Traumatic brain injury (TBI) may lead to enduring cognitive end emotional deficits. Assessment of such deficits by psychological testing requires testing for effort and cooperativeness, especially when litigation is involved. How strong is the effect of effort and does lesion site, especially frontal lobe damage, influence effort?

N= 208 subjects with TBI were assessed between 2004 and 2006 by a neurological, a psychiatric and a psychological examination. The referral sources were the German workers compensation board and private insurance companies. The psychological battery comprised measures of memory, attention, cognitive speed and intelligence as well as self report instruments for assessment of psychiatric symptoms. Effort was assessed with the WMT (Green 2003). Lesion site and type was available through reports on brain CAT scans and MRIs. Assessment was done a median 25 months after the injury.

The results indicate that effort explained the largest share (50%) of the variance in psychological tests scores. There was no effect for lesion site on effort. A factor analysis on test scores produced a two factor solution, with the largest loadings on effort.

It is evident that in cases involved in litigation the performance in neuropsychological assessment is mainly explained by effort. However, there was no evidence, that injury to some brain areas would specifically impair effort. The study adds support to the construct validity of effort testing and its robustness in frontal lobe damage.

Every year the number of adherents of totalitarian sects in Ukraine grows. They are referred for forensic psychiatric examination more and more frequently, both in civil and criminal cases.

The purpose of our research was to determine the degree of harm done by the activity of totalitarian sects existing in Ukraine to the mental health of their adherents. To create standardised methodological approaches to the procedures of forensic psychiatric examination.

We examined adherents of different totalitarian sects directed to the Odessa psychiatric hospital N 1 for forensic psychiatric examination. Special cards were used, in which we registered the description of his/her mental state, and the data of psychological investigation.

As a result of psychological techniques used in the totalitarian sects the adherents can easily develop new psychological characteristics, which are described in ICD-10, part F60.7 as the Dependent personality disorder. In particular, this disorder includes risk factors of the development of induced psychoses. The worsening of initial mental disorders (especially schizophrenia) was observed in many cases as a result of stressful influence (of psychogenic and somatogenic nature), to which the adherents were exposed.

To assess the extent of harm done to the adherents?? mental health by the activity of totalitarian sects it is necessary to provide inpatient complex forensic psychiatric examination with the investigation of additional materials (audio- and video-records of the religious ceremonies).

200 male offenders suffering from epilepsy.

Clinical, EEG and statistical analysis.

The 4-stage of psychiatric disorders in epilepsy evaluation has been proposed: 1. Diagnosis. The choice of expert approach is determined by individual clinical picture and course of the disorders; character of prevailing psychiatric disorders - personality disorders, psychoses, dementia, paroxysmal states; 2. Finding out the cause and effect relationships. Revealing the psychopathological mechanisms of an offence and qualification of a principal syndrome at the moment of offence. 3. Situational analysis. Evaluation of an adequacy of perception of the situation by a patient, his chances to choose other ways of behavior; capability to foresee a result of his behavior; 3 Building an expert conclusion: comparing of the current clinical picture and psychopathological disorder at the moment of crime with medical and juridical criteria of the formulas of irresponsibility, diminished responsibility and criteria for involuntary hospitalization.

The proposed algorithm distinguishing different types of the relationships between psychopathological condition and criminal situation gives a possibility of precise evaluation of persons suffering from epilepsy. It takes into consideration the clinical diversity of psycho-pathological conditions that can differently contribute to the persons' responsibility.

Accused offenders considered to be partially responsible for their actions under forensic psychiatric assessment in Serbsky Centre in 1996-2005.

Psychopathological, follow up.

Diminished responsibility was introduced into the Russian legislation ten years ago only. The current experience demonstrates its active assimilation. Besides that, there is a distinctive specificity of its use determined by peculiarities of the object of assessment, i.e. by non-psychotic level of disorder and therefore not clearly apparent in evaluation. It became clear that in many cases all involved persons including the offender are not interested in this legal norm equally. It is a good possibility for officials (experts, judges, barristers) to take into consideration during investigation every important issue of legal case (psychological abnormality first of all). The advantage of being partially responsible for offenders is not so evident. Moreover according the follow up results this fact can be the discrediting information for a prisoner. The label of mental illness is well known obstacle and especially in custody where human values are rather specific and distorted.

