The aim of this presentation is to introduce a new instrument, used for assessment of symptoms connected with characteristics of sexual life in population of patients with neurosis and related personality disorders.

During the first week of psychotherapy the patients fill a questionnaire, containing statements which cover different areas of sexual life such as: overall satisfaction, present sexual relationships, present sexual activity, dysfunctions of sexual intercourse, experience of sexual trauma, feelings towards one's own body and attractiveness. Data from the pilot study were analyzed in search for preliminary, statistically significant differences between groups of symptoms.

The pilot study on 80 patients (43 females, 37 males) confirmed, that different symptoms connected with sexuality are important component in distress of patients beginning intensive group psychotherapy. In overall, 58% of patients perceived their sexual life as unsatisfactory. Nearly 50% do not experience pleasure connected with sexual activity. Over 85% regard sexuality as important matter. Significant difference was found, as up to 85% patients expect improvement of their sexual life, but only 35% are explicitly interested in including sexuality as one of the themes in psychotherapy.

Results of the pilot study confirm clinical importance of symptoms connected with sexuality in neurotic disorders. Further group psychotherapy effectiveness assessment will bring an opportunity to recognize the specific role of these symptoms in diagnosis and psychotherapy treatment.

Stability of psychiatric disorders has increased with the introduction of DSM-III and ICD-9 criteria. A scrutiny of these claims is important so as to ascertain possible disease co-morbidity or fluctuation of symptoms over time.

To evaluate the long-term stability of psychiatric diagnoses given in first-time patients of an Acute Mental Ward of a Psychiatric clinic.

We reviewed a total of 918 patients who received psychiatric care in the Acute Mental Ward of our Clinic from 2004 to 2009.

As expected, results varied according to how many years have elapsed since the initial admission. The highest number of readmissions was in the 2004 group, with 61 patients out of 194 being readmitted since then and 20 of those having their initial diagnoses changed in some way. Stability of diagnosis in broad diagnostic categories (psychotic disorders, mood disorders, personality disorders, substance abuse) was generally high. Changes in diagnoses between admissions were mostly in cases with suspected bipolarity of affect, dual diagnosis in Axis I (severe mental illness concurrent with substance abuse) and/or personality disorders in Axis II.

The temporal consistency of mental disorders was moderate. Although initial and subsequent diagnoses tended to remain within the broad diagnostic category, cases with lability of mood, personality disorders, and those receiving dual diagnoses were problematic. The relative stability of diagnoses in the psychotic spectrum is most likely due to them being inpatients. The high number of re-admissions and subsequent changes in diagnosis necessitates further study.

200 persons (20-55 years old) with the different state of vessels of cerebrum. In the (control) group 50 persons (30-42 years old) at which the state of the vascular system was within the limits of norm. In the II group - 70 man (34-46 years old) with discirkulyatory hypertensive encephalopathy (DE) II degrees, and in III - 80 persons in age 34-46 years, with the signs of DE III degrees.

Ultrasonic dopplerography vessels of cerebrum conducted in a duplex, as an ekstrakranial'nogo department: general carotid (WASP), vertebral artery (STEP), so transkranial'nym angioskanirovaniem: supratrochlear artery (NBA), perednemozgovaya artery (PMA) by the vehicle of «Sonomed-300». The got results were analysed in the statistical packages of Statistica 5.5, Statistica Neural Networks 4.0c, Medstat 2004.

At persons with the disease of discirkulyatory hypertensive encephalopathy II and the III degrees there were reliable changes of row of indexes. For the exposure of meaningfulness of influence of factor signs the logistic regressive model of prognostication of pathology of the state of the vascular system was built (p< 0,001).

We can diagnose development and burdening of vascular pathology, both ekstrakranial and intrakranial river-beds and to expose the early forming of vascular disorders which are, either in the phase of functional vascular violations or to warn development of complications at the expressed vascular pathology.

The notion of “Ich-Störungen” (self-disorders) depicts a major aspect of Kurt Schneider's concept of first rank symptoms of schizophrenia. Terms such as “passivity phenomena”, “delusions of alien control” and “ego pathology” have been used to characterise these phenomena once postulated to be pathognomonic for schizophrenia. The present review focuses on clinical studies examining the symptoms’ diagnostic and nosological implications.

We conducted a semi-structured literature review. 374 references were obtained using the key words “ego disorder/(psycho)pathology”, “thought insertion”, “alien control”, “passivity symptoms/phenomena/experiences”, “first rank symptoms”, “schneiderian” and “self disorders”. We distinguished two major fields of research:

1. (1) neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;

2. (2) studies on diagnosis and nosology (including assessment instruments and factor analyses), outcome and prognostic value.

