Social, family and environment factors significantly influence the evolution of schizophrenia, earning a place in compliance and adherence to treatment. Tools considered valid in assessment of correlation between risk of schizophrenia and social stressors can demonstrate their limits.

Retrospective-prospective clinical trial on 81 patients diagnosed with paranoid schizophrenia, admitted in Craiova Mental Health Center (July 1st 2007 - June 30th 2012). We assess social stress using Social Stress Indicators (SSI) (Lloyd et al., 1995) and personal and social functioning using Personal and Social Performance Scale (PSP) (Morosini et al., 2000).

The study group included 48 women (59.26%) and 33 males (40.74%), average age 45.36±8.50 years, average age of onset of disease 25.78±7.38 years and a median of evolution 18.96±8.97 years. SSI scores reveals the presence and intensity of social stress, average scores 99.89±18.24 (101.67±16.88 males, 98.67±19.20 women) correlated with unfavorable evolution. Aggressiveness (69.14%) and suicidal behavior (7.40%) was precipitated by acute stressors, confirming the common root of Cloninger behavior and social stress theory of depression (Turner). The relationship between social and genetic factors supports the diathesis model of schizophrenia. PSP scores (37.22±8.75) decrease in the presence of aggressiveness and suicidal behavior.

Inversion affection for mother, feeling of stolen social independence, manipulating of material and social action through mechanisms of delirium were independent factors for social stress. In schizophrenia, the high level of stress is dependent on the degree of remission and relationship between patient, family and society.

Affective temperament is a phenotype underpinned by a constitutional substrate.

It represents signs related to certain mood stability and attitudes to react to environmental stimuli.

Temperament has been related to predisposition to bipolar disorder.

Bipolar disorder is highly related to Substance Abuse Disorders but it is less clear which affective temperaments are more involved in this relation and if they can influence substance abuse patterns.

The aim of this study was to investigate temperamental traits, according to the Akiskal and Mallya formulation, in patients with bipolar I disorder associated with comorbid substance abuse disorders.

Data from 120 patients with Bipolar Disorders and Comorbid substance abuse disorders, were assessed in inpatient unit.

The brief TEMPS- M self-questionnaire was used to assess the temperamental distribution. The temperamental scores on various outcomes were investigated using Sperman rank (Rho), Principal Component Analysis (PCA), Cluster Ananlysis (CA).

Chyclothymia was positively correlated to Opiate Addiction (ρ 0.18 p< 0.001).

Irritability was positive correlated with Alchol Abuse and Cannabis Abuse (ρ 0.26 and 0.27 p< 0.001).

The PCA and CA did not show statistically significant results although showed a trend to link irritability with alchool abuse.

Our results suggest that bipolar patients with comorbid substance abuse disorders exhibit a prevalent temperament of irritable and cyclothymic related to alcohol and cannabis abuse and opiate dependence respectively. Further studies are needed to explore this relationship.

Children can experience traumas in family, school and society, as well as participants in natural disasters, terrorism, war and civilian casualties. Their reactions depend on age, sex, individual ego strength, coping strategies, but also on the reactions of child's surrounding.

Clinical entities associated with the traumatic experience in children are common in psychiatric practice. Frequent manifestations of these experiences are classical clinical picture of PTSD, as well as depression, anxiety, somatization, behavior disorder, dissociative reactions, etc.

The child's perception of the traumatic event, and subsequent developing psychiatric symptoms were the aims of this case report.

We present difficulties in growing a 9 years old girl, whose father, after being stricken at the front and had been treated for PTSD, attempted suicide.

Faced with the traumatic situation, the patient used a self-protective mechanism suppressing negative emotions and memories to combat the negative effects of traumatic experience. Ways of coping were associated with the low degree of reliance with mother, brother and siblings. During adolescence she manifested symptoms intensified anxiety and depresion, guilt to encourage a sense of protection.

Secure attachment is the first line of defense against psychopathology launched traumatic experience. In terms of traumatic events in the child unless objective factors related to the traumatic event affects a child's perception of danger / threat, and perceptions of care required and provided by others. In that space shape the emotional experience of the child, which includes a sense of helplessness, irretrievable loss, anger and betrayal.

Anxiety of pain plays a very important role in pain persistence and disability in patients with musculoskeletal pain.

This study examined the effect of pain anxiety symptoms on chronic pain.

