Psychosocial treatments, broadly defined, refer to the use of human interactions for therapeutic purposes. Psychosocial treatments, in conjunction with pharmacotherapy, are increasingly utilized in treating schizophrenia. Reference is made to recent literature and research, showing that - although a number of current psychosocial treatment approaches address motivation to varying degrees, treating motivation as a primary target is needed to maximize functional outcomes in schizophrenia.

The paper describes a group-based intervention designed for persons with schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing psychosocial treatment in an outpatient setting in Moscow Research Institute of Psychiatry. The intervention is designed to enhance motivation to change maladaptive patterns of behavior, and to facilitate engagement in psychosocial treatments.

Individuals diagnosed with schizophrenia were recruited as they entered outpatient psychosocial rehabilitation programs. Patients completed interview-based measures of motivation. The conductor's work is, in first instance, to turn the group into an effective therapeutic tool.

Inclusion and exclusion criteria of patients, therapeutic team, setting, methodology, techniques, strategies and therapeutic factors - will be presented. We will discuss the modification of motivational enhancement techniques needed at different points in the treatment\rehabilitation process and the evidence for effectiveness.

Potential psychosocial treatment implications are suggested, especially those that emphasize motivational enhancement. Implications for the theoretical understanding and psychosocial treatment of intrinsic motivation in schizophrenia are outlined.

In bipolar disorder affective status is significantly associated with subjective well-being. That relationship is particular significant for depressive symptoms.

The purpose of the present study was to analyze whether it is appropriate the use of the Subjective Well-being under Neuroleptic Scale (SWN-K) among patients with bipolar disorder.

50 outpatients with bipolar disorder were recruited. Subjective well-being was evaluated using the SWN-K. Current symptomology was rated using the Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS).

In our sample, there is a strong inversely correlation (/r/ > 0.7. p <0.01) between the score on the HAM-D and the total score on the SWN-K. HAM-D and SWK are linearly related and that relationship is inverse, this strong inversely correlation is maintained between each subscales of the SWN-K and the HAM-D.

There is a modest direct correlation (0, 30≤ r ≤0, 70. p<0.01) between the total score on the YMRS with the total score on the SWN-K. Both variables are linearly related and this relationship direct. In each subscale of the SWN-K is detected this relationship with the YMRS.

According to previous studies, our results suggest that affective status is associated with subjective well-being in bipolar patients and this relationship is particular significant for depressive symptom. In contrast to previous studies, we found a modest but direct correlation between YMRS score and SWN-K. Further investigations are necessary in patients with acute mania in order to determine whether SWN-K is a good tool for it.

The psychological modulation of stress-related disorders, such as gastrointestinal complications, is a well-established phenomenon in psychoneuroimmunology. Recent studies of stress have highlighted the effects of chronic psychological and environmental stressors to health and well-being, but the evidence is still minimal.

This study analyzes health outcomes in a clinical case modulated by exposure to psychosocial stressors, focusing on gastrointestinal function, but also evaluating how those stressors are related to anxiety, depression and hypochondria.

A single case study was conducted for a 66 years-old woman diagnosed with gastric carcinoma. In addition, stressful life events and social support were registered.

Characteristics of stressors, such as intensity and chronicity, and type A personality were associated with increase gastrointestinal complications.

Results of this study point out the role of perceived stress in health outcomes.

Bipolar affective disorder in the elderly is a complex entity not only in its clinical dimension but also in its therapeutic management. Elderly patients are very sensitive to pharmacological secondary effects.

The objective of this study is to longitudinally analyze the pharmacological route of a sample of outpatients above 65 years old.

Review of clinical histories and data collection from a sample of 12 patients over 65 years old.

Most of the patients experienced at least three drugs prior to their current treatment. The fundamental reason for changes were intolerable adverse effects and, in one of them, irreversible (kidney failure). The trend is to replace drugs by atypical antipsychotic or antiepileptic ones. The prescription of gabapentin is not based on scientific evidence but with a positive response. The available literature is still limited to justify these decisions based on clinical experience, somatic background and tolerance of the patient.

Traumatic experiences are a decisive factor for the manifestation of dissociative symptoms and, in turn, dissociative symptoms are often part of severe psychopathology.

