Valproic acid is a broad-spectrum drug used in neurological disorders but also in psychiatric disorders such as mood stabilizer in bipolar or schizoaffective disorders.

Despite being a usually well tolerated drug, valproic acid may be associated with some adverse effects. Most of which are mild and transient, however some adverse reactions may be serious like encephalopathy. In fact, valproic acid induced encephalopathy is an unusual but serious complication, characterized by decreasing level of consciousness, focal neurological deficits, cognitive slowing, vomiting, drowsiness and lethargy, with or without hyperammonemia.

The aim of this work is to describe a case report of a woman who developed valproic acid induced encephalopathy during her hospitalization in the Coimbra's Psychiatric Department.

This is a woman, 46 years old, diagnosed with a bipolar disorder who was hospitalized for stabilization of their depressive symptoms.

At the entrance, a confusional state was found with fluctuating state of consciousness, psychomotor slowing and incoherent speech.

An analytical study was conducted which showed a hyperammonemia of 70μg/ dL.

Immediately the valproic acid was suspended on suspicion of encephalopathy induced by this drug.

Gradually, in about 2 or 3 weeks, confusional state disappeared, and the patient discharged from the hospital oriented in time and space, with coherent speech, euthymic mood and regularized sleep.

Valproic acid induced encephalopathy, is a reversible but potentially fatal adverse reaction that requires a high index of suspicion. Organic brain damage and polytherapy appear to be important risk factors for its occurrence.

A 23 year old woman with an established diagnosis of eating disorder was analysed for multiple personality traits in the background of a multifactorial etiology.

1. 1) Establishing secondary complications in the case

2. 2) Diagramatically representing the findings

1. 1) Identifying the personality traits

2. 2) Etilogical analysis

1. 1) Retrospective analysis of all medical and psychiatric events.

2. 2) Interviewing the patient and relatives.

3. 3) Research

4. 4) Analysis of all medical investigations carried out.

5. 5) Response to multidisciplinary management.

It was confirmed that multiple factors played their roles in the development of the condition including both familial and environmental agents.

53 patients and 47 matched controls were studied using a new questionnaire (SEXSAM Scale) measuring relevance of sexual and emotional relationships in patients’ daily life. A specific Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX Montejo 2001-2008), Sexual Activity Assessment Scale modified from Kinsey (Montejo 2006) and the HONOS Scale measuring bio-psychosocial functioning were also applied.

Sexuality (physic and emotional) was scored as high valuable and the main motivation for sexual activity was looking for love and fondness in both groups. No differences were found in the value of more affective behaviours such as kissing, caressing, hugging or massaging. Global satisfaction in sexual and emotional life was significantly superior in control group and linked to the higher frequency of sexual relations. Many patients suffered for sexual dysfunction related to the treatment use and many of then were dissatisfied with their sexual life. Just a few numbers of patients had regular sexual intercourses. Patients describe an improvement in the self-perception of mood, appetite, sleep, anxiety level, humour sense and self-esteem when they have sexual relations. Predominant sexual activity for patients was masturbation. Prostitution use was higher in patient group. All these findings are negatively influencing personal satisfaction and quality of life.

Relevance of sexual and emotional life in patients is as high as in normal population. These patients are more concerned about affection and companionship than about physical pleasure.

Depression is very common among institutionalized elders. Because of the increased risk of cognitive impairment/dementia, and mortality we want to describe the evolution of depression and analyze predictive factors.

In the Aging Trajectories Study (Instituto Superior Miguel Torga - Coimbra), we followed up a sample of 83 nondemented persons (M ± SD baseline age = 79.51 ± 6.58; men: 17; women: 66). In a 2-year prospective cohort analysis (2010-2011, and 2013), we assessed depression using the Geriatric Depressive Scale/GDS as screening tool and the Mini International Neuropsychiatric Interview to diagnose depression. We also used the UCLA Loneliness Scale, the Geriatric Anxiety Inventory/GAI, the Positive and Negative Affect Scale/PANAS. Sociodemographics, and health were control variables. We performed a multinomial logistic regression to identify predicitive factors.

Fifty participants had depression at baseline, nine developed, 49 maintained, nine remitted, and 16 maintained without depression.

