To assess the teaching of a method, the “Crisis Dialogue” (CD), designed to improve the therapeutic relationship during the first days of care for acute psychosis - hence the outcome. The “Crisis Dialogue” is fundamentally different from usual “empathetic” speech in that it provides tools meant to help de-construct the delirium. The underlying theory is induced from patients’descriptions of the onset of the psychotic crisis and uses the concepts of generalised concern, dys-mimetism and undifferentiation of the self. This dense and precise verbal technique requires 3 minutes of the consultation time and is meant to complement usual work in emergency psychiatry.

CD was taught to all health professionals of 3 emergency psychiatry wards and assessed in an exploratory multiple study (n = 105 patients) including case series, “before-and-after” comparisons and a pilot randomised controlled trial (RCT).

In the case series, no adverse reaction was reported and most clinicians expressed satisfaction with CD use. In the “before-and-after” study, duration of hospital stay after CD implementation was shorter (median 46 days) than before (61 days)(p = 0.01). In the RCT, all measured indicators were equal to or better with CD, most significant with the model including Working Alliance Inventory, Difficult Doctor- Patient Relationship and patient perception of reassurance (p=0.02).

In this pilot study, the CD appears as a promising aid for the establishment of a good therapeutic relationship in the first days of care for acute psychotic patients. It may also have a positive impact on patient progress.

Attention Deficit/Hyperactivity Disorder (ADHD) has been linked to substance use disorders later in life. However, the unique contribution of ADHD is not clarified yet. Insufficient research in this area has considered first substance use, associated behavioral problems and female gender in longitudinal and community settings.

To study the association between childhood attention problems and substance use 18 years later.

Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems (dimensional constructs) and substance use between ages 22 and 35, adjusting for potential childhood and family confounders.

Individuals with high levels of childhood attention problems presented higher rates of substance use (regular tobacco smoking, alcohol abuse/dependence, cannabis problematic use, cocaine lifetime use). However, when taking into account other childhood behavioral problems, early substance use, academic difficulties and family adversity, childhood attention problems were only related to regular tobacco smoking and cocaine lifetime use.

This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood attention problems and substance use is confounded by a range of early risk factors.

In patients suffering from borderline personality disorder (BPD) primarily psychotherapeutic care is indicated. Pharmacotherapy is considered as adjuvant and often controversial way of treatment.

Demonstration of pharmacological approach to BPD patients in Olomouc Czech Republic and compare with treatment guidelines. treatment guidelines.

The aim of our study was to compare treatment of BPD patients in 2007 and 2011

The paper examines the state in 2007 and 2011 in BPD patients at the Department of Psychiatry, University Hospital. Our study included outpatients and inpatients treated in all departments. Inclusion criteria were diagnosis BPD. Medication was assessed according to the documentation at discharge or during outpatient care according to the transcript record.

In most cases are BPD patients treated according to current guidelines. The treatment consists of SSRI antidepressants, anticonvulsants and second-generation of antipsychotics. Problem can be considered in some cases with medication dosage, combination, administration of benzodiazepine anxiolytics, hypnotics.

BPD patients are treated according to current recommendations. Inpatients are more medicated than outpatients. The reason is probably in relation with the severity of the symptoms. Medication did not differ from the majority of best practices. But with a lack of strong evidence about its effect, it seems appropriate to move towards its reduction. Supported by the project IGA MZ CR NT 11047-4/2010

To examine the prevalence of violent behavior, victimisation and its consequences among people receiving in-patient treatment for schizophrenia and control group.

Data on violent behavior and victimization, sexual and physical abuse in childhood, posttraumatic stress disorder (PTSD), and substance abuse were obtained from adult in-patients with psychotic disorders and from their collaterals. A total of 167 patients (57.5% men and 42.5% women) participated. Control group was recruited from Department of Stomatology (n = 211).

Violent behaviour during preceding 6 months was higher in men (34%) and women (34%) patients compared to controls (13%, resp. 15%) (p < 0,01). Victimisation was higher in women patients (39%) compared to controls (26%) (p < 0,05). There were not significant difference in male patients (30%) and controls (24%).

Any form of sexual abuse was more frequent in women patients (39%) compared to controls (20%) (p < 0,01).

Comorbidity of schizophrenia and PTSD was detected in 7% of men and 14% of women. There were not significant difference in male patients (0%) and controls (24%). While PTSD was more frequently (p < 0,05) detected in women (11%) then in men control (3%), the difference was not significant in patients (7% of men, 14% of women).

Patients with psychotic disorders are often victims of violent attacks. Gender does not differ in aggressive behavior, but plays role in victimisation. Victimisation and its impacts (e.g PTSD) among patient with schizophrenia are underreported and consequently not properly treated.

