Panic disorder is common disease characterized by spontaneous attacks of massive anxiety and fear. Anxiety is generally considered to be a condition in which the organism is increasingly aroused and EEG may therefore play an important role in the study of the biological basis of anxiety disorders. Standardized low-resolution electromagnetic tomography (sLORETA) is a new quantitative EEG method for determining distribution of neuronal electrical activity in the form of three- dimensional images of current density of the cerebral cortex.

EEG may be usefull method in searching for predictors to the pharmaco and cognitive-behavioral therapy (CBT).

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

The study comprised 24 patients diagnosed with panic disorder with or without agoraphobia. The severity of symptoms was measured with the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Sheehan Anxiety Scale, subjective and objective Clinical Global Impression (CGI) and Dissociative Experiences Scale (DES). Based on final BAI score decreases by 25%, the patients were classified into two groups - responders and non-responders. 21-channel EEGs were recorded at baseline and after completion of therapy.

In non-responders, there were no statistically significant changes in sLORETA findings following therapy. Responders showed a significant decrease of alpha-2 sources (p< 0.05) in the occipital lobes and cuneus and a statistical trend for increased beta-3 sources (p< 0.10) in the posterior cingulate.

Only treatment response was associated with significant changes of electric neuronal activity.

In Brazil, children and adolescents are considered holders of Special Rights, as depicted in Article 227 of the 1988 Brazilian Constitution. Special Rights refers to a condition in which their rights should be respected, but also protected from physical, moral and psychological harm. Moreover, the Brazilian Child and Adolescent Statute (Law n. 8.069) specifically guarantees full protection of children and adolescents.

This case-report sought to discuss the intersection of Psychiatry and the Brazilian Law in a case of suspicious recurrent child abuse. AIM. To demonstrate the importance of protecting children from maltreatment by reporting the case of a suspicious recurrent child abuse.

Case-report: A 7-year-old child and her mother were evaluated by two psychiatrists, as requested by the Public Attorney Office of the State of Rio de Janeiro. Denouncements of possible recurrent negligent treatment by the parents had been referred to the Public Attorney Office since the child was one year old. Other family members were also interviewed, to better understand the family dynamics. RESULTS. The mother had no symptoms of mental disorder. The child had symptoms of possible child abuse, such as physical and school failure, emotional and social withdrawal.

Clinicians must pay attention to emotional signs and symptoms that can be indicators of child abuse, which must be reported to law enforcement. We also highlight the importance of evaluating and giving support to the whole family.

Suicide is a major public health problem. Although suicide statistics have always been difficult to determine, there is no doubt that deaths caused by this psychiatric challenge are similar to the ones caused by homicide or road traffic injuries. The presence of a personality disorder has often been related to suicide.

In the present work we analyze the presence of personality disorders (PD) in suicide victims and controls, in order to determinate such axis II disorders were more common in the suicide group.

We compared the results of two samples (271 suicides and 142 sudden-death controls), which were studied using a psychological autopsy. Personality disorders were diagnosed using the SCID-II. Data were analyzed using the SPSS software 19.0 version.

Although age differences were found between both groups, they were almost not statistically significant (p=0’049). There were no differences in gender results (p=0’289). The prevalence of PD was statistically significant (p=0’00) among the suicide group. When we studied the suicide group, we found that the existence of previous suicide attempts and PD was statistically significant also.

Although PD were more frequent among suicide victims, we found that PD also had more previous suicide attempts. Therefore, the presence of more PD among suicide victims may be due to the higher rates of suicide attempts

To describe a case of Ekbom Syndrome with Folie à Deux, between mother and daughter, that has the mother as the “primary patient” even with borderline intelligence and the daughter as the induced patient, but without any cognitive deficits.

To highlight that some cases of Folie à Deux can occur in a strictly affective dominance fashion relationship.

Case report.

MRC, 46 years old, illiterate, was referred to the outpatient psychiatric clinic of the University Hospital of the Federal University of Alagoas-Brazil, by a dermatologist of the same hospital because of hyperchromic scaly pruritic skin lesions in legs and back with no findings at skin biopsy that the patient attributed to “bugs” under her skin and that her daughter also believed that existed even when her mother showed her desquamative skin as being the bug.

The dominance between the primary patient and the induced one can be of affective nature only but not cognitive nature in Folie ... Deux with Ekbom Syndrome.

