Chronic pain is a prevalent condition worldwide. Opioids have beneficial effects when treating pain, but also involve risks. Opioid iatrogenic dependence(OID) is becoming more prevalent in western countries. Co-occurring psychiatric disorders are both among its predisposing factors and its complications.

To review factors predicting response to opioid treatment, especially those related with psychiatric comorbidities. We describe a case of OID as an example of the patient-type.

Attention needs to be paid to OID considering its growing health impact.

Throughout the case of a patient with chronic pain due to post-radiotherapic proctalgia, who suffered from depression and showed maladaptive personality traits, we describe a case of OID.

All patients assisted at our Pain Clinic have current or previous psychiatric disorders, and in almost half of the cases is major depression, as it happens in our case-example. Concomitant psychopharmacological treatment of opioid dependence and psychiatric comorbidities (including other drugs abuse/dependence) improves outcomes.

A global view of the opioid-consumer that includes comorbid psychiatric conditions is needed.

Studies show that children of oncologic patients resort more to psychiatric care and document the possibility that they face these episodes as traumatic events, easily developing PTSD if not properly signaled and followed.

The authors present the case of a boy who faced his father disease as a traumatic event, developing PTSD. They aim to describe the potential impact of parental oncologic diseases in children, as well as the benefits of acting preventively in those scenarios.

Report of the clinical case of a 14 years old boy who was admitted as an outpatient at the Department of Child and Adolescent Psychiatry after being referred by his General Practitioner for having initiated behavioral disturbances in reaction to his father oncologic disease, which led to a radical surgery of the face and neck with significant physiognomic changes. He has been followed in consultation, medicated with Risperidone 0,5mg and submitted to psychotherapy.

During approximately three months of treatment there was a wide improvement of the clinical condition with better acceptance of his father oncologic disease and of the physiognomic changes caused by the treatment. It is also noticeable the fading of his indignation against the medical community caused by the aggressive nature of the surgery.

This case shows a situation that would have benefited from a preventive intervention, because given the mutilating nature of the treatment, the adolescent should have been prepared to face his father's new appearance from a therapeutic perspective and not as a traumatic event.

Prevalence of violent behaviour within acute psychiatric services is about 10%.

To assess compliance of management of acutely disturbed patients with the National Institute for Health and Clinical Excellence (NICE) guidance for use of Rapid Tranquilisation (RT).

A sample of 24 patients admitted to local Psychiatric Intensive Care Unit (PICU) receiving RT during 2011 was assessed using retrospective analysis of records.

100% compliance was achieved in many of the criteria assessed, including recording the risk assessment and management plan appropriately.

None of the patients had up-to-date advance directive detailing their preferred strategies in case of violent incidents.

50% of patients had their baseline blood pressure, pulse, temperature and respiratory rate recorded and 33% at regular intervals.

25% were debriefed and none offered an opportunity to write their account of RT.

38% had their medication reviewed following RT.

46% were suffering from psychotic disorders; manic episode accounted for 25% of all patients.

54% of all (65% of men) received Zuclopenthixol acetate for RT and 46% the combination of Haloperidol plus Lorazepam; however, the combination of Haloperidol plus Lorazepam was used in 71.4% of women and 35% of men.

12.5% required a short period of seclusion.

All patients were detained under the Mental Health Act.

Training of the PICU staff in the NICE Guidance: The short-term management of disturbed/violent behaviour in psychiatric inpatient settings and emergency departments.

The study used psychometric method. The validated scales used were Leonhard Personality Inventory, NEO-PI-R, SAS, SDS, HCL-32- R1, Holmes and Rahe stress scale, SAF. We included all patients who have applied to the Institute of Plastic Surgery and Cosmetology from February 2012 to June 2012 and who gave Inform Consent.

Study sample consists of 123 patients (103 women), 18-70 years. In the group of cosmetologists’ patients (n=92; 76 women; mean age 44,6+-2,5 years) histrionic and anxiety-phobic personality traits predominated. Constitutionally determined or gained extroversion, expressivity, impulsivity and emotional instability were detected. Anxiety symptoms were detected in 32,4% of patients; depressive symptoms were detected in 35,8% of patients. In the group of plastic surgeons’ patients (n=31; 27 women; mean age 36,7+-1,8 years) pedantic, sticking and disthymic personality traits predominated. Introversion, high level of self-control and detachment were detected. Anxiety symptoms were detected in 22,9% of patients; depressive symptoms were detected in 21,7% of patients.

