The aim of this study was to test the efficacy of caffeine with or without biperiden in the treatment of cocaine dependent patients.

A randomized, double blind, placebo-controlled clinical trial has been carried out in an inpatient regime during up to 13 days. Eligible patients were randomized to caffeine plus biperiden or caffeine plus biperiden placebo or caffeine placebo plus biperiden placebo.

Eighty five treatment-seeking patients were enrolled in this study. Patients were stabilized with a mean caffeine dose up to 15 mg/Kg. Results show that all three treatments are well tolerated and a clear reduction in cocaine withdrawal and craving was observed. Nevertheless, no statistically significant differences were found between groups in any outcome.

This study shows that inpatient cocaine detoxification with high caffeine doses, with or without biperiden, is well tolerated and allows further research on the usefulness of caffeine in the treatment of cocaine withdrawal and craving. Nevertheless, the selection of an inpatient hospital regime hampered the demonstration of the superiority of caffeine treatment versus placebo.

Despite the increase of research and awareness in delirium it remains underdiagnosed, protean, difficult to manager and more difficult to comprehend.

To find the clinical diagnosed rates of delirium, the possible aetiologies to describe treatment (psychotropics) and to investigate the reasons of referrals to Old age psychiatric team in relation to delirium in a general medical hospital.

Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during a 6 month time

156 files had a documentation of delirium (time prevalence 2%).

Mean age of the sample was 82 years old (SD=7.2), 66 (42%) were male.

69 (44.2%) of the total sample had a previous history of dementia, 57 (36.5%) had a previous history of delirium. In 62 (40%) the cause was infection while in 4 no specific cause was indentified.

90 (58%) referred to liaison service but only in the 26 (28.9%) the reason for referral was’acute confusion’ or’delirium’ while in a majority of referrals the reason was one of the affective disorders and more often depression. There were not any significant differences between delirium subtypes and referrals (χ2=3.868, df:3, p=0.28). Examination of the amount of antipsychotics prescribed pre during and after delirium shows that there was a significant increase of antipsychotics during the delirium (χ2=17.512, df:8, p=0.025) decrease of z-medication, (χ2=20.114, df:4, p<0.001) while benzodiazepines and antidepressants remained same.

Delirium is often misdiagnosed and unrecognized in hospital settings, however when is indentified the pharmacological management is rather optimal

Munchausen Syndrome (MS) is the most severe and chronic psychiatric disorder of factitious disorders. As a rule, external incentives are absent, being the core motivation the willingness to assume the sick role.

Literature review on topic Munchausen Syndrome, with presentation of a clinical case.

Performed a literature review. Clinical data was collected in clinical process of the patient.

The authors report a case of 47 years-old women, presenting marital and family stable relationship and good professional status, with MS. Was admitted to inpatient psychiatry unit in June 2013, by history of 177 episodes admissions at Dermatology and Surgery Departments, with 346 days of hospitalization, due to mixed panniculitis of infectious etiology with repeated abscesses, which started with a bite of a dog in the lower limb, 4 years before. In this period, was resistant to all treatments, only improving during hospitalizations. Medical conditions were excluded. During hospitalization showed depressive mood and refuted the self-inflicted nature of the injuries. Was referred for outpatient psychiatric unit, with the diagnosis of factitious dermatitis, medicated with venlafaxine 75 mg daily, Lorazepam and Flurazepam.

We highlight the case by dermatological repercussions and by psychodynamic myriad, given that the patient was raised by her grandparents after being abandoned by her mother at 20 months, which continues to avoid the rapprochement. As enshrined in the literature, the skin can be a vector for expression of certain psychosomatic unconscious conflicts and these in turn may have a cardinal role in the MPS.

Regular physical activity should be encouraged given its major role in health maintenance and disease prevention. However, in excess, exercise has the potential to cause physical and psychological harm and can become addictive. Excessive exercise can be described in an obsessive-compulsive dimension but it is included among the behavioural addictions since it presents some of its typical characteristics such as mood modification, tolerance, withdrawal symptoms and relapse after periods of abstinence or control.

The authors aim to describe the concept of Exercise Addiction and the current understanding of its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms.

Exhaustive review of the literature on Exercise Addiction and its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms, using PubMed.

