DPD is a highly disabling condition for which no efficacious treatment exists. Imaging and neurophysiology findings suggest that the right temporo-parietal junction (RTPJ) plays a crucial role in the conscious experience of the normal embodied self, mediating spatial unity of mind and body, a process impaired in DPD.

We tested the potential therapeutic value of RTPJ rTMS and found that after 3 weeks 6/12 DPD patients responded with 51% reduction on the Cambridge Depersonalization Scale (CDS). After 3 more weeks of RTPJ rTMS responders showed 68% improvement.

Here we present results of 3 and 6 weeks of RTPJ rTMS on each of four cardinal symptom domains of depersonalization, i.e. emotional numbing, anomalous subjective recall, alienation from surroundings, and anomalous body experiences.

In responders we performed a retrospective analysis and applied repeated measures ANOVA on the average scores of each of the four symptom domains derived by the CDS.

Responders to 3 weeks of RTPJ rTMS showed a significant improvement (71% reduction; P= 0.01) in anomalous body experiences. However, after receiving 3 more weeks of RTPJ rTMS they reported further reduction in anomalous body experiences (76% reduction; P= 0.00) and a clinically significant improvement in alienation from surroundings (54% reduction; P= 0.02), emotional numbing (52% reduction; P= 0.05), and anomalous subjective recall (57% reduction; P= 0.11).

This is the first study suggesting that RTPJ rTMS may show therapeutic promise in DPD, and that anomalous body experiences scores might represent an early predictor of response for the remaining symptoms.

Phenomenon of presence of catalytic properties in immunoglobulins has been actively investigated. Research of catalytic properties of antibodies in schizophrenic patients with various clinical manifestations of the illness has not been carried out previously.

To study DNase and proteolytic activity of immunoglobulins G isolated from serum of blood of patients with schizophrenia.

IgG have been isolated from serum of blood of 34 persons with affine chromatography. DNase activity of antibodies was identified according to degree of hydrolysis of supercoiled form of DNA of plasmid pBluescript per unit of time. Proteolytic activity was assessed according to degree of hydrolysis of basic protein myelin and its peptides. IgG were electrophoretic homogeneity.

We have identified that IgG of schizophrenic patients possess a higher (0,392 ± 0,19 nM DNA /mgAB/h), than in healthy persons (0,029 ± 0,06 nM DNA /mgAB/h) specific DNAse activity. It has been shown that DNase activity is an own property of antibodies. It has been found that proteolytic hydrolysis of serum of blood of schizophrenic patients is 5 times as high as indices of hydrolysis in healthy persons. It has been revealed that patients with predominant negative symptoms show maximum high percent of protease hydrolysis 66,9%, different from patients with leading positive symptoms (13,9%).

Increase of DNA-hydrolyzing properties of Ig G is likely to be associated with great number of extracellular DNA. Detection of high values of proteolytic activity may be associated with occurring in serum of blood of patients of large number of destructed or damaged proteins.

Incest may be defined as sexual relations between close blood relatives. It is found in all walks of life and all cultures. Incest is a taboo in all populations. This “secret” lived in childhood raises questions about the future of such a psychological trauma. Father-daughter incest is the most common. It has psychological, social, medical, and legal ramifications. Recently, it was reported that being the victim of paternal incest during childhood might be a significant predictor of a borderline personality disorder and complex posttraumatic stress in adults. Tunisia is among the countries from which incest cases are rarely reported.

Browse the impact of this early trauma on victims to become adult and difficulties the therapeutic approach.

We propose from a clinical case of a family, in which five girls were victims of father-daughter incest.

This would suggest that father-daughter incest is the most traumatic experiences which deserves attention and that we cannot afford to ignore. In-depth knowledge of the dynamics and effects of father-daughter incest suggest specific treatment strategies are indeed necessary.

There are 3 High Secure Psychiatric Hospitals in United Kingdom. The Autism Act passed in 2009 introduced the Adult Autism Strategy, which sets out how local services should be improved to meet the needs of adults with Autism.

There are specialist services available to care for offenders with Autism in low and medium secure forensic settings but there is a lack of dedicated support in high secure settings.

The objective was to identify whether current care provided for such patients is appropriate.

The aim of the audit was to evaluate the need for specialist service for offenders with Autistic Spectrum Disorder within High Secure Psychiatric Care.