Our data give evidence of statistically significant differences in pathocharacterological and pathopsychological traits of plastic surgeons and cosmetologists’ patients. about one-third of these patients report about symptoms of depression, anxiety and hypomania. Complex diagnostic examination needed in order to determine nosological diagnosis and treatment strategies.

Fragile X syndrome is the most common inherited form of X-linked mental retardation. The aim of this study was to screen and identify fragile X syndrome-affected individuals in Tamil Nadu (South India) using DNA-based molecular analysis and chromosomal abnormalities.

Genomic DNA extracted from 47 (29 males and 18 females) individuals with mental retardation, including 47 controls, was analyzed using polymerase chain reaction, DNA gel electrophoresis and sequence analysis. Individuals with mutation were determined according to the CGG repeat size in the FMR1gene on chromosome Xq27.3. At same set of mentally retarded individuals, including controls 3ml of blood were collected in Lithium heparin tubes. The blood samples were incubated in 72 hours under culture conditions and harvested for Gbanding technique and results were guaranteed by SKY techniques.

The sequence analysis shows that the CGG repeat was found in fragile x site which expressed Fragile X syndrome highly when compared to healthy controls. The major Chromosomal aberrations (CA) like deletion, translocation and mosaic were also found. However, when compare with experimental subjects, the controls exhibited low levels of CA (P<0.05).

Results of this investigation suggest that, deregulation of the FMR1 gene might have responsible for fragile X syndrome of mental retardation, and CA among the individuals. Further investigation of this study helps to predicts the causes of this syndrome in molecular level (RNA based FMR1gene – Protein).

Children and adolescents make up one third of the world's population. Neuropsychiatric disorders are the most prevalent cause of health burden in this age group and are estimated to effect 10 to 20 per cent of children worldwide. Little is known about the prevalence of child psychiatric morbidities and associated risk factors in countries like Pakistan.

This is a prospective cross sectional study of 300 participants aged 6 to 18 years. Participants were recruited from a general psychiatric outpatient department over 12 weeks in Lahore, Pakistan. Information was collected on presenting complaints, possible risk factors and mental health disorders using the strengths and difficulties (SDQ) questionnaire.

Our preliminary results show that frequently reported presenting complaint were fits and alterations in consciousness (54%), disturbed behaviour (14%) and depressive symptoms (8.3%). The most frequent mental health disorder on SDQ was hyperactivity, followed by conduct. Emotional problems were least commonly reported. Male participants scored higher for conduct disorder. A history of epilepsy was reported by 35.3% of participants. Low socio economic status, low educational achievement and nuclear family setup were associated with higher rates of illness.

Our results show that fits and alterations in consciousness was the most frequently reported presenting complaint. Hyperactivity was most prevalent followed by conduct. The majority of child and adolescent patients attend general practitioners or general psychiatry out-patient departments. They are managed by practitioners who lack adequate training. Training these clinicians would help utilisation of limited resources.

The aim of the study was to identify sociodemographic, and clinical risk factors for suicide in the population of service-users (SUs) and nonservice users (NSUs) and gender-related characteristics of suicidal behaviour in a limited geographic region.

Data of 68 suicide cases (ICD-10 X60-X84) collected for residents on the Isle of Wight District between January 2006 and December 2009. All data were statistically analysed by using Pearson's chi-squared test and Yates’ correction for continuity.

The mean annual suicide rates were 5.65 per 100.000 for women and 19.28 for men. Significantly (p=0.0006) more men than women (male/female ratio 3:1) died as a result of suicide. Relatively (p=0.07) more women (56.2%) than men (32.7%), and significantly more (p=0.05) SUs (45.3%) than NSUs (13.3%) were unemployed. Significantly more (p=0.0006) SUs (64%) than NSUs (20%) had a history of suicide and relatively (p=0.06) more (50.9%) SUs than NSUs (20%) had attended the A & E. Depression as the most common Axis-I illness was diagnosed in 36% of all; but significantly (p=0.008) more in women (66.6%) than men (17.3%). Relatively (p=0.07) more women (56.2%) than men (32.7%) have contactacted serivces before their death. Suicide by hanging was the most common cause acounting for death of 71% of men and 50% of women.

