Electroconvulsive therapy (ECT) is a treatment alternative in bipolar disorder (BD) depression. Cognitive side effects are the major concern limiting its use.

We present data from the Norwegian randomized controlled trial of ECT in treatment resistant depression in bipolar disorder.

To compare effects on cognitive function of ECT or algorithm based pharmacological treatment at the end of a six-week acute, BD depression treatment trial.

Prospective, randomised controlled multi-centre, six-week acute treatment trial. Pre- and post-treatment assessments with the MATRICS Consensus Cognitive Battery (MCCB); a neuropsychological test battery designed to be sensitive to changes in cognitive function.

N = 51 patients ≥ 18 years fulfilling criteria for treatment resistant BD depression (MADRS score ≥ 25).

ECT group: Three sessions per week for up to six weeks, total up to 18 sessions, and right unilateral electrode placement. Algorithm-based pharmacological treatment group: Based on Goodwin & Jamison, 2007.

Both groups showed a net gain on MCCB scores without significant differences between the study groups. Mean change in MCCB composite T-score was 4.0 (5.7) in the ECT group and 2.7 (3.6) in the pharmacological group (F = 0.78, eta2 = 0.021, p = 0.383).

In treatment resistant BD depression ECT and algorithm-based pharmacological treatment have comparable effects on cognitive function assessed with the MATRICS.

Cognitive dysfunction is a core feature in the course of bipolar disorder (BD) and persists during the remission periods. Only few studies valueted separately patients with BDI and BDII.

To analyze the pattern of neurocognitive dysfunction between healthy controls and euthimic patients with BDI and BDII.

27 patients with BD (17 BDI patients and 10 BDII patients, according to DSM IV TR) and 20 controls underwent a neuropsychological battery. The inclusion criteria for the bipolar groups was an Hamilton Rating Scale For Depression's score ≤ 7. The neuropsychological battery consisted of:

1. i) the Mini Mental State Examination

2. ii) The Corsi and the verbal span, to assess the short term memory;

3. iii) the Rey Auditory Verbal Learning Test (RAVLT) and the logical memory test, to assess the long term memory;

4. iv) the progressive Raven Matrices, to assess the logical - abstractive capacity

5. v) The frontal assessment battery and the phonetic verbal fluency, to assess the executive functions

6. vi) The continuos performance test to assess the selective attention.

Patients affected by BDI performed significantly worse to controls when the short term spatial memory, the long term verbal memory, logical abstractive capacity, the executive functions and the selective attention were measured (p< 0,05). Patients affected by BDII performed significantly worse (p< 0,05) to controls when the long term verbal memory was measured.

Euthimic Patients with BDI disorder seem to have a more severe cognitive profile respect of BDII patients.

The primary objective was to assess the reasons for antipsychotics switch to amisulpide and to evaluate the outcome at 6±1 months following the switch from any antipsychotic drug(s) to amisulpride (Solian®).

This is an open, non-randomized, multicentric, retrospective, non-interventional study that included 1165 subjects who were already stabilized on amisulpride for at least 6±1 months. These patients were previously switched from other antipsychotic to Solian®. Data were collected retrospectively on the patients’ status 6±1 months ago and their present status.

Reasons for switching previous antipsychotic treatment: inadequate control of symptoms in 79.3% of the patients, relapse of the disease under treatment 54.5%, adverse reactions 61.9%, reduced compliance 49.1%, comorbities 7.7%, patients request 28%, family request 24.5%, high cost 1.8%. Reasons for choosing Solian®: quality of life improvement 20.3%, cognitive function preservation 18.7%, better efficacy on positive symptoms 18.7%, better efficacy on negative symptoms 15.1%, low risk of extrapyramidal symptoms 12.3%, reduced weight gain 9.8%, minimal interactions with other drugs 4.2%. The compliance was significantly improved (61%), moderately improved (16%), unchanged (7.6%). Adverse reactions were significantly improved (53.5%), moderately improved (18.5%), unchanged (8.9%), minimum worsening (0.2%), medium worsening (0.1%). The efficacy was significantly improved (69.8%), moderately improved (19.2%), unchanged (2.2%), minimum worsening (0.1%).

