There is an increasing demand for treatment for dependence on different psychiatric medication like benzodiazepines. The goal is to determine the user's profile that is attended in a mental health center.

We obtained a sample of 30 users, divided into two groups: A) main drug benzodiazepines, B) primary drug others.

Sociodemographic, psychiatric and drug use variables are collected, making a descriptive retrospective analysis, using means for quantitative variables and proportions for categorical variables.

Group A is composed mainly of women (63.6%) of average age 46 years, and the group B of males (75%) with slightly higher average age (48 years). In group A and B the average level of education is primary/secondary education. Overall, they do not work and are single, having more pensioners and separated in group B.

In both groups, more than half have a history of affective disorders, often followed by anxiety disorders, with higher prevalence in group A (54.6% vs 36.8%), and personality disorders (77.3% and 75%).

In reference to group B, the primary drug of abuse is mostly alcohol. In general there is higher prevalence of nicotine dependence.

The profile of group A is a middle-aged woman who presents comorbidity with affective and personality disorders. The profile of group B is a middle-aged man, alcohol dependent, with earlier onset of use and with personality disorder.

Tramadol withdrawal symptoms are either natural (typical) or unnatural (atypical). In this context, psychotic symptoms as atypical Tramadol withdrawal symptoms have been rarely reported.

A case report and review of literature by a research on medline database. Key words: 'psychosis', 'psychotic symptoms', 'tramadol withdrawal', 'opiate withdrawal'

Mr. A. L. is 35 years-old man with a past medical history of alcohol dependence and cannabis abuse. He was admitted in 2012 for an alcoholic pancreatitis. Following this episode he began taking 650 mg/d of tramadol. He was put on Acetaminphen, clorazepate and paracetamol. When he started tapering Tramadol, he began experiencing auditory and cenesthetic hallucinations. He presented in our outpatient unit with restlessness, grandiosity thoughts, messianic delusions and sleeplessness. He was treated with antipsychotic medication and could stop taking Tramadol a week after his first consultation. After 8 days mental symptoms including hallucinations and delusions persisted. Therefore the diagnosis of Tramadol-induced Psychotic disorder with onset during withdrawal was the most likely diagnosis. Neurological examination was normal and brain CT scan showed no organic abnormalities.

There is evidence that only a few patients with tramadol dependency are susceptible to atypical withdrawal symptoms. Atypical withdrawal symptoms may include severe anxiety, panic attacks, unusual CNS symptoms such as confusion, delusion, derealization, depersonalization, paranoid thoughts, visual and auditory hallucinations. There have been some reports in the literature on psychotic episodes related to opiate withdrawal but only one previous case with Tramadol.

Trihexyphenidyl (THP) is an anti-Parkinson and anticholinergic drug, indicated in the treatment of parkinson disease, abnormal movements and parkinsonism induced by neuroleptic. The prophylactic use of anticholinergics in patients on neuroleptic treatment isn't recommended and may be justified only early in treatment. Howerver, in usual practice, the THP, is widely prescribed and used by patients. Recent observations suggest the existence of THP abuse linked to its hallucinogenic and euphoric effects.

to assess the tunisian psychiatrists perception on abuse and dependence potential of THP and their attitude toward this misuse.

A descriptive study among 100 tunisian psychiatrists (76: the public sector and 24: the private sector) who responded to a questionnaire, investigating the subject (dependence potential of THP, efficacy of THP, opinions about banning the THP from the tunisian pharmaceutical market).

87% of whole psychiatrists think that THP is associated with dependence potential. In the public sector, 77,63% of psychoatrists don't think that THP is more efficient than other anticholinergics and 78,94% agree to introduce other anticholinergic drugs in the hospital pharmacy. 3/4 of whole psychiatrists are for banning the THP from the national pharmaceutical market, espacially in the public sector, whose 80% of them approve the exclusion of THP from all public structures.

The majority of tunisian psychiatrists think that trihexyphenidyl is associated with a high risk of addiction. Many of them consider that banning THP and substitue it with other anticholinergics may be the solution. Is that really the best solution ?

Tramadol is an atypical, centrally acting, synthetic, analgesic. Its anti-nociceptive effects are mediated by a combination of μ-opioid agonist effects, and norepinephrine and serotonin reuptake inhibition. Initially, tramadol was said to have a low-abuse potential. However, its abuse liability and diversion were soon recognized, with several reports on physical dependence.

