Health-Related Quality of Life has been considered suitable for outcome measurements in chronic illnesses.

Feasibility of collecting routinely data on health gains during treatment was assessed during a outpatient service development project in Satakunta hospital district. Finland. Patients contacting the outpatient services for the first time were asked to fill in scales during their first visit. The sacles were sent by mail three months, one year and two years after the first visit. The instruments used were AUDIT-5, BDI-21 and 15D. 15D is a scale developed for purposes of estimating QALY’s in health economic research. It has been widely used in Finland in general population and patient populations including psychiatric patients. Previous studies have defined a population standard (0.9402 out of a score of 1) for 15D assessments and a universal cut-point (change of 0.03) for clinically significant change.

The use of routine-based outcome measurement has been well feasible in outpatient care. So far 949 patients have undergone the first measurement point, 590 the second assessment point and 312 the third assessment point. The data collection is still on-going and numbers of responses at later intervals are likely to increase. At the first assessment the mean 15D score was 0.7616, at three months 0.7857 and at one year 0.7995. Scores increased especially concerning anxiety and depression, but considerably less regarding sleep.

Routine measurement of health gains is feasible within the context of public psychiatric services. Measurement implied also need for development of insomnia treatment.

Across various cultures, dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment, occurring without evidence of significant brain damage (as detected by conventional structural brain imaging). In a substantial number of cases, the memory impairment follows a chronic course. Sometimes dissociative amnesia occurs on a background of a personality disorder (narcissistic or borderline). Other times, amnesia itself triggers long lasting personality changes.

This work’s objectives are establishing greater recognition among health care providers of the spectrum of the personality changes that may accompany chronic forms of dissociative amnesia.

We review data from own patients with chronic forms of dissociative amnesia.

Patients were investigated medically, psychiatrically, neuropsychologically and and neuroradiologically.

Changes in personality dimensions occur after the onset of amnesia. These may involve affectivity, perception (e.g. impaired self face or face-emotion processing), cognition (e.g. social cognition) and behaviour (e.g. changing in eating, smoking, drinking or working habits).

The observed personality changes may represent a consequence of amnesia. Functional imaging studies show metabolic changes in dissociative amnesia in brain areas involved in conscious mnemonic processing. Several structures engaged in processing within episodic-autobiographical memory system were also implicated in self and reward-related processing. Alternatively, the personality changes may be viewed as being pivotal in the development and maintenance of dissociative amnesia; this personality shift may subsequently lead to enduring changes in ways of cognitive processing, self-processing, perception and affect.

The meeting of families who share the same problem enables the creation of a new therapeutic space that allows a rich exchange regarding solidarity and mutual aid. The presence of others allows reviewing each family’s beliefs, questioning the secrets, incomplete information and taboos, and raises questions about assumptions maintained over time.

To characterize group meetings of chronic mental patients and their families regarding thematic and interaction of participants.

Understand the interaction between chronic mental patients and their families.

This is a qualitative participant observation study. Five weekly outpatient groups with 15 patients and their families were analyzed.

The subjects discussed were related to symptoms of mental illness, treatment options and cures, expectations of patients and families facing the reintegration of those in work and other activities, and the group concern with the difficulty of expressing feelings. Emotions had resonance in these meetings and, among them, feelings of gratitude, recognition and reconciliation, as well as anger, boredom, disappointment or discomfort. The possibilities of group contention expanded, and each person was accompanied and stimulated the expression of his/her own feelings, for being a witness and co-participant of expression of affection from others. When psychotic patient gather with their families, deep and unwieldy anxieties are mobilized.

The importance of including the family is in the fact that we can confront patients with the real objects of their family history and make corrective emotional experiences of primitive distorted object relations.

To study the effect of personal anxiety on relative risk of myocardial infarction (MI) and stroke and its relation with awareness and attitude towards the health in female population of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” program random representative sample of women aged 25–64 years (n=870) were surveyed in Novosibirsk. Levels of personal anxiety were measured at the baseline examination by means of Spilberger’s test. From 1995 to 2010 women were followed for 16 years for the incidence of MI and stroke.

High level of anxiety (HLA) in studied cohort revealed in 60% of women. Women with HLA had 1.5-3-fold growth of negative self-rated health (87.5%), about 90% had health complaints, more likely had negative behavioral habits and higher levels of job and family stress compared to those with lower levels of anxiety. Risk of MI development in women with HLA over 16 years of study was higher in 4.2 times (95%CI=1.946-18.583; p=0.05), risk of stroke was higher in 3.5 times (95%CI=1.020-12.015; p< 0.05). MI and stroke incidence rates were higher in married women having HLA with low and high educational level who being in both “middle executives” and “hard manual labor” social classes.

