When social anxiety and psychotic disorders occur in the same patient, they have mutual implications in both disease courses.

Social anxiety disorder is mainly characterized by the fear of embarrassment in social or performance situations, accompanied by the intense concern about other people's opinion.

Psychotic disorders are traditionally seen as being accompanied by affective blunting and deterioration of social skills.

The authors pretend to review different interactions between these disorders, by exploring several clinical scenarios where both disorders influence themselves in different ways.

The authors review reports and literature in the files of Pumed, Medline and others. They also consult psychiatry textbooks.

Many psychotic patients have other affective disturbances than that of affective blunting. Social anxiety is one of them; some studies point a prevalence of 25% in these patients.

But if in some patients social anxiety seems to act as a trigger of psychotic symptoms, acting as a persistent stressor, other patients have anxiety in interacting with others as a consequence of having a psychotic disorder and the fear of being noted as having a serious mental disorder affecting ones behaviour.

In a third scenario, social anxiety occurs as a product of a primary thought disorder (psychotic self-reference).

It is possible to identify therapeutic implications of these comorbidity, namely by the use of cognitive behaviour therapy.

Comorbidity between psychosis and social anxiety can occur in different ways, influencing the prognosis of both disorders. It also can challenge the knowledge about these disorders.

The aim of the hereby-presented multi research center studies is the description of how frequent sexual impairments touch the patients with affective disorders in diagnosis, as well as the assessment of illness’ and pharmacotherapy's influence on their occurrence. 207 patients aged 18-65 have been examined.

The research was based on a number of standardized questionnaires: The BSP Questionnaire (Pole's Sexuality Research), Female Sexual Functioning, Male Sexual Functioning, the Hamilton Rating Scale for Depression and the Young Mania Rating Scale. The above-mentioned questionnaires were then supplemented with data on patients’ social and economic status (education, professional activity) as well as a number of other health conditions that might influence the quality of sexual life (associated somatic diseases, drugs influencing the cycle of sexual responses). Additionally information was gathered on the course of illness itself, duration of episodes and types of pharmacological treatment.

The presence of sexual dysfunction in patients should encourage therapists to answer the question to what extent are they caused by the disease or antidepressant drug administrated. The issue of sexual dysfunction should play a greater role in the course of therapy. All patients in the course of the study were taking antidepressants. A significant difference between the percentage of patients reporting directly to their doctors the presence of sexual dysfunction and the results carried out on the basis of questionnaires should encourage therapists to direct questions about the presence of the disorder in this sphere of life.

As various studies show, women after mastectomy are accompanied by many problems in the sexual sphere; it considerably lowers their quality of life. Goal of the study is to describe the relationship between the illness as well as the treatment of choice and the sexuality of Polish patients. Another goal is a comparison of the study results with results obtained in similar studies in Europe.

The target group of 300 women after mastectomy is in the process of assessment. The subjects are recruited among Polish patients diagnosed and treated at the Department of Clinical Oncology, Cracow University Hospital in Cracow, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw and its branches in Katowice and Cracow.

The following questionnaires are used: Changes in Sexual Functioning Questionnaire (CSFQ – F – C), Body Image Questionnaire (KOC-BR), Sexual Interaction Inventory (SII), Quality of Life Questionnaire QLQ – BR23. Questionnaires were supplemented by questions related to socialeconomic status and oncology treatment.

The type of treatment has a major impact on patients’ health, including sexual health. During chemotherapy, hormonal therapy, changes in mood and appearance of patients are present, which has an impact on both self-image of women after mastectomy, as well as the relationship with their partners. Mastectomy patients feel less attractive, less likely to engage in sexual activities. They have ambivalent feelings about their body image and sexual attractiveness.

Mood and anxiety disorders are common in youth and are associated with reduced quality of life and high costs. Access to effective treatment is limited due to long waitlists, high costs and perceived social stigma. Given the high prevalence and treatment barriers, there is a need for brief, inexpensive and effective interventions.

Psychoeducational interventions are inexpensive, easily administered and more accessible than conventional interventions. There is some evidence that these are effective in treating or preventing mental disorders.

To compare knowledge acquired by participants via email or live psychoeducation groups, to measure symptom change and to compare effectiveness of each modality.

Psychoeducation (live or via email) in multifamily groups will be offered. Forty participants in each group will be enrolled. There will be six 40-minute sessions. Primary outcome measures are: change in parental knowledge about the child's disorder and level of expressed emotion in the parent-child relationship. Measures are Understanding of Mood Disorders Questionnaire and Expressed Emotion Adjective Checklist. To measure changes in symptoms the Children's Depression Inventory and Multidimensional Anxiety Scale for Children will be used. Questionnaires will be administered before, after and at 4 months.

Data entered in Excel format. ANOVA used to compare effectiveness of group versus email psychoeducation. Both methods equally effective in delivering psychoeducation.