A case report and review of literature by a research on medline database. Key words: 'Tramadol”, 'opiate dependence”, 'tramadol withdrawal”, 'tramadol addiction”

Mr. L.M. is a 24 year-old man without past history of substance abuse. In 2012, he underwent leg surgery after gunshot wounds. He was started on Tramadol treatment for his pain. He progressively increased Tramadol dosage and was taking 250mg to 750mg intravenous injections per day. He tried several times to stop taking Tramadol but each time his developed nausea, muscle aching, dysphoric mood and insomnia. His withdrawal symptoms had bad impact on his daily life and resulted in family life breakdown.

Tramadol has long been considered to have a very low abuse potential. According to the US Food and Drug Administration, the rate of addiction was 1 in 100,000 during the last 18 months period of surveillance. Most of the cases had been in patients with a prior history of substance abuse. This case shows that Tramadol addiction may also occur in patients with no psychiatric or substance abuse history.

The aim of this study was to assess the differences in peak velocity of eye movements between alcohol-dependent and healthy controls.

Participants

Ninety-nine alcohol dependent patients were examined. Patients with oculomotor impairment were excluded. Thirty-eight healthy controls were matched to the affected cohort according to demographic characteristics.

Assessment

In this study we used the Saccadometer Advanced System (Advanced Clinical Instrumentation, Cambridge, UK). The eye movement measurements are automated and synchronized with stimuli presentation. The person conducting the experiment needs to ensure that the sensor is placed correctly and to give instructions to the test subject. The Saccadometer System does all other measurements and recordings of test data automatically. The study analyzed the peak velocity of eye movements of amplitude of 10 degrees and the deviations in peak velocity.

There was a statistically significant higher mean peak velocity of saccadic eye movements in alcohol-dependent individuals (440.82±86.33deg/s) when compared to healthy controls (411.39±86.33deg/s).

Greater asymmetry of mean peak velocity between right-sided and left-sided saccades was observed in the affected cohort when compared to the healthy test subjects.

There was a higher mean right-sided peak velocity (462.73±118.54deg/s) in the alcohol dependent subjects when compared to healthy controls (414.68±73.79deg/s) and also a higher mean of left-sided peak velocity (418.82±79.83deg/s) when compared to healthy controls (405.13±49.50deg/s).

It was found that alcohol dependence is associated with differences and significant increased asymmetry of peak velocity of eye movements.

The aim of this study was to assess the differences in saccadic latency (a measure of time delay experienced in eye movements) between alcohol-dependent and healthy controls.

Participants

Ninety-nine alcohol dependent patients were examined. Thirty-eight healthy controls were matched to the affected cohort according to demographic characteristics.

Assessment

In this study we used the Saccadometer Advanced System (Advanced Clinical Instrumentation, Cambridge, UK). The Saccadometer System allows quick and easy collection of saccadic responses within the shortest physiologically possible time (100 saccades in 5 min). The brevity of the testing routine minimizes any potential influence on the results due to fatigue in the test subjects. The eye movement measurements are automated and synchronised with stimuli presentation. This study analyzed saccadic latency and standard deviation of mean latency.

There was higher saccadic latency and standard deviation of mean latency in alcohol-dependent individuals (224.43±56.24 msec) when compared to healthy controls (187.84±25.65 msec). A marked asymmetry of standard deviation of mean latency between right-sided and left-sided saccades was observed in the affected cohort. There was an increased standard deviation of right-sided saccades mean latency (69.96 msec) in alcohol-dependent individuals when compared to healthy controls (30.93 msec) and also an increased standard deviation of left-sided saccades mean latency (59.33 msec) when compared to healthy controls (33.09 msec).

It was found that alcohol dependence is associated with impaired (longer time delay) saccadic reaction.

The people who seem to have less social support And suffer lack of multiple social supports are more likely at risk to drug abuse.

This research was an experimental with pre-test post-test design with randomly assigned 30 patients referred to drug addiction treatment centers in experimental and control groups. present aim at testing the effect of eight, 2- hour sessions of stress management training based on cognitive behavioral techniques. Subjects were tested at the beginning and at the end of the project with (SSQ).

