Movement disorders are a frequent finding in psychiatric practice, even in emergency. Studies on acute movement disorders in psychiatric emergency are rare.

To determine characteristic features of patients presenting with movement disorders in psychiatric emergency.

We conducted a retrospective study over one year period including all patients presenting in psychiatric emergency of Razi Hospital for movement disorders (from October2012 to September2013). Clinical, etiological and therapeutic features were analyzed.

We included 335patients consulting in emergency for movement disorders (3.36% of all consultations in psychiatric emergency; sex-ratio: 3.53; mean age of 37.8 years). Main movement disorders (unique or in association) were acute and tardive dyskinesia(40%), Parkinsonian syndrome(34%), tremor(28%), acute dystonia(16.2%) (Mainly torticolis(22%), orofacial dystonia(17%)), akathisia(5.7%), oculogyric crisis(2.4%). Only one patient presented with neuroleptic malignant syndrome. Etiologies were mostly iatrogenic causes (drug abuse, weaning, errors, incomplinace). Most of patients had chronic psychosis (38.5%); 6.8% had simulated mevement disorders and 3.9% hysterical conversions. Anticholinergics (Trihexyphenidyle chlorhydrate in 64.5%) and benzodiazepines(14.3%) were the most used drugs in emergency. Only 3.9% of patients were admitted in hospitalization in emergency.

Our series shows the relative frequency (>3%) of movement disorders as a chief complaint in psychiatric emergency. The predominance of young male adults may be explained by the higher prevalence of dyskinesias in our series, for which younger age and masculine sex are risk factors. It is necessary to distinguish authentic movement disorders from psychogenic ones and simulations to avoid abusive prescriptions of anticholinergics, often explicitly claimed by simulators.

Brain connectivity changes have been recently demonstrated in victims of psychological traumas treated with the eye movement desensitization and reprocessing (EMDR).

Forty victims of psychological traumas were investigated at the first EMDR session (t0) and at the last one performed after processing the index trauma (t1).

To investigate differences in EEG functional source connectivity during bilateral ocular stimulation (BS) during EMDR therapy at t0 and t1.

Brain electrical activity during whole EMDR sessions was record with a 37-channel EEG. EEG functional connectivity analysis was based on the lagged phase synchronization (LPS), derived by a two-step eLoreta procedure: dimensionality reduction of inverse matrix from 6239 voxels to 28 regions of interest (ROIs); LPS index computation, for each spectrum band, in all possible ROI pairs.

Significant differences were detected between t0 and t1 in alpha band LPS indexes. A prevalent enhancement in right intrahemispheric functional connectivity was found in t1 respect to t0, particularly among ROI pairs of (a) frontal regions (anterior frontal, orbital frontal, lateral frontal cortices) and limbic structures (anterior cingulate cortex, ACC), (b) frontal regions and associative areas (insula cortex, parietal lobe), (c) ACC and primary visual cortex and (d) ACC and associative areas.

These findings suggest that EMDR efficacy is associated to electrical brain connectivity changes during BS. An enhancement in the right hemisphere alpha band functional connectivity of areas involved in cognitive control, emotional processing and visual associative functions may play a key role in the elaboration of psychological traumas.

The aim of this study was to detect longitudinal differences in white matter brain structures in adults with schizophrenia compared to healthy controls.

Twenty adult patients with multi-episode schizophrenia under stable antipsychotic medication and twenty-two age- and sex-matched healthy subjects were included in the study. Diffusion Tensor Imaging (DTI) was applied at baseline (t1), after 6weeks (t2) and after 3months (t3) and data processing was done with tract-based spatial statistics (p<0.05, corrected). Two subjects in the schizophrenic sample dropped out at t2 and one healthy subject at t3. Clinical and neuropsychological variables were measured and correlated with the most significant DTI findings.

Compared with healthy age- and sex-matched controls schizophrenic patients showed widespread decreases in mean fractional anisotropy values (p<0.05, corrected). The most obvious FA decrease in the long-term was found in the anterior part of the corpus callosum (p<0.005, corrected), the left temporal lobe (p<0.004, corr.) and the mid-cingulate gyrus bilateral (p<0.004, corr.). Correlations to demographic variables, clinical rating scales (PANSS, CGI and GAF), verbal learning and memory and working memory will be presented.

