Panic disorder is frequent psychiatric disorder characterized by sudden and unexpected onset of a panic attack, characterized by terror or impending doom, and associated with many somatic symptoms. Panic is considered as a state of hyperarousal, the EEG has had a prominent place in anxiety studies. sLORETA (standardized low resolution brain electromagnetic tomography) is now widely used research method investigating the electrical activity of the brain with zero localization error and ability to reconstruct multiple resources.

EEG may be useful toll in looking for predictors to therapeutic response.

The study aimed at finding electrotomographic differences between patients with panic disorder who respond to combined therapy.

We measured patients with Panic disorder. Diagnosis was confirmed by M.I.N.I. (MINI-international neuropsychiatric interview). Patients were treated both by psychotropics and CBT (cognitive behavioral therapy) for six week. The symptoms intensity was assessed using BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). They were also examined by EEG. It was measured in rest state with closed eyes, using standard 10-20 montage with 19 electrodes. Measurements were carried out at the beginning and after 6 weeks of therapy.

We found decreased absolute power in alfa-2 (10.5 - 12 Hz) activity in anterior cingulated, and increased absolute power in beta-3 (21.5 - 30 Hz) activity in superior frontal gyrus.

Our findings suggest that cognitive behavioural psychotherapy can cause changes in brain activity.

IGA MZ CR NT 11047-4/2010

These findings demonstrate a lower autonomic power in panic disorder patients and tendency to increase it during the treatment.

Supported by: Project IGA MZ ČR NS10301-3/2009

Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patiens in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission.

Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication).

Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1- lie down 5 minutes, 2 - stand up 5 minutes, 3 - lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission.

We found highly statistically significant negative correlations between level of dissociation measured by DES and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder.

Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patiens and age of onset and duration of disorder.

Supported by: Grant IGA MZ CR NT11474

We describe step by step the cognitive-behavioral group therapy of patients with panic disorder. We are explaning the concept of cognitive model of panic disorder, vicious circle, cognitive reconstruction, control of breathing and exposure. We also present personal experience with group cognitive-behavioral therapy and possible complications that may occur.

The results of our research in this group concerning the efficacy of the program, changes in the heart rate variability during program and EEG changes (using sLORETA) are presented. We also try to point on possible complications that may occur during the therapy and coping with them.

Supported by: Project IGA MZ ČR NS 10301-3/2009

Short psychodynamic psychotherapy or systematic CBT was tailored according the needs of each patient. Pharmacology treatment remained mainly unchanged during the trial period. Outcome measures were: CGI, Dissociative Experience Scale (DES), Somatoform Dissociation Questionnaire (SDQ-20), BDI, BAI. The primary outcome measures were clinical response defined as 30% decrease in BAI and remission defined as a 1 or 2 points in CGI.

190 patients were included into the study and 15 dropped out. Altogether 175 patients completed at least 5 of 6 weeks of intensive psychotherapy program. Patients of all diagnostic groups showed significant improvement in CGI, BAI, BDI. At the end of the treatment 51.1% of the patients achieved clinical response and 42.3% clinical remission. The main characteristics present at the beginning of the trial increasing probability of achieving response or remission during the treatment were BAI score lower than 25, BDI score lower than 20, no comorbidity with personality disorder, no comorbid depression, no being divorced or widowed.

Therapeutic efficacy of the intensive psychotherapeutics programs for anxiety disorders was predicted with level of anxiety and depression, comorbidity with depression and personality disorders and marital status.

Supported by: IGA MZ CR NT 11047

The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly Anxiety disorders patients. As a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.

683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for Anxiety disorders, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.

22% of the sample fulfill the diagnosis of dual diagnosis. 19.3% of the sample were schizophrenic, 17.42% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses. No difference among anxiety spectrum disorders regarding rate of dual diagnosis.

Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

There's an increasing professional and popular interest in relation of spirituality and general health. Although mental health professionals have traditionally avoided concerns, evidence has been accumulating that people with mental illness attach significance to spiritual beliefs. In contrast, around 60% of psychiatrists report minimal interest in spiritual matters. Some authors found spiritual well being as an active relation with a higher power to be positively correlated to good mental health.

Cross sectional comparative study design, 60 patients during detoxification and 20 patients in rehabilitation program with open group psychotherapy after detoxification, demographic data were collected and participants were subjected to spirituality subscale from substance misuse program philosophy questionnaire Arabic version.

Response to the 6 questions of the spirituality subscale used to assess level of spirituality didn’t show difference among the three groups, those during detoxification, those less than 3 months abstinence and those more than 3 months abstinence in rehabilitation program with open group psychotherapy.

Spirituality is persistently high through out detoxification and residential rehabilitation program. Spiritually inspired psychological intervention may be of help during the whole course of management of opiates addicts.

There's an increasing professional and popular interest in relation of spirituality and general health. Although mental health professionals have traditionally avoided concerns, evidence has been accumulating that people with mental illness attach significance to spiritual beliefs. In contrast, around 60% of psychiatrists report minimal interest in spiritual matters. Some authors found spiritual well being as an active relation with a higher power to be positively correlated to good mental health.

