Suicidality has a multifactorial determination and is clinically under-diagnosed. Self-reported poor health, negative affect and sleep difficulties are associated with psychological distress, including suicidality.

To analyze the association between lifetime SRH, sleep difficulties, negative affect (NA) and suicidal ideation in pregnancy (T0) and post-partum (T1) and if they are predictors of suicidal ideation.

397 pregnant women completed the Portuguese version of POMS, PDSS and a set of items evaluating SRH, and sleep difficulties in the last trimester of pregnancy an three months of post-partum.

In pregnancy, suicidal ideation was significantly associated with lifetime SRH (p < .05), NA (p < .01) and difficulties of initiating sleep (DIS) (p < .01). In post-partum, suicidal ideation was also associated with DIS (p < .01), NA (p < .01), but not with SRH. In pregnancy, the predictors of the probability of having or not suicidal ideation are both SRH and DIS. In postpartum the suicidal ideation predictor was only DIS. However when NA was introduced in the regression model, NA was the only predictor of suicide ideation in both pregnacy and postpartum.

Difficulties of initiating sleep should be considered an indicator of suicidal ideation during the perinatal period. However NA might explain this association.

Few data are reported in medical journals about physicians perception in optimal care of mental health disturbed patients accessing emergency departments in general hospitals.

To investigate the subjective psychological burden and perception of proficiency in managing patients with somatic psychiatric comorbidities between physicians providing emergency care in County Emergency Hospital of Timisoara.

An anonymous multiple choice questionnaire was distributed to active medical personnel from emergency units in September 2012.

105 doctors answered- emergency unit 27, ICU 12, neurosurgery 15, trauma and surgical services 51. 38,1% declared at least a lifetime burn-out episode, 19% an episode last year, 69,5% declared they should request professional help. Psychiatric disturbances estimated in emergency care: dementia 1 out of 5 patients, depression 1: 4. Confidence rates in diagnosing dementia(%): very good 7,6, good 35,2, satisfactory 41,9, unsatisfactory 15,2; depression: very good 8,6, good 42,9, satisfactory 41, unsatisfactory 7,6. 78,1 respective 7,6% of the responders declared that mental health issues is insufficiently or not at all addressed in an emergency department. Disturbed mental status in patients was considered responsible for communication 89,5%, and treatment 85,7% difficulties, poor compliance 88,6%, and outcome 66,7%. 80% would appreciate a screening mental health program. 98,1% valued liaison psychiatrist collaboration.

By acknowledging the increasing incidence in mental health disturbances among patients accessing emergency services and their medical care management challenges, as well as their own psychological needs, medical and surgical professionals in SCJUT appreciate the active involvement of the liaison psychiatry department in emergency care.

Several questions still exist in the literature on the relationship between cumulative exposure to work-related incidents and posttraumatic stress disorder (PTSD) in First Responders (FR).

To address three unanswered questions in the field.

1. (1) Are different cumulative exposure scoring algorithms similarly related to PTSD?

2. (2) Is PTSD associated only with incidents rated as severe and traumatic?

3. (3) Can we identify cut-off scores of cumulative exposure that maximize sensitivity and specificity to predict PTSD?

To better characterize the relationship between cumulative exposure and PTSD in FR.

The association between exposure and PTSD was examined with logistic and linear regression and with receiver operating characteristic analysis in 349 FR.

1. (1) The strength of the association between PTSD and total cumulative exposure indexes varied across different scoring algorithms.

2. (2) Compared to total cumulative exposure indexes and to sub-scores of exposure to non-traumatic and/or less severe incidents, sub-scores indexing exposure to severe traumatic events only were more strongly and significantly associated with PTSD.

3. (3) The use of two cut-off scores maximizes sensitivity and specificity to predict PTSD.

1. (1) The relationship between current PTSD and cumulative exposure is partially dependent on the approach used to quantify exposure.

2. (2) Focusing on the assessment of cumulative exposure to severe traumatic events is sufficient to predict PTSD, and might be more useful and effective in research and clinical decision-making.

3. (3) Sensitivity and specificity of exposure scores might help improve secondary prevention (early detection and effective intervention) of individuals at risk.

Egypt has the highest prevalence of hepatitis C in the world (10–13%) yet understudied in terms of mental health services.

To shed light on depression among chronic hepatitis C patients in Egypt.

To assess the prevalence of depression and it's correlates in a group of Egyptian patients with chronic hepatitis C infection.

