Body shape and weight concerns are considered core features of eating disorders (EDs); however, it is still debated whether subjects with anorexia nervosa (AN) also present distortion of the body perception with respect to those with bulimia nervosa (BN).

To demonstrate differences in behavioral response patterns to their own distorted and undistorted body images in subjects with and without EDs.

To characterize the perception of body images in EDs.

We recruited 15 female subjects with AN, 13 subjects with BN and 22 healthy controls (HC). All subjects were presented with their own body images, distorted according to the body shape questionnaire score (BSQ), an index of body dissatisfaction, and control stimuli including own non-distorted and “scrambled” body images. Each image type was presented 80 times in a randomized order and contained one, two or three body images; subjects were asked to press a button when two body images of any kind appeared.

Although BN patients had the highest score on the BSQ (131.4) as compared with AN (111.1) and HC (97.58) subjects, AN patients committed significantly more omissions (6.34%), with respect to BN (2.23%) and HC (1.54%) subjects. Furthermore, AN patients needed a significantly longer time to process distorted body images (670.7 msec, on average), with respect to BN (650.1 msec) and HC (579.6 msec) subjects.

Our preliminary data confirmed the presence of a body distortion bias in AN subjects and suggest that it is independent from the degree of body dissatisfaction.

Suicide rates in the United States Army have steadily risen over the past eight years to record levels and continue to rise. The suicide rate now is greater than the general US population even after controlling for sex and age. This change is even more concerning based on the previous steady decreased rate compared to the US general population in the thirty years prior to 2004. In 2012, suicide deaths have outpaced combat deaths year to date.

1. Using epidemiologic surveillance data and new scientific data, describe factors associated with the increase in suicide deaths and potential targets for interventions.

Provide overview of factors associated with suicide in military populations and effects of combat on suicide rates.

Information provided will be based on current published and ongoing research synthesizing the larger suicide research literature.

Suicide in the Army has steadily increased since 2004 along with other surrogate markers of increased psychiatric illness including post deployment surveillance, anonymous surveillance, clinical utilization rates and rates of drug misuse and abuse.

Integrating media and scientific reports on the increased rates of miltary suicide is challenging. However, clinically relevant targets to impact rates along with strategies to research factors associated with suicide and larger prevention efforts hold promise.

Since Kraepelin times, it is considered that the delusional disorder (DD) does not imply a cognitive deficit, unlike the paranoid schizophrenia (PS). However, empirical evidence is very limited.

To compare the neurocognitive functioning differences among healthy controls (HC), DD and PS patients.

Neurocognitive functioning was evaluated in 51 healthy controls, 69 DD patients and 41 PS patients (according to the SCID-I) using an extensive neuropsychological battery which evaluate five domains (attention, working memory, verbal memory, executive function and social cognition). Was performed multivariate analysis of covariance (ANCOVA) to compare differences in neuropsychological performance between the three groups. The potential confusion factors were controlled, like the socio-demographic characteristics, premorbid IQ (“National Adult Reading Test”), depressive symptoms (“Beck Depression Inventory”) and the positive and negative psychotic symptoms (“Positive and Negative Syndrome Scale”).

DD patients showed a considerably worse neurocognitive functioning than healthy controls regarding to attention, verbal memory, executive functions and social cognition; while DD patients compared to PS only present a better neurocognitive performance in attention.

DD patients shown that neurocognitive deficit is relevant, unlike what it is considered since Kraepelin up to date, as shown in the DSM-IV-TR and the CIE-10.

High dosage buprenorphine (Subutex) is actually the principal treatment for substitution medication. Some misappropriations and wrong uses have been seen; the most frequent and sever being using tablets for injections. Since the introduction in different countries, the high dose buprenorphine as a substitition treatment for opioid drug dependence, the number of overdose deaths and heroin users are significantly declined. But the existence of non-use replacement of this processing, mainly intravenously, was born a new scourge of addiction, especially in Tunisia. Besides the risk of overdose, there is a risk of viral contamination.

To study the sexually transmitted diseases among patients addicted to high dose buprenorphine in Tunisia and followed in the outpatient hospital Razi.