Magnetic resonance imaging was able to detect altered structural connectivity in patients with multi-episode schizophrenia in a longitudinal design.

The new version of DSM-5 provides nearly the same criteria as DSM-IV for delirium with an exception. The DSM-5 requires a disturbance in awareness while DSM-IV, a disturbance in consciousness.

Awareness is not the same as consciousness. In this study we examined the concordances between awareness and consciousness and the agreement between DSM-5 and DSM-IV.

All acute medical admissions 70 years and over. Exclusion criteria: terminal phase of illness, severe aphasia, intubated. Those included were assessed on Day 1, 3, 7, 10 of their admission. During the assessment each individual was tested with: MoCA, DRS-98R, CAM, RASS and the subscale of levels of consciousness and awareness of surroundings from RCDS; APACHE II, CAPE and BARTHEL index. Demographic data and a medication list were also recorded.

123 participants;

Mean age: 81.3 SD (6.7) range 70-100 years old

Females 60(48.9%)

Delirium according CAM 21 (17.1%)

Delirium 23 (18.7%)

Subsyndromal delirium 28 (22.8%)

No delirium 72 (58.5%)

Previous cognitive decline: 76 (61.8%)

RCDS (awareness and consciousness)

Mean awareness: 0.4, SD (0.8)

Mean consciousness 0.4 SD (0.8).

Correlation (agreement) between awareness and consciousness Kendal's Tau =260, p=0.026

Using the awareness definition of delirium 8 participants with full awareness of surroundings have been indentified as delirious according to DRS 98, while using the consciousness definition 12 participants where indentify as delirious.

DSM-IV and DSM-5 detect two slightly distinct populations with delirium. Awareness and consciousness are not the same. DSM-5 is more restrictive in indentifying delirium.

Cognitive impairment during acute illness in older patients is acknowledged, although factors that underpin this condition are less well studied.

To investigated the relationship between cognitive recovery and a range of clinical and biological variables.

Observational and longitudinal study. Participants were consecutive patients aged ≥70 years assessed within 3 days of their admission to elderly medical unit and re-assessed twice weekly with the DRS, CAM, MMSE, APACHE II, APS, Barthel index, frailty scale. Cytokines and APOE genotype were measured in a subsample.

142 patients were analysed [mean age 84.8±6.4; 47 (33%) male; 64, (45% with comorbid dementia]. 55 (39%) experienced cognitive improvement, of which 30 (54.5%) had delirium while 25 had non-delirious acute cognitive disorder. Using bivariate statistics, subjects with more severe acute illness, lower IGF-I levels and more severe delirium were more likely to experience ≥ 20% improvement in MMSE scores. When the criterion of cognitive improvement was a 3 point improvement in MMSE, those with more severe delirium, females and greater age were more likely to improve. Longitudinal analysis using any criterion of improvement indicated that improvement was significantly (p<0.05) predicted by higher levels of IGF-I, lower levels of IL-1 (alpha and beta), lack of APOE epsilon 4 allele, female gender and the interactions of APOE genotype with IGF-I, and dementia with IGF-I.

Cognitive recovery during admission is not exclusively linked to delirium status, but reflects a range of factors. The character and relevance of non-delirious acute cognitive disorder warrants further study

In schizophrenia about 40% of patients have an additional diagnosis of metabolic syndrome (MetS). In this present study the effect of MetS on cognition in a relatively young group of patients with schizophrenia was examined.

290 schizophrenia patients (age/sd = 30/6.37 years old) were included in the study. Patients were divided into two groups, those with and those without MetS (MetS+/MetS-). Neuropsychological performance was assessed with the Wechsler Adult Intelligence Scale-III, the Continuous Performance Test-HQ, the Word Learning Task and the Response Shifting Task.