Study findings showed that the subjects of experimental group that were under the intervention(training)compared with control group showed significantly better scores and test effectiveness.

Interventions based on cognitive – behavioral approaches, is effective treatment that it can alters behavioral and cognitive factors associated with substance abuse and be as an efficient model for the prevention of drug abuse and also after treatment.

Enucleation is a topic discussed in psychiatry which is a self-injury matter. Enucleation is observed as psychotic disorder due to substance abuse. In people with mental disorders who also have substance use leading to hallucinations and delusions, unusual eye evacuation were reported. In most cases, enucleation was done using sharp tools.

This report describes a man suffering from psychosis after consuming hashish and has attempted to evacuate his eyes with his finger.

Given the increasing prevalence of hashish use by young people, and false beliefs about the use of hashish in order to withdraw other substances, preventive methods and education for young and vulnerable people are suggested.

Only a limited number of studies have examined the association of conversion disorder (CD) with depression and anxiety in adolescents. Furthermore, no data regarding the association of CD with anxiety sensitivity and perceived social support are available. This study aimed to assess the relationships among psychological characteristics and conversion symptoms in adolescents.

We assessed 50 outpatients, aged 8–18 years, who had been diagnosed with CD and members of a control group using the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI), and Multidimensional Scale of Perceived Social Support (MSPSS). Symptoms of CD were assessed using the Somatoform Dissociation Questionnaire (SDQ) and Children's Somatization Inventory (CSI).

Compared with controls, adolescents with CD scored higher on the CDI, SCARED, CASI total, CASI physical and cognitive subscales, and MSPSS total and MSPSS family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the SDQ scores and that CDI and CASI total scores predicted the CSI scores of subjects.

This study suggest that adolescents with CD had poor psychosocial well-being, and depression and global AS and AS cognitive concerns may play a role in the development of conversion symptoms.

Literature describes important comorbidity rates between somatization and mood disorders. Furthermore, there are data suggesting an association between affective temperament and somatization traits in healthy subjects.

In the present observational study, we investigated affective temperaments and somatization aspects in clinical and healthy samples.

The study focused on differences between unipolar depressive inpatients (DEP) and controls (C).

We administered to 20 DEP and 20 C following questionnaires: Mini International Neuropsychiatric Interview (MINI), 17-item Self Rating Depression Scale (SDS), Hypomania check list 32(HCL-32), Self Rating Anxiety Scale (SAS), DCPR diagnostic criteria for psychosomatic research, Brief TEMPS-A, Modified Somatic Perception Questionnaire (MSPQ), Somatosensory Amplification Scale-SSAS. DEP and C were matched for age, sex and marital status.

About temperaments, ANOVA showed that DEP were more cyclothymic (p<0,0001), depressive (p<0,0002) and irritable (p<0,0425) (scores to Brief TEMPS-A) than C. In addition, in DEP, MSPQ scores (somatic perception scale) were higher than C (p<0,0001). Similar results were about SASS scores (somatosensory amplification scale). DEP present more frequently than C Type A Behavior Pattern (DCPR diagnosis) (CHI-SQUARE p <0,0601).

Our data suggest that DEP present an important affective temperamental dysregulation. Relative to somatization aspects, DEP show a greater vulnerability than C.

Anxiety symptoms have variable prevalence rate of 26.3% to 50.4% in schizophrenic patients compared to 28.8% for general population. Some atypical antipsychotics (Quetiapine, Olanzapine) are effective in reducing anxiety in patients with schizophrenia or schizoaffective disorders.

The purpose of this preliminary study was to compare the efficacy of typical and atypical antipsychotics in reducing anxiety in patients diagnosed with schizophrenia and schizoaffective disorder hospitalized in Arad between 2013- 2014.

Considering the treatment, 63subjects patients were divided in two groups: T1 (treated with Olanzapine, Quetiapine) and T2 (treated with Haloperidolum, Risperidone, Aripiprazol).

After treatment, the level of anxiety is reduced with significant improvement of total score of PANSS; the effect is higher in group T2 compared to T1. Before treatment, anxiety is positively correlated with total score of PANSSN (r=.285; p=0.010), PANSST (r=.260; p=0.040) and total score of HAM-D (r=.455; p<0.0001). Also the score of the YMRS is negatively correlated with negative items of PANSSN scale (r=-.321; p=0.010). The cognitive level (QI) was decreased post-treatment for both treatments, but T1 had had a higher effect on it.

