Violent behavior of patients is a common problem in emergency psychiatry and evaluation, diagnosis, management and treatment of which is very difficult.The absence of a test that could be used to predict violent behavior hampers proper decision in the case of emergency admissions, as well as discharge from the hospital. The application of such a test would upgrade assessment offering solve this problem.

To identify risk and protective factors of violent behaviors : to establish the degree to which the HCR-20 predicts the frequency and severity of violent behavior; to examine the predictive validity of the scales of the HCR-20.

Improve assessment, management and treatment of patients with violent behaviors in the psychiatric ward.

Prospective cohort study, during 24 weeks. Psychiatric evaluation based on structural clinical interviews and questionnaires related to violent behaviors and risk factors were conducted to patients admitted in psychiatric hospital on UHC “Mother Tereza” Tirana.

According to our data, the relationship between violence and mental illness vary considerably across different diagnoses.

The highest rate of violence is reported in subjects with substance abuse disorder and antisocial personality disorder followed by Bipolar disorder and psychotic patients.

Among the risk factors verified so far, the past violence behaviors reported show the highest predictive value.

HCR-20 tool has currently shown good results to roughly estimate probability of future violence and taking appropriate measures in order to prevent unwanted consequences.

Dandy-Walker syndrome is a congenital brain malformation. The major presentations are mental disorder, cerebellar ataxia and symptoms related to hydrocephaly. It can be associated with psychiatric symptoms. Although, since this presentation is less prevalent, it has been insufficiently discussed

The subject is a 17 year old girl suffering from mental retardation. Her signs started 3 months ago when she was considered as having decreased need to sleep and walking during the night mostly. Her appetite increased as well. she was found to be getting more talkative than past; especially she talked to herself more.

She was admitted to hospital with the diagnosis of bipolar I disorder (the most recent episode: mania) in axis I and deep MR in axis II. In her brain MRI, enlargement of fourth ventricle and cisterna magna and atrophy cerebellar vermis were seen. EEG showed unspecific changes and there was no positive finding in her blood count, electrolytes,renal and liver function tests and blood sugar.

Despite two weeks of treatment with risperidone 3 mg/day and biperidine 4 mg/day and partial control of some symptoms, irritability and anger remained consistently. So, valproic acid (VPA) 400 mg/ day was added to treatment and after one month the patient was discharged from hospital with complete remission of newlypresented symptoms.

This report indicates the importance of taking psychiatric symptoms into consideration while evaluating organic brain disorders. With respect to treatment, the same treatment as primary mood disorders was indicated effective.

Propranolol prescribed by physicians in various fields. The extensive use of beta adrenergic antagonists are their various side effects such as nausea, vomiting, diarrhea, constipation, agitation and confusion, Sleep disorders, nightmares, depression and anxiety auditory hallucination. Also a case of induction of mania phase due to discontinuing propranolol has been reported.

A 11 year old boy was admitted with the diagnosis of Bipolar I disorder. Patient was started on 200 milligrams of Sodium Valproate twice daily and 1 miligram of Respridone twice daily. During the next 2-3 weeks his symptoms were gradually relieving and after 1 month patient left the psychiatric ward symptom free. At the one-month follow-up patient was still without any symptoms but had developed mild tremor and 10 milligrams of Propranolol was prescribed.

A week later patient accompanied by euphoria, restlessness, insomnia and increased energy after discontinuing it the symptoms had waned. He toke propranolol again but in a lower dose of 10 milligrams. Interestingly after taking a single dose of 10 milligrams propranolol patient developed the same symptoms. The symptoms were relieved by discontinuing the medication. Low doses of potent benzodiazepines were used to control tremor, which was a successful strategy.

The patient with the diagnosis of BMD, who contrary to our expectations developed symptoms of manic episode after taking low doses of Propranolol.

We propose that clinicians take into consideration proper percussions before prescribing this drug to patients with mood disorders.