124 (42%) patients with schizophrenia met the criteria for MetS. MetS+ and MetS- groups did not differ on amount of cigarettes, alcohol, drug use, severity of illness, socioeconomic status and antipsychotic medication. MetS+ had a significantly lower estimated IQ (sd) 94.9 (17.4) compared to MetS- 100.1(16.3) (t=2,54; p=0.012). MetS+ performed significantly worse on immediate (t=3,12; p=0.002) and delayed recall (t=2,92; p=0.004) and processing speed (t=-2,80; p=0.006) as compared to MetS-. Linear regression analyses revealed that WAIS IQ scores (p=0.026) and immediate memory (p=0.003) were associated with waist circumference.

Patients with schizophrenia and an additional diagnosis of MetS had lower IQ, performed worse on immediate and delayed recall and processing speed as compared to patients without MetS. This suggests that, even at a relatively young age, metabolic abnormalities are related to poor cognition in schizophrenia. Future studies are needed to examine whether treatment of MetS will also have a beneficial effect on cognitive performance in schizophrenia.

The attention deficit is the main symptom of the Attention Deficit Hyperactivity Disorder (ADHD) in adults. This diagnosis is difficult in adults and comorbidity with substance abuse (SA) is high. As ADHD influences negatively the prognosis of the patients with SA, it is important to treat the ADHD in individuals with DS. Furthermore, it is common the use of substances to relieve ADHD and its comorbidities's symptoms.

It is known the paradoxical effect of amphetamines in individuals with ADHD and it was also described with cocaine. This characteristic is an important clinical clue to the diagnosis of ADHD and it is a predictor of a positive response to the therapeutics.

It is intended to approach the issues related to the psycopathology, differential diagnosis, prognostic and therapeutic implications when there is comorbidity between ADHD and SA in the adult.

Therapeutic implications of the comorbidity between ADHD and SA.

Analyses of a clinical case and a non-systematic review of the literature was made.

A 23-year-old woman, lawyer, has the diagnosis of ADHD since childhood. She regularly used cocaine for the last 2 years, without doing any medication, as she felt quiet, relax and focused, being more productive at work. The treatment with prolonged-release methylphenidate allowed to stop the use of cocaine without a recurrence of cognitive symptoms.

The ADHA is an independent risk factor to the SA; The early detection and treatment of ADHD helps to prevent the substance abuse;

The aim of this study was to test the efficacy of caffeine with or without biperiden in the treatment of cocaine dependent patients.

A randomized, double blind, placebo-controlled clinical trial has been carried out in an inpatient regime during up to 13 days. Eligible patients were randomized to caffeine plus biperiden or caffeine plus biperiden placebo or caffeine placebo plus biperiden placebo.

Eighty five treatment-seeking patients were enrolled in this study. Patients were stabilized with a mean caffeine dose up to 15 mg/Kg. Results show that all three treatments are well tolerated and a clear reduction in cocaine withdrawal and craving was observed. Nevertheless, no statistically significant differences were found between groups in any outcome.

This study shows that inpatient cocaine detoxification with high caffeine doses, with or without biperiden, is well tolerated and allows further research on the usefulness of caffeine in the treatment of cocaine withdrawal and craving. Nevertheless, the selection of an inpatient hospital regime hampered the demonstration of the superiority of caffeine treatment versus placebo.

Despite the increase of research and awareness in delirium it remains underdiagnosed, protean, difficult to manager and more difficult to comprehend.

To find the clinical diagnosed rates of delirium, the possible aetiologies to describe treatment (psychotropics) and to investigate the reasons of referrals to Old age psychiatric team in relation to delirium in a general medical hospital.

Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during a 6 month time

156 files had a documentation of delirium (time prevalence 2%).

Mean age of the sample was 82 years old (SD=7.2), 66 (42%) were male.

69 (44.2%) of the total sample had a previous history of dementia, 57 (36.5%) had a previous history of delirium. In 62 (40%) the cause was infection while in 4 no specific cause was indentified.

