To discuss a case of zolpidem-induced galactorrhea.

The prevalence of insomnia can be as high as 32 to 33%. Non-benzodiazepines (such as zolpidem) have become more commonly used to treat insomnia.

The patient is a 29-year-old woman with a history of (PTSD) who presented with PTSD associated insomnia. She was started on zolpidem 5 mg po qhs. Two months after the initiation of zolpidem treatment, the patient presented with breast tenderness and galactorrhea. Zolpidem was discontinued and the galactorrhea resolved after two weeks. A serum prolactin level drawn shortly after discontinuation of zolpidem was 15.67 mg/ml.

Zolpidem has a high affinity at the α1 containing GABAA receptors, with reduced affinity for those containing the α2- and α3- GABAA receptor subunits and minimal affinity for α5 receptor subunit. Psychotropic drugs have been well recognized to produce hyperprolactinemia. However, there has been no reported case of zolpidem-induced hyperprolactinemia. Specifically, zolpidem has been noted to activate GABAergic neurons within the ventral tegmental area (VTA), where there is a sizable population of GABAergic neurons. These GABAergic neurons regulate the firing of dopaminergic counterparts, also located in the VTA, which send projections throughout the brain. This inhibition results in a decrease in the dopaminergic inhibitory influence on prolactin and an increase in prolactin releasing factors which act on the anterior pituitary, leading to hyperprolactinemia and thus galactorrhea.

Pharmacologically induced hyperprolactinemia may be a problem of underestimated prevalence due to the lack of externally visible symptoms.

Research has shown that ADHD symptoms and functional impairment often persist beyond childhood into adulthood. Thus an effective therapy that can be tolerated over long-term use in adults is needed. This is the first long term safety and tolerability study of an adult ADHD medication in Asia.

Assess long-term safety, tolerability, and efficacy of atomoxetine (ATX) in adult Japanese ADHD patients.

Demonstrate the safety and tolerability of long-term ATX.

ATX (40-120 mg/day) was evaluated based on integrated analyses of a 10 week double-blind (DB) study and a 48 week open-label long term (LT) extension study. Long-term safety and tolerability were assessed by adverse events, discontinuation rate, and vital-signs. Efficacy measures included change from baseline in Conners’ Adult ADHD Rating Scale- Investigator Rated (CAARS-Inv:SV) total symptoms score, behavior Rating Inventory of Executive Function (BRIEF-A), and Adult ADHD/QoL Measure (AAQoL).

233 patients took ATX (LT mean final prescribed dose: 108.3 mg/day). AEs leading to discontinuations were seen in 37 (15.9%) patients, the most common being nausea in 10 (4.3%) patients. Statistically significant baseline-to-endpoint reductions in mean CAARS-Inv:SV total symptoms score during in the DB study continued throughout the LT study. Similar reductions were seen in BRIEF-A Self Report scores. These findings along with AAQoL results indicated that patients perceived improvements in both QoL and Executive Function.

Long-term ATX treatment was shown to be generally safe and tolerable in Japanese adult ADHD patients. Results also suggested ATX improved ADHD core symptoms, QoL and Executive Functions.

In some cultures, including ours, direct explanation of inner psychic world is inhibited and stigmatized, therefore finding alternative modes of expression.

The aim of this cross-sectional study was to reach to an estimation of the frequency of somatization in the depressed patients.

500 patients with major depressive disorder referred to the outpatient clinic of Shiraz University of Medical Sciences were recruited and diagnosed based on DSM-IV-TR. Through psychiatric interview, we assessed the presenting complaints of these patients. the presenting symptoms were divided into three main categories namely: mental symptoms, pain, and physical symptoms other than pain. Statistical analysis (chi-square and logistic regression) were performed to assess the relationship between presenting symptoms and some demographic variables such as age, gender, marital status, educational level and cultural background.

Physical symptoms other than pain in 193 (38.6%), mental symptoms in 186 (37.2%) and pain in 121 (24.2%) of the patients were seen. Pain and physical complaints were more common in patients with rural cultural background, lower education, women and the married ones. Headache (15.2%), irritability (10.6%) and pain in other areas of the body (10.4%) were the most frequent chief complaints the patients had stated. the symptoms of hypochondriasis, suicidal idea, crying, irritability and insomnia were significantly associated with the complaint of somatization.

Somatic symptoms, especially pain, have a significant weight in the chief complaints of depressed patients. Physicians need to pay proper attention to this important issue in order to better understand their patients.

