To compare prescribing practices of hypnotics against NICE guidelines (National Institute of Clinical Excellence) and to develop recommendations with action plan. The NICE recommends:

• • Due consideration should be given to non-pharmacological measures prior to hypnotic prescription.

• • Hypnotics should be prescribed for short periods of time only (maximum 4 weeks)

• • The drug with the lowest purchase cost should be prescribed.

• • Switching from one hypnotic to another should only occur if a patient experiences adverse effects.

The audit tool was developed. The data was compiled using medical records of the patients who were seen during a specified three month time period in an out-patient setting. A total sample size of 308 was generated out of which 41(12.5%) were being prescribed hypnotics. The medical records of these 41 patients were scrutinised to gather evidence whether NICE guidelines were adhered to. The data was analysed using the tool recommended by NICE.

The significant results are:

• • Only 25% of the patients were advised Non-pharmacological measures.

• • Duration of prescription ranged from one week to more than 10 years, with 33% approximately being prescribed for less than one year, and 10% being prescribed for more than 10 years.

• • There is no evidence that consideration was given to cost while prescribing.

• • Only in one patient hypnotic was switched. However, there was no evidence of adverse reaction which could be directly related to the hypnotic prescribed.

The overall compliance with guidelines was found to be 42%.

When comparing the efficay of antipsychotics in clinical studies it would be of high practical relevance to know which doses of the respective drugs would result in equivalent blocking of dopamine-D2-receptors. This study aimed to find clinically applicable dose equivalents for haloperidol, risperidone and olanzapine.

As the occurrence of EPS correlates closely with a blockade of about 80% or more of dopamin-D2-receptors the proportion of patients developing EPS in relation to various doses of either Haloperidol (n=5252), risperidone (n=5017) or olanzapine (n =5029) was calculated. This retrospective, observational study included 20.252 inpatients from 20 hospitals with a diagnosis of schizophrenia and related disorders (ICD10 F20-25). The prescription of anticholinergic medication was utilized as surrogate parameter for the occurrence of EPS. OR, RR and NNH under different doses of AP were calculated and data entered into a probit model to predict the risk of EPS over a continuous dose range. For filtering the data ToscanaJ (FBA) was used.

1. 1.) Same doses of risperidone and haloperidol induced the same proportion of EPS, reflected in a constant dose ratio of both drugs of ∼ 1:1 over the whole dose range.

2. 2.) Over the whole dose range there was no linear relation between olanzapine on one hand and haloperidol and risperidone on the other hand.

3. 3.) The results were corroborated by the probit analysis.

Previous clinical trials comparing olanzapine, risperidone and haloperidol found higher risks of EPS for Haloperidol. We propose a new model to calculate dose equivalents.

Escitalopram is considered to be more effective than citalopram and to have less side effects. Previous studies have found that common cardiac manifestations of escitalopram overdose are QT prolongation and bradycardia. Some case reports inform about bradycardia without ECG abnormalities with therapeutic doses of escitalopram.

We report of a 29-year-old female patient diagnosed with major depression, hospitalized for 2 weeks. She had no history of any treatment with antidepressive drugs. After administration of 5 mg/day escitalopram the patient's blood pressure and pulse rate were mildly reduced and we observed presyncopal episodes daily. After 1 week of treatment the dose of escitalopram was raised to 10 mg/day and she complained about dizziness. In this case we found that presyncopal episodes lasted longer and both hypotension and bradycardia increased. These symptoms disappeared within 24 hours after escitalopram treatment was discontinuated. Results from routine laboratory tests, ECG, EEG, brain CT were normal. No other farmacologic causes were supposed to induce the above mentioned vegetativ symptoms.

Bradycardia and hypotonia have been previously reported with citalopram, but there are only a few case reports about these side effects induced by a therapeutic dose of escitalopram. Both central and - by directly inhibiting the entry of Ca into vascular smooth muscles resulting in vasodilatation - periferial effects of escitalopram are supposed to be responsible for these rare phenomena. This case report supports the importance of monitoring heart rate and blood pressure when escitalopram treatment is introduced, especially in cases of previously untreated depressive patients.