90 (58%) referred to liaison service but only in the 26 (28.9%) the reason for referral was’acute confusion’ or’delirium’ while in a majority of referrals the reason was one of the affective disorders and more often depression. There were not any significant differences between delirium subtypes and referrals (χ2=3.868, df:3, p=0.28). Examination of the amount of antipsychotics prescribed pre during and after delirium shows that there was a significant increase of antipsychotics during the delirium (χ2=17.512, df:8, p=0.025) decrease of z-medication, (χ2=20.114, df:4, p<0.001) while benzodiazepines and antidepressants remained same.

Delirium is often misdiagnosed and unrecognized in hospital settings, however when is indentified the pharmacological management is rather optimal

Munchausen Syndrome (MS) is the most severe and chronic psychiatric disorder of factitious disorders. As a rule, external incentives are absent, being the core motivation the willingness to assume the sick role.

Literature review on topic Munchausen Syndrome, with presentation of a clinical case.

Performed a literature review. Clinical data was collected in clinical process of the patient.

The authors report a case of 47 years-old women, presenting marital and family stable relationship and good professional status, with MS. Was admitted to inpatient psychiatry unit in June 2013, by history of 177 episodes admissions at Dermatology and Surgery Departments, with 346 days of hospitalization, due to mixed panniculitis of infectious etiology with repeated abscesses, which started with a bite of a dog in the lower limb, 4 years before. In this period, was resistant to all treatments, only improving during hospitalizations. Medical conditions were excluded. During hospitalization showed depressive mood and refuted the self-inflicted nature of the injuries. Was referred for outpatient psychiatric unit, with the diagnosis of factitious dermatitis, medicated with venlafaxine 75 mg daily, Lorazepam and Flurazepam.

We highlight the case by dermatological repercussions and by psychodynamic myriad, given that the patient was raised by her grandparents after being abandoned by her mother at 20 months, which continues to avoid the rapprochement. As enshrined in the literature, the skin can be a vector for expression of certain psychosomatic unconscious conflicts and these in turn may have a cardinal role in the MPS.

Regular physical activity should be encouraged given its major role in health maintenance and disease prevention. However, in excess, exercise has the potential to cause physical and psychological harm and can become addictive. Excessive exercise can be described in an obsessive-compulsive dimension but it is included among the behavioural addictions since it presents some of its typical characteristics such as mood modification, tolerance, withdrawal symptoms and relapse after periods of abstinence or control.

The authors aim to describe the concept of Exercise Addiction and the current understanding of its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms.

Exhaustive review of the literature on Exercise Addiction and its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms, using PubMed.

The most addictive type of exercise varies with countries. Studies show that physical exercise activates de dopamine reward system contributing to stress reduction and there is evidence of the association between running, endorphins and cannabinoids – explaining the’runner's high’ that can cause addiction. Genetic studies reveal that the same genes control preference for drugs and for naturally rewarding behaviours. Psychological approaches focus on reward, habituation, social support, stress-relief, avoidance of withdrawal and anxiety reduction.

Exercising regularly has several positive effects on physical and mental health but in excess, may have serious physiological and psychological consequences. There are several hypotheses for the mechanisms of exercise addiction including reward, stress reduction, the euphoric effect, mood regulation and sympathetic arousal. More studies are needed to improve our understanding of this behavioural addiction.

Sleep is disrupted in depressed subjects; it also deteriorates with age and with the transition to menopause. The nature of the interrelationship between mood, sleep, age and reproductive state is not well-defined.

To evaluate the relationships between mood and sleep among healthy women in different reproductive states.

We analyzed data from 11 young (20–26 years), 21 perimenopausal (43–51 years) and 29 postmenopausal (58–71 years) healthy Finnish women. Mood was assessed with the Beck Depression Inventory (BDI), subjective sleep quality with the Basic Nordic Sleep Questionnaire (BNSQ), and objective sleep with all-night polysomnography (PSG) recordings.