The hospital wide secure email system was used to identify wards which had patients with ASD. A questionnaire was developed which explored the clinical practice, willingness and knowledge of the Gold standards of care. It was circulated on the 9 identified wards to the staff on 3 different shifts. 100 completed forms were received which were stored in a secure area.

The results revealed that most of the staff was aware about ASD but majority had not heard about standard approach of care. Majority of the staff were willing to train and work in a dedicated ASD team.

Effort should be made to increase awareness and train the staff to care for offenders with ASD. Work should be done towards accreditation with the National Autistic Society to set up specialist care for ASD patients in High Secure Unit.

ll antipsychotics act via dopaminergic receptor antagonism. This pharmacology is shared by all first (FGA) & second (SGA) generation antipsychotics. We reviewed the efficacy & safety of all antipsychotics in clinical use for BMJ Clinical Evidence (Barry et al 2012).

Our paper summarises key results from this systematic review based on comprehensive literature search of the Medline, Embase, Cochrane Library, and other databases including safety information from the FDA and MHRA in UK. The main clinical questions of interest were: What is the efficacy of drug treatments for positive, negative, or cognitive symptoms of schizophrenia? How effective are treatments for people with schizophrenia resistant to standard antipsychotic drugs?

We found 51 systematic reviews, RCTs, or observational studies that met our inclusion/quality criteria and performed GRADE analysis to assess quality of evidence. Key results are presented for efficacy & safety for: amisulpiride, chlorpromazine, clozapine, depot haloperidol, haloperidol, olanzapine, pimozide, quetiapine, risperidone, sulpiride, ziprasidone, zotepine, aripiprazole, sertindole, paliperidone, flupentixol, depot flupentixol, zuclopenthixol, depot zuclopenthixol, and clozapine.

The evidence for some ‘standard’ treatments is surprisingly weak. Up to 1/3 -1/2 of patients fail to respond to currently available antipsychotics, and all antipsychotics cause side effects in most people. This downbeat conclusion is not surprising, given clinical experience and the common mechanism of action of all antipsychotics. More efficacious antipsychotic medication will only be developed from understanding the biological pathogenesis of schizophrenia.Barry S, Gaughin T, and Hunter R. Schizophrenia. BMJ Clinical Evidence 13 July 2012.

http://clinicalevidence.bmj.com/x/systematic-review/1007/overview.html.

A consensus is emerging for functional remission to be routinely assessed in the treatment of major depression. This is because, in many cases, clinical remission is not necessarily accompanied by optimum functioning which would favour the rehabilitation of patients.

The objective was to study in depressed patients treated with agomelatine their global clinical response and their social functioning. The QFS (Questionnaire de Fonctionnement Social) provides information on specific areas of functioning: objectively via the frequency of social behaviours (F: Frequency index) and subjectively via the patient's perception of his/her social performance (S: Satisfaction index), making up a global index (G).

3139 patients were followed over 6-8 weeks. Assessments were carried out at inclusion (C1) and at the follow-up visit (C2): QIDS-C, CGI, QFS and SDS.

At C1 the mean QIDS-C score was 17.0 ± 3.4. For the QFS-G: 72.4% of functioning was “poor”. The SDS global score was 21.3 ± 4.8. At C2, a reduction in the QIDS score was observed: -7.9 ± 4.7 (p < 0.01). QIDS response rates were 50.2% [48.4-52.0%]. Improvement on the SDS was significant and the 3 QFS indexes saw significant increases, but more markedly so for S (6.7 ± 6.7) than for F (4.2 ± 5.4).

The results show an improvement in the social functioning of depressed patients treated with agomelatine. They suggest that a specific action of the treatment contributes to providing the patient with the possibility of better rehabilitation into his/her social, family and professional environments.

The concept of the “social network” (SN) describes the set of social relationships of an individual. SNs of patients with psychotic disorders have often been investigated in the last few decades, however, diverse theories and different assessment methods were utilised within this field of research.

To assess morphological (size, density, degree) and interactional (direction and intensity) characteristics of SNs of patients with psychotic disorders reported in different studies.

To explore the characteristics of the SNs of psychotic patients and to identify the factors that influence their size and composition.

A systematic literature review was carried out using the databases MEDLINE, PsychInfo and EMBASE. When feasible, the characteristics of SNs were compared across studies.