Of the studies on the second field, 83 have clinical relevance and are reviewed here.

Several specific instruments with sound foundations in psychopathology have been developed for the assessment of self-disorders; however, they have rarely been included in research. Factor analyses have consistently shown a highly loaded factor consisting of self-disorders, in some studies distinct from other first-rank symptoms. There is contradictory data on outcome and prognosis.

Self-disorders remain ill-defined and inconsistently included into diagnostic criteria, and therefore lack nosological significance. Their clinical relevance has been insufficiently studied, although they have been consistently shown to form a highly specific factor within the schizophrenia symptom spectrum. The present review stresses the need for a global definition of self-disorders on the basis of phenomenology.

Management of mentally unwell people and understanding of mental disorder in general has swung from the earlier, Meyer-ian (DSM founder) developmental approaches to the more commonly practised medical/disease model of the mind rooted in the quest for “hard” evidence in macro and micro level changes.

Sadly, it is made out that these two schools are at conflict, or at best exist in dialectic with each other and that one needs to be practised at the expense of the other. This belief is extended to assessment and management of risk to self and harm to others (bio-psycho-social approach mainly receiving a lip service), which is one of the primary outcome measures in psychiatry.

The training in cure-oriented model of medicine is in contrast to the bread and butter of what a psychiatrist deals within a day to day setting: recovery and rehabilitation of chronic remitting and relapsing illnesses. The psychiatrist thus left with an armoury of descriptive based approaches to deal with behaviour patterns that are seemingly irrational and leading to serious outcomes such as suicide and harm to others.

Highly specific interest in the nature/form of illness has ironically led to the sacrifice of sensitivity of the person's story, which brought the patient to us in the first place.

We suggest that in addition to “routine case management” the risk that patients present to self and others becomes comprehensive and an interesting exercise, leading to better outcomes for both patients and their guardians by marrying the two approaches.

An approach to chemobrain as a neuropsychiatric entity.

Literature review on chemobrain (OVID, 1998-2009) and revision of the patient's clinical records, neuropsychological evaluation and imagiological studies.

A 44 year old female without previous psychiatric history has presented anxious and depressive complaints on the diagnosis of invasive breast cancer (stage T2 N1 Mx). By then she was subjected to surgery (modified radical mastectomy), FAC chemotherapy (fluorouracil, doxorubicin, cyclophosphamide) and radiotherapy. For two years since the treatment, the patient has been presenting a mood-independent syndrome, characterized by concentration and memory impairment, fatigue and anergic symptoms, not being able to accomplish her work-related intellectual functions, and refractory to psychopharmacotherapy. Brain scan pattern is not abnormal. These symptoms are described informally since the early 80's as a syndrome named chemobrain.

As intensive therapeutic schemes and long time survival become reality, attention must be drawn to possible obstacles in post-cancer quality of life. Lack of consensus on the diagnosis of chemobrain and the absence of pre-illness neuropsychological evaluations are thoroughly mentioned in the literature as obstacles to implement this diagnosis. However severe professional and social changes on the patient's abilities are surely noteworthy of further investments.

Involutional melancholia was first described by Kraeplin in 1896, who, since 1907, omitted this entity from his publications. However, involutional melancholia kept on being accepted under various names. We intend to analyse if there are still evidences for the existence of this entity nowadays and its clinical utility.

We describe and analyse a case of a woman with the diagnosis of involutional melancholia and make a bibliographic review about this disorder.

Nowadays the broadening concept of mood disorders denies involutional melancholia as a valid independent entity, so it is included in mood disorders as a unipolar endogenous depression with late onset. Psycopathologically, however, it still seems to have several differences that could justify its separation from the current mood disorder concept, such as proeminent motor agitation and restlessness, anxiety and apprehension, an exaggerated hypochondriasis sometimes with bizarre delusions and occasional paranoid ideation These differentiating symptoms arise on a basic depressive substrate, marked by insomnia, anorexia and weight loss. Some studies point out the fact that now patients are treated earlier with antidepressives or ECT and so these classical severe symptoms may not develop, because the syndrome is aborted at a prodromal stage.

Study results are contradictory and further controlled investigations are mandatory. Even if involutional melancholia does not stand as a separate entity, it is important to keep in mind that depressive illness appearing for the first time in the involutional period of life may present as a somewhat atypical clinical picture.