Having depression was associated with worse scores in UCLA, GAI, and PANAS. Not having depression was correlated with higher positive affect.

Baseline higher GAI and UCLA, and lower positive affect and satisfaction predicted recurrent depression.

Improvement in GDS, GAI, and positive affect predicted depression remission.

Results show that depression is a concern issue for professionals working with institutionalized elderly. Anxiety, loneliness, low positive affect and satisfaction constitute a risk factor for maintaing depression in institutionalized elderly and low anxiety and depressive symptoms are a protective factors for depression. These results could be used in depression prevention programs.

In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy.

In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10 mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy.

QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome.

Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.

Cognitive rehabilitation techniques, reminiscence therapy, and reality orientation therapy, have shown an impact on cognition, life satisfaction, mood, and on the progression of cognitive decline in elderly.

To test the effectiveness of a NRGP on the cognitive and emotional functioning of institutionalized elderly.

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single blind randomized controlled study with paired groups.

Coimbra institutionalized elderly, aged between 64-92 (N = 88) with cognitive impairment no dementia, mostly women (75.0%).

randomization of participants to the rehabilitation group/RG (n = 41) and to the comparison/waiting-list group/CG (n = 23). NRGP involved groups of five elders, and took 90 min. per day, once a week, for 10 weeks.

Mini-Mental State Examination/MMSE, Frontal Evaluation Battery/FAB, Geriatric Depression Scale/GDS.

We used general linear model with repeated measures analysis of variance.

RG improved significantly on cognitive, and executive function (p < 0.001), and CG worsened on cognitive, executive function, and mood (p < 0.01). There was a significant effect on the MMSE, FAB, and GDS scores, after excluding pre-rehabilitation scores as covariates [F (1, 81) = 43.98, p < 0.001; η2 = 0.35; F(1, 80) = 28.37, p < 0.001; η2 = 0.26; F(1, 79) = 19.66, p < 0.001; η2 = 0.20].

A NRGP including cognitive rehabilitation, reminiscence therapy, and reality orientation proved to be effective on cognitive and executive functioning, and on depressive symptoms of institutionalized elders with cognitive impairment no dementia.

The Beck Depression Inventory-II [BDI-II] (Beck et al., 1996) is the self-report instrument to depressive symptoms most widely used. A 2-factor structure is frequently obtained in clinical and nonclinical samples. Our group found an identical 2-factor solution in pregnant (3rd trimester) and postpartum women (3 months); the two factors were: Cognitive-Affective and Somatic-Anxiety (Bos et al., 2009).

To investigate the BDI-II factor structure in a sample of childbearing age women who were not pregnant or that did not have children in the last year and to compare the structure of depression symptoms experienced by women in the perinatal period versus outside the perinatal period.

120 non-perinatal women (students and employees at health and education institutions), aged 18-44 (M=29.42±7.159 years), currently or in the last year unpregnant, were asked to to fill in the BDI-II. A principal components analysis with Varimax rotation was performed.

The internal consistency coefficient Cronbach alpha (α) was of .82. Following the Kaiser and the Cattel's Scree Plot criteria, a two factors structure was selected, which explained 43.56% of the variance [EV]. Based on items content, Factor [F] 1 (EV=33.55%; a=.83) and F2 (EV=10.26%; a=.82) were respectively denominated’Somatic-Anxiety’ and’Cognitive-Affective’. The dimensions composition completely overlapped with the Bos et al. (2009) structure, obtained with perinatal women.

The BDI-II factorial structure in non-perinatal childbearing age women is robust and meaningful. Our results support the view that the structure of depressive symptoms does not differ between perinatal and non-perinatal women.

Ketamine, an N-methyl-D-aspartate antagonist, rapidly improves depressive symptoms in individuals with treatmentresistant depression. However, most trials using ketamine were limited to single administration and were performed with the racemic mixture of ketamine. The aim of this case series was to investigate the clinical efficacy of multiple intravenous administrations of S-ketamine in the acute treatment of treatment-resistant depression.