Major depressive disorder (MDD) is associated with abnormal functional connectivity (FC) of amygdala and decreased function of cortico-limibic circuit, which play important roles in the pathogenesis of MDD. However, little is known about the connectivity alterations in late-onset depression (LOD), and whether such disrupted function is correlated with cognitive impairment is unclear.

A total of twenty-three LOD patients and thirty-seven controls underwent neuropsychological tests and resting-state functional magnetic resonance imaging (RS-fMRI). Regional homogeneity (ReHo) and FC of bilateral amygdala seed were used to analyze blood oxygen level-dependent fMRI data between groups.

Compared to controls, LOD groups showed weaker functional activity in bilateral middle frontal gyrus and left medial orbitofrontal gyrus, moreover, the decreased ReHo was positively correlated with Trail making test-B score (TMTB, r= 0.462,P= 0.04). In aspects of FC, left amygdala has reduced FC with right fusiform gyrus, right superior temporal gyrus and right putamen, while right amygdala has reduced FC with left cerebellum. Further correlative analysis found that the decreased FC between amygdala and right putamen was positively correlated with Verbal fluency test-verb score (VFT-verb, r= 0.513,P= 0.021) and the decreased FC between amygdala and superior temporal gyrus was positively correlated with Auditory Verbal Memory Test-delayed recall score (AVLT-delayed recall, r= 0.446,P= 0.049).

Our finding of reduced activation of prefrontal gyrus as well as decreased connection of bilateral amygdala may be key factors of impaired cognitive function in LOD patients and these changes could be early indicator for cognitive deficits.

Prospective studies have supported the validity of Vochs and colleagues’ three-factor interactive etiologic model of bulimic symptomatology (BS) among female undergraduates.

Given the comparable rate of binge eating between young adult men and women, we sought to examine for the first time the validity and sensitivity of the interactive model of BS in men.

We examined whether the interaction between Perfectionism x Male Body Dissatisfaction x Low Self-Esteem predicted increases in BS over 1-year (Study 1) and over 6-weeks (Study 2). Two different samples of college men were used. Time-1 BS scores as well as Time-1 and Time-2 Body Mass Index, Depression and Social Desirability scores were controlled for.

Data from college men (Study 1: N = 308, Mage = 21.04; Study 2: N = 344; Mage = 20.87) were analysed using hierarchical multiple regression/correlation procedure on participants’ Time-2 BS scores.

Both studies revealed that an increase of BS in men was predicted by the Perfectionism x Male Body Dissatisfaction x Low Self-Esteem interaction. BS increased in men who initially had high levels of BS and perfectionism, low levels of selfesteem, and were dissatisfied with their body. However, men with initially low or average levels of BS did not have an increase in BS even if they were perfectionistic, body dissatisfied and had low self-esteem.

The results support the interactive model's ability to predict increases of BS; however, the support is in regard to the maintenance of BS, not the onset of BS.

Schizophrenia is a worldwide public health problem that exacts enormous personal and economic costs. Schizophrenic patients often have difficulties to care by themselves and need from family and community support, including invalidity benefits.

Determine clinical and neuropsychological factors which predict global functioning and incapacity in paranoid schizophrenia.

40 paranoid schizophrenic outpatients (DSM-IV TR) were evaluated. Global functioning and incapacity was assessed with the DAS (Disability Assessment Schedule). Sociodemographic and clinical data were collected using a questionnaire including: age, gender, years of education and premorbid IQ (National Adult Reading Test), illness onset and triggers, admissions, adherence (Compliance Rating Scale), pharmacological treatment and drug abuse. In addition, psychopathology was assessed with PANSS, depressive symptoms’ with the Beck Inventory, insight with SUMD and cognitive functioning with a wide neuropsychological battery of tests which assessed attention, executive functions, verbal and working memory and social cognition.

T-tests and chi-square analyses were used to explore binary or categorical variables and Pearson correlation coefficient for quantitative scales. A stepwise multiple regression analysis was used to predict DAS.

