The concept of alexithymia refers to difficulties in identifying and verbalizing emotions, an externally oriented thinking style and a paucity of fantasy. Theoretically and clinically we expect typical ways of regulating affect in alexithymic individuals. The few existing studies on this topic mainly rely on self-report methods, which are inherently problematic since affect representation and affect regulation are not conscious processes.

This study investigates whether alexithymia is associated with dysfunctional methods of affect regulation using clinical ratings of interviews. We hypothesize that alexithymic individuals will use affect regulation methods that do not reflect psychic mediation (H1) and will be unable to solicit cognitive resources (H2) or social support (H3) when confronted with emotional distress.

51 psychiatric in-patients were interviewed with

1. 1) the Clinical Diagnostic Interview which was coded with the Affect Regulation and Experiences Q-sort (ARE-q) and

2. 2) the Toronto Structured Interview for Alexithymia (TSIA).

In general, alexithymia was positively related to avoidant defenses and negatively to reality focused responses. On item level, we found relationships with for example self-destructive behavior and dissociation (H1), items referring to the inability to use self-talk to cope with distress and the inability to anticipate problems and develop realistic plans for them (H2), and finally a negative relation with ‘responds to potentially distressing situations by talking directly to the people involved.’ (H3).

Alexithymia is associated with typical dysfunctional methods of affect regulation. This should be taken into account in the diagnostic process as well as treatment for alexithymia.

It is well studied that children with attention deficit hyperactivity disorder (ADHD) are physically abused by their parent. However, there are few studies on different forms of abuse.

The parents of a clinical sample of 108 children and adolescents with ADHD and 102 mothers of a control group were included in this study. The ADHD diagnosis was made according to DSM-IV diagnostic criteria, using K-SAD. The Parent-Child Conflict Tactics Scales (CTSPC) was used to assess the frequency of the three different forms of child abuse by their parents including “Nonviolence discipline”, “parental psychological aggression” and “parental physical aggression”.

The mean scores of “nonviolent discipline”, “parental psychological aggression” and “parental physical aggression” for the parents of children with ADHD were more than those of the control group. “Parental psychological aggression” and “Parental physical aggression” were significantly correlated with each other.

The physical abuse of children with ADHD by their parents is very common. However, Child abuse in children with ADHD occurs in a cluster of different types of abuse irrespective of parental age or education. So, other types of abuse should be considered in the management of children with ADHD.

Electroconvulsive therapy (ECT) is widely and effectively used to treat psychiatric disorders. When electrodes are placed on both sides of the head on temporal bones it is unclear whether ECT affect on hearing system because hearing system situated in temporal lobe. Whereas these electrodes are placed on temporal bone and hearing system in TEMPORAL LOBE this study was designed.

We studied the effects of electroconvulsive shock on hearing system. Audiometric tests were performed in 15 adult patients with major depression under treatment with ECT before and 24h after ECT.

Hearing was decreased at 24 hours after ECT about 5 db. Right ear was affected more and the most changes were observed at 8000 khz.

It appears that electroconvulsive shock has early effects on hearing system. Further studies should be performed with more cases and Delayed effects should be investigated.

Scientific research regarding Catatonia is limited to individual clinical cases. Few well-design studies investigating its clinical course or therapeutic options have been carried out. We aimed to describe a sample of consecutive Catatonic patients admitted to the Basurto's Hospital Adult Psychiatric Inpatient Unit to obtain more data about its clinical presentation.

Subjects diagnosed of Catatonia anytime during admission were included (n = 12). Subject's admission dates ranged between December 2008 to September 2010. Catatonia was diagnosed following DSM-IV-TR criteria. Data was retrospectively obtained reviewing subject's clinical notes.

The sample was predominantly composed of women (66.7%). Media of age was 55.3 years. All subjects reported previous mental illness. More prevalent diagnosis were Schizophrenia (33.2%), Bipolar Disorder (33.2%), Non Specified Psychotic Disorder (16.6%), Schizoaffective Disorder (8.3%) and Recurrent Depressive Disorder (8.3%). Nine subjects (75%) reported previous admission to a psychiatric unit. No subjects had previously suffered from Catatonia and only 2 had previously received electroconvulsive therapy (ECT). More frequent catatonia subtype was retarded (66.7%) with no subjects presenting with malignant catatonia. CGI at admission showed a media of 6.64.

Regarding treatment, 83.3% did not recover with benzodiazepines and needed ECT anytime during admission. Media admission length was 36.17 days.