150 chronic HCV infection non cirrhotic Egyptian patients enrolled in the study. Patients are without past history of psychiatric disorder, having neither alcohol nor substance dependence disorders, did not receive interferon therapy. Psychiatric caseness, and depressive symptoms were assessed using General health questionnaire, and BDI-II questionnaire respectively.

The study included 82 Males patients (54.67%) and 68 female patients (45.33%). Seventy three Patients (48.67%) were found to have current psychiatric morbidity with higher affection rates in younger (p < 0.001) and educated (p = 0.019) patients. Among those, 64 patients (42.67%) suffered from symptoms of depression (55 patients (36.67%) of them had mild depression, 6 patients (4%) had moderate depression and 3 patients (2%) had severe depression) with higher affection rates in younger (p < 0.001) and educated (p = 0.019) patients. Gender showed statistically non-significant difference.

There is strong evidence of an association between chronic hepatitis C and psychiatric morbidity in the form of depression in relation rates recorded in general population. Depression is strongly positively correlated with age and level of education. It warrants the attention for providing specialized mental health services in such neglected population.

The Brain-derived neurotrophic factor (BDNF) gene is a candidate gene for influencing the clinical response to treatment with antidepressants.

The aim of the study was to determine the effects of 3 and 6 weeks of escitalopram treatment in depressed patients subdivided according to the treatment response.

We included 188 French subjects with depression, 153 completed a 6-week treatment with escitalopram (10–20 mg/d). Clinical evaluation was performed using the Montgomery and Asberg Depression Rating Scale (MADRS) before treatment and after 3 and 6 weeks of treatment.

At 3 weeks of escitalopram treatment, the Met carriers had increased antidepressant response in comparison to Val/Val homozygotes. No significant clinical difference between genotype groups remained at 6 weeks of escitalopram treatment.

Our findings further support that the Brain-Derived Neurotrophic Factor gene polymorphism (Val66Met) may play a role in antidepressant treatment response phenotypes in mood depressive episode.

There is a marked increase in the role of perceptions of parents and professionals identifying of problems in preschool children (Verhulst, & Verloove-Vanhorick, 2004). Only 2–5% of consultations of children and adolescents include presentations with emotional or behavioral problems (Garralda, 2002).

This study examined the way how mentally ill children arrive at psychiatric clinic in Tirana.

The data used here are from an Albanian study about mental health problems and service use among children and adolescents. 100 children and their respective parents participated in this study and completed different parent questionnaires during the first study session. Age range was between 6 to 17 years, 58% of them were female.

The clinic of child/adolescent psychiatry was the second most common point of entry for children up to 14 years old and first point of entry for youths between the ages of 14 and 17.

Based on the results of this study, several groups that needed intervention in order to increase child mental health service use were identified.

The present data are part of a wider study aimed at analyzing psychological aspects and mental health of Albanian immigrants presented at Clinic of Psychiatry-University Hospital Center “Mother Teresa”, Tirana Albania. The experience of migration can negatively influence mental health (Furnham & Bochner, 1986) and immigrants may have an increased risk for mental health disorders and distress when compared to non-immigrants (Breslau, et al., 2007).

To see the correlation between immigration factors and most frequent psychotic symptoms of the participants in the study.

Study sample was made up of 41 Albanian individuals (M:F = 4.9:1), presenting at University Hospital Center “Mother Teresa” Tirana during six months, with psychotic symptoms and a history of Immigration. Mean age of the subjects was 33.7 years. Semi-structured interviews that utilized several cross culturally validated questionnaires were conducted with all participants, Personal and Psychiatric History Schedule and Structured Clinical Questionnaire for DSM-IV.

The most commonly reported type of trauma was material deprivation (73%), followed by death or disappearance of family members (55%), witnessing violence (43%). Greater numbers of immigration factors were significantly associated with higher levels of persecutory delusions (χ2 = 168.4, p = .001), auditive commanding hallucinations (χ2 = 42.1, p = .001), and intrusive thoughts (χ2 = 34.1, p = .001).

It is the first study on mental health of Albanian immigrant people in Albania and very important for recommendations in future research in this target group.

Studies indicate that about 20% of patients experience depression after acute Myocardial infarction (MI) and that the presence of depression is associated with increased risk for recurrent hospitalization and death. Anxiety seemed to be an independent risk factor for incident Coronary heart disease (CHD) and cardiac mortality. CHD death rates vary with age, gender and socio-economic status. Heart attack patients feel a wide range of emotions including depression, fear and anger, for about two to six months post-MI.

Examine a level of depression and anxiety in patients after acute MI compared to outpatient control group according to age, gender and education.

