The authors would like to report on the case of an individual who developed psychosis, following pulse therapy of Itraconazole. We discuss his clinical presentation, history and similar reports in literature on Itraconazole.

Case-report, Literature review, Discussion.

Mr.X was a 36 year old male who developed an acute psychotic episode after starting his second course of pulse treatment of Itraconazole. Subsequently he had three inpatient admissions for his psychosis, in which he was treated informally

1. - initially with Olanzapine and Quetiapine, and following the third admission with Clozapine.

In the back ground of a negative history of any previous psychotic episode, no family history of psychosis or any mental illness, no concordant illicit substance abuse, and the emergence of clear cut psychotic symptoms at the age of 36 following treatment with a course of oral Itraconazole, our opinion is that Itraconazole has possibly contributed to the development of psychosis in a potentially vulnerable individual. Our literature review revealed only very few case reports of Itraconazole associated psychotic disorder.

This case highlights, although rare, the potential risk of idiosyncratic reactions and psychiatric manifestations associated with the antifungal agent Itraconazole. We recommend increased awareness amongst clinicians about the potential idiosyncratic reaction and risk of psychosis associated with Itraconazole and also the importance in highlighting such cases for the awareness of the public as well as clinicians.

Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. Thousands of research participants were administered hallucinogens in the context of basic clinical research or therapeutic clinical research, resulting in hundreds of publications. Results across studies were ultimately inconclusive due to such variations in methods and a lack of modern controls and experimental rigour. The growing controversy and sensationalism resulted in increasing restrictions on access to hallucinogens throughout the 1960s (ultimately resulting in the placement of the most popular hallucinogens into Schedule I of the 1970 Controlled Substances Act in the United States).

Renewed human administration research began in the 1990s. Recent clinical studies have administered hallucinogens to evaluate their safety and efficacy in the treatment of psychiatric disorders: specifically, anxiety related to advanced-stage cancer (Grob, 2005), obsessive-compulsive disorder (Moreno, et al., 2006), heroin dependence (Krupitsky, et al., 2007), personal meaning and spiritual significance (Griffiths, et al., 2008), and a meta-analysis of randomized controlled trials of LSD for alcoholism (Krebs,et al., 2012).

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic drugs to enhance the normal mechanisms of psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline. This phenomenon was termed a “psychedelic afterglow”.

Fhurther research, blinded, randomized, placebo-controlled, methodology should explore the efficacy of hallucinogens.

There was a high degree of comorbid NSSI in our sample of suicide attempters (44%). Suicide attempters with both behaviours reported more interpersonal violence as adults (Z=3.0, p=0.003) and more severe suicidal behaviour compared to suicide attempters without NSSI. Comorbid NSSI in suicide attempters seems to be related to severity of suicidal behaviour differently in male and female suicide attempters. Comorbid NSSI in suicide attempters may increase suicide and violence risk, and methods for assessment of both violence and NSSI are important for targeting and intervention.

Previous studies have shown that not only mental health patients but also mental health professionals are stigmatized. Thus stigma toward psychiatry and psychiatrists may be implicated in the diminishing recruitment rates within the discipline of psychiatry.

To measure the level of stigmatization towards psychiatry and psychiatrists among medical academics.

We randomly selected 90 medical academics (other than psychiatrists), by consulting the list of all the employees of this institution. We employed the “Perceptions of Psychiatry survey” developed by the World Psychiatric Association which contains 37 items that refer to psychiatry as a discipline, psychiatrists, and psychiatric patients.

More than 50% of the respondents had at least one item coded as a negative attitude towards psychiatry. The most frequent negative attitudes were:

1. i) psychiatry is not a scientific discipline,

2. ii) psychiatrists are not paying attention to physiology and they can help patients only in a small degree,

3. iii) psychiatry has a low prestige among medical students. Furthermore, few medical academic (other than psychiatrists) would encourage students to choose psychiatry as a career path.

The level of stigmatization toward psychiatry and psychiatrists could be considered high. This study could contribute to the delineation of future interventions aimed to reduce stigma.

Depression in people aged 65 and more appears to be a major public health problem. Efficient mechanisms of inhibition are important to communicate with other people and to interact with the environment but seem to be deficient in young depressed patients. This function needs to be evaluated in late life depression which has specific features.

Twenty inpatients (mean age = 70.4) meeting DSM-IV criteria for major depressive disorder were compared to forty seven healthy controls. They performed a neuropsychological and psychiatric assessments and two eye movement tasks: a prosaccades task to obtain basic parameters of eye movements and an antisaccade task to evaluate the inhibition capacities.