The prevalence of psychiatric disorders in the general population in Portugal is estimated to be 30%. It is already known that many patients who present a psychiatric disorder do not seek a medical doctor, in part because they do not recognise their illness but also because of stigma associated to these disorders. Mental health promotion programs for schools are believed to help overcome these difficulties.

To analyse the knowledge on mental health issues and psychiatric disorders of Portuguese school students from the 7th to the 12th grade, and to assess their contact and interactions with patients who have a psychiatric disorder.

Five students from each class at Pedro Alexandrino high school were selected and they were asked to answer to a questionnaire. Data collected from the questionnaires was then statistically analysed.

The sample collected for this study included a total of 145 students, 60% male and 40% female, with a mean age of 15years-old. Global knowledge about mental health and psychiatric disorders among students was poor and it was primarily acquired through the media. A comparatively high percentage of students in our sample (46%) knew at least one patient with a psychiatric disorder, and in most cases those patients were from their family group or circle of friends.

Education on mental health and psychiatric disorders should be implemented at schools and within the context of health education, in order to promote mental health and also to help reduce stigma usually associated to psychiatric disorders.

The prospective study design included baseline two follow-up assessments within a year. Follow-up sample included a total of 708 adolescents from schools throughout Israel. the students completed self-report questionnairesregarding suicide ideation and attempts, psychopathology, life style, socio-demographic background, non-suicidal self-injury, life events and social support.

Results indicate that interpersonal distress and internalizing disorders at baseline predicted later levels of suicidal ideation. the effects of interpersonal factors on ideation were partly or fully mediated by internalizing symptoms. We also found that increases in suicidal ideation and in engagement in risk behaviors and NSSI over time were associated with the occurrence of a suicide attempt within the follow up period.

The model identifies the different phases along the path to suicidal behavior, and risk factors associated with each phase. Hopefully this model will improve our understanding of the short-term course of suicidal behavior among adolescents, which may lead to potential improvements for intervention and prevention.

Between the risk factors for developing a first episode psychosis, social functioning is considered to be one of the most important factors.

The aim of the study is to compare social functioning in schizophrenia offspring and controls, and to determine possible associations between social functioning and prodromal symptoms.

The study examined social functioning (by using the Social Functioning Scale) in 25 Schizophrenia offspring seeking psychiatric help for different problems, and 25 healthy controls.

Clinical status was assessed with the Brief Psychiatric Rating Scale, HAM-D and HAM-A.

Schizophrenia offspring had significantly more social functioning deficits than controls. Social functioning was most strongly associated with depression and anxiety symptoms and less with minor psychotic symptoms.

Social functioning deficits precede the onset of first episode psychosis, especially in persons at risk and, therefore, it could represent an early detection sign. Association with depression and anxiety symptoms should be an early intervention point.

To estimate the risk of developing autism-spectrum disorder (ASD) in children born to immigrants as compared to children of Dutch-born parents.

Retrospective, population-based cohort study of all live births (N= 106,953) between 1998 and 2007 in a circumscribed geographical region in the Netherlands. Cohort members were linked to the Psychiatric Case Register to identify diagnosed cases.

518 cases of ASD were identified, including 150 children with autism and 368 children with Asperger syndrome or PDD-NOS. Children born to migrants from developing countries were at significantly lower risk of ASD (rate ratio (RR)= 0.6, 95% (CI) 0.5-0.9) than children of Dutch-born parents. Within the ASD group, the risk for the subgroup with Asperger syndrome and PDD-NOS was reduced (RR= 0.4, 95% CI 0.3-0.6), whereas that for narrowly defined autism was nonsignificantly increased (RR= 1.4, 95% CI 0.9-2.4). Migrant groups did not differ in age at diagnosis.

The results echo Swedish findings indicating a reversal of risk gradient in children of parents from developing countries, specifically a decreased risk for high-functioning and increased risk for low-functioning autism.

Study of suggestibility in persons with schizophrenia to ascertain whether it is advisable to use hypno-suggestive methods in the system of psychotherapeutic help to them.

As a method of study we used Barber's Creative Imagination Scale. to subjects of the experimental group this method was applied from 2 to 5 times, during 6 months.

In the experimental group the subjects have been distributed in the following way:

1. (0) lack of suggestibility - 12.68%;

2. (1) weak degree of suggestibility - 20.56%;

3. (2) average degree of suggestibility - 13.8%;

4. (3) high degree of suggestibility - 24.51%;

5. (4) very high degree of suggestibility - 28.45%.