The main reasons for antipsychotic switch were the inadequate control of symptoms, relapse of the disease under treatment and adverse reactions. Psychiatrists’ evaluation of the switch outcome at 6±1 months following the switch underlined significant improvement of compliance, adverse reactions and treatment efficacy.

To evaluate characteristics of the antipsychotic switch from any antipsychotic to amisulpride (Solian®) through the integration of the significantly variables.

This is an open, non-randomized, multicentric, retrospective, non-interventional study that included 1165 subjects who were already stabilized on amisulpride for at least 6±1 months. These patients were previously switched from other antipsychotic to Solian®. Data were collected retrospectively on the patients’ status 6±1 months ago and their present status.

The population consisted of 38.5% hospitalized patients at the moment of antipsychotic switch and 61.5% outpatients; 56.3% of the patients were in acute exacerbation at that moment. Previous treatment of the patients: 100% antipsychotic, 17.9% antidepressant, 38.8% mood stabilizer, 39.4% benzodiazepine and 22.2% other treatments. Switch type: sudden in 63.7% of the patients, gradual in 35.4% and unknown in 0.9%. The mean dosage of Solian at initiation was 581.04 mg/day. For 38.1% of the patients the initial daily dose of Solian® was of 600 mg, for 29.6% of them 400 mg and for 22.7% 800 mg. The mean dosage of Solian during the 6±1 months was 571.39 mg/day. For 39.8% of the patients the daily dose of Solian® was of 600 mg, for 30.5% of them 400 mg and for 20.7% 800 mg.

The switch to Solian® was made suddenly in a majority of patients, preferred start dose being 600 mg, while the mean dose was similar to baseline values (in almost 40% of cases) or smaller during the 6±1 months of the study.

The lack of social skills and self-image distorsions are frequently met in the avoidant personality disorder (APD) and although the personality disorders are egosyntonic, subjects could experience prolonged dysforic episodes and a will to change their relationship patterns.

To evaluate the efficacy of social skills training on the overall APD features and on the self-image distorsions, in particular.

A group of 12 subjects with APD, diagnosed using Structured Clinical Interview for Axis II Disorders of DSM IV (SCID II), were included in a psychotherapy program focused on social skills training with 2 sessions per week, for 3 months, with a follow-up visit after 6 months from baseline. These patients were included in an individual therapy (12 sessions) and group therapy (12 sessions). All of these subjects were monitored using a semi-structured interview focused upon the avoidant-type cognitive schemata and self-image related automatic cognitions. A diary was held by every patient and cognitive restructuring was monitored, as well as the effect of role-playing, imaginative and in vivo exposures.

The social skills training decreased the occurrence of social exposure associated discomfort, self-image self-reported automatic cognitions (as reflected by the diary entries). The overall evolution reflected an increase in self-confidence and a more stable sense of self in relationships, although the SCID II confirmed the maintenance of the APD diagnosis at follow-up visit.

Social skills training has a positive impact over the self-image, decreasing the social exposure discomfort and inadequacy feelings in the patient relationships.

Drug-related disorders are observed in 30–50% of the patients diagnosed with schizophrenia and is therefore an important problem to be adressed in clinical practice. There are many reasons for the overlap between addictive disorders and schizophrenia: the tendency to alleviate antipsychotic-related side effects, the need to decrease anxiety or depression, to interfere with sensory gating defficits etc.

To assess the effects of atypical antypsychotic treatment in decreasing the drug of abuse consumption in a population of schizophrenia diagnosed patients.

A group of 23 patients, diagnosed with schizophrenia and a drug related disorder (dependence 52.1%, polisubstance dependence 17.4%, substance abuse 26%, other 4.5%), according to DSM IV TR criteria, were monitored for 6 months, while being treated with atypical antipsychotics (olanzapine 43.4%, risperidone 34.7%, aripiprazole 17.4%, amisulpride 4.5%), using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Clinical Global Impressions (CGI) and Inventory of Drug Taking Situations (IDTS) every 4 weeks.

