Time of profound change, adolescence is a critical period of development and transition between childhood and adulthood. Age life source of conflict, opposition and misunderstanding highlights some psychological fragility of life and the subject is likely to develop psychiatric disorders including psychosis.

Meeting the demographic characteristics of a population of adolescents who had been hospitalized for a first episode of psychosis.

Retrospective and descriptive performed on patient records adolescents whose ages are between 16 and 19 years hospitalized for a first episode of psychosis in psychiatric wards of Hospital Razi between January 2004 and June 2008. The socio-demographic data were collected using a pre-established form and analyzed using SPSS software version 11.

Our series consisted of 27 boys and 13 girls with a sex ratio was 2.07. The average age of our sample was 17.9 years. About 65% of their patients were students, 20% held irregular work and 15% were unemployed. For socio-economic conditions, they were poor in 60% of cases, moderate in 35% of cases and good in only 5%.

Despite the study of socio-demographic characteristics of this population, the onset of first episode psychosis in adolescents has still practical difficulties in preventing the occurrence of this disorder remains uncertain outcome which the clinician cannot predict how scalable.

Time of profound change, adolescencethis is a period of development where a psychodynamic point of view, can be activated archaic defense mechanisms to meet psychological difficulties that may be encountered adolescents. Once the defense mechanisms fail, the evolution towards schizophrenia can be.

Study of clinical and therapeutic aspects of first psychotic episodes occurring in adolescence, having evolved later to schizophrenia.

Descriptive retrospective study on 40 subjects whose ages are between 16 and 19 years admitted to our psychiatric institution for entry into schizophrenia. The information was collected through a pre-established form. Data analysis was performed by SPSS software version 11.

71.4% of subjects who received the initial diagnosis of schizophrenia were male, family history of schizophrenia and mood disorders were found with respective rates of 19% and 14.2%. The average time of treatment was 13.5 months. The first problems identified by families were: sleep disturbance, irritability, aggressiveness tend to hetero, difficulties in attention and concentration, exaggeration of social isolation and somatic complaints. Psychotic symptoms were found most emotional blunting, delusions and auditory hallucinations. After 2 years of follow up, 38% of subjects who carried the diagnosis of schizophrenia were reinstated at least once, and only 28.5% of subjects had continued their studies.

Schizophrenia is the major fear facing psychotic disorders occurring in adolescence. and it is important to note the diagnostic difficulties and the frequent confusion between schizophrenia and bipolar disorder in adolescence. Great care practitioner is required before any diagnostic decision.

The psychiatric expertise, medical discipline in the legal system, is an act in which the expert must establish the existence of mental illness at the time of the offense and the latter results.

Describe the socio-demographic profile of the subjects appraised in order to help to improve and clarify the mission of expertise.

Retrospective study, involving 120 subjects examined records within a forensic psychiatric assessment over a period ranging from January 2004 to May 2009. Socio-demographic data collected were processed using Microsoft Excel. Our results were compared with those of literature.

Our series consisted of 113 men and 7 women representing 94.1% and 5.9% (sex ratio F / M = 1/16). The average age was 34 years 2 months with a peak at 20-29 years (41% of cases). A solitary life characterized 70.0% of the subjects examined, with a predominance of single (64.2%). Educational level was relatively low and the employment situation was precarious for the majority of subjects with a frequency up to 35% without occupation.

At the end of this study, we find that the socio-demographic and clinical profile of subjects appraised consistent with conventio.

Given the concept of bipolar spectrum which extends across the family, healthy relatives of bipolar patients, which are a population at high risk for developing mood disorders, may have temperamental deregulations.

To compare the mean scores of affective temperaments among patients with familial bipolar I disorder and their unaffected first-degree relatives.

This was a cross-sectional study, concerning 50 families of bipolar I disorder which have at least two patients with bipolar I disorder (DSM-IV-TR). We have included 80 clinically recovered patients with bipolar I disorder and 120 unaffected first-degree relatives. The affective temperaments were assessed by Tunisian version of TEMPS-A. Dominant affective temperament is the temperament witch score was more than 2 SD of mean scores.

