The onset of Bipolar Disorder secondary to a stroke event is a rare clinical entity, although few cases of isolated post-stroke depression or post-stroke mania have been reported.

A 65-year-old male patient without previous psychiatric history presented symptoms of mania, with desinhibition, agitation, insomnia and elevated mood after 6 months of a stroke located to the left side of the brain. The patient was treated efficaciously with mood stabilizers and antipsychotics and his symptoms resolved gradually after 3 months. The patient maintained in remission several months, but then almost a year after the manic episode he presented depressive symptoms indicative to start an antidepressive treatment and the remade of diagnosis to Bipolar Disorder secondary to a stroke.

A non-systematic review of PubMed articles since 2000.

Numerous emotional and behavioral disorders occur following cerebrovascular lesions. There is higher ‘cerebrovascular risk’ in elderly patients with late onset Bipolar Disorder, compared to those patients with an early onset. This suggests that cerebrovascular risk may be an important factor for the expression of bipolar disorders in later life, and has significant management implications for older bipolar patients.

The occurrence of a depressive disorder after a neurological disease is a condition classified in the International Classification of Diseases (ICD-10) as an Organic mood [affective] disorders [F06.3], and in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a Mood disorder due to a general medical condition [298.83]. Cerebrovascular disease is associated with an increased risk for depression, with incidence rates of 30-40%. Frequency of post-stroke depression is highest during the first month after the ischemic event, but remains high for several years.

The aim of this poster is to show and discuss some troublesome and complex issues on diagnosing and managing patients with post-stroke depression, based on a case report.

Herein we report a case of a 46-year-old woman, without significant prior psychiatric history, who presented with depressive symptoms after left middle cerebral artery stroke (with cardioembolic source) and right hemiplegia/hemiparesis and motor aphasia sequelae.

Depression has shown to be the most common psychiatric post-stroke complication, and the one associated with a worse poorer functional prognosis. It may be difficult to accurately diagnose a post-stroke depression, particularly in patients with aphasia, anosognosia and other cognitive dysfunctions.

Mortality due to physical illness is greater in schizophrenia than in the general population. Antipsychotics have been linked with weight gain, diabetes and hyperlipidaemia. UK guidelines recommend annual health screens in primary care, and secondary care ensure patients receive this and document results in notes.

To establish whether patients taking antipsychotics received annual monitoring of U&E, FBC, Lipids, Glucose, LFT, weight and blood pressure. Standards for the audit were derived from the Maudsley Prescribing Guidelines and NICE Guidelines on Schizophrenia.

To improve physical health monitoring for our patients.

We retrospectively reviewed 82 case notes. Intervention following initial audit included education of professionals involved in monitoring and inclusion of a Prescribed Medication Monitoring Form in case notes. Re-audit occurred 12 months after initial audit. Statistical analysis used χ2-test with Yates’ Continuity Correction.

Following intervention recommendation of physical health monitoring to primary care increased from 40.2% to 76.8% (P < 0.0001), as did monitoring frequency: Weight (7.3% to 54.3%), BP (7.3% to 49.4%), U&E (64.6% to 82.5%), FBC (61.0% to 78.5%,) Lipids (47.6% to 72.2%), Glucose (59.8% to 79.7%) and LFT (61.0% to 81.3%) (P < 0.05 for all parameters). Documentation of blood results in secondary care notes was also increased (P < 0.05).

Monitoring of physical health comorbidity in patients with serious mental illness was poor in the initial audit. This can be improved in both primary and secondary care by relatively simple measures and by increasing clinicians' understanding of the importance of monitoring.

Sleep problems in children with common psychiatric disorders present a considerable challenge for clinicians in developing effective diagnosis and treatment strategies. Whilst sleep-disordered breathing (SDB) and periodic leg movements in sleep (PLMS) are very frequent in children with attention-deficit/hyperactivity disorder (ADHD) which can deviate sleep architecture, their co-existence in Tic disorder (TD) and ADHD/TD co-morbidity is less well understood.

To investigate the frequency of SDB and PLMS across children with ADHD, TD and ADHD/TD co-morbidity compared with healthy peers.

We asked whether and how the frequency of SDB and PLMS relates to sleep architecture.

Twenty-four children with ADHD, 21 with TD, 21 with ADHD/TD co-morbidity and 22 healthy controls underwent a two-night polysomnography supplemented by monitoring of apnea-hypopnea (AH) and PLMS events per hour of total sleep time.

