Various biological risk factors for aggressive behaviours have been proposed, including disturbances in monoaminergic neurotransmission, endocrine axes and central nervous system (CNS) integrity.

To describe findings of correlations between markers of CNS chemical integrity, neurotransmission and hormone metabolism in relation to personality traits from forensic psychiatric investigees and normal subjects in a stress paradigm.

Cerebrospinal fluid (CSF) and serum (S) samples from 46 forensic psychiatric investigees and 35 healthy subjects undergoing knee replacement surgery were analysed in relation to aggressive personality traits as rated by the Karolinska Scales of Personality, the Psychoapthy Checklist-Revised and the Temperament and Character Inventory.

Aggressive traits were especially associated with increased HVA/5-HIAA ratios, indicating a deficient serotonergic tonic regulation of the monoaminergic activity, and with indices of deficient CNS integrity, such as increased CSF/S albumin ratios.

Neurobiological vulnerability factors are associated with aggressive behavioural and personality traits.

Emotional regulation plays a pivotal role in socialization and personal development. However, little is known about the time course of emotional responses and the interaction with the subjective assessment of emotional intensity. The aim of this project was to examine the time course of emotional responses to visual stimuli when they naturally subside and when they are cognitively suppressed.

Healthy volunteers (n=48) viewed 54 images, each lasting for 6 sec, taken from the International Affective Picture System (18 positive, 18 negative, 18 neutral). In the passive condition, subjects had to press a button to view the next image when their response had subsided. In the active condition, subjects had to press a button to view the next image when their response was successfully suppressed. After each presentation, participants rated the intensity of their response on a scale from 1 (lowest) to 9 (highest). Time to resolution (TTR) after image presentation and intensity ratings were averaged (mean±SD).

TTR (seconds) for neutral images was 7.22 ± 7.91 and 4.49 ± 5.41 for passive and active condition, respectively. For positive images, 12.1± 9.2 and 8.66 ± 7.13 for passive and active condition, respectively. For negative images, 15.68 ±10.14 and 11.42 ±8.25 for passive and active condition, respectively. TTR was statistically significantly shorter (p<0.006) for all images during suppression. TTR in both conditions correlated positively with intensity of emotional response.

TTR of emotional responses to emotionally valenced images increases with intensity of the associated response and decreases with voluntary suppression.

This study explores the contribution of personality dimensions as a source of individual variability, to electrodermal arousal, subjective ratings of intensity and time to resolution (TTR) of emotional responses to affectively valenced images.

Healthy volunteers (n=48) viewed 54 images from the International Affective Picture System equally split in positive, negative and neutral categories. Subjects pressed a button to view the next image when their response had naturally subsided (passive condition) or following voluntary suppression (active condition) and then rated the intensity of their response on a scale from 1 (lowest) to 9 (highest). The amplitude of the maximum peak of skin conductance responses (SCRs) was also measured. Personality dimensions were assessed with the Eysenck Personality Inventory (EPQ-Neuroticism, EPQ-Psychoticism and EPQ-Extraversion).

Linear regression analyses were conducted to examine the effect of EPQ-P, EPQ-N and EPQ-P on TTR, intensity ratings, and maximum SCR amplitude in each experimental condition.

The emotional valence of the pictures was the strongest predictor of all 3 main outcome measures in both active and passive condition accounting for 36% of the variance for TTR, 72% for the intensity ratings and 16% for the maximum SCR amplitude. Higher EPQ-Psychoticism scores predicted lower intensity ratings accounting for about 10% of the variance in both conditions. EPQ-Extraversion and EPQ-Neuroticism explained 15% of the variance in TTR but in opposite directions. Higher EPQ-Neuroticism scores predicted lower SCR amplitude accounting for 8% of the variance.

Measures of emotional reactivity show distinct patterns depending on experimental condition and personality characteristics.

To explore the characteristics of cerebral activation during the performance of WCST in first-episode, drug-naive schizophrenic patients by functional magnetic resonance imaging,Wisconsin Card Sorting Test (WCST) and Color Card Sorting Test (CCST).

Twenty healthy adults and twenty schizophrenic patients underwent fMRI with a 1.5T MR imager with gradient echo-EPI sequence during the performance of Wisconsin Card Sorting Test (WCST) and Color Card Sorting Test (CCST). The functional images of two groups were analyzed with analysis software. The active volume of interested brain areas and the performance of WCST were compared between healthy group and patient group. Results:(1) The performance of WCST in first-episode drug-naive schizophrenic group were significantly lower than the performance in healthy group(P<0.01) . (2) The images subtracted the functional images of CCST from those of WCST in healthy group suggested that activations were mainly localized in the bilateral frontal lobe, especially the dorsolateral prefrontal cortex,posterior parietal cortices and anterior cingulate gyrus.(3)The patients group showed less activations in left dorsolateral prefrontal cortex(P<0.01), left anterior cingulated (P<0.05),but more activations in left posterior parietal cortices(P<0.05).