The response rate of obsessive compulsive disorder is 21.6% to 61.3%; which shows the relative resistance to current treatments and a need for novel methods. Here, we have reported a case of resistant obsessive compulsive disorder (OCD) with fast and dramatic response to a relatively new method named repeated transcranial magnetic stimulation (rTMS). In rTMS a pulse magnetic field is emitted from a coil over the surface of the scalp which induces a localized electrical current in the cortex below. Cortical activity can then be either inhibited or stimulated.

The patient is a 40 years old female admitted for severe OCD in Mashhad Ibn-e-Sina Psychiatric Hospital. The patient was treated with 10 sessions of rTMS on right supplementary motor area (SMA) with 110% intensity, 1 Hz frequency and duration of 30 minutes per day (a total of 1200 pulses per day). Improvement of patient was evaluated serially with Yale Brown scale. By the end of the 2nd day she reported a major improvement of her symptoms. Her improvement was so dramatic in obsessive and compulsive behaviors and her avoidance recovered completely. She also reported significant improvement in her ability to control her obsessive thoughts and impulses and her anxiety symptoms.

Considering that rTMS is a low risk method and has almost no interaction with the common medications and the faster response with this method, it seems that it can be used as supplementary treatment in resistant cases and even in the initial stages of OCD.

To analyze the use of Clozapine in six children and adolescents with Serious Conduct Disorder, whose symptoms had been refractory to other pharmacology treatment. Scalar analysis is supplied for the more important psychopathology aspects and the changes with therapeutic one.

Six patients diagnosed with Serious Conduct Disorder are described who had begun the use of Clozapine. They had been widely studied and received application of standardized instruments of infantile psychiatry (CBCL - Child Behavior Check List) before and after the use of this medication.

The patients had mainly significant improvement in relation to the level of aggressiveness and social behavior.

Although ample studies on the use of this medication in children and adolescents do not yet exist, more precisely for cases of Serious Conduct Disorder, the preliminary results are very positive and indicate that Clozapine could be an important tool in the handling of the aggressiveness in those refractory patients with Serious Conduct Disorder.

To evaluate the comparative efficacy of 3 antidepressants, each representative of a distinct psychopharmacologic class, in the treatment of depressive disorders associated to Parkinson disease with dementia (PDD).

A group of 23 patients, mean age 72.1, diagnosed with PDD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with escitalopram (mean dose 15 mg daily, n=7), duloxetine (mean dose 45 mg daily, n=8) or trazodone (mean dose 150 mg daily, n=8). All patients received treatment for PDD with rivastigmine or donepezil continuously, for at least 12 months. The distribution of patients on the antidepressant treatment was randomized, in a single-blind manner. Patients were evaluated monthly, for 6 months, using Montgomery Asberg Depression Rating Scale, Hamilton Rating Scale for Depression- 17 items, Clinical Global Impression-Improvement and Mini Mental Status Examination.

Patients treated with duloxetine had the most significant improvement in the depressive symptoms, as the endpoint MADRS (-18.6+/-2.3, p< 0.01), HAMD (-13.2+/-1.1, p< 0.01) and CGI-I (- 3.2+/-0.5, p< 0.01) scores reflected. The differences between escitalopram and trazodone didn’t reach a significant level but, overall, both improved the depressive symptoms compared to baseline (p< 0.05). The difference between duloxetine and the other two antidepressants became significant after 8 weeks (p< 0.01). The severity of dementia symptoms didn’t vary significantly between the three groups at endpoint.

Duloxetine had proven itself more efficient than escitalopram and trazodone in the improvement of the depressive symptoms in PDD.

To evaluate the impact of depression treatment over the quality of life in oncologic patients.

A group of 27 patients, 14 male and 13 female, mean age 56,3, diagnosed with lung (n=7), gastric (n=7), prostate (n=5), colon (n=4) and breast (n=4) cancer, were also diagnosed with moderate or severe depression (Hamilton Depression Rating Scale-17 items score at the inclusion was over 14). These patients received a combined, psychopharmacological (escitalopram mean daily dose 15 mg, n=15 or mirtazapine, mean daily dose 30 mg, n=12) and psychotherapeutic (cognitive behavior therapy) approach for 3 months and were monitored using monthly HAMD, Global Assessment of Functioning and Lehman Quality of Life Interview (QOLI). Patients didn’t present any significant axis I, II or III comorbid condition.