Compared with controls, only ADHD children displayed a significantly higher AH and PLMS indices. Yet correlation analyses showed significant and negative association between AH and PLMS indices and rapid eye movement (REM) sleep amount in all, the ADHD, the TD (Fig. 1), the co-morbid, and the control (Fig. 2) groups. No such associations with the other sleep stages were found for all the groups.

[Figure 1]

Our preliminary results suggest that

1. (1) presence of co-existing sleep-related disorders may partially explain the contradicting sleep results found so far in children with ADHD,

2. (2) high frequency of SDB and PLMS could be associated with REM sleep reduction regardless of psychopathology.

The authors propose an integrative approach in group work psychotherapy for schizophrenic patient’s relatives. This approach integrates three components into session: psycho education (knowledge for systemic family psychotherapy), cognitive behavior (family solving problem skills) and psychotherapy (reflection and coping strategies). These components are integrative for communication process, which provides their synergetic interaction within the theme educate limits.

Study the effectiveness of a synergetic approach in enhancing the impact of rehabilitation.

Identifying markers of efficacy of the approach through a comparative analysis of the two groups of mothers of patients, one of whom used a synergistic approach, in the other using traditional programs.

SCL-90-R (Derogatis); URICA (McConnaughy); MSPSS(Zimet). Objective conclusion is provided by using Mann-Whitney U-test.

Synergetic integrative approach to group therapy significantly affects the reduction of somatization (p = 0,05), depression (p = 0,01), hostility (p = 0,05) and Global Severity Index (p = 0,05). In participants of the experimental group was significantly higher overall perception of social support (p = 0,01), measures of social support from family (p = 0,05), friends (p = 0,01) and significant others (p = 0,05). Diagnostic stage of psychotherapeutic process showed that participants of the control group mostly are on initial stages of therapy, while the experimental group members are at a mature stage.

Synergetic integrative approach showed high efficiency to work with the families of schizophrenic patients by reducing the level of psychiatric symptoms, enhance feelings of social support and accelerate the psychotherapeutic process.

Many experts claim that transference and countertransference analysis has no place in cognitive behavioural therapy (CBT) and should be used solely in psychodynamic psychotherapy. However, attention paid to emotional and cognitive reactions to the patient or supervisee is the basic component of cognitive behavioural therapy and its supervision, especially if work with difficult patients is supervised.

PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: “countertransference”, “cognitive behavioral therapy” and “supervision”. No language or time constraints were applied. The resources were confronted with our own experiences with psychoeducation in bipolar patients and only most relevant information was included in the text.

Countertransference reaction may be observed especially in our behaviour, but also in our thoughts, emotional experiences and physical symptoms. The essence of countertransference is usually previous experiences of the supervisor which were not adequately processed and thus tend to be projected into current relationships. They may be recognized in work with core schemata and derived rules themselves. They lead to behaviour which may be avoidance (e.g. lack of openness or congruence) or compensatory (e.g. excessive help, competition, showing off). Self-reflection or realizing countertransference during supervision aids in overcoming countertransference reactions and may be crucial for establishing a more real relationship and more objective work in both therapy and supervision. Adequate self-reflection and supervision of one's own work is one of prerequisites for adequate development of the supervisor's competences.

This paper was supported by the research grants IGA MZ ČR 10301-3/2009

Bipolar disorder or bipolar affective disorder (historically known as manic-depressive disorder) is a psychiatric diagnosis for a mood disorder in which people experience disruptive mood swings that encompass a frenzied state known as mania (or hypomania) and, usually, symptoms of depression. Bipolar disorder is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The Maine Purpose of this descriptive -analytic study is assessment of QOL In Persones with BD.

60 out of 200 persons with BD who were member o Ebnesina Psychiatric Hospital in Shiraz City selected randomly classified as the sample.

Data gathering was conducted through a questionnaire in three parts and collected data was analyzed by SPSS software.

The finding of the study demonstrated that 81.3% of clients with BD rated their quality of life at high or intermediate level equally.

The study indicate that there is a significant difference between the mean of quality of life score with regard to sex in this group, so that the mean of quality of life in Men is more than Of quality of life in the women and there was significant difference between the mean of quality of life score type and duration of BD and no significant difference between the mean of quality of life score to age.

