The goal of the authors is to stimulate reflection on the distribution in continuum of compulsive and impulsive behaviours and highlight how important it is to constantly question psychiatric diagnoses, to avoid running the risk of dangerous categorisations.

They describe the case of a 31 year-old patient who attended the Emergency department of Coimbra University Hospitals complaining of depression and obsessive-compulsive symptoms that interfered with his daily life and with his sleep. He said that he used to attend psychiatry appointments and that he was “antisocial”, but added: “I'm as impulsive as much as I'm emotional”.

The patient's records show that he was always diagnosed with antisocial personality disorder, established by the first consultant he saw,specifically mentioning: “problems obeying rules”, “impulsiveness”, “getting into fights and brawls entailing legal action” with the obsessive-compulsive symptoms being secondary. However, the follow-up of the patient conduced by me revealed obsessive-compulsive symptoms in special compulsive checking rituals (which began in childhood), excessive concern with the size of his nose (and other parts of the body) that started in adolescence, as well as a personality marked by impulsiveness and a poor frustration tolerance, leading to highly aggressive episodes triggered by events/circumstances that he himself did not regard as particularly relevant. The results of the studies on the relationship between impulsiveness and compulsiveness could have a strong impact on reformulating the psychiatric nosology. Whenever we come across a new patient, as complete a clinical history as possible should be taken and easy diagnoses should be avoided.

Complete assessment is a key to the conceptualization process in Cognitive Psychotherapy. Given the data-orientation of the model and the need for outcome measures, the assessment of neuropsychological functioning plays a large part in the process. Using a computer-based program, several scales measuring neurocognitive functioning can be assessed rather quickly. The obtaimned scores then become baseline for the evaluating the reults of the therapy. The required reading level is approximately fourth grade, and the norm population includes children, adolescents and adults. Available in 58 languages, the CNS-VS can be demonstrated to be a powerful tool in the psychotherapeutic process.

Chair: Dr. Norey Nigro (USA)

Discussant Prof. dr. Arthur Freeman (USA)

Panelists: Prof. dr. Andrzej Kokoszka (Poland)

Prof. dr. Daniel David (Romania)

Dr. Corey Nigro (USA)

Psychiatric diagnosis depends more from the experts' opinion than from the biological basis of the diseases. Therefore the lack of diagnostic stability among the psychiatric practice is not a rare situation. This usually results in increased costs in treatment and sometimes in worst outcome for the patient who is misdiagnosed at the onset of the illness.

The authors evaluated diagnostic stability among a population of 302 patients receiving psychiatric treatment in a day-care unit of a central hospital between January/2005 and June/2008. The study compared diagnostic stability of 146 patients diagnosed as mood disorder with diagnostic stability of 83 patients diagnosed as psychotic disorder.

There was high diagnostic stability either for mood disorders as for psychotic disorders. This fact provides the chance of planning more accurate treatment strategies and better outcome.

The idea that schizophrenia and bipolar disorder stand as two distinct entities of mental illness came from German psychiatrist Emil Kraepelin in the late 1800s. So began the separation of the diseases that still marks today's psychiatry. However, in practice, it's not always easy to distinguish the two disorders. Schizophrenia and bipolar disorder have a number of symptoms and epidemiological characteristics in common, and both respond to dopamine blockade. Family, twin and molecular genetic studies suggest that the reason for these similarities may be that the two conditions share certain susceptibility genes.

The authors present a revision of several articles that reveal new evidences supporting the unitary psychosis theory. This theory has its origins in 1830s with Guislain, Zeller and Griesinger and defends a continuum of mental illness from schizophrenia to bipolar disorder. More recently genetic studies show overlapping of some predisponent genes of both diseases and some imagiological findings are also present in both. The existence of a continuum of mental illness may be useful for new treatment strategies and prognosis.