Alterations of the Hypothalamic-Pituitary-Adrenal Axis (HPAA) may be related to the development of psychiatric disorders, especially in the context of childhood adversity. The “attenuation hypothesis” postulates that chronic childhood adversity leads to initial hyperactivation of the HPAA, which subsequently may turn into hypoactivation during adolescence, and support the development of emotional and behavioural problems. However, studies investigating this hypothesis during the course of adolescence are rare.

The sample comprised 49 adolescents (f/m 19/30), subsampled from a larger longitudinal study on adolescent development. Assessments were performed at three points in time (T1-T3). Pituitary Gland Volume (PGV) as an estimate of chronic HPAA activity was measured by MRI at T1 (mean age 12.5) and T3 (mean age 16.5). HPAA functioning was assessed via multiple salivary cortisol measures at T2 (mean age 15.5). The Cortisol Awakening Response (CAR) was calculated as a measure of HPAA activity. Additionally, childhood adversity was assessed at T2 using the Childhood Trauma Questionnaire (CTQ).

There was a significant sex-specific association of PGV at T1 and HPAA activity at T2. While PGV was positively predicting HPAA activity in boys, girls showed a reverse pattern (attenuation of the HPAA). A blunted CAR in girls was significantly related to their report of childhood adversity.

The results show that girls may have a higher tendency of attenuation of the HPAA in the context of childhood adversity and initial hyperactivation of the HPAA. This may contribute to their higher risk for diverse psychiatric disorders during adolescence.

Physical domestic violence (DV) against women is associated with adverse health effects and great burden on victims, families and communities. The phenomenon, though prevalent in EMR countries, is not well defined regarding the determining factors.

This systematic review is to sum up evidences from the EMR countries, on factors associated with physical DV.

Methods:

Pubmed, EMBASE, ISI, PsycInfo, IMEMR, Ovid, Global health, Cochrane Library, IranMedex, SID, IranDoc, Science direct, Elsevier, Proquest and Magiran were searched with no language limits up to December 30, 2011. The hand searching included papers’ lists of references and evidence list of “The National agenda for preventing domestic violence”.

Quantitative studies on ever partnered, not-pregnant women in the EMR countries, which referred to either predisposing or protective factors of physical DV, in each of victims, perpetrators and community domains, were selected. A criterion based critical appraisal was performed by two reviewers.

The Odds Ratios of all reported factors - regardless of statistical significance- were either directly extracted from the papers or indirectly calculated from provided contingency tables, and used to make summary tables.

According to 16 finally selected articles, either partners’ lower levels of education, their witnessing /exposure to DV in childhood, personal/ family unfavorable socioeconomic status, rural residency and husbands’ alcohol / drug abuse were predisposing; while consanguinity, women’s age and employment were protective factors.

Findings are consistent with most international evidences. A meta-analysis will provide a more comprehensive understanding and evidence.

In the last decades, the early intervention on individuals at risk of developing mental disorders became one of the most important and emerging issue not only in psychiatry but also in the overall evidence-based medicine. Subjects who reported severe psychotic-like experiences may be considered five times more likely to manifest psychosis in the following four years when compared to the general population. We aimed to conduct a general screening with the scope to detect subjects at risk for psychotic-like experiences, depression and suicide. Also, we aimed to evaluate the possible correlation between the screening evaluations, gender and early traumatic experiences.

A total of 120 patients was screened using the TeenScreen Program, Community Assessment of Psychic Experiences, Beck Depression Inventory, Beck Hopelessness Scale, Childhood Trauma Questionnaire.

At the bivariate analyses, male subjects had significant lower total scores in several measures (p=0.001) than female. When multivariate analyses were performed to evaluate the association with gender and early traumatic experiences, we found that female subjects were 1.7 times more likely to be older (p< 0.01) and 1.52 times more likely to report depressive symptoms compared to male. Also, subjects with higher total scores at the CTQ were several times more likely to be older than those with lower total scores.

Although the small sample size did not allow to generalize the present findings, the detection of some subgroups of subjects at higher clinical risk may play a critical role in terms of prevention and early interventions.