Catatonia was more frequently observed in female, middle-aged women with no previous history of catatonia or ECT treatment but a history of previous psychotic or affective illness and hospital admissions. Symptom severity was very high and thus required aggressive treatment and longer hospital stays in order to achieve recovery.

In a previous study (Senín-Calderón et al., 2010) we observed that the REF scale of referential thinking (Lenzenweger et al., 1997) didn’t discriminate among different mental disorders.

We try to verify if self-references in various disorders are related to the severity of psychopathology (patients from public hospital and a private clinical). We predict that there will be differences between patients and controls, but not between the clinical samples. Psychotic disorders will be characterized by a significantly greater presence of self-references.

Participants: 287 subjects, 47 patients from a private clinical center, 57.4% women (mean age = 35.02, SD = 12.69), 30 patients from a public hospital, 53.3% women (38.36 years, SD = 9.53), and 210 controls selected from the general population, 50.5% women (33.80 years, SD = 11.79). Cross-sectional design, correlation method. All analysis were accepted at p < .05.

There are significant differences in self-references between patients and controls in frequency (t (285) = 2.33, p = . 021) and intensity (t (83.98) = 3.59, p = . 001). No significant differences between patients groups (p>.05) (REF-intensity without homogeneity, p < .05). No significant differences in self-references between types of diagnoses except psychotic patients versus adjustment disorder (frequency and intensity).

Self-references are highlighted in psychosis but, with the exception of adjustment disorders, doesn’t discriminate between personality, mood or anxiety disorders. Differences are more related to the clinical severity (BPRS) than with referential thinking.

In previous works, referential thinking was predicted by clinical and dispositional variables such as social anxiety or vulnerability to depression (Rodríguez-Testal, Senín-Calderón & Fernández-Jiménez, submitted to revision).

We propose to find personality variables to characterize the emergence of referential thinking. We predict a greater referential thinking in subjects with a high sensitivity to punishment and higher scores on social anxiety.

Participants: 366 subjects selected from the general population, 66.6% women, mean age = 33.18 (SD = 12.79).

We used the REF-scale (Lenzenweger et al., 1997) adapted to Spanish language, GHQ-28 (Goldberg, 1996), SPSRQ (Torrubia et al., 2001) and The Revised Self-Consciousness Scale (Scheier & Carver, 1985).

It was applied a cross-sectional design and a correlation method. All the analysis were accepted at p < .05.

The multiple linear regression analysis showed the importance of the clinical variable of depression, public self-consciousness, and sensitivity to reward and punishment as predictors of referential thinking (34% of the variance explained). The discriminant analysis according to scores in referential thinking was significant (Lambda = .87, p = .001). The combination of the above variables correctly classified 85.1% of cases.

Subjects more concerned about how they are perceived by others tend to a greater presence of self-references, although they don’t show a high score in social anxiety. Susceptibility to reward and high vulnerable to punishment are the personality variables that best predicted referential thinking.

Musical hallucinations are a rare subtype of complex auditive hallucinations where we can find a disorder of the processing of complex sounds and the perception is formed by music, instrumental sounds or songs.

A 75-year-old women, accompanied in otorhinolaryngology consultation in the last two years, was oriented to psychiatry consultation for suspected anxious symptomatology. In the second psychiatric observation, she complained of hearing portuguese popular music since the previous month. She could identify the lyrics and sing the songs heard and allocated the sounds out of her head, although having doubts about their reality. There were no other auditory or visual hallucinations. She refused to take psychopharmacs. She had a previous history that included complains of hyperacusis and tinitus, mainly in the left ear. An electrococleography made in the past showed endolymphatic hidropsis at the left and an audiogram identified presbiacusis. Her cerebral MRI showed a dilatation of the ventricular system. She had mild hypertension and hypercholesterolemia and had been medicated with sinvastatine, carvedilol, omeprazole, triflusal and betahistine dihydrochloride.

Musical hallucinations occur mainly in females and in patients over 60 years, although patients whose hallucinations are caused by focal brain lesions are significantly younger. Because most of the patients have a hearing impairment, a similar mechanism to that of Charles-Bonnet syndrome has been proposed.

There is no accepted classification of musical hallucinations - many authors prefer to call them halllucinosis when patients have insight; others think it can represent a mental image. Treatment is not consensual.

For decades, the fundamental ability known as intelligence, has been interpreted as a unitary concept: g. The distinction between crystallized intelligence (Gc) and fluid intelligence (Gf), introduced by Horn and Catell in 1966, is corroborated by recent neuropsychological research. Since Gf is sensitive to frontal lobe lesions, studies have focussed on its relation with executive functioning (EF). The most widely used intellegence test (WAIS), measures predominantly Gc, even with its subtasks for performal intelligence.

