The pregnancy and the motherhood of adolescents are complex phenomena that happen on the trajectory of life of the young persons under physical, psychological and social aspects.

To deepen knowledge of the emotional experiences of socially disadvantaged adolescent primiparous with premature babies.

qualitative-clinical. Criteria of inclusion: age group, to be primiparous with premature baby and acceptance in participating of the inquiry. The intentional sample was made up of five adolescents aged between 16 and 19. The study was carried between June/2008 to October/2009. Semi-directed interviews based on the trigger question “Tell me about your pregnancy and your baby's birth”. The data were submitted for thematic analysis and from this the following categories emerged: 1. Late discovery of pregnancy: “Mine was a lightning pregnancy”; 2. The symbolization of the child: “It was a present for me…” discussed within a theoretical framework of reference, with special emphasis on the psychodynamic approach.

On a psychological perspective, the adolescents had presented feelings of omnipotence, unfamiliarity, shock, surprise, anger, fear, anguish and happiness at the birth of their child. They appeared to use immature, narcissistic and neurotic defence mechanisms such as denial, dissociation, acting out and idealization as well as revealing the desire to be good mothers and to engage in maternity.

These finds can subsidize the team of health responsible for the service in neonatal intensive care units, developing attitudes more effective of support and giving emotional presence aiming to reduce the fear and anguishes resulting from the situation.

To interpret the meanings of the silence from Brazilian working women about their urinary incontinence (UI).

A clinical-qualitative method was used with semi-directed interviews with open-ended questions. The sample consisted of eight women aged 30 to 45 from low-income brackets of the population with complaints of UI and who had never sought treatment. The resulting data was analyzed according to the thematic content analysis technique, based on psychosocial and psychodynamic approaches. The authors were aware of the polysemic character from the speeches in Human Science research.

The difficulty that women with urinary incontinence face in talking about the problem is an indication of the anxiety involved. They generally avoid discussing it due to embarrassment and from fear of being judged and misunderstood. In addition, their underprivileged social, economic and cultural situation may have aggravated their limitations in expressing their feelings. In terms of psychic processes, these women’s silence can be seen as a way for them to contain the physical symptom that their UI has brought on. Since it is so hard to express themselves in words, everything remains “unsaid,” but this silence can be interpreted as a way of expressing painful and unnameable feelings.

The silence of Brazilian women with urinary incontinence proved to be an essential element of communication about this disorder and was as important as the words they uttered. Their silence evidenced the pain and anxiety they experienced, and it emerged as an adaptive psychosocial mechanism.

To discuss meanings associated with the body and experiences of sexuality reported by Brazilian women with urinary incontinence.

Clinical-qualitative method was used with semi-directed interviews with open-ended questions. The sample consisted of eight women aged 30 to 45 from low-income brackets of a population with complaints of UI and who had never sought treatment. Resulting data was analyzed according to the thematic content analysis, based on psychodynamic approaches. The researchers paid attention to the emic perspective, that is, the insider’s point of view or the reasons for certain interviewees’ customs/beliefs.

Women's experiences of living with UI are presented in two categories:

(1) A body that is damaged: They report their current body image is one that is marked by a lack of physical and emotional control, worn by time and motherhood, which has resulted in the feeling of growing old prematurely.

(2) An interrupted sexuality: They desire a sexually active life, but UI results in a constant state of unsatisfied desire, since they experience incontinence as something that inhibits sexual pleasure. They experience sexual intercourse as a means to satisfy their partner, but do not derive pleasure from intercourse themselves.

Women with UI - young and within their reproductive period - have reported life experiences that indicated feeling powerless, with a sense of rejection of their body. They exhibited a sense of loss in terms of inability to experience orgasm due to urinary loss, as well as feeling secondary to the satisfaction of their partner.

Adolescents who was born with HIV, usually followed by paediatricians, present new challenges to health care teams during transition to adult medical care.

To discuss the emotional meanings of transitioning this group to adult health care.