The most addictive type of exercise varies with countries. Studies show that physical exercise activates de dopamine reward system contributing to stress reduction and there is evidence of the association between running, endorphins and cannabinoids – explaining the’runner's high’ that can cause addiction. Genetic studies reveal that the same genes control preference for drugs and for naturally rewarding behaviours. Psychological approaches focus on reward, habituation, social support, stress-relief, avoidance of withdrawal and anxiety reduction.

Exercising regularly has several positive effects on physical and mental health but in excess, may have serious physiological and psychological consequences. There are several hypotheses for the mechanisms of exercise addiction including reward, stress reduction, the euphoric effect, mood regulation and sympathetic arousal. More studies are needed to improve our understanding of this behavioural addiction.

Sleep is disrupted in depressed subjects; it also deteriorates with age and with the transition to menopause. The nature of the interrelationship between mood, sleep, age and reproductive state is not well-defined.

To evaluate the relationships between mood and sleep among healthy women in different reproductive states.

We analyzed data from 11 young (20–26 years), 21 perimenopausal (43–51 years) and 29 postmenopausal (58–71 years) healthy Finnish women. Mood was assessed with the Beck Depression Inventory (BDI), subjective sleep quality with the Basic Nordic Sleep Questionnaire (BNSQ), and objective sleep with all-night polysomnography (PSG) recordings.

Among young women, less arousals associated with higher BDI total scores (p=0.026), and higher SWS percentages with more dissatisfaction (p=0.001) and depressive-somatic symptoms (p=0.025), but with less depressive-emotional symptoms (p=0.001). Also, less awakenings either from REM sleep or SWS associated with more punishment (p=0.005; p=0.036), dissatisfaction (p<0.001; p=0.001) and depressive-somatic symptoms (p=0.001; p=0.009), but with less depressive-emotional symptoms (p=0.002; p=0.003). In perimenopause, higher BNSQ insomnia scores (p=0.005), lower sleep efficiencies (p=0.022) and shorter total sleep times (p=0.024) associated with higher BDI scores, and longer sleep latencies with more depressive-somatic symptoms (p=0.032). In postmenopause, higher REM percentages associated with higher BDI total scores (p=0.019) and more depressive-somatic symptoms (p=0.005), and longer SWS latencies with more depressive-somatic symptoms (p=0.030).

Depressive symptoms associated with sleep impairment in perimenopausal and postmenopausal women. In young women, specific BDI factors revealed minor associations, suggesting different types of sleep impairment in relation to different depressive features.

Drugs administered to Alzheimer's disease patients usually aim to increase the levels of acetylcholine or block NMDA receptors, thus producing improvements in cognitive function.

To study the drugs administered to Alzheimer's patients and its possible motor side effect.

Our study included 45 geriatric patients enrolled in a private long-term care institution with mean age of 88.38 ± 0.84 years old, mean weight of en 60.28 ± 2.00 kg with Alzheimer's disease.

Drugs administered to patients with Alzheime's disease were:

donepezil 0.16 mg/kg/day, administered to 53.33% (24) of patients ; rivastigmine patch 9.50 mg/day given to 15.56%(7) of patients and galantamine 0.40 mg/kg/day given to 4.44% (2) of patients.

26.67% (12) of subjects did not received any specific drug for Alzheimer's disease.

Psychomotor agitation and aggressive behavior were observed in 70.83% (17) of patients who received donepezil and in 57.14% (4) patients who had received rivastigmine.

The increase of cholinergic activity due to inhibiton of acetilcholinesterase by donepezil, or due to the activation of cholinergic receptor by rivastigmine in basal ganglia could be related to psychomotor agitation.

This imbalance of cholinergic-dopaminergic activity produced by these drugs may cause motor agitation in a similar way to akathisia induced by neuroleptics.

Insomnia is a common symptom that may interfere with the efforts of alcohol-dependent (AD) patients to initiate and maintain sobriety, with a range from 36% to 91%. To date, only four studies have evaluated nonpharmacological approaches to insomnia complaints in AD subjects in early recovery. However, none of these studies were computer-based, and none were performed in Ukraine.

of the current study was to develop an online computer-based cognitive-behavior therapy for insomnia (CBT-I) for Ukrainian alcoholdependent patients.

