Differentially study the effect of antidepressant Cipralex on higher cortical function and on affective patients with rheumatoid arthritis.Characteristic of the material: For the study groups were formed with the diagnosis rheumatoid arthritis, remission. All patients received standard therapy non-steroidal anti-inflammatory drugs and antidepressant Cipralex.

Should first be noted that the study confirmed the clinical efficacy of the Cipralex in therapy of anxiety and depressive disorders in RA. Therapeutic results were achieved in most cases. (98%)

In summary, these data show the effectiveness of the complex treatment of RA. The quality of life in patients with RA affects of factors, including not only the patient's medical condition, but also affective and cognitive areas. The study found the optimizing effect of the drug on cognition. This is evidenced by the fact that on the background of therapy by Cipralex was reduction in the total amount of time required to perform the test tasks and reducing the number of mistakes.

Results obtained in the study of data leads to the conclusion that Cipralex may be included in the complex therapy of patients with RA.

Every year 4,000 to 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many youth have risky behaviours and mental health issues that put them at risk for sexually transmitted infections (STIs).

Document the prevalence of STIs (chlamydia and gonorrhoeae) among adolescents aged 14-17 years old entering Quebec residential YPCs and identify associated risk factors.

In 2008–2009, adolescents residing in six YPCs completed a questionnaire covering sexual and substance use behaviours, as well as other health issues affecting their well-being. Urine samples were collected for Chlamydia trachomatis (CTGI) and Neisseria gonorrhoea (NGGI) genital infections.

Among 578 participants, 14-17 years old, 89% were sexually active. Risk behaviours included: early sexual initiation (66% < 14 years); multiple partners (median: girls 5, boys 8); group sex (girls 38%, boys 43%); sex for money or goods (girls 27%, boys 8%). Half of sexual relations were under the influence of drugs/alcohol. Regular substance use (3x weekly and +) was: tobacco: 75.0%; cannabis: 63.1%; alcohol: 24.2%; amphetamines: 16.7%; and cocaine: 7.4%. Prevalence of CTGI: 9.3% girls, 1.9% boys; NGGI: 1.7% girls, 0% boys. In multivariate analysis, factors significantly associated with chlamydia infection among girls were: alcohol intoxication hospitalisation or history of suicide ideation with plan.

Serious alcohol misuse or mental distress were significantly associated with STI infections among adolescents. Mental health professionals are encouraged to provide sexual health and substance use counselling with adolescent patients given the highly woven interaction between mental distress and risk of sexually transmitted infections.

Transitions from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) can often be problematic due to high eligibility thresholds, inconsistent support during transition and limited participation from young people. The TRACK Study highlighted several clinical, organizational and policy related reasons for Services to develop and implement transition protocols effectively.

This audit aims to examine whether the Trust's Transitions Policy is adhered to during transitions of young people across services. It also aims to review the qualitative experience of young people and professionals involved.

A Questionnaire Survey method was used to collect quantitative and qualitative data from involved professionals and young people who moved from CAMHS into AMHS (Aug11–Jan12). The data was analyzed against the audit criteria, which relate to specific aspects of the Transitions Policy.

A variable response rate showed that majority of the young people and involved professionals were satisfied with the planning and transfer of care with high policy adherence rates. Young people wished for better communication, more information on the nature of services offered and greater support, while professionals hoped for greater consideration of engagement levels and joint working. Alternative support was requested for declined referrals.

Improved adherence to the Transitions Policy can be achieved through proper planning, better communication, more joint working and regular feedback from young people and professionals. It can also help to achieve higher standards and continuity of clinical care to meet the needs of young people.

“I watch death” it is an English mnemonic acronym for the myriad causes of Delirium. It characterizes for sudden onset, low consciousness, attention and cognition levels. Although its origin is because of different organic disorders, it is usually consulted to the mental health services because of its psychopatology. An early detection and the subjacent cause treatment are fundamental.

We performed a retrospective analysis of those patients visiting the Emergency Services and/or hospitalized in San Agustín's Hospital of Linares and being subsequently diagnosed of delirium by the liaison psychiatry team during the year 2011. We studied the following variables: medical diagnostic, sex, age, comorbidity and psychopatology, A follow-up of the patients was also done.

The 5% of 299 liaison psychiatry consultations corresponded to patients with delirium. Traumatology and General Medicine generated the 72% of the consultations to liaison psychiatry team. All patients were male, 50% of them were under 40 and older than 60 years. They had several comorbid factors such as polytraumatism, post-surgery, previous brain damage, ischemic heart disease, HIV, etc. The most widely used drug treatment for mental symptoms was low-dose of haloperidol, according to clinical guides evidence. A 25% of patients died within two weeks after the consultation to liaison psychiatry team despite treatment of the subjacent cause.