The aim of the present study was the evaluation of pain anxiety symptoms in patients with chronic low back pain (CLBP) and the differences between genders.

Two-hundred and one patients with CLBP participated in the present study (53 men - 148 women, mean age±SD 37,4±13,7). The measures used were: Pain Anxiety Symptoms Scale-PASS-20 (McCracken & Dhingra, 2002) and another questionnaire with socio-demographics and attitudes and self-reported questions data on the impact of the chronic pain in their life.

The mean scores (±SD) for men and women with CLBP and the p values from the T-tests were respectively: PASS- 20 total score, 22,19±9,09 and 30,11±14,15, (P=0,000), for avoidance, 8,15±3,02 and 9,65±4,46, (P=0,025), for fearfull thinking, 6,64±2,99 and 8,33±3,91, (P=0,002), for cognitive anxiety 3,98 ±2,72 and 5,90 ± 4,20, (P=0,005) and for Physiological Responses 3,42 ±2,53 and 6,21 ± 3,67, (P=0,000).

The results of the present study revealed the high levels of pain anxiety symptoms in patients with CLBP. Furthermore, women were found to be affected of pain anxiety symptoms more than men.

Negative syndromes in Schizophrenia are of increasing interest to drug developers. Several assessment strategies have emerged for identifying negative symptoms including the NSA-16, PANSS negative symptom subscale and the Marder subscale. Assessment of patients with schizophrenia by videoconferencing has been shown to yield results equivalent to those obtained when the scale is administered face-to-face.

To assess remote assessment of negative symptoms including blinding to protocol details and visit number, effectively eliminating enrollment and expectation biases.

To assess whether negative symptom scales can be reliably assessed in a clinical trial by videoconferencing.

The PANSS and the NSA-16 were administered to 227 subjects with schizophrenia in a randomized clinical trial via live videoconferencing by 17 blinded independent central raters. Subjects were interviewed at screen, at 11 more visits over 36 weeks, and at endpoint or 1 year. On a subset of subjects, a senior clinician observed and independently rated the PANSS and NSA as a quality control measure.

ICCs between raters and observing trainers were .98 on the NSA total score (N = 65 pairs) and .96 on the PANSS total score (N = 69 pairs). ICCs of individual NSA items ranged from .72-1.0, with a mean ICC of .91. ICCs of PANSS subscales ranged from .94 -.96 with ICCs of .95 for the Marder subscale and .94 for the negative subscale.

Excellent item-level ICCs for the NSA suggest that negative symptoms can be rated reliably by videoconferencing using well-calibrated blinded independent raters.

assess relationnal dynamics and representations (explicit and implicit) among SO

Provide interactionnal datas

CaMir, MINI, AAI, structured interview

The sample is too small, though 1/ interactionnal patterns and distorsions can be individually identified, 2/ Two significant variables in SO group : misperception of parental support and memory block.

We can infer from this preliminary results the clinical relevance of the test, and the theoretical perspective to identify some schemes (or internal working models) among this population.

ON-GOING RESEARCH (results to present):

1. - comparison to control Group

2. - multicentre study

Assess relationnal dynamics and representations (explicit and implicit) among SO according to the diagnosis and coping strategies

Provide interactionnal datas in assessment and treatment perspective, correlate the significant variables to coping strategy and other dimensions (social desirability…)

CaMir, MINI, AAI, structured interview, Rorschach (Exner).

to come.

Near 25% of chest pain patients who refer to cardiologist do not have coronary disease or any other organic cause. Psychogenesis of their symptoms is often unrecognized so, they are treated neither cardiologic, nor psychiatric.

We have evaluated 30 nonorganic chest pain patients and compare with 30 coronary patients in regard their socio demographic characteristic, stressful life events, level of anxiety and depression and presence of psychiatric disorder. We have used SCL- 90 R, M.I.N.I, Hamilton Anxiety and Hamilton Depression Scale, Holms -Rache Scale of life events.

Non organic patients were predominant women, age under 40, who have had their job lost or death in the family. Panic disorder was present at 8 patients, General Anxiety disorder at 5, and Somatoform disorder at 10 patients in these groop. Coronary patients had Minor depression disorder at 4 patients, and General Anxiety disorder at 2 patients. Level of anxiety (Hamilton Scale, SCL-90 R) somatization (SCL-90 R) and global distress (SCL-90 R) was significant higher in nonorganic chest pain patients compared with coronary patients.