The dorsolateral prefrontal cortex and anterior cingulate of first-episode schizophrenic patients are hypofunction,which maybe involved in the executive function disorder in schizophrenia. The hyperactivity of posterior parietal cortices maybe can compensate the hypofrontality in a certain extent.

Working memory and executive functions, connected with the activity of prefrontal cortex play an important role in complex mental processes. Wisconsin Card Sorting Test (WCST) is a main tool used for neuropsychological assessment of prefrontal cortex activity. Molecular genetics studies show the association between the performance on WCST and polymorphism of dopaminergic system genes in schizophrenia and healthy subjects, also with polymorphism of BDNF gene in bipolar disorders.

In this study an association between performance on WCST and polymorphisms of selected candidate genes was assessed.

The study included 200 healthy volunteers aged 18-60 years. Neuropsychological assessment was performed using WCST and following domains were evaluated: perseverative errors (inability to change the reaction), nonperseverative errors (attentional inability to avoid distraction), number of completed categories (ability to utilize new information), percent of conceptual responses (ability of conceptual thinking) and set to complete 1st category (ability to formulate a logical conception). Genotyping were done for polymorphism of dopaminergic: D1receptor (-48A/G) and catechol-O-methyltransferase (COMT108/158Val/Met), serotoninergic (5-HTTLPR), glutamatergic: FYNkinase (93A/G, IVS10+37T/C, Ex12+894T/G) and neurotrophic: brain-derived neurotrophic factor (BDNF:C-270T,Val66Met) genes.

A/G polymorphism of DRD1 gene was connected with better results on trials to complete 1st category. Better performance on nonperseverative errors was observed in females with Val/Val genotype of COMT. The C/T genotype of C-270T BDNF polymorphism was associated with higher percentage of conceptual responses.

The results obtained suggest a contribution of studied candidate genes to working memory and executive functions efficiency, connected with prefrontal cortex activity, in healthy subjects.

The International Classification of Headache Disorders (2nd. Edition) recognizes, among headaches secondary to psychiatric disorders, the relatively rare ones attributed to psychotic disorders.

The Delusion of Infestation has unknown prevalence. It may occur at any stage, but is more frequent in senior individuals. The rate male-female is 1:1 and 3:1 before and after 50 years old, respectively. The diagnostic classification reveals a great rate of “pure forms” (Delusional Disorder according to DSM-IV or ICD-10), but the syndrome was also described in Schizophrenia, Affective or Organic Psychosis, or even as a neurotic symptom.

The present report describes the case of one 56 years-old woman admitted to a psychiatric ward due to a Delusion of Infestation. This condition was evolving for several years with the occurrence of both visual and coenaesthetic hallucinations. Complaints were of severe unspecific headaches with delusional believes about its aetiology (brain infestation). No alterations were detected after an organic medical examination. She started antipsychotic and antidepressive medication, with consequent decrease of the delusions. The patient is currently in recovery, referring reduced pain and no delusion ideation.

To describe a clinical case of headache secondary to Delusion of Infestation.

Clinical file review, bibliographic review.

Attention deficit hyperactivity disorder (ADHD) is a developmental syndrome expressed along three domains: inattention, hyperactive-impulsive, and combined type. To compare subtypes of attention-deficit/hyperactivity disorder (ADHD) (predominantly inattentive and combined types) and a comparison group on an objective measure of activity level (actigraphy).

Actigraphs were worn by 21 children (19 boys, 2 girls) during 3 full-days clinical diagnostic assessment.10 subjects had a diagnosis of ADHD predominantly inattentive type, 11 had ADHD combined type. Children were diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Measurements: ADHD: ADHD Rating Scale DSM IV- Home Version to subdivide children into those with predominantly attention deficit, mainly hyperactivity, and those with both aspects equally. Mean actigraph scores were calculated for tree days.

There were no significant group differences in activity level between two groups; there were no differences between ADHD subtypes. There was poor correspondence between parent report and actigraphy.

These data no support specifications in the DSM-IV regarding hyperactivity in ADHD. Furthermore, the findings contradict specifications in the DSM-IV that suggest that children with ADHD combined type should be more hyperactive than children with ADHD predominantly inattentive type.

To assess the adaptation of employed mothers one year after childbirth depending on 6-weeks psychiatric status and received treatment.