Mean scores of cyclothymic and hyperthymic temperaments were higher in bipolar I patients than in their healthy relatives. The difference was significant for only hyperthymic temperament (p=0.038) but it was not significant after adjustment for age, sex and school level. The rate of dominant affective temperament was not differed between bipolar I patients (26.3%) and their healthy relatives (20%). Investigating the role of family, we showed a significant association with depressive (p< 10-3), cyclothymic (p=10-3), irritable (p=0.023) and anxious (p=0.003) temperaments.

Our findings suggest that patient with family bipolar I disorder and their unaffected first-degree relatives had a temperamental deregulation which confirms the concept that affective temperaments are a potential phenotype of bipolar condition.

“Folie à deux” is also known in the ICD-10 as Induced Delusional Disorder. A subtype is “folie imposee” where the primary individual holds delusional beliefs shared by a secondary individual. When the delusional beliefs of the primary individual cease it is observed that the beliefs of the secondary individual also disappear. Mr A was a 36 year old Caucasian male presenting with an array of psychotic symptoms centred on a task which involved finding an energy source at the centre of the earth. Mrs A was highly resistant to his treatment and further investigation revealed a case of folie à deux.

To demonstrate the phenomenon of folie à deux.

Individual and combined interviews were held with Mr and Mrs A where the psychotic symptoms were discussed. A comprehensive study of Mr A's past and current psychopathology was also undertaken.

Mrs A shared the delusions of her partner and was strongly against treatment as it would nullify his delusions rendering him incapable of completing his task. Once treatment was facilitated, Mr A experienced a drop from his unusually high levels of energy which reflected an equal and immediate drop in energy levels of his partner which led her to further discourage him from medication. When Mr A's delusional beliefs lifted, it was apparent that his partner no longer held the same delusional beliefs.

We concluded this case fulfilled ICD-10 and DSM IV criteria for a shared delusional disorder (folie à deux) with specific sub-type “folie imposee”.

To examine the factors that influence mental health professional's prescription of antidepressant.

There are many studies on factors affecting decision of mental health professionals regarding selection of antidepressant. The clinical experience of the developing countries is different from that of the developed countries where nonpharmacological attributes of a drug like affordability and availability play a greater role in prescription of drug.

A semi-structured questionnaire was used to investigate which antidepressant was the preferred choice of psychiatrists and nurses and factors which influenced their decision making. Ethical permissions were obtained from local research and ethics committees.

The results of this study show that health professional would consider efficacy (64%) and tolerability (24%) to be the most important factors in choice of anti psychotics for themselves while efficacy (56%) and cost (24%) would be considered important factor while prescribing drugs to the patient.

Beside efficacy other factors like cost & affordability found to be the important factor in influencing the decision of the psychiatrists.

Divorce rates are high among wives of alcoholics and the most frequently identified cause is domestic strife in the form of harassment, torture or beating from the husband and or in-laws. However, there is only limited literature in this regard.

To study the stress, various coping styles and domestic violence among the wives of alcohol dependent individuals, who are admitted to the de-addiction centre of a tertiary care psychiatric centre in India.

An exploratory descriptive design was adopted. Wives of 75 alcohol dependent individuals, admitted in the deaddiction centre of National Institute of Mental Health and Neuro Sciences, Bangalore were selected. Data was collected by personal interviews with all 75 wives using socio-demographic information schedule, Perceived Stress Scale, Coping with Drinking Questionnaire, and Domestic Violence Questionnaire.

Wives of alcohol dependent patients had high levels of perceived stress. Avoidance, discord, fearful withdrawal and sexual withdrawal were the most common coping components identified. Domestic violence was experienced by 90% women, mostly intellectual (69%), emotional (59%), social (58%), physical (47%), economic (42%) and sexual violence (27%). Domestic violence was found to increase the stress and influences the coping styles of these women.

Domestic violence is a major problem in wives of alcoholics. Routine screening for domestic violence is needed during the intake of alcoholic for substance abuse treatment so that appropriate interventions can be planned. There is a need for substance abuse treatment providers to be trained on the issue of domestic violence.

Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. in other hand, there is conflicting evidence about the influence of personality disorder on outcome in depressive disorders.

The present study assesses whether personality may predict the dropout of a psychotherapy group for patients with depressive disorder.

A personality disorders (PDs) self-report questionnaire based on the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was completed by 39 depressed outpatients. All patients attended a group-based CBT program for depression consisted of 10 weekly 90 minutes sessions. Patients were categorized in groups as completers vs. dropouts. Dropout was defined as attendance at less than 7 sessions. Differences between groups were tested using Student's t-test and in order to measure the specific contribution of personality on dropout a logistic regression analyses were performed.

Comparing treatment completers (67%) vs. dropouts (33%), groups differed significantly on number of items in schizotypal, narcissistic and borderline PDs. The dropout group scored significantly higher on these PDs than the completer group. Scores on borderline personality disorder emerged as a significant predictor of dropout.

Depressed outpatients with comorbid borderline traits are at higher risk of premature termination and may require modified treatment strategies.

The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus.

In this study, the altereration of the ARC neuropeptide/hormone levels in rats were determined as one of the weight gain mechanism. To examine olanzapine's weight gain effects, olanzapine was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides.

Food consumption was found to be increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and α-MSH decreased significantly but CART levels were also reduced unexpectedly. in conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain due to olanzapine therapy.

Attention Deficit Hyperactivity Disorder (ADHD) is the ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed more often in boys than in girls. ADHD has a wide range of symptoms. It may affect cognitive and executive functions; it may also lead to behavioral problems and further psychiatric symptoms and disorders. Currently it has been hypothesized that ADHD may also lead to specific lifestyle that is influenced by core symptoms of ADHD. This specific lifestyle may negatively influence or even induce further mental and somatic problems.

The aim of the study was to compare lifestyle of ADHD and non ADHD boys in age of 6 - 10 years.

We have assessed a group of ADHD boys (n=50) and non ADHD boys (n=50) with structured interview oriented to life style in nutrition and health and free time and social life.

In our pilot study we identified that lifestyle of ADHD boys substantially differs from non ADHD boys - in most of all monitored areas, especially in nutrition and way of spending free time. ADHD life style is characterized by lower level of organization.

Upon the presented study we may suggest that ADHD may lead to specific lifestyle that is characterized by lack of organization and stability. This may lead to further mental or even somatic problems. Clinicians and researchers should pay more attention to these questions.

The prevalence of internet game use among children and adolescents has been increased in the recent years.

Internet addiction has been found to cause various psychiatric symptoms and psychological problems. Internet addiction has been found to cause various psychiatric symptoms and psychological problems.

The aim of this study was to examine the association between problematic internet game use and psychiatric symptoms in a sample of the Child and Adolescent Psychiatric Clinic, Ulsan University Hospital.

We analyzed data from 447 subjects who first visit the Child and Adolescent Psychiatric Clinic of the Ulsan University Hospital. The level of Internet addiction was categorized as either high-risk (≥108; group 3), potential risk (95 to 107; group 2), or no risk (≤94, group 1) based on the total score. Data were analyzed using SPSS version 17.0 and one-way ANOVA and multiple logistic regression method were used.

Thirteen adolescents met the criteria for high risk group of internet game addiction. in the high risk group, 10 were male and 3 were female adolescents. There was an mean difference among group 3 (high risk)< 1 (no risk),2 (potential risk) in AHI ; whereas group 3 (high risk)>1 (no risk), 2 (potential risk) in BDI, BAI, inattention, hyperactivity/impulsivity and K-ARS score. with multiple logistic regression analysis, K-scale was significantly related with male sex, BDI, ARShyperactivity/ impulsivity score.

We conclude that having male sex, happiness and depressive symptoms is associated with the risk of developing internet use disorders.

Valproate (VPA) is widely used for acute and maintenance therapy of bipolar disease and it is the most prescribed drug for epilepsy treatment worldwide. VPA-induced hyperammonemia is a serious and unusual advers effect of VPA treatment.

