Eating disorders are one of the most intriguing and challenging psychiatric illnesses.

Treatment recommendations for eating disorders are still based heavily on expert clinical judgment instead of on scientific evidence from controlled trials.

According to APA's 2006 Practice Guidelines, patient's level of care is determined considering overall physical condition, psychology, behavior, and social circumstances, rather than simply relying on one or more physical parameters, such as weight. Of the five levels of care proposed, inpatient treatment is considered the last resort.

Therefore, inpatient treatment should not be intended to replace outpatient treatment, but to precede and prepare for long-term recovery.

The decision to hospitalize is usually based on several criteria, including medical (e.g. severe weight loss, significant psychiatric comorbidity), psychotherapeutic (e.g. lack of response to outpatient treatment) and psychosocial criteria (e.g. marked family disturbance). Indeed, hospitalization may have its own positive indications, especially when a supporting and stimulating therapeutic milieu is offered.

The primary aim of this study is to characterize a group of 97 eating disorders inpatients admitted in Hospital São João Psychiatry Department between 2000 and 2007, respecting gender, age, diagnosis, previous treatment length, motive for hospitalization and its duration, BMI and number of hospitalizations. Secondarily, significant correlations will be explored and further discussed.

At present there is no unique view point to clinic, etiology and pathogenesis of the obesity evaluation, which can be use for the differential care. Dozen pathologic features should simulate initial forms of obesity such as normal fatness. 37 young people at the age from 19-21 year, self-esteemed their body exterior view, their figure, in 0 to 5 scales, that it is close to ICD-10 with code F 50.4. To all wrote down rest electroencephalogram. We are obtained in training, blind and common group linear regression equation with 300 oscillations parameters. The relations in training and blind subgroups have been close. Prognostic validity firs five predictors, calculated on the correlation coefficient between the computer approach and the reality, R=0.59. Physiological predictors introduced like the same beta rhythm in all brain areas and frequency of 14 Hz in the right occipital region with weights of 59% and 37%, respectively. Three others cover 4%. Main codes related to coherence oscillations and close to man cognitive space. At the level of contemporary ideas it is necessary to individualize selection of excess weight in each case. Thus, the neurophysiologic approach to obesity under nosologic form will draw therapeutic interferences to the case of suffering.

Suicide is a common cause of death in eating disorders and suicide attempts are currently associated with binge eating and obesity. Research has shown that childhood adversities predispose to suicidal behaviour and other impulsive behaviours, such as compulsive eating. The aim of this work was to characterize the relation between childhood adverse experiences and adult suicide attempts and understand in morbid obese adults.

One hundred morbid obese (bariatric surgery candidates) filled out Life History Questionnaire (Felitti & Anda, 1998; translated by Silva & Maia, 2007), an instrument that evaluates the presence of 10 different forms of childhood adversity.

88% report at least one adverse childhood experience and almost 50% report at least five.

25% of the participants report at least one suicide attempt, almost 75% from this group more than one and 30% report an injury as a result of this attempt. In a logistic regression analysis, adversity had increased odds of suicide attempts (X2 (1) = 23.645, p< .000, odds ratio = 2.026).

Adverse childhood experiences and suicide attempts are prevalent in morbid obese adults. Adversity was associated with an increased risk of suicide attempts among bariatric surgery candidates. Taking in account that eating behaviour and suicide attempts can be conceptualize as impulse control problems resulting from adversity, these results should be taken in consideration in the evaluation of bariatric surgery candidates. It's also important to re-think all the selection criteria for inclusion in bariatric treatment, the follow-up of this patients and the philosophy of preventive programs.

The term self-destructiveness is related to human behaviours that lead to reduction of positive consequences and increase the probability of experiencing negative results. According to statistical data a growing number of acute self-destructive behaviours, like suicides, drug addiction and alcohol abuse has been observed in European population recently.

