The TAS-9-C is a short form of TAS-20 validated for assessing alexithymia in adolescent populations. Tam & Wong (2012) reported the invariance of the one-factor model of TAS-9-C; yet this resulting model has yet been tested against its original three-factor model of the TAS-20. The objective of this study was to test the goodness-of-fit of both models in three different Chinese samples.

Data were obtained from adolescents (n = 1294), healthy adults (n = 196) and adult psychiatric outpatients (n = 243). Confirmatory factor analyses (CFAs) tested the fit of a one-factor model and a correlated model that comprised three correlated first-order factors (including difficulty identifying feelings, difficulty describing feelings and externally-oriented thinking) to the data. The factorial invariance of the TAS-9-C between independent samples was investigated using multigroup CFAs.

The CFAs results demonstrated a better fit of the correlated three-factor model (CFI > 0.776) over the one-factor model in both adolescent and adult samples (CFI > 0.871). While the correlated model showed evidence of strong factorial invariance among different adolescents from different grade levels, configural invariance was evidenced in the adolescent, healthy adults and adult psychiatric outpatients samples.

The three meaningful clusters of TAS-9-C mirrored the original factor structure of TAS-20. The use of subscales representing different aspects of alexithymia adds incremental value to the measurement using full scale alone among Chinese across developmental stages and settings. Configural invariance among these samples suggests that growth-related change leads to different developmental trajectories for adult alexithymia. Future research is necessary to ascertain this.

The aim of this study was to audit the effectiveness of individual psychodynamic psychotherapy and group therapy in a London psychotherapy service.

The data between January 2002 and July 2012 were reviewed. Of 255 profiles with an End-of-therapy form, 121 (47.45%) patients provided analyzable data at initial assessment and last session. Data was extracted on sociodemographic and mental health characteristics, responses on End-of-Therapy form, and item scores on CORE-OM on each time of measurement.

Patients who terminated prematurely did not differ from those who completed on most of the patient characteristics despite age (t=2.16, p< 0.05), risk to harm others (t=2.93, p< 0.01), percentage of attendance (t=-3.51, p< 0.01), unplanned ending (X2=30.68, p< 0.05), contextual factors (ts ranging from -2.56 to -4.84, ps< 0.05) and benefits of therapy (ts ranging from 5.29-16.18, ps< 0.05). Results indicated that IPP is effective, with a significant difference on CORE-OM (All Mann-Whitney Us range from 2697.50—4253.50, all ps< 0.001) and risk assessment (All Mann-Whitney Us range from 3161.00—3706.50, all ps< 0.001) between initial assessment and last session. However, GT patients demonstrated a significant improvement in risk assessment (All Mann-Whitney Us range from 9.00—20.50, all ps< 0.01).

Our findings further substantiate the effectiveness of IPP. Yet, it is premature to conclude that GT is not as effective as IPP due to small sample size in this study. In fact, this audit was more difficult to carry out than anticipated due to client and data attrition. Recommendations for future audit are discussed.

The relatively recent propagation of the specialty of Family Medicine in Greece has created a new reality in the Greek society. This resulted in the “co-inhabitation” of the Family Medicine specialists and the Internal Medicine specialists in various Primary Care units of the country.

To investigate the internal and external shame of the residents in Family Medicine and Internal Medicine and the comparison of both groups.

To demonstrate the distinct role that Family doctors must have in Primary Care.

102 Greek resident doctors, 52 specializing in Family Medicine and 50 specializing in Internal Medicine participated in the study. The scientific tools used were: a)the Other As Shamer Scale, b) the Experience of Shame Scale, c) the Hostility and Direction of Hostility Questionnaire, d) The Symptom Checklist-90-R, e) Eysenck Personality Questionnaire.

Comparing the two groups using the T-Test, it was observed that the residents of Family Medicine showed a statistically significant higher mean value compared to the residents Internal Medicine in the subscales of: characterological shame, behavioral shame, bodily shame, total shame, emptiness, criticism of others, self-criticism, guilt, intropunitiveness, total hostility, neuroticism and an statistically lower mean value compared to the residents of Internal Medicine in the subscales of: mistakes, Anxiety, Phobic Anxiety and Psychotism.

The results of the study are supporting the common belief that the specialty of Family Medicine has not yet obtained a specific and distinct role and furthermore has not yet gained the necessary recognition by the Greek society.

