Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.

Describe a case of a 53 year old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address this behavioral problems. Her husband noticed that she had become “hyper” in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.

Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.

Prednisone was suspended and Risperidone 2 mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.

These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.

Intramuscular (IM) medication may be considered as part of an appropriate plan to treat safely patients who are at immediate risk of violence. We aimed to assess the characteristics and monitoring of IM medication use in an inpatient population, in the context of the Sheffield Rapid Tranquillisation (RT) protocol, based on the National Institute for Clinical Excellence (NICE) guidelines.

The population studied included 639 discharges from four acute inpatient wards in Sheffield, U.K., from April 2011 to April 2012. Thirty patients who had been administered IM RT were identified. Demographics, Mental Health Act (MHA) status, diagnosis, non-pharmacological interventions and monitoring procedures were recorded.

Patients were female on 20(66.7%), White British on 14(46.7%), and under the MHA on 29(96.7%) occasions respectively. Diagnoses most frequently recorded were Schizophrenia 7(23.3%), Bipolar Disorder-Mania 7(23.3%) and Acute and Transient Psychosis 5(16.7%). Verbal de-escalation was used on 8(26.7%), oral medication was repetitively offered on 23(76.7%), a doctor was contacted on 14(46.7%), and the patient was restrained on 22(73.3%) and secluded on 13(43.3%) occasions respectively. Physical observations (blood pressure, pulse, temperature, oxygen saturation, level of consciousness and respiratory rate) were monitored and recorded on 13(43.3%) cases only, and only 3(10%) and 6(20%) had a pre-treatment and post-treatment ECG respectively.

IM RT was used on a small percentage of general adult inpatients, almost all detained, mainly with Schizophrenia, Bipolar Disorder-Mania and Acute & Transient Psychosis. Better implementation of the monitoring protocol is needed to improve the quality of care of acutely disturbed patients.

Smoking cessation services targeted for underserved populations usually have lower retention and higher relapse rates.

This study reports the results of two consecutive randomized trials aimed at improving smoking cessation rates through better adherence to the intervention plan among residents of low income urban community in the United States.

We compare the effectiveness of a behavior change and pharmacotherapy intervention across participants in the clinic-based and the community-based interventions. A total of 543 participants were recruited. Participants in both trials received training on smoking cessation for twelve weeks, but the second intervention was delivered by peer motivators and included use of more motivational techniques, based on lessons learned from the first trial using principles of a participatory approach.

The smoking cessation rate in the first trial was relatively low (i.e., quit rates of about 10%), with a high level of attrition (i.e., only 14% attended 6-12 sessions). Preliminary data show a very significant increase in the proportion of participants in second trial who quitted smoking, as compared to participants in the first trial (OR=4.4; 95%CI= 2.4, 8.3; P< 0.001) with significantly higher level of retention rate (53%).

Community based smoking cessation programs in underserved communities can be more successful if they include proper incentives to retain participants and are supported by community organizations. The process of how the new intervention is informed by the previous trial will be described with special attention to a new incentive program that includes non-monetary club membership awards and status.

With rapidly grouwning geriatric population and with the improvement in quality of life, sexuality is becaming an increasingly aspect of aging.

Investigation of of the role of physical training program of moderate intensity on amelioration of depression and sexual function in elderly men. Our study has been done on 42 patients aged 60-82years old.: 21 active (groupA) and 21 sedentary (group B) admited in Rehabilitation Clinique for different osteo-articular and postraumatic pathologies.Standard physical exercise program (F.Revnic, N.Teleki GERIATRIA, vol.XIV, nr.1 2002) has been applied for 24 weeks. hTSH,T3,T4,HGH,Testosteron and Cortisol have been evaluated before and after training with1234 DELFIA Research Spectrofluorimeter using Eu+ labbeled kits purchased from Pharmacia.The results have been processed with a Multicalc program.

