High level of assertiveness and low anxiety are important factors that caused suitable communication and increase of intellectual abilities, abstract thought, power & autonomy and personal well-being in of nursing and midwifery students. Only few studies have been done this issue. The objective of this study was to determine relation between Assertiveness & Anxiety in Midwifery & Nursing students.

This was a correlational and cross-sectional study. 173 nursing (68 male & 105 female) were recruited respectively in census & rational method and 77 midwifery students were recruited in census method. The data were collected using a self report tool included “personal information form”, “Trait Spilberger Anxiety” and “Assertion Inventory (AI) of Gambrill & Richey”. The data were analyzed using descriptive and inferential statistical methods.

Results show that more than half of nursing and midwifery students (59/5%, 59/7%) have moderate assertiveness. Also 43.3 & 36.4 percent them have moderate & high levels of anxiety. Pearson correlation test revealed that assertiveness and anxiety in nursing (r= -0/51, p< 0/001) and midwifery (r=-0/449, p< 0/001) students were negative and significant correlated.Some variables have significant difference with assertiveness and anxiety of students.

In regard to relation between assertiveness and anxiety and effect on mental health, educational & occupational functions of students, it is need to specific attention of educators to this point. Also interventions is need for increase of students knowledge of interpersonal skills specially increasing assertiveness and decreasing anxiety.

Many patients with Obsessive Compulsive Disorder (OCD) fail to respond to specific serotonin reuptake inhibitor (SSRI) medications. Glutaminergic dysfunction has been shown to be related to the pathophysiology of OCD. Topiramate is a novel anti-epileptic drug that inhibits glutaminergic action. The aim of this study is to survey the effects of topiramate on obsessions and compulsions of patients with OCD.

This trial has been designed as an 8-week randomized, placebo-controlled, double-blind study. Eighty four patients suffering from OCD were randomly allocated in to one of the treatment group: fluoxetine plus topiramate or fluoxetine plus placebo. Efficacy measures comprised assessment of obsessions and compulsions and global functioning.

Both groups demonstrated significant improvement in their clinical condition (P< .000) but the group taking topiramate adjunctive compared to the other group had more decrease in Yale-Brown Obsessive Compulsive Scale (P< .001) and better Clinical Global Improvement (P< .002).

Our study indicates that topiramate can enhance the effect of SSRIs in treatment of OCD patients and can be considered as an appropriate adjunctive agent. However, it should be noted that our study is preliminary and larger double blind studies are needed to confirm these results.

Specialty studies show that the emotional state of the patient with Multiple Sclerosis is deteriorating in relation to the phisycal condition and medication and motor re-education without psychological re-education is just not effective. The present paper tries to make an evaluation of the anxiety and depression in pacients with Multiple Sclerosis.

Two groups, each composed by 30 subjects(even proportions between men and women). The research group consisted of pacients diagnosed with MS and the control group, with subjects selected from the general population, not diagnosed with any chronic disease. Two tests were used: State Trait Anxiety Inventory and Beck Depression Inventory.

Anxiety, as a trait of a personality is significantly evidenced in patients diagnosed with MS, in comparison to the control group. Depresive states, with variable intensity are also more frequent at the research group, compared to the control group. The highest average of the depression was recorded in subjects diagnosed with MS for 1 year. These results were coherent with the high scores of the patients from the research group, as well as the difference that is significant from the statistical point of view (p>0.10).

The frequency of the psychiatric disturbances in MS is much higher than the general population. Depression and anxiety contribute greatly to the development of the disability in this particular disease.

To analyse the effect of Pregabalin (PGB) on anxiety and depression symptoms in patients with refractory-severe Generalized Anxiety Disorder (GAD) and severe concomitant depressive disorder.

Post-hoc analysis of a multicentre, prospective and observational study conducted in outpatient psychiatric clinics to ascertain the impact of broadening GAD criteria. Men and women above 18 years, with GAD (DSM-IV criteria), PGB naïve and refractory to a previous course of benzodiazepines and/or anti-depressive drugs (minimum 3 months) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were included. Changes in HAM-A and MADRS were assessed after 6 months of receiving PGB as per psychiatrist's judgement.