DAS was correlated to positive (χ2 = .415; p = .008) and negative symptoms’ (χ2 = .530; p = .000), insight (χ2 = .519; p = .000) and executive functioning (χ2 = -.335; p = .035).The multiple regression analysis revealed that insight and negative symptoms’ predicted disability (R2 = .417).

Psychological and psychosocial interventions that increase insight and improve negative symptoms’ should be included in a comprehensive treatment of schizophrenia to prevent disability. Future research on antipsychotics should be addressed to improve negative symptoms’.

Recent estimates suggest Bipolar disorder (BD) affects approximately 1% of the population, with diagnosis often made during late adolescence and early adulthood, and that it is lower in the elderly (up to 0.1%). The initial onset of BD generally presents with depressive episode, but an initial maniac episode is not uncommon, although it becomes less likely with increasing age. In spite of the fact that elderly is a growing population in developed countries there are only few studies on late-onset BD (LOBD). Its etiopathogenesis and heterogeneity are complex, sharing several commonalities with organic brain diseases, which is denoted on frequent neuroimaging white matter hyperintensities, and involves higher medical and neurological burden.

To provide a comprehensive review reporting prevalence, features, course and comorbidity on LOBD. Additionally to report one selected case, intending to better understand this patient's subgroup.

The literature was systematically reviewed by searching on PubMed and reference psychogeriatric textbooks. We have selected one case of an elderly woman with LOBD with inaugural acute mania episode associated with previous diagnosis of Parkinson disease.

Distinguishing older adults with BD by early or late age at onset have limited clinical usefulness, although LOBD patients are more likely to have an organic mental disorder superimposed and more extensive and severe cognitive impairments, as well as vulnerability to extrapyramidal symptoms.

This case-report and literature review suggests that LOBD as a distinct diagnostic entity by its different presentation and etiology, and consequently different treatment, needs further investigation.

An association between low levels of serum cholesterol and violent or suicidal behaviour has frequently been reported. However the role of serum cholesterol in the cycle of violence (Widom 1989) has not been studied. The aim of this study was to investigate association between exposure to violence during childhood and expressed violent behaviour in suicide attempters with low and high serum cholesterol levels.

A total of 81 suicide attempters were assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6–14 years of age) and during adult life (15 years or older). We used median split to dichotomise groups below and above median serum cholesterol.

In patients with serum cholesterol below median, the correlation between exposure to violence as a child and violent behaviour as an adult was significant (rho = 0.52, p = 0.0024), while in patients with serum cholesterol above median, the correlation between exposure to violence as a child and expressed violent behaviour as an adult was not significant (rho = 0.23, p = 0.23).Comorbid substance abuse predicted violent behaviour as an adult only in patients with serum cholesterol above median.

Cycle of violence hypothesis is modified by serum cholesterol.

This study was aimed at evaluating the effect of the new, centralised (regional) referral system on the local Primary Mental Health Care (PMHC) Service, two years after inception.

Prior to the Single Point of Entry (SPOE) system, which is also known as triage, referrals were sent directly to each Consultant Psychiatrist and Community Mental Health Team by General practitioners (GPs). Theoretically, the new referral system should streamline referrals using resources efficiently, make access to mental health easier and reduce the time patients wait to be seen after referral.

Via user-satisfaction questionnaires, we conducted an on-line survey of GPs and the PMHC team in the Newry and Mourne area over a period of three months, asking for their views on the SPOE system.

The response rate for GPs was 28.3% (17), and 68.4% (13) for PMHC team. 65% of GPs and 85% of the PMHC team felt the new referral system was moderately or very effective overall. Both groups agreed that the time patients wait to be seen after routine referrals should be shortened. Emerging themes from qualitative analysis include the need to improve communication, training of staff and access to patient records during triage.

The low GP response rate suggests that Mental Health services should obtain more effective ways of engaging GPs in service development. This study indicates that the single point of entry system is effective overall but needs improvement in terms of accessibility and adequate communication between GPs, PMHC team and triage staff.

