Digital EEG pattern specific for Alzheimer disease has not studied yet.

Resting EEG (16 channels) was recorded by the use of “Brainscan” system in 150 persons: 50 healthy 20-55 year old volunteers, 50 healthy 55-75 year old volunteers, 50 patients with mild Alzheimer. Alpha rhythm frequency was checked after Furie's reversal transformation in periodmetric analysis for single “pure” alpha rhythm (8-13.5 Hz).

Significant distinction between a healthy subjects and Alzheimer patients has proved to be changed spatial - frequency alpha rhythm structure. High-frequency alpha rhythm is dominant in the occipital zone and low - in the frontal one of healthy subjects. Alzheimer patients show the opposite relationship. This phenomenon named the “inversion” can be revealed only by mean of digital EEG, visually - no, because the difference between frontal and occipital mean frequency may be less than 0.01 Hz.

The inversion discovered in 90% of Alzheimer patients, while among healthy persons of 20-55 years - in 2%, among healthy persons elder 55 - 7%.

CT investigation has not revealed any occipital or frontal lobe pathology. Therefore alpha inversion is stipulated by violations of thalamic rhythm generator's function. Inversion mean EEG quality decline and determined by disharmony between thalamic and anterior alpha generators.

For Alzheimer disease inversion may be considered as diagnostic sign revealing organic brain damage. Future studies should evaluate it's clinical usefulness in early differential diagnosis, disease staging and therapy monitoring.

Delusional disorder is characterized in current classifications by the development of one delusional thought or set of related delusional ideas that are usually permanent. Body dysmorphic disorder is sick preoccupation with appearance of the whole body or focused on particular areas of body, when the patient is convinced that there is a change of shape, structure or function.

We will present 36-year old patient who was sent to a psychiatry recommended by the otorinolaringology specialist, where he was treated three years for sore throat. The patient was very focused and concerned about the problems of the target organ.

Correct diagnosis is very important for choosing adequate therapy.

clinical interview, psychologic testing, EEG egzam.

He was treated with different combinations of drugs, but the combined therapy showed that the most effective were quetiapin, venlafaksin and valproat acid.

Individual access and knowledge of the pathophysiological background of patients with delusional body dysmorphic disorder is of great importance in choosing psycho pharmacotherapy.

5 subtypes of PNES emerged from the statistical analysis showing reproducibility of seizures in 61.54% of patients:

1. - brief crisis with automatisms and dystonia

2. - “pauci-kinetic”, sensitive crisis with preserved contact

3. - brief and brutal crisis with break contact and clonic jerks

4. - “major crisis” with extended axial spasms

5. - prolonged, fluctuating with hyperventilation preceded by prodrome.

The identification of a typology can move from a clinical based diagnosis to a real positive diagnosis. The reproducibility of the crisis allow to make common pathophysiological hypotheses. The history of psychological trauma query on a relationship between the management of neuro-psychological affects and PNES “dysfunction” of connections between the frontal lobe, the limbic system and the basal ganglia. Beyond the positive diagnosis, the fundamental and therapeutic perspectives are many.

Atypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy.

A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical, or non specified depression, and those without depression.

Seventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4%, and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate.

Differential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.

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.