Care giving for the HIV/AIDS individual in developing countries has become the responsibility of the family, and an identified primary care giver amongst them, who is subjected to enormous stress in fulfilling that role. Those who adopt healthy coping strategies, render better care to their wards, improving their quality of life.

To study the coping styles among primary caregivers of HIV/AIDS patients.

To assess patterns of coping among primary caregivers of patients infected with HIV/AIDS.

A cross sectional study design was employed. 60 consecutive patients were recruited for the study after consent, from the ART centre of a tertiary care hospital. Socio demographic details were collected, and coping strategies assessed using Active behavioral, Active cognitive and Avoidance coping strategies Scale (Billings & Moos, 1984).

Three patterns of coping were used. Avoidance as a strategy was predominant in older care givers, males, bread winners, influenced by their age, gender and financial independence, respectively. Professionally employed individuals used more coping strategies while those with lower levels of education and employment used fewer strategies, probably an indication of their access to information regarding the illness. Primary carers, for less than a year, used more avoidance; those for more than five years used more cognitive strategies, those between these groups used more behavioral ones.

Intervention for those primary care givers who employ fewer coping strategies, predominantly avoidance would help improving the quality of care rendered to the afflicted individuals and thereby their quality of life.

On the eve of its entry into the DSM-V, hebephilia is a sexual deviance under debate. Few studies describe hebephiles, then who are these sex offenders?

Assess the profile of adolescents sex offenders and their victims, and the characteristics of their penal treatment.

This is a retrospective study carried out from the court records of adolescents sex offenders followed by the State Department on the Enforcement of Sentences of Tours and Chateauroux (France).

31 offenders and 57 victims have been identified.

1. - Concerning offenders: the average age was 37.8 ± 9.4 years. 71% had a job and 51.6% lived in couple. 87.1% had normal or borderline intellectual level. 38.7% had been victimized in childhood, of which 58.3% had experienced sexual violence.

2. - Regarding penal treatment: 42% of subjects were judged by a correctional court, and 58% by a criminal court. 22.6% of subjects were in recidivism. The average length of imprisonment was 7.5 ± 4.2 years. 67.8% of subjects were sentenced to treatment with 48.4% imposed an injunction care. The average duration of treatment was 4.4 ± 3.1 years.

3. - Concerning victims: 57 victims were identified of which 86% were female. The mean age was 14.1 ± 2.1 years. 58.1% of violences experienced were rapes in with 48.4% of intrafamilial. 67% of violence had repeated character.

This French study in which data are comparable to those of the North American literature, provides details on the characteristics of hebephiles that are passed to the act.

To evaluate the efficacy of paliperidone ER in patients with psychotic symptoms, assessing the improvement of positive and negative symptoms and functioning.

An observational, prospective and multicentre study was carried out, collecting in a systematic way all the information after the prescription of paliperidone ER in patients with psychotic symptoms with a 12 weeks follow up. Baseline visit (V0), 15 day visit (V1), one month visit (V2), two month visit (V3) and three month visit (V4).The primary variable of efficacy used was the assessment of severity in symptoms with the ICG-S scale. Other variables of efficacy used were PANSS and ICG-C scales in all visits and PSP scale at baseline visit and final visit. At baseline visit medical and psychiatric history were collected.

Paliperidone ER treatment was initiated in 26 patients with a mean age of 35.6 years old (SD 11.62). The main reason of treatment initiation with paliperidone ER was the lack of efficacy of other previous treatments in 12 patients (46.15%), followed by lack of tolerability in 5 patients (19.23%). The used dosage ranged between 3 and 18 mg/day, mean dosage of 8.28 (SD 3.16). There was a statistically significant decrease of the PANSS scores throughout the study in positive, negative and global symptoms .There was also a statistically significant reduction of ICG and PSP scores throughout the study.

Paliperidone ER was effective in the treatment of the psychotic symptoms on both positive and negative symptoms and also in functioning.

Stigma of mental illness can be defined as a set of stereotypes and prejudice established in the society that leads to discriminatory behavior against people who suffer from a psychiatric condition. Mental illness stigma is widely spread in community and reaches not only general population but also health professionals. The impact of these negative attitudes in mental ill people is severe and is becoming more relevant as mental illness gets more prevalent.

To characterize and evaluate attitudes and prejudicial reactions adopted by a population of medical students and doctors from psychiatry, internal medicine and surgery that study/work in Braga's region (North of Portugal).