Given the lack of research in Portugal examining dissociation and trauma in patients with Schizophrenia and Bipolar Disorders, we intended to determine if these patients dissociate and what kind of traumatic experiences they had, to analyze associations between dissociation and trauma, and check if there are differences by gender and formal education.

We assessed, through Dissociative Experiences Scale and Traumatic Experiences Checklist, 30 patients (M ± SD age = 42.6 ± 12.38; range 20-65 years) with Schizophrenia (n = 22) and Bipolar Disorder (n = 8) from a Residence for mentally ill (Mini International Neuropsychiatric Interview confirmed diagnoses).

Twelve patients (40%) revealed pathological dissociation (M ± SD = 33.52 ± 17.74), scoring highest in DES absorption factor, and had more traumatic experiences between 7-12 years of age. Dissociation correlated moderately with traumatic experiences (?? = 0.40). Significantly, women had more dissociation and traumatic experiences (M ± SD = 34.55 ± 18.60; 2.14 ± 2.53) than men (M ± SD = 27.55 ± 16.48; 1.51 ± 1.91). There were no significant differences by education.

Many schizophrenic and bipolar Portuguese patients dissociate and had traumatic experiences in childhood, which is supported by the literature, but is necessary to replicate with bigger samples, and compare the two disorders to draw more conclusive interpretations. Nevertheless, therapeutic interventions should consider these aspects.

Adolescence is a critical period for dissociation, until more effective coping strategies are developed. Dissociate in a chronic manner is likely to interfere with the construction of a cohesive sense of self, and may potentiate later psychopathology. Adolescent Dissociative Experiences Scale/A-DES is yet to be studied in Portugal.

Analyze the psychometric properties of the A-DES 11-item format; compare between nonclinical with psychological disturbed adolescents/PDA; and determine the variables that associate with A-DES.

A sample of nonclinical (n = 69) and PDA (n = 45) aged between 11 to 18 years, 55.3% boys and 44.7% girls, education mean years 8.96 (SD = 2.74), completed the A-DES and the Youth Self Report/YSR.

The A-DES had a very good internal consistency (α = 0.94), presenting significant large correlations with YSR (r = 0.67). Confirmatory factor analysis suggested a 1-factor structure.

The mean scores (2.78 ± 1.82) were equivalent to other countries, and significantly discriminated (t = 6.02; p < 0.001; Cohen's d = 1.12) between the nonclinical (M = 2.06 ± 1.41) and PDA (M = 3.89 ± 1.84).

There were no differences between the sexes, but the younger, less educated, and institutionalized had more dissociative experiences (r = 0.21 to 0.30). Hierarchical multiple regression revealed that only YSR was statistically significant in predicting levels of A-DES (Beta = 0.64; p < 0.001).

The Portuguese A-DES version seems a valid and reliable screening for dissociation amongst adolescents.

The liaison psychiatrist often attends Bipolar disorder (BD) patients when they are admitted to a general hospital. There is little research and literature about special needs of these patients. It is important a detail examination of characteristic of the consultations carried out by liaison psychiatrist.

Analyse the demand for mental health liaison consultation for people diagnosed of Bipolar Disorder (BD).

Evaluation of clinical data obtained from the consultations attended to patients diagnosed of BD by a liaison psychiatry service from 2010 to 2012 in a general hospital.

The number of consultations attended was 824. 34 of them (4,12%) were patients diagnosed of a BD. Their mean age was 61,26 (DE 12,93). All the patients attended had previous psychiatric history. The 65% of them were receiving outpatient psychiatric treatment at admission. The departments that most frequently requested consultation were internal medicine with 26, 47% of the total ; Neurology and Surgery both with 14,7%; Traumatology, Digestive, Cardiology and intensive care with 8,82% each of them. A pharmacological intervention was carried out in 44% of cases while only 5,88% of patients required both pharmacological and psychotherapeutic interventions. In 50% of the requests an evaluation was the intervention.

We found a low percentage of demand of attention in patients with BP. This data are similar to studies. We should consider the possibility of inappropriate consultations among data analyzed. This might be related to lack of information for the management of people with BD in other specialties.

For our investigation we observed 167 patients with paranoid schizophrenia according to the criteria of ICD 10.