The vast majority considered pharmacological intervention as a legitimate treatment for behavioural problems in adults with Autism spectrum disorder (ASD) and intellectual disabilities (ID). Yet, sensory integrative therapy (SIT) has in recent years acquired increasing attention with regard to its improvements in functioning.

To report a case of ASD and ID presented with severe problem behaviors. To present and discuss the effect of a combined intervention of home-based SIT and pharmacological therapy on daily functioning.

Case study and literature review.

A 24-year-old male with moderate grade ASD and ID was referred to a home-based training service. He exhibited poor attention, daily self-stimulating behaviors and self-injurious behaviors (SIB). He was treated with 1/2 mg/day of Apohaloperidol. Home-based SIT (Wilbarger Deep Pressure and Proprioceptive Technique) which evokes calming was first started on a weekly interval for five months and then on a daily basis for another five months. Improvement was first demonstrated by a reduction in temper tantrum and SIB during weekly treatment. When treatment became daily, he was able to demonstrate increasing attention in self-care activities as well as reducing frequency and duration of self-injurious and stimulating behaviors.

Despite paucity of published evidence, our findings lend initial support to the effectiveness of SIT as a complimentary approach to treat behavioural problems and enhance daily functioning. Hence, SIT can be incorporated into treatment plan on behavioural problems. Further research using experimental design is called for given the promise of the present findings.

There is emerging evidences that presence of dissociative symptoms could be a significant co morbid condition in a proportion of schizophrenic patients with a history of traumatic events.

The purpose of this study is to analyze the effects of traumatic experiences and the intensity of co morbid dissociative symptoms in the course of schizophrenia.

80 inpatients diagnosed with schizophrenia according to DSM IV and being treated in acute psychiatry clinics at Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were enrolled to the study. Socio- demographic Data Form, Traumatic Experiences Check List, Dissociative Experiences Scale (DES), Dissociative Disorder Interview Schedule were performed.

39 of the patients (48.8%) were found to be exposed to traumatic events at least once in their childhood or adulthood. Significant positive correlation was found between the average DES scores and total number of traumas (r= 0,683; p< 0, 01), the number of psychiatric diagnosis during the course of the disorder (r= 0,374; p< 0, 05), the number of change in treatment due to inadequate response (r= 0,505; p< 0,01) and the number of suicide attempts (r= 0,447; p< 0,01). Moreover, significantly positive correlation was found between the mean DES scores and the number of treatment change due to insufficient response (r= 0,404; p< 0, 01) among the patients without trauma.

The results of this investigation claim that the high scores of DES, independent of traumatic life experiences, may cause resistance to treatment in schizophrenic patients.

The pharmacological properties of betel nut which is consumed in immense quantities in the East as a cognitive enhancer. There was no evidence to prove the cognitive enhancement effect of chewing bet nut.

We tried to demonstrated that chewing betel nut enhanced cognitive performance, mainly attention, especially when they felt fatigue.

First, we demonstrated the fatigue effect induced by repeated continuous performance attention tests. Second, we tested the cognitive enhancement effect induced by betel nut.

Experiment 1, thirty-four volunteers, naive to betel nut, performed a continuous performance test three times without chewing anything before-and-during the test. Experiment 2, seventeen subjects who are used to chew betel nut performed the same tests. During the second and third session, they were given two pieces of gums or five piece of betel nut to chew. The sequence of chewing were counterbalanced.

In experiment 1, omission error rate was significantly different between section 1 and 3. Commission error was significantly different between section 1 and 2, 3 (Figure 1). In experiment 2, omission error rate was significantly different between baseline and section of chewing betel nut (Figure 2). Commission error rate had no difference between three sections. In both experiments, reaction time of different sections had no difference.

[Figue 1. The error rate of different types errors.]

Chewing betel nut could reverse the increase of omission error rate but chewing gum could not improve it. Either chewing betel nut or gum improved commission error rate. This study demonstrate the cognitive enhancement effect of chewing betel nut.

Many studies have concluded that doctors -irrelevant of their specialties- have higher levels of hostility and psychological problems compared to these observed in the general population.

The investigation of psychological characteristics of Greek male and female resident doctors.

To demonstrate the high hostility rates among physicians.

102 Greek resident doctors in the field of Internal Medicine, 45 male and 57 female, participated in the present study. The scientific tools used were: a) the Other As Shamer Scale (OAS), b) the Experience of Shame Scale (ESS), c) the Hostility and Direction of Hostility Questionnaire (HDHQ), d) The Symptom Checklist-90-R (SCL-90-R), e) a questionnaire concerning socio-demographic information.