Although religion is one the protective factors classically related to suicidal behavior, as far as we know, no studied based on psychological autopsy has been published. Holy Week in Seville (Spain) may be the most important traditional event of the city. Besides socio-cultural and economic aspects, it is the celebration of the Passion and Death of Christ through the brotherhood processions to the Cathedral, and its religious feeling is present in a large majority of the population.

In the present work we tried to study if, as well as other religious aspects, belonging to a brotherhood and participating actively in it are protective factors for suicide.

We compared the results of two samples (271 suicides and 142 sudden-death controls), which were studied using a psychological autopsy. We developed a questionnaire to study religious thoughts/feelings, specially those related with the Holy Week brotherhoods.

In our sample, religious people committed less suicides than the atheist (80 %-68’1% between the males, 100%-92’4% between the females), being the differences statistically significant for the males (chi square test =0’002). Belonging to a brotherhood was also a protective factor (only 22’5% of the suicide victims belonged, compared with the 37’8% of the controls), and if the participated actively they had even less risk (RR=0’562).

In the absence of biological measures, diagnostic long-term stability provides the best evidence of diagnostic validity.Therefore,the study of diagnostic stability in naturalistic conditions may reflect clinical validity and utility of current schizophrenia diagnostic criteria.

Describe the diagnostic evolution of schizophrenia in clinical settings.

We examined the stability of schizophrenia first diagnoses (n=26,163) in public mental health centers of Madrid (Spain).Probability of maintaining the diagnosis of schizophrenia was calculated considering the cumulative percentage of each diagnosis per month during 48 months after the initial diagnosis of schizophrenia.

65% of the subjects kept the diagnosis of schizophrenia in subsequent assessments (Figure 1). Patients who changed (35%) did so in the first 4-8 months. After that time gap the rates of each diagnostic category remained stable. Diagnostic shift from schizophrenia was more commonly toward the following diagnoses: personality disorders (F60), delusional disorders (F22), bipolar disorder (F31), persistent mood disorders (F34), acute and transient psychotic disorders (F23) or schizoaffective disorder (F25).

Once it is confirmed, clinical assessment repeatedly maintains the diagnosis of schizophrenia.The time lapse for its confirmation agrees with the current diagnostic criteria in DSM-IV. We will discuss the implications of these findings for the categorical versus dimensional debate in the diagnosis of schizophrenia.

A new generation of synthetic compounds, readily available on the web, has recently come on the market. Designer Drugs are produced with the intent to elicit effects similar to controlled substances getting round the drugs laws. Two of the most recent Designer Drugs are “Spice” and “Bath Salts”. They produce psychoactive reinforcement, are highly attractive, perceived as safe drugs and not easily detectable in urine and blood samples.

The study focused on quantifying the presence of these compounds among the possible illicit substances usually consumed among adolescents and young adults. Besides we aimed to evaluate the existence of websites related to Designer Drugs and aimed at dividing their positions towards drug use in three main categories : Anti Drugs, Pro Drugs and Harm Reduction Approach.

The diffusion of the phenomenon is still at his beginning, although most of the subjects interviewed had some knowledge of the phenomenon. A web mapping has underlined the preponderance of Pro Drugs websites. As regards “Spice”, 77 is the total number of related websites: 53 (69 %) Pro Drugs, 17 (22%) Anti Drugs and 7 (9 %) Harm Reduction Approach.

Although the internet provides a wide range of information about the side effects of Designer Drugs and many Countries have banned them, there is still a high number of Pro Drugs websites that actively promotes their consume. However, the level of use in Italy is still low, according to the data emerging from the sample recruited.

To find out the language disorders in a sample of schizophrenic female patients. Also to explore the relationship between female sex hormone estradiol and language disorders in schizophrenic patients.

Schizophrenic females show language disorders as a part of their overall cognitive impairment. The female sex hormone, estrogen, acts as a neuro- active hormone that is assumed to have effects on the central nervous system and specifically on the cognitive functions.

This case-control study included 30 schizophrenic female patients who were admitted in Al Abasseia Psychiatric Hospital. It also included 15 healthy controls that were matched in age and education. They were assessed using: Psychiatric interviews, The Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms, Serum estradiol level on 3 consecutive weeks and language and speech items of The Luria-Nebraska Neuropsychological Battery (LNNB). General and neurological examinations were performed as well.

There were statistically significant differences between both groups in all the clinical scales (receptive and expressive speech, reading and writing) of the LNNB, as well as most of the factor scales covering a wide range of linguistic abilities. High estradiol levels were correlated with poor performance in speech and language scales.