Apart from the acute self-destructiveness some authors have attempted to identify chronic self-destructive behaviours as the tendency to avoid behaviours that lead to positive consequences for oneself. The studies were performed on 15 anorectic women (diagnosed by EAT-26) and 39 non-anorectic women, aged 21,7 ± 1,0 years. All subjects were asked to answer on Kelley's test of chronic self-destructiveness modified to Polish conditions by Suchanska. The results were evaluated in the five-point scale and subsequently analysed with the use of t-Student's and Chi-square tests.

The results showed lack of tendencies to indirect auto-destructiveness in the studied subjects. However the were differences (chi-square=7,54; p< 0,05) in the distribution data showing that anorectic are more prone to such behaviours compared to non-anorectic (14% vs. 0%, relatively).

This work was supported by grant from the National Committee of the Science Research of Poland No 2 P06T 02330.

The Multidimensional Health Locus of Control Scale (MHLC) designed by Wallston, Wallston, and DeVellis (1978) belongs to the most popular tests, assessing the health locus of control in respondents on three levels: internal, external, and accidental. The MHLC is used in health promotion programs, in prophylaxis effect. According to authors, the background of this conception is the conviction that internal locus of health control favours pro-health behaviour like taking physical activity, reduce smoking and alcohol drinking, weights control, HIV protection etc. In this preliminary study we would like to exam the health locus of control in anorexia women.

The MHLC was curry out in 15 anorectic women (diagnosed by EAT-26) and 39 non-anorectic women, aged 21,7 ± 1,0 years. The results were analysed with the use the Chi-square test.

We found the statistically significance differences between anorectic and non-anorectic women in the health locus of control (p< 0,001; Chi=13,24). However, the most of subjects (non-anorectic vs. anorectic, respectively 69% vs. 60%) located the health control inside, more anorectic felt that control on their health depend on the accidence than non-anorectic (respectively, 20% vs. 5%).

The results of this preliminary study could suggest that the health locus of control may play the important role in initiate the anorexia behaviour in women.

The one of the most popular way to slim is used the free-will starvation especially in young women population. The aim of this preliminary study was to assess the influence of free-will starvation on the relative mood in women.The 32 volunteers, non anorectic, aged 26 ± 2,9 (20-30), randomly separated onto two 16-persons groups, were asked to starve one or two days a week by six eight-days periods (48 days). We assessed the relative mood during starve and common days using the 15-centimetres scale from “definitely unfavourable” and the ending as “definitely favourable”. The volunteers were also asked to answer on 15 items Likert’s five-points scale describing psychology, interpersonal, emotional, and functional being. It was no differences in the assess of relative mood in the one-day starve volunteers between starve and non-starve days (average on 10-centimetres point), it was significance differences (p< 0,05) in the two-days starve volunteers (12 vs. 9,5 centimetres, relatively days without vs. with starvation). In the details items it was observed the significant differences in assessing of the mood in both of groups of women between starve and non-starve days in psychological and emotional status especially in increasing feeling of tiredness, nervousness, interpersonal contacts, as well as decreasing feeling of happiness, understanding, support of family and friends.The results of this preliminary study suggest that uncontrol starvation could be reason of family problems and other interpersonal incorrect behaviour.This work was supported by grant from the National Committee of the Science Research of Poland No 2 P06T 02330.

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This disorder is associated with a significant rate of suicide attempts and completed suicides (4 to 10%), a major impairment in social functioning and an increased healthcare utilization cost. Treatments available include psychotherapy and pharmacotherapy. Research has shown some efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) on post-traumatic stress disorder and mood disorder which both share common biological or clinical features with BPD. It is then likely that rTMS might prove efficient on BPD symptoms.

A review of the literature on neuroimaging and neuropsychology of BPD shows a hypoactivity of the dorsolateral prefrontal cortex which may be a potential target site for rTMS.

We will conduct a pilot randomized sham-controlled trial on 30 BPD patients assessing the efficacy of a 10-day course of daily rTMS on neuropsychological tasks, BPD symptoms severity, risk taking behaviour, depression and general psychopathology.

