient populations, a single question related to general health has been shown to be a strong predictor of mortality. We examined whether self-reported physical health (PH) in patients hospitalized for an acute myocardial infarction (MI) or unstable angina predicts mortality 1 year later.

Prospective observational study of 801 patients assessed with the SF-12 during a hospitalization for MI or unstable angina and followed for 1 year. Two logistic regression equations to predict mortality based on either the PH subscale of the SF-12 or on a single self-rated health (SSRH) item from the SF-12 and controlling for age, gender, diagnosis (MI vs. unstable angina), history of MI, Killip class, and Beck Depression Inventory (BDI) score.

The 49 patients who died in the first year following the index hospitalization had significantly lower SF-12 PH scores at baseline (33.2 vs. 40.9, p < .01). They also rated their health significantly poorer on the SSRH item (p < .01). The SSRH item was not a significant multivariate predictor of mortality (p = .74). Significant multivariate predictors of 1-year mortality included older age, female gender, history of MI, low BDI score, and SF-12 PH score (all p < .05).

During a hospitalization for MI or unstable angina, both depression and self-reported physical health on the SF-12, but not a single self-rated health item, predict mortality 1 year later.

Previous reports have demonstrated that depressive mixed state (DMX) (major depressive episode + 3 or more co-occurring intradepressive hypomanic symptoms) and agitated depression are overlapping conditions. The aim of the current study was to examine the relation of DMX and suicide attempt.

Using a structured interview (modified Mini International Neuropsychiatric Interview) and determining all the symptoms of 16 Axis I psychiatric diagnoses defined by the DSM-IV, the authors examined 100 consecutive nonviolent suicide attempters (aged 18-65) within 24 hours after their attempts. Results. DMX was present in 63.0% in the total sample and in 71% among the 89 depressive suicide attempters. More than 90% of the patients with DMX had the symptoms of irritability, distractibility and psychomotor agitation. The rate of DMX was significantly higher among the 29 bipolar (I+II) than in 37 unipolar depressive suicide attempters (90% vs 62%).

This study included suicide attempters who had presented self-poisoning, but not individuals with very high risk of fatality.

In suicide attempters there is a very high prevalence of DMX, especially among bipolar depressive suicide attempters. This study underlines the importance of detecting and appropriate treating DMX and especially depressive bipolar mixed subgroup in suicide behaviour prevention.

Patients with bipolar disorder may be at elevated risk for metabolic syndrome or its components. Little is known about awareness of metabolic issues among European psychiatrists, or the impact on management of bipolar disorder.

In 2006, 718 psychiatrists in UK, France, Germany, Spain and Italy were recruited to complete an online survey. Eligibility criteria were: practicing 4-30 years, spending ≥50% of time in direct patient care, and treating ≥10 bipolar patients in the last month. Aggregate data were weighted according to the number of psychiatrists in each country. Data comparing individual countries were not weighted due to possible biasing factors such as demographic differences.

22% of respondents were unfamiliar with metabolic syndrome. More than half (56%) had diagnosed it and 72% saw it as a significant health risk. Based on NCEP criteria, the estimated prevalence was ~25% in bipolar patients and ~20% in the general population. With bipolar medications, side effects of greatest concern to psychiatrists were weight gain, cognitive impairment, and glucose intolerance. Treatments associated with increased risk of metabolic syndrome were olanzapine (76%), risperidone (42%), and quetiapine (36%). Although 39% said metabolic concerns rarely or never lead them to stop or switch bipolar disorder therapies, 65% have changed their interviewing and monitoring habits in the past 3 years regarding metabolic health.

European psychiatrists view metabolic syndrome as prevalent and are concerned about the metabolic risks of bipolar medications. Two thirds say that metabolic health issues have prompted changes in patient care in recent years.

Bipolar disease type I has an estimated prevalence of 1% in the general population. Approximately 50% of first episodes are of the manic type. In the last decades, there have been major advances in the understanding of the disease and its psychopharmacological treatment, namely through the usage of anti-psychotics (both typical and atypical), mood stabilizers and anxiolitics.

To study the farmacological treatment of acute mania in Hospital Miguel Bombarda over the last 20 years.