The study of the relation between Gf and EF with the Kaufman Adolescent and Adult Intelligence Test (KAIT), a test specifially designed for the measurement of the Gf-Gc distinction.

While WAIS-research on the Gf-EF association may lead to unreliable conclusions, both KAIT and selected CANTAB tasks were used to re-investigated this relationship.

The relation between Gf, Gc and EF was studied in a latent variable analysis using both a group of patients with an array of psychiatric diagnoses and a group of healthy controls, comprising a total of 66 subjects. For EF, the model of Miyake was used by differentiating EF in the three subprocesses: updating, shifting and inhibition.

A high correlation between Gf and EF was found, indicating significant but incomplete overlap between the Gf and EF constructs.

KAIT constructs adequatly reflect Gf, Gc and the three executive processes as defined by Miyake. Deviant scores on KAIT-Gf, however, do not fully capture the actual executive funtioning of patients. In such cases, detailed examination of EF is warranted.

Coping plays an important role in processes involved in the development of mental disorders, influencing decompensation and recovery from patients. Coping is defined as an active self-generation of cognitive and behavioural procedures, which impact directly on the symptom or reduce distress caused by it. How patients cope with delusions lack empirical evidence. Although, in the last years, delusion has been considered a multidimensional phenomenon where emotional, cognitive and action-oriented aspects were recognized, the impact of delusional dimensions on coping is still unknown.

To assess coping strategies used by patients with schizophrenia and psychotic depression to deal with delusion. The relationships between coping, psychopathology and the dimensions of delusional experience will be examined.

Thirty deluded schizophrenics and 30 psychotic depressed patients were investigated. Instruments to the assessment of delusion were used, as the Positive and Negative Syndrome Scale (PANSS) and the Heidelberger Delusion Profile (HDP).

Correlations between psychopathology, coping and delusion dimensions were calculated.

Coping strategies used to deal with delusion were different in the 2 groups of patients. Schizophrenic patients use more medical care, while psychotic depressed patients use more depressive coping. Significant correlations between psychopathology, coping and delusion dimensions could be shown. In contrast to depressive patients, the emotional and cognitive dimensions of delusion seem to influence coping in patients with schizophrenia.

Coping strategies are different depending on the diagnosis. In schizophrenia, the emotional and the cognitive dimensions seem to influence how patients cope with delusional experience.

Delusion and hallucinations occur in a variety of psychiatric disorders. In the last years they have been considered multidimensional phenomena, since emotional, cognitive and action-oriented aspects were recognized. According to the cognitive model of the development of positive symptoms, emotional processes play an important role for the relationship between delusion and hallucinations. Although delusion and hallucinations often coexist, there are few empirical studies, which explore this relationship.

Aim of the study is to elucidate the relationship between delusion and hallucinations taking into consideration their multidimensionality.

Eighty-two patients with delusion and hallucinations with a schizophrenia spectrum disorder were examined. Several instruments to the exploration of delusion and hallucinations were used as the Psychotic Symptoms Rating Scales (PSYRATS), MacArthur-Maudsley Delusions Asessment Scchedule (MMDAS), Dimensions of Delusional Experience (DDE), Positive and Negative Syndrom Scale (PANSS), Brown Assessment of Beliefs Scale (BABS), Clinical Delusion Rating Scale (CDRS) and the Heidelberger Delusion Profile (HDP). The correlations between formal hallucination and delusion criteria, as well as formal hallucination criteria and delusion content were calculated. The causal relationship between delusion and hallucinations was tested through a structural equation modelling.

Correlations between delusion and hallucinations dimensions could be found, at item, subscale and scale levels. Emotional and cognitive delusion dimensions correlated significantly with hallucinations magnitude. The delusion content showed a significant influence on the occurrence and emotional dimension of hallucinations. Delusion secondary to hallucinations could only be partially confirmed.

The results confirm the complex structure of the relationship between delusion and hallucinations.

CJD is a neurodegenerative disease with a rapid onset characterized by progressive dementia, myoclonus and also cerebellar, pyramidal and extrapyramidal signs. It is caused by an increased loss of neurons due to the abnormal conformation of a membrane protein.