A total of 8 individuals with alcohol dependence screened for the study. Demographic information was assessed at the baseline. At baseline, at the end of the study, in 6 and 12 week follow-up patients reported bedroom environment, eating, exercises and substance abuse habits; treatment activities; alcohol use and related clinical variables; daytime functioning measures and sleep variables.

The average age of participants was 44.4 years; 50% were male; all were Ukrainians; 83% had higher education; 67% were married. Baseline mean AUDIT score was 27, SPQ - 17 (all individuals categorized as having insomnia as they endorsed any one item with a 4 or 5). A web-based platform includes psychoeducational information on alcohol dependence, insomnia and CBT-I. Five sessions and a battery of scales examine the effectiveness of the CBT-I package. Each session contains additional materials as homework for patients.

This online Internet intervention for alcohol-dependent individuals with insomnia is the first computer-based treatment program in Ukraine. The findings underscore the importance of assessing and treating insomnia in addition to alcohol consumption with the novel nonpharmacological treatment.

Defendants commonly claim amnesia for their criminal actions especially in cases involving extreme violence. While some claims are malingered or result from physiological factors, other cases may represent genuine partial or complete amnesia resulting from the psychological distress and/or extreme emotion associated with the perpetration of the crime.

To identify possible psychological differences among homicide or severe violence offenders presenting amnesia for the event and those who do not. Due to a small number of offenders commiting such a sever violent crimes. We are presenting results of ongoing research. The preliminary data were presented at the EPA meeting 2013.

We examined homicide or severe violence offenders presenting amnesia for the event (n=20) and those who do not (n=20) with a complex psychological a psychiatrical assessment. Further we evaluated social and criminal anamnesis. Offenders with psychotic or schizophrenic symptoms were excluded.

The ongoing study still shows no differences in cognition or personality in the studeid group (p < 0.01). Elevated levels of dissociation and score in IES questionnaire was found in offenders presenting amnesia for the event.

This ongoing study supports hypothesis that there are no any neuropsychological impairments in nonpsychiatric offenders of murder or severe violence presenting amnesia. Higher level of dissociation and score of impact of events scale (p < 0.05) suggest, that this group of offenders may be more predisposed to dissociative and stressful reactions in overloading events. Thus the question whether the amnesia is malingered or not is still unclear.

Criminal behavior in adolescence is often considered as a consequence of inadequate social support or involvement with risk social groups. Current research shows that youth showing signs of specific psychopathology may be more vulnerable to criminal behavior.

The aim of the study was to compare of developmental psychopathology in adolescence with criminal experience (n=20) to the control noncriminal group. We conducted a structured interview and psychological assessment.

In our pilot study we identified that adolescence with specific developmental psychopathology – i.e. ADHD and conduct disorders are more prone to crime, comparing to the control group at statistically significant level (p< 0.01). The intensity of psychopathology may be connected to the profanity of ongoing criminal behavior.

Nausea/vomiting and other gastrointestinal system disorders may cause severe nutritional complication in elderly neurologic patients.

To identify possible gastrointestinal side effects in patients receiving Alzheimer's disease treatment.

This research included 45 geriatric patients enrolled in a private long-term care institution with mean age of 88.38 ± 0.84 years old, mean weight of en 60.28 ± 2.00 kg with Alzheimer's disease.

Drugs administered to patients with Alzheime's disease were: donepezil 0.16 mg/kg/day, administered to 53.33% (24) of patients ; rivastigmine patch 9.50 mg/day given to15.56%(7) of patients and galantamine 0.40 mg/kg/day given to 4.44% (2) of patients.

26.67% (12) of subjects did not received any specific drug for Alzheimer's disease.

Nausea and vomiting were observed in 20,83% (5) patients who received donepezil, in 85.71% (6) from rivastigmine group and in 2 patients treated with galantamine.

Appetite loss was identified in 20,83% of patients receiving donepezil.

The increase of cholinergic activity induced by donepezil, rivastigmine and galantamine intensify cholinergic neurons inputs from chemoreceptor trigger zone, solitary tract nucleus and cerebellum to medullary emetic centre and thus may lead to emese stimulation in these patients.

Regarding the possibility of nausea/vomiting and appetite loss in patients receiving Alzheimer's disease cholinergic drugs, a more easily digestible meal should be considered for these patients.

Compulsory community treatment (CCT) is intended to be a less restrictive alternative to involuntary hospital care but its use, acceptability and effectiveness remain controversial.