159 patients [69.2% women, 45.9 (12.6) years] fulfilled criteria for analysis. Respectively, 92% and 90% of subjects were previously exposed to benzodiazepines and anti-depressives before adding PGB [mean dose: 223.1 (126.3) mg/day]. PGB therapy reduced both anxiety and depressive baseline symptoms by a mean of, respectively in HAM-A and MADRS scales, 57.9% (from 35.5±5.8 to 14.8±9.4; p< 0.001, effect size: 3.57) and 58.1% (from 39.4±4.3 to 16.5±10.3; p< 0.001, effect size: 5.33). As a result, the percentages of patients without symptoms of both anxiety and depression were 34.4% and 40.9%, respectively at the 6 month visit (p< 0.001 in all cases). Similarly, responder rates (≥ 50% reduction of baseline scoring) were 63.1% and 62.9%.

Despite limitations, Pregabalin therapy had a meaningful and significant effect of symptoms of anxiety and depression in patients with severe refractory GAD and concomitant severe depressive disorder.

The aim of this study is the investigation of anxiety prevalence between first semester and last semester students in university and this research explains the rate of students’ anxiety in university's terms.

This investigation is a descriptive study that 120 students (60 F, 60 M) in Ardabil University from the first and final semesters as the accidental samples by questionnaire are selected. We used Cottle Anxiety test and gained results by SPSS and statistical analysis.

First semester students' anxiety rate was (50%) and final semester students too (50%). (57.7%) of cases were native. most of them (93.3%) was jobless and single (87.5%).

This study shows that there isn’t meaningful relation between rate of Anxiety and age, situation of marriage, occupational situation and living place in first or last semester students of Ardabil University.

This study examined the initial clinical presentation and monthly re-assessments of treatment outcome for a group of combat veterans and deployed peacekeepers with posttraumatic stress disorder (PTSD).

Participants were 102 Canadian combat and peacekeeping Veterans attending specialized PTSD treatment clinic (Operational Stress Injury Clinic).

Help seeking veterans with PTSD presented with significant comorbid major depressive disorder and results at 12 months demonstrated significant improvement in symptoms of PTSD, depression and anxiety. There was no significant predictor of PTSD symptoms decline. Initial depression significantly predicted anxiety symptom declines, and initial anxiety predicted depression symptom declines. There was also a demonstrable improvement in health-related quality of life as measured by the SF 36.

Abnormalities of emotional processing have been reported in both anxiety and depressive disorders. Anxiety might be related to a hyperactive preattentive fear response or to a reduced efficiency of late regulatory processes, whereas depression might be related to a reduced response to positive emotions. In the present study event-related potentials (ERPs) were used to investigate involuntary processing of stimuli with different emotional valence in 33 healthy controls [HC] and 55 clinically stable patients (16 with panic disorder [PD], 15 with obsessive-compulsive disorder [OCD], 13 with unipolar depression [UD] and 11 with bipolar depression [BD]).

The ERPs were recorded during a target detection task, in which erotic, threatening, disgusting and neutral stimuli were used as distracters.

Patients showed abnormalities of the sequence, duration and topography of the ERP components related to emotional processing. Patients with anxiety disorders showed abnormalities of the early components in response to threatening stimuli. Patients with BD showed abnormalities of both early and late ERPs components. OCD and UD patients demonstrated similar abnormalities of the late ERP components in response to erotic stimuli.

According to our results, abnormalities of emotional processing are observed in both anxiety and affective disorders and might have both distinct and shared characteristics in these disorders.

Generalized anxiety disorder (GAD) is the second more frequent disorder after mayor depression in primary care. It has great impact in patients functioning and consumption of health services. The clinical presentation in this setting, predominantly somatic, and its frequent comorbidity may lead to underdiagnosed and mistreatment. Features of GAD in this setting are evaluated.

An epidemiological and multicenter study was carried out, collecting demographic data and clinical history, on a randomly selected representative sample of 225 patients from three primary care centers of the area of Madrid (Spain). Also Patient Health Questionnaire (PHQ) and Dream Questionnaire of Oviedo were reported.

Chi-square test were used to compare in patients diagnosed of GAD versus other psychiatric patients and non-psychiatric diagnosed.

Clinic prevalence of GAD was 11,1% in the sample. In GAD cases, mayor depression was found in 68,0% (Chi2, p< 0,001). So, it shows the comorbidity of GAD with mayor depression has a relevant presence in primary care. This suggest a possible relation between both disorders.

On the other hand, the presence of depressive symptoms were significantly higher in GAD patients (U test, p< 0,001). Unexpected non statistical significant differences were found in the number of somatic symptoms, sick leave days and utilization of medical services. Comorbidity with mayor depression disorder may work as a confounding factor masking the differences found in other epidemiological studies.