A conception of a mental health is treated very ambiguous. Along with this an assessment of treatment efficacy for mentally ill persons includes a significant number of criteria which are changed continuously in time. Always there is a number of factors influencing on a development, course and outcome of disease. All of them might be considered as predictors of treatment efficacy and must be taken into account in a choice of criteria for therapeutic efficacy.

At the “Institute of Neurology, Psychiatry, and Narcology of the AMS of Ukraine” State Institution an investigation of 184 patients with neurotic disorders had been performed with analysis of predictors of therapeutic efficacy and on the base of data obtained criteria for assessment of treatment efficacy were improved. 81 male and 103 female patients from 18 to 60 years old were examined.

Clinical-psychopathological and pathopsychological predictors with a negative and positive influence on therapeutic efficacy were defined. The most significant of them were included into an integrative index of therapeutic efficacy for patients with neurotic disorders. It consists of such parameters as structure of psychopathological manifestations, level of psychotrauma generalization, level of compliance between the patient and his/her physician and surrounding, peculiarities of personality accentuations, level of a subjective self-control, patient's anxiety and rigidity, importance of a social and personal self-realization, type of attitude to the disease. These actual issues must be taken into account in a psychotherapeutic process. That will allow to increase its efficacy and to prevent recurrence of the disease.

Hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, author propose a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from any other DSM or ICD disorders including depressive disorders. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder.

The WCST has shown to be useful in detecting frontal-lobe dysfunctions in patients with ADHD, schizophrenic patients, Parkinson's disease. The computerized version of the WCST is based on the same normative data developed previously for the standard (manual) 128-card version. However, the equivalence of the measures of both versions has not yet been investigated.

The present study investigated the performance of a sample of Brazilian children aged 6-10 years, using the computerized version of the WCST. The results were compared to those of Brazilian and American children which used the manual version.

The Brazilian sample in the present study was composed of 400 children. The comparison between groups was carried out by age-group using t student test.

Results showed significant differences of North American children (manual version) in almost all measures in the age groups, where the Brazilian children presented a poorer performance. The comparison between the Brazilian samples (manual and computerized version) showed differences only in some measures; however, children of the present study obtained higher scores than those which used the manual version.

In conclusion, the differences between computerized and manual versions in both Brazilian samples indicate that the norms provided for the manual version should not be used for the computerized version. The comparison between American and Brazilian samples also indicates that regional normative data must be provided for computerized WCST adaptations.

Catatonia is a neuropsychiatric syndrome characterized by a combination of disturbed motor functioning and changes in thought, mood and vigilance. Two patterns - one consisting in catalepsy, posturing, mutism and negativism and a second consisting of echophenomenon, automatic obedience, verbigeration, and other stereotypies - have been abstracted. Catatonia has been associated with psychiatric disorders - schizophrenia and bipolar disorder for example - as well as secondary to various underlying medical conditions.It will be described a case report of a 55 years old woman with prior psychiatric history of hospitalization with an unspecified nonorganic psychosis (F29-ICD10), presenting features of catatonia - immobility with fixed posture and gaze (sometimes presenting posturing), an almost absence of spontaneous movements and speech, echophenomenon (echolalia, palilalia, coprolalia) erupting in a otherwise mute state and showing, on occasions, periods of purposelessness motor excitement and restlessness, verbigeration and screaming with a grim of terror. She was disoriented and performed poorly on the MMSE. No neurologic focal signs were disclosed other than prominent primitive reflexes. Prior to admission, her family reported a sudden mood change: she became irritable, argumentative, with delusional thought content of persecutory nature, grandiose ideas. Viral and immune-mediated encephalitis were discharged. The MRI scan showed a right temporal medial lesion (amygdala atrophy). It will be addressed the hypothetical relationship between the dramatic clinical presentation and the cerebral lesion, grounded on the scientific research regarding limbic encephalitis, catatonic symptoms and neurophysiology. It will also be underscored the clinical relevance of differentiated psychopathology of catatonia.