To investigate the level of blood and urine cortisol and cell mediated immunity response changes among patients with post-traumatic stress disorder resulting from war.

In this case-control study, 20 patients with post traumatic stress disorder (PTSD) with the mean age of 41.9±7.6 and 20 healthy individuals (control group) with the mean age of 42.4±7.6 were compared. At the beginning, 24-hour urine and blood samples were obtained, and three antigens, tuberculosis, tetanus and candida were injected sub-cutaneously. Skin reaction was evaluated for each of the injections. Analysis was performed using t-test.

There was a significant increase regarding cell-mediated immunity in cases in comparison with the controls (p =0.017) and also a significant increase of blood cortisol was observed in cases (p = 0.003). There was no significant difference in two groups regarding urine cortisol level.

This study showed that there was a significant difference in the activation of cell-mediated immunity in PTSD patients as compared to control group. This increase in activity was not due to the influence of life stressors or intensity of illness signs or following illnesses. It is recommended to study and treat the autoimmune disease in PTSD patients more seriously in the countries like Iran that were involved in war problems.

Considering the excessive contacts of the hospital staff with death and the ability of death anxiety to reduce functional ability in an individual.the aim of this study was to evaluate the prevalence of death anxiety among a state hospital staff.

This is a descriptive study that conducted in an overall of 612 individuals received a questionnaire at a state hospital in Sari(Iran) during spring 2008. The questionnaire was consisted of two parts; demographic part and Templer Death Anxiety Scale (DAS; Templer, 1970). The data were analyzed by SPSS software version 16.0 using t test and chi-square test.

The range of age was 20-53. About 42.2% of the participants had mild death anxiety while 57.8% had severe death anxiety. The mean scores achieved by the individuals was 7.70 ± 3.133 in women and 6.19 ± 2.552 in men. The severity of death anxiety had a significant correlation with sex while having no correlation with age, marital status, having or not having children, educational level and occupation.

Due to high levels of death anxiety among the staffs, mental Health interventions are recommended to the same population in order to improve the mental health Quality. Additionally, performing comprehensive studies in the general population is needed.

The notion that cerebellar deficits may underlie clinical symptoms in schizophrenia is tested by evaluating two forms of cerebellar learning in recent-onset schizophrenia patients. A potential medication effect is evaluated by including patients with or without antipsychotics.

Saccadic eye movement adaptation and eyeblink-conditioning were assessed in 39 male patients with recent-onset schizophrenia who were on antipsychotic medication (clozapine n=10 haloperidol n=16) or antipsychotic-free (n=13), and in 29 age-matched male control subjects.

All participants showed significant saccadic adaptation. Adaptation strength did not differ between healthy controls and schizophrenia patients. The speed of saccade-adaptation, however, was significantly lower in schizophrenia patients. Patients showed a significantly lower increase in the number of conditioned eyeblink responses (CR). Over all experiments no constistent effects of medication were observed. These outcomes did not correlate with age, duration of education, psychopathology or dose of antipsychotics.

In this study we find several cerebellar learning deficits in patients with schizophrenia that we cannot attribute to the use of antipsychotics. Although this finding, combined with the fact that deficits are already present in recent-onset schizophrenia, could suggest that cerebellar impairments are a trait deficit in schizophrenia, this should be confirmed in longitudinal studies.

Patients with schizophrenia (SC) show deficits in the processing of social cues. Little is known whether this deficit in social cognition also influences non-social, “cold” cognition. Interactions between these domains can be tested with a Simon task using social stimuli (gaze direction).

We investigated whether the Simon effect, the slowing of reaction times produced by stimulus incongruities in the spatial domain, differs in patients with schizophrenia and healthy controls as a function of the social nature of the cues. Participants: Thirty-five recent-onset, male SC and 30 male HC participated in the study.

We used the gaze-direction Simon effect paradigm described by Zorzi et al.[1], in which the Simon effect is generated by a schematic drawing of human eyes (social cues) or rectangles (non-social cues).

Overall SC had longer reaction times. Furthermore, groups showed a Simon effect in both tasks. While in HC the Simon effect was stronger in the eye-like compared to the rectangle condition, for SC the Simon effect was less strong in the eye-like compared to the rectangle condition. Current psychopathology or treatment with antipsychotics did not influence results.

Although the Simon effect is present in SC, the influence of social cues was much reduced in the patient group.