Better clinical diagnosis tools and longitudinal studies might be proceed to clear this relation and improve its treatment.

An operation is undoubtedly a stressful event, which can induce emotional, cognitive and physiological reactions in preoperative patients. Aim of our study is to investigate the associations between the levels of state - trait anxiety and the demographics (gender and age) in patients prior a thoracic surgery.

Seventy-six (57 males and 19 females) patients, with ASA I-III and with mean age 45.65±15.17 years were included in the study. All subjects fulfilled the Spielberger State-Trait Anxiety Inventory (SSTAI), 12 - 15 hours before the thoracic surgery.

Mean state and trait anxiety scores were 42.35±11.50 and 38.55±9.03, respectively and presented a strong positive correlation (Pearson Correlation, p< 0.001, r=0.585). Percentages of 30.3% and 13.2% of the sample were presented with clinically significant anxiety levels (t-test, p=0.001). Females appeared with higher state (t-test, p=0.001) and trait (t-test, p=0.076) anxiety scores compared to males. As to age, we observed a negative correlation with the levels of state and trait anxiety. (Pearson Correlation, p=0.05, r=-0,226 and p=0.006, r=-0.313, respectively).

Our findings suggest that females and younger patients are more vulnerable to anxiety symptoms prior a thoracic surgery. Thus, gender and age should be taken into account for the preoperative assessment in order to develop supportive psychological interventions.

Long-term follow-up of the patients suffering of combat-related traumatic stress revealed that co-occurence of Posttraumatic Stress Disorder (PTSD) and Mild Traumatic Brain Injuries (TBI) proved to be “the rule rather then exception”.

The aim of the paper was to determine the possible influence of the mild TBI on the severity and on the duration of the PTSD.

Totaly 60 patients suffering of PTSD were assessed and divided in two groups: with mild TBI and without the history of head trauma. The presence and the severity of the PTSD and TBI were assesed using following instruments: The Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX) and Glasgow Coma Scale, respectively.The differences between groups were evaluated using Student t test

Results obtained showed that two groups differed significantly on the following items of the CAPS score: total severity, severity of the D cluster, functional deficits, and duration of symptoms.

Mild TBI might influence on the clinical course and severity of the PTSD, by diminishing the capacity to employ cognitive resources that would normally be engaged in problem-solving and regulationg emotions after trauma and leaving the individual more helpless and susceptible to persistent trauma related psychopathology.

The study's aim was the comparison of OCD patients treated with Sertraline toward those treated with Clomipramine, divided in two subgroups with gender related symptoms differences.

The study was focused on the inpatients and outpatients presented at Psychiatric Clinic, diagnosed with OCD during September 2005-March 2006. The criteria of being selected were randomization of those with > 20 points according to Yale-Brown Obsessive Compulsive Scale and > 4 points according to Clinical Global Impression Scale. There were two groups: first group was treated with clomipramine and the second with sertraline. Sertraline doses were 50 and 200 mg/day and clomipramine 100, 125 and 150 mg/day. The study was conducted during a period of 12 weeks including three evaluations through YBO C scale and CGI.

91.8% of the patients completed the study. Men had a higher frequency of sexual symptoms, symmetry and exacteness obsessions, while women suffered a later onset of the disorder and presented a higher rate of aggressive obsessions. The patients treated with sertraline reported less side effects frequency and intensity and more tolerance than the patients treated with clomipramine.

Both treatments showed therapeutic efficacy in treating the OCD symptoms, but depends on symptoms and gender. Clomipramine caused more side effects and the number of patients dismissed from the study was higher in the group of clomipramine. Sertraline is as effective as clomipramine for treating the OCD but has more compliance and less side effects.

To ascertain what motivates patients with obsessive-compulsive disorder (OCD) to perform compulsions.

Fifty-nine OCD patients underwent a comprehensive assessment, which included a structured interview designed to elicit one or more functions of their compulsions. Each patient was interviewed about the maximum of 3 compulsions.

The functions of 138 compulsions were identified, and compulsions were classified in accordance with OCD symptom subtypes as washing/cleaning (n=35), checking (n=33), mental/covert (n=23), ordering/symmetry (n=17), hoarding (n=10), and miscellaneous (n=20). Compulsions were most frequently performed to decrease distress or anxiety (n=87, 63%) or automatically, without patients thinking why they were doing it (n=87, 63%). However, the reasons for performing compulsions varied significantly, depending on the OCD subtype. In comparison with patients from other subtypes, those with checking compulsions were more likely to perform them because they believed something bad would happen if they failed to do so, patients with washing/cleaning compulsions were more likely to perform them to alleviate the feeling of disgust, and patients with mental and ordering/symmetry compulsions were more likely to perform them to achieve a “just right” feeling.