We aimed to describe the 20 year-old-woman bipolar case of VPA induced hyperammonemic encephalopaty with therapeutic VPA levels and normal liver functions.

The case will be discussed.

The patient complained of confusion, disorientation, somnolance, agitation and slurred speech at the end of the first week of VPA treatment. VPA blood level was 116.5 μg/mL (N:50-125) and ammonia level was 237 μmol/L (N:10-50). Other laboratory tests including serum transaminases (both ALT and AST) and coagulation profile (PT, PTT and INR) were normal. After discontinuation of VPA treatment and hydration, these symptoms have disappeared dramatically. After 24 hours, blood ammonia level was 80 μmol/L and patient returned the baseline mental status.

Hyperammonemia occurs due to inhibition of mitochondrial enzymes in the urea cycle by valproic acid. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA- induced hyperammonemia and encephalopathy is still one of the most feared side effects of VPA which may require emergent management.

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood. It affects about 3 - 5% of school aged children. ADHD may lead to cognitive and behavioural problems and further psychiatric symptoms and disorders. Current research shows possible changes of somatic development of ADHD children comparing to non ADHD children. Etiology of these changes is still unclear. It is hypothesized that it can be caused by ADHD specific endocrinologic changes, medication or a ADHD life style. The growth of children may be influenced by further external factors - i.e. length of breastfeeding.

The aim of the study was to compare how long a group of ADHD children - comparing to non ADHD children had been breast fed after the birth.

We assessed a group of mothers of ADHD children (n=100) and non ADHD children (n=100) with structured interview oriented to breast feeding.

In our pilot study we identified that ADHD children were breastfed substantially shorter time (avg = 2,5 month) than non ADHD children (avg = 7,8 month) at statistically significant level (p< 0.01).

The presented study suggests that ADHD in very young children may influence mother's behaviour leading to shortening time of breastfeeding. This may lead to further developmental changes. The presented study proposes that developmental changes in ADHD - especially somatic ones may be caused by complex ethology and therefore it is necessary assess not only the child but also conditions of its development.

Sleep plays a vital role in both mental and physical functioning. Sleep disturbances are not only associated with psychiatric disorders, but also with many chronic physical conditions.

The aim of this report was to assess the frequency of poor sleep quality, daytime and dream anxiety and their response to subsequent surgical treatment for a representative group of 68 patients with nasal septum deviation.

Nasal airflows and airway resistances were measured employing rhinomanometry and the participants were also asked to fill in Pittsburgh Sleep Quality Index, Beck Anxiety Inventory, and Van Dream Anxiety Scale directly before the submucous resection without turbinectomy and two months later.

Repeated measure analyses of variance models showed that patients reported significantly lower scores of poor sleep quality, daytime anxiety, and as well as dream anxiety after surgical treatment (p< .01).

Nasal septal surgery might have beneficial effects on sleep variables in patients with deviation.

Against a backdrop of poor mental health education in UK schools a group of students from Norwich Medical School have formed a student society called ‘Headucate’ in order to create, deliver and evaluate an educational intervention for adolescents, initially to be delivered in Norfolk schools.

To create an educational intervention that:

• Is the length of a standard lesson

• Is age appropriate and acceptable

• Contains appropriate signposting

• Contains content that challenges common myths and replaces them with knowledge

• Contains content that encourages empathy and understanding towards those with mental illnesses

• Is easily delivered in the same way each time so that its effectiveness can be evaluated

To create an intervention effective at tackling stigma and empowering adolescents to recognise signs of poor mental health and access services appropriately.

Lesson plan created after consultation with psychiatrists, a psychologist, a GP, a university outreach professional, a teacher and secondary school age children, then trialled and revised.

Interactive workshop produced with 5 sections.

1. 1) Myth vs Fact activity that dispels prevalent myths

2. 2) Scenario based activity to demonstrate that mental health is a spectrum

3. 3) An interactive presentation covering the most common mental illnesses and their symptoms

4. 4) An activity focusing on talking to those with mental illnesses, furthering the scenario from the previous activity

5. 5) A question and answer session. Every student leaves with a leaflet containing appropriate signposting.

