Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.

Describe a case of a 53 year old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address this behavioral problems. Her husband noticed that she had become “hyper” in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.

Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.

Prednisone was suspended and Risperidone 2 mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.

These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.

The authors have not supplied their declaration of competing interest.

The concept of male depression is based on the hypothesis that typical symptoms of depression in men often seem to be masked by non-typical male distress symptoms not considered in common depression inventories. Despite clinical evidence, scientific evidence is still lacking. The study describes symptoms reported by males (on the Gotland Male Depression Scale (GMDS) in a community study and these were further validated against MDS criteria.

In a community study in Reykjanes Iceland, 534 males were rated by the GMDS. In the second phase a sub-sample of healthy and depressive males were examined by a trained psychiatrist in a semi-structured interview (N=137). Diagnosis was according to the DSM-IV for MDD. The symptoms on GMDS are self-rated from 0-3.

In the community sample the prevalence (>1 GMDS) of single symptoms was following: More stressed out than usual (16.8%), aggressiveness (11.8%), feeling of being burned out (14.5%), tiredness (18.2%), more irritable (15.3%), difficulty making decisions (10.8%), sleep problems (21%), anxiety/uneasiness (10.5%), increased use of alcohol/substances, hyperactivity ( 10.3%), behavioural changes (4.7%), feeling sad/hopeless (10.4%), self-pity (4.8%). All symptoms on GMDS correlated strongly with MDD. In a stepwiselogistic regression model, controlling for medication and age, three items contributed independently to MDD diagnoses. These were aggressiveness, being more irritable and anxiety/uneasiness.

Sleep problems and tiredness were most commonly reported symptoms. The best predicting symptoms for MDD were anxiety and acting out symptoms, aggression and irritability. This is of interest as these symptoms are not in the criteria for MDD.

The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.

The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.

102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.

The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.

The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

All offenders commited neonaticide were mothers of killed nweborn. Analysis of forensic psychiatry examination reports showed only 12 offenders (21.4 pr.) with psychiatric disorders which caused diminished responsibility and irresponsibility. There were 8 offenders with severe depression and 2 – with schizophrenical psychosis in irresponsible offenders group. Diminished responsibility was found in 2 offenders with light mental disorder. In 44 (78.6 pr.) reports offenders were found responsible for criminal act. Main diagnosis of this group was personality disoeder (N 30), alcohol addiction was found in 5 cases. In cases responsible for crime of neonaticide some reasons for criminal action were disclosed : material difficulties (N9), unwanted child (N8), spousal revenge (N7), not mentioned reason (N20).It was no more mentioned material difficulties as reason for neonaticide in cases after 2002 year. Conclusion :Neonaticide was commited by psychiatrically ill persons in only one fifth part of examined cases. Main diagnosis in cases responsible for neonaticide was personality disorder. The results of analysis show psychosocial prevention work, health education and adequate psychiatric diagnoses and treatment are neccesary in pregnant women for avoiding neonaticide.

The goal of this research was to explore the use of PCR as a marker of inflammation and CVD in patients with Schizophrenia.

A cross-sectional analysis of the BSA administrative claim database was conducted including all men and women, >18 years, with a schizophrenia spectrum disorders (by DSM-IV criteria) diagnosis. PCR measurement together with socio-demographics, evolution, medical history, 10-years CVD risk (Framingham equation) and biochemistry data was extracted for analysis.

705 patients [53.0% men, 48.2 ± 15.8 years (mean ± SD), 5.9 ± 3.2 years of evolution, 79.7% on atypical drugs] met criteria for analysis. Mean 10-year CVD risk was high; 11.9% ± 5.7% and mean PCR levels were 2.6 + 2.5 mg/L with 30.4% showing values above normal's (≥ 3 mg/L). Unadjusted PCR slightly correlated with CVD risk; r = 0.171, p < 0.001. After adjusting by age, sex, evolution, smoking and anti-inflammatory drugs treatment, PCR was linearly associated with 10-year CVD risk stratified by its level of risk (low, moderate, high/very high); respectively, 2.3 (95% CI: 2.1–2.5), 3.1 (2.6–3.5) and 3.7 (3.2–4.1) mg/L; F = 13.5, p < 0.001. Patients with known CVD showed also higher PCR levels; 3.7 (2.9–4.5) vs. 2.5 (2.4–2.7) mg/L, p = 0.008, and higher probability of values above normal's; Odds Ratio = 4.71 (2.01–11.04), p < 0.001.

