Illness management group programmes providing information and coping strategies for clients and their relatives have gained importance in Europe.

At the Department for Psychiatry and Psychotherapy LMU Munich three cognitive-psychoeducational treatment programmes in schizophrenia, bipolar disorder and major depression were implemented and evaluated. Randomised controlled trials with two year follow-up were to evaluate programmes in schizophrenia and in major depression.

196 clients with schizophrenia were randomised to Coping-Oriented Cognitive Therapy (COP) or Supportive Therapy (SUP). Psychopathological Symptoms (BPRS-E), Psychosocial Functioing (GAF), Knowledge about Psychosis and its treatment, Illnesss concepts, and Cognitive Functioning were assessed.

Participants in COP showed higher gains in knowledge compared to SUP from pre- to post-treatment. At two year follow-up there were no significant differerences between the groups in relapse rates, however compared to other studies the rates were promising.

Cognitive therapy gains importance in treating inpatients with depression, however, there are only few controlled studies available.

119 inpatients with major depression were assigned to cognitive-psychoeducational therapy (CPT) or supportive therapy (SUP).

A comprehensive battery for cognitive, psychopathological and psychosocial variables was asessed

Clients in CPT had a significant lower relapse rate compared to SUP.

Recently contolled studies (e.g. Schramm et al. 2007) showed the superiority of combining pharmacotherapy and psychotherapy in major depression. The high drop-out rate in our sample has to be acknowledged and to be discussed.

Recent studies suggest that depression is associated with somatic pain. Despite growing research interest in the topic, the effects of depression-related somatic pain remain unclear. The present study sought to investigate the relationships between depression-related somatic pain, treatment satisfaction, and functions of daily living, and to compare them with the relationships between these factors and mental health measures.

We administered an Internet-based survey to 663 patients with depression in Japan, including questions about pain symptoms, mental health, functions of daily living, and dissatisfaction with depression treatment. The SF-8 questionnaire was used to assess functions of daily living. We conducted a multiple linear regression analysis to examine the associations between depression-related somatic pain, functions of daily living and treatment satisfaction, and between mental health measures, somatic pain and functions of daily living.

An increase per unit in the number of pain symptoms was associated with a 1.04-unit decrease in physical functioning score (P < 0.001), a 0.67-unit decrease in the role functioning-physical score (P < 0.001), and a 0.53-unit decrease in role functioning-emotional score (P = 0.0010). Meanwhile, we found no significant association between the number of pain symptoms and patients’ satisfaction with treatment, and no significant association between the number of pain symptoms and social functioning.

These results suggest that even when patients report satisfaction with their treatment, they may be suffering from reduced physical functioning and role functioning. These impairments may escape clinical recognition when clinicians or patients fail to discuss pain symptoms.

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1. - To measure the insight of a clinical population of schizophrenics.

2. - To specify factors correlated with a great insight.

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1. - A cross-sectional study on 30 schizophrenic male followed in the Department of Psychiatry B, Hedi Cheker hospital in Sfax, Tunisia.

2. - For each patient:

We collected the demographic and clinical data and we used the following scales:

1. * The Insight Scale (IS) for the measurement of ‘insight.

2. * Positive and negative syndrome scale (PANSS) to assess the severity of symptoms.

3. * The Drug Attitude Inventory (DAI-10) to assess the assumption relating to drugs.

4. * The Calgary Depression Scale for Schizophrenia (CDSS) to assess depression.

5. * The Satisfaction With Life Scale (SWLS) to determine the degree of life satisfaction.

The average age of the group was 40,08 years. Fifteen patients had a primary school and 68% were unemployed. Socioeconomic level was low in 80% of cases. Paranoid schizophrenia was the predominant type (56%). The average duration of hospitalization was 7.28 weeks. Twenty patients consulted regularly after their first hospitalization. The insight was poor in half of cases. Twenty-six patients had a positive subjective response to treatment. The majority of subjects had no depression (84%). Eleven subjects were satisfied with their life.

The great insight was correlated with positive subjective response to treatment (p = 0.023).

The great insight was associated with better drug compliance, with a limited number of relapses and a favorable disease progression. However, it was also associated with poor life satisfaction.

Ear acupuncture based on the NADA-Protocol combines the use of five standardized ear points in an open group setting. The NADA-Protocol has shown some positive effects in patients with different psychiatric diseases. To assess the practicality and effectiveness of NADA ear acupuncture we conducted a prospective observational trial on a psychosomatic ward.

During the 6 months investigation period the CGI, SCL-90R, SF-36 and ‘Cohen’s Perceived Stress Scale’ (PSS) were applied at baseline, every six weeks before and every four weeks after introduction of the NADA-Protocoll. The current level of ‘stress’, ‘sensation of pain’, ‘agitation’ and ‘fatigue’ were assessed using visual analog scales (VAS). We applied regression models with NADA group intervention and time or their interaction as factors.