80% of all suicides were conducted by people suffering from mental disorders. Depressive disorders in women and stressrelated disorders in men were the most common mental disorders. Treating mental disorders seem to be one of the key elements in suicide prevention.

Cognitive behavioral therapy emphasize the role of supervision during the training of the therapists Our study measured the trainees' expectations from the supervision and relation of the expectations with the therapeutic competencies.

Beliefs and attitudes toward supervision were assessed by the Attitudes and Beliefs about Supervision Scale (ABSS). It is 25-item questionnaire which measures the attitudes in 5 domains of therapy and supervision (therapeutic relation, skills, self-reflection, structure and process). Trainers and supervisors rate the level of competencies of trainees in Therapy Competencies Questionnaire (TCQ).

The trainees (n=50, mean age 34.8 + 7.3 years) prefer helping with self-reflection and understanding of therapeutic relation (mainly countertransference) during supervision slightly (but significantly) more, than supervison of classical CBT domains like skills, structure and process. There were not the correlations of the most of ABSS domains with the trainees' therapeutic competencies measured by CTQ with the exception of domain ‘skills’, which statistically highly correlate with some specific CBT competencies like skill to reward patient, using conceptualization and leadership of the social skills training,

The trainees of cognitive-behavioral therapy courses expect from the supervision helping in the understanding of the therapeutic relation (mostly counter-transference) and the improvement of the self-reflection and these expectations are higher than the expectations about supervision of skills and therapy structure. Nevertheless, on the other side, only level of expectations of the supervision of domain ‘skills’ highly correlate with the level of some competencies of the trainees rated by their trainers and supervisors.

This systematic review is to provide evidence for the guideline for the treatment of interictal psychosis in epilepsy for Kempenhaeghe, a categorical epilepsy treatment center in Heeze, the Netherlands.

Life-time prevalence of psychosis in patients with epilepsy ranges from 2-7% of which 10-30% interictal.

Typical and atypical antipsychotic drugs are widely used to treat.

The combination with epilepsy, drug-interaction and the effect of anti-psychotic medication on the seizure threshold are complicating factors.

Evidence for the efficacy of pharmacological treatment is lacking.

The research question is: Which antipsychotic medication is effective and safe in the treatment of interictal psychosis?

We searched in: Medline, Embase, Psychinfo and the Cochrane database.

Two independent reviewers made a first selection from the titles and abstracts. If necessary the selection was made with the full text version. In case of disagreement, a third reviewer decided.

Study, patient, intervention characteristics

Cohort studies and Case control studies were assessed with the appropriate CASP (Critical Appraisal Skills Program) assessment tools.

The search yielded 206 articles. After final selection 6 articles remained. 3 prospective cohort studies, 1 case series and 2 case reports.

Anti-psychotic medication can be effective (grade 3)

Possibly the dose needed can be lower. (grade 3)

Possibly clozapine lowers the seizure threshold. (grade 3)

No other anti-psychotics lower the seizure threshold (grade4)

No anti-psychotic is especially effective (grade 4)

There is no evidence for length of treatment.

The review and the guideline will be presented.

Antonovsky's salutogenic construct of sense of coherence (SOC) includes the dimensions of meaningfulness, comprehensibility and manageability. SOC is assumed to promote and protect health in stressful situations, such as the adaptation to severe illness. There is highquality evidence on this in several areas of mental health, and one could expect dementia to be one of them.

We conducted a literature review to uncover the role of SOC as moderator or mediator in the ability of patients and their partners to cope with the impact of dementia.

We searched the major databases (1994-2012), using selection criteria, data extraction and methodological quality assessment. Nvivo10 software was used to accomplish a rigorous literature review.