Data retrieval from the clinical files of the patients admitted for bipolar disease, manic type, and its sociodemografic caractherization. Study of the farmacotherapy used in a sample of the first 30 clinical admissions due to the illness over 20 years, with intervals of 5 years. (1986, 1991, 1996, 2006)

There has been an overall increasing rate of admissions due to bipolar disease, manic type over the last 20 years. This evolution is depicted graphically.

Anti-psychotics were the class of therapeutic agents most comonly used, especially haloperidol. In the last years, there has been a slow but steady increase in the usage of mood stabilizers; however, atypics lagged behind in the prescriptions habits for bipolar disease, manic type in the sample studied.

The objective of this study was to evaluate the efficacy,safety and tolerability of quetiapine and olanzapine in association with valproate in the treatment of RCBD.

30 patients diagnosed with RCBD by DSM IV criteria were divided in 2 groups - group A included 15 patients treated with quetiapine (600-800mg/day) and group B included 15 patients treated with olanzapinum (10-15 mg/day). Both groups received valproate 500mg/day.

At the beginning of the study 12 patients were maniac, 8 in a mixed state,7 depressed,3 hypomaniac. Patients were assessed with Clinical Global Impression Scale for Bipolars, the Young Mania Rating Scale and the Hamilton Depression Rating Scale.We evaluated al groups at baseline, after 1 week, 2 week, and every month during the period of study (1 year).

A similar and significant improvement was observed in both group for all the scale scores (CGI-BP, YMRS,HDRS). Doses of quetiapine and olanzapinum were significantly reduced by the end of the study in compare with baseline. Doses of quetiapine and olanzapinum differed according to the initial episode.

Quetiapine and olanzapinum in association with valproate were an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment.

Attention Deficit Hyperactivity Disorder (ADHD) is common chronic mental health condition in children and adolescents and has severe impact on their social functioning. This study explores mutual relationship between children attributions (implied in M. Seligman terms) and school, familial and peer functioning in ADHD and non ADHD populations.

The study cohort of children exclusively suffered for ADHD, in the age of 12 and 13, majority of boys, was pair-matched with non-referred children. Both groups were administered sociodemographic and school achievements specification along with the Children's Attribution Style Questionnaire and Achenbach Youth Self Report Questionnaire (YSR). Parents completed The Children's Global Assessment Scale (CGAS) and Child Behavior Checklist (CBCL). In this preliminary report we evaluate data concern 40 participants as well as their parents (all study group is 4 times folded).

Substantial differences were observed between the ADHD and non ADHD groups on child attributions measures. Children with ADHD had additional difficulties in all domains of social functioning. The pessimistic styles of attribution in ADHD children interfere with the correlation of the severity of the disorder and the degree of social deterioration.

Several important cognitive motivational issues emerged. ADHD children's repeated negative experiences arised from ADHD phenomenology failed in creating the optimistic thinking. The certain attribution styles of children with ADHD may place them at risk for poor self esteem and/or depression in future. When ADHD is present, there is an additional burden on peer, school, and family functioning.

One of the partial solved issues in the treatment of Bipolar Disorders is mixed episode. Often, antidepressant monotherapy increases the risk of switching into mania/hypomania. Also, discontinuation of mood stabilizers leads to relapses. In long term treatment, adding mood stabilizers may help to avoid the disease burdens.

to estimate the clinical efficacy and acceptability, in mixed episodes, of valproate-VPA vs. carbamazepine-CBZ, associated or not with olanzapine (OLZ).

clinical open study including 51 patients (28-56 years), both sexes, with Bipolar Disorder-Mixed Episode (DSM-IV), mean scores YMRS=21,3 and MADRS=17,5 at baseline. Instruments: depression (MADRS), mania (YMRS), CGI-S, CGI-I, side effects, somatic conditions and relapse (follow-up: 6 month). We divided those patients in 3 groups: Group A: OLZ (17,5mg/day), N=17, Group B: OLZ+ CBZ (1250mg/day) N=17 and Group C OLZ+VPA (1350mg/day), N=17. After 4 weeks: 42 patients were responders (MADRS and YMRS< 50% vs. baseline), 9 drop-outs. Responders Group A: 11pts, Group B: 7pts, Group C: 16pts. The 6 month follow-up period we evaluated the relapses in all groups.

