In the present study, the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in adult psychiatric outpatients was investigated. Moreover, co morbid psychiatric diagnoses in adults with ADHD were determined. Patients with and without co morbid ADHD were compared regarding axis I-II co morbidity and socio-demographic characteristics.

The current study included 246 patients admitted for the first time to Numune Hospital psychiatric outpatient clinic in a four months period where they were evaluated for adult ADHD. Diagnosis of ADHD was made by evaluating symptoms of childhood via WURS scale, Turgay's adult ADD / ADHD evaluation scale. For the exact diagnosis DSM-IV criteria were applied to the patients who exceeded the cut of points of both above-mentioned scales. To assess the presence of psychiatric co morbidity a structured clinical interview (SCID-I and II) were applied. Socio demographic characteristics of patients were determined with a semi-structured form. In addition, to grade general psychopathology, Symptom Check List (SCL-90-R), Beck Depression Inventory (BDI) were given.

Prevalence of ADHD in adult psychiatric clinic was 15.9%. Adults with ADHD usually referred due to co morbid psychiatric problems. It was determined that they had deficits in education and social functions. Substance abuse and suicide were among the most prevalent psychiatric problems.

ADHD was common in adult psychiatric outpatients and axis I-II co morbidity was highly prevalent among these patients.

Hyponatremia due to antidepressant-induced SIADH can cause significant morbidity and serious complications. It is commonly associated with SSRIs, but the frequency and class-specificity are unclear.

To determine the relationship between hyponatremia and antidepressants, defining incidence and odds ratios for antidepressant classes, along with patient risk factors.

A review of the literature was performed in Web of Science and Pubmed until April 2012, using combinations of search strings “antidepressants” and antidepressant class and generic drug names with “hyponatr(a)emia”, “SIADH” or “inappropriate antidiuretic hormone secretion”.

19 effect studies and over 50 case reports were considered, the majority concerning SSRIs. Variation in study design, population and cut-off values caused divergence of hyponatremia incidences of 0.06-40% for SSRIs and 0.08-70% for venlafaxine. Incidence numbers for mirtazapine and TCAs were tenfold lower. Odds ratios for SSRIs (1.5 -4.0) were consistently higher than for TCAs (1.1-1.9). The risk associated with MAO-inhibitors, reboxetine and bupropion could not be established due to insufficient information. Patient risk factors included older age (OR 6.3) and concommitant use of (thiazide) diuretics (OR 11.2-13.5).

Hyponatremia is an underdiagnosed and potentially dangerous side-effect of antidepressants and this risk is not exclusive to SSRIs. Current evidence suggests a relatively high risk for hyponatremia with the use of SSRIs or venlafaxine, especially combined with patient risk factors, in which cases clinicians should actively screen for this complication. Mirtazapine and TCAs entail a moderate risk and can be considered as alternative treatment for patients with increased risk or history of hyponatremia.

Type 2 Diabetes mellitus (T2DM) is a chronic disease that requires long-term medical care and lifestyle change. Many patients find it challenging to implement required behaviour changes and consequently, do not achieve glycaemic control. It is essential to research social cognitive factors that impact self care in T2DM.

To study the impact of barriers and illness perceptions on self care in T2DM

To explore barriers to self care and illness perception and examine their relationship with self care, metabolic control and quality of life in T2DM.

A cross-sectional design was employed. The sample consisted of 60 patients with type 2 DM, meeting specified inclusion and exclusion criteria, recruited from the out-patient services of a hospital at Bangalore. The Barriers of self care questionnaire (Glasgow, 1994), The Revised Illness Perception Questionnaire (Morris et. al, 2002), The Summary of Diabetes Self Care Activities (Toobert & Glasgow, 1994) and The Diabetes Quality of Life Questionnaire Brief Clinical Inventory (Burroughs, Desikan, Waterman, Gilin & McGill, 2004) were administered. Metabolic control was assessed using glycosylated haemoglobin levels (HbA1c).

Findings revealed that barriers to self care, negative perceptions of consequences of the illness and negative emotional representations were associated with poorer self care. Adherence was associated with better metabolic control and quality of life.

Barriers to self care and maladaptive illness representations pose a challenge in achieving self-care goals. Understanding barriers is the first step in facilitating practitioners to identify their role in enabling patients to overcome them.