Out of 739 identified studies, 142 reported quantitative findings on SN characteristics. 27 (19%) of them reported figures on the size of SNs in a way that allowed meaningful comparison across studies. For all other SN characteristics, only descriptive accounts were possible. The overall mean network size was 15.2 (SD 9.4). Being single was negatively correlated with SN size.

The concept of SNs in psychotic disorders has been underpinned by diverse theoretical frameworks and assessed with a variety of tools. Only a small number of studies were methodologically comparable, which makes findings on SN characteristics and associated factors difficult to interpret. There is a need to develop standardised instruments in order to advance the quality of the research in the field.

Late life depression is still not well recognized. As depression increased risk for mortality and morbidity in elderly,it is necessary to have efficient instrument for detecting and measuring depression in this population. The Geriatric Depression Scale (GDS-15) is a screening test for depression in late life but it is not use in Serbian erderly population.

To show preliminary results of using the Short Form Geriatric Depression Scale (GDS-15) in Serbian elderly population.

We wanted to estimate whether this scale correlate with Beck Depression Inventory (BDI) which has been validated in Serbia.

We studied 248 pariticipants (40,3% were male,59,7% female) age 65 and older. Mean age for the whole sample was 70,87 ± 5,79. Hamilton depression scale, BDI and GDS-15 we used for assessing depressive symptomathology and two psychiatrist confirmed diagnosis of depression. According to inclusion criteria,102 participants met criteria for depression (experimental group) and 146 were in control group.

We found statistically significant difference in mean GDS-15 score between experimental (4,83 ± 4,93) and control group (1,51 ± 1,42) and no gender differences were found according to GDS-15 mean score. Significant difference (p≤ 0,05) was found on GDS item 11(Do you think it is wonderful to be alive now?),where woman scored higher in control group. Strong positive correlation was found between BDI and GDS-15 mean scores (r=0,863; p< 0,001).

The preliminary results confirm that GDS may be accepted as useful tool for measurement depression in Serbian elderly population. This may facilitate recognition and treatment of depression in elderly.

During the last years an increasing number of abusers of various psychoactive substances (surfactants), leads to a high incidence depending on the surfactant in patients with various forms of mental disorders, including schizophrenia patients. Interaction between schizophrenia and drug addiction is very complex, because of atypical clinical picture of both diseases and there are a lot of different opinions about the impact of drug use on the progression of schizophrenia. That's why this problem must be studied.

To study influence of psychoactive substances (alcohol, cannabis) on the paranoid schizophrenia's clinic, to develop treatment and prevention measures. This research includes studies of 60 patients with paranoid schizophrenia and addiction of cannabis and alcohol.

Admission mentally active agents in patients with schizophrenia impact on the overall clinical and dynamic patterns of endogenous disease: manifest in patients receiving mentally active substances episode schizophrenia are exogenous type. With the progression of the development of schizophrenia complicated by psychoactive substances we can see smoothing of psychotic defect. Adherence of psychoactive substances to schizophrenia affect social functioning.

The significant differences in the dynamics of mental health status in patients with paranoid schizophrenia, depending on psychoactive substances addiction were described. Joining alcohol and cannabis addiction increases the frequency of hospitalizations, but did not affect the level of social functioning of patients with schizophrenia.

Lithium has been used in the treatment of bipolar disorder in pregnant women. However, information on the pharmacokinetics of lithium during perinatal period is scarce.

To study pharmacokinetics of lithium during delivery and in the neonatal period.

A prospective, observational and naturalistic study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA, from 2005 to 2012. We included all consecutive cases of pregnant women with bipolar disorder I or II (n = 22), and on maintenance treatment with lithium monotherapy (n = 13) or polytherapy (n = 9) during pregnancy who elected artificial feeding. Lithium plasma concentrations in maternal blood and umbilical cord were detected. Lithium plasma concentrations in infants (n = 16) at delivery and in the neonatal period were obtained to calculate elimination half-life, which was estimated by lineal regression. Technique: AVL 9180 electrolyte analyser using a lithium-selective electrode (detection limit =0.10 mEq/L).