After 4 weeks, VPA and CBZ associated with OLZ were similarly effective, with an advantage in the OLZ+VPA group. The follow-up period demonstrate fewer relapses in the OLZ alone Group and OLZ+VPA Group versus OLZ+CBZ Group.

1.For the treatment of mixed episodes in Bipolar Disorder, OLZ monotherapy and OLZ+VPA seemed to be more effective and best tolerated. 2. In long term treatment, considering the different adverse events of VPA and CBZ, VPA may be more effective than CBZ.

Post-stroke depression is common. In contrast, mania after stroke is rare.

case report.

Mr A., a 55 years old, right handed man, presented sudden non fluent aphasia during 10 minutes, investigated in an emergency department. Computed tomography (CT) revealed focal atrophy in the right temporal cortex. According to the general practitioner and the emergency department, the patient developped mania within 24 hours, characterized by psychomotor agitation, insomnia, distractibility, irritable affect, disorganised thought, and flight of ideas. He was admitted in our psychiatric department without consent 9 days later. He fullfilled DSM-IV criteria of manic episode. The patient was correctly orientated. Cognitively, the patient was able to score 28 out of 30 on the Mini-Mental State Examination. He was being treated for hypertension and diabetes by his general practitioner for 10 years. There was no family history of psychiatric disorder. His treatment included amlodipine 10 mg/day, trinitrine 5 mg/day, and glibenclamide 5 mg/day. A second CT scan showed ischemic focal change in the right temporal pole. B12 and folates levels were within the normal range. The patient tested negative for the syphilis serology. He received valproic acid 900 mg/day and had a good response. Over a 15-day period, his elevated mood settled to an euthymic level. His daily medication included valproic acid, risperidone 2 mg and hydroxyzine 200mg.

Mania could be associated with right-hemisphere lesions, particularly in limbic areas that have strong connections with the frontal lobe (Starkstein & Robinson, 1997).

Bipolar Disorder (BD) is associated with structural and functional abnormalities in prefrontal and limbic areas implicated in emotional processing. Lamotrigine (LTG) has been shown to improve depressive features in BD although its mechanism of therapeutic action is not known. The current study examined the possibility that LTG may improve functional activation within the neural circuitry involved in emotional processing.

We used functional Magnetic Resonance Imaging to examine changes in patterns of brain activation in 12 stable BD patients (a) compared to healthy controls when medication free and (b) after 12 weeks of Lamotrigine monotherapy whilst performing a sad facial affect recognition task on both occasions.

At baseline, compared to controls, BD patients showed overactivity in response to sad facial affect recognition in temporal lobe regions and under-activity in dorsal medial and right ventrolateral PFC and the dorsal cingulate gyrus. After 4 weeks of LTG monotherapy, patients showed reduced activation in temporal regions and increased neural response in dorsomedial and ventrolateral prefrontal regions.

This preliminary evidence suggests the possibility that LTG may enhance functional activation within prefrontal regions responsible for emotional self-regulation.

This study was supported by an unrestricted grant from GlaxoSmithKline

Two studies to date have been published regarding the prevalence of the metabolic syndrome in bipolar patients. The unadjusted prevalence rates reported were 30% and 32%. The aim of this study was to evaluate the prevalence of the metabolic syndrome in a group of 142 bipolar patients from Spain.

Bipolar patients (ICD-10 criteria) from 11 centres in Spain were assessed cross-sectionally for metabolic syndrome according to the NCEP ATP III criteria.

The mean age was 47.3 (SD 14.5), 51.1% were male. On average, patients were receiving 2.8 (SD 1.3) drugs for the treatment of their bipolar disorder. Ninety-one percent were receiving mood stabilizers, 63.4% antipsychotics and 29.6 antidepressants. Eighty-seven percent of the antipsychotics prescribed were atypicals. The overall prevalence of metabolic syndrome in our sample was 24.6% Fifty-seven percent of the sample met the criterion for abdominal obesity, 37.4% for met the criterion for hypertriglyceridemia, 36.4% for low HDL-cholesterol, 25.2% for high blood pressure and 12.5% for high fasting glucose. No statistically significant difference was found between with and without the metabolic syndrome for gender, illness status (acute versus in remission), CGI-S-BP scores and number of medications used. Patients taking tow mood stabilizers had significantly higher metabolic syndrome rates than patients taking one mood stabilizer and than patients without mood stabilizer treatment (40% versus 17.8% and 11.1% respectively, p .02).