There is good evidence from epidemiological studies that the diagnosis of schizophrenia is associated with an increased risk of violence.Some studies have linked the presence of positive symptoms, first psychotic episode, duration of untreated psychosis and lack of insight with violent behavior.

The primary objective was to identify factors related to violent behavior in patients diagnosed with psychotic disorder attended by our group, a multidisciplinary mobile outreach team (EMSE).

We evaluated a total of 249 patients diagnosed with psychotic disorder between 2007 and 2012. We administered the following scales: PANSS, GAF (Global Assessment of Functioning), CGI (Clinical Global Impression), GEP (Severity of psychiatric illness scale, AVAT (Instrument to assess violent behavior in mental illness) and SUMD (Scale unawareness of mental disorders). To study the correlation between the scales and the score of the AVAT instrument we used the Pearson correlation. Clinical variables were also compared between aggressive and non-aggressive patients using Chisquare and Student's.

There is a positive correlation between AVAT and PANSS-P (r = 0.544), ICG (r = 0.472), GEP (r = 0.515) and a negative correlation between AVAT and GAF (r = -0357). The correlation between AVAT and SUMD is positive (r = 0.119) but not statistically significant.

The presence of positive symptoms and clinical severity has been linked to increased aggressiveness and to predict the occurrence of violent behavior in the course of psychotic disorder. Unlike other studies, no correlation was observed with the lack of insight.

86 PD patients and 51 SCZ were evaluated by using the PSAS scale. Data from correlational analyses supported the construct and discriminant validity of the scale in all hallucinatory modalities were related to both gold-standard (PANSS P3 and UPDRS I Item2). Test-retest reliability (33 SCZ and 50 PD) over a 1-week interval determined 2 patients groups :stable : there's no significant (p>.05) differences between before and after measurements in each domainand unstable: all sub-scale and total score significantly (in the range .045 to .002) changed.Inter-rater reliability (18 SCZ and 17 PD) varied by subscale sense hallucinations and domain-specific κs ranged from .56 to .94.

The results suggest that the usefulness of PSAS as a clinical tool is for initial detailed evaluation and monitoring changes in hallucinations, in SCZ and PD. The next step will be to compare all modality hallucinatory manifestations in PD and schizophrenia.

Fear of crime is a kind of unpleasant and often intense emotion caused by perceived risk of being victimized. It is evidenced that fear of crime has tremendous impacts on the mental health of older people who resort to avoidance behaviors for self-protection.

This study examined the impact of fear of crime on the mental health and avoidance behavior of the communitydwelling older adults living in urban China.

For the present study, data were collected from a representative sample of 453 older persons aged 60 years and above from Kunming, Yunnan province using face-to-face interview. Associations between fear of crime and mental health, and avoidance behavior were measured using linear regression.

The final sample ranged from 60 to 100 years of age (Mean = 72.29, SD = 8.27) and included 198 (43.7%) males and 255 females. Preliminary results showed that 258 participants (57.0%) reported fear of one or more types of depicted crimes; 397 (87.6%) carried on one or more kinds of avoidance behaviors; and 234 (51.7%) presented deteriorating mental health. Results of hierarchical regression analyses indicated that fear of crime was a significant predictor of both poorer mental health (p < .05) and more avoidance behaviors (p < .001), independent of gender, age, education, household finance, length of residence in neighborhood, household size, living arrangement, physical health and social networks.

Fear of crime had detrimental impacts on mental health of older Chinese and resulted in reduced social participation due to their avoidance behaviors.

Existential anxiety (EA) has been described as the anxiety about the meaning of life, death and the necessity to make choices (Tillich, 1953).Although recent research found EA to be associated with trauma and general psychological symptoms in community samples (Weems et al. 2004), to date, no study has investigated its relationship with trauma exposure and posttraumatic stress disorder (PTSD) symptoms in psychiatric outpatients.

To examine the association between EA and self-reported trauma history and PTSD symptoms in psychiatric outpatients.

Seventy-two stable psychiatric outpatients (mean(SD) age=46.1(14), 55% females) were assessed with the Existential Anxiety Questionnaire (EAQ; score ranging 0-39), the Trauma History Questionnaire which reports on criminal experiences, natural disasters, death exposure and questioning about physical and sexual experiences, and the PTSD Checklist (PCL; score ranging 17-85).