Clinical-qualitative approach with preliminary interviews conducted with eight HIV-infected adolescents followed at Federal University of São Paulo, Brazil. The data were processed through Qualitative Content Analysis and discussed based on theoretical psychodynamic frameworks.

The emergent themes were feelings of loss, risk of rupture of solid ties and unpreparedness to changes perceived as threatening. The transition to adult health care points to the need for developing patient self-care: “... I have to take more responsibility, I’m not ready, I’m still a teenager.” They also mentioned concerns in moving away from their paediatricians, “here is like a family. I feel like they care about me ... they are not just doctors... kind of teacher... mother, you know, “If I have to leave, I’ll cry... “Is there a place where the paediatricians could follow us until 30 years?” On the other hand, there were testimonies showing compliance or interest in changing, it's normal, I’m older, I have to stay right there”, “I’m the oldest ... it's weird to be among children.”

Although adolescents understand the need of transition of health care, they manifest several difficulties. Individualized transitioning plans and increasing interaction between paediatric and adult HIV care providers could better address the needs of this unique population.

The bladder and prostate cancer have similar invasive treatments, which imply in psychological alterations for the patient. They face changes in their way of life, have their male fragility exposed and they still charge themselves as the provider role in their families.

To discussemotional meanings related to cistectomized and/or prostatectomized outpatients who exercise the leading condition in their family structure.

Clinical-qualitative with semi-directed interviews with open-ended questions and using saturation sampling closed with 9 married patients between 40 and 77 years old. Interviews were recorded and transcribed for later psychological interpretation.

It is emerged five topics as patients’ biggest concerning on postoperative:

(1) Ego and Probe: There is a physiological and psychological discomfort about using a probe. They are afraid of what people will think, affecting their self-esteem and making them feel incapable;

(2) Lack of Bladder Control: They reported “moral decay” and prefer being away of their day-to-day activities instead of using a diaper and deal with limitations;

(3) Sexuality: The most important topic. There is an important loss of sexual practice and frustration. There is a connection between fear of being impotent and development of new ways to find pleasure and sexual satisfaction;

(4) Relationship: Marriages were not shaken by the situation and intimacy increased; and

(5) Escape of Reality: They said they had “lived life” as a way not to feel private about everything they had lost.

It is important to have a bigger emotional and psychosocial support for these patient’s postoperative.

The object of this study have covered the psychological and sociocultural experience in context of depression occurred in postpartum period. The research assumes that pregnant women have the expectation that the motherhood is one of the most important moments of their lives and thus need to feel happy in face of childbirth, while women who had postpartum depression can experience feelings of anxiety and guilt. In addiction, there could be limitations on the child care and support or false sense of support felt by these women in relation to her partners, relatives, doctors, nurses and others.

The aim was to discuss what the perceptions and points of view brought by the women about this health problem represent or represented, emotionally and socio-culturally.

We used the clinical-qualitative method, employing the technique of semi-directed interview with open-ended questions and we close the sample using the theoretical saturation of information, were sought on issues that could support better ways of managing such patients by health professionals. The researchers paid attention to the emic perspective, that is, the insider’s point of view or the reasons for certain interviewees’ customs/beliefs.

In processing the data through both qualitative content analysis and free-floating readings, it emerged the following discussion categories:

(1) the escape the feeling of guilt brought by the difficulty of caring for the child;

(2) how to deal with family support upon arrival in the home;

(3) to learn to manage the strong sadness;

(4) the need for baby care.

Varicella Zoster Virus infection is quite a common condition overseas, for which Acyclovir seems to specifically help reducing the duration and severity of its symptoms.

Some central nervous system side-effects have been described while receiving treatment with Acyclovir or one of its analogs Ganciclovir and Valacyclovir, and eventually psychiatric disturbances between them.

We report the case of an Acyclovir-induced psychosis with manic symptoms in a 22 years-old woman with no previous psychiatric history.

The patient presented with irritable mood and grandiose delusions 72 hours after starting oral Acyclovir for a chickenpox infection coursing with diseminated rash.