The evolution of IDTS scores were not parallel to the PANSS evaluations: while the psychotic symptoms decreased continuously during the 6 months of the study (-40.5% at week 12 and -67.5% at endpoint), the IDTS decreased initially (- 33.2% at week 12) but increased slightly to the end of the study (-31.2% at endpoint). The CGI-I score has a decrease of 50.4% at week 12 and of 55.6% at week 24.

The evolution of drug related disorders during the atypical treatment of schizophrenia doesn’t correlate with the severity of psychosis and necessitates a specific management.

There is a lack of evidence for the efficacy of stimulant pharmacotherapy in patients with substance dependence and comorbid attention deficit hyperactivity disorder (ADHD).

The aim of the present trial was to test the efficacy and safety of 180 mg extended release methylphenidate for treating ADHD in patients with amphetamine dependence.

54 incarcerated men, mean age 42 years, meeting the DSM-IV criteria for amphetamine dependence and ADHD were randomized to methylphenidate or placebo in a 24-week randomized double-blind, placebo-controlled trial, with parallel groups design. The medication started within 14 days before release from prison and continued in outpatient care with twice weekly visits including once weekly cognitive behaviour therapy. The primary end point was relapse to any drug use measured by urine toxicology. Secondary endpoints included relapse to amphetamine use, retention to treatment, and change in selfrated ADHD symptoms.

The methylphenidate group had significantly fewer drug positive urines compared to the placebo group (95% CI -0.31 to -0.05, P=.034), fewer amphetamine positive urines, (95% CI -0.36 to -0.07, P=.019) and better retention to treatment (95% CI 15.64 to 78.58, P=.001). Compared to the placebo group, the methylphenidate group also significantly reduced their selfrated ADHD symptoms (95% CI -21.09 to -3.37, P=.008) during the 24-week treatment.

This is the first randomized clinical trial to demonstrate the efficacy of a stimulant treatment for substance dependent individuals with ADHD. The treatment with MPH led to reduction in drug use and a clinically relevant improvement of ADHD symptoms.

Immigrants may experience several negative consequences as a result of their migration including discrimination, unsatisfactory economic conditions, and rejection from the host countries, which may contribute to psychiatric illness and vulnerability to suicidal behaviors. The purpose of the current study was to determine whether or not the theorized components of measured dimensions of suicidal ideation and psychopathology vary across samples of Italians and immigrants.

We investigated 310 Italians and 322 immigrants, who were administered self-report questionnaires to assess temperament (TEMPS-A), hopelessness (BHS), personality (EPQ-R), and self-other perception (9AP).

Multi-group Confirmatory Factor Analysis presented a final model with an excellent fit to the data (x2(53) = 57.56; CFI = .994; RMSEA = .014), significantly better than the previous models, showing the same pattern of relationships between suicidal ideation and psychopathology across Italians and immigrants.

Although immigrants represent a unique population and may experience specific stressors contributing to psychopathology and suicide risk, our findings suggest that the samples of Italians and immigrants may be more similar on the study variables under investigation than previously thought. Implications are offered for the improved identification and treatment of immigrants and resident citizens in Europe in general and in Italy in particular.

Several investigations have shown the influence of environmental factors, i.e. seismic activity on human health. However, no studies have focused on the effect of earthquakes on mental health. Crete is located within a rectangular region at the boundaries of Eurasian and African tectonic plates with high seismicity.

To investigate the effect of seismic activity on mental health.

To explore possible association between seismic activity and rates of hospital admissions of psychotic patients.

We compared the seismic activity (EQs with magnitude M>2) in a geographical area of Crete, and admissions to the Psychiatric Inpatient Unit/ University General Hospital of Heraklion, Crete during the years 2008–2010.