Ontario has long waitlists for youth with mood and anxiety disorders. Psychoeducation is effective in increasing understanding of illness, improving symptoms and problem-solving skills of the family. Multifamily group versus email psychoeducation will facilitate access.

Multiculturalism has become a powerful force in Canada in recent years. Approximately 25% of physicians are International Medical Graduates (IMGs). In psychiatry, cultural variations affect the symptomatic manifestations of mental illness. Psychiatric trainees need to develop cultural competence since cultural knowledge is an important determinant of treatment outcome.

The Mental Health Commission of Canada in its Framework for Mental Health Strategy included addressing issues of race, ethnicity, national origin, citizenship, gender, creed, sexual orientation, class/socioeconomic status, age and disability. The Royal College Objectives for Psychiatry state ‘the resident must be able to address issues of gender, sexual orientation, age, culture, ethnicity, spirituality, and ethics in a professional manner.’

To teach residents components of cultural competency; to measure change in attitudes before and after the module; and to increase awareness of link of cultural competency to professionalism and communicator role.

The Queen's University Department of Psychiatry designed an innovative Cultural Competency Module for its residents. Queen's staff from Human Rights Office, International Center and Dept. of Psychiatry provided: a) a full day workshop on cultural self-awareness; b) modules on Sexual and Gender Diversity and c) Race/Ethnicity. Each section included didactics, case vignettes, small group discussions, and role plays of culturally sensitive interviews. Gain in knowledge and attitude change was measured by pre and post questionnaires. Residents also participated in an online version of the Intercultural Developmental Inventory to find out their group score.

Residents had shift in attitudes/knowledge of cultural competency after the module.

Blood was collected from patients diagnosed with chronic obstructive pulmonary disease and comorbid depressive symptoms (COPD+DS, (N=13), individuals with either COPD (N=16) or recurrent depressive disorder (rDD) alone (N=15) and from healthy controls (N=19). Levels of IL-2, IL-6, IL-8, IFN-g, TNF-a, IL-17 and GITR were detected with ELISA. Surface phenotype expression of T regulatory and T effector cells was analysed with a flow cytometery.

We observedthat COPD, depression and COPD with comorbid depression are associated with increased IL-6 levels when compared with healthy controls 42.2±1.87 pg/mL, 41.9±1.51 pg/mL, 41.7 ±1.31 and 34.7±1.36 pg/mL, respectively (p<0.05). Concentrations of IFN-g were significantly increased in COPD+DS patients when compared with controls (24.3±1.49 pg/mL and 17.8±0.70 pg/mL, respectively, p<0.05). IL-2 levels were highest in COPD+DS (3.20±0.389 pg/mL) and differed significantly when this group was compared with controls (2.30±0.176 pg/mL), p£0.05. GITR was significantly higher in COPD patients (0.332±0.04849) when compared with depressed (0.183±0.0492), when compared with COPD +depressive symptoms (0.194± 0.0357) and also when compared with controls (0.1601±0.0191), all p<0.05. We observed strong significant positive correlation between GITR and IL-2 and also between GITR and IFN-g in the study groups (p<0.001). Further, we checked the ratios of IL- 2/GITR and IFN-g /GITR. We observed significantly increased IL-2/GITR ratio in depressed groups (p<0.01). We also observed strong positive correlation between IL-2/GITR and Treg/Teffector (p<0.001).

In this study we identified GITR and IL-2 as putative inflammatory agents associated with depressive symptoms in COPD patients. Furthermore our study revealed that alterations of IL-2/GITR balance modulate immunological self-tolerance mediated by Treg cells. Our observations suggest that modulation of IL-2/GITR and its effects on T cell population(s)are putative immune pathways contributing to systemic inflammation in depression.

Stress exposure increases the risk for the development of depression, butonly in individuals combining a vulnerable genetic background with (repeated) stress exposure. However, it is currently unknown which (combination) of stressful life events is etiologically the most relevant for depressive symptoms. The mineralocorticoid receptor (MR) which is essential for optimal HPA axis functionality has been implicated in stress resilience.

To determine whether the effects of cumulative stress on subclinical depressive symptoms (Beck Depression Inventory) depend on MR haplotypes (rs5522 and rs2070951). Cumulative stress was operationalized childhood trauma, major life events, and daily hassles.

All three stress domains were independently and cumulatively associated with depressive symptoms. MR haplotypes significantly modified the effects of cumulative stress on depressive symptoms.

Cumulative exposure to stress is related to depressive symptoms, and our data implicate the existence of a multiple hit model in which independent but cumulative stress exposure leads to increased depressive symptoms. Importantly, MR haplotypes which are closely involved in HPA axis funtionality moderate the cumulative effects of stress on depressive symptoms. Together, these results provide more insight into the neurobiological background of stress resilience.