A prospective study was designed. A randomly stratified group (according to EPDS score) of 325 employed mothers was interviewed at 6-weeks postpartum to establish psychiatric diagnosis according to DSM-IV criteria (SCID-I). Some cases were treated (mostly diagnosed of major depressive and panic attack disorders). 258 mothers were reassessed with the same procedure one year later. Chi-square was calculated to determine if psychiatric diagnosis one year after childbirth is related with psychiatric diagnosis at 6-weeks postpartum. Odds ratio (OR) were calculated to determine the increased risk of having a disorder at one year according to 6-weeks psychiatric diagnosis.

At one year, 50% of women in our sample were psychiatric cases and were significantly associated with clinical diagnosis at 6-weeks (X2=52.91; gl 2, p<0.001). The risk of being a psychiatric case at one year was three times higher (OR: 3.35; CI95%: 1.62-6.93) for non treated cases and nine times (OR: 9.46; CI95%: 4.96-18.06) for treated cases.

Half of our sample received a clinically relevant psychiatric diagnosis at one year.

Our results support the hypothesis that maternity is a vulnerable period for psychiatric disorders. Additionally many cases receiving treatment do not remit or remit partially and tend to chronification. The special characteristics of this population suggest that specific treatment units with specialized professionals are needed.

This study has been supported in part by grant 13/00 from Institute of Women, Spain.

Violent behavior is a serious complication in acute psychiatric inpatients. Several risk factors are known that facilitate such behaviors, preventive measures are however difficult to evaluate, since prevented violent events usually are not recorded. The aim of the study was to assess the possibility to predict violent events and efficaccy of preventive measures.

The study is prospective observational study at large 32-bed PICU in University Psychiatric Hospital, that covers 900.000 population with the average of 8 admissions per day. Recording of violent or other unexpected events is done routinelly. The risk for violent events was measured by BVC and by subjective assessment on a 7-point scale, both done three times daily. Using a special form, a number of prevented violent events is recorded with the same frequency. The results were compared with number of violent events before new assessments were introduced in everyday practice. Events were correlated with clinical assessments using CGI, GAS and BPRS.

The number of actual violent incidents dropped significantly with new assessment methods. Subjective assessments of the risk for violent behavior showed superiority in the prediction of events then BVC. The majority of violent incidents were predictable and preventable, that reflected in low frequency of actual behaviors observed in the study.

Simple routine assessments done by educated stuff at PICU predict well unwanted and dangerous behaviors in acutelly ill psychiatric inpatients. Prevention strategies include known risk factors and give some new insights in the extent of the problem.

The value of psychiatric diagnosis is challenged by comorbidities and outcome prediction compared with symptom clusters and the role of common personality factors, such as impulsivity. The usuall clinical scales such as BPRS, HAM-D, YMRS or MMSE often mislead away from important symptoms or behaviors, since their validities are compared to valid classifications and diagnosis and do not include important coommon pathways to clinical manifestations and outcome.

Using prospective design the study evaluates diagnosis, results of clinical scales (BPRS, HAM-D, YMRS and MMSE) and impulsivity (BIS) to retrospectivelly assessed course of illness and outcome of index episode in adult patients presenting with acute episode or worsening of schizophrenia, unipolar depression, bipolar disorder and dementia.

120 patients were included (30 in each diagnostic group) in the study, that is on-going at present. We found no correlation between past and present outcome and diagnosis, the corrleations were confirmed to clinical scales used, but the strongest corrleations were found between impulsivity and outcome in all four patient groups.

Current diagnostic systems are limited in longitudinal and outcome strenght. Other symptom clusters and impulsivity seem to predict outcome more consistently.

The aim of the study was to analyse EEG investigation to diagnose the tic disorders in children and adolescents.

The analysis was conducted on a group of 76 patients admitted to the Department of Developmental Neurology between 2000-2005 years to diagnose the tic disorders. The average of children's age was 11,4 +/- 3,7 years. In investigated group of patients there were 62 boys (81,6%) and 14 girls (18,4%). The video-EEGs were carried out at 7 patients (22,4%).

There were recorded a single sharp waves in 37 patients (47,4%) and the groups of sharp waves in 21 cases (27,6%). Accordingly there were registered the spike and wave complexes in 7 cases (9,2%) and the sharp and wave complexes in 4 cases (5,3%) in EEG. The generalized paroxysmal activity was recorded in 7 patients (9,1%). The abnormal activity appeared in the temporal part of cerebral hemispheres in 41 children (53,9%). The hiperventilation activated EEG recording of 33 children (43,4%). In 18 cases (23,7%) the abnormal graphoelements didn't appeare in EEG recording. The video recording and the clinical observations during EEG invstigation didn't revealed any coincidence between changes in EEG recording and the involuntary movements presented by patients.

The resting, routine EEG revealed abnormalities in most cases. Therefore video-EEG recording enabled to differentiate tics from epileptic seizure by finding any corelation between the occurrence of involuntary movements and abnormal graphoelements recorded during in EEG investigation.