We included a total of 31 patients, (22 females (71%); mean age 42,6 years), mainly diagnosed with a Major Depressive Episode. We found an increase in SF-36 total scores in linear regression (p = 0.04, t = 2.17). The VAS scores for’stress’ (before 4,1 (SD 3,2); after 2,5 (SD 2,3); linear regression p < 0.0001), and’agitation’ (before 4,6 (SD 3,2); after 3,0 (SD 2,5); linear regression p < 0.0001) dropped significantly. In all models the intervention, the time and their interaction were significant factors.

The NADA-Protocol seemed to have some impact on increase in overall health-related quality of life and ‘stress’ and ‘agitation’ levels. As for now the NADA-Protocol appears to be a useful additional treatment option in the context of patients on a psychosomatic ward.

The aim of the study was level of anxiety, depression and alexithymia in patients with rheumatoid arthritis (RA).

Alexithymia is defined as the difficulty in verbal expression of feelings. Alexithymia is more common seen in patients with chronic and temporary health problems.

One hundred forty eight patients with rheumatoid arthritis and a hundred healthy subject were included into the study. The level of alexithymia was assessed with Toronto Alexithymia Scale- 20 (TAS-20). Depression and anxiety disorders severity and quality of life (QoL) were assessed Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Assessment- Brief (WHOQoL-BREF), respectively.

TAS-20 scores in patients group was higher than control group. The patients with rheumatoid arthritis had significantly poorer scores in all domains of WHOQoL-BREF (p<0.001). BDI and BAI scores were greater than control group. There was no significant difference between patients with or without alexithymia in terms of sociodemographic features, treatment and scales scores.

The results of this study suggest that alexithymia is more common in patients with RA. Treatment of alexithymia may improve QoL, depressive and anxiety symptoms.

We investigated whether the personality factors measured in individuals with irritable bowel syndrome (IBS) symptoms differ from healthy participants, taking into account the subgroups of IBS (IBS-diarrhea, IBS-constipation, IBS-mixed and IBS-undetermined).

A cross-sectional survey of 4763 participants was carried out in Isfahan University of medical sciences. They were asked to fill two questionnaires: A validated questionnaire which fulfilled Rome III criteria for IBS considering their sociodemographic and lifestyle data as well, and the NEO-FFI questionnaire. Data was processed and analyzed using SPSS, Student's t-test for quantitative variables and Chi-squared statistic test for qualitative variables. Prevalence of each IBS subgroups was also assessed according to predominant stool pattern.

There were significant differences between IBS and non-IBS group in all dimension except openness(p<0.01). The mean score of neuroticism was significantly lower in non-IBS group but they showed a significantly higher level of extraversion, agreeableness and conscientiousness. Mean score of all dimensions was reported to be higher in female patients except extraversion (p<0.01).

The results indicate that the personality dimensions in irritable bowel syndrome differ from non-IBS group.

Paraphilias are rarely diagnosed in the clinical setting, although the estimated highest possible lifetime prevalence is approximately 12% for males and 4% for females. There are various presentations, including transvestism and fetishism. In this regard we present a case report of a 41 year old patient with a clinical picture compatible with Transvestism and Fetishism, whose clinical diagnosis was clinched years later.

The objective of this paper is to describe a case report whose diagnosis is compatible with transvestism and fetishism.

Understanding the clinical features of this pathology, regarding a diagnostic and therapeutic improvement.

Case report and bibliographic research on Pubmed e Medscape

Travestism and Fetishism is often under-diagnosed and occurs almost exclusively in heterosexual men and can cause significant distress. Therefore, it is crucial to clinch an early diagnosis in order to start an appropriate treatment.

Neurosteroid dehydroepiandrosterone (DHEA) has been associated to various functions in the central nervous system, including modulation of memory and behavior. It has been suggested that the effects of DHEA are mediated through several neurotransmitter systems; however its mechanisms of action are not fully understood. This study aimed to investigate the behavioral profile of DHEA in the forced swim test (FST), and also its impact on locomotor activity.

FST was performed in a glass cylinder, 45 cm high, 20 cm diameter filled with water up to a height of 30 cm. On the first day, male Wistar rats were forced to swim for 15 min. Rats were re-exposed to the FST for a single 5 min session, after the acute and chronic challenge with saline or DHEA. The measurement of locomotor activity was performed in a clear Plexiglas box (40×25×35 cm) for 30 min without any habituation period. The data were analyzed by one-way ANOVA, followed by Dunnett's test.

In FST, ANOVA indicated statistically significant effects of DHEA. Dunnett's analysis showed that DHEA significantly decreased the duration of immobility at the dose of 10 mg/kg, exerting acute, but also chronic antidepressant-like effects. However, DHEA did not induce significant differences in time of struggling behavior. ANOVA did not show a significant effect of treatment on locomotor activity.