In comparison with healthy subjects, depressed patients showed impaired performances in both oculomotor tasks. Concerning the prosaccade trial, depressed patients had higher reaction times and error rates than healthy controls. In both populations, hypometric saccades are the main kind of error. In the antisaccade task, reaction times and error rates were also higher in depressed patients than healthy subjects. However, the two populations showed similar correction rates.

The results of this study offer new insight on the inhibition impairment of aged major depressive patients by two simple eye movement tasks. The findings indicate psychomotor retardation and inhibition impairment, consistent with the findings obtained in young depressed subjects.

The cerebrovascular disorders, traumatic brain injury and epilepsy lead to the development of dementia, which requires a psychometric verification of cognitive disorders.

In patients with dementia due to vascular brain diseases, traumatic brain injury and epilepsy was analyzed psychometric indicators of cognitive impairment.

Was studied the severity psychometric characteristics of cognitions in patients with dementia due to vascular diseases of the brain, brain injury and epilepsy.

5 groups patients with dementia: F01.00 - 14 patients (mean age 55 years), F01.1 + F01.3 - 14 patients (mean age 60 years), F01.8 - 14 patients (mean age 65 years), F02.802 - 21 patients (mean age 50 years), F02.803 - 15 patients (mean age 38.5 years).

The psychometric methods: MMSE, FAB, Schulte, the clock drawing test, nonparametric statistical methods.

Table of results:

Severity of cognitive impairment is increasing in the following order:

1. 1) dementia due to epilepsy;

2. 2) dementia due to brain injury;

3. 3) acute post-stroke dementia;

4. 4) atherosclerotic, vascular dementia unspecified;

5. 5) multi-stroke, mixed cortical and subcortical vascular dementia.

Disorders of frontal functions dominate in the structure of cognitive impairment in all dementias.

Our aim was to examine the role of Group Cognitive Behavioral Therapy (G-CBT) in increasing compliance to pharmacological treatment, and in preventing relapse in BPD type I (BPD-I) patients participating in group CBT at ‘Aghios Charalambos’ Mental Health Centre.

Forty patients [20 female and 20 male, age range 30–55 years, mean age 45 years] diagnosed with BPD-I attended a 60 min G-CBT session twice a week for 16 weeks. All patients were normothymic and stable on medication before entering G-CBT. The Beck Depression Inventory (BDI) and the Young Mania Rating Scale (YMRS) were used to monitor mood symptoms at 3 time-points (baseline, on completion of the 16 weeks’ period and at the one year follow-up visit). Objective and subjective functioning was rated using the Global Assessment of Functioning (GAF) scale and psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) at the same time points. Treatment provided was based on CBT principles and was conducted by two CBT-trained psychologists.

Separate one-way ANOVA's with time interval (3 levels; baseline, 16 weeks, 1 year) as the between-subjects factor, for each scale were conducted. Both the GAF scale's and mood scale's scores increased significantly in the post-treatment stage at 16 weeks and at the 1 year follow-up visit.

The combination of G-CBT and pharmacological treatment proved to be effective in significantly improving adherence to treatment in patients undergoing bipolar affective disorder rehabilitation both following 16 weeks of G-CBT and at the 1 year follow-up visit.

Postpartum psychosis occurs in 1 of 500 mothers, with rapid onset in the first 2-4 weeks after delivery. It is considered a psychiatric emergency and usually results in inpatient psychiatric hospitalization. Infanticide is one of the most serious risks of postpartum psychosis.

The purpose of this article is to report a clinical case of Postpartum Psychosis.

Case study and review of the literature.

A 38 year old woman developed a clinical picture characterized by agitation, irritability, mood swings, hyperactivity, disorganized behavior and insomnia, within the first week after delivery. She had no history of mental illness and no family history of mood disorder. The patient was hospitalized to study this first episode of Psychosis occurring after the childbirth of her second son.

Postpartum psychosis impacts 0.2% of women of childbearing. The recurrence rate is about one in four pregnancies. Postpartum psychosis is considered a psychiatric emergency due to the potential for catastrophic suicide and/or suicide. Treatment with haloperidol should be used with caution, because dangerous side-effects including neuroleptic malignant syndrome have been reported. The newer neuroleptic drugs, seem to be safer. Women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of relapse postpartum. Some authors recommend initiating prophylactic treatment immediately postpartum in women with a history of psychosis limited to the postpartum period.

First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals.

The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder.

One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records.

The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007).

Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals.

Many studies suggest that post-traumatic stress disorder (PTSD) in some children after severe stress may become a chronic mental illness. According to Peters J.J. (2006), PTSD is associated with the acceleration of age-related memory decline. At the same time, this disorder is characterized by dissociative reliving of the trauma. Guez J. (2011) proved that traumatic stress is linked to a deficit in associative episodic memory. Although PTSD is associated with chronic pain, while there is evidence for reduced pain sensitivity in this disorder.