The patient was admitted to the psychiatric unit 2 weeks after stopping treatment, albeit symptoms persisted. She was treated with Olanzapine in first place with modest improvement and Haloperidol in second place, finally recovering her previous mental state with no residual symptoms.

There is a significant body of evidence warning about neuropsychiatric disturbances as a side-effect of treatment with Acyclovir and its analogs, specially when using intravenous administration, or in a renal failure condition. Although uncommon, psychosis with manic symptoms in young and healthy patients should be kept in mind in order to recognise it and offer best support.

Systemic Lupus Erythematosus (SLE) can affect central nervous system (CNS), leading to neurological and/or psychiatric disorders. The use of corticosteroids for the management of SLE may induce psychiatric disorders.

Differential diagnosis of the origin of psychosis in patients with SLE (CNS lupus vs. induced by corticosteroid therapy).

A 22 year old female patient presented asthenia, oral bleeding, epistaxis, metrorrhagia, bicytopenia, hypoalbuminemia, low complement, with anti-DNA > 300, ANA, IgG Anticardiolipin, Anti-Sm, anti-RNP, anti-Ro, Anti-La and Anti-Histone positive.

A diagnosis of SLE was made. She presented also diffuse grade IV nephritis. There were administered 3 iv 6-methylprednisolone pulse therapies (750 mg/day) with a cycle of cyclophosphamide. Subsequently she continued with oral prednisone 60 mg/day. Four days after the end of the pulses, the patient developed anxiety, suspicion, injury delusions, auditory hallucinations and behavioral disinhibition. A MRI was normal. Risperidone was started up to 6 mg/day and oral prednisone was tapered. After a progressive improvement she was discharged.

Corticosteroids induce psychiatric disorders in 3–10% of patients. Low levels of complement, hypoalbuminemia and a positive ratio (≥ 9) of albumin in CSF x103/serum albumin are indicators of blood brain barrier damage and psychosis induced by corticosteroids. The presence of ac Antiribosoma P, ac antineuronals, MRI or EEG abnormals suggest the diagnosis of CNS lupus (lupus psychosis)

Differential diagnosis between lupus psychosis vs. psychosis induced by corticosteroids is complicated. In case of doubt, some authors advocate increasing the dose of steroids and awaiting a clinical response. Others advocate rapid tapering and stopping steroids.

The discharge letter plays a crucial role in continuity of care from secondary to primary care. We found no existing study of outpatient discharge letters, including Mental Retardation services. New Ways of Working for psychiatrists has encouraged the discharge of stable outpatients to primary care in order to provide a responsive, flexible service. This study set standards for discharge communication and identified areas for improvement.

This was a retrospective random audit of 30 service users discharged from a psychiatric outpatient clinic. Standards were set with consultant psychiatrists and general practioners. Data was collected from the service users’ last two clinic letters using a pre-developed audit tool and compared the current practice with the standards identified.

Standards for status and future planning were largely achieved with reference to current mental state (97%), current medication (90%), other LD professionals involved (95%), advice and how to re-refer (90%).Standards for historical factors were partially achieved; including summary of contact with services (70%), summary (57%) and evaluation (67%) of treatments received. Some standards were not achieved; including requesting view of primary care prior to discharge (27%), statement of capacity (23%), risk factors (23%) and relapse indicators (27%).

The audit showed areas of good practice and areas for improvement. Results were disseminated to MDT's and a template developed for outpatient discharge letters. A re-audit has commenced to ensure progress in this important information-sharing process and to enhance the delivery of safe and effective health care.

Risperidone has been recommended for the management of disruptive behaviour disorders in children with learning disabilities. This study explored the effects of Risperidone on absolute body weight in children with learning disabilities who received Risperidone for disruptive behaviour disorders.

Data was collected for children (n = 70) with learning disabilities who were prescribed Risperidone for disruptive behaviour disorders in out patient clinic. Weight, height and BMI were recorded at the first appointment and at the follow up for up to one year. Data was analysed to find any changes in weight and BMI during the course of treatment with Risperidone.