Mean(SD) EAQ and PCL scores were 20.0(7.8) and 40.0(15), respectively. A majority of participants (93%) reported at least one lifetime trauma exposure. Results revealed a positive correlation between existential anxiety and lifetime trauma exposure (r=.28, p< .05).Furthermore, in patients with lifetime trauma exposure, increased EA was associated with increased PCL total score (r=.57, p< .001) as well as with all PTSD symptom clusters: re-experiencing (r=0.45, p < 0.001), hyperarousal (r=.51, p< .001) and avoidance (r=.53, p < .01).

Our findings suggest that EA might be an interesting construct to examine further in the assessment and treatment of PTSD and paves the way for empirical investigations of existential therapies.

The onset of Bipolar Disorder secondary to a stroke event is a rare clinical entity, although few cases of isolated post-stroke depression or post-stroke mania have been reported.

A 65-year-old male patient without previous psychiatric history presented symptoms of mania, with desinhibition, agitation, insomnia and elevated mood after 6 months of a stroke located to the left side of the brain. The patient was treated efficaciously with mood stabilizers and antipsychotics and his symptoms resolved gradually after 3 months. The patient maintained in remission several months, but then almost a year after the manic episode he presented depressive symptoms indicative to start an antidepressive treatment and the remade of diagnosis to Bipolar Disorder secondary to a stroke.

A non-systematic review of PubMed articles since 2000.

Numerous emotional and behavioral disorders occur following cerebrovascular lesions. There is higher ‘cerebrovascular risk’ in elderly patients with late onset Bipolar Disorder, compared to those patients with an early onset. This suggests that cerebrovascular risk may be an important factor for the expression of bipolar disorders in later life, and has significant management implications for older bipolar patients.

The occurrence of a depressive disorder after a neurological disease is a condition classified in the International Classification of Diseases (ICD-10) as an Organic mood [affective] disorders [F06.3], and in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a Mood disorder due to a general medical condition [298.83]. Cerebrovascular disease is associated with an increased risk for depression, with incidence rates of 30-40%. Frequency of post-stroke depression is highest during the first month after the ischemic event, but remains high for several years.

The aim of this poster is to show and discuss some troublesome and complex issues on diagnosing and managing patients with post-stroke depression, based on a case report.

Herein we report a case of a 46-year-old woman, without significant prior psychiatric history, who presented with depressive symptoms after left middle cerebral artery stroke (with cardioembolic source) and right hemiplegia/hemiparesis and motor aphasia sequelae.

Depression has shown to be the most common psychiatric post-stroke complication, and the one associated with a worse poorer functional prognosis. It may be difficult to accurately diagnose a post-stroke depression, particularly in patients with aphasia, anosognosia and other cognitive dysfunctions.

Mortality due to physical illness is greater in schizophrenia than in the general population. Antipsychotics have been linked with weight gain, diabetes and hyperlipidaemia. UK guidelines recommend annual health screens in primary care, and secondary care ensure patients receive this and document results in notes.

To establish whether patients taking antipsychotics received annual monitoring of U&E, FBC, Lipids, Glucose, LFT, weight and blood pressure. Standards for the audit were derived from the Maudsley Prescribing Guidelines and NICE Guidelines on Schizophrenia.

To improve physical health monitoring for our patients.

We retrospectively reviewed 82 case notes. Intervention following initial audit included education of professionals involved in monitoring and inclusion of a Prescribed Medication Monitoring Form in case notes. Re-audit occurred 12 months after initial audit. Statistical analysis used χ2-test with Yates’ Continuity Correction.

Following intervention recommendation of physical health monitoring to primary care increased from 40.2% to 76.8% (P < 0.0001), as did monitoring frequency: Weight (7.3% to 54.3%), BP (7.3% to 49.4%), U&E (64.6% to 82.5%), FBC (61.0% to 78.5%,) Lipids (47.6% to 72.2%), Glucose (59.8% to 79.7%) and LFT (61.0% to 81.3%) (P < 0.05 for all parameters). Documentation of blood results in secondary care notes was also increased (P < 0.05).

Monitoring of physical health comorbidity in patients with serious mental illness was poor in the initial audit. This can be improved in both primary and secondary care by relatively simple measures and by increasing clinicians' understanding of the importance of monitoring.