These data experimentally support the findings that under certain circumstances, DHEA might have triggered the antidepressantlike effects in rats. Furthermore, these effects were not confounded by change in motor function.

Schizoaffective disorder is a poorly understood disease. In order to better understand it, we have to look at its history. Kraeplin believed that most psychoses could be divided into Dementia praecox and manic-depressive insanity, however this dualistic division was strongly contested and several descriptions of atypical psychoses appeared. In 1933, Kasanin proposed for the first time the term schizoaffective psychosis as a variant of schizophrenia. Since then, and up until 1979, 23 definitions of schizoaffective disorder have been counted. Sometimes different disorders have been called by the same name and similar disorders have different nosological names.

To describe the concepts of schizoaffective disorder, focusing on its historical aspects and the evolution of its diagnostic criteria.

To understand schizoaffective disorder by projecting its nosological position in the future.

We conducted a literature review using textbooks and PubMed.

Schizoaffective disorder is one of the most confusing and controversial concepts of psychiatric nosological entities.

After more than 80 years since its first definition, the term schizoaffective remains poorly defined. Indeed, there are studies that do not support the theory that schizoaffective disorder is a separate and distinct mental illness. Thus, the description, characterization, and understanding of this nosological entity continue to be a challenge in the field of mental health.

to investigate FC in RSNs in TLE patients with ADS.

54 patients with TLE from 18-50 y.o.were included. ADS were assesed by psychiatric interview with use of scales:BDI, HADS, HAMA, MADRS. All subjects underwent 9-min resting-state fMRI session.

SPM8,’GIFT’ toolbox ICA for isolate RSNs; for comparison - one-way ANOVA and two-sample t-test.( p< 0.005,10-voxel clustersize)

In groups of patients with ADS (n=36) a moderate level of depressive and anxiety symptoms (HAMA=25,4±2,6; MADRS=20,1±2,6) was found. There are 8 RSNs were identified: visual, FC audial, sensomotor, frontotemporal dorsal and ventral, frontoparietal right and left, default mode(e.g.DMN) networks. The main interest was focused on FC in key nodes of DMN as they are involved in emotional processing and may play a significant role in the origin of affective symptoms. Significantly increased FC was identified in the left insula, superior parietal cortex, left frontal cortex, right precuneus, right parahippocampal gyrus, right frontal cortex in patients with ADS. Increased FC in these nodes of neuronal networks can be explained as by the presence of affective symptoms in this group so as an their association with epileptic processes.

significant advances in imaging represent an opportunity to investigate psychopathological features, where TLE can be considered as a good model for investiagion other mental disorders.

Buprénorphine haut dosage (Subutex) est le médicament le plus couramment utilisé dans le traitement de médicament de substitution. Mais cette molécule est également bien connu pour son usage détourné ou abusif. Depuis la révolution tunisienne, le trafic de plusieurs médicaments a été une montée très dangereux.

Pour étudier la prévalence de la dépendance à la buprénorphine haute dose en consultation psychiatrique en 2010 (avant la révolution tunisienne) et 2012 (après la révolution).

Comparer les caractéristiques cliniques du patient accro à la buprénorphine haut dosage avant et après la révolution tunisienne.

Une étude rétrospective, descriptive et comparative a été effectuée sur les fichiers de patients qui ont consulté le service de consultation externe de l’hôpital Razi à Tunis depuis deux ans: 2010 et 2012 dont diagnostic était la dépendance à la buprénorphine haut dosage.

34 patients dépendants à la buprénorphine haute dose ont été recrutés: six patients en 2010 et 28 patients en 2012. Tous étaient des hommes. L’âge moyen était de 31,83 années en 2010 et 32,13 années en 2012. 44,11% de l’ensemble de la population de l’étude a développé une symptomatologie dépressive: quatre patients en 2010 et 11 patients en 2012.

Les groupes d’âge, la période de chômage et le montant des benzodiazépines consommées ont été corrélés avec l’année de consommation.

Ces résultats confirment l’impact de la révolution tunisienne sur la prévalence et le profil de dépendance à la buprénorphine haute dose dans notre pays. D’où la nécessité de mesures générales de gestion de ces toxicomanes est imposée.

Light-to-moderate alcohol consumption is associated with a reduced risk of overall dementia; however, moderate-to-heavy alcohol consumption is a risk factor for the development of dementia prior to age 65. Here we describe a case report of a 51-year-old man whose clinical presentation is consistent with dementia related to alcohol consumption.

To describe the clinical case of a patient with a probable diagnosis of dementia related to alcohol consumption.

This report aims to understand the role of alcohol consumption as a risk factor for dementia.