As a result of our findings we coordinated a clinical session with others Hospital Departments to improve clinical care for these patients in order to improve the early diagnostic and intervention.

Describe cases related to reactive attachment disorder.

Describe diagnosis of reactive attachment disorder and its limitations.

Describe treatment options for reactive attachment disorder.

Be familiar with diagnosis of reactive attachment disorder.

Be familiar with treatment options.

Be familiar with challenges in complex scenarios.

Case of a 15 year old black female with history of neglect, legal issues, school truancy, witness to domestic and community violence who presents with escalating aggressive behavior and affective instability.

Literature review focusing on treatments options in complex scenarios.

Many children are suffering from “maltreatment” and there are difficulties with making an appropriate diagnosis due to co-occurring symptoms and potential differential diagnoses; therefore treatments are limited.

The disorder warrants further research especially in addressing the timing and critical period for an intervention. The disorder necessitates a multi-modal approach in particular a collaborative approach involving in home services with the child and caregiver. The disorder becomes even more complex when dealing with patient populations with intergenerational adversity and the patterns of disordered attachment are evident.

Mental disorders are not uncommon in late life. The emergence of psychotic symptoms for the first time in later life poses a diagnostic challenge for clinicians assessing and treating elderly persons with mental illness.

To determine the clinical characteristics and cognitive function impairments in elderly patients with late-onset psychosis compared with normal healthy control.

A cross-sectional case-control study; 50 patients with late-onset non-schizophrenic psychoses compared to 50 normal, healthy volunteers matched for age, sex, and social standard. The case group was interviewed using the Structured Clinical Interview for DSM Axis-I diagnosis (SCID-I), the control group was chosen on basis of assessment using the General Health Questionnaire (GHQ). Both groups underwent a functional assessment of daily living using the following: (a) Activities of Daily Living scale (ADL), (b) Instrumental Activities of Daily Living (IADL), (c) Cambridge Mental Disorders of the Elderly Examination, section B (CAMCOG), and (d) the Wechsler Adult Intelligence Scale (WAIS) for cognitive assessment.

No significant differences between both groups in sociodemographic variables, family, and medical histories, except occupational status, in case group they had significantly more professional and skilled jobs. They also showed significantly higher rates of diseases of the gastrointestinal, renal, and central nervous system. Moreover, they showed very high significant cognitive decline, as well as functional impairment in daily living activities compared with their healthy counterparts.

Patients with late-onset psychoses show more severe cognitive and functional impairments in their daily activities.This paves the way for future studies.

Few scientific studies have been devoted to the study of crime among the mentally ill elderly, however, all the studies agree on the importance of recognizing risk factors associated with passage to forensic action in elderly patients.

The objectives of our work are to clarify the sociodemographic, clinical and forensic characteristic of mental elderly patients who commit forensic acts.

Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92–83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code.

Our study included 25 patients, their ages ranged between 60 and 90 years. They mostly had a low socio-economic level (64%), a low educational level (48%) and a marital status of married (64%).

All patients had a neuropsychiatric disease: schizophrenia and other psychotic disorders in 48% of cases, dementia and Delirium nonspecific in 32% of cases, mood disorder in 16% of cases and mental retardation in 4% of cases. The medico-legal act was murder or attempted murder in 40% of cases, sexual crimes in 16% of cases, aggression against property in 16%, violence against people in 8% of cases and different offenses in the remaining cases.

The concept of hoarding is a matter of study and debate since several years and has been trough various changes concerning its definition and categorization, namely in what concerns the differentiation from “normal” collecting behaviour and the association with other mental disorders as Obsessive-Compulsive Disorder.

This comunication reviews the evolution of the concept of hoarding and its implications in the assessment, management and treatment of the patients.

The authors pretend to highlight the nosological path traced by the scientific research until today and present the state of the art in this field.

The authors selected articles referring to hoarding disorder in PUBMED and SCIENCEDIRECT databases and made a literature's review about the theme.

Latter findings have identifyed clinical, neurobiological and treatment features in hoarding individuals that seem to be specific and that suggest the conceptualization of a standalone condition that presents independently from other disorders. The recent proposal of a Hoarding Disorder for the new DSM-V advances with some criteria in order to categorize this entity and establish its diagnostc boundaries.