It is a retrospective study of twenty-three (23) patients (23 men), injection of high dose buprenorphine, having consulted the outpatient clinic of Razi Hospital between January and July of 2012.

8 patients had a communicable disease: 1HIV, 5 Hepatitis C, 1Hepatitis B, 1 syphilis. 4 patients had infectious complications: 3 cases of skin infections and 1 case of endocarditis. 9 had never been screened. 8 recognized using a used needle.

The addiction to high dose buprenorphine is a widespread phenomenon in Tunisia. Lack of information and awareness of companion in Tunisia is at the origin of serious infectious complications. Health professionals have to play an important role in drug addict patients’ education and supervision, to prevent addiction to buprenorphine and related infectious complications.

Premenstrual dysphoric disorder is a premenstrual syndrome comprising physical and psychic symptoms. Bipolar disorders, particularly “soft” forms, share symptoms such as depressive mood, irritability or mood reactivity with premenstrual dysphoric disorder, posing challenges on differential diagnosis. In the present work a case of a woman suffering from cyclothymia is reported, with mood episodes confined in the luteal phase of the menstrual cycle.

Case Report.

A 42-year-old married Caucasian woman is presented, suffering from mood disorder episodes lasting for 10-12 days each, during the luteal phase of the menstrual cycle, and remitting after the beginning of her menses. The mood episodes occurred since the age of 20, in almost every menstrual cycle. The patient described hypomanic symptoms during the first 4-5 days of the luteal phase, reporting irritable mood, pressured speech, increased libido as well as vividness of her perceptions and excessive goal-directed activity. The hypomanic symptoms were followed by irritable and depressive mood, fatigue, hypersomnia, tearfulness, decreased self-esteem and pessimism, lasting for another 6-7 days. The patient also reported migraine and binge-eating episodes during each depressive phase. A full range of examinations, including blood and hormonal tests, yielded normal results. Lamotrigine was titrated at 200 mg/day, with subsequent amelioration of symptoms.

The exact relationship between premenstrual dysphoric disorder and other disturbances, which either coexist, or deteriorate premenstrually, or even synchronize with the menstrual cycle, has not been elucidated yet. Studies aiming at a better understanding of this relationship could aid at accurate diagnosis and treatment.

The aim of the study was to assess the state and trait anxiety in women with vasovagal syncope.

The study group consisted of 50 women referred to tilt testing with finally diagnosis of vasovagal syncope and 166 women from general population: 115 women who have never experienced faints (control negative group), 51 women who reported at least one faint episode (control positive group). All women were aged 21-40 years old. Women filled State and Trait Anxiety Inventory (STAI), the women from study group just before tilt testing after the whole procedure explanation. No one asked woman refused STAI completion or tilt testing. The STAI results were presented as raw results and trichotomized into lower than average, average and higher than average.

The raw result of STAI as a state was significantly higher in the study group (41.6 ± 9.8) than in the both control groups (37.6 ± 10.6 and 39.8 ± 10.5) p< 0.05. The raw results of STAI as a trait did not differ among groups (respectively 41.3 ± 8.7 vs 40.4 ± 9.4 vs 42.3 ± 8.8 p=NS). The occurrence of lower than average trait anxiety was significantly lower in study (36.0%) and control positive group (37.3%) than in the control negative group (56.5%) p< 0.05. The percentage of women with higher than average trait anxiety did not differ.

1. 1. High trait anxiety seems not be related to the occurrence of vasovagal syncope.

2. 2. Lower than average trait anxiety may play protective function of vasovagal syncope occurrence.

Truancy negatively affects almost every aspect in the life, including physical, mental health, social and economical conditions.

To implement and evaluate outcomes of three different kinds of intervention against truancy. A mechanistic intervention to stop truancy will be used as control.

To reduce truancy among European adolescents improving mental health in European high schools.

The WE- STAY intervention carried out in 6 different European Countries. In Italy a sample of 2265 High school students (mean age 15.6 ± 0,6; 64,4% females) was selected. The students were randomized into one of four different intervention arms. Baseline evaluation of students' lifestyle, coping styles, at-risk truancy, self-harm behaviours and mental health issues was collected using a structured questionnaire.