70% patients from group A were euthyroid, HGH,Testosteron and Cortisol were in normal range, with a positive atitude towards sexual life. 56% sedentary patients of group B presented hTSH values >6I.U/ml corresponding to hypothyroidism with elevated levels of Cortisol and low levels of HGH and Testosteron. They exhibited anxiety with the following symptoms: irritability, exagerated fear for the future, tiredness, difficulty in communication, sleep disorders and a negative atitude towards sex. After training, a decrease in Cortisol and an increase in Testosteron and HGH in group B has been recorded with a positive consequence upon affectivity (interest in sex). Physical training with its multiple aspects (cognitive, mental and socio-afective) had a great impact upon reorganisation of hypothalamo-pituitary-thyroid-adrenal-gonadal axis in elderly men connected with changes in many effector hormones secretion with a positive impact upon emotional well being, mental health and an increase in desire for sexual life.

Enuresis Nocturna has a very high prevalence in the preschool populationand the prevalence slowly reduces during childhood such that only 1-2% ofadults continue to experience the problem. Imipramine which is a tricyclic antidepressant is widely used in treatment of nocturnal enuresis (1).

B. L. 8-year-old boy was assessed in our outpatient clinic and he had severe torticollis. In history, he had been diagnosed as enuresisnocturna by a child psychiatrist and had given imipramine 10 mg/day for treatment. After three days initiating imipramine 10 mg/day, he had severe muscular spasm on his neck. He had no psychiatric and neurological history.Physical examination, vital signs, serum chemistries, blood counts were withinnormal limits. Biperiden 5 mg administered intramusculary and after 45 minutestorticollis was resolved and he was refered to child psychiatry for the treatment of enuresis nocturna.

In literature there are a few cases that are reporting imipramine induced dystonia.The mechanism of dystonia induced by imipramine is elusive but possibly involves complex interactions of dopamine, serotonin, acetylcholine and norepinephrine between cortical structures and basal ganglia (2). Since imipramine is administrated widely in child population; the prescribers should be aware of this rare side effect.

Bipolar disorder (BD) commonly co-occurs with anxiety disorders (AD) and this comorbidity has been associated to worse clinical outcomes in BD patients. However frequency and clinical outcomes data might be biased once some of them had been originated from acutely ill bipolar patients as well as those in remission.

To assess AD in bipolar sample in order to know if this frequency vary according illness phase and identify possible clinical outcomes related to this comorbidity.

A population of 355 outpatients with bipolar I disorder were evaluated using structured instruments (SCID). The sample was split into four groups considering the illness phase and the presence of AD: euthymic without AD (euthymic/non- AD); euthymic with AD (euthimic/AD); non-euthymic without AD (non-euthymic/non-AD) and non-euthymic with AD (noneuthymic/ AD) groups. Clinical and socio-demographics differences between the groups were compared through bivariate analysis.

There was a progressive and significantly increasing in some worst clinical outcomes frequency, such as rapid cycling, suicide attempts, substance and alcohol use disorders, history of antidepressant use and decreased scores in all domains of QoL, from control group (euthymic /non-AD) through out intermediate group (non-euthymic/non-AD) until the group most affected (non-euthymic/AD). Both euthymic/non-AD and euthimic/AD groups did not differ.

We identified a group of severe bipolar patients that have worse clinical outcomes, and among them, the anxiety comorbidity. But, contrary to what has been stated, AD appears to be related with poor bipolar prognosis only when other severity clinical factors are presents.

The fight against discrimination and stigmatization of consumers of mental health services is a priority for the WHO and WPA. The purpose of the psychoeducation - destigmatisation of mental disorder and mental health care, an understanding of the society daily living of the consumers of psychiatric care and their families.

Comprehensive survey of 97 patients with schizophrenia in a period of stabilization. The main group - 67 patients in whom therapy used psychopharmacotherapy, psychoeducation and training. Control - 30 patients receiving psychopharmacotherapy.

To estimate the effectiveness of psychoeducational programs in the treatment of patients with schizophrenia.

Trainings were conducted in closed groups, the number of participants from 6 to 12 people. Each cycle consisted of 12 psychoeducation sessions lasting 2.0 hours with a frequency of 2 times per week. In our work we used an integrative model of psychoeducation includes information modules, techniques of cognitive-behavioral therapy, problem-oriented discussion, family therapy.

Analysis of the dynamics of social functioning and quality of life of patients with schizophrenia before and after psychoeducation showed that they increased in the intervention group significantly greater and more sustained than in the control group, especially in areas such as the general welfare, health, performance, family relationships and social contacts.