The present study supports earlier findings of altered processing of social cues in SC. Crucially; we demonstrated that this deficit in social cueing affects early attentional processes in schizophrenia.

To investigate the role of chronobiological disorders in the pathogenesis of insomnia in case of depression.

38 patients have been studied (F 31.3 - 31.4, F 32.0 - 32.2, F 33.0 - 33.2). Severity of depression was determined in accordance with HAMD-17. The patients have been divided into two groups: group 1 (HAM-D: insomnia early + insomnia middle + insomnia late - 0-4) - 10 patients (HAM-D - 27.5±4.2) and group 2 (HAM-D: insomnia early + insomnia middle + insomnia late - 5-6) - 28 patients (HAM-D - 31.7±5.9). The spectral analysis of heart rate variability was applied. The power spectrum density of LF (low frequency) and HF (high frequency) range was established. The patients were examined at 1 a.m., 7 a.m., 1 p.m., 7 p.m. prior to the beginning of treatment.

Prior to the therapy de-synchronization of the circadian rhythms of the parameters of spectral analysis of heart rate variability and the “sleep-wake” rhythm has been observed. This manifested itself in the shift of the phase of the circadian rhythms of the parameters under study towards the earlier time of the day. The phase shift to an earlier time was more pronounced in group 1.

Insomnia in severe depression may depend rather on the usual nocturnal hour position change after phase displacement in the circadian curve, than on the severity of de-synchronization of circadian rhythms. In these hours the change (increase or decrease) of sympathic/parasympathic activity may be of greater importance.

The Young Psychiatrists' Network (YPN) is an international group of young psychiatrists (YP) from Eastern and Western European countries organizing annual meetings to facilitate the exchange of knowledge and experience between YPs from different backgrounds, promote networking and development of leadership skills.

To evaluate the YPN Meetings in Eastern Europe.

The 3rd YPN Meeting, was held in September 2012 in Minsk, Belarus. 74 YPs from 21 countries participated. At the end of the conference anonymous evaluation surveys were distributed.

52 participants from 14 countries returned the survey (70%). In contrast to the previous meeting in Riga where ⅔ participants received grants, in Minsk all participants attended self-funded. It was the first YPN meeting for 60% of them. The meeting was evaluated positively by all participants and 44% expressed a wish to actively organize a consecutive meeting. Majority of participants thought that the meeting would have positive influence on their professional career (81%) and personal development (88%). Some questions addressed 21 participants who had attended the previous meeting in order to measure effects on YPs' activities in the past year. ⅓ of participants stated that the meeting changed their clinical practice, 90% reported indirect and 86% direct personal contact with international colleagues after the meeting. As the result of previous meeting 81% of them became involved in national and 62% in international trainee/YPs organizations. 52% established international research contacts.

YPN Meetings seem to be valuable, and have major impact on personal growth, networking and collaborative research.

To analyze the prevalence of stress factors, mental disorders (MD) and their influence on pain in rheumatoid arthritis (RA) patients (pts).

125 RA-pts with a mean age of 47.4±1.01 yrs and disease duration of 138.4±10.1 month were enrolled. The RA disease activity was assessed by DAS-28. BPI was used for pain severity assessment. MD were diagnosed in accordance with ICD-10 criteria.

MD were diagnosed in 117 (93.6%) RA pts: depressive episode (n=46,39%) (RDD incl. - 27%); dysthymia (n=41,35%), adjustmend disorders(n=21,18%); GAD (n=9,8%). Mild cognitive disorder was diagnosed in 83 (66.4%) of RA-pts. The significant stress factors preceding RA manifestation were found in 97 (77.6%) cases; in 76 (61%) - stress factors preceded RA exacerbation. Significant chronic stress events during childhood had 84 (67.2%) patients. Patients with MD more often (p< 0.05) had the fourth X-ray stage of RA and maximal stage of functional disability. Mean age of the first prednisone intake was significantly higher (p< 0.05) in patients with MD. RA-pts with severe pain (=7 BPI-points) were 3 times more likely to have depressive disorder than RA-pts with mild pain (1-4 BPI-point) (48.6% vs 15.6%, ?R=3.1, 95% CI=0.97-9.93, ?=0.004).

The results have shown high prevalence of stress related MD in RA-pts and confirm the stress-diathesis approach to pathogenesis of MD in rheumatic disease. The RA patients group with MD had high level of pain severity, X-ray stage and functional disability in comparison with patients without MD.