Distinct subtypes of depression presenting with characteristic symptom clusters have different neuroanatomical and neurochemical background, and these subtypes behave differently also pharmacologically. Based on the neurocircuitry theory, several studies investigated the possible neuroanatomical and neurochemical substrates of major depressive symptoms. Our team has developed a new scale, the Depression Profile that incorporates symptoms associated with depression forming symptom clusters that can be mapped to different neurotransmitter systems.

339 major depressive patients completed the original 90-item structure of Depression Profile. Confirmatory and exploratory factor analysis was used to establish the final structure. The external validity of the new structure was tested against the Zung Self-Rating Depression Scale and Sheehan Patient Rated Anxiety Scale.

After exploratory factor analysis the number of items decreased to 67. Reliability of the new structure proved to be very good and its construct validity was supported by confirmatory factor analysis. Convergent validity testing of the new structure showed average correlation with the two other questionnaires.

Current depression scales do not provide for the separate in-depth screening of depressive symptom clusters associated with different neurotransmitter systems playing a role in depression. We attempted to develop a new depression scale separately assessing depressive symptom clusters reflecting the activity of different neurotransmitter systems. First psychometric tests indicate that our scale is a promising instrument for decomposing depression to subtypes with different neurochemical backgrounds, which would make it a useful tool in selecting a tailor-made pharmacological treatment for each patient that most effectively treats their depressive symptoms.

1st episode psychoses are a common attendance in a city mental hopital, like Calcutta Pavlov Hospital in Calcutta & they constituse approximately 35-40% of new OPD registration in a day. These data is derived from the OPD register during the period 1st Jan 08-30th june09. The average new consultation in this opd is around 38 patients/day, and old repeat consultations usually around 300 case.

Management style usually practiced in this hospital is detailed here with the proportion of different management & their type as diagonosed on the 1st day.

Here this presntation of style in a devoloping country with meagre facities may be assesed & compared with those in other countries in Europe.

1st episode psychosis in new OPD attended cases are 12-14/day.They constitutes BPMD, hypomania 40%,Schizoprenia 30%, delusional disorders10%,Brief psychotic Disorder 8%,Pshyotic behavioral disurbances 5% and other non-specified psychoses 6-7%.

50-55% of 1st episode recieve drug only and after 7 days follow up return 80-90% become calm and tranquile with majority of their positive sypmtoms like delutions, hallucination losing sharpness. In 1/3rd no. of cases, mainly with violent, aggressive or refusal to medication inj. preparations are used. Previousely 1-2 cases were given ECT treatment, but that is stopped after Govt. banned ECT in OPD setting. Inj. commonly used are Inj. haloperidol, Promethazine HCl, and lorezepam in agrresives, Inj Olanjapine in negative or positive scizophrenic group, followed by Inj. Clopixol(zupixol)aquaphase follwed by depot.

Injection in 1st 2-3 days makes the compliance better and quick.

1sd episode management is the key in sucsess of psychosisas a whole.

Several factors may predict adherence with adherence with follow-up appointment for patients seen in the emergency department by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

To examine the factors which could predict adherence with psychiatric follow-up appointments for patients assessed in the ED by the liaison psychiatric team.

The records of all patients assessed over a three month period by the liaison psychiatric team in the emergency department of Beaumont Hospital who were then referred for follow-up were examined for relevant demographic and clinical variables. Phone contact was then made with the centres to which patients had been referred to confirm the appointments made and if the patients had attended follow-up appointments. The data was analysed with SPSS (version 17).

Overall, only 55.9% of the patients were found to have attended their follow-up appointments with lrsquo;known to psychiatric services’ being the only statistically significant predictor of adherence. Patients’ who were single, separated, divorced or widowed and those who had consumed alcohol before an act of deliberate self-ham were more likely to attend follow-up appointments compared with those who were either married or cohabiting and those who did not consumed alcohol respectively. However these were not statistically significant when controlling for other predictors.

Patients who are not known to psychiatric services prior to assessment in the emergency department may need a more proactive outreach if compliance with psychiatric follow-up appointments is to be improved.

Alcohol use and related harm is a growing problem in Ireland with far-reaching consequences for health services generally. Areas which are most affected include accident and emergency departments and psychiatric hospitals or units. The purpose of this paper is to examine the role of alcohol in psychiatric admissions to an Irish psychiatric hospital

The inpatient records for all patients admitted over a one year period were examined retrospectively. All 378 patients admitted within that time were included and their admission records were examined manually for age, gender, diagnosis of psychiatric illness, co-morbid alcohol abuse, and the role of alcohol in precipitating the admission. Data were analysed using the Statistical Package for Social Sciences, version 11.5.

