Postpartum depression is a common but yet under diagnosed condition that affects new mothers but has also been linked to psycho-emotional and developmental difficulties in the offspring. Autistic disorder is a severe developmental disorder that has a much better prognosis when diagnosed early. The aim of this study was to examine the possible association between maternal postpartum depression and the presence of autistic traits in the offspring.

We undertook a longitudinal study in Athens, Greece, following a cohort of 291 women with questionnaires for 24 months after delivery. The women filled out the Edinburg Postnatal Depression Scale (EPDS) at six and twelve months postpartum and the Modified Checklist for Autism in Toddlers (M-CHAT) at around 18 months after delivery. Both questionnaires are used as screening tools, using a cut-off of 12/30 for the EPDS and 3/23 for the M-CHAT.

95 women who had filled out both the EPDS at 12 months postpartum as well as the M-CHAT were included in the analyses. Self-reported postpartum depression in the mother at 12 months postpartum was strongly associated with the presence of autistic traits in the offspring at 18 months of age (OR= 5.24, 95% CIs 1.15-23.79).

Maternal postpartum depression was found to be associated with the presence of autistic traits in the offspring at 18 months of age. These findings stress the need for early identification of postpartum depression cases and careful follow up of both mother and offspring.

To evaluate newborn fluoxetine exposure at different period on development and behavior of adult rats.

Male rat pups were randomized to be treated once daily with fluoxetine(s.c.) or saline(s.c.) during postnatal day 1∼7 and postnatal day 8∼21. Recorded the body weight. Starting at 90 days of age, all rats were tested with several experimental facilities, including open field test, elevated-plus maze, novelty- suppressed feeding test and forced swim test.

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1. 1 Weight gain of rats with fluoxetine exposure during postnatal day 1∼7 were lower than controls (P<0.05).

2. 2 Exploratory behavior decreased and depression anxiety behavior increased in adult rats with neonatal fluoxetine exposure (P<0.05), and more severe with postnatal day 1∼7 exposure (P<0.05).

Newborn fluoxetine exposure may result badness weight gain and depression anxiety behavior in adult rats, and the earlier exposure may accompany the larger risk.

Selective mutism is a psychiatric disorder characterized by consistent failure to speak in specific social situations despite speaking in other occasions.

To demonstrate different therapeutic approaches: Cognitive Behavioral Therapy (CBT)/ CBT besides medication.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

Two six-year-old children visited the Child/Adolescent Clinic of the CMHC of Katerini. They both presented reluctance to speak at school while interaction in other activities varied between them. Although they were both initially treated with CBT, the severity of symptoms in one case led to the administration of Fluoxetine in addition to CBT. Fluoxetine was initiated at 4 mg/day and gradually titrated to 20 mg/day. Two years later, both cases show clear improvement. The first one treated only with CBT has begun to speak at school, mainly when asked to do so, and appears more willing and comfortable among strangers. The second one shows signs of progress especially after the initiation of Fluoxetine. The patient interacts with strangers, speaks to children out of school and appears in better mood. Despite the progress, she still mutes at school.

In accordance with other international references, this presentation shows that cases of Selective Mutism respond to variant therapeutic approaches. Although CBT can be proved quite effective, Fluoxetine can be used to provide extra benefit.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions, actions which disrupt everyday functioning, and is frequently recognized in youth. Selective Serotonin Reuptake Inhibitors (SSRIs) are widely recommended as first-line pharmacotherapy.

The aim of this presentation is to demonstrate Escitalopram monotherapy in juvenile with OCD.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

A 9-year-old child was referred to the Child/Adolescent Clinic of the CMHC. The patient presented unwelcome repeated thoughts that induced anxiety symptoms while at the same time he performed several actions (compulsions) to neutralize his obsessions. From his history, a mood disorder episode was described at simultaneously with the onset of OCD. Then, the patient was admitted in a General Hospital (for a month) and was treated with Fluoxetine on and off for several years. Due to relapse of the symptoms, Risperidone was introduced (1mg/day). The scheme was not beneficial enough, so another SSRI (Escitalopram) was initiated while Risperidone was withdrawn gradually. Six months after the initiation of Escitalopram, the patient's situation is stable, the obsessions and compulsions have been restricted and he appears in better mood.