Choosing appropriate medication when faced with intolerance or treatment non-efficacy can be challenging. Evidenced reasons for non-efficacy include medicinal interactions. Interactions between non prescribed products and psychotropics may be overlooked with negative consequences for clinical effectiveness and/or patient safety.

This study was conducted to explore the awareness and current practice of doctors in Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) with regards to obtaining and documentation of information on service users’ use of nonprescription products.

TEWV “Policy for Medicines Reconciliation on Admission of Adults to Hospital” states that lists of medicines prescribed by GP including those bought over the counter should be one of the minimum information available on admission. The availability of this information should ensure continuity of care and identification of adverse interactions. An electronic survey, using semi quantitative questionnaire, of doctors of all grades within the trust was used.

69 responses were received. There was a high level (94.2%) of awareness of potential interactions and a corresponding high standard (94.2%) of practice in enquiring about use in medication history. Only 78.3% would document this and where indicated, only 50.7% would investigate further. There were 25 comments received under the themes of health concerns (4), choice and autonomy (5), responsibility (2), practice issues (10), survey design (1), training Issues (3).

There was a high level of awareness among respondents but deficiency in documentation and further exploration indicating missed opportunities for health promotion.

Valproic acid (VA) is an effective mood stabilizer. Although it's usually well tolerated, it may cause hyperammonemia through carnitine deficiency created by its inhibition of mitochondrial enzymes in the urea cycle. Clinical presentation of hyperammonemia usually involves lethargy and somnolence but this diagnosis is often overlooked due to a clinical presentation that may include normal liver enzyme tests and serum VA levels within therapeutic range.

To present case-reports of VA-induced encephalopathy and a review study regarding the theme available in Medline.

Brief literature review.

Three case-reports are presented and literature of this theme shortly reviewed.

The authors present cases of three adult females with Personality Disorder with lack of impulse control and Bipolar Disorder who have began treatment with VA and presented in the Emergency Department with generalized weakness and confusion. Subsequently, they developed hyperammonemia, despite its therapeutic serum levels and normal liver enzymes. În all cases the patient's mental status and ammonia level returned to baseline following discontinuation of VA.

Confusion with VA is a serious, rather frequent but reversible side affect. It has been reported that VA can interfere with the enzyme carbamoylphosphate synthetase, which is responsible for incorporating ammonia into the urea cycle. It can also increase the transport of glutamine across the mitochondrial membrane in the kidney, thereby increasing the production of ammonia causing neurotoxicity. Clinicians should be aware of changes in patient's cognitive and functional capacity, especially in elderly patients and during the first two weeks of treatment.

In many European countries, doctors and patients are required to inform their respective driving authorities of their condition and treatment. However, in the UK, there is no means to monitor performance and check if such advice is given during the treatment.

The purpose of the survey was to evaluate the awareness and adherence to the DVLA (UK) guidelines about psychiatric diagnoses and the impact of psychotropic medications on skills such as driving.

A questionnaire on clinical practice and advice given to patients about driving to mental health diagnoses and medication was sent out to psychiatrists working in the local hospital. The responses were collated and analysed for trends.

Out of 42 doctors, 36 responded and 34 responses were eligible. The survey revealed that though all the doctors were aware of the guidelines only 38% discussed this with their patients. 50% of the doctors did not refer to guidelines and admitted of giving superficial advice to their patients. 50% of the doctors did not discuss the effect of medication on their motor abilities, concentration and sedation.

About 60% of the times the advice was only verbal and not documented.

Psychiatrists have a duty of care to inform the patients and document the advice on driving when they newly diagnose and start treatment. The survey suggests that the current practice needs further improvement. Psychiatrists should be aware of guidelines and realise the need to check the patients’ driving status and document the advice given.

To assess the knowledge produced in Brazilian literature on the social representations of madness on the part of health professionals in primary care.

Integrative review. The question that guided this study was: what are the health professionals’ social representations about madness in primary care?

Six articles were selected; the articles were written by nurses, psychologists and psychiatrists and published in refereed journals. All articles were qualitative and published between 2005 and 2012.

Professionals are centered in an organicist model, on the doctor, on medicalization, and have ambiguous and often unscientific concepts about mental illness. Some believe there is no cure or improvement for mental illness, relate aggression and violence to mental illness, and admit to having little knowledge about mental health and feel unprepared to work with these individuals. Social reintegration practices were not identified.

Hyponatraemia is an important medical condition, relevant to all practitioners working in old age psychiatry. This has important clinical implications to ensure patients commenced on antidepressant medication are monitored for electrolyte imbalance.