Analysis of characteristics of adaptation based on authors’ many-level model of family functioning.

Identification of quality of life of mental health care users, FACES-3, scales of prognosis of compliance in psychiatry (Lutova N. B. et al., 2007) and MARS. We have examined 152 schizophrenic patients (ICD-10 F2.0) and 38 their relatives.

Quality of life of patients and relatives is affected; family are characterized by schizophrenic patients as a whole as balanced and middle-balanced in 82,35% of cases, as imbalanced - in 17,65%. Relatives of patients define families as balanced in 27,3%, as middle-balanced - in 54,5%, as imbalanced - in 18,2%. There are more middle-balanced families according to rating of probands and lesser balanced than relatives’ ratings. Imbalanced families are found almost with equal frequency. During the first hospitalization the insight of necessity of maintenance therapy, in opinion of patients, was found only in 27,6%; there was insight but they did not adhere recommendations of the doctor - 49,0%; there was not insight regarding meaning of doctor's prescription and they did not adhere doctor's recommendations - 23,4%. In the first year after the first hospitalization to psychiatric institution 55,0% persons have been re-hospitalized, out of them with non-compliance - 42,0%.

Traits of adaptive behavior of families in schizophrenia have been revealed.

Anorexia Nervosa (AN) is a serious psychiatric disorder associated with high mortality.

To examine mortality patterns in patients with anorexia nervosa and psychiatric comorbidity.

6009 women who received in-patient treatment for AN between 1973-2003 were followed up retrospectively using Swedish registers. SMR were calculated on the basis of 74 523 person-years for natural causes of death and 80 388 personyears for unnatural causes of death. SMR was calculated for the group as a whole but also for patients with comorbid inpatient-treated psychiatric disorders, defined by respective ICD-codes from the Swedish patient discharge register.

Nearly half of the patients (44.9%) received in-patient treatment for a psychiatric disorder other than AN during the follow-up time. The overall SMR for anorexia nervosa with psychiatric comorbidity was 6.5 (95% CI: 5.2–7.9) for natural causes and 17.6 (95% CI:14.3–21.4) for unnatural causes of death. Comorbid psychiatric disorders yielded very high SMR for unnatural causes of death. The highest SMR for natural causes was estimated for anorexia nervosa with comorbid alcohol use disorder (16.8; 95% CI: 11.7–23.3).

Anorexia nervosa is a disorder with high mortality for natural and unnatural causes of death, especially when psychiatric comorbidity is involved. To correctly diagnose psychiatric comorbidity, particularly alcohol use disorder, and initiate early treatment could be a way to decrease mortality.

Many children experience severe anxiety symptoms that lead to impairment in daily functioning (Albano, Chorpita, & Barlow, 2003). Anxiety disorders are among the most common psychiatric problems experienced by children and they appear to remain stable and problematic for many youngsters throughout childhood and adolescence. About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder; girls are affected more than boys. Various parenting styles have been associated with the development of a wide range of anxiety disorders.

This study will look at correlations between parenting styles and symptoms among children with symptoms of anxiety disorders, at the Child/Adolescent Clinic of Psychiatry at University Hospital Center “Mother Teresa”.

Families participating in this observational study completed different parent and child questionnaires during the first study session. The child questionnaires asked for information regarding the child's feelings and family interactions. Parent questionnaires asked for information about their own personal feelings as well as the child's feelings, symptoms, and behaviors. Age range was between 6 to 17 years, 58% of them was female. Exclusion criteria were mental retardation, current or past diagnosis of autistic spectrum disorders, current or past diagnosis of psychotic disorders.

There was a significant statistical correlation between overprotective parenting and number, intensity and severity of anxiety symptoms.

Results of this study may contribute to the future treatment of children with anxiety disorders.

The role of general hospital in dealing with patients following suicide attempt has been discussed considerably lately.

Of the present study is the epidemiological record of referrals characteristics following suicide attempt.

36 of 256 patients referred to the specialist liaison team of the Psychiatric Department, 16-62(M = 33.6 ± 14.5) years old.

