Psychiatrist write reports for a variety of judicial processes; employment law, family law, and personal injury. For a variety of reasons the commissioning agents may object to the report and seek to undermine its utility or validity. Attacks can take a range of forms from impugning an experts expertise, their competence, impartiality, the validity of the material used, the tests used, or via proxies such as another expert. After the event a refusal to pay for services provided is not unusual.

To familiarise psychiatrists with some of the common tactics used, illustrated by real case.

Analysis of papers submitted to Court and in the public domain

Results, by order of frequency:

• Allegations of substandard work, or even negligence are common, a feature being a lack of specifics in the assertions made in the pre-action protocols and witness statements.

• Threats to report the expert to a governing body, a feature being a lack of specific details.

• Threat of counter-claim for financial loss due to an unfavourable report.

• Refusal to pay for the report, up to including until court proceedings for debt recovery have been issued.

Outright attacks on the report are rarely successful, particularly where experts for each side meet to discuss the differences. However a refusal to pay fees is far more likely. Psychiatrists need to adopt a robust approach to Lawyers and learn which intimidatory techniques are probably hot air, and devoid of substance.

Raising a child with an autism spectrum disorder (ASD) is a daily stressful experience implying changes in family functioning [1]. Parents are more likely to experience psychological and educational difficulties and their vulnerability is clearly described [2, 3]. Most studies deal with parental difficulties (medical, psychological…) whereas those focusing on parental self-reported support needs, related to ASD are lacking.

The aim of this study was to investigate parents’ needs and their support expectations in order to investigate needs priority.

Two parents groups of children aged between 3 and 10 years are compared (ASD or control group). Mothers and fathers were interviewed about unmet needs using The Parental Needs Questionnaire, developed for this study and semistructured interview used to evaluate parents’ needs in terms of quality.

141 parents were included, 57 with an ASD child and 84 with TD children. There are 6 need areas for ASD child parents as well as controls: materials, time management, information, education, psychological support and relational difficulties. Parents of ASD child describe priority information needs (89.5%), psychological (73.5%), material needs (71%) and education (58.5%). These needs are listed last in the control group (respectively 10.5%, 26.5%, 29%, and 41.5%).

Providing parental assistance should be based on three key dimensions to receive specific information, to have psychological and social support and to manage child disorder. in practice today only the third axis is often considered in programs [4]. So, we make relevant recommendations about support for parents of ASD child.

The purposes of this study were to estimate the prevalence rates of subtypes of late life depression (LLD) including (vascular depression and non-vascular depression) in the baseline study, to examine the natural course of LLD and to investigate influence of white matter hyperintensities (WMH) volume on depression and neurocognitive function in the 3-year follow-up study.

WMH was rated by the modified Fazekas scale and the volume of WMH was also calculated by an automated quantification method. Patients were classified as having vascular depression if they suffered from any type of depressive disorders and had a score of 2 or more on either deep white matter hyperintensity or subcortical gray matter ratings. in the 3- year follow-up study, the participants of the in the baseline were follow-uped with the same methodology of the baseline study.

The prevalence rates of vascular major depressive disorder (MDD) and vascular non-major depressive disorder (nMDD) were 2.39% (53.6% of MDD) and 4.24% (34.0% of nMDD), respectively, in the baseline study. Among non-depressive group in the baseline study, subjects with WMH(+) had 13.5 times (OR=13.5, 95% CI=1.10-165.97) risk of developing depressive disorder in the 3-year follow-up study, as compared to those without WMH(+). Log WMH volume (OR=5.78, 95 CI=1.04-31.72) in the baseline study was an independent predictor for depressive disorder in the 3-year follow-up study

WMH is a crucial predictor for future depressive disorder, which supports the previous vascular depression hypothesis. Vascular depression is a useful construct accounting for clinical characteristics of LLD.

Different questionnaires were formulated in order to assess the severity of gambling. The most used questionnaire is the South Oaks Gambling Screen (SOGS), based on DSM-III criteria for gambling, even though it has poor specificity, because overestimates the prevalence of the disorder when used in general population.

Try to overcome SOGS limits using a questionnaire based on DSM-IV criteria for gambling.

Validate the questionnaire based on DSM-IV criteria, using as gold standard the clinical interview developed through the SOGS.

The sample used is formed by 71 subjects, 58 men (81.7%) and 13 women (18.3%), recruited from the Psychiatric Department of Gemelli General Hospital in Rome, who were asked to fill out both questionnaires.

The sensitivity of our questionnaire was 93% (compared to 100% in the SOGS); the specificity was 100% (97.1% in the SOGS). False negatives were 7%, while they were absent in the SOGS ; false positives were absent in the DSM-IV questionnaire, while they were 2.9% in the SOGS.

We also determined the prevalence of each item of DSM-IV questionnaire in all gamblers identified (66 subjects): the most relevant item was “chasing one's losses”(item6), instead the least one was “committing illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling”(item8).