Patients responded well to the combined therapy, as the final HAMD (-11.2, p< 0.01) and GAF (+12.3, p< 0.01) scores reflected, with no significant inter-group difference (p=0.23). The quality of life scales regarding health, family relations and social relations from the QOLI registered significant improvement compared to baseline (+10%, +12.2% and +12.5% respectively, p< 0.01). Patients who had the higher response rate to the treatment also had the higher rate of life quality improvement (r=0.65).

The treatment of depression in oncologic patients is a necessity, due to the impact of depressive symptoms over the patient quality of life and is associated with a significant rate of success. The improvements are observed especially in the patient perception of health, family and social relationship and functioning.

Comparative studies prove that levetiracetam therapy presents a major frequency of behavioral disturbances, producing problems of impulsive aggressiveness with a relative frequency. Principally if a previous psychiatric history is associated.

Report a case of Impulsive homicide aggression in a patient treated with Levetiracetam. Extensive bibliographical review.

We describe the case of a patient admitted in our Psychiatric acute unit because a major depressive disorder and mild cognitive impairment associated with vascular factors that developed strange impulsive aggressive behavior after the initiation of treatment with levetiracetam, even to try to assassinate his wife. Follow-up visits were performed at 6 and 12 months after discharge to assess aggressive behavior and the change in the Barratt impulsivity scale and the hostility inventory of Buss-Durkee. We conducted a literature review of behavioral and aggression problems associated with treatment with levetiracetam and its possible mechanisms.

After the phasing out of levetiracetam and replacement by oxcarbazepine, aggressive behaviors disappeared. No significant psychopathology was showed in the patient in the follow-up visits, except secondary to preexisting cognitive impairment.

According to studies reviewed a 7-13% of patients treated with levetiracetam may develop behavioral disorders with impulsive aggression that usually resolve after discontinuation of drug.

Comparative studies show that levetiracetam has a greater frequency of such effects, leading to problems of impulsive aggression relatively often, especially if there is a comorbid psychiatric pathology.

Improvement in symptoms of depression is typically delayed with antidepressant treatment. Pipamperone (PIP) at low doses acts as a highly selective 5HT2A/D4 receptor antagonist. The purpose of this study was to investigate whether the addition of PIP to the SSRI citalopram (CIT) would increase the rate of resolution of depressive symptoms.

This was an 8-week, double-blind, parallel-group, single-dummy study in patients with MDD who received either CIT 40 mg daily or PIP 5 mg bid plus CIT 40 mg daily (PIPCIT).

The mean total MADRS score (±SD) of the 165 patients (81% women; mean age, 40 y) was 32.6±5.5. More CIT than PIPCIT patients discontinued treatment in the first 4 weeks [15 (18%) vs 3 (4%); P=0.003]. Reductions in mean total MADRS scores were significantly (ITT LOCF) larger in patients receiving PIPCIT after 1 week [-6.42±6.18 vs -3.99±5.15; P=0.007] and 4 weeks [-15.06±8.48 vs - 12.11±8.30; P=0.025] compared with those receiving CIT alone. Significant differences in favor of PIPCIT were observed in MADRS items “reduced sleep,” “reduced appetite,” “concentration difficulties,” and “pessimistic thoughts.” Mean CGI-I scores were also improved after 1 week of PIPCIT [3.09±0.85 vs. 3.47±0.72; P=0.002]. There were no significant differences observed at 8 weeks. No additional, clinically significant adverse events were noted in the PIPCIT group.

A low dose of PIP added to CIT provided superior antidepressant effects and less discontinuations compared with CIT alone during the first 4 weeks of treatment, and especially in the first week, at apparently no tolerability/safety cost.