There is high prevalence of HLA in female population aged of 25–64 years. Women with HLA had poor selfrated health and awareness about their health and it associated with higher risk of MI and stroke over 16 years of follow-up.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a small-vessel disease of the brain that is genetically transmitted and often is diagnosed in middle adulthood. It can lead to progressive cognitive deterioration, emotional and personality changes. The disorder is often erroneously diagnosed as it may mimic other neurological or neuropsychiatric conditions (such as multiple sclerosis).

This work’s objectives are establishing greater recognition among health care providers of this relatively common, but yet underestimated cause of cognitive and emotional changes.

We present a middle aged patient with genetically confirmed Cadasil.

The patient underwent extensive neuropsychological testing. In addition, he underwent comprehensive medical, neurological, neuroradiological and genetic investigations.

Neuroimaging data showed significant changes in both white and gray matter. Neuropsychological investigations revealed variable degrees of impairments in executive functions, emotional and social information processing and conscious mnemonic processing (episodic-autobiographical memory).

Impairments in episodic-autobiographical memory, executive functions and social and emotional processing may represent early neuropsychological changes in Cadasil. Identifying both the early neurological and neuropsychological features of this condition, in order to enable early accurate diagnosis is a crucial task for future research.

In a public elementary and secondary education school, in the interior of São Paulo state, an Extension Project of the University of São Paulo that aims to invest in the promotion of physical, mental and social health of a group of students is developed. Structured activities, including games, group activities and experiences are offered, coordinated by nursing students and supervised by a faculty member responsible for the project.

To verify the opinion of a group of students about the school and the roles of significant people; to identify existing conflicts, according to the type of violent acts.

To know the circumstances of the interaction of a group of young students with the school and family.

This qualitative study with participant observation analyzed 3 group meetings conducted with twenty 6th grade students of the elementary school.

Students’ perceptions about the school and its professionals were different. They considered family members as important people, who take care, place limits, scold and beat. They struggled to establish their role and that of colleagues at school. Colleagues are friends to play with. The following types of violence were identified: physical, psychological and negligence.

To work on self-esteem, tolerance and cooperation; alleviate conflicts with affective attitudes that express respect; offer educational spaces where young people can take positions, facilitate their interaction and exercise their creativity and reflection preventively collaborate to decrease violence at school. Thus, it may be easier to build models of peaceful coexistence in other social environments.

Periods of financial crises have been associated with impairment of mental health and increased suicidality. The purpose of this research is to study the potential impact of the consequences of the financial crisis, such as unemployment, job insecurity, debts, poverty, social exclusion on the suicidality in the Greek population.

The records of patients who were hospitalized in the Internal Medicine Clinics of a general hospital after attempting suicide in the years 2007 and 2011, before and during the financial crisis respectively, were studied. Demographic data, methods of suicide attempt, psychiatric history and severity of psychopathology at the time of suicide attempt, were recorded for each patient.

The statistical analysis showed that during the financial crisis there is an increase in the number of suicide attempts. Most affected are those who are unemployed, married, who are reaching the age of retirement or are already retired and have no history of psychiatric disorder or suicide attempt. Furthermore, there was evidence suggesting that a decreased threshold of psychopathology was adequate for individuals to exhibit suicidal behavior.

It seems that the economic crisis in Greece has a negative impact on the mental health of its population and causes an increase in suicidal behavior. Consequently, mental health promotion and suicidality prevention programs are essential for the accurate and timely identification and the immediate and effective management of high risk individuals.

The type D personality (negative affectivity and social inhibition) has been associated with increased risk for adverse cardiovascular outcomes. The prevalence however of type D personality appears to vary significantly among different societies and cultures.

The objective of the present study was to verify the prevalence of type D personality in Greece.

To identify the prevalence of social inhibition, negative affectivity and personality type D, as measured by the DS-14 scale, in Greek patients.

A randomly selected sample of 100 patients with acute myocardial infarction and 100 patients with hyperparathyroidism were recruited. All patients were asked to complete the Hospital Anxiety and Depression Scale, the Athens Insomnia Scale and the DS-14 scale.