Women did not fulfil diabetes criteria pre-pregnancy and during pregnancy. Attending to neonatal outcomes, infants exposed to polytherapy had a higher weight at birth (percentils) than those exposed to lithium alone [53.38 (33.40) vs. 70.22 (26.25)]. No statistically significant differences were found in umbilical cord:maternal plasma concentration ratio between those treated with lithium monotherapy and women treated with polytherapy (1.05 vs. 1.08). The lithium mean elimination half-life (SD) in infants was 6.73 (9.12) days.

Lithium crosses placental barrier almost completely. Elimination half-life in neonates exposed to lithium in utero was 6.73 days. Moreover, lithium treatment during pregnancy requires therapeutics monitoring in exposed dyads.

Young women with personality disorders (PD) are common in psychiatric inpatient care. The clinical impression is that there is a considerably increased incidence the last decade.

To show changes in frequency and extent of inpatient care for PD, and the relation to suicide.

All admissions for inpatient care given a primary diagnosis of PD in compulsory or voluntary care years 1990 to 2010 were extracted from the National Patient Register. Subsequently, data from the Cause of Death Register were extracted and linked for the same time period.

There were more than 60,000 admissions for PD in Sweden 1990–2010. During the last ten years there was a doubling of the number of yearly admissions for young women in the ages 18 to 24 years, and inpatient care hospitalization for PD are currently six times more common for women than for men in this age group. The same is true for compulsory care. Every fifth woman in this age group who had committed suicide had been treated for PD within the last five year period prior to the suicide.

The incidence of inpatient care in young women with PD did show a sharp rise during the last decade. There was a corresponding increase in suicide with a diagnosis of PD. Guidelines for treatment and care exist but more knowledge and action plans directed both to health care and the society are urgently needed.

People suffering from Severe Mental Illness (SMI) have a shorter life expectancy than general population. The excess of mortality may be primarily due to premature cardiovascular diseases. Subjects with a diagnosis of SMI may have an high prevalence of Metabolic Syndrome (MetS).

To estimate the risk of MetS among subjects with SMI compared to their counterpart without SMI.

A systematic review and meta-analysis of English and non-English articles using PubMed, Embase and PsycINFO was performed. ORs with related confidence intervals were used as association measures. All pooled analyses were based on random-effects models.

The pooled analysis showed a statistically significant association for MetS in people suffering from SMI. However, we found a consistent level of heterogeneity between the included studies. Subanalyses showed that both SCZ and BD had higher risk than general population without SMI. No statistical differences were found comparing SCZ and BD subjects.

People with SMI have significantly higher risk to having MetS than general population. Despite some limitations, the results of present meta-analysis emphasize the relevance of a continuous cardio-metabolic assessment in the SMI population. Longitudinal researches are needed in order to assess the impact of a regular cardiovascular screening, prevention and treatment on the improvement of health status and life expectancy among people suffering from SMI.

The Hypothalamic-Pituitary-Adrenal Axis (HPA axis) has been implicated in the pathogenesis of many affective disorders. Peripartum depression is a condition that includes depressive episodes occurring during pregnancy and the postpartum period. During uncomplicated pregnancy, mean cortisol levels rise substantially, mostly due to high levels of corticotropin releasing hormone produced by the placenta (p-CRH). The latter also suppresses hypothalamic CRH, leading to hypo-cortisolemia after partus. Cortisol concentration is usually normalised within two weeks after delivery. Failure of the above process results in continuing hypo-cortisolemia, which might increase susceptibility to PPD.

The current study aims to investigate the relationship between evening salivary cortisol levels and depression during the peripartum period.

Three hundred and forty six pregnant women were asked to participate in the study. They completed the Edinburgh Postnatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory-State version (STAI-S) at the 36th week of pregnancy and the 6th week after delivery. At both times, study subjects were also asked to collect evening salivary samples by using a mail-delivered kit. Moreover, they were interviewed at the 36th week of pregnancy using the Mini International Neuropsychiatric Interview (MINI).

Preliminary results indicate significantly higher evening salivary cortisol levels in depressed women during late pregnancy compared to healthy controls. No difference in cortisol levels was found between women with postpartum depression and healthy controls.

Our study results support the hypothesis that depression during pregnancy resembles melancholic depression characterized by hyperactivity of the HPA-axis and hyper-cortisolemia.

Schizophrenia is a chronic illness with a worldwide lifetime prevalence of about 1% [1]. Non-adherence and partial adherence to antipsychotic medication treatment is common and long-acting injectable “depot” preparations of antipsychotic medications have been used as an alternative to oral medication therapy for patients for whom adherence is a clinically significant problem [2].