Monotherapy with Escitalopram seems to provide significant levels of symptomatic improvement in cases of OCD in juvenile producing effective results to this young patient.

In 2008 a new support group based on psycho-educational principles, attachment theory and neurodevelopmental practice, began at the Womens and Childrens Hospital (WCH) in South Australia. This group caters for parents, grandparents and other carers, who have children in neonatal intensive care and special care nurseries.

2 years of research have been done to evalaute the parent experience of neonatal intensive care and the support networks available for parents.

Qualitative interviews have been performed with parents who have attended the group. The 1st set taken when their babies were in the nursery and then 5 months post discharge. Interviews with nursing staff who work within the nursery were also completed in 2009. A survey study using the PSS-NICU is underway at present and will conclude in late 2010.

The parent interviews were reviewed with framework analysisand indicated a number of themes. The main theme was the loss of control of the parental relationship and the distress at sharing their child with nursing staff. Nursing staff interviews were analysed with framework analysis and the main theme was of chronic parental distress and difficulties managing the parental grief.

These results indicate that psychological support should be focussed on 1. the attachment relationship in trauma and 2.dealing with grief at deviating from the normal parenting experience. These results were used to provide modifications to our parent group and to structure education and support for nursing staff in the intensive care unit.

Population-based analysis of regional and provincial data has permitted identification of areas for modeling innovative service delivery paradigms. Attention Deficit and Hyperactivity Disorder (ADHD) serves as an example. Within the same catchment region, comparing tertiary service utilization with provincial ADHD rates, we have identified a potential service gap. Potential to improve capacity based on a fiscally neutral model is discussed.

Annual data collected in the regional child and adolescent mental health program information system from 2002-2009 was used to describe characteristics of those referred with a provisional diagnosis of ADHD. Regional population-based utilization rates were compared to the region-adjusted provincial rates of ADHD.

As is typical, receiving a provisionally diagnosis of ADHD was significantly associated with longer wait for service and length of stay, being male and younger, greater comorbidity (e.g., conduct disorder), more behavioral problems and more problems at school. About half of the referrals came from community-based primary care physicians. Many children are diagnosed with ADHD by community physicians and relatively few receive specialized treatment.

Analysis of population-based service rates identify potentially large knowledge gap. Within this gap, the quality of service and fidelity to evidence-based practice in community-based treatment of ADHD are unknown. Community-based primary care practitioners have little specialized mental health training and may require support in delivering evidence-based care. To this end, we describe a model to address the identified service gap for ADHD.

Attachment theory offers both a conceptual framework and an empirical basis for understanding the development of parent-child relationships and their contribution to individual psychosocial adaptation across the life cycle. Although no existing model adequately predicts suicide, family relationship problems are increasingly implicated in the etiology of adolescent suicidal behaviour.

We sought to examine the association between felt attachment security and a history of suicidal behaviour among a group of adolescents in psychiatric treatment.

In this cross-sectional study, we examined the association between felt attachment security and a history of suicidal behaviour among 122 hospitalized adolescents. Felt security (as measured by the validated Adolescent Attachment Questionnaire) has been defined as one's perception of the availability and responsiveness of an attachment figure.

Compared to others, the group coded as both depressed and suicidal had significantly higher scores on the AAQ subscales of ‘perceived unavailability’ and ‘angry distress’, as well as higher comorbidity and lower self-esteem compared to non-suicidal, non-depressed adolescents. The model accounted for approximately 50% of the observed variance.

Attachment theory integrates ethological and psychoanalytic principles in describing the origins and growth of human personality. It provides a coherent framework for understanding adolescent suicidality.