Orexin (hypocretin) neuropeptides are produced by a cluster of neurons in the hypothalamus. They are central to a variety of functions, including promoting arousal and sleep, feeding and metabolism, addiction and regulating motivation. Deficiencies and over-activation in each of these functional systems have a great impact on the daily lives of millions. We need to apply the lessons learned from the current knowledge to potentially modulate them by pharmocological interference in a clinical setting.

To analyse current experimental literature on the orexin pathways in reward and addiction; assessing potential molecular targets for pharmacological interference; reviewing clinical evidence already available.

PubMed - searched with MeSH term “orexin” or “hypocretin”, with additional terms; “addiction”, “stress”, “relapse”, “VTA”, “Nucleus Accumbens”, “treatment”.

We outline all the important parmacological targets through which orexins have their effect via different downstream effectors. Moreover we propose that since orexins have an important interplay with corticotrophin-releasing-factor (CRF) in the role of stress-mediated drug-seeking behaviour; it is a ripe target for intervention. Novel, orally administered orexin antagonists, have potential to promote sleep and attenuate reward circuitry, however only within narrow therapeutic ranges.

Orexin functions are so wide-ranging that systemic orexin antagonism would cause detrimental side-effects, unless low enough doses are applied. Therefore molecule-specific and locationspecific down-stream targeting will be required, using knowledge of experimentally elucidated molecular mechanisms. Various orexin agonists and antagonists are available, and by understanding their mechanism of interaction we can potentially use them as a model for future treatments of addiction.

Tardive dyskinesia(TD) is a syndrome characterized by repetitive involuntary movements, usually involving mouth, face and tongue and sometimes the extremities. Atypical antipsychotics are of significantly lower risk for causing tardive dyskinesia, about one-fifth comparing with first generation antipsychotics. Furthermore, there is growing evidence that they may have a therapeutic effect on TD. We present a case that demonstrated a marked improvement in risperidone-induced TD following treatment with aripiprazole.

Mr. A is a 21-year-old single male with a DSM-IV-TR diagnosis of schizophrenia, of approximately 2 years duration. He was mainly maintained on risperidone 4-6 mg/day during this time. Upon his admittance to our clinic, he was suffering auditory hallucinations, persecutory delusions, social withdrawal and he was noticed to have had some involuntary mouth movements. The patient scored three out of four (moderate) on the ‘lips and peri-oral area’ subcategory of the- Abnormal Involuntary Movement Scale (AIMS). A cranial CT scan was unremarkable and there was no past history or family history of neuro-psychiatric disorders. He was started on aripiprazole 15 miligrams per day.

Within two weeks a marked improvement was seen in his psychotic symptoms and he scored 2 on the AIMS. Two months after starting aripiprazole, he was free of psychotic symptoms and dyskinetic movements.

Altough atypical antipsychotics are known to be associated with lower risk of developing tardive dyskinesia, psychiatrists should be aware of these rare conditions. Aripiprazole, as a partial dopamine agonist, might be an alternate pharmacotherapy in threating psychosis and atypical antipsychotic-induced TD.

We investigated biological and clinical-genealogical peculiarities in families of patients suffering from non-psychotic mental disorders with disturbance of respiratory system function - hyperventilation syndrome (HVS).

We studied content of alveomucin in serum of blood of 43 patients from them 40 women and 3 men. Age was from 18 to 63 years. Genealogies of families of patients with indication of mental and somatic health of relatives were composed.

In personal assessment of patients in 39 from 43 cases (90%) hysteric traits of various degree of severity. In 18 cases HVS was manifested as vegetative crises while in 25 cases disturbances of respiration were not abruptly expressed but permanent. Concentration of alveomucin in persons with hysteric disorders constitutes 20,87±1,85, in patients with adjustment disorders with predominance of depressive reactions this index is 24,91±3,36, what is somewhat higher of content of alveomucin in mentally healthy persons (20,21±4,17). In families of patients relatives of first degree with personal peculiarities and mental disorders have been revealed as well as somatic diseases of organs of respiratory system.

Non-psychotic mental disorders with disturbance of function of respiratory system are accompanied by increase of content of alveomucin in serum of blood of patients and mental peculiarities and diseases of respiratory system in nearest relatives.