Cross sectional comparative study design, 60 patients during detoxification and 60 patients in rehabilitation programs after detoxification, 20 in 12 step rehabilitation program, 20 in residential rehabilitation program and finally 20 in rehabilitation program with open group psychotherapy. Demographic data were collected and participants were subjected to spirituality subscale from substance misuse program philosophy questionnaire Arabic version.

Response to the 6 questions of the spirituality subscale used to assess level of spirituality didn't show difference among the three groups, those during detoxification, those less than 3 months abstinence and those more than 3 months abstinence in rehabilitation program. Results show that spirituality is high during detoxification and throughout rehabilitation programs regardless model of rehabilitation program.

Spirituality is persistently high through out detoxification and residential rehabilitation program. Spiritually inspired psychological intervention may be of help during the whole course of management of opiates addicts.

We compared the efficacy of 6 week therapeutic program in pharmacoresistant patients suffering with panic disorder and comorbid personality disorder (19 patients) and panic disorder and/or agoraphobia without comorbid personality disorder (43 patients). Patients were treated with CBT and psychopharmacs. They were regularly assessed every week on the CGI, BAI, BDI. Before and after treatment were used also Sheehan anxiety scale, Dissociative experience scale, Quality of Life.

A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with panic disorder and/or agoraphobia with or without comorbid personality disorder. The treatment effect between groups did not differ in rating scales, but there are more remitted patients in group without personality disorder.

Supported by: Project IGA MZ ČR NS 10301-3/2009

The object of this research is to determine the relation among characteristic specialty and happiness feeling in Talasemi persons. (Major).

The design of this research, is descriptive and correlation one. The society of research includes: All talasemi persons of major kind in which are treating in Amir kola Talasemi center in 2011 in which about 150 persons has been selected by simple collision sampling by the aid of Morgan table. We have used of Pierson correlation and multi-linear regression analysis in analyzing dates. Also, for gathering dates, referred persons completed five neo factors of characteristic questionnaire and oxford happiness questionnaire.

Based on regression findings, neo characteristic and happiness of talasemi person indicators is about 0.45 in which shows linear correlation among neo-characteristic and happiness variables in Talasemi persons in which there is meaningful relation among characteristic specialty. (Psycho-anger, extroverts, flexibility, agreeability, responsibility).

Among characteristic specialties, extroverts, flexibility, agreeability, responsibility, there is positive meaningful relation to happiness in which it means the less psycho-anger is equal to more happiness.

Parental alcoholism may lead to adverse psychological outcomes for those who grow up in such family environments.

Several studies show that children of alcoholics (COAs) live in family climates characterized by conflict, unpredictability, and manifestations of contempt. Moreover, COAs are exposed to a high level of expressed emotion due, for instance, to threats and denigration.

We compared a group of COAs with a group of non COAs measuring the family climate, the level of expressed emotion and the parental attitudes on the basis of both children and parents' point of view.

25 COAs (mean age 17,8 ± 3,3 years) and 25 non COAs (mean age 18,3 ± 3,3 years), matched for age and sex, were evaluated in the frame of an observational naturalistic study design. Self-administered rating scales were used to assess the level of expressed emotion in the family (Level of Expressed Emotion Scale - LEES), the parental (Parental Attitudes Scales - PAD) and family (Family Attitudes Questionnaire - FAQ) attitudes.

The two groups did differ for FAQ total score and for the FAQ subscale assessing the relation between parents. They also differed for the level of expressed emotion (i.e., LEES total score) and for the LEES subscale assessing tolerance and expectations.

COAs are characterized by the perception of a negative family climate that is primarily expressed in terms of conflict and deterioration of relationship between parents.

In order to improve global functioning in psychotic patients is necessary to know the kind of variables influencing those.

To research that of a clinical and epidemiological variables group which of them are associated to a better outcome in global functioning in patients affected by psychosis.

A total of 73 psychotic patients were included in this study. All of them were evaluated through a battery of tests including GAF and SIX, PANSS, S-GPTS and a comprehensive questionnaire for clinical and epidemiological variables. A binary logistic regression analysis was applied to the data set of global functioning scores divided by the median in two halves: better and worse global functioning. The model included the following variables: positive, negative and general psychopatology PANSS subscales, PANSS subtype, first or second generation antipsychotic, stimulants drugs use, tobacco use, sex, age, onset age, number of psychotic episodes and S-GPTS score.

Treatment with second generation antipsychotics and lesser scoring in S-GPTS scale were associated with a better outcomes in global functioning. We found an association between lesser negative symptoms and lesser number of psychotic episodes with a better functioning which showed a marginal statistical significance.

We raise the question about preferential use of second generation of antipsychotics as opposed to older antipsychotics and the necessity of improving adherence to treatment for breaking the vicious cycle between psychotic episodes and a worse global functioning. Further studies with greater sample are needed to explain these and another questions.