The purpose of this presentation is to describe two cases of teenage addiction to on-line gaming where the subjects required medical attention due to unintentional, self-inflicted injuries to the tongue and upper lip during the course of the game.

Case study of two teenage boys, both aged 15, who attended the Specialized Outpatient Unit for Internet and PC Addiction in our Clinic, due to incessant on-line video-gaming that had a number of detrimental effects to their well-being.

The first teenager had repeatedly bitten his tongue due to stress experienced during gaming while the second had bitten his upper lip. In both cases their injuries required emergency medical assistance and thorough examinations for other possible causes (e.g spasms) for their injuries were negative. The first teenager was diagnosed with Internet Addiction Disorder and separation anxiety - pathological attachment to mother, he scored 78 on WISC-III. A behavioral intervention for separation anxiety and a CBT program for IAD was successful; his on-line gaming was limited to 2 hours/day on follow-up. The second teenager was diagnosed with IAD and co-morbid depressive disorder. Fluoxetine (30mg/day) was initiated and his mood improved while his computer usage time fell from 16 to 4 hours/day. A CBT program was initiated and he's under treatment with good progress.

Teenagers addicted to on-line gaming can experience severe stress which they may instinctively attempt to alleviate with self-inflicted wounds. Co-morbidity with other psychiatric disorders should be carefully assessed. Treatment can be pharmaceutical or psychotherapeutic.

The purpose of the current study was to investigate the influence of therapeutic alliance (TA) as a treatment process variable on outcome in cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Although CBT for pediatric OCD disorder is considered a first-line treatment, not all youth have positive treatment responses, suggesting the need for investigating factors that enhance or reduce treatment effects.

Twenty-five youth aged 7-17 years (M = 13.16, SD = 2.69) with a principal diagnosis of OCD and parents participated in the study. Using a multiple-informant, multiple-time point design, the current study examined the role of TA in family-based CBT for pediatric OCD.

Findings indicated

1. (1) stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome,

2. (2) larger, more positive early alliance shifts (rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome.

TA was a predictor of subsequent change in OCD symptoms in youth treated with CBT. These findings correspond with alliance-outcome research among youth treated with evidence based therapies for behavior disorders.

Obesity and its related disorders are growing epidemic across the world. As some forms of abnormal temperament are considered as subtype of the soft bipolar spectrum, we aimed to evaluate abnormal temperaments in morbid obese patients.

Using a short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego, we investigated abnormal depressive, cyclothymic, hyperthymic, irritable or anxious temperament in 213 patients with morbid obesity compared to a control group of 90 patients admitted prior to transplantation. Additionally, the Beck-Depression Inventory (BDI) and the Self-Report Manic Inventory (SRMI) were applied to assess the current mood states.

The obese group showed statistically significant more psychiatric comorbidities compared to the control group. Abnormal temperaments were significantly more often observed in patients with morbid obesity rather than in controls. Cyclothymic, irritable and anxious temperaments showed specificity to obesity. Obese patients had significantly higher scores in BDI, while no difference for SRMI scores was registered among the whole groups. All temperaments were positively correlated with BDI and SRMI in the obese group.

Our results need replication but indicate an affective overlap in form of abnormal temperament and depressive symptoms in obese patients, whereas mood swings should be evaluated and early mood stabilization considered for patients with significant weight gain to prevent obesity or to reduce already existing overweight. Studies of mood stabilizers and prospective observations would shed further insight on this complex interface of a major clinical and public health issue.

Description of the patients initially attended by the medical area at Emergencies service that later required psychiatric assessment.

Retrospective review of the clinical histories of the previous three months (July to September) using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.

55 patients were assessed, 25 male and 30 females, with an average age of 34 years old. Many of the patients were frequent users of our Emergencies service: almost half of the patients (45%) had already come between 2 and 5 times, and only 11 of them (20%) had never been there before. 74% of these patients were already receiving psychiatric care in their ambulatories.