6% has been absent from school for 7 days or more without a valid excuse during the past year. 55,0% of the sample has smoked cigarettes; 7,2% drank alcohol 4 or more time during the week (13,9% male and 3,4% female). About the use of drugs, 17,4% of them used drugs at least once in a lifetime. 16% of the students started a fight at least once in a lifetime.

Truancy is often related to mental health problems and at-risk behaviours. The truancy has been the focus of a different policy initiatives, often ended in failure. Through the implementation of WE-STAY is possible to acquire more data on truancy prevalence and its correlated psycho-social and psychiatric aspects, as well as information on school and parents attitudes toward this phenomenon.

DPD is a highly disabling condition for which no efficacious treatment exists. Imaging and neurophysiology findings suggest that the right temporo-parietal junction (RTPJ) plays a crucial role in the conscious experience of the normal embodied self, mediating spatial unity of mind and body, a process impaired in DPD.

We tested the potential therapeutic value of RTPJ rTMS and found that after 3 weeks 6/12 DPD patients responded with 51% reduction on the Cambridge Depersonalization Scale (CDS). After 3 more weeks of RTPJ rTMS responders showed 68% improvement.

Here we present results of 3 and 6 weeks of RTPJ rTMS on each of four cardinal symptom domains of depersonalization, i.e. emotional numbing, anomalous subjective recall, alienation from surroundings, and anomalous body experiences.

In responders we performed a retrospective analysis and applied repeated measures ANOVA on the average scores of each of the four symptom domains derived by the CDS.

Responders to 3 weeks of RTPJ rTMS showed a significant improvement (71% reduction; P= 0.01) in anomalous body experiences. However, after receiving 3 more weeks of RTPJ rTMS they reported further reduction in anomalous body experiences (76% reduction; P= 0.00) and a clinically significant improvement in alienation from surroundings (54% reduction; P= 0.02), emotional numbing (52% reduction; P= 0.05), and anomalous subjective recall (57% reduction; P= 0.11).

This is the first study suggesting that RTPJ rTMS may show therapeutic promise in DPD, and that anomalous body experiences scores might represent an early predictor of response for the remaining symptoms.

Phenomenon of presence of catalytic properties in immunoglobulins has been actively investigated. Research of catalytic properties of antibodies in schizophrenic patients with various clinical manifestations of the illness has not been carried out previously.

To study DNase and proteolytic activity of immunoglobulins G isolated from serum of blood of patients with schizophrenia.

IgG have been isolated from serum of blood of 34 persons with affine chromatography. DNase activity of antibodies was identified according to degree of hydrolysis of supercoiled form of DNA of plasmid pBluescript per unit of time. Proteolytic activity was assessed according to degree of hydrolysis of basic protein myelin and its peptides. IgG were electrophoretic homogeneity.

We have identified that IgG of schizophrenic patients possess a higher (0,392 ± 0,19 nM DNA /mgAB/h), than in healthy persons (0,029 ± 0,06 nM DNA /mgAB/h) specific DNAse activity. It has been shown that DNase activity is an own property of antibodies. It has been found that proteolytic hydrolysis of serum of blood of schizophrenic patients is 5 times as high as indices of hydrolysis in healthy persons. It has been revealed that patients with predominant negative symptoms show maximum high percent of protease hydrolysis 66,9%, different from patients with leading positive symptoms (13,9%).

Increase of DNA-hydrolyzing properties of Ig G is likely to be associated with great number of extracellular DNA. Detection of high values of proteolytic activity may be associated with occurring in serum of blood of patients of large number of destructed or damaged proteins.

Incest may be defined as sexual relations between close blood relatives. It is found in all walks of life and all cultures. Incest is a taboo in all populations. This “secret” lived in childhood raises questions about the future of such a psychological trauma. Father-daughter incest is the most common. It has psychological, social, medical, and legal ramifications. Recently, it was reported that being the victim of paternal incest during childhood might be a significant predictor of a borderline personality disorder and complex posttraumatic stress in adults. Tunisia is among the countries from which incest cases are rarely reported.

Browse the impact of this early trauma on victims to become adult and difficulties the therapeutic approach.

We propose from a clinical case of a family, in which five girls were victims of father-daughter incest.