The aim of our study was to compare the level of cognitive impairment, as well as the intensity and frequency of disturbing physical symptoms (pain), and the incidence of cerebrovascular diseases (arterial hypertension, myocardial infarction, stroke) in two groups of patients: the first one - former war participants, and the second one - former young prisoners of Nazi concentration camps.

All patients have suffered severe stress associated with war in the past. We had evaluated the patients’ complaints, and studied their medical history, emotional state, cognitive functions and coping strategies.

Our patients from second group more often had high blood pressure somatic complaints proved to be significantly more frequent in this group, demonstrating reduced tolerance to pain in former prisoners. They also had the tendency to depressive reactions and poor performance on cognitive tests.

However, in patients with PTSD verbal memory was better than without PTSD in both groups.

Somatization is a common symptom of depression. Somatization is also related to sleep problem including insomnia.Depression is the one of the most common cuase of insomnia. Therefore, it would be needed to investigate the interaction between depression, insomnia and somatization.

To investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization.

To compare somatization of primary insomnia, MDD with insomnia, MDD without insomnia, and normal controls.

A total of 181 participants without serious medical problem were recruited. Subjects were divided into 4 groups based on the SCID-IV and ICD-10 insomnia criteria:

1. 1) normal controls,

2. 2) primary insomnia,

3. 3) MDD without insomnia, and

4. 4) MDD with insomnia.

The somatization subscores of the SCL-90-R were completed by participants.

There were significant between-group differences in somatization (F=25.30, p< 0.001). MDD with insomnia showed higher somatization compared to normal controls (p< 0.001), primary insomnia (p=0.01), or MDD without insomnia (p< 0.001). Primary insomnia had higher somatization than normal controls (p< 0.01), while there was no significant difference between MDD without insomnia and normal controls. Presence of insomnia predicted higher somatization (beta=0.44, p< 0.001), while there was only non-significant association between MDD and somatization (beta=0.14, p=0.08).

In the current study, insomnia was associated with somatization independently from major depression. Subjects with primary insomnia showed higher somatization. Within MDD patients, presence of insomnia was related to higher somatization. Our finding suggests that insomnia may partly mediate the relationship between depression and somatization.

Lower Limb Edema (LLE) is a common finding among admitted psychiatric patients in general and is associated with agitated state. Possible explanations include general medical condition and treatment adverse effects.

To determine association between LLE and the type of psychiatric exacerbations among hospitalized patients.

A retrospective study was conducted using medical data from 2529 patients admitted to Geha mental Health Center between 2002 and 2012. Incident cases of LLE and the type of psychiatric exacerbation were included. A logistic regression models were used to estimate the odds ratio (OR) for LLE among patients admitted to psychiatric hospital for manic episode, psychotic episode or depressive episode.

Lower limb edema was diagnosed in 95 of 2529 admitted patients (3.8%). Edema was found in 38 of 366 cases of manic episode (10.4%), 41 of 1563 cases of psychotic episode (2.6%) and 16 of 600 cases of depressive episode (2.7%).OR of LLE was 4.3 (95% CI, 2.7-6.7) for manic episode vs. psychotic episode and 4.2 (95% CI, 2.3-7.6) for manic episode vs. depressive episode. Applying a multivariate model adjusted for age, sex, number of past admissions, length of hospitalization, substance abuse, cardiovascular and endocrine co-morbidities, pulse, Positive and Negative Syndrome Scale (PANSS) score and blood test results did not substantially altered the risk for LLE associated with manic episode vs. psychotic episode(OR, 4.1 [95% CI, 1.6-9.9]).

Admission to psychiatric hospital for manic episode was associated with significantly increased risk for LLE.

Studies conducted with American and Australian samples of pre-adolescents and adolescent girls support the tenets of Stice and colleagues’ dual-pathway (DP) model. The DP model is a cohesive framework for understanding how sociocultural pressures are translated into behavioural and negative affect risk factors potentially promoting binge eating. Males are likely to exhibit sub-threshold binge eating disorder and are roughly equal to females in regard to the number of cases of any binge eating. To date, only preliminary support has been provided for the validity of the DP model's core predictions with adolescent males.

The current prospective study examined the suitability of the DM model in other western cultures (such as an Italian one) where adolescent boys are characterised by high levels of eating and body-related disturbances in response to sociocultural pressure.

221 Italian adolescent boys (Mage = 14.9) were examined at Baseline and after 1-year through semi-structured clinical interviews and self-reported measures. Data were analysed via a latent variable longitudinal structural equation modeling approach.