To identify the incidence and key features of cases of hyponatraemia in consecutive referrals to a rural community Psychiatry of Old Age service (population 18,000 over 65)

Naturalistic study design, routine referrals to the service were reviewed between 1/4/10 to 30/9/2011 and considered for inclusion. All hyponatraemia cases were identified and recorded at the MDT meeting. Clinical case notes and/or correspondence reviewed, data collected on demographics, psychiatric, medical diagnoses, psychotropic and general medication.

796 referrals reviewed, 22 cases of hyponatraemia identified, (2.8%), 15 case notes available for review, 4 review letters (include key information required), 3 casenotes were missing and 2 did not meet inclusion criteria as outside the period of study. Of the 17 included (12 female, 5 male), mean age was 82.1, all widowed/ single, 94% diagnosis of depression, 5 dual diagnoses, Mean MMSE 26/30. 100% on psychotropic medication, (87% antidepressants, 58% SSRI's). Mean medication number was 9. 6/17 (35%) cases of hyponatraemia were judged to be directly related to SSRI medication.

Hyponatraemia is an important clinical outcome that should be looked for in vulnerable populations with complex medical and psychiatric morbidity. Although many potential causes for hyponatraemia, SSRI antidepressants should be monitored with regular electrolytes in at risk patients (older age, polypharmacy, medical co-morbidity).

A review of published studies shows that depressive disorders are correlated with specific defense patterns which may underlie particular personality trials. High comorbidity among depressive and personality conditions is a consistent but not well-understood finding.

We assessed the relations between defense mechanisms and MMPI-2 profiles used by depressive patients.

The aim of the present study was to investigate how depressive disorders are related to the use of specific defenses and how it is corelated with particular MMPI-2 scales.

Authors examinated a sample of 50 adult outpatients aged 21 to 55 diagnosed with depressive disorders according to DSM-IV. The Bond Defense Style Questionnaire (DSQ) was used to assess defense styles. Patients were also examined with MMPI-2.

Depressive disorder patients scored higher for the immature defense styles. Increased scores in psychopatological scales in MMPI-2 were positively related to the immature, neurotic and particular narcistic, and negatively to the mature defense mechanisms.

These findings suggest that interpretation of defense styles and particular MMPI-2 scales is useful for the psychological and personological diagnosis to direct psychological assistance. These findings could lead to the development of specific psychotherapeutic interventions.

We aimed to study HMGB1, pro- and antioxidant status alongside with T cells phenotype and Th1 and Th17 proinflammatory cytokine profiles in depressed patient. We also investigated the glucocorticoid response.

Blood was collected from patients diagnosed with recurrent depressive disorder (rDD) (N = 15) and from healthy controls (N = 19). We measuredplasma hydrogen peroxide (H2O2) and reduced glutathione (GSH), malondialdehyde (MDA) levels as well as SOD1, GPx, GR activities in red blood cells. HO1 and NOX4 levels in plasma were also assayed. IL-2, IL-6, IL-8, IFN-g, TNF-a, IL-17, HMGB1, neopterin and cortisol were analyzed in sera. Further, we examined surface phenotype expression of T regulatory and T effector cells with flow cytometer. The glucocorticoid response was measured by dexamethasone-induced inhibition of IL-6 produced by LPS-stimulated peripheral blood.

We observed pro- and antioxidant imbalance in depressed patients expressed by significant changes in the enzyme activities, increased MDA, decreased GSH, increased H2O2. Shifted Th1/Th17 cytokine ratios, increased Treg/Teffector cells ratio and increased levels of neopterin were also detected. Moreover, we revealed a distinct role of HMGB1 in maintaining cytokine and Treg/Teffector cells balance in depressed patients. HMGB1 remained also in relation with oxidant potential of the blood. The important role of IL-17 and inhibitory effect of MDA on glucocorticoids response was also revealed.

Strong immunomodulatory role of HMGB1 might be related to the change of its activity caused by redox imbalance in depressed patients. The shifted immune balance alongside with prooxidative environment modulates glucocorticoid response in these patients.

Paraphrenia was one of the last great inventions of classical psychiatry. Both the French school as the German school, have strongly discussed and tracked this clinical entity which is an intermediate form between paranoia and schizophrenia. First originally by Kahlbaum and then described by Kraepelin, the term will fall into oblivion after the appearance of the manual diagnosis DSM III, which will be listed under concepts so various as schizophrenia or delusional disorder chronic.

Presenting a case report of paraphrenia, we discuss around its nosography classification, its clinical presentation, its evolutionary process and possible differential diagnoses.

We ask ourselves whether current standardized textbooks, it is still possible to observe this rich clinical entity.

To describe the epidemiology and clinical care of the emergency department by use of licit and illicit drugs in 2001 and 2011. Compare if there was a change in profile over the past 10 years.

Epidemiological descriptive study. We analyzed 1982 medical records in 2001 and 2465 in 2011. The study was approved by the Ethics Committee.