We have created an educational intervention ready to be delivered and evaluated.

Pathological Gambling (PG) includes extremely different types of game and many gamblers suffer from anxiety disorders. According to the self-medication hypothesis, Gambling Behaviour may be a strategy to tolerate suffering and compensate uneasiness; otherwise social problems related to gambling may lead to anxiety disorders, possibly unmasking an adult form of Separation Anxiety Disorder (SAD).

To investigate possible relationships between PG and SAD, considering the different games, the age of onset, the symptom severity, and the distinction between Adult and Child SAD.

32 gamblers attending an outpatient psychiatric clinic completed the following tests: SOGS and ASI to investigate the kind of gambling, the age of onset and the social conditions of gamblers; SCI-SAS, SASI, ASA-27 to evaluate the Separation Anxiety in childhood and adulthood; HAM-A; GAF.

There are statistically significant correlations between later age of onset of PG and development of SAD in adults. Higher scores in GAF are related to lower scores in Separation Anxiety scales and HAM-A. There is a strong inter-correlation among the Separation Anxiety scales. Higher scores in HAM-A correlate with higher scores in SASI and ASA-27. Male gamblers have an earlier onset and increasing with the age of onset increases the addiction to “dissociative” games instead of “active” ones.

Our preliminary data do not support self-medication hypothesis; possibly, a later-onset gambling is related to a more neurotic and less impulsive psychopathological pattern.

Postpartum Depression (PPD) is a common problem connected to pregnancy. Related previous data showed a prevalence of depressive symptoms between 8% and 51% and a prevalence of Major Depressive Disorder between 10% and 17%.

Find a correlation between Psychosocial Risk Factors and the develop of Mood Disorders during pregnancy and post-delivery.

Develop strategies of prevention and treatment of PPD.

A population of pregnants has been analyzed, proposing an anamnestic questionnaire, the Edinburgh Postnatal Depression Scale (EPDS) and the Hypomania checklist Symptoms (HCL-32), in two times: between the 35th and the 37th week of pregnancy and 2-3 days after the delivery.

We found that at the first survey were depressed (EPDS score >9) 21 women of 149 (14.1%) and hyperthymic (HCL score >14) 59 women of 149 (39.9%).We noticed that risk factors for depression were a complicated pregnancy (p=0.004), a conflicting relationship with the partner (p=0.009) and a permanence in Italy < 6 months (p< 0.001). An history of illnesses during the pregnancy (p=0.042) and previous psychological problems (p=0.049) were correlated to an hyperthymic state. At the second survey, data were confirmed: the incidence of depression was 17,4% (12 /69 women) and that of hyperthymia was 44% (30/69 women).

Our data confirm previous evidences about the incidence of PPD and the contribution of risk factors of the pregnancy in its pathogenesis; moreover, high scores at HCL can express an hyperthymic dimension peculiar of pregnancy, rather than a mood disorder, considering HCL as a dimensional assessment.

Thyroid function is known to be affected during pregnancy. Risk of depression is particularly high for women during the prenatal period.

Various investigators have attempted to establish a link between thyroid function and post partum depression. While the pathogenesis of postpartum mood disturbances remains unclear.

This study aimed to investigate whether thyroid function differs in women with postpartum depression compared to a control group.

In this case-control study, Forty eight patients suffering from postpartum depression according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition totally revised (DSM-IV-TR), and 65 normal controls underwent diagnostic evaluation using Structured Clinical Interview for DSM-IV-TR. Then the Persian version of Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. Finally, their thyroid functions were assessed. Data analyses were done using the SPSS program 13.

No statistically significant differences were observed between thyroid function tests and postpartum depression. According to multiple regression analysis with stepwise method, subjects with lower serum TSH, T3RU and T3 levels tended to have higher EPDS scores (P-value=0.008).

The present study reports that those women with postpartum depression had a no greater prevalence of thyroid dysfunction than the control subjects. It seems that thyroid dysfunction should be considered in women with postpartum depression individually, but the role of thyroid as an important cause of this condition is not yet established. This suggests that future studies should concentrate on this concept in postpartum depression.