A 69 year-old woman was admitted to Psychiatry with a clinical picture characterized by psychomotor agitation, disorientation, confusion, confabulation, false ricognition, circumstantiality, perseveration, logorrhea and dysphoria. She presented no alterations of sense-perception. Her psychiatric history was silent. The neurological examination showed no focal neurological deficits and the first EEG was nonspecific. She became progressively more confused, with subsequent drowsiness with psychomotor agitation, aimless buste, disorganization and visual hallucinations. She started treatment with quetiapine (200 mg/die) and lorazepam (4 mg/die) without benefit. The second EEG was characterized by triphasic waves with diffuse projection. MRI angiography revealed the presence of diffuse cortical ribbon hyperintensity of gray matter. CSF examination showed positivity of 14/3/3 protein and a TAU protein value greater than 16000 pq/ml allowing diagnosis of CJD.

We emphasize the importance of a correct differential diagnosis in patients with psychiatric symptoms and rapidly progressive dementia unresponsive to therapy.

The impact of typical and atypical anti-psychotics on developing obsessive-compulsive symptoms in schizophrenic patients were investigated in this study.

64 schizophrenic patients (32 cases in typical anti-psychotics group and 32 in atypical anti-psychotics group) participated in the study. All the patients first interviewed by SCID and then Yale Brown Obsessive-Compulsive Scale (Y-BOCS) and Brief psychiatric Rating Scale were administered in the beginning, 3 weeks and 6 weeks after treatment. The Data then transferred to SPSS program. for analysis.

In typical group the mean scores of Y-BOCS were 2.40, 2.30 and 2.18 in the beginning, 3 weeks and 6 weeks after treatment. In atypical group the mean scores of Y-BOCS were 4.12, 4.46 and 4.53 in three trials. There were no significant differences in the mean scores of Y-BOCS of two group in the beginning of the trial although a trend toward significance was observed but the differences between scores were significant in trial 2 (3 weeks) and trial 3 (6 weeks).

Based on this study and in line with previous studies, atypical anti-psychotics may induce obsessive compulsive symptoms (although mild) in patients with schizophrenia.

To determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing for patients with psychotic disorders.

A retrospective audit of prescriptions issued for outpatients at the Psychiatric Hospital in Bahrain.

Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two- and three- drugs in 10.4 and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Majority of the study population (93.2%) were prescribed an oral antipsychotic, whereas 3.1% each were on depot preparation or on depot plus an oral antipsychotic. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalents (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq>1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy) mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose of antipsychotics and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics.

Antipsychotic monotherapy is the common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

Pulmonary embolism is a very serious, life threatening condition. It has been associated with the use of antipsychotic drugs, both typical and atypical, thus consisting a rare but potentially lethal side effect of this drug category. SSRIs/SNRIs on the other hand, are associated with bleeding, increased INR results and platelet dysfunction.

A clinical case was followed and reviewed to illustrate the possible connection between the withdrawal of duloxetine and the ongoing use of olanzapine with pulmonary embolism.

A 36-year- old male, smoker of 30 cigarettes/day had been under treatment with olanzapine 30 mg/day and aripiprazole 30 mg/day for the past year. Duloxetine 90 mg/day had also been added for the past nine months and withdrawn after the improvement of depressive symptoms. Approximately one month after its withdrawal the man suffered pulmonary embolism and was hospitalised. During hospitalisation tests found no other factors predisposing to emboli creation. He was discharged with acenocumarol (Sintrom). His psychiatric medication was therefore adjusted to omit olanzapine and SSRIs /SNRIs because of their potential effect on coagulation.

Can it be that olanzapine played a role in promoting pulmonary embolism in this patient ?

Can it be that duloxetine was playing a protective role and its withdrawal facilitated the onset of pulmonary embolism? There is no certain way to tell but, to our knowledge, there has not been a similar case before and the time sequence of the events might not be coincidental.

In the treatment of psychotic disorders, any such instrument or way that could help to improve their prognosis should be valued and taken into account.

To determine the impact of the administration of RLAI in the deltoid, assessing patient satisfaction and acceptance, as well as efficacy and tolerability.

Prospective, naturalistic and descriptive, 20 patients with chronic psychosis treated with RLAI, performing a change in administration (gluteal to deltoid muscle).

We realize 2 valuations:

1. 1 Basal: demographic, clinical (PANSS, CGI, UKU, dose and duration RLAI).

2. 2 Final (6 months): clinical, patient satisfaction (Questionnaire Medication Treatment Satisfaction, Visual Analogue Scale VAS).

Analysis SPSS v15.0.

In subscales TSQM, punctuations very raised for deltoid: Efficiency 75, 55 %; adverse events 94, 38 %; Administration 75, 27 %; Global satisfaction 74, 64%. The VAS of satisfaction with deltoid was of 7′ 4 ± 1′ 3 (0–10).

less pain, adverse events and more normal (100%), more capacity decision (80%), less stigmatizing (85%).