Psychoeducation not only increases the volume of knowledge increases confidence in combating the disease, but it solves the problem of social reintegration of the patient.

Several studies have shown that excessive emotional involvement of health care professionals may lead to burnout (Zapf et al 2001; Brotheridge&Grandey 2002). As our perevious studies (Fülöp, Devecsery & Csabai 2012) also showed, medical and paramedical professionals who are prone to overinvolve in the interactions of the patients experiencing distress, may suffer from emotional exhaustion for long run.

We looked for correlations between disturbances of emotional regulation, lack of mentalization, and intensive emotional distress.

We used a descriptive approach, where a set of questionnaires were applied. The sample consisted of 200 health care professionals - nurses, and assistents for oxyology-, from all over Hungary. Questionnaires used: Maslach Burnout Inventory, (Maslach and Jackson, 1986), Interpersonal Reactivity Index (Davis, 1980), Difficulties in Emotional Regulation Scale, (Gratz és Roemer, 2004) and Secondary Traumatic Stress Scale (Bride 2003). Our research team developed a test for mentatalization consists of 3 pictures of provider/patient interactions, and exposed with different instuctions according to 3 levels of mentalization.

Our preliminary results show that the “3-picture test”, as a global one, can be useful to measure the complexity of mentalization, its components, as spontaneous mentalization, emotional identification, and emotional anticipation. This test may help the further understanding of the relationships between emotional regulation and the phenomenon of burn-out.

Fatigue is an important clinical finding in Hepatitis Virus Chronic Infection. However, the absence of scales to measure fatigue, translated and validated for Brazilian Portuguese, prevents access to information essential to clarify specific clinical conditions in this population.

To determine the psychometric properties of the Fatigue Impact Scale for Daily Use (D-FIS), in Brazilian Portuguese, in patients with hepatitis C virus (HCV) and hepatitis B virus (HBV) chronic infection.

In this cross-sectional study, the authors evaluated the D-FIS in 101 outpatients, followed at the reference hospital.

Relevant psychometric D-FIS results were: floor effect proved to be 1%; skewness was 0.46; item homogeneity was 0.59 and SEM (SD = 8.51) was 2.4. The Cronbach's alpha was 0.920 and item-total correlation yielded coefficients ranging from 0.65 (item 1) to 0.85 (item 3). In a linear regression model, fatigue and depression influenced the self-report quality of life.

This study concludes that the Fatigue Scale for Daily use in Brazilian Portuguese can be considered as a useful tool to verify the presence of fatigue in patients with hepatitis viruses B and C.

Although cognitive subtypes have been suggested in schizophrenia patients, similar analyses have not been carried out in their unaffected siblings. Subtype classification may provide more insight into genetically driven variation in cognitive function.

To investigate cognitive subtypes in siblings.

Cluster analyses were performed in 654 unaffected siblings, on a cognitive battery that included tests of attention, intellectual function, and episodic memory. Resulting subtypes in the siblings were analyzed for cognitive, demographical, and clinical characteristics and compared with that of their proband.

Three sibling subtypes of cognitive function were distinguished: ‘normal’, ‘mixed’, and ‘impaired’. Normal profile siblings (n= 192) were unimpaired on cognitive tests, in contrast to their proband (n= 184). Mixed profile siblings (n= 228) and their probands (n= 222) had a more similar performance pattern. Impaired profile siblings had poorer functional outcomes (n= 234), and their profile was almost identical to that of their proband (n= 223). Probands with cognitively impaired siblings could be distinguished from other schizophrenia patients by their own cognitive performance. They also had poorer clinical characteristics, including achievement of symptomatic remission.

Unaffected siblings of patients with schizophrenia are heterogeneous with respect to cognitive function. The poorer the cognitive profile of the sibling, the higher the level of correspondence with the proband. The sibling's cognitive subtype was predictive for disease course in the proband. Distinguishing cognitive subtypes of unaffected siblings may be of relevance for genetic studies.

Smoking is one of the main risk factors for cardiovascular disease (CVD). The mechanism(s) for the effects of smoking on CVD are not clearly understood; however, a number of atherogenic characteristics such as insulin resistance have been reported.