The emerging of a new nosologic entity constitutes a change of perspective in the understanding of this condition that has implications at various levels, such as the aproach to the patient, his management and treatment.

The elderly in general, and those with dementia in particular are more likely to be victims of abuse, neglect or self-neglect.

These demented elderly, because of biological aging, psychological disorders of character, behavior and conduct are themselves sources of violence that may lead to medico-legal.

The objectives of our work are to specify the profile of mentally ill elderly dementia and identify the characteristics of their medico-legal.

Our work has focused on all patients older than 60 years hospitalized under the mode of office between 1995 and 2012 in the service of forensic Razi hospital according to article 29 of the law n° 92-83 of the third of August 1992 as amended by the law 2004-40 of 3 May 2004, following a non-legal place due to insanity within the meaning of the 38 article of the Tunisian Penal Code, and which the diagnosis of dementia was increased.

Our study included 7 patients, whose average age was between 65 and 90 years. The majority being married, having a low socioeconomic level. Acts forensic being uxoricides (2 cases), attempted murder (2 cases), attempted rape (1 case), violence against people (1 case), false and corruption (1 case). Almost all committed crimes against people associated with violence.

The diagnosis of dementia was retained and all patients were referred to the neurology department for further explorations.

The type of dementia was noted in 4 cases: mixed dementia, Alzheimer's disease, dementia due to Huntington's disease and dementia due to Parkinson's disease.

Among the causes of headache, migraine headache are most common. Migraine is most common referrals to neurology clinics in all human societies. Today it is confirmed that many of chronic headache is associated with psychological and behavioral problems. Personality is defined as the capacity of individual protest :and temperament &character are subsets of personality. TCI(temperament &character Inventory)is a questionnaire that evaluate these dimensions.The relationship between temperament and migraine were also considered.

To evaluate The relationship between temperament and character pattern with migraine

To provide information for psychiatrists, neurologists and other clinician to aware of this relationship.

This is a prospective case control study which was done on 63 migraine patients as case group and 63 controls. TCI was used for evaluation.

In case group the average score in patients were: Novelty seeking 41.51,mean Harm avoidance was 52.16 and Reward dependence 62.14. The average score of Selfdirectedness was 53.14, cooperativness 78.45, Preseverence 63.21 and Selftranscedence was 60.95.

In control group the average score in patients were: Novelty seeking 44.77,mean Harm avoidance was 49.28 and reward dependence 62.42.The average score of Selfdirectedness was 54.81,Harm avoidance 73.92, Preseverence 54.09 and Selftranscedence was 62.42.

Harm avoidance and Cooperativness had a significant difference between groups(P ha=0/048, P co=0/043).

Results showed a significant difference between groups in HA and CO. We can conclude that migraine patients had a higher score in HA and CO subsets. HA is related to serotonergic system and this results presents the role of serotonin in migraine pathology, This shows the role of serotonin in the incidence of HA in migraine patients.

In schizophrenia, depot formulations are not widely used in everyday practice. Clinicians’ attitudes play a major role in this low level of use of Long Acting Injectable (LAI). As a consequence, only 35% of patients declare to be well- informed about those formulations.

This study aims to assess psychiatrists’ attitudes toward the use of long-acting injectable antipsychotics in schizophrenia.

During the French Congress of Psychiatry (November 2010, Lyon), we interviewed 113 psychiatrists about the factors that influenced their prescription of LAI. We used a structured interview, adapted from the two questionnaires developed by Heres et al. in two studies about the attitudes of German Psychiatrists. Multidimensional and cluster analyses were performed to identify correlations.

Hazard risk for others, depot experienced, non-compliance and relapse in the past incited psychiatrists to prescribe LAI antipsychotic. Two different clusters of patients were identified: cluster I corresponded to patients with a past history of relapse and poor compliance and cluster II corresponded to patients with a high level of insight and of therapeutic alliance. The most important factor against the use of LAI was a sufficient estimated compliance with the oral formulation. The risk of extrapyramidal symptoms is, in our sample, one of the main reasons for a limited use of depot neuroleptic.

Most factors influencing clinicians’ attitudes toward the use of LAI are shared in many countries. Some attitudes related to organisational aspects, particularly the relevance of healthcare costs may vary from one country to another.

As part of a process to improve the quality of care, the Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) developed recommendations for the use and management of Long Acting Injectable (LAI) Antipsychotics in clinical practice.