High PCR levels (above normals) were associated with both known CVD and high/very high 10-year risk of CVD event in patients with schizophrenia. Then, PCR might be a marker of inflammation and CVD in this psychiatric disorder.

The progressive increase in the prevalence of anxiety disorders in advanced ages advises the extensive use of of screening measurements in this population, that, everywhere in the world, has raised numerically.

The aim of this study was to examine the psychometric properties of a Portuguese version of the Geriatric Anxiety Inventory-Short Form (GAI-SF, 5-item format) in a sample of 932 elders.

Quantitative and cross-sectional study with descriptive and correlational planning. Translation and back-translation was performed by language proficiency experts. The reliability was assessed through Cronbach's alpha coefficient and the factorial validity through Principal Components Analysis. The convergent validity was conducted with the Geriatric Depression Scale (GDS) and the Positive and Negative Affects Scale (PANAS-Negative sub-scale), while discriminant validity was performed with the PANAS-Positive sub-scale and the Satisfaction With Life Scale (SWLS). A Confirmatory Factor Analysis, using a structural equation modeling, was performed to test the fit of the model with the five items.

The GAI-SF showed good internal consistency (α = 0.77), good convergent, and discriminant validity (p < 0.05). The factorial structure presented a single factor that explained 52% of the variance. The model showed a good fit to the data (χ2= 1.233, TLI = 0.997, CFI = 0.999, RMSEA = 0.020).

The GAI-SF, a brief self-report scale, has good validity and reliability, and factorial qualities adequate to measure anxiety symptoms in epidemiological surveys and in geriatric settings.

The authors have not supplied their declaration of competing interest.

The study collected data of 143 absconding patients, 33% of whom were in confined hospitalization. Most of them were young, single and of low socioeconomic status. Most escaped in the evening shift. There were no significant differences in patient variables between the 2 hospitals. Previous hospitalizations was higher in one of the hospitals (t=2.568, p= .013). There were more staff members in one of the hospitals (t=4.016, p<.0001). There were no difference between the day and the absconding shift.

The authors have not supplied their declaration of competing interest.

The study explores subjective image attributed by parents to their child that was formed under the influence of different socio-cultural conditions and affects communication with a child. Methodological basis of Vygotsky's scientific school was used in the research.

The study included two groups of families from different social strata: group 1 — middle-high stratum, group 2 — middle-low stratum (n1 = 31, n2 = 36), all the families live in Moscow; the children (5.5–7 years old) attend extracurricular activities. Following methods were used: analysis of social context of child's development; long-term overt and covert observations; analysis of complaints, ambitions and expectations — “a project of future development” of a child imagined by parents followed by reconstruction of their relations that appear to be the basis for the “project”; method of semi-structured interview.

First group demonstrates high level of irrelevance in subjective extra-positive image of a child. That poses risk for child's emotional and personal development. Families from different strata tend to demonstrate irrelevance between ambitions and real success of a child. First group tend to overstate, 2nd group — to understate. In some cases parents’ mindsets cause emotional peculiarities of the child: individuality and as a result inflated ego, demonstrative behavior accompanied by interest to external attributes. In 2nd group children are mostly anxious and encounter difficulties in demonstration their abilities, but they possess higher level of emotional and personal maturity and social flexibility.

Socio-cultural features of the stratum influence parental expectations that form potential risk zones in child development.

The authors have not supplied their declaration of competing interest.

Instruments for diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in childhood are well validated and reliable, but psychometric assessment of ADHD in adults remains problematic. To date the Conners Adult ADHD Rating Scales (CAARS) are frequently used in the assessment of ADHD.

The CAARS were translated into German and a series of studies planned to establish psychometric properties of the CAARS-self and -observer rating scales.