Sleep problems in children with common psychiatric disorders present a considerable challenge for clinicians in developing effective diagnosis and treatment strategies. Whilst sleep-disordered breathing (SDB) and periodic leg movements in sleep (PLMS) are very frequent in children with attention-deficit/hyperactivity disorder (ADHD) which can deviate sleep architecture, their co-existence in Tic disorder (TD) and ADHD/TD co-morbidity is less well understood.

To investigate the frequency of SDB and PLMS across children with ADHD, TD and ADHD/TD co-morbidity compared with healthy peers.

We asked whether and how the frequency of SDB and PLMS relates to sleep architecture.

Twenty-four children with ADHD, 21 with TD, 21 with ADHD/TD co-morbidity and 22 healthy controls underwent a two-night polysomnography supplemented by monitoring of apnea-hypopnea (AH) and PLMS events per hour of total sleep time.

Compared with controls, only ADHD children displayed a significantly higher AH and PLMS indices. Yet correlation analyses showed significant and negative association between AH and PLMS indices and rapid eye movement (REM) sleep amount in all, the ADHD, the TD (Fig. 1), the co-morbid, and the control (Fig. 2) groups. No such associations with the other sleep stages were found for all the groups.

[Figure 1]

Our preliminary results suggest that

1. (1) presence of co-existing sleep-related disorders may partially explain the contradicting sleep results found so far in children with ADHD,

2. (2) high frequency of SDB and PLMS could be associated with REM sleep reduction regardless of psychopathology.

The authors propose an integrative approach in group work psychotherapy for schizophrenic patient’s relatives. This approach integrates three components into session: psycho education (knowledge for systemic family psychotherapy), cognitive behavior (family solving problem skills) and psychotherapy (reflection and coping strategies). These components are integrative for communication process, which provides their synergetic interaction within the theme educate limits.

Study the effectiveness of a synergetic approach in enhancing the impact of rehabilitation.

Identifying markers of efficacy of the approach through a comparative analysis of the two groups of mothers of patients, one of whom used a synergistic approach, in the other using traditional programs.

SCL-90-R (Derogatis); URICA (McConnaughy); MSPSS(Zimet). Objective conclusion is provided by using Mann-Whitney U-test.

Synergetic integrative approach to group therapy significantly affects the reduction of somatization (p = 0,05), depression (p = 0,01), hostility (p = 0,05) and Global Severity Index (p = 0,05). In participants of the experimental group was significantly higher overall perception of social support (p = 0,01), measures of social support from family (p = 0,05), friends (p = 0,01) and significant others (p = 0,05). Diagnostic stage of psychotherapeutic process showed that participants of the control group mostly are on initial stages of therapy, while the experimental group members are at a mature stage.

Synergetic integrative approach showed high efficiency to work with the families of schizophrenic patients by reducing the level of psychiatric symptoms, enhance feelings of social support and accelerate the psychotherapeutic process.

Many experts claim that transference and countertransference analysis has no place in cognitive behavioural therapy (CBT) and should be used solely in psychodynamic psychotherapy. However, attention paid to emotional and cognitive reactions to the patient or supervisee is the basic component of cognitive behavioural therapy and its supervision, especially if work with difficult patients is supervised.

PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: “countertransference”, “cognitive behavioral therapy” and “supervision”. No language or time constraints were applied. The resources were confronted with our own experiences with psychoeducation in bipolar patients and only most relevant information was included in the text.

Countertransference reaction may be observed especially in our behaviour, but also in our thoughts, emotional experiences and physical symptoms. The essence of countertransference is usually previous experiences of the supervisor which were not adequately processed and thus tend to be projected into current relationships. They may be recognized in work with core schemata and derived rules themselves. They lead to behaviour which may be avoidance (e.g. lack of openness or congruence) or compensatory (e.g. excessive help, competition, showing off). Self-reflection or realizing countertransference during supervision aids in overcoming countertransference reactions and may be crucial for establishing a more real relationship and more objective work in both therapy and supervision. Adequate self-reflection and supervision of one's own work is one of prerequisites for adequate development of the supervisor's competences.

This paper was supported by the research grants IGA MZ ČR 10301-3/2009