The SOC within the dementia context has been explored in 8 different countries. Some studies addressed the caregiver's SOC, but the focus on the person with dementia and a systemic perspective on couples remain largely neglected. There were significant associations between SOC and lower caregiver's burden, and between SOC and higher caregiver's perceived health and quality of life, namely in advanced dementia.

There is a dearth of research-based discussions of the SOC role in living with dementia. Results highlight the importance of studying couples, in a dyadic perspective, while acknowledging the voice of the patients themselves, despite several methodological challenges. Research should address the role of SOC in the individual and family's ability to cope with dementia, especially at the early stages of the process, aiming to provide new insights into dementia care.

The combination of dementia and depression in elderly patients is challenging for the differential diagnosis of the clinical situation

To examinethe comorbidity of dementia and depression in elderly patients

231 patients aged 70 years and older.

MMSE and clock drawing test, HADS and Cornell Scalefor Depression in Dementia (SCDD).

The study revealed the presence of mild cognitive impairment in 118 patients, unequivocally proven symptoms of dementia - in 113 patients.

Depressive disorders were found in 88 patients. Depressive symptoms were found in 136 patients. In patients with mild cognitive disorders prevailed depressive disorders of mild to moderate severity.

The relations of depression and dementia in Alzheimer's disease or vascular dementia are the following options:

1. 1. Depressive disorders are often detected in the patients who later developed dementia.

2. 2. The clinical picture of depression in Alzheimer's disease may occur with atypical symptoms, as well as a number of symptoms of dementia can be mistakenly classified as a manifestation of depressive disorder.

3. 3. In some cases, patients with incipient dementia can be set psychogenic the nature of depression.

The development of depression in elderly patients, especially without the presence of a ‘trigger’ social factor may be a predictor or risk factor for cognitive impairment in the future. This applies particularly to patients who have depressive disorder is an atypical clinical picture and the processes of the clinic ‘pseudodementia’ and to the patients, in addition to having a depressive disorder clinically significant neurologic deficit.

Stigma can be divided into several subgroups – social, structural, and internalized (i.e. self-stigma).

The purpose of this study was to identify the extent of internalized stigma in in-patients with neurotic disorders with or without comorbid depressive disorders and to clarify the relationship between internalized stigma and change of the severity of the symptoms during a treatment. The following methods of evaluation were used at the start of the treatmen: MINI, Internalized Stigma Of Mental Illness (ISMI); and at the start and in the end of the treatment: BAI, BDI-II, CGI. All patients underwent a treatment by group therapy (CBT or psychodynamic) and pharmacotherapy.

76 patients were included, the mean age was 40.20 + 12.85 years. The primary diagnosis was an anxiety disorder in 52 patients (68.5%) and a depressive disorder in 24 patients (31.6%). The mean overall scores in BAI, BDI-II, subjCGI, and objCGI significantly declined during treatment. There was a negative correlation between a subjective evaluation of the change of the anxiety symptoms during the treatment and internalized stigma. As for the change of the severity of the symptoms evaluted by a physician, the overall score of the ISMI scale statistically highly negatively correlated with the change measured by objCGI (Pearson r= -0,7665; p≤0,0001).

The more individuals agree with prejudices about psychiatric patients and apply them on themselves, the less they improve in their anxiety symptoms severity during the treatment both from the subjective and objective point of view.

Schizophrenia is a major mental disorder, with complex symptoms involving psychosis, apathy and cognitive impairment. The Trail Making Test (TMT) is a useful tool to assess cognitive functioning. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a noninvasive technique that allows monitoring of cerebral hemodynamics with a high temporal resolution during cognitive tasks.

We assessed cerebral hemodynamics and lateralization in the middle cerebral arteries (MCA) using fTCD while patients with chronic schizophrenia and healthy subjects performed the TMT Part A and B, as well as a control task.

fTCD was used to asses bilateral mean cerebral blood flow velocity (MFV) changes in the middle (MCA) and anterior (ACA) cerebral arteries. Fifteen patients with chronic Schizophrenia and 20 healthy control subjects with similar sociodemographic characteristics performed the TMT during fTCD measurements of the MCA and ACA.

Schizophrenia patients demonstrated an overall poorer performance, with a significant different lateralization pattern for both forms of TMT than healthy subjects. There was a significant slowing both forms of TMT, schizophrenia was associated with initially left sided lateralization. Healthy subjects showed a bilateral pattern.