The most frequent cause of consulting were suicidal attempts (50’9%) and drug abuse (18’2%). Up to 56’4% needed to continue been attended by a psychiatry ambulatory, 20% required hospitalization at the psychiatric unit and only 5’5% of the patients did not need any psychiatric care.

The medical area in our Emergency Service is well trained in recognizing psychiatric symptons, that is the reason why around 95% of the patients of our study needed psychiatric treatment.

Sucidial attempt is the typical case in which it is necessary a close collaboration between different medical areas that work in the Emergency service.

To identify prevalence rates and related patient characteristics associated with depression, alcohol use disorders (AUD), and nicotine dependence among individuals admitted to a university general hospital.

4352 consecutively admitted patients were assessed using the HAD scale and AUDIT. They were also asked on daily cigarette smoking during the previous month. Multivariate logistic regression analyses were performed.

56.6% were male. The average age was 49.3. Prevalence rates of depressive disorder, AUD and nicotine dependence were, respectively, 14%, 9.8% and 16.9%. In the multivariate analysis depression was associated with previous suicide attempt (OR = 8.7), less schooling (3.6), prior use of psychotropic medicines (3.1), cancer (1.7) and pain (1.7). AUD were associated with male sex (OR = 6.3), smoking (3.5), admission for an external cause (2.4), mainly road accidents, and previous suicide attempt (2.3). Nicotine dependence was associated with AUD (OR = 3.4), young adulthood (2.3), widowhood (2.2) and previous suicide attempt (1.8).

This is the largest sample of medical and surgical inpatients surveyed by standardized screening instrument, for 13 months, in a Brazilian general hospital. High prevalence rates of psychiatric disorders and respective patient profiles highlight the need to develop more effective methods for detecting and managing these disorders. Hospital admission should be considered a milestone in a person's life from which a psychiatric disorder is detected and specific treatment strategies are implemented.

Chronic pain disorders have been accepted as one of major comorbid disorder in chronic posttraumatic stress disorder (PTSD). The main purpose of this research was to evaluate subjective processing of the pain in war veterans suffering from chronic PTSD and low back pain.

227 Croatian war veterans participated in this study. Based on their personal history, psychiatric and surgical assessment they were divided in three groups: subjects suffering from PTSD and chronic low back pain (N=88), subjects suffering from chronic low back pain (N=50) and healthy controls (N=89). The following questionnaires were used in assessment of PTSD, depressive disorders and pain: Trauma Symptom Inventory, Hospital Anxiety and Depression Scale and the short-form McGill Pain Questionnaire.

We have shown the significant differences between three groups. The group of PTSD patients experience the higher level of the intensity of pain and have an altered perception of pain complaining more of the affective and sensory pain than the group suffering from the chronic low back pain only. Both groups suffering from pain show depressive pattern rather than the the control group. We have shown that the affective and sensory pain is in the strong positive correlations with the specific PTSD symptoms and depression.

Patients suffering from PTSD seem to have an altered processing of the pain, especially the affective component of pain, probably because of functional pain disorders in many those patients. However, the neurobiological mechanism is needed to thoroughly understand the processing of pain in chronic PTSD.

Referrals for advice regarding treatment of alcohol related disorders form a large component of the liaison psychiatry workload. This study aims to demonstrate whether the addition of an alcohol liaison nurse specialist would decrease the number of patients needed to be seen by psychiatrists.

In-patient ward referrals were examined over 2 nine month periods. The first nine month period examined all alcohol related referrals when there was no liaison alcohol nurse. In the second period, the nurse was present. Data was analysed using SPSSv15.

A total of 243 referrals were examined over the 18 month period. The number of alcohol related referrals to psychiatrists dropped from 145 to 97 after the arrival of the alcohol nurse. This represented a 33% drop in the number of referrals. The alcohol nurse saw a total of 175 referrals. The psychiatrists saw a higher percentage of delirium tremens, 13.3% increased to 27.7%, p value .009. Also of note, the percentage of female referrals increased from 28.9% of all referrals to 44.3% of all referrals after the arrival of the alcohol nurse p=.027.