The prevalence of the metabolic syndrome in bipolar patients is high. It appears to be higher than that estimated for the Spanish general population.

Child – Family relations studied using family drawing method reveal risk factors of a future mental disorders development and other psychological problems in preschool children.

The pupils from 12 kindergarten (n=161, 85 boys, 76 girls, age 3-6 years) were tested during the “Teddy bear hospital“project carried out by Lithuanian Medical Students' Association. The priority, accuracy of depiction and collocation of family members in the drawing were evaluated. Software package SPSS 10.0 was used for data processing.

31,1% of all children drew themselves as the first object. 56% of these children were in age 5-6 years. Possibly the self perception of the group is underdeveloped. 21.1% of all children didn't drew themselves at all. That suspects their weak relation with the family. The mother and the child himself – were clearly emphasized in 60.3% of the drawings. 31.1% drew themselves and 29.2% - drew the mother as the first object. The tendency of the girls to identify themselves with the mother and for the boys – with the father was clearly expressed. Integral bodies (all big parts of the body) were depicted in 57.1% of all drawings. 63% of such drawings were made by elder children.

Family drawing test revealed underdeveloped self perception of investigated population. Stronger relation of girls with their mothers and boys with their fathers was clearly expressed. Age related development of intellectual level of the child was reflected by integral body drawing.

We investigated the effect of the parental age at child birth on the age-of-onset (AO) of bipolar disorder in a sample of 336 bipolar I patients directly interviewed with DIGS (DSM-IV-R criteria) in connection with the type of family history (FH): 1) no family history of major psychoses (sporadic); 2) only recurrent unipolar major depression (MDD-RUP); 3) bipolar disorder, schizoaffective disorders or schizophrenia (BP/SA/SCHIZ).

Familial psychopathology data were collected through direct interview about 76% of first-degree relatives and through FH-method (FIGS-interview) about first- and second-degree relatives not available to direct investigation.

Linear/logistic regressions showed a significant effect of the paternal age (PATAGE) on AO in offspring in the total sample (p=0.040); PATAGE was negatively correlated with AO in offspring when interacting with the proband gender (p=0.026) and FH-type (p=0.003). The division of the patients by sex revealed a significant association between PATAGE and AO only in females (p=0.003); the fathers of females with FH of MDD-RUP and the fathers of sporadic females were significantly older than the fathers of females with FH of BP/SA/SCHIZ. The first two groups generated the negative correlation appearing in the total sample. No correlation between PATAGE and proband AO was observed in the third group. Maternal age had no impact on AO in offspring.

The PATAGE effect on AO in bipolar offspring was related to female sex and FH-type and it was detectable in bipolar probands with no familial loading or with milder loading like the MDD-RUP.

Bipolar Disorder (BD) is associated with impairment in emotional self-regulation and verbal working memory. Lamotrigine (LTG) is effective in the clinical management of BD.

To investigate whether treatment with LTG is coupled with altered function within neural circuits subserving emotional processing and verbal working memory, in a BDI sample.

Functional Magnetic Resonance Imaging (MRI) was used to explore blood oxygenation level-dependent (BOLD) response across the whole brain in 12 stable BDI patients at baseline and following 12 weeks of LGT monotherapy. Stimuli were presented in a block-design while individuals performed a verbal working memory (N-back sequential letter) task and in an event-related fashion during an angry facial affect recognition task. Data was acquired using a 1.5-Tesla MRI scanner and analysed using SPM2. Group activation maps were generated for each task and for the drug-free and post-medication condition. A threshold of p < 0.001 was used. Effect of LGT on brain activation during tasks was explored using a random-effects, within-group comparison.

In both tasks, LGT monotherapy was associated with increased BOLD signal when compared to baseline in a number of brain regions, mostly within the prefrontal cortex and cingulate gyrus. All foci of increased activation with LTG monotherapy were observed within cortical regions normally engaged in verbal working memory and facial affect processing.

LTG monotherapy in BD patients may enhance cortical function within neural circuits involved in memory and emotional self-regulation.

This study was supported by an unrestricted GlaxoSmithKline grant.

To investigate the effectiveness, tolerability, functionality and quality of life (QoL) under naturalistic conditions of once daily extended release methylphenidate (OROS®-MPH) in children and adolescents with attention-deficit/hyperactivity-disorder (ADHD), who had previously been treated with IR-MPH.