Students and professionals were surveyed using a socio-demographic questionnaire and AQ27 questionnaire - Portuguese version, a validated questionnaire to measure stigmatizing attitudes and reactions. A total of 353 questionnaires were collected. Response rate was 68,8% among doctors (n=150) and 32,6% among medical students (n=203). Scores between groups and contributes of age, sex and past experience were analyzed with linear regression modeling.

High scores in several stigmatizing attitudes were found in both medical students and professionals. Psychiatrists displayed lower levels of stigmatizing attitudes in all categories analyzed, except “pity” which was dependent on age of responders. Interestingly, students showed significantly lower stigmatizing attitudes in help, pity and avoidance. No differences were found between groups among coercion and segregation.

The results show that both medical students and professionals, including psychiatrists, exhibit stigmatizing attitudes, which should be specifically addressed in order to improve care.

The conventional two-class psychiatric conceptualization of PTSD has been criticized for ignoring the existence of “trauma without symptoms” and “symptoms without trauma”.

To present and test a new four-class conceptualization of the relationship between trauma and symptoms that responds to the above criticism. The proposed four classes are: PTSD (high trauma and high symptoms); Resilient (high trauma but low symptoms); Stress Prone (low trauma but high symptoms); and Ideal Norm (low trauma and low symptoms).

To demonstrate fit between new conceptualization and empirical data.

Sample: 673 adults age 18-19. Measures: a trauma index incorporating five types of frequently experienced potentially traumatic events; a standardized 16 item measure of posttraumatic stress symptoms; multi-item scales of two protective factors (social support and self efficacy). Statistical procedures: cluster analysis and ANOVA.

Statistical cluster analysis produced four classes of individuals: 19% of sample had high trauma and high symptoms (PTSD); 23% had high trauma and low symptoms (Resilient); 21% had low trauma and high symptoms (Stress Prone); and 36% had low trauma and low symptoms (Ideal Norm). “Resilient” and “Norm” groups also had high “protection”. Four-class model was a better fit to data than two-class model.

The proposed re-conceptualization, using four classes and incorporating protective factors, better describes the empirical trauma-symptom relationship than the conventional two-class psychiatric conceptualization of PTSD; and begins to clarify the psycho-social dynamics of the trauma-psychopathology relationship.

Capgras syndrome is a misidentification syndrome typically characterized by the delusional belief that a close relative has been replaced by an impostor. This monothematic delusion can be found in numerous disorders such as paranoid schizophrenia, schizoaffective disorder, affective disorders, Alzheimer's disease, Lewy body dementia, head trauma, epilepsy, cerebrovascular disease and dementia, pituitary tumor, multiple myeloma, multiple sclerosis, viral encephalitis, frontal lobe pathology and AIDS. We present a case of a patient that presents Capgras Syndrome at the first psychiatric evaluation in the context of three-decades untreated paranoid schizophrenia.

A 56-year-old woman was brought to the psychiatric department for evaluation for aggressive behavior directed to relatives. She has a history of auditory hallucinations, experiences of self-reference and paranoid delusions with more than 30 years of evolution. More recently, she started becoming aggressive with relatives, saying her real family members had been taken by strangers to an unknown hospital. She also said that her ID photo had been replaced by another person's photo. After detailed psychiatric evaluation, blood analysis and imaging study, the diagnosis of Paranoid Schizophrenia was established. She was treated with olanzapine 20mg/day with behavioral improvement.

Although Capgras Syndrome is not a psychiatric diagnosis but a feature of several different conditions, psychiatrists should be aware of this syndrome as it can signalize underlying psychiatric disorders and is usually associated with violent behaviors that should be managed.

Musicians are a population often stereotypically linked to a wide range of substance use behaviors. A number of convenience studies provide support for the perception of disproportionately high substance use rates by musicians.

An association between alcohol and substance abuse and musical activity has been reported previously. However, up until now, no study has been carried out on the relationship between Internet overuse and musical activity.

The aim of this study was to evaluate Internet addiction among adolescents and to examine the correlation between problematic Internet use and musical activity.

The study was conducted among 1905 students, aged between 14 and 18 years. Internet Addiction Test (IAT) and a sociodemographic query form were used in the collection of data. Students were also asked if they were regularly engaging in a musical activity.

The students with problematic Internet use and Internet addiction were more likely to engage in musical activity than students with avarage Internet use (p<0.001). Adolescents who regularly engage in a musical activity scored higher on IAT than adolescents who do not (36.3±17.5, 28.9±14.9, respectively; p<0.001). Additionally, students who regularly engage in a musical activity were found to spend more time on Internet when compared to those who do not (p<0.001).