Our analysis showed (1) a very low rate of admissions of psychotic patients suffering from acute psychotic disorders, during the period with several great (M>6.4) and middle (4.5< M< 6.4) magnitude period earthquakes (EQs), (2) an increasing trend of admissions of acute psychotic disorders during a period with increasing number of relatively small EQs(r=0.667; p< 0.001), (3) a correlation between the number of total monthly admissions and the number of M>2 EQs.

It appears that strong EQs have a protective effect on the relapse of major psychiatric disorders, whereas small EQs are associated with an increasing number of relapses. We hypothesized that the beneficial/adverse effects are related to anomalous electric fields/Extra Low Frequency (ELF)-Ultra Low Frequency (ULF) emissions.

Differentially study the effect of antidepressant Cipralex on higher cortical function and on affective patients with rheumatoid arthritis.Characteristic of the material: For the study groups were formed with the diagnosis rheumatoid arthritis, remission. All patients received standard therapy non-steroidal anti-inflammatory drugs and antidepressant Cipralex.

Should first be noted that the study confirmed the clinical efficacy of the Cipralex in therapy of anxiety and depressive disorders in RA. Therapeutic results were achieved in most cases. (98%)

In summary, these data show the effectiveness of the complex treatment of RA. The quality of life in patients with RA affects of factors, including not only the patient's medical condition, but also affective and cognitive areas. The study found the optimizing effect of the drug on cognition. This is evidenced by the fact that on the background of therapy by Cipralex was reduction in the total amount of time required to perform the test tasks and reducing the number of mistakes.

Results obtained in the study of data leads to the conclusion that Cipralex may be included in the complex therapy of patients with RA.

Every year 4,000 to 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many youth have risky behaviours and mental health issues that put them at risk for sexually transmitted infections (STIs).

Document the prevalence of STIs (chlamydia and gonorrhoeae) among adolescents aged 14-17 years old entering Quebec residential YPCs and identify associated risk factors.

In 2008–2009, adolescents residing in six YPCs completed a questionnaire covering sexual and substance use behaviours, as well as other health issues affecting their well-being. Urine samples were collected for Chlamydia trachomatis (CTGI) and Neisseria gonorrhoea (NGGI) genital infections.

Among 578 participants, 14-17 years old, 89% were sexually active. Risk behaviours included: early sexual initiation (66% < 14 years); multiple partners (median: girls 5, boys 8); group sex (girls 38%, boys 43%); sex for money or goods (girls 27%, boys 8%). Half of sexual relations were under the influence of drugs/alcohol. Regular substance use (3x weekly and +) was: tobacco: 75.0%; cannabis: 63.1%; alcohol: 24.2%; amphetamines: 16.7%; and cocaine: 7.4%. Prevalence of CTGI: 9.3% girls, 1.9% boys; NGGI: 1.7% girls, 0% boys. In multivariate analysis, factors significantly associated with chlamydia infection among girls were: alcohol intoxication hospitalisation or history of suicide ideation with plan.

Serious alcohol misuse or mental distress were significantly associated with STI infections among adolescents. Mental health professionals are encouraged to provide sexual health and substance use counselling with adolescent patients given the highly woven interaction between mental distress and risk of sexually transmitted infections.

Transitions from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) can often be problematic due to high eligibility thresholds, inconsistent support during transition and limited participation from young people. The TRACK Study highlighted several clinical, organizational and policy related reasons for Services to develop and implement transition protocols effectively.

This audit aims to examine whether the Trust's Transitions Policy is adhered to during transitions of young people across services. It also aims to review the qualitative experience of young people and professionals involved.

A Questionnaire Survey method was used to collect quantitative and qualitative data from involved professionals and young people who moved from CAMHS into AMHS (Aug11–Jan12). The data was analyzed against the audit criteria, which relate to specific aspects of the Transitions Policy.

A variable response rate showed that majority of the young people and involved professionals were satisfied with the planning and transfer of care with high policy adherence rates. Young people wished for better communication, more information on the nature of services offered and greater support, while professionals hoped for greater consideration of engagement levels and joint working. Alternative support was requested for declined referrals.