Based on a literature review, a written survey was prepared that asked about 539 options in 32 specific clinical situations. We contacted 64 national experts, 42 (65,6%) completed the survey. According to the answers for each situation based on a 9-points scale, a categorical rank (first-line/preferred choice, second-line/alternate choice, third-line/usually inappropriate) was assigned to each option. First-line option was defined as a strategy rated as 7–9 (extremely appropriate) by at least 50% of the experts.

For French experts, LAI Antipsychotics are indicated in patients with schizophrenia, schizoaffective disorder and bipolar disorder. According to their efficacy and tolerability risperidone LAI then olanzapine LAI are recommended as first line for maintenance treatment in schizophrenia, even after the first episode. Depot neuroleptics are recommended as second line for maintenance treatment in schizophrenia. LAI Second Generation Antipsychotics are recommended as second line in bipolar disorder. Several clusters of patients are identified, characterizing a specific profile for the use of LAI. Recommendations for the use of LAI and switch from oral to injectable formulations are suggested.

The use of LAI has advantages as maintenance treatment but their prescription rate is generally below 30% in different countries. Specific guidelines for the use and management of this formulation could improve their use in clinical practice.

Anxiety disorders are highly prevalent and among the leading causes of the global disease burden. Cognitive behaviour therapy (CBT) is an effective treatment, but demand is high and resources to deliver CBT are scarce. Embracing new technologies to meet these growing needs, there is an emergent evidence base of the efficacy of internet-based CBT (ICBT).

Evaluating (1) treatment effects, (2) cost-effectiveness and (3) cost-utility of ICBT for panic disorder.

To evaluate clinical effectiveness and health economics of ICBT for patients within regular psychiatric care.

Longitudinal analysis of 570 patients diagnosed with panic disorder that have been treated between 2007 and 2012 at an ICBT unit within regular psychiatric care. The ICBT was therapist-guided and lasted for three months. Clinical outcome measures were improvements in symptom severity and health related quality of life. Economic outcome measures were direct and indirect costs and incremental cost-effectiveness ratios (ICER).

Analyses of treatment outcome suggest significant reductions in primary symptoms of panic disorder and that ICBT is an economically and clinically effective treatment for panic disorder leading to improvement of symptom severity and quality of life for these patients.

The findings of this study can aid decision makers when considering options of evidence-based treatment delivery formats within psychiatric care.

The problem of eating disorder is increasingly affecting teenagers in Polish schools. This phenomenon needs to be screened and analyzed to allow early detection and diagnosis and providing proper treatment.

The purpose of the study was to assess the correlation between school students’ results in EAT-26 self-report questionnaire and their daily diet behavior and to analyze the occurrence of eating disorders among students in Silesian schools.

Our survey was based on the EAT-26 (Eating Attitude Test) and Behavioral Four Questions Test. 150 questionnaires were given to students of Secondary Schools, 116 were filled out properly. The interviewed group consisted of 85 girls and 31 boys. Average age was 17,24 +/- 1,18. All of the data were analyzed statistically.

Average BMI was 21,06; half of the recruited subjects had correct BMI whereas over 40% of them presented underweight. Within 116 responses from the EAT-26 nearly 93% were the a group of the small risk of the future eating disorders. Nevertheless, over 6% of survey participants were in the group of the high risk. In the Behavioral Four Questions Test 10% were in the compulsive overeating group, others in the group of a probable development of anorexia (7%) or bulimia nervosa (3%).

Specific socio-cultural factors are challenging for the public service- both, in terms of health promotion programs and the organization of free after school hours.

To identify AD stages, we propose morphologically determined “Tomography Dementia Rating scale (TDR)” based on the determination of dementia stages according to the severity of atrophic changes in the temporal lobes obtained during CT or MRI.

The research included 81 patients aged 34–79 (average age 67), 28 male (34.57%), 53 female (65.43%), with AD different stages.

All the patients underwent MRI, CT with subsequent calculation of the temporal lobes atrophy degree.

CT and MRI showed that objective brain morphological features characteristic for all patients with AD are atrophic changes in the temporal lobes, which at AD different stages range from 4 to 62%. These data made it possible to set up a scale that allows to identify certain atrophic changes at each disease stage:

• Preclinical AD stage - TDR-0 - temporal lobes atrophy with 4–8% tissue mass decrease.

• Early AD stage - mild dementia - TDR-1 - temporal lobes atrophy with 9–18% tissue mass decrease (corresponds to CDR-1).

• Middle AD stage - mild dementia - TDR-2 - temporal lobes atrophy with 19–32% tissue mass decrease (corresponds to CDR-2).