Infants are very sensitive and special attention is needed to take care of their physical and mental health. Some studies showed that massage by parents can improve infants’ sleep quality. The aim of this study was to compare the effect of massage with sunflower oil or sesame oil on infants’ crying and sleep times.

This triple-blinded clinical trial was conducted on 120 infants who were 10-15 days old, full-term, single, exclusively breastfed and with no history of hospitalization. The infants were assigned randomly into three groups of sunflower oil massage, sesame oil massage and massage with no oils. Mothers administered 15 minutes of massage to their infants twice per day (morning and afternoon) for 28 days. Times of crying and sleep were measured by a parents’ information form at baseline, and at the end of the first, second, third, and fourth weeks of the study. Data were analyzed using the repeated measures ANOVA.

Within four weeks of following, decreasing pattern of infants crying time was not significant (P=0.18); however, the mean of crying time between the three groups was significant (P=0.007). The interaction effect of crying time and groups was not significant (P=0.18). Increasing pattern of infant sleep time was statistically significant in the fourth weeks of the following (P<0.001); however, the mean of sleep time between three groups was not significant (P<0.56). The interaction effect of sleeping time and groups was not significant (P<0.10).

Since there were not statistical significant differences between the infants’ crying and sleep times between the three groups, and despite the fact that increasing pattern of infants sleep time is a normal pattern, it is not possible to have a proper conclusion.

Clinical polymorphism of schizophrenia, defined by Liddle in three classic psychopathological dimensions (psychotic symptoms, disorganization, negative symptoms) is based on factor analysis strategy and casts doubt on the idea of common nature of disease's classical symptoms within a single specific process. The search for biological determinants (endophenotypes, risk alleles) of psychopathological dimensions of schizophrenia represents an actual task, nevertheless the system of gene expression regulation (DNA methylation) is still underinvestigated in this aspect.

To explore the association between C677T polymorphism of MTHFR gene – the key enzyme for methionine synthesis – and psychopathological dimensions of schizophrenia in repetitive episode of illness relapse.

SAPS\SANS questionnaires were used for clinical assessment of patients, many years suffering from schizophrenia (mean illness duration 16,4±9,9 years); PCR genotyping strategy was used to identify allelic variants of MTHFR.

Mean score of dimension ‘disorganization’ was almost twice higher (18,26 vs.10,91, p<0,05) in group of T-allele carriers with lower enzymatic activity of MTHFR (mostly due to such symptoms as derailment, tangentiality, incoherence, circumstantiality, logorrhea, distractibility, also SANS sign ‘inappropriate affect’).

Genetically determined dysregulation of methylation patterns in brain can mediate specific biochemical and electrophysiological ‘shifts’ and result in specific abnormalities of thinking and behavior in schizophrenia. Neurocognitive and neurophysiological dysfunction underlying such linkage is under further investigation

Ketamine, a NMDA antagonist, replicates both cognitive and psychotic features of schizophrenia when administered to healthy volunteers. In this study, we aimed to test whether the administration of IV ketamine would replicate with cognitive and electrophysiological patterns that was observed in schizophrenia patients and schizotypal individuals.

44 healthy volunteers were randomised to receive IV infusion of ketamine or placebo. A 64 channel EEG kit was used to obtain eventrelated potentials in response to a working memory (WM) task. The two groups were compared in respect to their performance task as well as the amplitude of the P1 and P300 ERPs.

The psychiatric scales scores (BPRS, CADSS) were significantly increased in the ketamine group when compared to saline. While there was no difference in terms of reaction times to the task, accuracy in the ketamine group worsened significantly with increase in working memory load than in controls. Ketamine significantly increased the P1 but lead to a decrease in P300.

In this study acute NMDA antagonism induced a WM deficit that was associated with visual processing and memory abnormalities. Specifically, ketamine increased the amplitude of the P1 potential and reduced the P300 amplitude. In addition P1 but not P300 predicted performance on the WM task. These effects could be mediated ketamine-induced acute glutamate release in the visual cortex, enhancing neuronal responses to visual stimuli and increasing the signal-to-noise ratio which in turn disrupted higher order cognitive function.

New psychopharmacology provides a better tolerability profile and drug adherence, which should be accompanied by lower relapse rate, incomings and improvement in psychosocial functioning of patients.

1. To describe sociodemographic, clinical and psychometric properties of a sample of psychotic patients admitted to the Acute Unit. 2. Assessing the functionality of psychotic patients requiring hospitalization.

Sample:patients admitted to the Psychiatric Hospital Unit of the Hospital San Juan de Alicante (August 1 to 31, 2013), with admission diagnosis of psychotic decompensation (F20). Register of sociodemographic and clinical dates, PANSS, CGI and PSP. Statistical analysis using SPSS.