Psychiatric interview and record of demographic characteristics of the sample was used. Statistics analysis was undertaken using SPSS.16.

13 men and 26 women. 36 were pathological cases with drug poisoning, 1 deliberate self-harm case with the use of sharp object, 1 fall and 1 deliberate self-harm with the use of gun. 15 diagnoses by ICD10 were recorded, with the majority of the patients suffering from adjustment disorder (47.8%), while 7, 9% had no psychopathology. 5 were admitted in the psychiatric ward, 8 needed psychiatric follow up, 5 psychological support, 2 were prescribed combination therapy, 4 pharmacotherapy, 2 were transferred to outpatient special unit, to 5 no treatment was recommended, and 6 refused admission. There was statistically significant difference (t = 3.756 p = .001), between average ages of individuals committing suicide attempt with psychopathology (M = 42.1 ± 13.5) and no psychopathology (M = 26.8 ± 11.5), but not between genders (t = -.355 p = .725). Gender is irrelevant to psychopathology existence (x2 = 9.506 p = .301) and treatment (X2 = 4.625 p = .201). Increased attempts were observed for both genders and psychopathology existence but not statistically significant (x2 = .056 p-.832) and (x2 = .165 p = .303) respectively.

The major percentage of adjustment disorders agrees with the common percentages of bibliography. The wide range of interventions reflects the psychosocial model.

To assess alcohol abuse severity of soldiers who suffer from Post-traumatic Stress Disorder (PTSD) during the Bosnia- Herzegovina 1992-1995 war.

A stratified sample was composed of 4 war veterans groups: (A- who asked for psychiatry help during the war, n = 51; B- who continued psychiatry treatment and after the war, n = 51; C- who did not ask for psychiatry help at all, n = 62; Dindustry workers who were not involved in war activities, n = 50). We used DSM IV trauma questionnaire; questionnaire for alcohol dependency self-assessment.

During the war, 45.4% participants in A, 40.0% in B, 32.8% in C and 14.0% in D group, drunk alcohol more often than before war, while 20.8% of participants in A, 25.5% in B, 27.9% in C and 54.1% in D group drunk alcohol less than before war. Ten months after the war, 58.0% of participants in A, 31.6% in B, 20.0% in C and 20,0% in D group drunk alcohol more than usual, while 18.0% of veterans in A, 36.8% in B, 38.3% in C group and 37,8% workers in D group drunk alcohol less than usual. Upon departure to execute of combat missions to front lines war veterans from A group and B group drunk alcohol beverages significantly more than usual (51.7% and 40,5% respectively).

War veterans who bear traumatic experiences with difficulties, with more severe symptoms of PTSD were significantly more consumed alcoholic beverages during the war and the execution of combat missions.

Schizophrenia is a chronic severe psychiatric disorder with multiple environmental and genetic determinants. Several reports indicate the possible role of immune system dysregulation in the pathogenesis of schizophrenia. An accumulating body of evidence indicates an association of schizophrenia and its psychopathology with altered cytokine production. The variation of the level of cytokines might be partly due to their functional gene polymorphism.

The study was carried out to investigate the association of schizophrenia with the following cytokine polymorphisms: IL-2 (-330T/G), IL-6 (-174G/C), IFN-gamma (+874 T/A), TGF-beta (+869 T/C and +915 G/C).

We included 130 patients diagnosed with schizophrenia and 184 controls in our study. The patients were evaluated for lifetime psychotic symptomatology using the Operational Criteria for Psychotic Illness (OPCRIT) checklist. The patients having history of traumatic brain injury, neurologic disorders, substance abuse or immune related diseases were excluded from the study by detailed medical examination.

The polymorphisms were in HWE both in the cases’ and controls’ groups. In single marker analysis, we did not find an association for the tested polymorphisms.

Our data do not support the role of IL-2, IL-6, IFN-gamma and TGF-beta gene polymorphisms in the predisposition to schizophrenia in the Polish population.

