Although depression is commonly related to cerebral stroke, mania is a strange but possible consequence of brain ischemia or intracranial hemorrhages. The maniacal episodes in relation to cerebral stroke have an incident, according to the bibliography, 1% in patients with sharp cerebrovascular diseases. So, in larger persons who show the first maniacal episode, it's recommended to perform studies of cerebral image to reject cerebrovascular disease's presence.

Study of the relationship between stroke and the onset of mania/bipolar disorder.

Review of the literature about this subject through Pubmed and report of the patient's medical history.

Let's show the 64-years-old male's case, with a personal record of schizotypal (without having needed previous hospitable admission) and arterial hypertension. The patient shows a set of symptoms, developing one month long, consisting of verbosity, desinhibicion, hipertimia, overheads increasing and conception delirious damage. This symptomatology, completely new in the patient, made suspect an organic origin, so he was admitted in Internal Medicine Unit, the presence of lacunar strokes were objetived in internal capsule. After he was admitted in our Unit of Psychiatric Hospitalization, neuroleptic with Haloperidol treatment is stablished, a rapid response is observed about it. As discharge time, the patient appears euthymic, clear psychomobility and verbalizing an important distance from the delirious clinic.

Despite the rarity of post stroke mania, the appearance of such symptoms in advances ages must be taken into account in every patient without previous affective symptomatology and concomitant neurological lesion.

Fabry disease (FD) is an X- chromosome linked recessive glycolipid storage disease caused by deficient activity of the lysosomal enzyme Alpha Galactosidase A, resulting in progressive accumulation of aberrant catabolites like Globotriaosylsphingosin (lyso-Gb3) in vulnerable cells. The disorder can affect multiple organ systems including the central nervous system. A high proportion of patients with FD are at increased risk of developing neuropsychiatric symptoms.

A 56 year old female inpatient suffering from treatment resistant recurring depression with psychotic symptoms for a period of over two decades was diagnosed with asymptomatic hypertrophic cardiomyopathy in a routine health checkup. The incidental finding lead to an elaborate diagnostic work-up including genetic testing for FD as a possible cause.

A novel, hitherto undescribed mutation in the Alpha Galactosidase Gene (c.1025.1027delGAC) affecting enzyme activity was detected. In addition, lyso-GB3 concentration was increased above the normal level, in concordance with the diagnosis of FD.

In this patient, undiagnosed FD associated with a novel mutation of the Alpha Galctosidase Gene may have caused predominantly psychiatric symptoms and contributed to therapy resistance.

Previous studies suggested that cognitive enhancement associated with nicotine may be a form of “selfmedication” explaining high rates of smokers among patients with Schizophrenia or Mood Disorders. On the contrary, patients with Obsessive-Compulsive Disorder (OCD), though are characterized by cognitive impairment, do not show a higher tendency to smoking than general population and show a lower tendency to smoking than other psychiatric patients.

Our pilot study aims to investigate the effect of cigarette smoking on cognitive performance in patients with OCD. No published studies investigated this issue.

Fifty-nine inpatients suffering from OCD (22 smokers and 37 non-smokers) were recruited. At the beginning of the hospitalization, we assessed different cognitive domains using a standard non-computerized neuropsychological battery (memory, attention and verbal fluency). In addition, 28 patients out of the 59 (12 smokers and 16 non-smokers) underwent a computerized neuropsychological evaluation specific for executive functions (CANTAB software). OCD-clinical symptoms were evaluated by Y-BOCS.

Smokers and non-smokers did not differ for demographic (age, schooling) and clinical variables (Y-BOCS scores). Compared to non-smokers, smokers showed worse performances on the phonemic fluency test (non-computerized battery) and a tendency to risk higher amount of money on a decision making task (CANTAB).

Smoking does not seem to improve cognitive performances of patients with OCD, whereas it seems to affect impulsivity, thus worsening decision making ability and flexibility, possibly by an effect of nicotine on dopaminergic neurotransmission in orbito-frontal cortex. This may explain the low rate of smokers in patients with OCD.