Mean weight gain for the sample was 6.1 kg (sd = 2.7), 1.7 kg more than expected in one year which was statistically significant (t = 6.2, df = 69, p < 0.001). Mean BMI change was 1.51 kg; significantly larger than the mean expected BMI change of 0.62 of this sample (t = 4.98, df = 1.6, P = 0.001). Change in BMI was more for girls, 2.17 (sd = 1.00) compared with boys 1.36 (sd = 1.18), but this was not significant (t = 1.90, df = 49, p = 0.06). There is no significant relationship between Risperidone dose and weight gain (Pearson's r = 0.21, p = 0.42) and BMI (Pearson's r = 0.03, p = 1.00).

Risperidone should be used with caution in children where weight gain could have long lasting impact. Prescribing clinicians should obtain baseline measures of weight, height, BMI and monitor them at regular intervals. Emphasis should be placed on life style interventions such as diet, physical activities etc. Further comparable studies with larger sample sizes using more homogenous diagnostic samples are needed.

Mental retardation (MR) is the most common developmental disability, affecting 2–3% of the general population. A major challenge in both clinical practice and research in the field of MR is to identify the underlying causes: genetic, chromosomal and environmental factors that have an influence on a person's development and behavior.

We present the results of our study regarding genetic abnormalities associated with mental retardation in children.

A total of 180 children were studied using a diagnostic protocol based on dysmorphologic and clinical assessment. A disease, familial and personal history were noted. All patients were evaluated by clinical and paraclinical exams (including dysmorphological features, psychological tests, neurological features, neuroimagistic studies). Genetic investigations included a karyotype with GTG banding, FISH and array-CGH.

A specific causes for the mental handicap was identified in 80 children (44%).

These included a chromosomal abnormality in 32 cases (17%), microdeletion syndromes in 25 children (14%), recognizable syndromes in 23 (13%). Array CGH identified a 22q11 deletion in a girl with unusual phenotype for DiGeorge syndrome, a Xp21 duplication in a girl with severe phenotype (including sever mental retardation, epilepsy, dysmorphic features, genital anomalies, glaucoma, dental anomalies), and a 4p14 deletion in a girl with moderate mental retardation, dysmorphic features, diparesis, congenital heard malformation.

While clinical diagnosis and conventional techniques form the mainstay of investigation of children with mental retardation, array CGH proved important diagnostic tool. Acknowledgments: National Research Program PN II, Project 42–130, CAPACITATI 29/2007–2009 Project; CNCSIS, Project 1203

The Programme d’éducation à la vie affective, amoureuse et sexuelle (ÉVAAS), an affection, love and sex education program for people with moderate intellectual disabilities (Desaulniers, Boucher, Boutet, & Voyer, 2001), is widely used in Quebec and is applied in several locations in Belgium, France and Switzerland.

An implementation evaluation was recently completed as the first stage of a program evaluation.

The aim of the project was to establish the value of this program.

For the purpose, 73 ÉVAAS sessions at five different sites were observed and questionnaires and interviews with 10 group leaders and their supervisors were analyzed.

It was found above all that the program was normally implemented in accordance with its spirit and objectives. However, it was also noted that follow-up to interventions carried out during ÉVAAS sessions was much less structured and sustained, particularly as regards those intended for friends and family.

The research team formulated seven recommendations regarding the program's implementation framework and adjustments required to ensure the achievement of its objectives. The recommendations concern the authors of the program, the educators who use it, their supervisors, as well as service managers.

Allied mental health services play important role in patients’ care in Learning Disabilities as they are more in contact with the patients. Their knowledge about common side effects of medication and relevance of routine blood investigations help Clinicians to provide appropriate care and support.

To ascertain the knowledge of Allied mental health services about common side effects of medication and relevance of routine blood investigations.

Survey questionnaire was distributed to staff between November 09 and January 10.

The questions included about the common side effects of Lithium, Insulin, High dose Antidepressants, High dose Antipsychotics and Anticoagulant Medication. Relevance of Routine Blood Tests and Blood Pressure Monitoring were also asked. Number of questionnaire distributed - 60. Number of Respondents -30. Responses were collected anonymously.