Various treatments are successful in reducing anxiety in psychotic patients. This conclusion is confirm duet our results: in group T2 the treatment has a higher effect on anxiety and lower size effect on intelligence.

Surgery operations of children causes serious anxiety for parents.

The study was designed to determine the factors increasing the severity of anxiety existing in the parents whose children will have an operation and what can be done to decrease it.

200 parents were asked to complete the social demographic data form, Beck Anxiety Inventory(BAI), State-Trait Anxiety Inventory(STAI) before the surgery.

Mothers had higher scores of BAI and Trait Anxiety. The BAI score of two year-old and older children's parents had greater value than the one year-old children's parents(p=0.020). The State Anxiety score of girls' family was found greater (p=0.049).

The State Anxiety score of the parents who are unlettered/graduated from primary school was greater than those who graduated from high school/college(p=0.026). The BAI scores of the parents with low occupational level/unemployed and housewives both were greater than those of the parents with average/high occupational levels(p=0.029). The BAI score of parents with large families was lower than the parents with nuclear/fragmented families(p=0.043). The BAI score of parents whose families hadn't have surgery before had greater values. The Trait Anxiety score of parents whose children had a, b,c types of surgery operations was smaller than d, e types(p=0.036).

It was found that the mothers and parents who have daughters, with low educational levels and low socioeconomic status have continuous anxiety. Therefore, parents need to be informed more about children's diseases, the type of the surgery operation and the technique of anesthesia in pre/postoperative term.

Individual ethnogenetic and psychophysiological characteristics influence on peculiarities of risk, incidence, diagnosis, and course of a number of diseases.

An investigation of ethnogenetic characteristics (on phenotypic variants (PhV)) was performed in comparison with psychophysiological parameters (temper structure, personality anxiety, and parameters of strength, stability and mobility of the nervous system (NS)) of 123 patients with neurotic disorders and 105 persons without them.

Patients with neurasthenia represented more often Alpine PhV (30.56%); patients with anxious disorders represented more often Dinaric (18.64%), Armenoid (11.86%), and Paleo-European (11.86%) PhVs; patients with somatoform disorder more often represented Alpine (28.57%), Atlanto-Baltic (21.43%), and Uralic (10.71%) PhVs. Among patients with neurotic disorders presence of PhVs, which were non-typical for the general population (Atlanto-Baltic and Armenoid PhVs), was also determined. Patients of Alpine PhV demonstrated a high rigidity (91.66%), personality anxiety (80.00%), reaction pace (83.33%), a moderate NS stability (46.34%), and a low NS mobility (48.00%), which were a prerequisite for neurasthenia formation. Patients of Atlanto-Baltic, Uralic, and Alpine PhVs predominantly showed a high rigidity (94.11%), a moderate extraversion (52.94%) and reaction pace (64.70%), a low NS activeness (76.74%) and stability (47.05%), which were associated with somatoform disorders. Patients of Dinaric, Armenoid, and Uralic PhVs demonstrated a high personality anxiety (78.75%), emotional excitability (84.61%), extraversion (69.23%), passivity (76.47%) and inertness (42.85%) of nervous processes, and a moderate NS stability (54.17%), which were factors of anxious disorders formation.

These data should be taking into account in diagnosis and treatment of neurotic disorders.

An increasing amount of chronic, prolonged forms of mental disorders stipulates an actuality of this problem and require development of diagnostic and therapeutic strategies directed on prevention and overcoming of resistance.

The aim of the investigation was to define clinical-psychopathological peculiarities of dissociative disorders with signs of resistance.

Fifty patients with dissociative disorders (including 30 with signs of resistance and 20 without signs of resistance) were examined. The clinical-psychopathological method including a clinical-phenomenological analysis of psychopathological symptoms was used with addition of the Symptom Check List-90-Revised (SCL-90-R) scale.

It was found out that resistant dissociative disorders were characterized with a prolonged onset of the disease (J (xij) = 0.37); a somatization of clinical manifestations with formation of permanent somatic symptoms in several systems of organism (J (xij) = 0.30); a comorbidity with somatic-neurological pathology (J (xij) = 0.49); a combination of hypochondriac, depressive, and phobic psychopathological syndromes (J (xij) = 0.22) accompanied by a steady limitative behavior (J (xij) = 0.30).