78 children and the teenagers. The first group - 6-11 years - 35 people (44,9%), the second group - 12-15 years - 43 people (55,1%).

kliniko-psychiatric, psychodiagnostic: «family Drawing», «the Nonexistent animal», a questionnaire «diagnostics presence of fears» by the Rostov medical university, ЕРI, a children's questionnaire of neurosises, uneasiness school.

The raised weariness and uneasiness are revealed at the 51 (65,4±5,4%) schoolchildren. Intensity and the emotional stress connected with school, were marked almost at the every second child with problems in study and at the every third in time pupil. These persons more often had psychosomatic diseases, school phobias, attention frustration, hyperactivity. 42 people (53,8±5,6%) have been established the diagnosis of vegeto-vascular dystonia. It is children and the teenagers more often suffering allergic diseases, a squint, an enuresis, stutter. 12 (15,4±4,1%) children and teenagers feel fear before to parents. The greatest quantity is necessary on “medical” fears - 22 people (28,2±5,1%) among the fixed fears. Then the fears were distributed connected with causing of a physical damage - 16 people (20,5±4,6%) and socially mediated fears - 11 people (14,1±3,9%). Aggression has been fixed at 27 people (34,6±5,4%) surveyed.

Psychological characteristics of children and the teenagers who have suffered owing to Chernobyl accident specify in high level neurotizen and family desadaptation, uneasiness, depressive, high degree neurotizen. The psychotherapy is the basic means of treatment and preventive maintenance in system of complex social-psychological rehabilitation: dezactual neurotic semiology; symptomatic psychocorrection; socially-psychological correction; individual and family correctional work.

Cognitive impairment in patients with eating disorders was reported by the majority of studies addressing this issue. However, heterogeneous patterns of cognitive dysfunctions were observed and, in a minority of studies, no impairment was found. The present study was aimed to define the pattern of neurocognitive impairment in a large sample of bulimia nervosa (BN) patients and to demonstrate that neuroendocrine, personality and clinical characteristics influence neurocognitive performance in BN.

Attention, executive control, conditional and incidental learning were evaluated in 83 untreated female patients with BN and 77 healthy controls. Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory-Revised (TCI-R), the Eating Disorder Inventory-2 and the Montgomery-Asberg Depression Rating Scale were administered.

No impairment of cognitive performance was found in subjects with BN vs. healthy controls. The higher the cortisol level and “Self-directedness” scores the better the performance on conditional learning, while 17β-estradiol levels showed an opposite pattern of association; “Reward dependence” scores were associated to a worse performance on incidental learning; depressive symptomatology negatively influenced the performance on the WCST.

No cognitive impairment was found in untreated patients with BN in the explored cognitive domains. An influence of neuroendocrine, personality and clinical variables on neurocognitive functioning was found, which might explain discrepancies in literature findings.

This study examined adolescents with anorexia nervosa admitted to a tertiary referral unit in Dublin over a 3 year period.The aims of the study were to assess changes if any in patient clinical and laboratory parameters specifically weight change, body mass index (BMI), cardiovascular, haematological and biochemical measurements over the course of in-patient stay.

Hospital computerized databases and clinical case notes were examined for each patient.Results were compared with Royal College of Psychiatrists (RCP) and National Institute for Clinical Evidence (NICE) guidelines for treatment of in-patients with anorexia nervosa.

There were at total of 42 admissions over the 3 years.7 males and 35 females were admitted.Median length of admission was 88 days. Female patients gained on average 7.2 kilograms during their admission.The average female BMI on admission was 14.9 on admission and 17.6 on discharge. 82.3% of female admissions had blood abnormalities, the most common being anaemia and hypokalaemia.45.7% of female patients had an abnormal electrocariograph.25% of female patients required transfer out during their admission for medical review.

The eating disorder unit fulfilled the RCP and NICE guidelines for 97.6% of patients in terms of blood results performed and 92.8% in terms of electrocardiographs performed.The average BMI on discharge for both males and females was above 17.5 which is regarded as the normal cut off point for anorexia nervosa.The importance of this study despite its limited sample size is that it is the first study of investigations and outcomes in an Irish in-patient adolescent eating disorder sample.

