Many studies investigated social, psychological, existential and environmental risk factors in the background of suicidal behavior, while recent researches put emphasis on the neurobiological basis by revealing impairments in decision-making related to the ventromedial prefrontal cortex. In this ongoing study we aimed to integrate these approaches with examining the correlating factors of personality character traits, impulsivity and the function of ventromedial cortex.

30 suicide attempters and 28 controls participated in our study. Data regarding the act of suicide, previous attempts, personal and family history, current medication and general health state were recorded. All participants received Temperament and Character Inventory (TCI) and Barratt Impulsivity Scale (BIS) and they were asked to perform the computerized version of Iowa Gambling Task (IGT).

Suicide attempters scored significantly higher on BIS. They achieved significantly higher harm avoidance and transcendence scores and lower self-directedness, social deviance and cooperation scores on TCI (p< 0.05). Suicide attempters selected less advantageous desks on both reward and punishment sensitive tasks of IGT (p< 0.05). Significant correlation was found between novelty-seeking personality trait and punishment sensitivity (p< 0.05).

Our study supports the previous findings regarding the impairment of ventromedial cortex in the background of suicidal behavior. Furthermore, we demonstrated relation between this alteration and specific personality traits of suicide patients. This approach may shed light on the interaction of psychological and neurobiological risk factors.

Psychiatric disorders are from prevalent outcomes of chronic diseases such as diabetes mellitus. In spite of focused attention of prior researchers on psychiatric distresses of diabetes type2, there were not enough researches about psychopathology of diabetes type1. The aim of this study was to compare psychopathology of diabetes type1 with type2, and assess its relationship to demographic factors.

In this cross-sectional study, all of type1 and type2 diabetic patients who have medical records in "Khorasan Center of Diabetes Researches" matched about age and gender, then assessed their psychopathologies by using SCL-90-R questionnaire. Finally, 66 diabetic patients (33 with type1 and 33 with type2) completed the questionnaires and results processed by SPSS software.

The most prevalent pathology in SCL-90-R items was related to paranoid ideations (69.7%) and less prevalent item was phobic anxiety (33.3%). Prevalence of psychopathology in diabetic patients was 56.1%, in type1 diabetics more than type2 (66.7%, 45.5%), and in men more than women (63.3%, 50%). Independent t-test did not demonstrate a significant correlation between psychopathology and type of diabetes (P=0.156), but obsessive-compulsive symptoms and hostility in diabetes type1 have seen more than type2 (P< 0.05). ANOVA only could demonstrate relationship of education (P=0.006) and frequency of complications (P=0.011) to psychopathology.

Great prevalence of psychiatric disorders in diabetic patients, need more attention for early diagnosis and treatment.

Hypochondrias is a psychiatric disorder that is recognized with a strong belief and concerns about having a serious illness. Objectives of this study were determination of the frequency of these symptoms in medical sciences fields’ students in their relation with age, gender & educational major and degree.

This study was performed on 500 randomly selected students in Mashhad University of Medical Sciences. Those with a known previous medical or mental disorder or defectiveness were excluded. Assessment was done with the hypochondrias questionnaire that includes 36 items. Data was analyzed with appropriate statistical descriptive and analytic tests such as chi-square, independent t and ANOVA.

In the present study the prevalence of hypochondrias in medical students were %36.8 at the borderline level and 16% as the disorder level. Out of 70 cases with hypochondriac disorder 57 had mild and 13 had moderate symptoms. This disorder was significantly more prevalent in girls than boys (P=0.000) and it was not related to marital status (P=0.318), However, all the students with moderate disorder were single.

The present study showed the higher prevalence of hypochondrias in Iranian medical sciences fields’ students compared to those in other countries. In contrast to other studies, the disorder was more prevalent in women in this research. Hypochondriac symptoms in medical sciences fields’ students especially in ones with inaccurate medical information are frequent, in this study also there was a higher prevalence of symptoms in people with bachelor degree than those with other educational levels.

The recent increase of immigrant population in some European countries represents a new social reality demanding an update of psychiatric clinical practice and resources. We aimed to:

1. 1. compare the clinical and demographic profile of immigrant patients admitted to a Spanish acute psychiatric ward with that of native patients, and

2. 2. detect changes over the last years regarding both the profile and the occupation of psychiatric beds.