Perceived pressure and internalization of societal ideals regarding male body shape led to body dissatisfaction, which in turn led to dietary restriction. Both body dissatisfaction and dietary restriction predicted negative affect, which in turn predicted binge eating. However, data did not support the relationship between body mass index and body dissatisfaction or between dietary restriction and binge eating.

The prospective validity of the DP model was partially supported in adolescent boys: body dissatisfaction predicted binge eating only via negative affect.

Physical appearance is a major component of human sexuality. Body image is associated with females' sexual functioning; and poor body image is strongly related to sexual functioning problems (SFP). SFP are becoming more pervasive throughout Western culture. Objectification Theory (OT) provides a framework for understanding how sociocultural pressure is translated into psychological risk factors that promote body concerns and SFP. Previous research indicated that the core constructs of OT (body monitoring, body shame and appearance anxiety) predicted higher self-consciousness, which according to a recent review of 57 empirical studies, interferes with sexual responses and experiences during sexual activity.

The central purpose of the current study was to build upon the extant literature by incorporating internalization of the norms for body shape and weight portrayed by the media and self-consciousness during sexual activity into the OT model. Thus, we aimed to examine a more comprehensive model of women's SFP (i.e., lacking interest in sex, inability to achieve orgasm, trouble achieving or maintaining an adequate lubrication) grounded in OT.

Data were analysed from 391 sexually active Italian college women (Mage = 20.9) using latent variable structural equation modeling approach. Results. Internalization of media ideals led to body surveillance, which was related to body shame and appearance anxiety. The latter were related to self-consciousness during sexual activity, which in turn strongly women's SFP.

The study points to the role of body-image attitudes in sexual functioning and suggests that OT provides a useful framework to identify predictors of women's SFP.

Prevalence of autistic disorder (AD) has increased dramatically in the last three decades. The comorbidity of the disorder with attention deficit hyperactivity disorder (ADHD) is well established, but current diagnostic criteria do not allow a dual diagnosis. In Greece, neither the prevalence of autism nor its comorbidity has been adequately examined.

The aim of the present study was to explore the prevalence of AD in schoolchildren in Crete and to assess its comorbidity with ADHD.

The initial sample was consisted of 7,661 children randomly selected. The study was conducted in two stages. Screening was based on school records. Only children with diagnosis of autism from the formal child psychiatric diagnostic centers were included in the sample. For each autistic child, the Teachers Report Form and the ADHD-IV scale were applied.

Out of 7,661 children, 25 (0.3%) had AD. The estimated prevalence was 0.5% for boys and 0.1% for girls (p< 0.0001). Ten children (40%) fulfilled DSM-IV diagnostic criteria for ADHD. Age and gender were found to be associated significantly with the presence of ADHD. The most prevalent co-occurrent subtype of ADHD was the combined. There was not significant evidence of an association between academic impairment of autistic children and the presence of ADHD.

The prevalence of AD in schoolchildren in Crete, the risk factors and its comorbidity with ADHD were comparable to those reported in other countries worldwide. Younger age and male gender seems to be associated with the presence of ADHD in autistic children.

The original cognitive-behavioural model of bulimia nervosa (CBT-BN) proposes that specific dysfunctional cognitions and behavioural factors maintain BN, and has provided the basis for the widely used cognitive-behavioural therapy (CBT) of BN. However, Fairburn et al. (2003) noted that among treatment completers with BN, only 40% achieved full remission of the bulimic symptomatology. The enhanced CBT-BN model (CBT-E) proposed by the authors describes how four additional factors (i.e., clinical perfectionism, low self esteem, mood intolerance and interpersonal difficulties) interact with the core psychopathology of BN (i.e., over-evaluation of eating, weight, and shape and their control) to maintain the disorder.

The goal of this study was to examine (a) the validity of the CBT-E model and (b) whether each of the four hypothesized maintenance factors intensifies the core psychopathology-bulimic symptomatology relationship in a clinical sample.

Data were analysed from 362 adults seeking treatment for BN (n = 167) or atypical BN (n =195) at four Italian specialized care centres, using latent variable structural equation modeling approach.

Both the measurement and the structural model were good fits for the data. All four hypothesized factors exacerbated the core psychopathology-bulimic symptomatology relationship. Core psychopathology explained approximately 47.7% of the variance of bulimic symptomatology. The inclusion of the direct effects and interaction terms increased the explained variance of bulimic symptomatology to 64%.

Overall, results supported the validity of the CBT-E model and highlighted the importance of assessment and treatment of the four maintenance processes included in the CBT-E model.