This would suggest that father-daughter incest is the most traumatic experiences which deserves attention and that we cannot afford to ignore. In-depth knowledge of the dynamics and effects of father-daughter incest suggest specific treatment strategies are indeed necessary.

There are 3 High Secure Psychiatric Hospitals in United Kingdom. The Autism Act passed in 2009 introduced the Adult Autism Strategy, which sets out how local services should be improved to meet the needs of adults with Autism.

There are specialist services available to care for offenders with Autism in low and medium secure forensic settings but there is a lack of dedicated support in high secure settings.

The objective was to identify whether current care provided for such patients is appropriate.

The aim of the audit was to evaluate the need for specialist service for offenders with Autistic Spectrum Disorder within High Secure Psychiatric Care.

The hospital wide secure email system was used to identify wards which had patients with ASD. A questionnaire was developed which explored the clinical practice, willingness and knowledge of the Gold standards of care. It was circulated on the 9 identified wards to the staff on 3 different shifts. 100 completed forms were received which were stored in a secure area.

The results revealed that most of the staff was aware about ASD but majority had not heard about standard approach of care. Majority of the staff were willing to train and work in a dedicated ASD team.

Effort should be made to increase awareness and train the staff to care for offenders with ASD. Work should be done towards accreditation with the National Autistic Society to set up specialist care for ASD patients in High Secure Unit.

ll antipsychotics act via dopaminergic receptor antagonism. This pharmacology is shared by all first (FGA) & second (SGA) generation antipsychotics. We reviewed the efficacy & safety of all antipsychotics in clinical use for BMJ Clinical Evidence (Barry et al 2012).

Our paper summarises key results from this systematic review based on comprehensive literature search of the Medline, Embase, Cochrane Library, and other databases including safety information from the FDA and MHRA in UK. The main clinical questions of interest were: What is the efficacy of drug treatments for positive, negative, or cognitive symptoms of schizophrenia? How effective are treatments for people with schizophrenia resistant to standard antipsychotic drugs?

We found 51 systematic reviews, RCTs, or observational studies that met our inclusion/quality criteria and performed GRADE analysis to assess quality of evidence. Key results are presented for efficacy & safety for: amisulpiride, chlorpromazine, clozapine, depot haloperidol, haloperidol, olanzapine, pimozide, quetiapine, risperidone, sulpiride, ziprasidone, zotepine, aripiprazole, sertindole, paliperidone, flupentixol, depot flupentixol, zuclopenthixol, depot zuclopenthixol, and clozapine.

The evidence for some ‘standard’ treatments is surprisingly weak. Up to 1/3 -1/2 of patients fail to respond to currently available antipsychotics, and all antipsychotics cause side effects in most people. This downbeat conclusion is not surprising, given clinical experience and the common mechanism of action of all antipsychotics. More efficacious antipsychotic medication will only be developed from understanding the biological pathogenesis of schizophrenia.Barry S, Gaughin T, and Hunter R. Schizophrenia. BMJ Clinical Evidence 13 July 2012.

http://clinicalevidence.bmj.com/x/systematic-review/1007/overview.html.

A consensus is emerging for functional remission to be routinely assessed in the treatment of major depression. This is because, in many cases, clinical remission is not necessarily accompanied by optimum functioning which would favour the rehabilitation of patients.

The objective was to study in depressed patients treated with agomelatine their global clinical response and their social functioning. The QFS (Questionnaire de Fonctionnement Social) provides information on specific areas of functioning: objectively via the frequency of social behaviours (F: Frequency index) and subjectively via the patient's perception of his/her social performance (S: Satisfaction index), making up a global index (G).

3139 patients were followed over 6-8 weeks. Assessments were carried out at inclusion (C1) and at the follow-up visit (C2): QIDS-C, CGI, QFS and SDS.

At C1 the mean QIDS-C score was 17.0 ± 3.4. For the QFS-G: 72.4% of functioning was “poor”. The SDS global score was 21.3 ± 4.8. At C2, a reduction in the QIDS score was observed: -7.9 ± 4.7 (p < 0.01). QIDS response rates were 50.2% [48.4-52.0%]. Improvement on the SDS was significant and the 3 QFS indexes saw significant increases, but more markedly so for S (6.7 ± 6.7) than for F (4.2 ± 5.4).