These novel results show performance and brain perfusion abnormalities in schizophrenia, supporting the idea that cognitive performance has a pathological functional correlate predominantly in the lateral hemispheres of the brain. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion.

Social support is an important variable involved in the process of health/disease. In the particular case of immigrants, social support is also related to the success of their life project and the integration in the society that received them.

Although Duke-UNC Functional Social Support Questionnaire is one of the most used with immigrants (e.g. National Health Survey), it has never been adapted to this population. In this research, Duke-UNC was adapted to Romanian immigrants living in Spain, in order to analyze the relationship between social support and mental health.

Verify the factorial structure and the psychometric properties and analyze the relationship between social support and mental health.

We administered Duke-UNC and GHQ-12 to a sample of Romanian immigrants (N = 116, mean age = 33.26; SD = 11.04), and conducted an exploratory factor analysis.

In the case of Duke-UNC, the results showed a structure of one factor that accounts for 51.46% of the variance. Cronbach's alpha value was .90. A significant negative correlation was found between the social support and the mental health (r = -0.34, p < .000). This shows that people who have more social support also enjoy better health state.

This study demonstrates that Duke-UNC is a practical instrument that can be used to assess Romanian immigrants'social support. This variable has to be taken into account when therapeutic interventions and health programs are created for immigrants because of its relationship with mental health.

Suicide is a major cause of disability and mortality.

Examine the role of neurobiological factors of suicidal behavior, includingneyrotransmitternyh and neurohormonal systems, which include the metabolism ofbiogenic amines.

55patients aged 17 - 35 years of both sexes (58 men and 97 women) who havecommitted suicide

Clinicalexamination, biochemical and immunogenetical methods.

Found thattheir violation and imbalance, namely increased concentrations of serotonin inthe blood (2,39 ± 0,24 mmol / l) reduction in plasma melatonin (0,71 ± 0,07 mmol / l) and decreasedexcretion rate adrenaline and noradrenaline at night (0,39 ± 0,06 and 1,21 ± 0,25 mmol / h) and daytime periods(1,66 ± 0,26and 4,56 ± 0,86 mmol/ h), creates neurohormonal background for the development of psychopathologicalconditions that lead to suicidal intentions and actions.

Patientswith specified neurobiological changes have been unable to get out of the longconflict through active variant of overcoming conflict and completed suicidalacts. According to the results of biomedical research, with to appropriatecorrection is differentiated use of natural biogenic stimulants herbalantidepressant that selectively affect the turnover of serotonin, melatonin, or drugs that stimulate the function of epiphysis.

numerous studies have shown higher rates of anxiety and depression, post-traumatic stress disorder (PTSD), chronic diseases and other physical symptoms in women exposed to intimate partner violence.

to analyze the relationships between duration and frequency of abuse and diverse health factors (mental health, physical complaints, post-traumatic stress disorder and self-perceived health) in a sample of battered women.

This study is composed of 274 battered women from Chile and Spain. The instruments used were: a semi-structured interview for victims of abuse, specifically designed for this research, which assesses sociodemographic characteristics of victims and circumstances of abuse; the General Health Questionnaire (GHQ-12) (Goldberg and Williams, 1988); Complaints Questionnaire, extracted from the National Health Survey of Spain (INE, 2006) and the Severity of Symptom Scale for PTSD (Echeburúa et al., 1997).

the results show that both the duration and frequency of intimate partner violence are associated to poorer health outcomes. For example, higher duration of violence leads to higher number of physical ailments and higher severity of PTSD symptomatology.

this results allow a better understanding of women health that suffer this kind of violence from their partners, and let us to develop treatment programs that best suit their specific needs, both in the private and public health field.

The etiology of psychiatric disorders in children with vertically acquired HIV is assumed to be related not only to neurotoxicity of HIV virus but also to environmental factors. To presence of comorbid psychiatric disorders has many consequences including worse compliance and engagement in risk behaviors which may lead to the expansion of HIV virus. By the end of 2012 - 118 children were subject to antiretroviral therapy in Poland.