In our study, we compared the prevalence of alexithymia in diabetic patients with non-diabetic controls and investigated the relationship between Alexithymia and glycaemic control in diabetes.

In this cross-sectional study, TAS-20 scores of 100 diabetic patients and 50 non-diabetic controls were compared.

A structured questionnaire was used to collect socio-demographic data to describe the participants and aspects of their diabetes.

Prevalence of Alexithymia was not significantly higher than in the control (45% Vs 40%;p=0.56).

The diabetic study population was predominantly female (71%) and married (73%).

The average age in diabetic population: 56.21 years (ET=10.58); starting age: 46.8 years; average duration of diabetes: 9.41 years.

Alexithymic diabetic patients have more traumatic events (93.3% Vs 78.2%; p=0.035), especially such as the death of a parent (73.3% Vs 50.9%; p=0.022), than non-alexithymic counterparts. Factors such as comorbidities and presence of diabetic complications were not significantly associated with TAS-20.

Alexithymic diabetic patients were under a worse glycaemic control compared to their non-alexithymic counterparts (84.4% Vs 65.5%; p=0.031).

The high prevalence of alexithymia among diabetic individuals is an indicator of its importance in the approach to diabetic patients. The presence of alexithymia seems to be related to glycaemic control and might be of value in terms of risk stratification of the individual diabetic patient for developing diabetic complications.

To assess the prevalence and structure of non-adherence in Russian population of patients with advanced atherosclerosis.

Sixty patients (mean age was 69±11 yrs, 30 males) with advanced cerebral arteriosclerosis and ischemic heart disease were randomly selected from cardiovascular department and enrolled in the study for subsequent psychiatric counseling, questionnaires and MRI procedures. Patients with stoke, focal neurological deficit and any psychiatric disorders in anamnesis were excluded.

We have shown that 80% of patients have decreased or completely absent adherence to medical care. This patients were subsequently divided into three subgroups. First subgroup (30%) was characterized by partial denial of illness, where 3 (5%) patients suggest that they understanding somatic disease clinical course better than doctors. Significantly decreased compliance was most apparent in secound subgroup (30%), manifesting in self-changing drug and dosage regimen (for instance, skipping the medication without the doctor advise. In this subgroup 6 patients (10%) showed denial of treatment pattern underscored that conventional treatment for atherosclerosis as a whole is harmful for them and prefer to avoid all medications after discharge. Third subgroup included patients with vascular dementia (20%), where MRI analysis revealed white matter lesions with preferable localisation in emotional areas of cerebral (sub)cortex. There was a strong and significant correlation between the MRI white matter leasions score and treatment non-adherence level (r = 0.75).

Non-adherence is very prevalent in patients with advanced atherosclerosis estimating for up to 80%, while severe non-adherence is observed in 35% of patients.

Several studies have examined the neuropsychological functioning in patients with Eating Disorders (ED) suggesting that they could be related to an impairment in several areas. We investigate such cognitive functions especially decision making and visual-spatial memory in an independent sample of patients suffering from ED and to evaluate possible differences between patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) as well as between ED subjects and healthy controls.

Trial Making Test (TMT), Iowa Gambling Task (IGT) and Gambling Task (GT) were administered to 15 AN patients 12 BN patients and 19 healthy subjects.

We observed that 80% of AN and the 75% of BN subjects performed poorly in the IGT compared to the healthy subjects (36,8%). Similarly, ED patients committed more mistakes and employed more time to complete TMT compared to healthy controls. However, no significant difference was found between ED groups and healthy subjects with respect to GT. Further, no significant difference was observed between AN and BN subjects with respect to IGT and GT.

Our results suggested that patients with ED could have a significant deficit in visual-spatial attention. As a consequence they need more time to complete the task and make more mistakes. Furthermore ED patient had a deficit in decision making tasks as well. This could reflect deficits in planning long term strategies to approach problems, possibly leading to improper behaviors for the control of their weight.