In the control group we have obtained the following percentage distribution of subjects:

1. (0) lack of suggestibility - 6.76%;

2. (1) weak degree of suggestibility - 17.18%;

3. (2) average degree of suggestibility - 22.25%;

4. (3) high degree of suggestibility - 27.89%;

5. (4) very high degree of suggestibility - 25.92%.

We also have studied changeableness of suggestibility during 6 months in the experimental group: invariable indices of suggestibility were shown by 27.95% of subjects; 37.26% of subjects had slight changeableness; suggestibility was considerably changed in 26.09% of subjects; and radical change was obtained in 8.7% of subjects.

The obtained results point to the advisability of applying hypno-suggestive methods in the system of psychotherapeutic help of individuals suffering from schizophrenia.

To investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared to pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation.

Cohort study supplemented by cross-sectional survey and nested qualitative study.

Three maternity services, London, UK

Pregnant smokers with and without mental disorders.

Case notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at 2 other sites; 27 pregnant smokers were interviewed using qualitative methods.

Acceptance of referral to smoking cessation services; Perceived barriers to quitting.

Pregnant smokers with a mental disorder recorded by midwives were a quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% vs 56%, AOR 1.70), but more likely to still smoke at delivery (69% vs 56% AOR 2.63). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice due to concern about adversely impacting mental health.

Pregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may thus lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.

There is little known about the extent to which men and women with mental disorders are at increased risk of being a victim of domestic violence. We therefore aimed to estimate the prevalence and risk of domestic violence victimisation among men and women with depressive and anxiety disorders, post-traumatic stress disorder, eating disorders, psychotic disorders, and among psychiatric service users.

We searched 18 biomedical and social sciences databases (including MEDLINE, EMBASE and PsycINFO) and supplemented the search by hand searching of key journals and reference lists of included articles, citation tracking, expert recommendations, and updating a systematic review on victimisation among people with mental disorders. We included cross sectional, cohort and experimental studies that reported on the prevalence and/or risk of adulthood domestic violence victimisation among people meeting either ICD or DSM diagnostic criteria for a mental disorder. Two reviewers independently extracted data and appraised study quality. Random effects meta-analysis was used to pool data where possible.

High quality papers reported a median prevalence of adult lifetime domestic violence in mental health service users of 30% (IQR 26% - 39%) in female inpatients and 33% (IQR 31%-53%) in female outpatients. There was an increased risk of experiencing domestic violence in all diagnostic groups and in men and women but there were few high quality studies for men.

Mental disorder is associated with a high prevalence and increased risk of being a victim of domestic violence in both men and women.

Sixty patients with pharmacoresistant anxiety disorder recommended for in-patient complex therapeutic program (combination of cognitive-behavioral therapy and pharmacotherapy) were evaluated during structured interview focusing on self-stigmatization with clinical psychologist. There were divided into 3 groups according level of self-stigmatization. the patients were treated in intensive 6 weeks cognitive behavioral therapy program combined with treatment of antidepressants.

Preliminary results show, that patients with high level of self-stigmatization improved less in complex therapeutic program than patients with low level of self-stigmatization.

IGA MZ CR NT 11047-4/2010

66 patients completed trial. Three patients refused the protocol. All patients finished minimum of 6 weeks of CBT and showed statistically significant improvement on S-Y-BOCS, CGI-S and BDI scales. the main predictors of achieving the response or remission were scores in S-Y-BOCS lower than 24, good insight, high resistance against symptoms, low level of dissociation, and aggressive character of obsessions. the negative predictors of achieving the response or remission were control/symmetry obsession and compulsions, and obsessive slowness/ambivalence.

IGA MZ CR NT 11047-4/2010

The aim of the study was to assess retrospectively the efficacy of the in-patients therapeutic program for in patients suffering with depressive disorder and comorbid personality disorder (40 patients) and depressive disorder without comorbid personality disorder (40 patients). the electronic and paper documentation of age matched patients with depressive disorder and personality disorder and patients with depressive disorder without personality disorder hospitalized between years 2008- 2010 in Department of psychiatry of University Hospital Olomouc were randomly choose and studied and assessed by blind assessor according prepared criteria measured the efficacy of the treatment. the other factors for the analysis are the age, gender, dose of medication, comorbidity, length of the treatment, CGI and number of hospitalizations during 2 years follow up.

Preliminary results show, that patients of both two groups significantly improved during the treatment period. the outcome of patients with personality disorders was worse in the assessment of clinical state at the end of the index episode treatment, longer time of hospitalization, higher dosage of medication and higher number of hospitalization in follow up.