In situation when a forensic psychiatrist realizes probability of labeling the person due making his own decision of partially responsible one more specific problem can arises for him - is it proved from ethical point of view to make such of decision or not? It can influence negatively the expert's professional activity in some cases.

Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.

We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).

115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.

61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.

Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).

Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.

To evaluate the clinical benefit of switching to quetiapine sustained release (SR) in patients with schizophrenia experiencing suboptimal efficacy/tolerability with their current antipsychotic.

This was a 12-week, multicentre, open-label study (D1444C00147). Quetiapine SR (mg/day) was initiated during a 4-day cross titration phase (300 on Day 1; 600 on Day 2; 400, 600 or 800 on Day 3; flexible-dosing [400-800] from Days 4-84). Primary objective was to demonstrate that >50% of patients would achieve clinical benefit (improved CGI-Clinical Benefit [CB] score, based on CGI-I Efficacy index and tolerability burden) at Week 12. Secondary endpoints included CGI-I and PANSS total scores. Tolerability was assessed by adverse events (AEs), SAS and BARS scores. Mean changes in rating scale scores were analysed using ANCOVA.

477 patients were switched to quetiapine SR, 370 (77.6%) completed treatment. 295 of 470 evaluable patients (62.8%) achieved a clinical benefit upon switching to quetiapine SR (95% CI 58.4, 67.1, p<0.0001). Significant improvements were observed in mean [SD] change from baseline in CGI-CB (-2.1 [3.62]) and PANSS total (-13.6 [19.23]) (both p<0.001). Mean [SD] CGI-I score at endpoint was 2.8 [1.49] (p<0.001 for mean CGI-I<4). Common AEs included somnolence (17.8%), sedation (15.1%), dizziness and dry mouth (14.0% each). The incidence of EPS was 8.0%. Mean changes (improvements) from baseline in SAS and BARS scores were -2.1 and -0.4 respectively (both p<0.001).

Switching to quetiapine SR was associated with clinical benefit and was well tolerated in patients with schizophrenia experiencing suboptimal efficacy/tolerability with their previous antipsychotic treatment.

The present study has the aim to evaluate the link between PTSD and Bipolar Disorder/Schizoaffective Disorder. There are great apparent differences between Bipolar Disorder and Schizoaffective Disorder, also many similitudes.

The sample consists of 22 patients, 14 females and 8 males, with average age 29,3 years. They were hospitalized for depressive or manic episode and diagnosed using DSM IV criteria with BPD (n1=12 patients) and Schizoaffective Disorder (n2=10). All the patients were screened for PTSD using module from the Structural Clinical Interview for DSM IV (SCID).

The study replicated the impact of PTSD on the onset of the two major disorders. In this sample, 8 from 10 patients with Schizoaffective Disorder (80%) have had PTSD (frequently after a suicide in patient`s family or rape), 3-4 years before onset. The most patients with Bipolar Disorder (n=7; 58,33%) had also a PTSD but the temporal link between this one and BD is longer (6,5 years average).

It may be concluded that PTSD is highly prevalent in patients with Schizoaffective Disorder, but there is also a great risk of having PTSD in patients with BD.

Early diagnosis and interventions are the standard in the field of Autism Spectrum Disorders, however ascertainment of these diagnoses is unreliable, in a large minority of high functioning cases given the ambiguity of diagnostic criteria of the Pervasive Developmental Disorders; Not Otherwise Specified, and the lack of clear boundaries with other developmental disorders. A “Difficult to Diagnose” clinic was developed 6 years ago to rapidly develop a consensual diagnosis to expedite treatment. The factors that cause diagnostic confusion will be outlined and a brief observational tool adapted from the Children's Autism Scale for Children will be described utilizing a videotaped presentation. The clinical diagnosis was compared to the “gold standard”, the previously validated Autism Diagnostic Observational Scale (ADOS). To bypass long waiting lists for interventions and provide immediate direction to help parents stimulate social engagement, a brief intervention called “Let's Get Started” was developed and will be described.

The consensual clinical diagnoses of two physicians and the findings on the ADOS will be correlated.

The ADOS does not consistently diagnose the “Difficult to Diagnose” children. By utilizing a collaborative clinical method focusing on the child's social interactive skills, the child on the Autism Spectrum can be differentiated from other developmental disorders. Those on the Autism Spectrum can receive a social interactive training program administered by their parents, who have been trained in the “Let's Get Started” program, taught to them when they felt most helpless and disempowered, and in mourning after being given the diagnosis of Autism.