Cardiologists should consider psychogenesis of unexplained chest and recomended psychiatric evaluation and treatment in the early phase of disorder. Careful cardiologic follow up is also recomended for these distressed patients.

The aim of the study was to analyze the medical history and EEG records of children diagnosed with Autism and Epilepsy in order to assess the frequency of different types of seizures in this group.

30 patients (aged 4-26 years) diagnosed with Children Autism and Epilepsy were included in the study. Based on the interview with parents and video-EEG records the analysis of seizures was carried out. Video-EEG of each patients was performed during sleep.

Based on the interview the following types of seizures were found: in 5 patients febrile seizures, in 20 patients partial seizures (in 3 patients generalized), in 11 patients generalized tonic-clonic and tonic seizures, in 5 atypical absence, in 3 simple partial seizures, in 2 mioclonic seizures. The analysis of EEG records revealed that in majority of patients abnormal temporal and parietal activity was observed (in 22 and 20 patients, respectively). In 15 patients generalized seizures were found. One patient was diagnosed with Landau-Kleffner Syndrome.

In patients diagnosed with Autism and Epilepsy, complex partial and generalized seizures were the most common types of seizures. In EEG records generalized seizures and abnormal activity appearing mostly in temporal and parietal areas were found.

Deficits in decoding emotion facial expressions have been reported in depressed patients and in subclinical depression. These deficits would be related to an attentional bias towards negative vs. positive expressions in the late stages of face processing. Such emotional bias would be a vulnerability factor for depression. Vulnerability to depressed mood has also been related to specific personality patterns (namely: high harm avoidance and low selfdirectedness) and it was advanced that personality-related differences in emotional stimulus processing might mediate this vulnerability.

Therefore, the present study aims to precise the role of personality in emotion facial expression perception deficits in subclinical depression, by the mean of event-related potentials (ERPs).

ERPs were recorded in 21 subclinically depressed participants and 18 not-depressed ones, while they were presented neutral and emotional faces (happy, sad, fearful).

The results show that in subclinically depressed participants only, happy faces elicited smaller P300 and LPP amplitudes than both negative and neutral faces, while earlier processing stages were not modulated by depressed mood. Covariance analysis indicated that these modulations are related to the decreased selfdirectedness reported in subclinically depressed participants, but not to increased harm avoidance.

These results suggest that harm avoidance would be independent from the specific bias of emotional face processing related to depressed mood, whereas selfdirectedness would be involved in this phenomenon. The results will be discussed regarding clinical implications.

To assess the teaching of a method, the “Crisis Dialogue” (CD), designed to improve the therapeutic relationship during the first days of care for acute psychosis - hence the outcome. The “Crisis Dialogue” is fundamentally different from usual “empathetic” speech in that it provides tools meant to help de-construct the delirium. The underlying theory is induced from patients’descriptions of the onset of the psychotic crisis and uses the concepts of generalised concern, dys-mimetism and undifferentiation of the self. This dense and precise verbal technique requires 3 minutes of the consultation time and is meant to complement usual work in emergency psychiatry.

CD was taught to all health professionals of 3 emergency psychiatry wards and assessed in an exploratory multiple study (n = 105 patients) including case series, “before-and-after” comparisons and a pilot randomised controlled trial (RCT).

In the case series, no adverse reaction was reported and most clinicians expressed satisfaction with CD use. In the “before-and-after” study, duration of hospital stay after CD implementation was shorter (median 46 days) than before (61 days)(p = 0.01). In the RCT, all measured indicators were equal to or better with CD, most significant with the model including Working Alliance Inventory, Difficult Doctor- Patient Relationship and patient perception of reassurance (p=0.02).

In this pilot study, the CD appears as a promising aid for the establishment of a good therapeutic relationship in the first days of care for acute psychotic patients. It may also have a positive impact on patient progress.

Attention Deficit/Hyperactivity Disorder (ADHD) has been linked to substance use disorders later in life. However, the unique contribution of ADHD is not clarified yet. Insufficient research in this area has considered first substance use, associated behavioral problems and female gender in longitudinal and community settings.

To study the association between childhood attention problems and substance use 18 years later.

Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems (dimensional constructs) and substance use between ages 22 and 35, adjusting for potential childhood and family confounders.