The aim of the study is to provide information about lithium effectiveness and safety in the treatment of very old patients with mood disorders.

All patients aged ≥75 years attending our private practice in the past 10 years.

We treated 183 subjects aged ≥75 years. 25 were in the lithium group and 138 in the no-lithium group. Bipolar disorder diagnosis and history of previous suicide attempts were more frequent in the Li group. Mean duration of lithium treatment was 31.3 ± 35.0 months. Mean daily dose of lithium was 390 (± 178.5) mg. Treatment with lithium was associated with better Clinical General Impression-Improvement scores than other psychopharmacological treatments. Rates of discontinuation were not significantly different between lithium and other treatments. In no patient, hypothyroidism or renal failure were major clinical problems.T4 treatment (a proxy for hypothyroidism) was prescribed to 8 (32%) of lithium-treated patients. Lithium was withdrawn in 6 (24%) patients.

The reasons for the suspension of lithium were:

1. 1) Unproven effectiveness of the drug for the individual patient.

2. 2) Occurrence of serious cardiac or renal disease, independent of the use of lithium.

3. 3) Erratic and unpredictable metabolism of lithium in the very elderly.

4. 4) Poor compliance (two cases).

5. 5) Age related spontaneous mitigation of the disease.

Lithium can be valuable in the treatment of elderly patients, with adequate precautions. Elderly patients require lithium dosages that are 25 to 50% lower than those used in younger individuals. A single bedtime dosing regimen is recommended.

The aim of the study is to assess the epidemiology of psychiatric symptoms in patients with Huntington Disease (HD).

All patients affected by HD attending our Movement Disorder Clinic in a 3-year period were evaluated by the Unified Huntington’ Disease Rating Scale and by the BPRS.

Among 70 patients, 61 (87.1%) presented depressive symptoms in the course of illness, 56 (80.0%) anxiety, 36 (51.4%) manic symptoms, 47 (67.1%) irritability, 15 (21.4%) delusions, 9 (12.4%) hallucinations, 23 (32.9%) obsessivecompulsive symptoms, 57 (83.7%) apathy, 28 (40%) aggressiveness/violence, 26 (37.1%) suicidality, and 29 (41.4%) dementia.

The results show that the nature of psychiatric manifestations cannot be generalized across all patients with HD for several reasons:

1. 1) in the course of HD, symptoms change spontaneously reflecting the degenerative pathogenesis of the disease;

2. 2) the phenomenology of symptoms depends on age of onset, patient's gender, number of CAG triplets, gender of the affected parent;

3. 3) drugs used to improve motor symptoms have psychiatric side effects which superimpose and merge with the mental abnormalities of the disease;

4. 4) Huntington’ gene is just one of the 30,000 expressed in the brain.

Therefore, the symptoms induced by the disease depend not only on the specific abnormal gene causing the disease but also on patient's general genetic background of both paternal and maternal origin, and on personal non genetic factors.

Rather than standardized approaches, the continuous re-evaluation of psychopathological dimensions in the individual patient with HD is essential for the proper management.

A recent meta-analyses by our team found baseline respiratory abnormalities in subjects with Panic Disorder (PD) compared to subjects without PD. However, it is still open the question whether these abnormalities are intrinsic to pathophysiology of PD or may be shared with other psychiatric populations with high trait and state anxiety levels, such as subjects suffering from other anxiety disorders.

To meta-analyze the results from all of the studies that compared baseline respiratory parameters between subjects with PD and subjects with other anxiety disorders.

A literature research in bibliographic databases was performed. Only fixed-effects models were applied due to the small number of studies available for each parameter. Several moderator analyses and publication bias diagnostics were performed.

Subjects with PD showed a lower end-tidal CO2 pressure and a higher mean respiration rate at baseline compared to patients with both Generalized Anxiety Disorders and Social Phobia. Furthermore, also a significantly lower venous CO2 pressure and a higher venous HCO3- (bicarbonate ion) concentrations in PD than Social Phobia was found. Moderator analyses suggested that these differences between groups are not explained by differences in the state anxiety levels experienced during the assessment procedure. No evidence of publication bias was found.