IGA MZ CR NT 11047-4/2010

IGA MZ CR NT 11047-4/2010

The aim of the study was to assess the efficacy of the in-patients therapeutic program for in patients suffering with pharmacoresistant panic disorder. the therapy was conducted in a group setting and systematic CBT steps were adapted to each individual patient in the group. Pharmacological treatment underwent no or minimal changes during the trial period. Outcome measures included the Clinical Global Impressions-Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Dissociative Experience Scale (DES). the primary outcome measure for treatment response was a rating of 25% improvement in BAI. A remission was defined by CGI-S scores 1 or 2.

67 patients with pharmacoresistance panic disorder entering into the study. Five patients drop out. 62 patients were treated with inpatients therapeutic program consisting from intensive CBT and pharmacotherapy. All patients finished 6 weeks of CBT and showed statistically significant improvement on BAI, BDI and CGI-S scales. the main predictors of achieving the response or remission were scores less than 20 in BDI, droping more than 5 point during the first week of treatment in BAI, not been married and low level of dissociation.

IGA MZ CR NT 11047-4/2010

There are two edifices left to represent one of the most impressive cultural monuments of mental homes in Middle-Europe. the destruction of these historical buildings is intended to establish a modern “Translational Research Centre”.

To outline the significance of the asylum in the history of psychiatric architecture.

To appreciate the first Bavarian mental home.

Study of literature.

The British philosopher Jeremy Bentham is considered to be the founder of the panoptical (“invisible from all around”) concept in architecture. Several panoptical asylums have been built in Great Britain. in France, Italy and Germany a unique exemplar was realized. as the entire ward could be checked from a central room, the possibility of optimal surveillance of the patients was given and the minimisation of staff was enabled. in contrast to the emergent industrial cities (e.g. Nürnberg, Fürth, Schwabach) Erlangen disposed of enough building ground. There, J.M. Leupold (1794-1874) gave a lecture on the new establishing medical department of psychiatry. Thanks to his advice the project of the first Bavarian mental home could be completed within 12 years. the cruciform floor plan was supplemented by cross buildings, which constituted a relevant modification of the panoptical system. Concerning the extension of buildings (1874-1879) the internationally appreciated “system of pavillons” was realized and could be used by university since 1903.

As the TRC-project may serve as a document for future medical progress, it is important to remember the “Kreis-Irrenanstalt Erlangen” as a milestone in the evolution of psychiatric architecture.

41 years-old; biological male; divorced; father of five children; university degree.

Regret following male-to-female sex-reassignment surgery (SRS) and facial plastic surgery; requesting sexreconversion operation.

Compulsive, high-risk sexual behaviour, triggered by traumatic life-events during puberty (death of father and departure of mother at the age of 14). Symptoms evolved throughout adolescence and adulthood with persistent identity diffusion, intense abandonment fears, feelings of chronic emptiness and guilt, mood swings, unstable and intense interpersonal relationships, impulsivity and self-destructive behaviour. Gender history and transition: No evidence of gender nonconformity, gender dysphoria, gender-role discomfort or cross-gender identification. Uncertainty regarding male's role and identity diffusion, persisting since puberty. An impulsive decison for SRS and facial plastic surgery at the age of 40 (performed abroad), without a recommendation letter, motivated by the urge to resolve identity confusion and diminish compulsive sexual behaviour. He subsequently acknowledged his male identity, which led to relief of symptoms and request for sex-reconversion surgery.

Gender history and clinical presentation confirmed that the patient did not sufficiently meet criteria for Gender Identity Disorder, but rather for Borderline Personality Disorder. the authors are highly aware that this topic is significantly connected to issues of the human right to free choice; however we would wish to impose a medical obligation for a rigorous psychiatric assessment for origin of gender identity diffusion and discomfort. Psychotherapy and pharmacotherapy should be the first treatment choices before any radical surgery interventions are undertaken.

41 patients suffering from bipolar disorder and 198 healthy controls were included in the study. Only patients in remission of the disorder, evaluated as 1 or 2 points of clinical global impression - severity scale, were included into the study. Patients were psychiatrically assessed and the state of the disorder was evaluated by experienced psychiatrist. All participants were assessed with the Dissociative Experiences Scale (DES).

The groups didn’t differ in demographic variables like age, gender and education. Patients had significantly higher mean score on the DES and pathological DES than healthy controls.

Our results suggest that the level of psychological dissociation in bipolar affective patients is higher than in healthy controls.

Grant IGA MZ ČR NT11047