To clarify if CCT can improve patient outcomes based on recent systematic reviews

A systematic literature search of PubMed/Medline and EMBASE up till December 2013. Only systematic reviews (including metaanalyses) were included. Randomised and non-randomised evidence were not mixed, and only RCTs included in meta-analyses.

Five systematic reviews were identified that included 90 papers. Studies with randomised or appropriately matched controls, including adjusting for forensic history, found limited evidence for CCT reducing health service use and improving social functioning, mental state, quality of life or satisfaction with care. Three RCTs provided 749 subjects for the meta-analysis. Two compared compulsory treatment with entirely voluntary care while the third had controls who received voluntary treatment for the bulk of the time (medians of 257 vs. 8 days respectively for initial randomised legal compulsion and 262 vs. 103 over the course of the study). Compared to controls, CCT did not reduce readmissions to hospital in the subsequent 12 months (RR=0.98, 95%CI=0.83 to –1.17). Neither were there significant differences in psychiatric symptoms or Global Assessment of Functioning. Sensitivity analyses of the effect of only including the two studies that compared compulsory treatment with entirely voluntary care made no difference to the results

CCT does not lead to significant differences in readmission, social functioning or symptomatology compared with standard care. Its use should be reviewed.

In Western countries depression and suicide attempts are more prevalent among women, and completed suicides among men; but in China women die more often than men by suicide. How can we interpret these contrasting findings?

Prospective studies of population cohorts.

The Zurich Study found that suicidal ideation was equally prevalent in women and men but suicide attempts more frequent in women. Suicidality was associated with multiple risk factors: both men and women with a depressive personality and severe punishment in childhood were more at risk. Furthermore, women more often reported a broken home, sexual trauma and a lower education level and men that they grew up in a tense family atmosphere.

In another study of 2768 19-year old Swiss army conscripts followed up until age 36, higher external aggression scores were found in the 46 men who died by suicide than in controls. In the Zurich Study women scored lower in external aggression than men.

Men generally choose more violent and women softer methods of suicide. Following the detoxification of gas in England and Wales, women's suicides fell sharply. In country areas in China women's free access to pesticides is considered to explain the high female suicide rates.

The findings call into question the hypothesis that suicide attempts in women are more of an appeal for help. Restricting the availability of weapons and toxic substances can prevent suicide.

Episodic-autobiographical memory (EAM) is the highest ontogenetic human achievement and is defined as the conjunction of subjective time, autonoetic consciousness and the experiencing self. The EAM system is more susceptible to insults than other memory systems and is predominantly affected in amnesic disorders. Dissociative amnesia is triggered by psychological stress and usually presents with retrograde memory impairment in the EAM domain.

This work's objectives are establishing greater recognition of the changes in the area of personality dimensions, self and autonoetic consciousness, accompanying dissociative amnesia.

We review data from own patients with dissociative amnesia or fugue

Patients were investigated medically, neuropsychologically and neuroradiologically.

We found impairments of self and self-referential processing in patients with dissociative amnesia, such as profound loss of personal identity, decreased ability for self-reflection and self projection and anomalous self-face processing. We also identified changes in personality dimensions involving affectivity, perception, cognition (e.g. social cognition) and behavior.

The observed changes in self and autonoetic consciousness may represent a consequence of amnesia. Studies indicate a right hemispheric bias for higher forms of self awareness. In retrograde dissociative amnesia, we found a hypometabolism in right fronto-temporal areas, suggesting a defective synchronization during retrieval between processing of affectively-loaded personal events and fact-based processing. This synchronization abnormality in our opinion not only leads to a memory blockade, but also to a shrinkage of self and loss of autonoetic consciousness in dissociative amnesic conditions.

It has been hypothesized that the first five years after first episode of psychosis constitutes a critical period in with opportunities for ameliorating the course of illness. Based on this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions.

The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials such as the Lambeth Early Onset (LEO) trial, the Croydon Outreach and Assertive Support Team COAST trial and the Norwegian site of Optimal Treatment (OTP) trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred back to standard treatment. However the positive effects on service use and ability to live independently seem to be durable.

Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing two years of intervention with extended treatment periods.

Linden, D. E., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., . . . Goebel, R. (2012). Real-time self-regulation of emotion networks in patients with depression. PLoS One, 7(6), e38115.