The results obtained are expedient to use as criteria for diagnosis and targets for treatment of resistant dissociative disorders.

Preoperative anxiety related to either anesthesia or surgery remains for many patients a major subject of concern.

Evaluation of preoperative anxiety in patients undergoing surgery.

Our study is transversal and analytical. It was conducted among 50 patients admitted to the surgical unit of CHU Habib Bourguiba in Sfax (Tunisia). The screening tool for the preoperative anxiety was the ‘Inventory self-assessment of State-Trait Anxiety” (STAI-Y) and the ‘Amesterdam Preoperative Anxiety and Information Scale” (APAIS).

Using the STAI scale reveal a moderate to severe level of anxiety “state” in 26% of cases and a moderate to severe level of anxiety “trait” in 18% of patients. While, by the application of the APAIS scale, preoperative anxiety was detected in 44% of our patients; it was fairly linked to surgery and anesthesia. In our sample, 40% had expressed a means to intense desire for information about anesthesia and surgery. A high score of anxiety was correlated with general anesthesia (p=0.016) and low level of information (p=0.006). A moderate to severe level of anxiety “state” was correlated with low socioeconomic level (p = 0.03), heaviness of the surgery (p = 0.02) and a moderate to severe level of anxiety ‘trait” (p = 0.026).

Our study confirms the concerns of patients regarding both anesthesia and the surgery and highlights the problem of lack of preparatory information. Thus, collaboration between the surgeon and the anesthetist during the preparatory stage is indispensable to decrease the level of preoperative anxiety.

Post-traumatic stress disorder (PTSD) is a debilitating condition, caused by exposure to an extremely traumatic, terrifying, or tragic event. Likelihood of some mental disorders increases among women during the postpartum period. In fact, women are potentially vulnerable to mental illnesses during and after pregnancy. This study aimed to determine the prevalence of PTSD among postpartum women in Zahedan city, Iran.

Data in this cross-sectional study were gathered from healthcare centers of Zahedan, located in Southeast of Iran. Four-hundred people were selected among women with previous childbirth experience over the past few months; almost 6-24 weeks had passed since their delivery. We used three questionnaires in order to evaluate demographic data, PTSD symptoms, and traumatic childbirth experience.

In total, 32% of the participants showed PTSD symptoms. Prevalence of PTSD was not significantly associated with parity, pain duration, education level, and employment status. In addition, PTSD was significantly correlated with the mode of delivery (p=0.013), curettage (p=0.005) and length of hospitalization. Also, prevalence of PTSD was substantially associated with the type of pregnancy (planned or unintended) (p=0.011).

As the results indicated, women with PTSD were not significantly different from those without PTSD in terms of parity, pain duration, education level, or employment status. Previous history of curettage, episiotomy, and vacuum evacuation increased the incidence of PTSD in postpartum women. Moreover, unwanted pregnancy was more common among women with PTSD, compared to normal subjects.

The treatment of anxiety disorders is subject to multiple factors (biological and environmental), this creates a complex situation while trying to achieve effective treatment of anxiety disorders.

This is the reason why in the current study, we decided to evaluate the effectiveness of specific relaxation techniques as an additional therapeutic measure.

To determine whether there is therapeutic benefit in the application of relaxation techniques among patients undergoing Pharmacological and psychological anxiety disorder treatment in comparison with patients with anxiety disorders receiving only the latter.

Firstly the process involved a pre and post intervention assessment using a psychometric equipment the Hamilton rating Scale for -HARS anxiety (HARS), the anxiety Inventory-STAI State (STAI-S) and Trait (STAI-T), which allowed us to perform an objective assessment of anxiety levels

Significant reductions in post intervention levels were obtained in comparison with pre anxiety levels, in HARS (30.56 and 22.75), in STAI-S (64.93 and 46.62) and in STAI-T (83.75 and 63.56).

Additionally the size effect (SE) was considerable, in the HARS (SE= 0,70), en STAI-S (SE=0.59) and STAI-T (SE =0.69).

From the obtained results, we can affirm there are benefits of introducing therapeutic relaxation techniques as a complement to pharmacological / psychological treatment in patients with anxiety disorders.

However more studies should be carried out to evaluate the maintenance of these results in the Long-term.