Social inhibition was present in 43% of patients suffering from hyperparathyroidism and in 55% of patients suffering from acute myocardial infarction. Negative affectivity was present in 51% of patients with hyperparathyroidism and in 68% of patients with myocardial infarction. As a result, type D personality was found to be present in 29% of patients with hyperparathyroidism and in 46% of patients with acute myocardial infarction.

Prevalence of personality type D was found higher in Greek patients when using the translated DS-14 scale and in comparison to other european studies. Interestingly, Greek patients with acute myocardial infarction had a higher type D personality prevalence than those suffering from hyperparathyroidism, confirming that the construct of type D, however variable, might play a role in the development of cardiovascular events.

There are only few reports on the use of aripiprazole during pregnancy. In our case, the patient was treated with aripiprazole throughout the pregnancy and delivered a healthy baby.

A 31-year-old female was admitted to our hospital for the first time in 2005 as she returned from her postdoctoral studies abroad; prior to the hospitalization, psychotic symptoms had been present for a few months. She had auditory hallucinations and was expressing paranoid delusions. After the treatment with risperidone, the psychotic symptoms subsided. Because of extrapyramidal side effects risperidone was replaced with olanzapine. While on olanzapine she experienced cognitive side effects and was switched to 15 mg of aripiprazole. She achieved good remission and started working again. She got married and in 2009 she decided to stop her medication because she wanted to conceive. Without psychotropic treatment she became paranoid again after 7 months. She resumed with 15 mg of aripiprazole and achieved remission once again. In 2010, after discussing treatment options, she decided to conceive while still on aripiprazole. She got pregnant in June 2011 and in she delivered a healthy baby in February 2012 after a normal pregnancy. She didn’t breast feed. The 6-months followup showed that the baby was developing normally; the parents intend to have another child.

In the presented case the benefits of effective and well tolerated antipsychotic treatment outweighed potential risks associated with prenatal exposure. This is the second case report of the use of aripiprazole during the whole pregnancy.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by symptoms of inattention, hyperactivity and impulsivity. Arises in childhood and can persist throughout adulthood, and may cause difficulties in personal, academic, familiar, social and professional life areas of the individual.

To know and describe the parents’ perceptions of teenagers with ADHD about this disorder.

To assist in the understanding of ADHD in adolescence.

Oral thematic research with parents of adolescent assisted in a Child and Adolescent Psychiatric Clinic of Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil. The semi-structured interviews were performed with 5 families at their residences.

The analysis of parents’ narratives identified two categories: “living with a teenager with ADHD” and “adolescent with ADHD in school context”. Parents realize that they, as well as, school professionals have difficulties in dealing with the adolescent with ADHD. Recognize that since childhood their children manifest different behaviors. They mentioned lack of knowledge, information and guidance related to this disorder. They were concerned about the future of these young people and the discrimination they suffer.

Social and family relations established with the adolescents with ADHD can be characterized by constant conflicts. It is necessary to offer support and guidance to parents, with the joint participation of health care and education professionals. The approaches must be constantly evaluated to its improvement and adequacy, following the different phases of young people's development.

The internship system of some institutes and adolescence period could constitute a favorable medium to develop addiction behaviors among students.

The objective of this study is to determine the prevalence of addicted students of an Institute of the vocational training in city of Mohammedia (North-West of Morocco) and the kind of substances used in this addiction.

An epidemiological study is conducted among 460 students of this institute. These students aged from 18 to 26 years, are individually questioned about their consumption of different kinds of drugs.

The obtained results show that only 100 boys speak freely of their consumption of drugs and/or alcohol and only 6 girls confess to be smokers (tobacco) including 2 consumers of drugs. Indeed, the drug most commonly used is cannabis rolled into cigarettes (Hashish). These drugs are used regularly at least once a day and especially at night before bed to facilitate sleep. The kinds of substances used depend also on socio-economic level of students; the students from rich families consume up to 12 joints a day against some puffs of joint shared by many consumers for poor students. In addition, the poor students consume some local preparation called “maajoune” or “cala”. Alcohol consumption is casual during weekends or ceremonies.

This study is an preliminary investigation that lighted the problem of addiction among students in this vocational training institute. So, deeper researches must be done in order to determine the factors causing and/or influencing this kind of pathologic behavior.

Despite improvements in treatment for patients with severe mental disorders, such as bipolar disorder and schizophrenia, there is still a long delay from first symptoms to correct diagnosis and treatment. Since these illnesses usually manifest themselves within adolescence and young adulthood, this time lag impacts chances for an adequate individual development.