The clinical features of patients with schizophrenia who respond to electroconvulsive therapy (ECT) are uncertain. There is also little information on the nature of symptomatic improvement with this treatment. Using a standardized protocol, 253 patients with treatment-resistant schizophrenia (TRS) were treated with combination ECT and flupenthixol, and 138 (54.5%) patients met response criteria. Independent of gender, duration of the current episode and severity of baseline negative symptoms were predictive of outcome. Duration of illness had weak relations with outcome and only among females. There were marked sex differences in other clinical features and symptoms associated with response. In contrast, no gender differences were observed in the nature of symptomatic improvement. Treatment resulted in marked improvement in specific positive symptoms, with an intermediate effect on affective symptoms, and no effect or worsening of specific negative symptoms. The findings challenge recommendations that long duration of illness or absence of affective symptoms portends poor response to ECT in patients with TRS. Gender may play a critical role in determining the features of the illness that predict outcome.

The ECT is still considered the fastest and the most efficient way in treatment of great depression, although there are some controversies about its effects on brain.

Most of patients suffering from great depression have family, and family members willingly or not, have impact on patient's quality of life, way and prognosis of disease.

Clinic for psychiatry Banja Luka in last year have reaffirmed use of ECT (pulse electricity in hospital condition) with machine which simultaneously monitor EEG, EMG, ECG and PSI.

With this work we want to present two cases (total 15 till now) of different diseases who were submitted to ECT treatment, with accent on family environment.

As long as we live inside sick family, everything that healing can achieve is only “first aid”, bandaging of psychological wounds so patient can function only in the same environment which made him sick in the first place.

Electroshock therapy is in fashion again, but modern psychiatry for this kind of treating is using up to date instruments and methods. Half a century ago this procedure was used for healing serious depression, but was substituted with pharmacotherapy due to side effects like short or long time lost of memory.

Today we have modern technology (ECT with pulse electricity), so side effects are milder, and effects of therapy are better.

With this work we want to present the latest concepts in use of ECT therapy and to present our modest, one year long experience in this area.

We also started prophylactic ECT therapy (in imitation on Military medical academy Belgrade), since we was forced to accept already started treatment some of our patients in above mentioned institution.

Despite the wide consensus over the safety and efficacy of electroconvulsive therapy (ECT), it still faces unfavorable attitudes of patients and families. Little is known about how the experience with ECT affects the patients’ and their families’ attitude toward it. This study examined a sample of Iranian patients and their families regarding their experience with ECT and compared their knowledge and attitude toward ECT before and after this experience and their satisfaction with it. We surveyed 22 patients with major depressive disorder about to undergo ECT and 1 family member of each patient for their knowledge and attitude toward ECT and then surveyed them again after the trial of ECT to compare those variables while assessing their experience and satisfaction with ECT. Patients were rated using the Hamilton Depression Rating Scale and Mini-Mental Status Examination before and after the treatment. Before ECT, family members had a more favorable attitude toward ECT than patients, but after ECT, the patients’ attitude changed more positively. Both patients and their families had a poor knowledge of ECT before the ECT trial, but their total knowledge increased afterward, although not in the areas of indications and therapeutic effects. The majority of patients and their families found ECT to be beneficial and were satisfied with it. There was a high rate of perceived coercion to consent to ECT. Attention should be paid toward educating patients and their families about the ECT as well as informing them about their freedom of choice and right to refuse.

ECT is the most powerful therapeutic tool in the treatment of acute mood episodes. However, data on the efficacy and safety of ECT in the long term management of affective disorders is lacking, despite overwhelming rates of chronicity and/or frequent relapses among patients with unipolar and bipolar depression. In this presentation we will review the data of the ECT unit of Hospital de Santa Maria, Lisboa, on maintenace ECT (m-ECT) in these patients. We compare intra and inter-individual evolution prior and after the institution of m-ECT. Considering the number of hospital admissions, mood symptoms and other parameters, our data support the use of this technique as a prophylatic approach for patients with mood disorders and a previous good response to ECT in the acute phase of disease.