No differences in efficacy, but better tolerated.

The administration of the deltoid RLAI in can be a useful tool for the treatment of psychotic disorders because it can allow the patient to engage in certain therapeutic decisions (to be able to choose the way), promote adherence, may improve the perception of treatment to be associated deltoid administration to something less traumatic and stigmatizing, that is “more normal.”

The emergence of new antipsychotics, such as Paliperidone Extended Release, demands a constant effort on behalf of the clinics to outline an appropriate profile for those patients who may benefit more.

To collect clinical and social-demographic data to develop a profile of the patient who has used Paliperidone Extended Release in our hospitalisation unit.

This is a naturalistic, descriptive and retrospective study; we will include 36 patients admitted to our Acute Patients Unit. The inclusion and exclusion criteria were clinical.

A total of 44.4% were over the age of 40 years; positive symptoms (52.8%) and behavioural alterations (19.4%) prevailed; the most common diagnosis was schizophrenia (47.2%). A total of 61.1% of cases were associated with other APs, especially Injectable Risperidone Extended Release or antipsychotics with a sedation profile. A total of 83.3% did not require mechanical restraint, and 80.6% did not present side effects. The most common side effects were extrapyramidal symptoms. The mean duration of hospitalisation was 19.60 ± 12.07 days. The mean dose of Paliperidone Extended Release was 14.41 ± 4.83 mg/day. Initially, a dose of 13 ± 4.42 mg/day was used, while the maximum dose was 27 mg/day.

Our experience with Paliperidone Extended Release in the hospital scope allows us to state that it is a drug with a very positive efficacy and safety-tolerability profile. Therefore, we may consider Paliperidone Extended Release a first line antipsychotic due to its contributions in different patient elements (clinical, functionality, tolerability, etc.)

An once-daily formulation, bupropion XL, was developed with the goal of further improving tolerability and compliance (1). Common adverse effects contain dry mouth, nausea, constipation, headache, agitation and skin rash (2).

A case of skin rash caused by bupropion XL used for depression is discussed.

A 39-year-old man with depression developed a rash on his extremities 13 days after the initiation of bupropion XL followed by pruritus of the arms, feet, and face.

To our knowledge, this is the first reported case of skin rash and urticaria induced by bupropion XL therapy. The most common cutaneous side-effect is urticaria and rash by bupropion XL. This develops from between 8 and 21 days after taking the medicine (3). In our case dermatological side effects developed on 13 days. On discontinuation of bupropion XL, there was whole resolution of symptom. We report this case to notify clinicians of the potential dermatological side effects that can occur with extended release bupropion therapy.

Palilalia is an acquired speech disorder characterized by involuntary and spontaneous repetition of words or phrases two or more time in a row. Palilalia can occur in a variety of disorders including postencephalic parkinsonism, advanced Parkinson disease, as well as in schizophrenia, and in Gilles de la Tourette syndrome. There is one report of palilalia induced by neuroleptics.

To review the literature related to palilalia. Clinical case: We described a case of a 28 years-old man with refractory schizophrenia that demonstrated palilalia with 300 mg of clozapine.

In the patient evaluation we just found unspecific alterations in the electroencephalogram. Palilalia disappeared with lowering doses of clozapine.

Palilalia can have several causes. The appearance of palilalia induced by clozapine is a rare side effect.

Cycloserine is a highly effective second line anti-tuberculosis medication, the use of which has increased in recent times due to emergence of multi-drug resistance. One of the side-effects is psychosis characterized by paranoia, hallucinations and affective instability. These symptoms are usually reported within the first 2 weeks of therapy in 30–50% of patients receiving Cycloserine 500 mg. At a dose of 100mg and above it leads to a hyperdopaminergic state which in turn could lead to psychosis. However, as this is a very effective treatment in people with multi-drug resistant tuberculosis, it is not always possible to omit treatment due to remergence of life threatening illness. We present findings from few patients on this medication who were referred to us for management of psychotic symptoms.

To treat the psychotic symptoms with anti-psychotic which would enable patient to continue Cycloserine. Also to monitor the response to an anti-psychotic.

Data was collected from the patient’s case notes, full psychiatric assessment and interviewing the relative. Patient was followed up in the out-patient clinic to monitor response to anti-psychotic medication.

Patients were treated with both typical and atypical medication with good response and it was possible to continue with Cycloserine in one case.

Cycloserine induced psychosis can mimic any other psychotic illness and can be effectively treated with anti-psychotics.