Results suggest that peculiar baseline respiratory abnormalities and particularly a chronic hyperventilation may be specific of PD pathophysiology also when compared to other anxiety disorders.

In 2007 the Mental Health Act in England and Wales was amended and the definition of Mental Disorder was broadened. This change affected people with Personality Disorders who now can be admitted for hospital treatment without consent, often for prolonged period of time.

This poster reviews clinicians’ attitudes towards the new legislation and its consequences and also presents the research on the different perspectives about the new law.

To review clinicians’ attitudes with regard to interfaces between Personality Disorders and the new law.

Use of the specifically designed questionnaire for clinicians providing hospital care for patients with Borderline Personality Disorders. MEDLINE and PsycINFO databases were also searched for all English-language articles published between 2008 and 2012 containing the keywords “rsonality Disorder”, “Mental Health Act” and “clinicians view on compulsory treatment of persons with Borderline Personality Disorder”. Additional key articles published before 2008 were reviewed. The most relevant articles were selected for the review.

There is still no common consensus in regard to the benefit of compulsory hospital admission of persons with Borderline Personality Disorders. Results from questionnaires are under review.

Although neuroimaging studies suggest brain regional abnormalities in depressive disorders, it remains unclear whether abnormalities are present at illness onset or reflect disease progression.

We hypothesized that cerebral variations were present in adolescents with subthreshold depression known to be at high risk for later full-blown depression.

We examined brain structural and diffusion-weighted magnetic resonance images of adolescents with subthreshold depression.

The participants were extracted from the European IMAGEN study cohort of healthy adolescents recruited at age 14. Subthreshold depression was defined as a distinct period of abnormally depressed or irritable mood, or loss of interest, plus two or more depressive symptoms but without diagnosis of Major Depressive Episode. Comparisons were performed between adolescents meeting these criteria and control adolescents within the T1-weighted imaging modality (118 and 475 adolescents respectively) using voxel-based morphometry and the diffusion tensor imaging modality (89 ad 422 adolescents respectively) using tract-based spatial statistics. Whole brain analyses were performed with a statistical threshold set to p< 0.05 corrected for multiple comparisons.

Compared with controls, adolescents with subthreshold depression had smaller gray matter volume in caudate nuclei, medial frontal and cingulate cortices; smaller white matter volume in anterior limb of internal capsules, left forceps minor and right cingulum; and lower fractional anisotropy and higher radial diffusivity in the genu of corpus callosum.

The findings suggest that adolescents with subthreshold depression have volumetric and microstructural gray and white matter changes in the emotion regulation frontal-striatal-limbic network.

The authors would like to report on the case of an individual who developed psychosis, following pulse therapy of Itraconazole. We discuss his clinical presentation, history and similar reports in literature on Itraconazole.

Case-report, Literature review, Discussion.

Mr.X was a 36 year old male who developed an acute psychotic episode after starting his second course of pulse treatment of Itraconazole. Subsequently he had three inpatient admissions for his psychosis, in which he was treated informally

1. - initially with Olanzapine and Quetiapine, and following the third admission with Clozapine.

In the back ground of a negative history of any previous psychotic episode, no family history of psychosis or any mental illness, no concordant illicit substance abuse, and the emergence of clear cut psychotic symptoms at the age of 36 following treatment with a course of oral Itraconazole, our opinion is that Itraconazole has possibly contributed to the development of psychosis in a potentially vulnerable individual. Our literature review revealed only very few case reports of Itraconazole associated psychotic disorder.

This case highlights, although rare, the potential risk of idiosyncratic reactions and psychiatric manifestations associated with the antifungal agent Itraconazole. We recommend increased awareness amongst clinicians about the potential idiosyncratic reaction and risk of psychosis associated with Itraconazole and also the importance in highlighting such cases for the awareness of the public as well as clinicians.

Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).

Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.

Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.

There was a high degree of comorbid NSSI in our sample of suicide attempters (44%). Suicide attempters with both behaviours reported more interpersonal violence as adults (Z=3.0, p=0.003) and more severe suicidal behaviour compared to suicide attempters without NSSI. Comorbid NSSI in suicide attempters seems to be related to severity of suicidal behaviour differently in male and female suicide attempters. Comorbid NSSI in suicide attempters may increase suicide and violence risk, and methods for assessment of both violence and NSSI are important for targeting and intervention.

Previous studies have shown that not only mental health patients but also mental health professionals are stigmatized. Thus stigma toward psychiatry and psychiatrists may be implicated in the diminishing recruitment rates within the discipline of psychiatry.

To measure the level of stigmatization towards psychiatry and psychiatrists among medical academics.

We randomly selected 90 medical academics (other than psychiatrists), by consulting the list of all the employees of this institution. We employed the “Perceptions of Psychiatry survey” developed by the World Psychiatric Association which contains 37 items that refer to psychiatry as a discipline, psychiatrists, and psychiatric patients.

More than 50% of the respondents had at least one item coded as a negative attitude towards psychiatry. The most frequent negative attitudes were:

1. i) psychiatry is not a scientific discipline,

2. ii) psychiatrists are not paying attention to physiology and they can help patients only in a small degree,

3. iii) psychiatry has a low prestige among medical students. Furthermore, few medical academic (other than psychiatrists) would encourage students to choose psychiatry as a career path.

The level of stigmatization toward psychiatry and psychiatrists could be considered high. This study could contribute to the delineation of future interventions aimed to reduce stigma.

Depression in people aged 65 and more appears to be a major public health problem. Efficient mechanisms of inhibition are important to communicate with other people and to interact with the environment but seem to be deficient in young depressed patients. This function needs to be evaluated in late life depression which has specific features.

Twenty inpatients (mean age = 70.4) meeting DSM-IV criteria for major depressive disorder were compared to forty seven healthy controls. They performed a neuropsychological and psychiatric assessments and two eye movement tasks: a prosaccades task to obtain basic parameters of eye movements and an antisaccade task to evaluate the inhibition capacities.

In comparison with healthy subjects, depressed patients showed impaired performances in both oculomotor tasks. Concerning the prosaccade trial, depressed patients had higher reaction times and error rates than healthy controls. In both populations, hypometric saccades are the main kind of error. In the antisaccade task, reaction times and error rates were also higher in depressed patients than healthy subjects. However, the two populations showed similar correction rates.

The results of this study offer new insight on the inhibition impairment of aged major depressive patients by two simple eye movement tasks. The findings indicate psychomotor retardation and inhibition impairment, consistent with the findings obtained in young depressed subjects.

The cerebrovascular disorders, traumatic brain injury and epilepsy lead to the development of dementia, which requires a psychometric verification of cognitive disorders.

In patients with dementia due to vascular brain diseases, traumatic brain injury and epilepsy was analyzed psychometric indicators of cognitive impairment.

Was studied the severity psychometric characteristics of cognitions in patients with dementia due to vascular diseases of the brain, brain injury and epilepsy.

5 groups patients with dementia: F01.00 - 14 patients (mean age 55 years), F01.1 + F01.3 - 14 patients (mean age 60 years), F01.8 - 14 patients (mean age 65 years), F02.802 - 21 patients (mean age 50 years), F02.803 - 15 patients (mean age 38.5 years).

The psychometric methods: MMSE, FAB, Schulte, the clock drawing test, nonparametric statistical methods.

Table of results:

Severity of cognitive impairment is increasing in the following order:

1. 1) dementia due to epilepsy;

2. 2) dementia due to brain injury;

3. 3) acute post-stroke dementia;

4. 4) atherosclerotic, vascular dementia unspecified;

5. 5) multi-stroke, mixed cortical and subcortical vascular dementia.