The 52% of the sample(73,3% of male and 33,5% of female) are single with mean age 33,9 and 34,2 correspondingly. In their comparison using the T-Test it was observed that the male resident doctors showed a statistically higher mean value in the subscales of: behavioral shame (P=0,045), criticism of others (P=0,031), extrapunitiveness (P=0,048). No other significant differences were demonstrated between the two groups.

There were not demonstrated significant differences between male and female doctors. Both male as well as female resident doctors of the sample showed high levels of hostility, a result that is supported by many other international studies. Concerning the socio-demographic results of the study it must be stressed that the medical doctors used in the sample are married at a higher age compared to the general Greek population of their coevals.

Recent researches on depression attach importance to the possibility of complex and reciprocal relations between stress and depression.

The purpose of this study is to compare the attitudes of coping with stress of patients with depression according to the healthy control group.

The sample of the study was composed of patients applying to psychiatry out-patient clinic of Bezmialem Vakif University Medicine Faculty Hospital (n=50) and healthy controls (n=50). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Coping Strategies with Stress (COPE), Beck Depression Inventory, Beck Anxiety Inventory and Sociodemographic Data Form were applied to the participants.

While scores of Positive reinterpretation and growth, Use of instrumental social support, Active coping, humor, Restraint and Planning subscales of the COPE were significantly higher in the control group, scores of Acceptance, Behavioral disengagement and Substance use subscales were significantly higher in the depression group.

As a result it could be argued that negative coping attitudes might be related to depressive disorder.

Post-Traumatic Stress Disorder (PTSD) affects nearly 10% of soldiers leaved waging war. So far, there is no standard treatment for PTSD. The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. Excessive brain responsiveness to norepinephrine appears to play a significant role in the onset of PTSD. A brain active alpha- 1 adrenergic receptor antagonist used to treat benign prostatic hypertrophy and hypertension, prazosin, is of major interest and might become the main therapeutic treatment for PTSD.

In order to further assess the therapeutic efficacy of prazosin, the present review analyzes the results of Medline-referenced outcome studies conducted.

Confirm the therapeutic efficacity of prazosin in the PTSD.

These studies concern 99 patients included in five clinical trials ran from 2004 to 2008. 24% of the patients have been exposed to civilian trauma and 76% to war trauma. Prazosin significantly (p< 0.05 versus controls) decreases trauma nightmares, distressed awakening, avoidance, sleep disturbance, hyper-arousal, re-experiencing and improves global clinical status in all studies. From a statistical point of view, any significant difference of blood pressure was observed at the end of trials.

Beyond the methodological biases, the present review confirms the effectiveness of prazosin in reducing overall PTSD illness severity and distress. Studies of longer duration in larger samples are necessary to confirm these preliminary findings.

In the United States of America, lifetime prevalence of the post-traumatic stress disorder (PTSD) varies between 8 and 11 %. The pathophysiology of PTSD is complex, involving the prefrontal cortex, the limbic system which amygdala and the locus coeruleus. We don’t have a specific treatment for this pathology but just a symptomatic treatment.

The present review analyzes the results of referenced outcome studies in Medline. The efficacity of prazosin, an alpha-1 adrenergic antagonistis is an evidence to this deregulation.

Confirm the hypothesis of a noradrenergic dysregulation in PTSD.

Of share its projections with the amygdale, the hippocampus and the prefrontal cortex and the reticular formation, the locus coeruleus is one of the main brain noradrenergic structure. It regulates the vigilance and attention in the alert situations and regulates the fear and anxiety. The locus coeruleus regulates the wakefulness-sleep cycle with this projection with the raphe nuclei and the paraventricular nuclei of hypothalamus. During a stress, activation of locus coeruleus causes a release of norepinephrine responsible for symptoms of avoidance, hyper-arousal, re-experiencing and trauma nightmares. Prazosin, significantly decreases the main clinical symptoms of PTSD and improve global clinical status to placebo in all studies. This results constitutes a harmul evidence to the implication of norepinephrine in the PTSD.

Norepinephrenine is a major actor in the pathophysiology of PTSD. The prazosin is led to become the first-line treatment of PTSD but longer studies in larger samples are necessary to confirm these preliminary findings.