Individuals with high levels of childhood attention problems presented higher rates of substance use (regular tobacco smoking, alcohol abuse/dependence, cannabis problematic use, cocaine lifetime use). However, when taking into account other childhood behavioral problems, early substance use, academic difficulties and family adversity, childhood attention problems were only related to regular tobacco smoking and cocaine lifetime use.

This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood attention problems and substance use is confounded by a range of early risk factors.

In patients suffering from borderline personality disorder (BPD) primarily psychotherapeutic care is indicated. Pharmacotherapy is considered as adjuvant and often controversial way of treatment.

Demonstration of pharmacological approach to BPD patients in Olomouc Czech Republic and compare with treatment guidelines. treatment guidelines.

The aim of our study was to compare treatment of BPD patients in 2007 and 2011

The paper examines the state in 2007 and 2011 in BPD patients at the Department of Psychiatry, University Hospital. Our study included outpatients and inpatients treated in all departments. Inclusion criteria were diagnosis BPD. Medication was assessed according to the documentation at discharge or during outpatient care according to the transcript record.

In most cases are BPD patients treated according to current guidelines. The treatment consists of SSRI antidepressants, anticonvulsants and second-generation of antipsychotics. Problem can be considered in some cases with medication dosage, combination, administration of benzodiazepine anxiolytics, hypnotics.

BPD patients are treated according to current recommendations. Inpatients are more medicated than outpatients. The reason is probably in relation with the severity of the symptoms. Medication did not differ from the majority of best practices. But with a lack of strong evidence about its effect, it seems appropriate to move towards its reduction. Supported by the project IGA MZ CR NT 11047-4/2010

To examine the prevalence of violent behavior, victimisation and its consequences among people receiving in-patient treatment for schizophrenia and control group.

Data on violent behavior and victimization, sexual and physical abuse in childhood, posttraumatic stress disorder (PTSD), and substance abuse were obtained from adult in-patients with psychotic disorders and from their collaterals. A total of 167 patients (57.5% men and 42.5% women) participated. Control group was recruited from Department of Stomatology (n = 211).

Violent behaviour during preceding 6 months was higher in men (34%) and women (34%) patients compared to controls (13%, resp. 15%) (p < 0,01). Victimisation was higher in women patients (39%) compared to controls (26%) (p < 0,05). There were not significant difference in male patients (30%) and controls (24%).

Any form of sexual abuse was more frequent in women patients (39%) compared to controls (20%) (p < 0,01).

Comorbidity of schizophrenia and PTSD was detected in 7% of men and 14% of women. There were not significant difference in male patients (0%) and controls (24%). While PTSD was more frequently (p < 0,05) detected in women (11%) then in men control (3%), the difference was not significant in patients (7% of men, 14% of women).

Patients with psychotic disorders are often victims of violent attacks. Gender does not differ in aggressive behavior, but plays role in victimisation. Victimisation and its impacts (e.g PTSD) among patient with schizophrenia are underreported and consequently not properly treated.

Choosing appropriate medication when faced with intolerance or treatment non-efficacy can be challenging. Evidenced reasons for non-efficacy include medicinal interactions. Interactions between non prescribed products and psychotropics may be overlooked with negative consequences for clinical effectiveness and/or patient safety.

This study was conducted to explore the awareness and current practice of doctors in Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) with regards to obtaining and documentation of information on service users’ use of nonprescription products.

TEWV “Policy for Medicines Reconciliation on Admission of Adults to Hospital” states that lists of medicines prescribed by GP including those bought over the counter should be one of the minimum information available on admission. The availability of this information should ensure continuity of care and identification of adverse interactions. An electronic survey, using semi quantitative questionnaire, of doctors of all grades within the trust was used.

69 responses were received. There was a high level (94.2%) of awareness of potential interactions and a corresponding high standard (94.2%) of practice in enquiring about use in medication history. Only 78.3% would document this and where indicated, only 50.7% would investigate further. There were 25 comments received under the themes of health concerns (4), choice and autonomy (5), responsibility (2), practice issues (10), survey design (1), training Issues (3).

There was a high level of awareness among respondents but deficiency in documentation and further exploration indicating missed opportunities for health promotion.

Valproic acid (VA) is an effective mood stabilizer. Although it's usually well tolerated, it may cause hyperammonemia through carnitine deficiency created by its inhibition of mitochondrial enzymes in the urea cycle. Clinical presentation of hyperammonemia usually involves lethargy and somnolence but this diagnosis is often overlooked due to a clinical presentation that may include normal liver enzyme tests and serum VA levels within therapeutic range.