Improved adherence to the Transitions Policy can be achieved through proper planning, better communication, more joint working and regular feedback from young people and professionals. It can also help to achieve higher standards and continuity of clinical care to meet the needs of young people.

“I watch death” it is an English mnemonic acronym for the myriad causes of Delirium. It characterizes for sudden onset, low consciousness, attention and cognition levels. Although its origin is because of different organic disorders, it is usually consulted to the mental health services because of its psychopatology. An early detection and the subjacent cause treatment are fundamental.

We performed a retrospective analysis of those patients visiting the Emergency Services and/or hospitalized in San Agustín's Hospital of Linares and being subsequently diagnosed of delirium by the liaison psychiatry team during the year 2011. We studied the following variables: medical diagnostic, sex, age, comorbidity and psychopatology, A follow-up of the patients was also done.

The 5% of 299 liaison psychiatry consultations corresponded to patients with delirium. Traumatology and General Medicine generated the 72% of the consultations to liaison psychiatry team. All patients were male, 50% of them were under 40 and older than 60 years. They had several comorbid factors such as polytraumatism, post-surgery, previous brain damage, ischemic heart disease, HIV, etc. The most widely used drug treatment for mental symptoms was low-dose of haloperidol, according to clinical guides evidence. A 25% of patients died within two weeks after the consultation to liaison psychiatry team despite treatment of the subjacent cause.

As a result of our findings we coordinated a clinical session with others Hospital Departments to improve clinical care for these patients in order to improve the early diagnostic and intervention.

Describe cases related to reactive attachment disorder.

Describe diagnosis of reactive attachment disorder and its limitations.

Describe treatment options for reactive attachment disorder.

Be familiar with diagnosis of reactive attachment disorder.

Be familiar with treatment options.

Be familiar with challenges in complex scenarios.

Case of a 15 year old black female with history of neglect, legal issues, school truancy, witness to domestic and community violence who presents with escalating aggressive behavior and affective instability.

Literature review focusing on treatments options in complex scenarios.

Many children are suffering from “maltreatment” and there are difficulties with making an appropriate diagnosis due to co-occurring symptoms and potential differential diagnoses; therefore treatments are limited.

The disorder warrants further research especially in addressing the timing and critical period for an intervention. The disorder necessitates a multi-modal approach in particular a collaborative approach involving in home services with the child and caregiver. The disorder becomes even more complex when dealing with patient populations with intergenerational adversity and the patterns of disordered attachment are evident.

Mental disorders are not uncommon in late life. The emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians assessing and treating elderly persons with mental illness.

To determine the clinical characteristics and cognitive function impairments in elderly patients with late-onset psychosis compared with normal healthy control.

A cross-sectional case-control study; 50 patients with late-onset non-schizophrenic psychoses compared to 50 normal, healthy volunteers matched for age, sex, and social standard. The case group was interviewed using the Structured Clinical Interview for DSM Axis-I diagnosis (SCID-I), the control group was chosen on basis of assessment using the General Health Questionnaire (GHQ). Both groups underwent a functional assessment of daily living using the following: (a) Activities of Daily Living scale (ADL), (b) Instrumental Activities of Daily Living (IADL), (c) Cambridge Mental Disorders of the Elderly Examination, section B (CAMCOG), and (d) the Wechsler Adult Intelligence Scale (WAIS) for cognitive assessment.

No significant differences between both groups in sociodemographic variables, family, and medical histories, except occupational status, in case group they had significantly more professional and skilled jobs. They also showed significantly higher rates of diseases of the gastrointestinal, renal, and central nervous system. Moreover, they showed very high significant cognitive decline, as well as functional impairment in daily living activities compared with their healthy counterparts.

Patients with late-onset psychoses show more severe cognitive and functional impairments in their daily activities.This paves the way for future studies.

Few scientific studies have been devoted to the study of crime among the mentally ill elderly, however, all the studies agree on the importance of recognizing risk factors associated with passage to forensic action in elderly patients.

The objectives of our work are to clarify the sociodemographic, clinical and forensic characteristic of mental elderly patients who commit forensic acts.

Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92–83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code.