In present study,we collected the sociodemographic and clinical data of 252 patients who were diagnosed as schizophrenia according to DSM-IV-TR and who were followed up by our outpatient clinic at least two years. The data obtained from medical records and interviews; patients were grouped according to using of long acting antipsychotics.

The long acting antipsychotics were prescribed to 96 patients of 252 patients. The rates of history of suicide attempt, family history of schizophrenia and violent bahaviour were significantly more in long acting antipsychotic group (p≤ 0.05). In regression analyze, history of suicidal and violent behaviour and family history of schizophrenia were found to be significant for predicting the use of long acting antipsychotics (p≤ 0.05).

Considering the commonness of poor adherence to treatment in schizophrenia, we suggest that predicting the sociodemographical and clinical factors associated with using of long acting antipsychotics is important for treating effectively schizophrenic patients with poor treatment adherence in early stages.

Considering the current Greek economic crisis, it is reasonable to discuss the potential and expected effects of the crisis in mental health.

This study examined the effect of borrowing on mental health.

This study aimed at detecting the interaction of borrowing on the bio-psycho-social health.

273 community individuals participated in the present study. The measures used were: Family Environment Scale, the Hostility and Direction of Hostility Questionnaire, the Symtom Checklist 90-R, State - Trait Anxiety Inventory, Family Crisis Oriented Personal Evaluation Scales, Other As Shamer Scale, Experience of Shame Scale, Cardiac Anxiety Questionnaire.

The borrowers have statistically higher average than non-borrowers parents at the scales of paranoid-ideation 6,55 ± 4,03, guilt (SCL - 90) 0,93 ± 1,14, orientation of the family for achievements 6,44 ± 1,54, moral emphasis of the family environment 4,67± 2,21, and at family mobilization to accept help in the periods when the family is in crisis 11,13 ± 4,65. Particularly interesting result of this study was the finding that borrowers with heavy debt from mortgages and personal loans and credit cards have higher levels of paranoid-ideation (8,38), more stress for their heart function (1,395) and avoiding activities for heart function (1,809), higher levels of internal shame (21,38), feeling empty (4,52), higher levels of behavioral shame (20,62) and higher levels of thoughts of death (1.05).

The heavy debt has not only economic consequences but also, is associated with serious psychological distress. The factors of personality, of postponement of satisfaction, of impulsivity are correlated with the borrowing.

Four theoretical models have been postulated in formation and maintenance of delusional idea in schizophrenia:

1. 1. Cognitive biases (attentional bias, jumping-to-conclusion, need-for-clousure, attributional bias),

2. 2. Social cognition alterations (theory-of-mind, emotion facial recognition),

3. 3. Perceptive alterations of anomalous experiences and

4. 4. Emotional anomalies (anxiety, depression, self-esteem, “self” discrepancies).

To exam the joint influence of these anomalies in delusional activity in DD.

We studied the delusional activity measured by the “Maudsley Assessment of Delusion Schedule” in 68 patients with DD (n=68) diagnosed by SCID-I (DSM-IV-TR). Cognitive biases were evaluated by “Emotional Stroop”, “Experimental Beads Task”, “Need-for-Closure Scale”, “Internal, Personal and Situational Attributions Questionnaire”. Social cognition alterations were measured by Faux-pas Task and Eyes-Test; perceptive alterations by “Cardiff Anomalous Perceptions Scale”; and emotional anomalies by “Hamilton Anxiety Rating Scale”, “Beck Depression Inventory”, “Rosenberg Self-esteem Scale” and “Personal Qualities Questionnaire”. The relationship between delusional activity and these cognitive anomalies were examined using lineal regression models controlled by socio-demographic characteristics, premorbid IQ (“NART”), negative symptomatology (“PANSS”) and neuropsychological function (attention, verbal learning, working memory and executive function).

High scores in delusion activity were significantly associated with high scores in jumping-to-conclusion and depression and low scores in faux-pas and self-esteem, after being adjusted by number of studied years and negative symptomatology.

Cognitive biases (jumping-to-conclusions), social cognition deficit (faux-pas) and emotional alterations are the most implicated anomalies in formation and maintenance of delusional idea in DD.