In 6 patients suffering from Major Depression (DSM-IV criteria) and being pharmacoresistant to at least 2 antidepressants, intravenous Ketamine treatment was started with a 40 minute administration of 0.25 mg S-ketamine/kg body weight i.v. The treatment was performed over 3 weeks using 2 infusions per week. Patients were kept on their current pharmacotherapy regimen (including antidepressants). The patients were rated using the 21-item version of the Hamilton rating scale for depression (HAMD-21) before and 120 minutes after each ketamine infusion.

In 5 of 6 patients a strong improvement of depressive symptoms occurred already after the first ketamine infusion. The response could be stabilized by the following infusions. In 2 patients dissociative symptoms could be seen.

Multiple administrations of ketamine appear to be well tolerated, although negative effects on cognition have been described after longer use. The occurrence of dissociative symptoms in two patients in our study must be viewed as an unpleasant side effect. In the literature there is some evidence, that S-ketamine has better tolerability than racemic ketamine but similar antidepressant effects.

At the conclusion of this presentation, the participant should be able to achieve a global perspective into mental illness.

Influenced by the social philosophy of Rousseau, primitive man was believed to be free of the anguish of mental illness. Studies of mental illness across cultures has brought out important differences in different illness variable: incidence, types, manifestations, outcome and treatment. In so far as variations across cultures exceed those within, culture can be said to play an important role in mental illness.

Schizophrenia has been reported from all societies, but there are differences, particularly in incidence, types and outcome. Paranoid schizophrenia appears to be less common in traditional societies. A distinctly better outcome of schizophrenia has been reported from the developing countries. Depression was felt to be less common in these countries. Personality disorders and neurotic illnesses seem to be less prevalent in developing countries. Multiple personality disorder seems to be rare. Sexual deviations are very rarely reported from many countries. Finally, the traditional, technologically less advanced countries have reported a number of specific conditions that are called culture-bound syndromes.

Separating the differences from similarities across cultures can give us better insight into the’core’ nature of a mental illness. Also, all countries can learn from each other, so as to augment the variables associated with lower incidence and better outcome; obviously a matter of great public health significance.

Perfectionism has been associated to Perseverative Negative Thinking [PNT]. Both are transdiagnostic processes. PNT (in the form of worry and rumination) is a prime candidate when investigating negative components of perfectionism (Macedo et al., 2013).

To investigate if PNT mediates the relationship between perfectionism and negative affect [NA].

344 university students (68.4% girls) were evaluated using Portuguese validated versions of the Perseverative Thinking Questionnaire (two subscales:’Repetitive Thought’ [RT] and’Cognitive Interference and Unproductiveness’ [CIU]), Multidimensional Perfectionism Scale, Profile of Mood States and Perceived Stress Scale, with an additional item to evaluate perceived social support [PSS]. Only variables significantly correlated with the outcomes [NA] were entered in the hierarchic multiple regression models. Mediation analyses using Preacher and Hayes bootstrapping methodology were performed.

Perceived Stress [PS] ((=.245), PSS ((=-.257), Self-Oriented Perfectionism [SOP] ((=-.126), Self-Prescribed Perfectionism [SPP] ((=.122; p=.011), Concern over Mistakes [CM] ((=.102), Doubts about Actions [DA] ((=.115) and CIU ((=.110) were significant predictors (all p<.05) of NA. Controlling for PS and PSS, the perfectionism variables still predict depression, accounting for a significant increment of 16.7% (p<.01). The CIU, introduced in the model after the Perfectionism variables, significantly increments the NA variance in 1.6% (p<.01). CIU was a total mediator in the relationship between SOP and NA (IC95% .025-.229) and a partial mediator in the relationship between SPP (.176-.456), CM (.142-.855), DA (.143-.863) and NA.

PNT potentiates the relationship between negative perfectionism and NA. Positive perfectionism is associated with NA, only in the presence of PNT.

The organic personality disorder (OPD) is a multi-faceted group of dia-gnoses in the boarder area of psychiatry and neurology. In the current teaching books OPD is treated rather cursorily. Evidence-based guidelines have not been published. However, OPD is a frequently observed phenomenon both in psychiatry and neurology.

In the present study an overview is given over historic conceptual principles of OPD. Furthermore, we searched MEDLINE for relevant studies regarding psycho-pathology of OPD. Twelve studies were included in the final analysis. Findings regarding etiology, symptomatology and treatment are summarized.