Auditory and musical hallucinations have been reported in patients as an adverse effect of the use of opioids. Hearing loss, old age, and female gender are considered risk factors in the development of musical hallucinations. The aim of this report is to describe a case of a patient with auditory and musical hallucinations and to discuss the role of an opioid –tramadol- in the origin of those.

An 80 years old woman experiencing auditory hallucinations was referred to our hospital from an emergency room. The patient had bilateral mild hearing loss and was receiving tramadol 112.5 mg/daily during the last year for cervical pain. In the last ten months, she had been gradually noticing the voice of her dead husband coming from under her pillow, as well as intermittently hearing popular songs being played inside her head. The patient had good insight on both types of abnormal perceptions, which were reported as increasingly unpleasant through time.

Tramadol was discontinued and pimocide (range 1-4 mg/day) and loracepam (2.5 mg/day) were introduced, achieving the improvement of the hallucinations and the anxiety associated with them.

The outcome of this case supports the hypotheses that Opioids could induce musical hallucinations. Hearing impairment, old age, and gender could be underlying risk factors on the development of musical hallucinations.

Perception of Quality of Life (QoL) in patients on antipsychotic treatment may differ depending on the perspective. This prospective, naturalistic study looked at differences between the "objective" physician perspective using the Quality of Life Scale (QLS) and the "subjective" patient perspective using the Subjective Well-being on Neuroleptics Scale (SWN).

Data were collected in a prospective, 12-month, prospective naturalistic study in 1462 outpatients on antipsychotic treatment for schizophrenia. Patients were grouped into 4 cohorts depending on the degree of concordance between SWN and QLS ratings. The impact of factors on the concordance was expressed as adjusted odds ratio (OR; QLS=SWN used as reference group).

Linear correlation was found between QLS and SWN ratings: 10 points on the SWN corresponded to 9.35 points on the QLS. Several factors affecting the concordance of both ratings were identified: Compared to the cohort with QLS=SWN, higher QOL ratings by the physician (QLS>>SWN) were more likely in females than in males (OR=1.36) and in older than in younger patients (?30 vs. >50 yrs: OR=0.58), but less likely in patients with high baseline CGI-severity (CGI>4; OR=0.63) or treatment with oral typicals before baseline (OR=0.53). Higher QOL ratings by the patient (SWN>>QLS) were less likely in patients with psychotherapy before baseline (OR=0.54), medication intolerability before baseline (OR=0.53) or patient request of treatment change at baseline (OR=0.64).

The combination of several factors predicted concordant QoL ratings, including male sex, young age, high CGI at baseline, and prior treatment with oral typical antipsychotics.

This secondary analysis of a multicenter, randomized, flexible-dosage, placebo-controlled, double-blind, parallel-group trial evaluated the efficacy of pregabalin, based on baseline anxiety symptom severity, as treatment of GAD in patients ≥65 years.

Patients underwent an 8-week double-blind, flexible-dosage (150-600 mg/d) treatment phase, including a 1-week dose-escalation period (50 mg/d to 150 mg/d). The study's primary efficacy measure was mean change from baseline to endpoint-LOCF in HAM-A total score. To determine whether baseline symptom severity influenced pregabalin's efficacy, we evaluated patient subgroups with baseline HAM-A total scores of ≥20 (pregabalin n=171, placebo n=95), ≥22 (pregabalin n=146, placebo n=85), ≥24 (pregabalin n=120, placebo n=72), ≥26 (pregabalin n=93, placebo n=48), and ≥28 (pregabalin n=65, placebo n=28).

Patients' mean age was 72 years, and mean duration of their GAD was 17 years. 77% were women. 177 patients received pregabalin; 96 received placebo. Pregabalin was significantly superior to placebo on the primary outcome measure: mean change from baseline in HAM-A total score was –12.84 for pregabalin and –10.7 for placebo (P=.044). Treatment differences between pregabalin and placebo for each symptom-severity stratum were: ≥20, –2.18 (P=.044); ≥22, –2.37 (P=.047); ≥24, –2.80 (P=.035); ≥26, –2.70 (P=.096); ≥28, –3.07 (P=.156). Comparison of effect sizes (pregabalin vs placebo at endpoint) showed sustained benefit as the severity of baseline anxiety symptoms increased: ≥20, 0.261; ≥22, 0.276; ≥24, 0.324; ≥26, 0.301; ≥28, 0.332.