These results indicate an association between the Internet addiction and musical activity. We hope that future studies will fruitfully draw upon our exploratory findings in order to generate a more nuanced understanding of the nature and implications of Internet addiction among musicians.

Paraphrenia is a disorder similar to paranoid schizophrenia characterized by phantastic, paralogical and extraordinary imaginative delusions, with better-preserved affect and rapport and much less personality and cognitive deterioration. Most affected patients are women, with onset of symptoms in late adulthood. It was firstly systematically described by Kraepelin in 1913 in order to define a group of psychotic patients who exhibited characteristic symptoms of dementia praecox, but with minimal disturbances of emotion and volition, and marked delusions. Later, it was considered to be unfounded and the term paraphrenia was not included in the current DSM-IV-TR and ICD-10 diagnostic criteria. However, several authors suggest that the concept of paraphrenia has not lost its usefulness and it seems to be that some psychiatrists recognize the illness, but labelled it as atypical psychosis or delusional disorder for the lack of a better diagnostic category.

The aim of this poster is to underline the modernity of Kraepelin's paraphrenia concept, suggesting that it could be possible to define and recognize the illness if practitioners would be induced to use a viable diagnostic entity.

Herein we report a case of a 51-year-old woman who presented three years ago with a psychotic disorder whose clinical features resemble de classical description of paraphrenia.

Very few systematic studies on paraphrenia have been carried out in the past 70 years. Further research in this field is needed in order to recognize the viability of this diagnosis and provide patients a better care and therapeutic management.

Self-image is developed by the way in which adolescents think, feel and behave and it arises from the person's body image during preadolescence. problematic A considerable amount of literature published so far on Internet addiction reveals that it is a worldwide phenomenon.

Internet use involves an individual's inability to control his or her use of the Internet, negative consequences (e.g., failing in school, decreased productivity), and marked distress and/or functional impairment Until now, no studies were performed to investigate the relationship between Internet addiction and self-image.

The aim of this study was to evaluate Internet addiction among adolescents and to examine the correlation between problematic Internet use and self-image.

We assessed 1912 high school students, aged between 14 and 18 years. Internet Addiction Test (IAT), Offer Self- Image Questionnaire (OSIQ), and a sociodemographic query form were used in the collection of data.

According to the IAT, 201 students (10.5%) were found to be a ‘problematic Internet user’ or an ‘Internet addict’. The students with Internet addiction scored lower on all subscales of OSIQ (impulse control, emotional tone, body image, social Relations, vocational and educational goals, family relations, mastery of the external world, emotional health and superior adjustment), except sexual attitudes. A significant negative correlation between daily OSIQ subscales and IAT and weekly Internet use was found.

The results of this study showed that Internet addiction was related to the development of the self-image, which is a crucial psychological structure gained in adolescence.

Delusion is one of the most characteristic features of all psychotic disorders. It is an essential symptom for both paranoid schizophrenia and persistent delusional disorder. Although delusion in schizophrenia is described as unorganized and organized in persistent delusional disorder, the delusional themes within these psychosis are relatively similar, with the exception of bizarre delusion which is considered as belonging to schizophrenia.

Identifying the types of delusions in long-term evolution of patients with paranoid schizophrenia and persistent delusional disorder and comparing the frequency of their occurrence in the two groups.

Highlighting significant differences in the frequency of delusional themes in long-term evolution of the two groups of subjects with the diagnosis we mentioned above.

We formed a sample of 60 subjects with persistent delusional disorder and a sample of 34 subjects with paranoid schizophrenia. Patients from both groups had an average course of illness of 10 years. We have quantified for each patient the number of hospital admissions during which they tested positive for a certain type of delusion.

Within the persistent delusional disorder group the most frequent type of delusion was of persecution, followed by delusions of reference. Delusions of persecution and delusions of being followed found to be the most common delusional themes in the paranoid schizophrenia group.

We have not found significant differences between the two groups regarding the type of delusions, with the exception of bizarre delusions. The paranoid theme is the most common theme for both types of pathologies.

A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.

To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.

All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.

N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).

Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.

Research suggests that internalized stigma of mental disorder (which reflects the degree to which a person holds internalized stigmatizing beliefs about mental illness) leads to decreased self-esteem, depression, delayed seeking of treatment, prolonged course of illness, poor outcome, social withdrawal, reduced self-efficacy and worsening of quality of life.