We aim to investigate the effects of cigarette smoking on insulin resistance and to determine the correlation between this parameter with smoking status characteristics.

This study was conducted on 138 nonsmokers and 162 smokers aged respectively 35.55±16.03 and 38.47±21.91 years. All subjects are not diabetics. Fasting glucose was determined by enzymatic methods and insulin by chemiluminescence method. Insulin resistance (IR) was estimated using the Homeostasis Model of Assessment equation: HOMA-IR = [fasting insulin (mU/L) × fasting glucose (mmol/L)] /22.5. IR was defined as the upper quartile of HOMA-IR. Values above 2.5 were taken as abnormal and reflect insulin resistance.

Compared to non-smokers, smokers had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index. A statistically significant association was noted between the smoking status parameters, including both the number of cigarettes smoked/day and the duration of smoking, and fasting insulin levels as well for HOMA-IR index. Among smokers, we noted a positive correlation between HOMA-IR index and both plasma thiocyanates and urinary cotinine.

The findings show that smokers have a high risk to developing an insulin resistant, hyperinsulinaemic, compared with a matched group of non-smokers, and may help to explain the high risk of cardiovascular diseases in smokers.

Psychogenic excoriations are also called neurotic excoriations, dermatillomania or skin picking syndrome. Psychogenic excoriations are lesions caused by scratching, picking, lancing, rubbing or squeezing, usually, in areas that patient can easily reach (face, upper back and upper and lower extremities). They are initiated because an urge to excoriate an irregularity of the skin or by a disturbing sensation in the skin. The classic lesions are characterized by clean, linear erosions, scabs and scars that can be hypopigmented or hyperpigmented and are usually similar in size and shape. Association with psychiatric comorbidities are common, particularly mood and anxiety disorders. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress. Psychotropic medications (e.g. SSRIs) and appropriate counseling can be effective treatments.

The purpose of the poster is to highlight the existence and characteristics of psychogenic excoriations. A

condition that can be chronic, causes significant impairment and is believed to be common but unreported.

Here we report the case of a 27 year-old woman, with a 10 years history of self-inflicted excoriations, associated to high anxiety levels, treated with an SSRI with good response.

Although it does not appear as a diagnostic category in DSM- IV, psycogenic excoriations is indeed a treatable condition that, isolated or associated with psychiatric comorbidity can cause marked distress, impairment and psychological suffering.

The description of clinical features of depression among children and adolescents in clinical research still remains insufficient. Better understanding of the family system and home relationships can contribute to the development of high-quality health care services for clinical patients.

The purpose of the study was to evaluate children's perceptions of the quality of their parents' relationship and the level of their family systemic resources.

The goal was to advance a comprehensive understanding of families with children suffering from depression, the depiction of various processes within the family, and ultimately, attempt to define the major predictors of depression.

The subject group consisted of 46 children and adolescents aged 9-19 with diagnosed depressive episodes. Symptoms of depression in children and their parents were evaluated with the Beck Depression Inventory. The qualitative assessment was conducted with the use of the Assessment and Documentation of Psychopathology Scale - AMPD.

Clinical group assessed their parents’ marital relationship as lower quality than the control group. Girls diagnosed with depression, perceived their parents’ relationship as more dysfunctional (t = 5,87; p < 0,01). A higher rate of commitment in the relationships of parents with depressed children coexisted with a higher rate of depression in their mothers (r = -0,40; p < 0,05).

Depression in children and adolescents is connected with negative representation of parent - child and marital relationships and the systemic resources of the family as various sources of emotional security for the child.

The recurrence of episodes of mania and/or depression is a feature of bipolar affective disorder and it interferes with neurocognitive performance.

Identifying specific domains of cognitive dysfunction for manic episodes in bipolar affective disorder.

Improving life quality of bipolar patients with cognitive deficits.

60 bipolar (HAMD score >= 17, manic/hippomanic: YMRS score >= 12, euthymic: 6 month of remission, HAMD score < = 8, YMRS score < = 6) patients (DSM IV TR). The cognitive battery included standardized test of IQ, attention, working memory, visual memory, verbal memory and executive functioning. Demographic data, data about family history, psychiatric history, past/current treatment, history of psychosis, duration of illness, age of onset were collected. We analyzed statistically these data and identified specific domains of cognitive dysfunction for manic episode.