Patients (n = 60) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI). The State - Trait Anxiety Inventory for Adults (STAI) within the first week of hospital admission for acute MI. The STAI has forty questions with a range of four possible responses to each. Patients with a positive depression score should be interviewed more extensively to confirm or rule out depression.

Significant anxiety and depressive symptoms were present in patients with MI compared to the healthy controls. Significant differences between anxiety and depression were found according to gender and age. According to education there were no substantive differences in either sample.

It appears that anxiety after MI a universal phenomenon. In future trials the cause effect relationships between depression, anxiety and adverse health behaviors in patients with coronary artery disease need to be clarified.

Hypoglycemia may present without classic symptoms especially in young patients and may imitate every neurological symptom. Undiagnosed hypoglycemia may be covered as traumatic, neurological, toxicological and psychiatric disorders.

We are presenting a rare case of acute hypoglycemia at a 14 years old girl admitted at Child and Adolescent Psychiatry Clinic. She presented with a panic attack and hypo maniacal symptoms.

This was an unusual presentation creating a diagnostic dilemma. To the best of our knowledge this is the first reported case of hypoglycemia presenting in adolescents as acute hypomania.

Mrs. A. B. is an Albanian girl 14 years old, with no prior history of mental disorders. She was brought to the child/adolescent psychiatry by her parents because of somatic complains, such as headache, fatigue, dizziness.

Our case provides a unique look at how a simple abnormality when overlooked can present as a difficult diagnostic challenge for both medicine and psychiatry services. Particular care should be exercised when dealing with psychiatric patients with these entities so that hypoglycemia is not missed. Significant medical harm to the patient and medicolegal risks for the emergency physician are issues to consider in cases involving misdiagnosis, incorrect therapy, and inappropriate disposition.

Although some improvements during the last decade, Portuguese mental health services still bear substantial shortages, in terms of accessibility, equity and quality of care. A new National Mental Health Plan with a community model has been launched in 2007.

To assess unmet needs at public mental health services in Portugal.

Cross-sectional study, steering all the public mental health services throughout the country, both for adults (39 units) and children/adolescents (11 units). Evaluation was done by means of the WHO “Quality Assurance in Mental Health Care” tool, which includes dimensions such as physical environment, administrative arrangements, care process, interaction with families, outreach, discharge and follow-up.

The quality of services, according to the assessment made with the participation of professionals, did not reach the “Good level” (> 80% met needs). Level of unmet needs was worse in adult outpatient services (35%) than in inpatient units (27%, despite the relevance of the former. Most critical areas of unmet needs included human resources (only 44% met needs, concerning provision, distribution, interdisciplinary composition of the staff) and administrative arrangements (66% met needs). Regarding the child/adolescent units, the weighted level of quality of outpatient services (67% met needs) was similar to that of inpatient units (68%).

The implementation of the mental health plan has to tackle some of the unmet needs present in mental health services in Portugal. Special attention should be given to the outpatient facilities, in order to undertake with the community philosophy of the National Mental Health Plan.

There is some evidence that cognitive behavioral therapy (CBT) in serious illness does work through its impact on coping. Cancer Coping Questionnaire (CCQ) was originally developed to assess coping strategies taught in CBT.

In this work the preliminary study of the psychometric characteristics of CCQ in a sample of breast cancer Portuguese women is described.

We purpose to evaluate psychometric characteristics of CCQ in a Portuguese sample, namely: internal consistency, test-retest reliability and concurrent validity.

The convenience sample included 189 breast cancer patients, who fulfill CCQ and the following measures: Courtauld Emotional Control Scale (CEC); Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Questionnaire Breast Cancer Module (EORTC QLQC30 and BR-23). CCQ was used in two moments of assessment, the second moment after 2 months of the first.

It was obtained a Cronbach alpha of .80. The test-retest reliability show significant statistical positive correlations (rS = .59, p = .000 for individual sub-scale and rS = 65, p = .000 for interpersonal sub-scale). Significant statistical correlations between CCQ and the other measures used were also obtained.

The validation of the Portuguese CCQ has good psychometric proprieties of internal consistency and test-retest reliability with Portuguese breast cancer women. This instrument also demonstrated to be correlated with other assessment tools used with this population. We conclude that CCQ is a useful and a valid scale for assess the evolution of coping strategies with cancer. Future studies should include other populations.

In the Past, no regulations existed to protect the public from dangerous drugs. Medications that were ineffective, potentially harmful were sold to the public. This is a drastically different reality from what exists today in the United States and Europe.

The approval processes of the FDA and EMA are complex. It is a process difficult to understand for patients. It is information that Clinicians should be familiar with. What does the FDA or EMA approval processes actually entail? What does it mean?