• Late AD stage - severe dementia - TDR-3 - temporal lobes atrophy with 33–62% tissue mass decrease (corresponds to CDR-3).

The application of morphologically determined AD stages scale - TDR - is an effective method to objectively identify AD stages by means of widespread CT and MRI.

The statistical dependencies among even remote brain regions are reflected by the functional connectivity. We studied the functional brain network across sleep stages for each relevant sleep EEG frequency band.

Nine healthy young subjects without somatic, psychiatric and sleep disorders were recruited. Sleep stages were defined in accordance with the Rechtschaffen and Kales criteria. The first 20 epochs of each sleep stage (Wake, stages 1 to 4 and REM sleep) were used for analysis in regard of specific sleep EEG frequencies as delta, theta, alpha, sigma and beta. Coherence analysis was applied between each electrode and each other of the 19 EEG electrodes.

Coherence analysis showed high values within the same hemisphere at wake and sleep stage 1. During stages 2, 3 and 4 and REM sleep, high correlations were extended to more regions, particularly for slow oscillations. In delta band, coherences values differed between right and left cerebral hemispheres during all sleep stages. In other frequency bands, none differences were observed between both sides. In the right hemisphere, coherence values changed across sleep stages in delta frequency but remained unchanged for other sleep EEG frequencies. In the left hemisphere, none changes in coherence were observed across sleep stages and each frequency except for sigma and beta.

Changes in coherence measurements showed different mapping in the three sleep main states (Wake, NREM and REM sleep) and for sleep EEG frequencies. Further analyses will investigate connectivity across sleep stages transitions and also, in psychiatric conditions.

Cerebral activity during can be approached by the measurement of functional activity in healthy young people. Functional activity reflects the statistical dependencies among near and distant brain regions by generalized partial directed coherence (GPDC).

Sleep stages of 9 healthy young subjects without somatic, psychiatric and sleep disorders were defined in accordance with the Rechtschaffen and Kales criteria (Wake, stages 1 to 4 and REM sleep). In regard of specific sleep EEG frequencies (delta, theta, alpha, sigma and beta), the first 20 epochs of each sleep stage were used for analysis. GPDC was applied between each electrode and each other of the 19 EEG electrodes.

In comparison to wake and REM sleep, GPDC showed increased interdependencies across each NREM sleep stage. Lower sleep EEG frequencies increased these changes. Moreover, during slow EEG rhythms, differences observed across stages were more pronounced. In addition, differences between bands were more marked during wake and sleep stages 1 and 2. None differences were observed for GPDC values between both sides of human brain. In the right hemisphere as well as in the left one, GPDC is similar between sleep stages in delta frequency while GPDC differed from wake to other sleep stages in theta, alpha, sigma and beta EEG frequencies.

A different mapping in the three classical sleep states (Wake, NREM and REM sleep) is showed by generalized partial directed coherence in sleep EEG frequencies. Additional studies investigating the directional information flow should be performed to complete our results.

Vascular factor is very important in the development of AD. The research investigates the changes in the cerebral angioarchitectonics at various AD stages.

The research included 92 patients of which:

Test Group: 47 aged 34–79 suffering from AD different stages including:

• 4 with preclinical stages or high risk of disease development (TDR-0);

• 15 with mild dementia (TDR-1);

• 20 with moderate dementia (TDR-2);

• 8 with severe dementia (TDR-3).

Control Group: 45 aged 28–78 with various types of brain lesions accompanied by dementia but without Alzheimer’s disease including:

• 15 with chronic cerebrovascular insufficiency of atherosclerotic genesis and moderate dementia;

• 12 with severe vascular dementia;

• 14 with atherosclerotic parkinsonism;

• 4 with Parkinson’s disease.

Each patient underwent MRI, CT, SG, REG, MUGA.

At AD different stages, changes in angioarchitectonics and microcirculation show themselves in:

• lack of expressed atherosclerotic lesions of intracranial vessels - 47 (100%) patients,

• reduction of capillary bed in the temporal and frontoparietal regions - 47 (100%),

• development of multiple arteriovenous shunts in the same areas - 47 (100%),

• corresponding early venous shunts - 47 (100%),

• abnormal development of venous trunks receiving blood from arteriovenous shunts - 42 (89.4%),

• venous congestion at frontal and parietal region border - 43 (91.5%),

• increased loop fromation of intracranial arteries - 37 (78.7%).

Control group patients had no combination of such changes.

We named the vascular factor in AD “the discirculatory angiopathy of Alzheimer’s type” (DAAT).