Among young women, less arousals associated with higher BDI total scores (p=0.026), and higher SWS percentages with more dissatisfaction (p=0.001) and depressive-somatic symptoms (p=0.025), but with less depressive-emotional symptoms (p=0.001). Also, less awakenings either from REM sleep or SWS associated with more punishment (p=0.005; p=0.036), dissatisfaction (p<0.001; p=0.001) and depressive-somatic symptoms (p=0.001; p=0.009), but with less depressive-emotional symptoms (p=0.002; p=0.003). In perimenopause, higher BNSQ insomnia scores (p=0.005), lower sleep efficiencies (p=0.022) and shorter total sleep times (p=0.024) associated with higher BDI scores, and longer sleep latencies with more depressive-somatic symptoms (p=0.032). In postmenopause, higher REM percentages associated with higher BDI total scores (p=0.019) and more depressive-somatic symptoms (p=0.005), and longer SWS latencies with more depressive-somatic symptoms (p=0.030).

Depressive symptoms associated with sleep impairment in perimenopausal and postmenopausal women. In young women, specific BDI factors revealed minor associations, suggesting different types of sleep impairment in relation to different depressive features.

Drugs administered to Alzheimer's disease patients usually aim to increase the levels of acetylcholine or block NMDA receptors, thus producing improvements in cognitive function.

To study the drugs administered to Alzheimer's patients and its possible motor side effect.

Our study included 45 geriatric patients enrolled in a private long-term care institution with mean age of 88.38 ± 0.84 years old, mean weight of en 60.28 ± 2.00 kg with Alzheimer's disease.

Drugs administered to patients with Alzheime's disease were:

donepezil 0.16 mg/kg/day, administered to 53.33% (24) of patients ; rivastigmine patch 9.50 mg/day given to 15.56%(7) of patients and galantamine 0.40 mg/kg/day given to 4.44% (2) of patients.

26.67% (12) of subjects did not received any specific drug for Alzheimer's disease.

Psychomotor agitation and aggressive behavior were observed in 70.83% (17) of patients who received donepezil and in 57.14% (4) patients who had received rivastigmine.

The increase of cholinergic activity due to inhibiton of acetilcholinesterase by donepezil, or due to the activation of cholinergic receptor by rivastigmine in basal ganglia could be related to psychomotor agitation.

This imbalance of cholinergic-dopaminergic activity produced by these drugs may cause motor agitation in a similar way to akathisia induced by neuroleptics.

Insomnia is a common symptom that may interfere with the efforts of alcohol-dependent (AD) patients to initiate and maintain sobriety, with a range from 36% to 91%. To date, only four studies have evaluated nonpharmacological approaches to insomnia complaints in AD subjects in early recovery. However, none of these studies were computer-based, and none were performed in Ukraine.

of the current study was to develop an online computer-based cognitive-behavior therapy for insomnia (CBT-I) for Ukrainian alcoholdependent patients.

A total of 8 individuals with alcohol dependence screened for the study. Demographic information was assessed at the baseline. At baseline, at the end of the study, in 6 and 12 week follow-up patients reported bedroom environment, eating, exercises and substance abuse habits; treatment activities; alcohol use and related clinical variables; daytime functioning measures and sleep variables.

The average age of participants was 44.4 years; 50% were male; all were Ukrainians; 83% had higher education; 67% were married. Baseline mean AUDIT score was 27, SPQ - 17 (all individuals categorized as having insomnia as they endorsed any one item with a 4 or 5). A web-based platform includes psychoeducational information on alcohol dependence, insomnia and CBT-I. Five sessions and a battery of scales examine the effectiveness of the CBT-I package. Each session contains additional materials as homework for patients.

This online Internet intervention for alcohol-dependent individuals with insomnia is the first computer-based treatment program in Ukraine. The findings underscore the importance of assessing and treating insomnia in addition to alcohol consumption with the novel nonpharmacological treatment.

Defendants commonly claim amnesia for their criminal actions especially in cases involving extreme violence. While some claims are malingered or result from physiological factors, other cases may represent genuine partial or complete amnesia resulting from the psychological distress and/or extreme emotion associated with the perpetration of the crime.

To identify possible psychological differences among homicide or severe violence offenders presenting amnesia for the event and those who do not. Due to a small number of offenders commiting such a sever violent crimes. We are presenting results of ongoing research. The preliminary data were presented at the EPA meeting 2013.