To describe the FDA and EMA as well as their approval processes for new medications.

A review of the literature as published by the EMA, as well as the FDA Orange Book from 1995–2012 to compare the FDA and EMA central approval processes.

The public trust the FDA and EMA to determine what medications are safe and effective, making the FDA and EMA approval a meaningful title to patients. Review of the literature and medication approvals in EU and US shows two of the world's most rigorous drug review processes.

In an increasingly expanding environment of global healthcare, we attempt to stimulate discussion about the challenges of cross cultural medicine. Some of these challenges are elucidated by the drug approval process of the EMA that tries to incorporate all member nations of the E.U under one regulatory agency. This is a theme that will continue to emerge as we look at world in which information and medicine become intertwined.

The transmission of perceived parental rearing styles through generations has been proved in several studies, mostly in studies with two generations samples.

The main aim of this study is to investigate the intergenerational transmission of the perception of parental rearing styles in families composed by three generations.

A convenience sample of 143 participants was collected, belonging to a female lineage subsystem, divided in three generations (G1/grandmother, n = 41, mean age = 74.8; SD = 6.26; G2/mother, n = 41; mean age = 42.4; SD = 5.61; G3/daughter, n = 41 mean age = 22.3; SD = 4.50). All the participants completed a questionnaire regarding sociodemographic, family and educational aspects, and the EMBU Inventory - My Memories of Upbringing.

Spearman correlations revealed several significant associations on the EMBU Inventory dimensions between G1 and G2. The G1 experiences of Emotional Warmth, Overprotection and Rejection, regarding mother and father, are correlated with the G2 experiences concerning the same dimensions. No significant associations were found in the same dimensions of the instrument between G2 and G3.

The results suggest the intergenerational transmission of the perception of parental rearing styles from G1 to G2, but not from G2 to G3. These findings provide partial support to the intergenerational transmission hypothesis, adding to the body of knowledge about the transmission of parenting styles across generations and the multigenerational family in which it occurs. Further studies are needed to elucidate the apparent absence of intergenerational transmission between G2 and G3.

With the widespread of atypical antipsychotics used among children and adolescents, the treatment effectiveness has been of great interest alongside with the efficacy and safety in this population. The study was designed to assess whether second-generation antipsychotics (SGAs) are associated with lower service costs in the real world. Factors associated with service costs were also examined.

The claim data (PIMC) of 1996-2008 from the National Insurance Plan of Taiwan was used. Patients aged less than 20 with an incident use of antipsychotics and last for 12 months during this period were included for analysis. Comparisons were made between 8 SGAs and 2 first-generation antipsychotics (FGAs). Changes in service costs were examined with 95% confidence interval. Multivariate regressions with propensity scores adjustment were performed to explore factors associated with psychiatric service costs.

A total of 343 treatment encounters were included and results showed no difference in psychiatric services costs in the SGAs group as the total service costs were offset to high antipsychotics costs of SGAs, though antiparkinsonian costs were not different between two groups. Factor positively associated with service costs were relapse (RR=4.0, p< 0.0001) and EPS incidence (RR=1.6, p< 0.008), while types of antipsychotics and diagnoses were not significant factors after adjusting for covariates.

Service costs were not different between FGAs and SGAs groups and medication costs were significantly higher in the SGAs group. Relapse and EPS incidence were factors of high costs among children and adolescents psychiatric patients treated with antipsychotics in Taiwan.

Psychiatry views humans through a spectrum of scientific specialties stretching from the “hard” natural sciences to the “soft” social sciences. But, since language is an inescapable aspect of human thought and behavior, and it is doubtful there could ever be a science of meaning, it is doubtful psychiatry can ever be completely scientific.

To determine the prospects for a science of meaning, and the prospects for a science of psychiatry if we remain unable to reduce meaning to a science.

To consider the problem of determining what information people express or absorb via language.

Examine the evidence types ideally accessible to a science of meaning from a logical point of view to see how much confirmation they could provide to hypotheses concerning the information content of linguistic behaviors.

Hypotheses about information content are not as strongly constrained by evidence as are hypotheses about physical properties. Physical properties are directly measurable, whereas information content cannot be measured, but only postulated in order to explain other behavior. Behavior, in turn, cannot be measured or detected except relative to the same explanatory system in which information content, or meaning, is embedded.

There is no absolute methodological barrier to a fully scientific psychiatry, but there are methodological problems a higher order of difficulty than in the hard sciences such as neurochemistry. Psychiatry will advance scientifically, while encountering methodological challenges with meaning that is expressive of values, desires, fears, goals, right and wrong.