On a sample consisting of 40 outpatients with ICD-10 diagnosis of schizophrenia, with average age of 40.73 (SD= 9.168) and mean illness duration of 15.525 (SD=8.202) years, we administered the Internalized Stigma of Mental Illness Scale, the Rosenberg Self-Esteem Scale, the Manchester Short Assessment of Quality of Life and Beck Depression Inventory II. The questionnaire also included several socio-demographic and clinically-related variables.

Schizophrenic patients showed a moderate level of internalized stigma (M= 40.125, SD= 9.946). Patients with higher levels of internalized stigma had significantly poorer quality of life (r= -0.422) and lower self-esteem (r=-0.318). There was a positive correlation between the level of depressive symptomatology and the level of internalized stigma (r=0.385). Correlation with the duration of illness was not statistically significant (r=-0.145).

Our results confirm the data of numerous researches, as well as our earlier findings on the negative effects of internalized stigma of mental disorder on self-esteem and quality of life in panic disorder patients. In order to improve the quality of life of schizophrenic patients, we should increase awareness of the negative effects of internalized stigma and focus interventions on altering stigmatizing attitudes and enhancing coping skills.

Hyponatremia is an antidepressants known adverse effect, ADH secretion has been postulated in its etiology.

To identify risk factors for hyponatremia induced by antidepressants and psychopharmacologic alternatives.

Literature search was performed in PubMed. We report of a case of recurrent hyponatremia treated in our center: woman, 57years old, HIV, HCV; performing 4 episodes of severe hyponatremia in 5 months of treatment involving thiazide, venlafaxine, citalopram, olanzapine,haloperidol, enalapril, escitalopram.

Risk of hyponatremia is higher in patients treated with antidepressants (OR = 2.97), especially serotoninergic antidepressants (OR = 3.96). Elderly and thiazide increment that risk (OR = 6.31 and OR = 8.4 respectively), specially age, thiazide and SSRIs (OR = 148). Higher prevalence in females, lower limit levels of sodium and low body weight. All SSRIs are likely to produce hyponatremia. The effect appears in the first month, it's not dose-dependent and recovers by interrupting treatment. Some cases have been reported following re-exposure to the same or different antidepressant: fluvoxamine and paroxetine (Arizon, 2002), duloxetine and escitalopram (Stovalle, 2009), sertraline and fluoxetine (Raphael, 2010), sertraline and citalopram (Pure, 2011).

Early detection is important, as well as the evaluation of concomitant risk factors in all patients starting antidepressant. Some asymtomatic cases can be unnoticed by clinicians, so risk patients it seems necessary to control ion pretreatment periodically, and to chose safer treatments (bupropion, agomelatine, mirtazapine and reboxetine). In our case, age, sex, concomitant diseases, low sodium and low weight were determinants for the recurrence of the disorder.

In the field of drug abuse treatment, noncompletion and negative outcome is a general problem.

Outcome of hospital treatment of opioid dependence was examined.

The purpose of the present study was examination of a cohort of patients treated at Centre for treatment of drug addiction at the beginning of the treatment, after three and six months.

A group of 113 patients consecutively admitted to a closed detoxification unit between October 2011 and September 2012 were assessed. Positive outcome of the treatment is defined as complete abstinence in the 28 days before review. Baseline data were obtained using The Treatment Outcomes Profile (TOP), The Drug Addiction Treatment Efficacy Scale (DATES), and a semistructured research interview for obtaining information on patient's sociodemographic characteristics. Follow up scores of TOP and DATES have been recorded after three and six months.

Fifty-two patients completed 6 weeks of detoxification program. After 3 months 45 of 84 evaluated subjects (53%) had a positive outcome, 14 patients (12%) abused heroin and 36 patients (32%) abused other drugs. After 6 months 14 of 52 evaluated patients (27%) had a positive outcome and 9 patients (8%) used heroin.

The share of patients with positive outcome peaked at 3 months, however the decreased use of heroin was sustained throughout the observation period.

Psychogenic polydipsia associated with hyponatremia is a potentially dangerous and fatal condition observed on patients with psychiatric illness, specially schizophrenia. This results on a peripheral oedema and can lead to cerebral oedema, mental status deterioration and intracranial hypertension if not identified and treated urgently. We present a case of polydipsia as first signal of psychosis.

20-year-old man without significant past medical or psychiatric history attended to emergency service presenting exuberant lower limbs oedemas. The analytical study stated an hyponatremia and hipo-osmotic urine. A psychiatric evaluation was made after organic illness exclusion. The patient presented serious behaviour changes, delusions and eating disturbances (“eat raw meat to recover the red cells that they had stolen from him”), polydipsia and auditory hallucinations with 2 weeks of evolution. The patient was compulsory hospitalized, treated with risperidone and lorazepam and discharged 28 days after admission without psychotic symptoms.