Identifying functions of compulsions improves understanding of the psychopathology of OCD and has important treatment implications. Cognitive-behaviour treatment approaches differ in accordance with the reasons for performing compulsions: exposure and response prevention tends to achieve better results when compulsions are driven by a need to decrease distress, anxiety or the feeling of disgust, whereas cognitive techniques may be more useful when compulsions are performed for other reasons.

Some studies have demonstrated high cognitive deficits in patients with post-traumatic stress disorder (PTSD). Considering the limited available information about this issue, we decided to assess the cognitive deficits and memory disturbances in these patients.

The present study is a case control research conducted on 50 patients with post-traumatic stress disorder who were admitted to Ibn-e-Sina psychiatric hospital in Mashhad, in north-eastern part of Iran in 2008. The control group included 50 people of first degree relatives of these patients who met the inclusion criteria of the study. Case and control groups were selected by simple sampling method; and for all of them, a questionnaire of demographic information, Wechsler memory scale, and mini mental status examination (MMSE) were completed. The gathered data were analyzed using SPSS 14th edition by chi square, T test, and analyze of variance.

The mean score of Wechsler memory scale in patients with PTSD (80.78±18.39) was signifantly higher than control group (67.92±7.38) (P=0.000). The mean score of MMSE was significantly lower in patients with PTSD compared to control group (P=0.000). The determined disability level assessed by Iranian veterans organization and also comorbidity of other psychiatric disorders with PTSD did not have a significant relationship with cognitive deficits, but the duration of PTSD and age of patients were signifantly related to the level of cognitive deficits.

Cognitive deficits and memory disturbances are higher in patients with PTSD than general population.

To verify the association of various risk factors with Post Traumatic Stress Disorder in adults among Internally Displaced Persons of Bajour and Swat.Design: Case Control study

Conducted on adult males and females among internally displaced persons, selected from the IDPs Camp in Peshawer and the IDPs visiting Psychiatric setting at Hayatabad Medical Complex, Peshawer from 1st of May to 15th of June, 2009.

Cases selected among the respondents through a screening questionnaire, suffering from PTSD. The controls were those respondents which screened out negative from the questionnaire for PTSD but were from the same camp. A total of 208 cases & equal number of controls were enrolled in the study. The statistical analysis was done in a stepwise manner (Uni-variate analysis, bi variate analysis, Logistic regression) using SPSS version 17.

The results show that the factors significantly associated with PTSD were Exposure to Injury (OR=19.181, 95% CI=5.740-22.797, p=0.000), Witnessing Death (OR=21.113, 95% CI=5.550-19.826, P=0.000), Hopelessness (OR=26.918, 95% CI= 3.403-13.101, p=0.000), Torture (OR= 5.008, 95% CI=1.795-3.962, p=0.009) and Loss of relative (OR=3.934, 95% CI=1.077-4.893, p=0.008).

The Posttraumatic stress disorder is highly prevalent in the vulnerable populations and various determinants are responsible for the morbidity associated with it. The degree that risk factors function to determine both the development and recovery from trauma, it is plausible that targeting risk factors may help both in the treatment of PTSD and in preventing recurrences of PTSD over time.

Obsessive-compulsive (OC) symptoms are common in both children and adults with Prader-Willi Syndrome (PWS), to the degree that they are considered central to the syndrome's behavioral phenotype and constitute diagnostic criteria for the disorder. Although efficacious behavioral treatments (e.g., exposure and response prevention) exist for OC symptoms in typically developing youth, these treatments are not tailored to meet the specific needs of youth with PWS and their families. The purpose of the current study is to report on a modified CBT protocol that addresses obsessive-compulsive symptoms in youth with PWS.

Three children received a modified version of cognitive-behavioral therapy targeting obsessive-compulsive symptoms in PWS. Measures were administered at screening, baseline, and post-treatment and included the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS), Family Accommodation Scale, Clinical Global Impression - Severity (CGI-S), Clinical Global Improvement (CGI), and measures of impairment and adaptive functioning. Treatment consisted for 12 family-based CBT sessions that included exposure and response prevention; cognitive restructuring; and other operant treatment elements.