Respondent Classification -Registered Nurses- 4, Nursing Assistants- 12, Care Assistants- 10, Associate Practioner- 1, Deputy Charge Nurses- 2, Occupational Therapist -1.

Of the Registered Nurses, Associate Practioners, Deputy Charge Nurses the results were 100%. With the Nursing Assistant- 25% (3), Care Assistant- 10% (1) and OT was aware of Routine blood tests and BP.

The Nursing Assistants and Care Assistants were aware of one side effect for Lithium, Clozapine, Anticoagulants and Insulin. They were not aware of side effects of High dose Antidepressants & High dose Antipsychotics. The awareness of relevance of Routine Blood Tests and Blood Pressure Monitoring was 80% and 90% respectively.

• • Arrange educational meetings to the Support workers

• • Conduct the survey in a year's time

1. To evaluate the resettlement process

2. To identify areas needing development

In January 2010 we identified 14 children admitted between November 2008 (guideline implementation) and March 2009 (ministerial target date). Data collection involved review of case notes and interviewing residential Care managers.

The admission dates of the children (aged 13 – 19) ranged between March 2003 and March 2009. 11 (79%) children had been resettled in the community. Standards were achieved 100% in several domains including risks assessments, information sharing and patient/carer involvement. 5 (45%) children were discharged within 4 weeks of trial resettlement. Common problems included aggression, seizures, constipation and encopresis. The feedbacks from current placements were mostly positive.

Compliance with standards ensured smooth resettlement. 45% discharged within 4 weeks of trial resettlement reflects the appropriate focus on patient safety rather than targets. Limited resources impacted on delayed discharge.

In depth study of the use of long-acting injectable risperidone in this specific population on the basis of a previous study on a sample of 60 Pack. To describe the demographic characteristics of the new sample of 80 patients, type of Mental Retardation and the most common psychiatric diagnoses. To analyze the therapeutic response to treatment by comparing the clinical course before and after treatment with long-acting injectable risperidone (episodes of aggression, hospitalization, emergency room visits, mechanical restraint, disruptive behavior ...). The dose of long-acting injectable risperidone used, the presence of antipsychotic combination therapy, side effects, etc. are analized. We analyze the information on family overload in relation to treatment with Long- acting injectable Risperidone in a part of the sample.

The study of a sample of 80 patients of both sexes, with diagnosis of mental retardation treated with LAIR is in the process of statistical analysis. But it is possible to appreciate the good therapeutic response and high tolerability of patients to treatment.

There is increasing evidence that Brain-Derived Neurotrophic Factor (BDNF) may be involved in the pathophysiology of depression and the actions of antidepressants.

The aim of the present study was to analyze the relationship between the BDNF plasma levels and clinical variables in unipolar versus bipolar depressed patients.

Thirty-three outpatients (17 with unipolar and 16 with bipolar depression) and 15 healthy controls were included in the study. BDNF concentrations were measured with an ELISA assay method. Severity of depression was assessed by means of the 21-item Hamilton Rating Scale for Depression (HRSD) and the Clinical Global Impressions (CGI) Severity of Illness scale.

The BDNF plasma levels were significantly reduced in patients with unipolar or bipolar depression, with no significant difference between the two groups. Significant and negative correlations were found in the total sample between BDNF levels and the HRSD total scores, the retardation factor scores and CGI “severity of illness” scores. When the same analyses were repeated in each group separately, these findings were confirmed only in patients with bipolar depression.

Our results show that lower BDNF levels may be related to both severity of depression and retardation symptoms in bipolar depression. Further studies need to ascertain whether and how the BDNF levels may be associated with any psychopathological dimensions of the depressive state and be used as a biological marker to differentiate bipolar from unipolar depression.

Abnormal vasopressin (VP) and oxytocin (OT) signaling may contribute to the altered activity of the hypothalamo-pituitary-adrenal (HPA) axis in major depression; the underlying mechanisms remain uncertain.