Diogenes Syndrome (DS) refers to a collection of features found mainly in older persons which includes social isolation, self-neglect, poor insight, domestic squalor and hoarding behavior. Underlying psychiatric disorders might be identified in most of those elders. Issues of law have been embedded in DS cases, since individuals commonly expose themselves and their neighborhood to preventable health risks, due to extreme self-neglect and poor sanitation.

This cross-section aims to assess health-care, cognitive and civil capacity status of patients with DS, based on data from forensic-medical reports.

Psychiatric-forensic reports concerning to elders living alone, recorded between January 2009 to December 2010 in the archives of the Public Attorney District of the State of Rio de Janeiro, Brazil, were analyzed.

Reports from 40 living alone elders (mean age=79.63 ± 7.84 years; mean schooling= 5.68 ± 5.43 years; 75% female) were eligible for the study. 20 individuals (50%) fulfilled diagnostic criteria for DS. DS individuals presented significantly lower mean scores in MMSE than non-DS persons (p= 0.019). More individuals with dementia were found among DS group. Fewer recent medical consultations (p= 0.038) and higher rates of civil incapacity (p= 0.001) were identified in DS elders. Negative moderate correlation was found between MMSE scores and diagnostic of DS (rho=-0.403; p= 0.016). Medical support (phi= 0.388; p= 0.016) and civil incapacity (phi= 0.554; p< 0.001) also correlated with diagnostic of DS.

DS might be related to poor cognitive status, health care neglect and impaired discernment, which may be of interest to both health and law practitioners.

The “Uncanny” (Das Unheimliche), a concept coined by Sigmund Freud (1919) and presented in art and psychotherapy. It is when an experience can be familiar, yet foreign at the same time, resulting in an uncomfortably strange or familiar feeling.

A theoretical investigation and comparison of the “Uncanny” concept in the cinematic and psycho-therapeutic setting.

1. 1. Exploring the cinematic Uncanny motifs in two films by screenwriter, Charlie Kaufman: “Being John Malkovich” and “Adaptation”.

2. 2. Exploring these motifs and understanding them in the context of a case study of prolonged psycho-dynamic psychotherapy.

3. 3. Outlining practical implications for the use of this concept in psycho-dynamic psychotherapy.

Through cinematic analysis of the films we describe the development of the uncanny experience. Thereafter, through narrative analysis of a case report, we refer to the obstacles created by the “Uncanny” experience in the psycho- therapeutic process.

The cinematic motifs (“The Double” and “The Secret”) involved in the creation of the “Uncanny” experience are present and have a major effect on the therapeutic process. Exemplifying and analyzing their presentation seem to clarify possible obstacles that challenge the therapist.

The “Uncanny” is a concept that describes the human experience of sudden familiarity in a novel and strange situation. In this study we describe this phenomenon through psychoanalytic literature and explore it via popular films. It seems that recognizing the Uncanny in the therapeutic process may assist in engaging a therapeutic relationship and improving therapy outcomes.

This descriptive study was held in the department of Internal Medicine in Hedi Chaker Hospital, (Sfax-Tunisia), during 04 months (From July to October 2012). We have included 50 patients, having corticosteroids with a dose equal or greater than 10 mg of prednisone per day for a period exceeding one month. We used in this study, the HAD scale for anxiety-depression, the SF-36 to investigate the quality of life of these patients, the ANGST score of hypomania and the Morisky score to investigate the adherence to treatments (Corticosteroids).

The average age was 43.43 + / -16.11 years. The age of discovery of the disease was 38.24 + / -14.28 years. An average score of anxiety was 10.6 + / -3.89. The mean score of depression was 8.75 + / -4.035. An average score of hypomania was 8.43 + / -4.025. We noted that 53.7% of patients belong to level 3 of anxiety, and 40.56% have some level depression by the HAD score.

Psychiatric complications were noted in 58.5% of patient with a major depressive state in 12.2%. Patients reported sleep disturbances in 24% with behavioral problems in 9.6% of cases.

The average score of SF36 was 56.55 + / -15.21, and 74% of patients had distorted quality of life, mainly affecting health psychic (92.54%), limitation due to mental state (95.75%).

Our results suggest the interest of a psychiatric examination before the introduction of corticosteroids, in order to detect patients requiring special supervision.

Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation.

To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance.

60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19.

Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p< .05) scores in hetero-evaluation measures of insight and treatment attitudes (ITAQ), yet exhibited no differences in the self-evaluation measures of those dimensions.

Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.