21.7% of admissions had alcohol dependency syndrome and it is the primary diagnosis in 10.1%. Alcohol was a factor in the admission of 29.1% of patients. Of the 110 patients in this category, 42 did not have a primary diagnosis of alcohol dependency syndrome, i.e. 61.8% had a primary diagnosis of a psychiatric illness other than alcohol dependency syndrome.

Alcohol is a factor in a large proportion of psychiatric admissions. It has been associated with poor compliance, exacerbation of symptoms and relapse. It is important to recognise the role of alcohol in psychiatry morbidity, both as a primary diagnosis (alcohol dependency syndrome), and also where the primary diagnosis is another psychiatric illness.

Violent behaviors in psychiatric emergency departments are a common problem. The aim is to study characteristics of patients who need intense preventive care measures and who act violently.

The study was conducted in a locked short term psychiatric inpatient unit and involved 172 patients admitted in a 8 months period. Sociodemographic and clinical data were obtained through a review of the medical records. Secclusion, restraint and agressive behaviors were noted on specific nurse sheets.

Aggressive behaviors or intense preventive measures concerned 34% (n=59) of the 172 patients. Among these 59 patients, 61% (n=36) are men and the mean age is 34,9 years, 28 had seclusion, 51 had restraint and 11 had physical aggression or against object aggression. The diagnosis are schizophrenic disorders for 63% (n=37), dependence or substance abuse for 11% (n=7), mania for 10% (n=6), depression for 3,5% (n=2). For 27% (n=16) of them it was first time in Emergency Department and 30,5% (n=18) were intoxicated at admission. The mean neuroleptic treatments dosis of these patients at admission were 656mg (equivalent chlorpromazine).

Patients concerned by seclusion, restraint and aggressive behavior are more frequently men with schizophrenic disorders, high neuroleptic dosis, and various past admissions in the Emergency Department.

Current treatments for agitation in schizophrenia or bipolar disorder (BD) have limitations in onset of action, invasiveness and tolerability. AZ-004 (Staccato loxapine) is a rapidly acting inhaled treatment designed for acute treatment of agitation delivering drug aerosol to the deep lung for rapid systemic absorption with intravenous-like kinetics. The objective was to evaluate the efficacy and safety of AZ-004 in the acute treatment of agitation in schizophrenia and BD.

Two randomized, double-blind, placebo-controlled trials included consenting male and female adults, 18-65 years old with DSM-IV-defined schizophrenia (N=344) or BD type 1 or mixed (314) who presented with clinically relevant agitation. Patients received a single inhalation of 5 or 10mg AZ-004 or placebo in a clinical setting with up to 2 additional doses within 24 hours if required. The primary efficacy endpoint was the absolute change in Positive and Negative Syndrome Scale Excited Component score from baseline to 2 hours following treatment.

In each trial, both 5 and 10mg AZ-004 were significantly superior to placebo for the primary endpoint (P< 0.001 for each dose in each trial). Significant improvements were noted for each AZ-004 dose versus placebo at all timepoints from 10 minutes through 24 hours. Clinical Global Impression-Improvement (CGI-I) at 2 hours post-dose and CGI-I responder analysis were statistically significant for each AZ-004 dose vs. placebo in both studies. Adverse events observed most often for all treatments were dysgeusia, dizziness, and sedation.

AZ-004 produced rapid and significant improvement in treating agitation in BD or schizophrenia patients.

Psychiatric emergency services (PES) are a main entry for patients with acute mental disorders. Most of them are voluntarily treated and a shared decision making model is implicitly used. Not much is known about decision making capacity (DMC) of patients and the utility of a shared decision making model in PES.

To assess neuropsychological abilities of DMC in a convenience sample of patients admitted to a PES.

Patients were assessed when discharged from the PES. A DSM-IV-TR diagnosis was generated. Neuropsychological abilities were assessed by the Trail Making Test (TMT), Stroop Colour-Word Test (SCWT) and the Mini-Mental State Examination (MMSE). MMSE was used a general assessment of cognitive functioning, TMT and SCWT as a more specific assessment of executive functioning. Patients with marked agitation, no cooperation or withdrawal symptoms were excluded.

47 patients were assessed. Most prevalent primary diagnoses were depressive disorder (11), adjustment disorder (8) and substance abuse/dependence (17). MMSE scores were normal in 87% of patients. SCWT and TMT differential scores were below the 20th percentile in 57% and 61% of patients respectively.

Cognitive functioning in patients, admitted to a PES, seems impaired when assessed by the TMT and SCWT. When replicated in further trials (larger study population, use of more extensive assessment of different components of DMC, careful consideration of ecological validity of these assessments), the implicit idea of a shared decision making model of care should be questioned.