Pregabalin efficaciously reduced the symptoms of GAD in patients aged 65 years and older, regardless of the severity of their anxiety symptoms at baseline.

The use of antipsychotic depot medication in old age needs to be reviewed for knowing the adequacy on its prescription in this part of the population. The patterns of depot medication use in an area of England are presented.

Know patient's sociodemographic characteristics, type of diagnoses, care status, and type of depot medication.

Review if depot medication is prescribed between the recommended frequencies and doses.

Value the suitability of depot treatments in these patients.

Value the follow up, included recommended investigations.

Retrospective and descriptive study over a Sample of 23 patients on depot medication (Age >64 years old).

Sociodemographic, clinical, care, suitability, follow up and monitoring variables are collected.

The results are analyzed in accordance with the NICE guidelines recommendations.

The profile of an old patient receiving depot medication is a woman, about 73 years old, single, living in a residential home or alone and with a diagnoses of schizophrenia (30 years on illness).

The 2 most prescribed medications were Zuclopentixol and Fluphenazine.

The majority of patients didn't relapse with depot medication.

Tthe patients have been seen by the community team between the recommended intervals; depot medications have been given between the recommended limits of frequency and range of dose.

In an important proportion of patients it's unknown the time on depot and which other oral medications have been tried.

About the follow up of the patients, The recommended monitoring hasn't been followed or it hasn't been recorded in the case notes.

To study the characteristics of the population attended in the Service of Urgencies of a General Hospital with a suicide attempt, and particulary characteristics of patients' subgroup of sixty or more years in comparison with the rest of patients.

Of all urgencies attended by psychiatry in the year 2003 in our hospital we selected those in which consultation motive was suicide attempt. In all of them were analyzed following variables: age, sex, psychiatric history, previous history of suicide attempts, need of income and suicide method used. Characteristics of patients over 60 years old were analyzed, comparing them with the rest of patients.

Middle age of the sample (n=286) were 35,7 years, 26 patients (9,1%) were 60 years or more. Among elders 46,2% was men and 53,8% women. 81% of elders had some psychiatric diagnosis (77% the rest of patients), most frequent was depression. Two (7,7%) of 26 elder patients had some personality disorder, opposite to 19,5% of other patients. 65,4% of elders committed suicide attempt by drugs ingestion, more employees were benzodiazepines (47,4%). All elders attended by suicide attempt needed to be income.

In over 60-year-old people psychiatric comorbidity is more frequent that in the rest of patients who commit suicide attempt, though personality disorders are minor. Method used does not differ from rest of patients. There is frequent these patients need to income.

Chronic pain is associated with opioid prescription. Chronic pain, as well as mental disorders are associated with initiation and use of prescribed opioid in the general population. Furthermore, psychiatric disorders are associated with increased physical symptoms and may be associated with opioid use (Sullivan et al., 2005).

To report a case in order to underline the relationship between chronic pain, depression and opioids misuse.

Case study and description of a patient admitted in a General Hospital.

A literature's review about chronic pain, depression and opioids misuse in elderly people was made through PubMed.

A 73 year old woman was admitted in a General Hospital's emergency room for renal failure related to opioid abuse. The patient was prescribed opioid 10 years ago, to treat spinal cord pain, which she followed until 2 years ago. At that time, she began to misuse her treatment. The case review showed that the patient had been suffering from an under diagnosed depression. The depression may have diminished her pain tolerance threshold, inducing opioid misuse.

In patients with chronic pain, there is a need to deal with patient's psychopathology when considering opioid treatment.

Pain tolerance threshold may diminish when patient suffers from a mental disorder.

When opioid medication is less effective, psychiatric comorbidities should be evaluated, instead of increasing opioid medication.

As many elderly patients suffer from chronic pain, it's recommended that they are evaluated for opioid misuse, especially when presenting with an unexpected clinical profile.

To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).

A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.

1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.

Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.

Depression affects practically one in three institutionalized elderly in Spain

Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.

The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.

Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.

From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.

992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).

35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.

NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.

Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.

It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.