This report contains a case report and a literature review that was performed using Pubmed and Medscape.

Although a gradual improvement in cognitive ability with prolonged abstinence can occur, some cognitive impairments appeared to persist despite prolonged periods of abstinence. Thus, the avoidance of excessive alcohol consumption is crucial for the prevention of this disease.

Recently there is growing interest with regards to personality and character traits that may have an effect on the incidence and severity of climacteric symptoms. Neuroticism emerges as one important factor according to the Big-Five and Eysenck's models, but little is known about the possible relationship of menopausal symptoms and Cloninger's model of personality.

The present study aimed to explore the relationship between Cloninger's model of personality and the severity of climacteric symptoms. Specifically, this study investigated whether certain temperament and personality traits associate with either psychological, somatic or vasomotor distress symptoms in menopause.

One-hundred-seventy menopausal women from a Greek University menopause clinic completed Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm Avoidance (HA), Novelty Seeking, Reward Dependence and Persistence, as well as three dimensions of character: Self-directedness (SD), Cooperativeness, and Self-Transcendence. Menopausal somatic, vasomotor and psychological symptoms were assessed using the Greene Climacteric Scale.

Higher HA emerged as the most significant temperament trait influencing anxiety and depressive symptoms. Lower SD resulted in more depressive climacteric symptoms. A multivariate regression model further showed that higher HA and lower SD independently associated with more depressive symptoms, whereas years since menopause, body mass index and waist-to-hip ratio influenced somatic and vasomotor symptoms only.

Our findings indicate that high HA and low SD associate to psychological climacteric distress symptoms, while somatic and vasomotor symptoms are independent of character or temperament traits and mainly influenced by menopausal age and body mass index.

The corticobasal degeneration (CBD) is a rare and severe neurodegenerative condition associated with a heterogeneous clinical syndrome of behavioral, motor, sensory and cognitive symptoms. Epilepsy is often associated with ictal, post-ictal and inter-ictal behavior changes, and it‘s a rare manifestation in DCB.

Literature review on topic Corticobasal Degeneration, with presentation of a clinical case.

Research conducted in Pubmed with the words:’corticobasal degeneration’,’neuropsychiatric symptoms’. The clinical information was collected from patient and family.

The authors report a case of a 55 years-old women with a history of anorexia nervosa, an affective disorder with features of Major Depression of 7 years of evolution and Epilepsy. Was admitted toInpatient Psychiatry Unit by rapidly progressive neurodegenerative clinical status of 6 months period, with temporo-spatial disorientation, incoherent speech, personality regression identifying substantial changes in behavioral pattern (apathy, depressed mood, anxiety), committing almost completely their autonomy. Neurological examination reported mnesic deficits, difficulty in memory recall, lack of ability to calculate and abstraction, ideational and ideomotor apraxia,’alien limb’ phenomenon, parkinsonism with global bradykinesia, gait in small steps and left hemibody stiffness. Emphasize the complementary diagnostic exams, the electroencephalographic study with bilateral paroxystic activity of central predominance and brain-MRI revealing leukoencephalopathy, Globus pallidus mineralization and cortico-subcortical atrophy.

The differential diagnosis of prion encephalopathy and limbic encephalitis were excluded, having performed therapeutic trial with methylprednisolone without improvements. It is discussed in this clinical case of DCB, the long pre-symptomatic period of pathological behavior and epilepsy, relative to rapidly progressive neurological deterioration.

Acute psychotic disorders include a heterogeneous group of disorders characterized by the acute onset of psychotic symptoms. Medico legal acts can be observed during these episodes.

To study different evolutionary terms of patients hospitalized in department of forensic psychiatry at Hospital Razi, Tunisia following a withdrawal of case by reason of insanity according to section 38 of the Penal Code and having been diagnosed as an acute psychotic d

A retrospective descriptive study was carried out on files of patients hospitalized in department of forensic psychiatry at Hospital Razi during the period of January 1991 to December 2011 and whose final diagnosis according to DSM VI was a brief psychotic disorder or schizophreniform disorder.

Our sample consisted of 30 patients. The average age was 28.6 years. Criminal acts were varied: they were dominated by homicide in 5 cases, attempted homicide in 5 cases, 4 cases in theft. On admission, the diagnosis of brief psychotic disorder was selected in 12 patients, whereas the diagnosis of schizophreniform disorder was labeled in 18 cases. Two cases of complete remission were objectified. The outcome was chronic in 17 case: it was paranoid schizophrenia in 5 patients, disorganized schizophrenia in 4 patients, schizoaffective disorder in 4 patients and a disorganized schizophrenia in 2 patients. 6 patients developed bipolar disorder later.

Acute psychotic episodes constitute a risk period of acting out. Screening for chronic psychiatric disorders occurs by the early identification of patients at risk from the prodromal phase.