We examined homicide or severe violence offenders presenting amnesia for the event (n=20) and those who do not (n=20) with a complex psychological a psychiatrical assessment. Further we evaluated social and criminal anamnesis. Offenders with psychotic or schizophrenic symptoms were excluded.

The ongoing study still shows no differences in cognition or personality in the studeid group (p < 0.01). Elevated levels of dissociation and score in IES questionnaire was found in offenders presenting amnesia for the event.

This ongoing study supports hypothesis that there are no any neuropsychological impairments in nonpsychiatric offenders of murder or severe violence presenting amnesia. Higher level of dissociation and score of impact of events scale (p < 0.05) suggest, that this group of offenders may be more predisposed to dissociative and stressful reactions in overloading events. Thus the question whether the amnesia is malingered or not is still unclear.

Criminal behavior in adolescence is often considered as a consequence of inadequate social support or involvement with risk social groups. Current research shows that youth showing signs of specific psychopathology may be more vulnerable to criminal behavior.

The aim of the study was to compare of developmental psychopathology in adolescence with criminal experience (n=20) to the control noncriminal group. We conducted a structured interview and psychological assessment.

In our pilot study we identified that adolescence with specific developmental psychopathology – i.e. ADHD and conduct disorders are more prone to crime, comparing to the control group at statistically significant level (p< 0.01). The intensity of psychopathology may be connected to the profanity of ongoing criminal behavior.

Nausea/vomiting and other gastrointestinal system disorders may cause severe nutritional complication in elderly neurologic patients.

To identify possible gastrointestinal side effects in patients receiving Alzheimer's disease treatment.

This research included 45 geriatric patients enrolled in a private long-term care institution with mean age of 88.38 ± 0.84 years old, mean weight of en 60.28 ± 2.00 kg with Alzheimer's disease.

Drugs administered to patients with Alzheime's disease were: donepezil 0.16 mg/kg/day, administered to 53.33% (24) of patients ; rivastigmine patch 9.50 mg/day given to15.56%(7) of patients and galantamine 0.40 mg/kg/day given to 4.44% (2) of patients.

26.67% (12) of subjects did not received any specific drug for Alzheimer's disease.

Nausea and vomiting were observed in 20,83% (5) patients who received donepezil, in 85.71% (6) from rivastigmine group and in 2 patients treated with galantamine.

Appetite loss was identified in 20,83% of patients receiving donepezil.

The increase of cholinergic activity induced by donepezil, rivastigmine and galantamine intensify cholinergic neurons inputs from chemoreceptor trigger zone, solitary tract nucleus and cerebellum to medullary emetic centre and thus may lead to emese stimulation in these patients.

Regarding the possibility of nausea/vomiting and appetite loss in patients receiving Alzheimer's disease cholinergic drugs, a more easily digestible meal should be considered for these patients.

Compulsory community treatment (CCT) is intended to be a less restrictive alternative to involuntary hospital care but its use, acceptability and effectiveness remain controversial.

To clarify if CCT can improve patient outcomes based on recent systematic reviews

A systematic literature search of PubMed/Medline and EMBASE up till December 2013. Only systematic reviews (including metaanalyses) were included. Randomised and non-randomised evidence were not mixed, and only RCTs included in meta-analyses.

Five systematic reviews were identified that included 90 papers. Studies with randomised or appropriately matched controls, including adjusting for forensic history, found limited evidence for CCT reducing health service use and improving social functioning, mental state, quality of life or satisfaction with care. Three RCTs provided 749 subjects for the meta-analysis. Two compared compulsory treatment with entirely voluntary care while the third had controls who received voluntary treatment for the bulk of the time (medians of 257 vs. 8 days respectively for initial randomised legal compulsion and 262 vs. 103 over the course of the study). Compared to controls, CCT did not reduce readmissions to hospital in the subsequent 12 months (RR=0.98, 95%CI=0.83 to –1.17). Neither were there significant differences in psychiatric symptoms or Global Assessment of Functioning. Sensitivity analyses of the effect of only including the two studies that compared compulsory treatment with entirely voluntary care made no difference to the results

CCT does not lead to significant differences in readmission, social functioning or symptomatology compared with standard care. Its use should be reviewed.