Regarding sex, remained unchanged; the male is responsible for most of the medical care. Regarding age, there was no change over the last ten years, being individuals between 20-39 years old the highest rate of attendance. As the etiologic profile, there has been a change over the last 10 years. In 2001 the diagnosis of ICD-10-F10 (Mental and behavioral disorders due to use of alcohol) was predominant. In 2011 the ICD-10 and ICD-10-F19 (mental disorder and behavior due to multiple drug use and use of other psychoactive substances). As for the number of attendances, in 2001 there was a large concentration in the first quarter, while in 2011 it was better distributed throughout the year. There was an increase in the number of visits in 2011 compared to 2001.

We believe educational and preventive actions are necessary to minimize the increase in drug use. It is also necessary to have measures to reduce damage.

Childhood-onset schizophrenia (COS) is a rare but severe psychiatric disorder with important individual, family and societal consequences. Its prevalence is approximately 2 per 10.000 in the general population and the incidence of COS increases with age.

The main objective of our study was to evaluate the prevalence of COS in French medical-social institutions or psychiatric day hospitals for children and adolescents in the PACA region. The secondary objectives were:

1. (1) to estimate the prevalence of children with both COS and autism diagnosis,

2. (2) to characterize clinical and neurocognitive presentation of COS using the evaluation of intensity of positive and negative symptoms (PANSS, SANS), of thought disorganization (TLC), of cognitive functioning, and of attention and executive functions (verbal fluency, TMT A, TMT B).

Subjects were patients from medical-social and psychiatric care centers for children and adolescents in three PACA sub-regions in the south-east of France. The study included French speaking girls and boys between 7 and 18 years old, registered in a partner structure of the study, and presenting an IQ > 35 (WISC-IV). The study design was constituted by two phases: the first one was the categorical diagnostic phase using the psychosis section of the Kiddie-SADS Present and Lifetime Version. The second phase consisted of the dimensional COS diagnosis and neurocognitive exploration for the subjects fulfilling the DSM-IV diagnostic criteria for schizophrenia.

The diagnosis of COS was not exceptional in this population. Most subjects diagnosed with COS also presented autism diagnosis and mental retardation.

Knowledge on the brain mechanisms of psychopathology is extremely important for successful treatment of patients. Depression is a group of disorders with varied origins and complex and yet unclear neurobiology.

Depressed patients show attentional bias to emotional (especially negative) stimuli. Automatic (implicit) emotional processing in such patients may differ compared to non-depressed controls.

We aimed at studying the EEG-correlates of implicit learning with emotional stimuli in patients with depression.

128-channel EEG was recorded in healthy volunteers (12 female and 7 male) and depressed patients (12 female and 7 male), while they performed categorization of pictures as human or animal photographs. Half of the photographs were neutral and half were showing aggressive people or animals. The pictures were preceded by the cue (simple abstract pattern, one for each picture category), which meaning was not explained to the participants. We analyzed visual response to the cue and the CNV recorded during the picture anticipation period (duration was 2s).

All participants reported that they did not notice cue-picture association. Unlike the healthy controls, our patients showed strong CNV differences in the right anterior area: larger negativity for the emotional face condition versus the neutral faces.

Although our participants were contingency unaware, the cue-picture association was established in our patient group: certain simple neutral pattern was associated with neutral or emotional (aversive) faces, eliciting different CNV during real face anticipation. This may underlie the impairment in depressed patients leading to their fixation on negative emotions.

The concept of person is connected to personality and self-transcendence belongs to its structure, as core component. The assessment of self-transcendence as part of human personality opens the gate of self-awareness in personology. Robert Cloninger is a distinctive researcher because he states that the comprehensive assessment of the human being includes the moral-spiritual dimension which implies deep self-awareness, in the absence of which subjective well-being is not possible.

Thus, in Cloninger's view self-transcendence is a character dimension. Self-transcendent individuals are often described as un-demanding, fulfilled, enduring, creative, altruistic, spiritualized. High self-transcendence has adaptive advantages when the individuals deals with suffering and death, which are inevitable once the person grows older.

131 patients with personality disorder aged 19 to 62 were included in the study. Temperament and Character Inventory; Multicultural Quality of Life Index (J. Mezzich et all, 2000).

The assessment of the relationship between the scores in personality dimensions and the quality of life.

Significant correlations were ascertained between the character dimension Self-transcendence and the Multicultural Quality of Life Index. Thus, according to this correlation analysis, (r2 = 0,035) of the variation of the score on the Multicultural Quality of Life Index is given by variations of the Self-Transcendence score.

The assessment of the self-transcendence dimension as part of human personality opens the doors of knowledge in personology.

Human personality directly influences scores in quality of life scales through character dimensions.