With rather unspecific symptomatology in early stages of the development of the disorders and the still existing stigmatisation, a broad and low-threshold strategy is needed. In November 2008 an early recognition and prevention centre for mental disorders was opened at the University Hospital in Dresden.

The aim of this service is to shorten the delay to correct diagnosis and treatment in severe mental disorders. In parallel, early detection instruments are developed and early intervention strategies studied in research projects.

In this specialized centre diagnostics, counselling and treatment are provided for subjects aged 12 to 40 by a multidisciplinary team in a low-threshold setting.

250 youth and young adults were offered diagnostics and, if appropriate, treatment. In about 2/3 of clients, mental disorders had already manifested themselves, in some cases an additional risk for even more severe developments was ascertained. Counselling and transfer to appropriate treatment is offered to all clients, all are followed up on a regular basis to validate the process and assess the prognostic value of our service.

A broad, low-threshold and multidisciplinary approach for early recognition and treatment of severe mental disorders holds the chance of earlier appropriate care.

Bipolar disorders (BD) are characterized by emotional and cognitive impairment reflected in functional MRI studies. Although the default mode network (DMN) would be also impaired, resting-state activity was much less explored in these patients. Our current study aims to assess the DMN functional connectivity in euthymic bipolar patients (EBP) in order to identify potential trait abnormalities of this disease.

Fifteen EBP and 15 matched healthy controls (HC) underwent fMRI exam during 6 min resting state (rest while keeping attention focused on a visual cross on a projection screen). The Independent Component Analysis (ICA) was used to identify DMN network and functional connectivity in each subject. The DMN group maps of EBP and of HS were compared statistically. Additionally, within-group analysis was performed in EBP group to explore the effect of disease duration on functional connectivity.

Compared to HC, EBP showed reduced DMN connectivity within medial prefrontal cortex, right angular gyrus and left occipital lobe as well as abnormal recruitment of right insula and right middle cingulate gyrus. For the EBP group, significant positive correlation between disease duration and functional connectivity has been observed within left amygdala and right middle cingulate cortex.

Our results revealed decreased DMN functional connectivity within frontal and parietal regions in EBP and suggest abnormal internally-focused activity in these patients. Furthermore, the abnormal recruitment of limbic regions such as right insula, middle cingulate gyrus and amygdala may reflect emotional instability and hyperreactivity of EBP, which might be amplified with the disease evolution.

Cognitive deficits belong to the most common symptoms of schizophrenia as well as of disorders related to substance abuse. It is then important to cope with those deficits effectively during the treatment of rehabilitation process of patients with dual diagnosis.

To analyze cognitive changes in patients with dual diagnosis participating in a cognitive rehabilitation program.

120 patients suffering from schizophrenia with a comorbid drug addiction were recruited to the study. All of them participated in a treatment program in a modified therapeutic community (TC) for patients with dual diagnosis. During their treatment they also took part in a program of rehabilitation of cognitive functions with a use of a computerized training battery. The cognitive functions were assessed twice: first time at the beginning of the treatment and second time after six weeks of cognitive rehabilitation. The applied neuropsychological tests were TMT, part A and B, Stroop Test and Verbal Fluency Test. The intensity of schizophrenic symptoms were measured by the PANSS scale. All participants of the study were treated with second generation antipsychotics.

After six weeks of cognitive rehabilitation all patient improved significantly in all applied neuropsychological tests. There were no significant changes in the PANSS scale results.

The above results confirm the necessity of introducing cognitive rehabilitation in therapeutic programs for patients with dual diagnosis. The above results may also be an effect of other therapeutic interventions used in the TC rehabilitation model, antipsychotic treatment or other factors, which need further investigation.

To explore the effect of depression (D) on relative risk of myocardial infarction (MI) and stroke and its relation with awareness and attitude towards the health in female population of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” (MOPSY) program random representative sample of women aged 25–64 years (n=870) were surveyed in Novosibirsk. D was measured at the baseline examination by means of test “MOPSY”. From 1995 to 2010 women were followed for 16 years for the incidence of MI and stroke.