Stable and lasting cognitive impairments involving executive functioning (working memory, executive control, verbal fluency, mental manipulation and cognitive flexibility), verbal learning and memory and attention are evident across all phases of illness. Sustained attention (vigilance) is impaired in bipolar patients regardless of whether they are studied during periods of mania or depression. Performances on task that tapes domains of verbal learning and memory, and sustained attention were particularly impaired in manic patients.

There are persistent cognitive deficits over the course of bipolar affective disorder and specific cognitive impairment of each phase of the illness, like mania. This study identified several important risk factors that may moderate these cognitive deficits in manic patients.

There are few studies on burnout doctors in Brazil.

Describe prevalence of the Burnout syndrome in intensive care physicians of Salvador, and evaluate if there are correlation between aspects of Life Quality and the Burnout Syndrome.

A cross sectional study assessed the correlation between Life Quality and Burnout Syndrome in a population of 333 Intensive Care Physicians from Salvador, Bahia, Brazil. An individual, self-report questionnaire evaluated the Life Quality' domains, using the WHOQOL-Bref and their mental health, using the Maslash Burnout Inventory (MBI).

The present study found a Burnout' prevalence of 63,6% (presence of high levels in at least one dimension of Burnout) and 7,4% (presence of high levels on the three dimensions of Burnout) in this population. It was founded a moderate correlation between psychological domain and the emotional exhaustion dimension of the Burnout syndrome (r = - 0,58). Physicians who had high level in anyone of the tree dimension of MBI presented low scores in the domains of the WHOQOLBref indicating association between both variable.

There was a negative correlation between scores in Quality of Life and MBI.

The past decades has shed new light on the key factors affected mental health service in different country. There is huge need to evaluate mental health service in Poland, but until now we have not any algorithm concerning this matter.

To develop a methodology for the assessment and review of the mental health service in Poland.

To identify the key factors for quality of mental health services, to test the unique methodology to evaluation of Polish mental health service, to develop the specific recommendations.

The research includes: I phase - identification of key factors for quality in mental health services, II phase - testing the methodology, III phase - development of recommendations and dissemination.

Three-steps analysis of key factors which have a strong impact on quality of mental health services:

1. 1) literature review of relevant analysis, research and policy,

2. 2) Delphi exercise with national experts,

3. 3) external experts consultations.

The phase II covers piloting and testing the evaluation methodology.

Development of recommendations is based on research findings and experts consultations.

The main result of quality and quantity analyses constitutes a set of key factors for quality of mental health service in Poland. The project is supposed to change the paradigm at Polish evaluation strategy in area of mental health service.

In the light of Polish National Mental Health Program (established in Dec 2010) the results may have a great impact on reforms in Polish mental health service.

Absenteeism from work and inpatient treatment are well defined events in the course of any illness and may be indicators for the need of an intervention. The aim of this study was to estimate of the influence of these events on later permanent disability and death in a working population when caused by anxiety and/or depression.

Data of 128,001 members of a health insurance with a observation period of 6.4 years were used. Excess risks were calculated for patients suffering from anxiety, depression or both using Cox's proportional hazard models adjusted for age, gender, education and job classification.

Patients who received outpatient treatment had higher rates of permanent disability (hazard ratio (HR) 1.48 (Confidence interval 1.30, 1.69) for depression, 1.25 (1.07, 1.45) for anxiety) but lower premature mortality (HR 0.80(0.62, 1.03), 0.53(0.38, 0.73)) than controls. Inpatient treatment and co-morbidity were associated with further raised rates of permanent disability. Depressed inpatients also had higher premature mortality (HR 2.50(1.80, 3.48)).

The study shows a dose-responsive relationship between depression, anxiety, comorbidity and need for hospital treatment. It was was unexpected that some exposures seem to reduce mortality risk. Life style may partly explain this effect. However, these patients are subject to many other exposures, into which more research is needed to get a better understanding of the phenomenon.