Female schizophrenic patients had menstrual irregularities and hypo-estrogenism. They performed significantly worse on their linguistic abilities, receptive and expressive speech, reading and writing. Increased estrogen levels correlated with poor performance on the linguistic functions, including writing and reading domains in patients with schizophrenia

In the last decades Sexual Addiction has received increased attention among mental health professionals; however, the phenomenon as a clinical syndrome is still controversial. The DSM-IV TR and CID-10 contain ambiguous categories to correspond with this. The American Psychiatric Association is now debating whether Sex Addiction should be added to DSM-V.

Using a recent movie as background, the authors present the state of art, describing behavior and theories:

1. a) compulsive behavior,

2. b) impulsive behavior or

3. c) addiction behavior.

Textbooks and studies published on Pubmed and Medlink. Analyses of Steven McQueen movie - “Shame”(2011).

Like a train toy that it always going around, caught in the distressing anguish of this damn, the movie’s protagonist lives a circular controlled martyrdom. In this movie full of sexual scenes, there is no eroticism, only discomfort, coldness and oppression. The body is his tether, isolated from the world and self-enclosed. Guilt and shame are his permanent emotions. The debate is coming to a conclusion - a DSM-V diagnose “Hypersexual Disorder”, characterized by a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment.

It’s a reasonable challenge getting a reliable classification to provide easier access and professional help to those who often suffer enormous pain and shame. There are still opinions against this, mainly because the limits of sexual normality aren’t clearly defined, the symptoms patterns aren’t distinct, moral judgments are involved and the label may be a misnomer.

Some patients have a chronic and/or recurrent form of the disorder. Reasons of treatment resistance have been described, but the neurobiological basis of disorder gravity is unclear.

Examine if the hyperactivity of right and left amygdala, left posterior cingulate cortex or left dorsolateral prefrontal cortex predict the treatment effect of Cognitive Behavioral Therapy (CBT).

The aim of our study is to test the hypothesis of treatment predictability in panic disorder patients in fMRI.

24 patients meeting the ICD-10 criteria for panic disorder with or without agoraphobia. Patients were studied in fMRI during the exposition of threat-related words compared with neutral words and emotional faces compared with fixation points. Patients were studied in fMRI scanner before and after CBT treatment. Psychopathology was assessed using Clinical Global Impression rating scale (CGI) and Beck Anxiety Inventory (BAI). Patients were divided into responders and non-responders groups by the 25% reduction in BAI scale.

Significant reduction of activity was observed in responders on the right amygdala, while the left amygdala decreased activity is lower, and could be the effect of habituation. Incresed activation of left Broca’s area 46, and 45 was negative treatment effect predictor.

Negative treatment effect predictor is hyperactivity in left dorsolateral prefrontal cortex BA 46 and 45. Positive predictors are higher reactivity of right amygdala for anxious faces, activation of right angular gyrus, right insula, right temporal pole.

Supported by the project IGA MZ CR NT 11047-4/2010

Drug abuse is typically initiated during adolescence, which is a critical period of brain maturation and vulnerability to drug dependence. Accumulating evidence suggests that the early initiation of drug use is associated with altered brain structure compared to individuals who start taking drugs at a later stage in life, suggesting that these brain abnormalities might reflect neurobiological markers of vulnerability.

Our objective was to identify neurobiological risk markers in the brain structure of cocaine-dependent individuals.

We aimed to investigate the effects of onset of drug use on the brain abnormalities typically seen in adults with cocaine dependence.

Sixty cocaine-dependent individuals and 60 healthy volunteers underwent an MRI brain scan. We used whole-brain voxel-based morphometry to find grey matter abnormalities in the cocaine group. We then performed three whole brain analyses of grey matter volume in the cocaine group using the general linear model with a within-group correlation design, separately for the drugs cocaine, tobacco and cannabis. We identified variance in grey matter uniquely attributable to the age at which each of these drugs was first used; the regressors were orthogonalised to the duration that each drug had been consumed.

The age of first use was associated with a reduction in grey matter volume in distinctly different brain regions for cocaine, tobacco, and cannabis; irrespective of duration of use.

We identified neurobiological markers for three common drugs of abuse that may be associated with the risk for developing dependence.