Participants experienced reduced CYBOCS scores at baseline to post-treatment, 25 to 15.3. All three youth were considered treatment responders on the CGI-Improvement scale. Similar reductions on secondary variables such as OCD impairment were reported.

Although these results are preliminary, initial results suggest that behavioral treatment of OC symptoms may be effective in the PWS population. This treatment holds promise for being a safe and tolerable method for reducing compulsive symptoms in youth with PWS.

The goal of the study was to establish the relationship between teenagers’ anxiety and depression symptoms and suicidal behavior.

Two groups of teenagers from 14 to 17 took part in the study: the study group (after suicide attempts, N=109) and the control group (no suicide attempts, N=218). Hospital Anxiety and Depression Scale (HADS) was used in evaluating anxiety and depression symptoms.

Evaluating adolescents’, who attempted suicide, anxiety and depression symptoms according to HADS, no significant differences between genders were determined: anxiety symptoms were determined to 22.8% of girls and 26.9% of boys (X2=3.50, df=2, p=0.2), depression symptoms were determined to 21.1% of girls and 26.9% of boys (X2=1.01, df=2, p=0.6). Evaluating possible impact on teenagers’ suicidal behavior, the odds rate was calculated, the chance was determined whether a suicide is possibly attempted. The possibility of suicidal behavior was increased significantly by anxiety and depression symptoms, determined with HADS: 3,9 times more anxiety symptoms (95%, CI 1,6-9,7) and 9,2 times more depression symptoms (95% CI 2,9-29,7) in boys, and in girls, respectively - 2,5 times (95%, CI 1,1-5,9) and 7,6 times (95%, CI 2,4-24,8).

Anxiety and depression symptoms, according to HADS, may have possible impact on teenagers’ suicidal behavior.

To explore functionality and quality of life outcomes in adolescents with ADHD transitioning from IR MPH, ER MPH or ATX onto PR OROS MPH.

Pooled analyses of two similar 12 week open label, flexible dose, non-interventional trials exploring outcomes in adolescents with ADHD (ICD-10) transitioning from either IR / ER MPH, or Atomoxetine onto PR OROS MPH. Connor's parents rating scale (CPRS), children's global assessment scale (CGAS) and quality of life (ILC) were measured.

186 adolescents (84.4% boys; median age 14yrs) were analyzed. Starting dose of OROS MPH was based on clinical judgment. Median dose of PR OROS MPH at baseline and endpoint was 36mg/day. Functionality based on C-GAS as well as burden of disease scores measured in parents and adolescents improved at endpoint (p< 0.001). 80% girls and 67% of boys achieved an at least 30% reduction on CPRS. ILC-LQ0-28 in adolescents and their care givers improved (p< 0.05). 56 adolescents (30,1%) experienced at least one treatment emergent adverse event (AEs≥4% were insomnia (4,8%), headache (3,7%), muscle twitches (3,2%).

Adolescents with ADHD transitioning onto PR OROS MPH showed clinically relevant improvement in daily functioning and quality of life aspects. Burden of disease in patients and their care givers was lowered.

of the help-seeking pathway study for children and adolescent mental health problems was to investigate all the potential routes to Child/Adolescent Psychiatry Clinic-University Hospital Center (CAPC-UHC) Tirana and to investigate factors influencing this process for children at risk.

Participants were 5-18 years old, newly referred children/adolescents in CAMHS during 2006. Measures used were Strengths and Difficulties Questionnaire for parents/children, Pathways Encounter Form. Patterns of care seeking, durations and previous treatments for diagnosis within ICD-10 groups were prescribed. Analysis: Comparisons between groups, diagnosis and predictive factors influencing help seeking care.

The child neurologist played an enormous role in referring the child to CAPC, followed by adult psychiatrist or GP. The most frequent diagnosis resulted to be pervasive developmental disorder (28.4%), phobic and anxiety disorders (19.1%), somatoform and dissociative disorders (17.3%), hyperkinetic and conduct disorder (15.4%).

This is the first study investigating the help seeking process to psychiatric care to CAPC Tirana-Albania. There is a need for further research on a general population level, including primary care settings, preschools and schools based services, because a clearer understanding is required about barriers to service use and also identifying children/adolescents with psychiatric disorders not referred to the specialist. These results could contribute to assisting a successful implementation of the National Service Framework for Children/Adolescents.