Psychopathology was not specific to type of etiology. Three major groups of symptomatology were identified (enechy-type, apathy and depression-type, impulsiveness and affective lability-type). There are no evidence-based treatement recommendations for OPD, a small number of case reports suggest a possible therapeutic effect of carbamazepine and trazodone.

With regard to psychopathology the traditional classification of Kurt Schneider was affirmed. A multiaxial diagnostic process can integrate a symptomatological and etiological perspective on OPD. Pharmacotherapy should focus on specific syndromes, e.g. hostility. There is a need for further research with the objective of preparing a clinical guideline.

The study was a comparison of two retrospective studies led in the department of emergency and external consultation of the Razi hospital. The first study had concerned 300 patients examined within the framework of a medical supervision during year 2001. The second study had concerned 430 patients having consulted for the first time in our department during the year 2012 and benefited from a long term sick leave.

Forty was the age the most represented with a net feminine ascendancy in both studies. More than 60% of the patients were married in both study but a decrease of the number of single men has been reported in2012. The middle manager was the most represented professional category: the transport had been the most represented body employer in 2012. Depression was the most represented diagnosis.

The economical impact of the long term sick leave can be important but never considered. The low social support, the dissatisfaction, the workload and the indistinctness of the professional task are at the same time inductive but also aggravating factors.

The clinical differentiation of schizophrenic and mood disorders is frequently challenged by co-occurring affective and psychotic symptoms. Thus, it has long been discussed whether these disease groups are subserved by common or distinct neurobiological surrogates.

The detection of diagnostic biomarkers for schizophrenic and mood disorders could facilitate clinical decision making in ambiguous cases.

To evaluated whether multivariate pattern classification of structural MRI enables the differential diagnostic classification of 158 patients with schizophrenia (SZ) and 104 patients with major depression (MD).

T1-weighted patient scans were processed using voxel-based morphometry. Diagnostic features were extracted from the age- and sex-adjusted GM maps using PCA and linear SVMs. Repeated nested cross-validation was emplyoed to assess the generalizability of diagnostic performance.

Cross-validated classification accuracy was 76% based on a discriminative pattern involving perisylvian, limbic, medial prefrontal and precuneal GM volume reductions in SZ vs. MD. GM volume reductions in MD vs. SZ were detected in the premotor, sensorimotor, parietal, cerebellar and brainstem structures. The 'SZ-likehood' of MD was correlated with the age of disease onset, leading to a significantly higher misclassification rate among MD patients with an age of onset between 15 and 30 yrs.

The findings suggest that SZ and MD can be identified at the single subject level using neuroanatomical pattern recognition. The decreased diagnostic separability of MD patients with an early disease onset may challenge the traditional nosological boundaries and may relate to higher levels of chronicity and unfavorable disease outcomes in this patient population.

patients suffering from psychic disorders are characterized with postponed health-seeking. The aim of this study was to find out factors affecting the activity of health care seeking behavior (HCSB).

200 inpatients took part the study. Most of them were female (74%). Mean age was 44,6±13,5. Among patients 29% suffered from affective disorders, 71% – from neurotic, stress-related and somatoform disorders. Patients were divided into 2 groups with active - aHCSB (n=99) and passive - pHCSB (n=100).

Coping-strategies (Lazarus) test, personality test and attitude towards disease test were used.

Higher degree of combination of moderate seeking of social support coping and moderate planning of problem-solving coping was present in aHCSB compared with pHCSB group (57% Vs 35%, p=0,001). Patients with pHCSB compared with aHCSB were characterized with higher degree of mild seeking of social support coping and mild planning of problemsolving coping (8% Vs 2%, p=0,049). Mild anxiety traits were more common in patients with aHCSB than pHCSB (31% Vs 19%, p=0,041). In contrast severe anxiety traits were more common in patients with pHCSB than aHCSB (15% Vs 6%, p=0,042). Sensitive type of disease attitude resulted in pHCSB (30% compared with 11% in aHCSB group, p=0,012). Hypochondriac type of disease attitude was more common in aHCSB (21% Vs 11% in pHCSB, p=0,047).

health care seeking behavior is affected with complex of psychological factors. Knowing of these factors can be used in prevention of passive health care seeking behavior.