The results show an improvement in the social functioning of depressed patients treated with agomelatine. They suggest that a specific action of the treatment contributes to providing the patient with the possibility of better rehabilitation into his/her social, family and professional environments.

The concept of the “social network” (SN) describes the set of social relationships of an individual. SNs of patients with psychotic disorders have often been investigated in the last few decades, however, diverse theories and different assessment methods were utilised within this field of research.

To assess morphological (size, density, degree) and interactional (direction and intensity) characteristics of SNs of patients with psychotic disorders reported in different studies.

To explore the characteristics of the SNs of psychotic patients and to identify the factors that influence their size and composition.

A systematic literature review was carried out using the databases MEDLINE, PsychInfo and EMBASE. When feasible, the characteristics of SNs were compared across studies.

Out of 739 identified studies, 142 reported quantitative findings on SN characteristics. 27 (19%) of them reported figures on the size of SNs in a way that allowed meaningful comparison across studies. For all other SN characteristics, only descriptive accounts were possible. The overall mean network size was 15.2 (SD 9.4). Being single was negatively correlated with SN size.

The concept of SNs in psychotic disorders has been underpinned by diverse theoretical frameworks and assessed with a variety of tools. Only a small number of studies were methodologically comparable, which makes findings on SN characteristics and associated factors difficult to interpret. There is a need to develop standardised instruments in order to advance the quality of the research in the field.

Late life depression is still not well recognized. As depression increased risk for mortality and morbidity in elderly,it is necessary to have efficient instrument for detecting and measuring depression in this population. The Geriatric Depression Scale (GDS-15) is a screening test for depression in late life but it is not use in Serbian erderly population.

To show preliminary results of using the Short Form Geriatric Depression Scale (GDS-15) in Serbian elderly population.

We wanted to estimate whether this scale correlate with Beck Depression Inventory (BDI) which has been validated in Serbia.

We studied 248 pariticipants (40,3% were male,59,7% female) age 65 and older. Mean age for the whole sample was 70,87 ± 5,79. Hamilton depression scale, BDI and GDS-15 we used for assessing depressive symptomathology and two psychiatrist confirmed diagnosis of depression. According to inclusion criteria,102 participants met criteria for depression (experimental group) and 146 were in control group.

We found statistically significant difference in mean GDS-15 score between experimental (4,83 ± 4,93) and control group (1,51 ± 1,42) and no gender differences were found according to GDS-15 mean score. Significant difference (p≤ 0,05) was found on GDS item 11(Do you think it is wonderful to be alive now?),where woman scored higher in control group. Strong positive correlation was found between BDI and GDS-15 mean scores (r=0,863; p< 0,001).

The preliminary results confirm that GDS may be accepted as useful tool for measurement depression in Serbian elderly population. This may facilitate recognition and treatment of depression in elderly.

During the last years an increasing number of abusers of various psychoactive substances (surfactants), leads to a high incidence depending on the surfactant in patients with various forms of mental disorders, including schizophrenia patients. Interaction between schizophrenia and drug addiction is very complex, because of atypical clinical picture of both diseases and there are a lot of different opinions about the impact of drug use on the progression of schizophrenia. That's why this problem must be studied.

To study influence of psychoactive substances (alcohol, cannabis) on the paranoid schizophrenia's clinic, to develop treatment and prevention measures. This research includes studies of 60 patients with paranoid schizophrenia and addiction of cannabis and alcohol.

Admission mentally active agents in patients with schizophrenia impact on the overall clinical and dynamic patterns of endogenous disease: manifest in patients receiving mentally active substances episode schizophrenia are exogenous type. With the progression of the development of schizophrenia complicated by psychoactive substances we can see smoothing of psychotic defect. Adherence of psychoactive substances to schizophrenia affect social functioning.

The significant differences in the dynamics of mental health status in patients with paranoid schizophrenia, depending on psychoactive substances addiction were described. Joining alcohol and cannabis addiction increases the frequency of hospitalizations, but did not affect the level of social functioning of patients with schizophrenia.