Disorders of frontal functions dominate in the structure of cognitive impairment in all dementias.

Our aim was to examine the role of Group Cognitive Behavioral Therapy (G-CBT) in increasing compliance to pharmacological treatment, and in preventing relapse in BPD type I (BPD-I) patients participating in group CBT at ‘Aghios Charalambos’ Mental Health Centre.

Forty patients [20 female and 20 male, age range 30–55 years, mean age 45 years] diagnosed with BPD-I attended a 60 min G-CBT session twice a week for 16 weeks. All patients were normothymic and stable on medication before entering G-CBT. The Beck Depression Inventory (BDI) and the Young Mania Rating Scale (YMRS) were used to monitor mood symptoms at 3 time-points (baseline, on completion of the 16 weeks’ period and at the one year follow-up visit). Objective and subjective functioning was rated using the Global Assessment of Functioning (GAF) scale and psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) at the same time points. Treatment provided was based on CBT principles and was conducted by two CBT-trained psychologists.

Separate one-way ANOVA's with time interval (3 levels; baseline, 16 weeks, 1 year) as the between-subjects factor, for each scale were conducted. Both the GAF scale's and mood scale's scores increased significantly in the post-treatment stage at 16 weeks and at the 1 year follow-up visit.

The combination of G-CBT and pharmacological treatment proved to be effective in significantly improving adherence to treatment in patients undergoing bipolar affective disorder rehabilitation both following 16 weeks of G-CBT and at the 1 year follow-up visit.

Postpartum psychosis occurs in 1 of 500 mothers, with rapid onset in the first 2-4 weeks after delivery. It is considered a psychiatric emergency and usually results in inpatient psychiatric hospitalization. Infanticide is one of the most serious risks of postpartum psychosis.

The purpose of this article is to report a clinical case of Postpartum Psychosis.

Case study and review of the literature.

A 38 year old woman developed a clinical picture characterized by agitation, irritability, mood swings, hyperactivity, disorganized behavior and insomnia, within the first week after delivery. She had no history of mental illness and no family history of mood disorder. The patient was hospitalized to study this first episode of Psychosis occurring after the childbirth of her second son.

Postpartum psychosis impacts 0.2% of women of childbearing. The recurrence rate is about one in four pregnancies. Postpartum psychosis is considered a psychiatric emergency due to the potential for catastrophic suicide and/or suicide. Treatment with haloperidol should be used with caution, because dangerous side-effects including neuroleptic malignant syndrome have been reported. The newer neuroleptic drugs, seem to be safer. Women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of relapse postpartum. Some authors recommend initiating prophylactic treatment immediately postpartum in women with a history of psychosis limited to the postpartum period.

First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals.

The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder.

One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records.

The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007).

Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals.

Many studies suggest that post-traumatic stress disorder (PTSD) in some children after severe stress may become a chronic mental illness. According to Peters J.J. (2006), PTSD is associated with the acceleration of age-related memory decline. At the same time, this disorder is characterized by dissociative reliving of the trauma. Guez J. (2011) proved that traumatic stress is linked to a deficit in associative episodic memory. Although PTSD is associated with chronic pain, while there is evidence for reduced pain sensitivity in this disorder.

The aim of our study was to compare the level of cognitive impairment, as well as the intensity and frequency of disturbing physical symptoms (pain), and the incidence of cerebrovascular diseases (arterial hypertension, myocardial infarction, stroke) in two groups of patients: the first one - former war participants, and the second one - former young prisoners of Nazi concentration camps.

All patients have suffered severe stress associated with war in the past. We had evaluated the patients’ complaints, and studied their medical history, emotional state, cognitive functions and coping strategies.

Our patients from second group more often had high blood pressure somatic complaints proved to be significantly more frequent in this group, demonstrating reduced tolerance to pain in former prisoners. They also had the tendency to depressive reactions and poor performance on cognitive tests.

However, in patients with PTSD verbal memory was better than without PTSD in both groups.