The addition of an alcohol nurse specialist led to a substantial drop in the number of alcohol related referrals to psychiatrists allowing additional time to be devoted to other aspects of the liaison psychiatry workload. More patients with delirium tremens and more women are being seen since the introduction of the alcohol nurse. Medical teams have a lower threshold of referral and more hazardous and harmful drinking was identified. Earlier intervention can help decrease longer term morbidity from alcohol.

Prostate and breast cancer share many similarities: high lifetime prevalence, increasing frequency, role of environmental factors, long survival also in metastatic disease and possibility of screening. The aim of this work is to evaluate the characteristics related to the patients, disease and treatment which can affect HRQoL at the beginning and after radiotherapy.

since June 2009, we have recruited patients, providing informed consent, before radiotherapy (T0). We assess demographic characteristic (age, qualification, work, marital status…); neoplastic staging and grading; radiation dose and other antineoplastic treatment (hormonal/chemio-therapy or surgery); concomitant medical disease and pharmacological therapy. We evaluate HRQoL by EORTC-QLQ-C30 and EORTC-QLQ-PR25 (prostate-specific) or EORTC-QLQ-BR23 (breast-specific). The protocol also includes HADS, Paykel Life Events Scale and EPQ-R. The work is ongoing and implies a follow-up at 6 and 12 months (T1/T2).

The majority of men have a localized disease with Gleason score between 6 and 8 and the median pretreatment PSA is 10.52 ng/mL; 70% will undergo adjuvant-RT; median age is 69.30 years. Women have a median age of 58.46 years, all underwent surgery and all have a localized disease and positive receptorial status. Global QoL is lightly higher in the man sample; both groups report a major deficit at Emotional Function and high levels of Fatigue. The personological characteristic more represented is “Extravertion”.

The results show an association between worse QoL, “Nevroticism” and high Anxiety levels only in the men sample at T0. At the moment, there is no significant relation in the women sample.

Following the matching in accordance with age, place of living, profession and marital status, 286 cases and 529 controls were interviewed looking for these parametres: death of the family member, an accident with severe consequences, the loss of work, a serious illness of a family member, divorce. Multifactorial logistic regression analysis was used for relative risk (RR), interval of cofidence (IC), attributive risk (AR), an estimation parametre vector, standard error, standard regressional coefficient, HI square test.

The study shows that the biggest emotional stress is death of child, death of mother, loss of work, disability, all of which were generally experienced two years prior to clinical diagnosis of the disease. RR for the cases is l.9 with the IC l.4 - 2.6 and AR 22%. RR for women in urban areas is higher than for those in rural areas and reads 2.2 with IC l.5- 3.l. It is interesting to point out that RR is the highest among the women aged 30 - 39 and reads 4.4, whereas for women aged 65 and beyond it is l.6.

According to the results in multifactorial etyology of the carcinogenesis we come to the conclusion that psychostress acted as a promoter two years before the illness was clinically diagnosed.

Hearing-impaired adults with hearing aids or cochlear implants have been proved to suffer from social isolation and that the under-use of these devices is possibly related to its impact on one's body image. The aim of the research was to evaluate the presence of social phobia and body image preoccupation, handicap perception, social functioning and psychopathological distress in patients with hearing aids or cochlear implant.

A clinical group of 70 hearing aid and/or cochlear implant wearers was compared with a control group of 75 healthy adults (age: 18-65) referred to the ENT Clinic of Modena University from 01/01/09 to 01/ 09/09. Both groups were administered the following psychometric instruments: Social Functioning Questionnaire, Brief Symptom Inventory, Liebowitz Social Phobia Scale, Body Uneasiness Test. Hearing-impaired subjects were also assessed by means of the following tests: International Outcome Inventory for Hearing Aids, Attitude towards Hearing Loss Questionnaire, Hearing Handicap Inventory for Adults.

the case group statistically differed from the control group as to lower level of social functioning (p< .05), higher level of somatization (p< .01), obsessive compulsive behaviour (p< .01), interpersonal sensitivity (p< .01), depression (p< .01), anxiety (p< .05), phobic anxiety (p< .01), paranoid ideation (p< .01), psychoticism (p< .01), social phobia (p< .001) and body image preoccupation (p< .05).