All patients received atypical antipsychotics. Patients were randomized into 3 groups. Patients of 1st group (n=52) received sertindole monotherapy 16–20 mg per day, patients of 2nd group (n=67) received paliperidone 9–12 mg per day and fluvoxamine in combination with zuclopenthixole depot 150–200 mg per day. Fluvoxamine was chosen because of its potential impact on sigma receptors.

the results of the study indicate the significance of differences of dynamics of neurocognitive deficit in schizophrenia and the importance of choice of biological therapy for correction of neurocognitive deficit in patients with schizophrenia. Also the study showed the possibility of correction of components of neurocognitive deficit in schizophrenia patients which was confirmed by objective psychological tests. The use of modern atypical antipsychotics and drugs which can influence on sigma-receptors can restore the social functioning in young patients with schizophrenia.

Chronically depressed patients show considerably impaired interpersonal features, which could be explained by a reduced Theory of Mind (ToM) ability.

The aim of this study was to examine whether chronically depressed patients are impaired in their ToM performance compared to a healthy control group in three different components of ToM: the social cognitive and social perceptual component as well as the ability to take someone else's visual perspective.

32 chronically depressed patients (DSM-IV) were compared to 32 matched healthy controls. ToM abilities were assessed by a cartoon picture story test (CT), the ‘Perspective task’ (PT) and the ‘Reading the mind in the Eyes’ test (RMET). In addition, information about depression severity, childhood trauma and executive functioning (working and logical memory) was assessed for both groups.

Patients mentalized significantly less frequently than healthy controls in the CT (Mann-Whitney-U=340,50, p<0,05). Furthermore, the CT was significantly correlated with the RMET (patients: r=0,46, p<0,05; controls: r=0,57, p<0,01). We didn’t find any significant difference between both groups in the RMET (p>0,05). In the PT, patients showed significantly lower scores than controls (t(35,68)=2,10, p<0,05). There wasn’t any significant correlation between the three ToM tests and severity of depression, duration of illness or childhood trauma (p>0,05).

Our results suggest that chronically depressed patients show deficits in their social cognitive ToM ability compared to controls, whereas their social perceptual ToM ability seems to be unimpaired. As to the capacity to take someone else's perspective, our results suggest that chronically depressed patients present significant deficits.

An early symptomatic response has been related with an early improvement in functionality, quality of life and subjective well-being.

The short version of the Social Functioning Scale (SFS) has been validated to get round the difficulty of lack of time in our clinical practice.

Evaluate functionality with SFS in a sample of schizophrenic outpatients treated with long-acting injectable antipsychotics.

20 outpatients with schizophrenia according to ICD-10 criteria. These patients were in treatment with long-term antipsychotic monotherapy during the past three months. Two treatment groups were established: paliperidone palmitate treatment group and another with the other long-acting injectable antipsychotics marketed in our country (constant release risperidone, olanzapine pamoate, zuclopenthixol, fluphenazine decanoate).

The severity of the disease was assesed by the CGI-S and function was assessed using the SFS. Antipsychotic medication was computed in equivalent mg of chlorpromazine (CPZe). Socio-demographic data were also collected.

Mean scores of SFS were: 25.91(SD 5.66) in paliperidone palmitate group and 27 (SD 6.78) in the other antipsycotics group. Mean score of CGIS were: 3.91 (SD 0.94) in paliperidone palmitate group and 3.33 (SD 1.41) in the other antipsycotics group. Mean score of CPZe was: 427.1 (SD 102,54) in paliperidone palmitate group and 580,59 (SD 332,54) in the other antipsycotics group.

We don’t find significant differences between the two groups. It should be noted observational design prevent us from make relevant inferences. It is likely that with a larger sample size these data can be modified.

Nicotine dependence is significantly more prevalent in patients with mental illness, e.g. 60% in affective and 60%–90% in schizophrenia spectrum disorders, than in the general population (about 30%). Smoking not only causes physical diseases and increases mortality, but also negatively affects psychiatric disorders.

To evaluate the acceptance, practicability and efficacy of a programme to help psychiatric patients quit or reduce smoking and to characterise smoking psychiatric inpatients.