Our study included 25 patients, their ages ranged between 60 and 90 years. They mostly had a low socio-economic level (64%), a low educational level (48%) and a marital status of married (64%).

All patients had a neuropsychiatric disease: schizophrenia and other psychotic disorders in 48% of cases, dementia and Delirium nonspecific in 32% of cases, mood disorder in 16% of cases and mental retardation in 4% of cases. The medico-legal act was murder or attempted murder in 40% of cases, sexual crimes in 16% of cases, aggression against property in 16%, violence against people in 8% of cases and different offenses in the remaining cases.

The concept of hoarding is a matter of study and debate since several years and has been trough various changes concerning its definition and categorization, namely in what concerns the differentiation from “normal” collecting behaviour and the association with other mental disorders as Obsessive-Compulsive Disorder.

This comunication reviews the evolution of the concept of hoarding and its implications in the assessment, management and treatment of the patients.

The authors pretend to highlight the nosological path traced by the scientific research until today and present the state of the art in this field.

The authors selected articles referring to hoarding disorder in PUBMED and SCIENCEDIRECT databases and made a literature's review about the theme.

Latter findings have identifyed clinical, neurobiological and treatment features in hoarding individuals that seem to be specific and that suggest the conceptualization of a standalone condition that presents independently from other disorders. The recent proposal of a Hoarding Disorder for the new DSM-V advances with some criteria in order to categorize this entity and establish its diagnostc boundaries.

The emerging of a new nosologic entity constitutes a change of perspective in the understanding of this condition that has implications at various levels, such as the aproach to the patient, his management and treatment.

The elderly in general, and those with dementia in particular are more likely to be victims of abuse, neglect or self-neglect.

These demented elderly, because of biological aging, psychological disorders of character, behavior and conduct are themselves sources of violence that may lead to medico-legal.

The objectives of our work are to specify the profile of mentally ill elderly dementia and identify the characteristics of their medico-legal.

Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92-83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code, and which the diagnosis of dementia was increased.

Our study included 7 patients, whose average age was between 65 and 90 years. The majority being married, having a low socioeconomic level. Acts forensic being uxoricides (2 cases), attempted murder (2 cases), attempted rape (1 case), violence against people (1 case), false and corruption (1 case). Almost all committed crimes against people associated with violence.

The diagnosis of dementia was retained and all patients were referred to the neurology department for further explorations.

The type of dementia was noted in 4 cases: mixed dementia, Alzheimer's disease, dementia due to Huntington's disease and dementia due to Parkinson's disease.

Among the causes of headache, migraine headache are most common. Migraine is most common referrals to neurology clinics in all human societies. Today it is confirmed that many of chronic headache is associated with psychological and behavioral problems. Personality is defined as the capacity of individual protest :and temperament &character are subsets of personality. TCI(temperament &character Inventory)is a questionnaire that evaluate these dimensions.The relationship between temperament and migraine were also considered.

To evaluate The relationship between temperament and character pattern with migraine

To provide information for psychiatrists, neurologists and other clinician to aware of this relationship.

This is a prospective case control study which was done on 63 migraine patients as case group and 63 controls. TCI was used for evaluation.

In case group the average score in patients were: Novelty seeking 41.51,mean Harm avoidance was 52.16 and Reward dependence 62.14. The average score of Selfdirectedness was 53.14, cooperativness 78.45, Preseverence 63.21 and Selftranscedence was 60.95.

In control group the average score in patients were: Novelty seeking 44.77,mean Harm avoidance was 49.28 and reward dependence 62.42.The average score of Selfdirectedness was 54.81,Harm avoidance 73.92, Preseverence 54.09 and Selftranscedence was 62.42.

Harm avoidance and Cooperativness had a significant difference between groups(P ha=0/048, P co=0/043).

Results showed a significant difference between groups in HA and CO. We can conclude that migraine patients had a higher score in HA and CO subsets. HA is related to serotonergic system and this results presents the role of serotonin in migraine pathology, This shows the role of serotonin in the incidence of HA in migraine patients.