To evaluate the German version of the CAARS.

We recruited 847 healthy German subjects and 466 adult ADHD patients to fill out the CAARS-self report and questions on socio-demographic variables. Additionally, 896 CAARS-observer reports were filled out by significant others and clinical experts. Factor analyses were conducted to obtain factor structure and to replicate the structure of the original American-model. Comparisons between patients and controls, and analyses on influences of gender, age, and education level were calculated. Additional analyses established psychometric properties.

Confirmative factor analysis based on the original American-model showed a high model-fit for both the German healthy control and the adult ADHD patient sample. Analyses of normative data showed significant influences of age, gender, and education level on the emerging subscales for the control sample only. Differences on all subscales were highly significant between patients and controls. Test-, test-retest-reliability was very high, and criterion validity could be established with DSM-IV based clinical interviews. Sensitivity and specificity ratings are overall very satisfying.

The German version of the CAARS is a cross-culturally valid instrument for the assessment of adult ADHD.

There seems to be geographical differences in decisions about breast conserving surgery (BCS) in breast cancer patients. This study was to evaluate patients’ attitude to BCS and to assess the factors affecting cancer practice in West China.

A structured questionnaire was distributed to 184 patients, eliciting information about the patients’ characteristics, occupation, education, family life, recognition of illness, knowledge about BCS, the main means of gaining surgery information, selecting surgery approaches, preferences to breast reservation.

In all, 163 patients completed the questionnaire. The results indicated that only 7.4% of patients received BCS and 23% of the remaining patients desired to have BCS and the affecting factors were significantly associated with their family life, recognition of illness and the main means of gaining surgery information (P < 0.05). No associations were between BCS selecting and the other variables studied. The most frequent reasons for selecting BCS were keeping the female shape and improving quality of life (71%), the second most were postoperative recovery, minimal influence of physical function (47%) and patients’ knowledge about BCS (42%). The most frequent reasons for not selecting BCS were uncertainty about BCS results and worry about recurrence (81%), the second most was the elderly age unnecessary for BCS (40%).

The findings indicate that breast cancer patients in West China do not take BCS as the first choice as the best treatment method. It is warranted that further study of more patients, attitude of patients’ partners and physicians to BCS.

To review current practice of lipid monitoring for patients prescribed colzapine and to improve the health of patients taking clozapine.

This was a retrospective audit targeting all patients who were taking Clozapine from May 2008 to April 2009 inclusive. Data was collected from pharmacy records, the heath centre records and patients’ personal care records. Current practice within the hospital was then compared with the standards proposed by the Maudsley Guidelines.

The total number of patients who were prescribed clozapine between May 2008 to April 2009 was 65. Of these patients 54 met the identified standards. We identified two patient groups; 56 patients were taking clozpaine for more than one year and nine patients were taking clozapine for less than one year. Out of those patients who were taking clozapine for more than one year, standards were met for 89% of patient (n = 50) compared to only 44% (n = 9) of those patients who were taking it for less than 1 year. Also, of those patients who had been taking clozapine for less than one year and do not meet the standard, none of them had lipid monitoring at three monthly intervals.

Although the vast majority of patients in the hospital who were prescribed Clozapine had their lipids monitored appropriately, a small percentage did not. Monitoring of lipid levels was particularly lacking in the first year of treatment.

Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge relation between ADHD and SUD has not been studied in Arab countries.

Assessment of scope of comorbidity between ADHD and SUD in Egyptian patients.

Estimating prevalence rate of adult ADHD among substance use inpatients and to compare substance use inpatients with and without adult ADHD regarding onset, and severity of SUD.

This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One Hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis.

36 patients were diagnosed as having adult ADHD (35.3%) according to DSM-IV TR criteria. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years) and larger number of hospital admissions, (6.83 vs. 3.39 times). ADHD subjects achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Data were fed to the computer using the Predictive Analytics Software (PASW Statistics 18). Significance of the obtained results was judged at the 5% level.

The results of this study confirm the high rates of adult ADHD among substance use patients mentioned in other studies. Presence of adult ADHD was associated with a more complicated course of SUD.