Social phobia and body image preoccupation are critical aspects in determining the psychosocial well-being and the compliance, the benefit and the personal satisfaction of hearing-impaired subjects in using the hearing aid and/or cochlear implant.

We aimed to assess the quality of life and psychosocial factor of patients presenting with medically unexplained symptom at a private general practice in Lagos Nigeria.

A total of 150 subjects presenting with unexplained symptoms out of 1,450 G.P consulted had world health organization Quality of life (Brif) questionnaire obtained. The Quality of life score and social factors were compared with patients without unexplained symptoms.

Majority of patients with unexplained symptom were female, with mean age of 42(±8) and unemployed. Among the patients, 80% had unexplained pain symptoms. Quality of life was poor in subject with unexplained symptoms and was significantly different in comparison with those without medically unexplained symptoms.

General practice patients with medically unexplained symptom had remarkably poorer quality of life and associated sociodemographic factors include age, sex and unemployment. Early identification and prompt treatment should be encouraged.

To evaluate psychiatric features in liver post transplant HIV recipients.

An observational study was conducted. Different psychiatric rating scales to evaluate cognitive status (MMSE), anxiety and depressive symptoms (HAM-A, HAM-D), social phobia (BSPS), quality of life (SF-36), sexual satisfaction (ISS), coping strategies (Brief Cope) and alcohol-drug abuse (LDQ) were submitted to a population of 11 HIV outpatients that underwent to OLT (19% of the Italian HIV transplant recipients). Scores were statistically related to socio-demographic and clinical data.

All patients were male, aged between 33 and 54 years. In the past 8 patients were drug abusers, three suffered from depression. At the moment of the evaluation 8 patients didn't suffer from any psychiatric disease while the three youngest patients presented a mild depressive status. BASIS-32 scores were related to HAM-D and to a history of drug abuse (p< 0.01). SF-36 was related to age (p< 0.05), HAM-D (p< 0.01), BSPS and BASIS 32 (p< 0.02).

Despite the higher risk for a HIV patient of developing an anxious or mood disorder, our population isn’t affected by psychiatric diseases; this is an encouraging data considering that post transplant period can be very stressful. This result may be due to a personality organization or a coping style strengthened by a long term disease such as HIV. Further studies are needed to investigate psychosocial outcome of OLT in HIV and to improve our knowledge of this controversial issue and guarantee a better take in care of these complex patients.

This study aimed to detect and quantify depressive disorders following strokes and to follow the evolution of such patients after administering anti-depressive medication in association with the rehabilitation program.

This is a prospective study on 36 patients suffering from post stroke hemiplegia, situated in an interval of two to twelve months after the stroke. The patients have been randomly divided into two groups, the study group consisting of 21 patients who received anti-depressive medication in addition to the rehabilitation program, and the control group (15 patients) who only received the rehabilitation therapy. All patients were evaluated for depression using the Hamilton depression scale (HAM-D) at the beginning of the study and after two months of anti-depressive medication. Their clinical and functional evolution was evaluated using standardized scales and quality of life scales (FIM). Other parameters were noted such as age, sex, level of education and family support.

As expected, both the depression and the functional scores improved significantly after two months of rehabilitation treatment associated with anti-depressive medication in the study group compared to the initial evaluation. Also, improvement was noted when compared to the results of the control group.

1. . in accordance with others published studies, this analysis shows the importance of early detection and treatment of post stroke depression

2. . A multi disciplinary team that includes a psychiatrist must be assembled for the treatment of stroke patients, as such a team brings the most benefit to the patients.