‘The smokers’ group’ is a voluntary, manualised, behaviour therapy group programme adapted to the special needs of psychiatric inpatients. It consists of six 75-minute open-group sessions. We recorded the smoking status of all psychiatric patients and evaluated the programme with standardised questionnaires.

In July 2012, 49.2% (116/236) of inpatients were active smokers (55% of men, 45% of women). From July 2012 to December 2013, 113 patients (56% women, 44% men; mean age 46 years) participated in ≥1 programme sessions. Median duration of smoking was 21 years and mean physical dependence was severe (5 on the FTND). Of those who completed ≥3 sessions, 23% (n = 26) roughly halved their cigarette consumption (from 22 to 10 cigarettes/d). Thirty-six (31%) stopped smoking, 30 with nicotine replacement. Eleven patients were abstinent after the programme, as verified by expired carbon monoxide.

Although smoking cessation is often difficult for psychiatric inpatients, they showed interest in the programme. about a third reduced or even stopped smoking. Adherence (high drop-out rate due to discharge and completely voluntary participation) and long-term followup require further attention.

World tendency towards overall age increase of the population leads to increase of elderly people among patients. Delirium (confusional state) is common in geriatric inpatients in general hospital. It is one of the most significant syndromes of cognitive dysfunction in people of senior age. The presence of delirium increases the duration of hospital stay, morbidity and mortality.

To evaluate the prevalence of delirium amongst inpatients of senior age in different departments of general hospital.

We have studied a total of 247 randomly selected inpatients. Of these, there were 113 patients in the Traumatology Department and 134 in the Neurology Department. Delirium was diagnosed based on the criteria of ICD-10. We used the Mini-mental state examination (MMSE) scale as a metric of the degree of the disorder of cognitive functions.

60 patients (24,3%) of the studied population were found to be delirious. There were 26,5% of delirious patients in the Traumatology Department and 22,4% in the Neurology Department. and the maximum prevalence of delirium was in the range of 81–85 years (39%).

We present statistically significant results showing unequal prevalence of delirium amongst elderly inpatients of the two biggest departments of the general hospital. The large amount of delirious patients forces of medical professionals to pay more attention on psychiatric condition of patients.

Pain is a frequent reason for psychiatric consultation. It is a symptom that is often associated with other mental disorders. It can have a significant impact on the quality of life of the patient. Yet pain is a complaint often underestimated by the clinician. It is considered inherent to mental illness and so poorly supported.

Studying the relationship between mental illness and pain and include means to support this co morbidity.

This is a cross-sectional and descriptive study on a population of 50 consultants who suffer from chronic pain. The evaluation consists of a questionnary on the characteristics of the pain, psychiatric illness and modality of care.

Among the patients studied, 80% were female. The mean age was 47.33 years. Predominant type of pain was headache in 78 % of cases, followed by stomach pains and diffuse arthralgia. The impact on daily life was average for most patients. Radiological exploration was performed in 35% (without abnormalities in 100% of cases). Depressive disorders were present in 60 % of cases. The most prescribed analgesics was Tier 1 (paracetamol) with a positive trend in 65 % of cases.

The pain, especially headaches are a common complaint in psychiatry. Their association with depression is classic. But it can also accompany other mental illnesses and worsen their prognosis. A better understanding of causality of pain and its management is essential to improve the quality of life of patients.

Sleep is a basic physiological need for the health and well being. Aging brings many changes in sleep holding the advance in age, multiple comorbidities and changes in lifestyle.

Describe the quantity and quality of sleep in the elderly.

Prospective and descriptive study involving 40 people aged over 65. The sleep evaluation was done over a period of four weeks with a sleep diary (daily self-assessment tool of sleep and wakefulness).

In our study, we found an average of hours of sleep in elderly subjects 8 to 9 hours per day. The sleep time was in 60% of cases before 10 pm and the wake-up time was in 52% cases at or before 6 am. The sleep latency did not exceed 30 min in 68% of cases. Sixty pourcent subjects have had nocturnal awakening for more than an hour. Sleep quality was considered poor by 55% of sujets and disturbance was attributed significantly to somatic diseases.

Sleep disorders in the elderly are common. The effective treatment must take account of psychological, psychosocial and somatic factors specific to age.