This study characterized plasma levels and affinities of OT-and VP-reactive autoantibodies (autoAbs) with relation to disease severity and plasma cortisol response to physical exercise in patients with mild and moderate depression and healthy controls.

Physical exercise was used to elicit plasma cortisol response in 23 male depressive and 20 healthy subjects. All subjects were evaluated by the MADRS. Plasma levels VP-and OT-reactive IgG, IgA and IgM autoAbs were measured by ELISA, before and after the exercise, and affinity was measured by plasmon resonance.

Plasma levels of OT-and VP-reactive total IgG autoAbs were lower in patients with moderate depression vs. controls and patients with mild depression. Both OT- and VP- free IgG autoAbs levels were negatively correlated with MADRS scores. Affinity values displayed 100 fold variability in both groups. Patients with moderate depression displayed blunted response of cortisol secretion to physical exercise. Baseline levels of VP total IgG and IgM autoAbs correlated negatively and of VP free IgG autoAbs correlated positively with plasma cortisol after physical exercise.

These data show that changes of levels but not affinity of OT- and VP- reactive autoantibodies can be associated with the altered mood in subjects with moderate depression and that levels of VP-reactive autoAbs are associated with cortisol secretion.

Basal ganglia (BG) activity plays an important role in action selection and reinforcement learning. Inputs from and to other areas of the brain are modulated by a number of neurotransmitter pathways in the BG. Disturbances in the normal function of the BG may play a role in the aetiology of psychiatric disorders such as schizophrenia and bipolar disorder.

Develop a simple animal model to evaluate interactions between glutamatergic, dopaminergic, serotonergic and GABAergic neurones in the modulation of action selection and reinforcement learning.

To characterise the effects of changing dopaminergic and serotonergic activity on action selection and reinforcement learning in an animal model.

The food seeking / consummation (FSC) activity of the gastropod Planorbis corneus was suppressed by operant conditioning using a repeated unconditioned stimulus-punishment regime. The effects of elevated serotonin or dopamine levels (administration into cerebral, pedal and buccal ganglia), on operantly-conditioned FSC activity was assessed.

Operantly-conditioned behaviour was reversed by elevated ganglia serotonin levels but snails showed no food consummation motor activity in the absence of food. In contrast, elevated ganglia dopamine levels in conditioned snails elicited food consummation motor movements in the absence of food but not orientation towards a food source.

The modulation of FSC activity elicited by reinforcement learning is subject to hierarchical control in gastropods. Serotoninergic activity is responsible establishing the general activity level whilst dopaminergic activity appears to play a more localised and subordinate ‘command’ role.

Second generation antipsychotic drugs (SGADs) including olanzapine trigger adverse metabolic alterations possibly by a direct action on adipocytes.

The system of the inflammatory 5-lipoxygenase (5-LOX) and its activating protein (FLAP) have been implicated in lipid dysfunction in obesity. We investigated whether this system could participate in the adipogenic action of olanzapine.

Experiments were performed in 3T3-L1 adipocytes in vitro. Cells were treated with olanzapine and a FLAP inhibitor MK-886. Their lipid content, 5-LOX and FLAP mRNA content, and FLAP protein content were measured.

Olanzapine treatment did not affect the cell content of 5-LOX mRNA; however, it decreased FLAP mRNA content at day five but not 24 hours after olanzapine addition. The inhibitory effect of olanzapine on FLAP expression was confirmed by quantitative Western blot assays. In the absence of a FLAP inhibitor, low concentrations of olanzapine (0.5 and 5 μM) increased lipid content only by about 13% (compared to about a 56% increase induced by 50 μM olanzapine) whereas in the presence of MK-886 these concentrations of olanzapine produced lipid increases comparable to the increase caused by 50 μM. In these experimental conditions, MK-886 alone did not alter the cell content of lipids.

5-LOX system may be involved in lipid dysfunction not only in conditions of obesity but possibly in SGAD-related metabolic alterations. The known polymorphism in the genes of the human 5-LOX system could play a role in setting a variable individual susceptibility to the metabolic side effects of SGADs.