To present case-reports of VA-induced encephalopathy and a review study regarding the theme available in Medline.

Brief literature review.

Three case-reports are presented and literature of this theme shortly reviewed.

The authors present cases of three adult females with Personality Disorder with lack of impulse control and Bipolar Disorder who have began treatment with VA and presented in the Emergency Department with generalized weakness and confusion. Subsequently, they developed hyperammonemia, despite its therapeutic serum levels and normal liver enzymes. În all cases the patient's mental status and ammonia level returned to baseline following discontinuation of VA.

Confusion with VA is a serious, rather frequent but reversible side affect. It has been reported that VA can interfere with the enzyme carbamoylphosphate synthetase, which is responsible for incorporating ammonia into the urea cycle. It can also increase the transport of glutamine across the mitochondrial membrane in the kidney, thereby increasing the production of ammonia causing neurotoxicity. Clinicians should be aware of changes in patient's cognitive and functional capacity, especially in elderly patients and during the first two weeks of treatment.

In many European countries, doctors and patients are required to inform their respective driving authorities of their condition and treatment. However, in the UK, there is no means to monitor performance and check if such advice is given during the treatment.

The purpose of the survey was to evaluate the awareness and adherence to the DVLA (UK) guidelines about psychiatric diagnoses and the impact of psychotropic medications on skills such as driving.

A questionnaire on clinical practice and advice given to patients about driving to mental health diagnoses and medication was sent out to psychiatrists working in the local hospital. The responses were collated and analysed for trends.

Out of 42 doctors, 36 responded and 34 responses were eligible. The survey revealed that though all the doctors were aware of the guidelines only 38% discussed this with their patients. 50% of the doctors did not refer to guidelines and admitted of giving superficial advice to their patients. 50% of the doctors did not discuss the effect of medication on their motor abilities, concentration and sedation.

About 60% of the times the advice was only verbal and not documented.

Psychiatrists have a duty of care to inform the patients and document the advice on driving when they newly diagnose and start treatment. The survey suggests that the current practice needs further improvement. Psychiatrists should be aware of guidelines and realise the need to check the patients’ driving status and document the advice given.

To assess the knowledge produced in Brazilian literature on the social representations of madness on the part of health professionals in primary care.

Integrative review. The question that guided this study was: what are the health professionals’ social representations about madness in primary care?

Six articles were selected; the articles were written by nurses, psychologists and psychiatrists and published in refereed journals. All articles were qualitative and published between 2005 and 2012.

Professionals are centered in an organicist model, on the doctor, on medicalization, and have ambiguous and often unscientific concepts about mental illness. Some believe there is no cure or improvement for mental illness, relate aggression and violence to mental illness, and admit to having little knowledge about mental health and feel unprepared to work with these individuals. Social reintegration practices were not identified.

Hyponatraemia is an important medical condition, relevant to all practitioners working in old age psychiatry. This has important clinical implications to ensure patients commenced on antidepressant medication are monitored for electrolyte imbalance.

To identify the incidence and key features of cases of hyponatraemia in consecutive referrals to a rural community Psychiatry of Old Age service (population 18,000 over 65)

Naturalistic study design, routine referrals to the service were reviewed between 1/4/10 to 30/9/2011 and considered for inclusion. All hyponatraemia cases were identified and recorded at the MDT meeting. Clinical case notes and/or correspondence reviewed, data collected on demographics, psychiatric, medical diagnoses, psychotropic and general medication.

796 referrals reviewed, 22 cases of hyponatraemia identified, (2.8%), 15 case notes available for review, 4 review letters (include key information required), 3 casenotes were missing and 2 did not meet inclusion criteria as outside the period of study. Of the 17 included (12 female, 5 male), mean age was 82.1, all widowed/ single, 94% diagnosis of depression, 5 dual diagnoses, Mean MMSE 26/30. 100% on psychotropic medication, (87% antidepressants, 58% SSRI's). Mean medication number was 9. 6/17 (35%) cases of hyponatraemia were judged to be directly related to SSRI medication.

Hyponatraemia is an important clinical outcome that should be looked for in vulnerable populations with complex medical and psychiatric morbidity. Although many potential causes for hyponatraemia, SSRI antidepressants should be monitored with regular electrolytes in at risk patients (older age, polypharmacy, medical co-morbidity).