N=19. 94%=male, 84.2%=single, 68.4%=family support.37%=schizophrenia, 52.7%=brief reactive psychosis, 10.5%=schizophreniform disorder. 9.7% first psychotic episodes. 52.6%=toxic consumption. Mean scores:PSP = 50.89, CGI= 4.42, PANSS=89.89. Significant relationship between the support and PSP(35=not, 53=yes, p<0.015). Direct relationship between PANSS and CGI (p< 0.0001, 0.89R).

Although toxics, poor adherence or the long course of the disease are associated with unfavorable scores on scales of function and psychopathology, our results donnot meet it. We attribute the negative results to low sample size and heterogeneity of the group of patients included in the study. Maybe factors such as family support, employment and intellectual level have a greater role. We consider it appropriate to continue the study in the future, standardizing clinical groups and expanding the sample size in order to obtain results with greater statistical significance.

Highlighting of clinical features of depressive disorder in women hospitalized in the Clinic of Psychiatry of Craiova and identification of risk factors for unfavorable outcome in short term hospital treatment.

Evolution of depression in women is unfavorable with a high rate of recurrence, associated with presence of somatic comorbidities.

Retrospective study on hospitalized female patients with depression in Psychiatric Clinic of Craiova (1 January 2005 – 31 December 2009) on the following categories: social-demographic, clinical, indicators of treatment, therapeutic response and evolution of depressive disorder.

From a total of 2463 patients hospitalized with depression, 60% were women. Socio-demographic analysis highlighted the highest frequency of depression in 40-49 years age-group (53.0%), medium educational level (66.9%), unemployed (28%), and married (66.5%), with a low (55.0%) economic level. Clinical analysis showed presence of psycho-trauma in childhood (92.2%), positive family history for depression (75.8%) and female specific psychiatric history. The antidepressants often used were the SNRIs (47.8%), followed by SSRIs (27.4%). Complete remission (?? ?-17<7) was present in 16.4%, while the decrease of GAFS (social functioning) and MMSE (cognitive impairment) scores is a significant indicator for prediction of unfavorable evolution (p<0.001).

Significantly associated factors with unfavorable short-term evolution were: positive family history for psychiatric disorders, incomplete remission, ages between 40 and 49 years (p<0.001), presence of psychotrauma in childhood (p<0.001), psychiatric history specific to women (p<0.001), SNRIs therapy (p<0.001), SSRIs and SNRIs associations (p<0.001).

Studies have shown higher rate of various psychiatric disorders among individuals with substance abuse / dependence. There is little data in developing countries, such as Pakistan, on prevalence of psychiatric co-morbidity in this population and impact on treatment.

To assess the psychiatric co-morbidity among individuals with substance dependence and to determine its demographic associations in patients with substance dependence in Pakistan.

This was a descriptive study conducted at a tertiary care hospital in Pakistan. Participants were 588 individuals with substance dependence admitted to a tertiary care hospital in Pakistan, mainly in male inpatient substance dependence unit. The patients were assessed for psychiatric co-morbidity using DSM IV criteria. Informed consent was obtained. The study was approved by the Institutional Research Committee. The results were obtained by using chi square test on SPSS 17.

Out of 588, 200 patients (34%) were found co-morbid with other psychiatric disorders along with substance dependence. Reason of first substance use and history of previous substance dependence were observed to be significantly associated with co-morbid psychiatric disorders, x2 (48, n = 549) = 112.396, p < 0.01 and x2 (18, n = 588) = 29.66, p = 0.041 respectively.

1. 1. There was high rate of psychiatric co-morbidity among individuals with substance dependence in this sample.

2. 2. Depression, personality disorders and anxiety disorders were the major co-morbid diagnosis among this population.

Childhood obesity has reached epidemic proportions: Some 4.7 million youths between 6 and 17 years of age are overweight or obese. The number of over-weight youths (11%) has more than doubled over the past 30 years. Obesity has links with disease such as diabetes, heart disease, sleep disorders and some forms of cancers. Developing and maintaining a healthy lifestyle are essential for the prevention of obesity.

In a cross sectional study we aimed to investigate and compare the attitudes towards healthy eating and obesity in adolescent students in Pakistan and the UK. The sample size for this study consisted of 618 students in total. A self administered anonymised questionnaire was given to the students and they were to answer questions regarding eating and exercise.

A Total of 151 students were recruited from the UK, while 467 students were recruited from schools in Pakistan. 5.4% of the students in the UK and 2.6% students in Pakistan were obese. The reasons for students' different eating habits varied between both countries; in the UK an increase in eating was linked to stress while in Pakistan it was linked to cravings. In both the UK and in Pakistan, a high percentage of students took part in physical activity, 80% and 81.8% respectively. There were some similarities in eating habits, with similar numbers of students refraining from eating unhealthy foods in both the countries.

We found significant differences in BMI and reasons for overeating when comparing students in Pakistan and the UK. These findings have implications for designing interventions