The recognition and management of the polydipsia as a first signal of psychosis are difficult because sometimes patients are uncooperative and tend to hide their water intake, but is important to be awhare to this signal to prevent the morbidity and mortality associated with this disease.

Many commonly prescribed drugs have anticholinergic properties which can induce side-effects e.g. delirium, especially in an ageing brain with increased sensitivity. Risk-assessment before starting therapy may prevent such sideeffects.

We rated anticholinergic pharmacological properties of prescribed medication and compared the theoretical risk with side-effects in clinical practice.

The scale should improve the safety of pharmacotherapy in gerontopsychiatry.

Based on five publications that considered anticholinergic properties of drugs, a risk-scale was established. Riskpoints for all drugs were summarized to a total score. Patients were selected from TDM-requests and data on patients’ sideeffects obtained from medical files. Reported anticholinergic side-effects including delirium were assessed retrospectively by the UKU-rating scale. Using linear regression and Spearman's correlation-analysis a possible correlation between risk-score points and severity of side-effects was determined.

The screened sample consisted of 53 patients. 38 patients aged from 64 to 89 years (mean 74±6, 63.2% women) could be included for analysis. They had 93 plasma-level determinations (mean 2.4 requests per patient). According to their medication, patients attained by mean 4.51±2.98 risk-points (range 0-16). Mean UKU severity-index of side-effects was 0.81 (±0.99). Risk-points correlated significantly with observed anticholinergic side-effects and delirium (R2=.631, P< 0.001, CI 95%). Spearman correlation-coefficient was 0.731 (P< 0.01, CI 95%).

Since the established risk-scale correlated well with reported anticholinergic side-effects we recommend to implement this in the planning of psychopharmacological treatment to improve the safety of pharmacotherapy in gerontopsychiatry. For practical reasons it should be amalgamated with therapeutic drug monitoring as Geronto-TDM.

Mild cognitive impairment (MCI) is considered today to be a prodromal stage of Alzheimer's dementia, but without standardized pharmacotherapy.

To follow the outcome of patients diagnosed with MCI treated with nootropics, alternative herbal agents, cholinesterase inhibitors.

To assess the efficacy of early treatment in MCI.

200 patients (over 60 years) diagnosed with MCI were evaluated using the MMSE (Mini Mental State Examination) scale at screening, after 1 and 2 years of treatment. They were divided in four groups:

• A -50 patients treated with Piracetamum 1600mg/day

• B -50 patients treated with Rhodiola-rosea, 2capsules/day

• C -50 patients treated with Galantamine, 16mg/day

• D -50 patients not treated

The improvement of the MMSE score was as following:

[Results].

Comparing the outcome of treated and non-treated groups, we observed that the early treatment of MCI delays the transition to dementia. The outcome of the treated groups after 1 year of treatment was approximately the same. Longtime treatment shows a better improvement in the group treated with cholinesterase inhibitors (Galantamine) compared to the other treated groups, but not statistically significant. Galantamine improves cognitive function. This study proves the necessity of early treatment for MCI to delay the transition to dementia.

We have conducted clinical-immunological examination of 90 patients with adjustment disorder (F 43.2).

From positions of clinical-dynamic approach, adjustment disorders have been differentiated depending on stage of development of disease: neurotic reactions (breakdown of mental adaptation), neurotic states (clinical full-blown states with sufficiently persistent neurotic symptoms and completion of formation of leading syndrome) and protracted states (developments, characterizing transition of the disease into chronic course).

Diagnosis of clinical manifestations of secondary immune deficiency has shown increase of incidence rate of allergic and autoimmune syndromes in persons with adjustment disorder with protracted states as compared with previous stages of development of the illness. At this stage, we have more frequently observed combination of several syndromes of immune deficiency.

Comparative analysis of immune and hormonal statuses has revealed the most informative indices, which characterize stages of development of adjustment disorders, and namely: total number of T-lymphocytes (CD2+-phenotype), level of serum IgM, indices of spontaneous and stimulated variants of NBT-test, level of cortisol and free thyroxin (T4).

Totality of alterations of revealed immunobiological indices is typical for every stage of disease that alongside with clinical signs of immune deficiency allows considering of them as an additional criterion in differential diagnostics of adjustment disorders.