Demographic and clinical data of immigrant patients admitted to the Doctor Peset University Hospital acute unit during 2005-2007 were retrospectively analyzed. For each case, a non-immigrant patient was assigned as a control. Immigrant subjects hospitalized during 2007 were compared to those admitted during 2000.

Over the three-year period, 38 immigrant individuals needed 45 hospitalizations (2.9-5.1% of total annual psychiatric admissions). Native patients presented similar demographics and produced a similar number of hospital stays, but had significantly more psychiatric (p=.02) and medical (p=.05) comorbid conditions. Immigrant patients hospitalized during 2007 (n= 12) were comparable to those admitted in 2000 (n=6), although the former accounted for a larger proportion of annual admissions (3.44% vs. 1.93%).

During the last seven years, the occupation of psychiatric beds by immigrant population has almost doubled but it is still in the low range. The clinical and demographic profiles of patients admitted to this acute ward were similar, regardless of their geographical origin.

The study sought to investigate the psychosocial determinants of quality of life 6 months after transplantation.

A liver transplant candidates sample (n=60), comprising consecutive patients attending out-patient clinics of a liver transplantation central unit (25% of the patients had Familial Amyloid Polineuropathy (FAP) and the remaining patents had chronic liver diseases), was assessed in the pre-transplantation period by means of Neo FFI personality inventory, HADS, Brief COPE, and SF-36, a quality of life self rating questionnaire. Six months after transplantation these patients were assessed by means of SF-36.

Psychosocial predictors where found by means of multiple regression. The physical component of quality of life 6 months after transplantation was determined by coping strategies and physical quality of life in the pre transplantation period (this model explained 32% of variance) and that mental component 6 months after transplantation was determined by depression in the pre transplantation period and by clinical diagnosis of patients (FAP patients with lower mental component of quality of life) (explained 25% of the variance).

Our findings suggest that coping strategies and depression measured in the pre-transplantation period are important determinants of quality of life 6 months after liver transplantation.

Further studies are needed to identify the extent to which early and continued psychotherapeutic interventions can improve not only mental but also physical related quality of life in patients at risk, for example patients with increased scores for depression and for non adaptive coping strategies in the pre transplantation period.

The effect of minor orthopaedic day surgery (MiODS) on patient's mood.

A prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of General Anaesthesia (GA) were included. The Medical Outcomes Study-Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and postoperatively.

The mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n = 148, p = 0.51, 95%CI = (-1.03 -1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient, r = 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well with χ2 (df = 1) = 0.86 for which p = 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.

MiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.

Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet.

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic are evaluated for the presence of alexithymia, with the use of the Toronto Alexithymia Scale, as part of a prospective cohort. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category. Association of psychiatric symptoms with prostatitis category was performed.

Preliminary results are reported for 30 patients (median age 43 years old; IQR= 36-52). According to the NIH Prostatitis Classification System patients were categorized as type II : 48.2%, type IIIa: 6.9 %, type IIIb: 38%, type IV: 6.9%. Median CPSI score was 16 (IQR: 11-25). Abnormal TAS score was noted in 72% of the population. Specifically, 90% had high scores in external orientation of emotions, 25% in identification of emotions and 38% showed reduced expression of emotions. It is of notice, that mean TAS scores were significantly higher in type IIIa prostatitis cases (p=0.002, ANOVA).

High rates of alexithymia were noted in prostatitis subjects especially in type IIIa cases. These findings need further prospective evaluation.

Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.

Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.

There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.

Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.

Dhat syndrome is a widely recognized clinical condition from the Indian subcontinent characterized by a preoccupation with semen loss in urine and other symptoms such as fatigue or depressed mood. This condition has been considered to be a culture-bound syndrome, and may be considered to be a culturally manifestation of depression or anxiety.

The purpose of this paper was to perform a systematic review of published literature on Dhat syndrome.

A review of the literature on Dhat syndrome until July 2008, without any language restriction was conducted by a search of the MEDLINE and PsycLIT indexing services using the following key words:Dhat syndrome, semen loss anxiety and loss of semen syndrome. Inclusion criteria were any case-control or cross-over study.

Twenty-three studies were identified, of which 10 met the inclusion criteria. There were 8 cross-over and 2 case-control studies. The reviewed studies included a total number of 680 cases and 93 controls. Patients included in these studies were mostly unmarried, young males (25.4 years old;18-45 years) from a poor socio-economic status. Majority of the studies involved patients from the Indian subcontinent. Some studies reported concomitant depressive symptoms (50%), anxiety (40%), fatigue (30%) and sexual problems (40%). Only 4 studies reported information about treatment (psychotherapy and pharmacotherapy).