Interim analysis of an open-label, prospective, multicenter observational study (42603-ATT-4001) in children and adolescents aged 6-18 years with ADHD (DSM-VI). After transition patients were treated with OROS®-MPH (CONCERTA®) in flexible doses for 3 months. Primary documentation parameters were change in IOWA Conners' parent rating scale, C-GAS, and inventory for the assessment of quality of life (ILK). Statistical analyses based on ITT population (LOCF, Wilcoxon-test for dependent samples).

Data from 296 patients (mean age 10.4±2.5 years; 85% male) were documented. There was a marked reduction in symptomatology from 29±11 to 19±11 points at endpoint on the IOWA Connor's parents rating scale (p<0.0001). QoL significantly improved from 17±4 to 20±4 points on the ILK parent rating scale (p<0.0001). Functionality showed a significant improvement of 12±14 points in C-GAS (p<0.0001). 19.3% of the patients had at least one adverse event (AE). In 2 patients serious AE were documented and were rated as unrelated to OROS®-MPH. Most frequent AEs were insomnia (5.7%) and nervousness (2.7%). Tolerability after transition to OROS®-MPH was rated as "good" or "very good" by 85% of the parents.

In this naturalistic study the transition to OROS®-MPH led to a significant improvement in clinical symptomatology, functionality and quality of life in patients with ADHD. OROS®-MPH showed to be safe and well tolerated.

Suicidal behavior becomes more and more actual problem in many countries. Lithuania is known as a country where suicides rate, especially among young people, is the highest in Europe.

The goal of this research was to establish the coherence between family, psychosocial characteristics and teenagers' suicide behavior.

Two groups of teenagers from 14 to 17 were researched: the analyzed group (N=109) and the control group (N=218). To evaluate anamnesis, psychosocial factors of the researched teenagers, structural questionnaire, concluded by the authors was presented.

Seeking to establish the coherence between psychosocial factors and suicide behavior, the comparisons were made between the frequencies of this factor among 14 – 17 year old teenagers, having no suicide anamnesis and the teenagers who have tried to commit a suicide.

The data analysis proved the statistically reliable evidence that in analyzed group both male and female teenagers, who have tried to commit a suicide, live in not full families (p<0,001). The frequent behavior in such families is addiction of both or one of the parents to alcohol (p<0,001); physical punishment is not an exception (p<0,001). The teenagers who have tried to commit a suicide indicated that they more often than the teenagers in the control group fell badly or even very badly among their contemporaries (p<0,001) and most of their time they spend alone (p<0,001).

According to the results, the psychosocial factors and teenagers suicidal behavior are related, but only they themself can't predeterminate the suicide.

Impaired executive function has been proposed as a trait marker for adult bipolar disorder. However, similar impairments in children bipolar disorder have not been yet documented. Here,we assessed executive function in 21 children and adolescents with bipolar disorder.

21 children and adolescents with bipolar disorder and 21 demographically matched healthy participants completed a standardized WCST test.

The operation result in children with bipolar disorder did not differ from that in controls. Severity of mood symptomatology was not associated with WCST performance in any bipolar subtype.

Findings suggest that executive function in children bipolar disorder are not similar to those seen in the adult form of the illness. Compares with the adult, the children bipolar disorder possibly may have different pathogenesis.

According to Sifneos criteria alexithymia is the disability for one person to express and identify emotions. In this study we investigate the possibility of a cerebral localization for alexithymia.

We examined 12 patients, 6 men and 6 women, with characteristic alexithymia symptomatology by a complete neurological, neurophysiological (24-hours EEG registration) control and biochemical tests.

We recorded. Compared between them and estimated the results according to a healthy population.

In all alexithymic patients there were certified significant pathological neurophysiological findings, mostly dysrhythmic epileptoform unloadings in frontal lobe ambilateral. In 9 of 12 patients there were increased amounts of prolactine and homocysteine. All of the patients with alexithymia had limitated REM stage during the hypnogram.

The results show clearly a cerebral dysfunction of frontal lobe in patients with alexithymia. This fact and the fact that prolactine and homocysteine were increased, can inform us that we have the possibility of an organic dysfunction with genetic disposition.