Epidemiological studies estimated that amongst patients with schizophrenia a large subgroup of up to 25% also suffers from comorbid obsessive compulsive symptoms (OCS). The association between these comorbid OCS and neuropsychological impairment remains unclear and somewhat contradictory. Longitudinal approaches which investigate the stability of OCS related cognitive deficits are missing.

37 patients with schizophrenia and comorbid OCS and 43 schizophrenia patients without OCS were assessed with a comprehensive cognitive test-battery and compared at baseline and again 12 months later.

Schizophrenia patients with comorbid OCS showed significant pronounced deficits with increasing effect sizes over the 12 month assessment period in specific cognitive areas such as visuo-spatial perception and visual memory (WAIS-R block design, Rey-Osterrieth Complex Figure Test), executive functioning (perseveration in the Wisconsin card sorting test) and cognitive flexibility (Trail making test B). These cognitive domains correlated with OCS severity and are known to be candidate domains in obsessive compulsive disorder (OCD).

OCS in schizophrenia is associated longitudinally stable specific cognitive deficits. Prospective studies involving patients with at risk mental states for psychosis are necessary to decipher the interaction of cognitive impairment and the clinical manifestation of schizophrenia and OCS. This might facilitate the definition of patients at high risk for OCS, an early detection of subclinical levels, therapeutic interventions and clinical monitoring.

Depression in children and adolescents is still underdiagnosed. Valid and brief screening-tools for these age groups are missing.

For children and adolescents in particular, we developed the screening-tools ChilD-S and DesTeen and assessed their validity as opposed to established instruments.

Both screeners were validated in a paediatric (228 children, 316 adolescents) and a clinical sample (77 children, 87 adolescents). Gold standard for validation were ICD-10 diagnoses of a depressive episode or dysthymia based on a structured interview. Using receiver operating characteristic analyses, the area under the curve (AUC) and the cut-offs with the highest sum of sensitivity and specificity were computed. In addition, it was examined whether the instruments differed significantly in validity measures.

Point-prevalences were 5.3% (children) and 9.8% (adolescents) in paediatric care and 23.5% and 26.1% in clinical care.The 8-item ChilD-S yielded AUCs of 98% and 93% in the paediatric and in the clinical sample. Sensitivities were 100% and 94%, with specificities of 87% and 78%.The abbreviated 6-item DesTeen showed an AUC of 95% in both settings. Sensitivities were 100% and 91% in the paediatric and in the clinical sample, specificities were 82% and 89%. Being even shorter, the two screening-tools performed equally well or better than the established instruments.

The ChilD-S and the DesTeen discriminate well between depression and depression-like symptoms in somatic diseases as well as between depression and other forms of mental disorders. Valid and brief, they can both be recommended for usage in paediatric and clinical settings.

There is widespread concern over the perceived indiscriminant prescribing of antipsychotic medications in children, particularly for those residing in low-income households or foster care. Ongoing safety and efficacy monitoring is suggested by many professional associations.

Describe reported diagnosis and symptomology for over 15,000 children prescribed antipsychotics in the 17- month period from April 2011 through August 2012.

Increase appropriate monitoring of children who are prescribed antipsychotics.

A policy was developed by the North Carolina Division of Medical Assistance, in collaboration with Community Care of North Carolina, that requires prescribers to register patients via a web portal before reimbursement is allowed to the pharmacy. Required registration elements include a patient's primary diagnosis, target symptom for medication use, initiating prescriber, caregiver support of medication use, adverse drug event reporting, and metabolic monitoring deemed best practice by the literature review.

From April of 2011 through August 2012, a total of 1,241 prescribers have written 29,691 prescriptions for 15,194 patients in the A+KIDS program. Unspecified Mood Disorder was the first most common representing 22%.of patients. Bipolar Disorder, Autism Spectrum Disorder, and ADHD, followed at 14%, 12%, and 12% respectively. “Aggression towards others,” “Irritability” and “Tantrums/temper” were the most common target symptoms (representing 63.6% of patients).

Mental distress among medical students is often reported. Social phobia is a highly prevalent yet often overlooked psychiatric disorder that can cause severe disability but fortunately has shown responsiveness to specific pharmacotherapy and psychotherapy. The aim of this work was to study the prevalence of social phobia problem and potential risk factors that may be associated with social anxiety among medical students.

The present study was designed to identify the manifestations and correlates of social phobia among medical college students. The sample for this investigation consists of 321 (170 female and 151 male) students aged 19-26 years. For detection of social phobia among the studied sample, we used Social phobia inventory which is a self rating scale that capture the spectrum of fear, avoidance and physiological symptoms. It demonstrates good test-retest reliability, internal consistency, convergent and divergent validity.

The sample consisted of participants from all medical stages (this was a proportionate representative sample from each classes), 56% were from higher income groups, nearly 45% had their residence in hostel, 21.5% of the students had a SPIN score of 19 and more, mean social phobia was present in almost 22% of the population. There was no statistically significant difference in prevalence of social phobia with respect to gender, family income or type of residence.

Social phobia has a high prevalence and marked impact on life, early identification and adequate treatment by college counseling centers will successfully help in reducing the burden of this common condition.