The prevalence of D in women aged 25–64 years was 55.2%. With growth of D levels positive self-rated health reduced and almost 100% of those women have health complaints. Women with major D significantly extended negative behavioral habits: smoking and unsuccessful attempts to give it up, low physical activity, they are less likely to follow a diet. Major D associated with high job strain and family stress. Risk of MI development in women with D during 16 years of study was higher in 2.53 times (95%CI=1.26-24.34; p< 0.05), risk of stroke was higher in 4.63 times (95%CI=1.03-20.89; p< 0.05 MI and stroke rates were more likely in married women having D with average educational level who being in both “managers” and “physical labor” social classes.

The prevalence of D in women aged 25–64 years more than 50%. Women with D had 2.53-fold risk of MI and 4.63-fold risk of stroke over 16 years of follow-up.

The literature mentions that being burned is one of the most traumatic situations that an individual can experience physically and emotionally. The burned patient has to fight the physical discomfort and the pain, as well as with early and late psychological problems, as delirium, regression, depression and altered body image.

To understand the physical and emotional pain of a group of people who suffered burns.

To understand the suffering of people who have burn injuries.

This is a qualitative participant observation study. 11 groups conducted with 10 patients in a burn unit of a public university hospital were analyzed. Meetings occurred weekly and were 30 minutes to 1 and a half hours long.

The themes related to feelings, fears and doubts resulting from the burn and its treatment were frequent. Patients could only speak of internal pain when they had space to report physical pain. In those moments, some of them could expose themselves to reveal that the burn had been an attempt of suicide. They realized that their problems, fears and fantasies related to recovery, consequences and social isolation were not unique; and they had the opportunity to share them, feeling so relieved.

The experience with the studied group identified some goals for groups with burned patients: to inform about the procedures and questions that cause anxiety; decrease the sense of isolation, stimulating exchanges, instilling hope in recovery; encourage the sharing of concerns about the consequences and social isolation; and identify destructive behaviors.

Group music/art therapy in patients with schizophrenia may not contribute to the treatment outcome but it certainly offers an opportunity to monitor patient's progress during psychiatric treatment. In our case we followed the patient's improvement through ten drawings.

A 24-year-old female psychology student was admitted to our hospital for the first time. She presented with unusual posturing, mannerisms, disorganized speech, auditory hallucinations, and paranoid delusions. According to her mother, the symptoms started about two years prior to the hospitalization. She was unsuccessfully treated with olanzapine at maximum dose. Additional treatment with a maximum dose of amisulpride also proved unsuccessful. After switching her to clozapine and aripiprazole her behavior normalized and the psychotic symptoms subsided. Because of epileptic seizures as a side effect of clozapine treatment she was given valproic acid. She achieved solid remission and was transferred to the day hospital. As an inpatient she attended group music/art therapy sessions once a week. At the beginning her drawings were abstract, disorganized and perseverative. As her mental status improved, her drawings became more and more realistic.

While it is difficult to imagine the way someone with a mental illness perceives the world, drawings produced by the mentally ill offer a hint of this experience. In itself, realistic expression is not ’better’ than abstraction; moreover, it could be ventured that in her early drawings our patient was more responsive to musical stimuli than later when her regaining control produced more organized but also more schematic and stereotypical drawings.

Expressed Emotion (EE) reflects the “emotional temperature” of a family. High EE and low EE families can be identified. The degree of family EE correlates with patients’ outcome, being a high family EE predictive of a greater likelihood of relapse, an increased need for care and inpatient treatment.

Firstly, to evaluate EE, life events and anxiety in a mixed sample of psychiatric, oncological and obese patients recruited from the Psychiatry, Oncology and Nutrition Wards of the “Maggiore della Carità” General Hospital, Novara (Italy). Secondly, to compare these parameters among the three subgroups of patients. Furthermore, we also recruited a cohabiting relative for each patient and compared the relative's EE and EE as perceived by patients.

112 patients attending the Psychiatry (n=34), Nutrition (n=56) and Oncology (n=21) Wards were involved. Patients were assessed by means of the following scales: Level of Expressed Emotion (LEE) scale, Paykel Life Events scale, State Trait Anxiety Inventory 1 and 2.

Data collection is ongoing. Anyway, preliminary results suggest that psychiatric patients are more likely to have a longstanding diagnosis, to have received inpatient care but they are less likely to suffer from comorbid organic disorders. Consistently with current literature, obese patients get higher scores than the other subgroups of patients at EE.

Clinical implications are discussed, focusing on the need to carefully address the issue of high EE families in order to reduce the need for inpatient treatment, increase compliance and improve patients’ and relatives’ quality of life.