There was a high degree of heterogeneity among the studies reviewed. In conclusion, Dhat syndrome appears to be commonly associated with depression, anxiety and somatic symptoms. More studies are warranted related to the various treatment approaches for this condition.

The purpose of this study was to examine the relationships in early adolescence between self-reported reading difficulties (RD) and psychosocial and socio-demographic factors in a large representative population sample of 2464 adolescents (50.8% girls) with a mean age of 13.7 (SD: range: ) in Norway.

Sub-sample: Students with self-reported RD; 7.5% (N = 191) of the total sample, 7% girls (N= 88) and 8.5% boys (N =103).

Standardized self-report measures of depressive symptoms based on DSM-IV symptom criteria, (The Mood and Feelings Questionnaire), and on self esteem (The Self-Perception Profile for Adolescents) and attachment (The Inventory of Parent and Peer Attachment) were used.

Adolescents with RD were compared to classmates. In univariate analyses RD adolescents demonstrated higher levels of depressive symptoms, more school stress, had lower school grades and lower attachment to parents. They also scored lower on Global Self-worth and on Social Acceptance scales. Further, they reported reduced levels of psycho-functioning during the previous year because of mental health problems. They also had received more help and had used more medication for such problems.

In the multivariate logistic regression analysis, receiving help for mental health problems and reduced psycho-functioning showed the strongest association with student RD status (OR=2.32 and OR=1.75, respectively). No gender differences were found.

The study demonstrated important differences between adolescents with and without RD. Adolescents with RD might be more at risk for mental health problems than others.

The aim of the study was to evaluate the response of different monoaminergic systems to psychostimulant treatment in children with mild form of hyperkinetic syndrome (HKS).

The levels of N-methylnicotinamide (end product of kynurenine pathway of tryptophan metabolism), 5-hydroxyindoleacetic (product of serotonin pathway of tryptophan metabolism), homovanillic and vanillylmandelic acids were measured in daily (3 days) urine samples of children (30 patients, 7-11 years old) with mild HKS with normal intellect or borderline mental insufficience. Biochemical measurements were performed before and 3 weeks after sydnocarb medication (5-15 mg sydnocarb daily). (Sydnocarb is a psychostimulant introduced into the clinical practice in the Soviet Union in the 70th of XX century).

After 3 weeks of sydnocarb therapy there were found the improvement of children's clinical status in both groups. It was followed by a significant decrease in the excretion of homovanillic (by 45 %), vanillylmandelic (by 35 %) and 5-hydroxyindoleacetic (by 50 %) acids but by a significant increase in N-methylnicotinamide excretion (by 30%).

Psychostimulant medication has revealed the involvement of kynurenine and serotonin in HKS pathogenetic mechanisms. There were found a reciprocal relationship between serotonergic and kynurenine systems. It is proposed the kynurenine hypothesis of pathogenesis of HKS. It is characterized by the decreased activity of kynurenine system in HKS children. Clinical improvement of HKS children under psychostimulant medication is connected with activation of kynurenine system along with the decrease of serotonergic activity.

Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.

Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.

We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.

In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

Videoconferencing (communicating with a two-way sound/picture system) may help reduce travelling and may save time and money for patients and the health care system. Despite the fact that studies have found videoconferencing as good as face-to-face interactions for certain therapies, few in Norway use this tool routinely for consultations with patients. We examine clinicians’ experiences with videoconferencing and their attitudes to using this tool for psychiatric consultations.

Qualitative interviews were carried out with five MDs and six clinical psychologists with videoconferencing experience. They were asked about their experiences with videoconferencing and about their thoughts about using videoconferencing for consultations. Data analysis was inspired by Grounded Theory.

While they generally were positive to the idea of conducting consultations by means of videoconferencing, they had little experience in doing so and were worried that videoconferencing may be less effective than face-to-face consultations. A central worry was that communicating is more difficult by means of videoconferencing and that subtle signals may be missed. They were also concerned about how they will be able to perform such tasks as demonstrating empathy. They expressed concern about possible technical problems and an increased total work-load. Some thought that establishing a system for training and assisting clinicians in their videoconsultations will increase use.

The clinicians had little experience with using videoconferencing for consultations. Despite some worries relating to relational, practical and technical matters, most were positive. Establishing a system for training and assisting clinicians may increase the use of this tool for consultations.