National association of experts dealing with psychiatry in our country named Psychiatric Association of Bosnia- Herzegovina (PABH) was formally started with its work on March 17th 2008, as the first national associations in the post-war Bosnia-Herzegovina (BH). Since 2009 has been actively promoted and profiling as one of the best organized professional associations in BH. Recognition on the international level and the active role of the PABH substantially achieved in 2010 in the World (WPA), and from 2011 in European (EPA) Psychiatric Association. The Third Congress of Psychiatrists of BH with international participation is the first in a series of future Congresses organized by PABH with the full support provided by EPA and WPA.

To show importance of the roles of EPA and WPA for the future PABH achievements.

A retrospective review of the significance of the PABH collaboration with major psychiatric association both nationally and internationally through the documentation and archives of the PABH development.

The PABH is included in major psychiatric events in the country (active participation in the organization, logistics and scientific programme) and had strong collaboration with EPA and WPA, particularly on the national Congress in Tuzla 2012.

The PABH is the leading BH psychiatric association, an active member of the most important international organizations, with a continuous increase of the number of members who recognize the importance, relevance and quality of the PABH and further progress in its development and tendencies to harmonize psychiatric practice in the country and internationally.

Augmentation treatment has been the subject of several studies in treatment-resistant obsessive compulsive disorder (OCD). We hypothesized that medications with a dual action on the melatoninergic and serotoninergic systems may be of use in treatment-resistant OCD.

In this open label study we investigated the efficacy and safety of agomelatine augmentation in treatmentresistant OCD.

Twelve patients, aged 18–50, fulfilling OCD criteria, with no response to a 16-week or longer treatment with a selective serotonine reuptake inhibitor (SSRI) at the indicated dose, were assigned to receive agomelatine augmentation. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and were screened for treatmentemergent side effects at baseline, week 8 and week 12 of treatment.

The overall Y-BOCS score fell during the duration of the study (all comparisons among baseline, 8th week and 16th week were statistically significant, p < 0.01). On the obsession Y-BOCS scale a drop was noted, which led to statistical significance at the 16th week of the study (p < 0.05). Regarding the compulsion Y-BOCS scale a drop was also noted, particularly from baseline to the 8th week of the study (p < 0.01). Dizziness (16.6%) and headache (8.4%) were the most often reported side effects of treatment.

Agomelatine could be efficacious and well tolerated as an augmenting agent in refractory to treatment OCD. Further controlled studies are warranted to explore the efficacy of agomelatine, as well as the potential role of circadian rhythm modulation both in the pathophysiology and treatment of OCD.

Since 3000 B.C. Man has been trying to classify mental disorders. However, there is still much to be done and the differential diagnosis of psychotic disorders remains one of the greatest challenges in modern psychiatry.

We aim to improve the differential diagnosis of psychotic disorders, namely by rethinking schizophrenia spectrum disorders as syndromes whose hallmark are not delusions or hallucinations.

We present the clinical report of a 57 year old woman admitted in our unit who was diagnosed with maniac type schizoaffective disorder. Her previous medical records documented different diagnosis, namely schizophrenia and bipolar disorder. Hence, we attempt to understand the evolution of classification systems, how clinical practice deals with these systems and how the future DSM-V and ICD-11 may correct existing flaws.

We demonstrate that the definition of psychotic symptom should be restricted to delusions and/or hallucinations, thus there is a need to rethink the core symptoms of schizophrenia spectrum disorders. Furthermore, the assessment of a patient should always take into account the longitudinal development of the disease, retrieving one of Kraeplin's concepts. We found conflicts between the existing classification systems and extraordinary shortcomings, such as a 50% chance of failure of DSMIV temporal diagnostic reliability.

Current clinical practice continues to give much emphasis to research on delusions and hallucinations - contradicting Bleuler's concepts - and neglecting other dimensions - cognitive dysfunction, disorganization and negative, affective and motor symptoms. The integration of these symptoms in stable diagnoses remains a challenge.