Trichobezoar was first described by Baudomant in 1779. This rare entity consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome.

It is only reliably diagnosed by CT scan and its size may require removal by open surgery.

Albeit trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but scarce reports on psychiatric literature. It is estimated that 30% of cases of trichotillophagia are of patients suffering from tricotillomania, and that 1% of those will eventually require surgical treatment.

The authors report a clinical case of trichobezoar without known trichotillomania, and revise the existing relevant literature, focusing on psychiatric evaluation and management.

Compulsive hoarding has been generally described as the compulsive acquisition of possessions and the inability to discard them. It has been considered as a syndrome consisting of compulsive acquisition, difficulty discarding and clutter. It is described mainly in association with obsessive-compulsive disorders (OCDs) and in geriatric populations, although it may be seen in a range of other disorders.

Compulsive buying or shopping disorder has been characterized by excessive or poorly controlled preoccupations, urges, or behaviours regarding shopping and spending that lead to subjective distress or impaired functioning. Although it has been considered as part of impulse control disorders, it has also been reported associated with other disorders.

These two entities have raised relevant questions regarding whether they are part of dimensional or categorical constructs, symptoms or well established disorders. By presenting two case reports, the authors address some of these issues and the existing scientific literature.

Mental disorders are one of the most problems in the world and influence on medical disease thus this study investigated the prevalence of mental disorders in medical wards of Beheshti hospital.

Mood disorders are common and account for one of the greatest causes of disability worldwide. Accordingly, those conditions are frequent among patients treated in Psychiatry Day-Hospitals facilities. Patients referred for treatment in Hospital de São João Day-Hospital have a previous variable period of follow-up in ambulatory clinic or hospitalization, commonly, with an established diagnosis. Notwithstanding, during the Day-Hospital stay, diagnosis may be reviewed because of new clinical data. Diagnostic stability over time is an important issue in clinical practice because it may influence treatment and, therefore, the final outcome. It is closely related with the contact between the patient and the healthcare system. Diagnostic instability is commonly due to fluctuation of disease manifestation over time or presence of co-morbid psychiatric illness in combination with rigid diagnostic criteria. The main objective of this study is to evaluate the diagnosis stability of Mood Disorders among patients treated in a Psychiatry Day-Hospital, applying ICD-10. The clinical sample includes patients admitted to Hospital de São João Psychiatry Day-Hospital whose main diagnosis is a Mood Disorder (F30-39), in the period between January 2005 and June 2008. Admission and delivery diagnosis were compared for each patient in this diagnostic category. Results suggest a high level of stability in this diagnostic group in the Day Hospital setting. For global conclusions about stability of Mood Disorders it would be interesting to replicate this study with larger samples and in different settings.

Anxiety and depression are very common in patients with medical illness and can be associated to a reduction in quality of life and a poor clinical evolution.

The actual concept of anxiety is based on many theoretical models as Goldstein's anxiety model, State/trate anxiety model, Lazarus' transactional stress model. The concept of depression is based on models such as Beck's Cognitive Model and Seligman's learned helplessness model of depression.

The link between anxiety/depression and medical illness can be of two kinds: biological (immunological, neuroendocrine, inflammatory systems) and behavioural (coping strategies, adherence to medical advice and prescription, etc).

A dimensional approach should be used to access anxiety and depression in medical once the thresholds of depression and anxiety that are associated with medical outcomes are not known.

Both self report and rating scale/interview measurements have certain advantages as well as certain inherent disadvantages. Neither approach is universally better than other.

Some of the most used instruments are Hamilton Anxiety Scale (HAM), Hamilton Depression Scale (HDS), Montgomery and Asberg Depression Rating Scale (MADRS), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and State Trait Anxiety Inventory (STAI).

The only scale validated exclusively to access depression and anxiety in medical population, and that can overcome the influence that medical disease has in depression and anxiety is HADS.