The goal of the study was to assess the prevalence of psychiatric disorders in children and adolescents with perinatal HIV infection.

The study is carried out in The Clinic of Infectious Diseases of Childhood in Warsaw's Hospital for Infectious Diseases. 59 vertically HIV infected children aged 6-18 were qualified for the study. The control group is made up of healthy children at risk of infection (healthy children of HIV positive mothers). All subjects are interviewed with K-SADS-PL, Child Behavior Checklist (CBCL) and Youth Self Report (YSR) questionnaires in the diagnostic process for the presence of psychiatric disorders and quality of life testing.

Out of thirteen HIV vertically infected children tested up to day eight met criteria for at least one current or past psychiatric disorder according to DSM IV including ADHD, mood and anxiety disorders. One patient met criteria for five psychiatric disorders.

62% of HIV vertically infected children presented symptoms of at least one psychiatric disorders. The results of the pilot study suggest that the continuation of the study is justified.

Many risk factors for cocaine-induced psychosis (CIP)in cocaine-dependent patient (CDP) have been described although there not exactly known. Differences in the personality traits or disorders in CDP with or without CIP has been described. However, there are few studies studding the relationship between CIP and personality with a dimensional approach in order to clarify if there are any personal dimension related with CIP or/and personality disorders (PD) in CDP.

This study the relationship between CIP and personality trails evaluates with ZKPQ, and attempted to identify any personality dimension as a risk factors for CIP.

We performed a cross-sectional, observational study in 260 (75.5% man, 36.5 y.o) CDP according DSM-IV-TR seeking treatment between May 2009 and April 2013. The SCID-I, SCID–II, ZKPQ and a structured interview about CIP were performed.

CIP was reported for 66.4% of the patients. Patients with CIP had an earlier onset of cocaine dependence (p<0.05). Any PD was identified in 46.9% of the sample. Patients with CIP were diagnosed with ASPD more frequently (28.9% vs. 15.6%, X2=9.9, p<0.05). ZKPQ mean were: Sociability (6.3± 3.6), Neuroticism-Anxiety (10.8± 4.8), Impulsive Sensation Seeking (10.8±4.5), Aggression Hostility (9.06±3.2) and Activity (8.3±3.4). Patients with CIP presented higher scores in Neuroticism-Anxiety (11,4±4,7 vs. 9,6±5, t=2.7, p<0.05) and Aggression-Hostility (9,4±3,1 vs. 9,4±3,1, t=2.3, p<0.05) than patients without CIP.

The detection of high scores of neuroticism-anxiety and aggression-hostility trails should lead to evaluate the presence of CIP in CDP in order to alert them of the risk of develop CIP.

NICE guidance (2009) advises not to use drug treatment specifically for Borderline Personality Disorder (BPD) or for the individual symptoms or behaviour associated with it. Despite this, the Prescribing Observatory in Mental Health (POMH UK, 2012) found that 82% of Personality Disorder patients with no co-morbid mental illness were prescribed at least one psychotropic medication. We aimed to assess characteristics of patients with BPD and their use of medication in an inpatient population.

The population included 100 discharges from four acute inpatient wards in Sheffield, U.K., with a diagnosis of Emotionally Unstable Personality Disorder (F60.3 and F60.31) from April 2012 to April 2013.

Of the 100 discharges, 69% were female, 91% unemployed, 59% single and 98% admitted under the Mental Health Act. Hospitalisation was usually after a crisis: 68% reported suicidal ideation, 37% a suicide attempt and 13% risk of harm to others. Most common co-morbid diagnoses were depression, (18%) illicit drug related disorders (7%), alcohol related disorders (5%) and schizophrenia (5%). Medications prescribed included antipsychotics (57%), antidepressants (66%), anxiolytics (38%), hypnotics (31%), and mood stabilisers (19%). Drug treatment specifically for BPD (e.g. repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms) was prescribed to 80% of patients.

Findings highlight that despite national guideline recommendations, patients with BPD continue to be prescribed psychotropic medications in clinical practice. As most admissions are associated with crises, a comprehensive crisis plan including (only if indicated) appropriate use of medication is essential in helping during periods of distress.