Our data confirm the greater specificity of the questionnaire of DSM-IV criteria for gambling compared to the SOGS. We suggest its use for the identification of gamblers in a sample formed by general population.

Frequent and increasing relations among psychiatric and substance dependence disorders, have made, to date, more complex the treatment of this dependence, especially when the patient is facing the difficult task of maintaining abstinence, which requires a work of self-awareness, motivation to change and active modification of dysfunctional lifestyles.

Our study has the aim to detect patients’ changes in personality between the beginning of the rehabilitative therapy and its end, trying to get information on aspects of addiction on which the treatment affects the most.

Our sample was formed by 153 patients, recruited at the Department of Psychiatry of Gemelli General Hospital, who were subjected to an integrated approach of treatment, both pharmacological and rehabilitative group-therapy, according to Minnesota rehabilitation model, that considers addiction as a bio-psycho-social problem.

Patients, after a first psychiatric evaluation, were asked to fill out two psychometric tests, the SymptomCheckList-90 R and the Structural Clinical Interview for DSM-IV, in two times, at the first meeting and at the last one, after 20 meetings of group therapy.

At the end of the group therapy 39 patients dropped-out, 114 patients had a significant improvement in depressive symptoms (DEP item), greater responsibility perseverance and attention in their activities and habitual contexts (GSI, DIS, W/S items), as well as better management of compulsion and impulsivity (OC item) and a lower sense of inferiority, inadequacy and discomfort in interpersonal relationships (PAR, ANX, IS, SOC. A., PSY. A. items).

Clinical observations indicate that atypical antipsychotics, especially clozapine, induce obsessive-compulsive (OC) symptoms in schizophrenic patients. Recent data from neuroimaging and clinical trials suggest a role for altered glutamate neurotransmission in the etiology of OCD. It has been reported that SLC1A1, GRIN2B and GRIK2 regulate glutamate transmission and affect OCD pathophysiology. This study aimed to determine whether SLC1A1, GRIN2B and GRIK2 are associated with clozapine-induced OC symptoms.

A total of 250 clinically stable schizophrenic patients receiving clozapine treatment and 261 sex- and age-matched controls were recruited. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the severity of OC symptoms. Based on the Y-BOCS score, 250 patients were divided into OC group and non-OC group (patients with and without OC symptoms, respectively). Three reported OCD susceptibility polymorphisms SLC1A1 (rs2228622), GRIN2B (rs890) and GRIK2 (rs1556995) were genotyped.

Trends of association with OC symptoms were observed in rs2228622A and rs890T alleles. SLC1A1 and GRIN2B interaction was found in the significant 2-locus, gene-gene interaction model (P=0.0021), using a MDR method. Further analysis showed a significant interaction between SLC1A1 and GRIN2B on the Y-BOCS score (F6, 137=7.650, P 0.001), and individuals with AA/TT genotypes had a significantly higher mean Y-BOCS score than those with other genotypes, except AG/TT.

These results suggest that SLC1A1, GRIN2B and interactions between the two might confer a susceptibility to OC symptoms in schizophrenic patients receiving clozapine.

Reports about medication adherence in Arab patients with schizophrenia and the possible confounding factors are lacking. The aim of this study was to determine whether insight, spirituality and patient beliefs about the necessity and concerns about medication were associated with adherence among those presenting with schizophrenia in an outpatient facility.

At the end of a routine follow up with their psychiatrist, patients completed questionnaires including the Schedule for the Assessment of Insight (SAI- E), Morisky Medication Adherence Scale (MMAS), Arabic Daily Spiritual Experience Scale (DSES) and Beliefs about Medicines Questionnaire (BMQ) in addition to demographic and clinical information from patients and their medical files.

A convenience sample of 92 patients with schizophrenia was studied .On the basis of the MMAS results, 33 (14.7%) patients were categorized as medication adherent and 59 (49.3%) as medication nonadherent. Regression analysis showed that the BMQ concern subscale and DSES scores were negative predictors of adherence whereas the SAI score was a positive predictor of adherence. The most important predictor of adherence was DSES and SAI, followed by BMQ concern subscale

This study extended prior research on the role of insight, spirituality and patient beliefs in medication adherence in a sample of Arab patients with schizophrenia which is consistent with previous research conducted in western cultures.

Exposure to second-hand smoke (SHS) has a detrimental impact on health and may lead to deficits in general memory. No research has focused upon whether exposure to SHS affects everyday memory, of which prospective memory (PM: remembering future intentions and activities) is a good example.

To explore the links between exposure to SHS and PM.

This study aims to compare a group of never-smokers who reported regular exposure to second-hand smoke (the SHS group) with a group of current smokers (the CS group) and a group of never-smokers who reported never having been exposed to SHS (the Non-SHS group) on objective PM.

An existing groups design was employed to compare 24 SHS, 27 CS and 28 Non-SHS on The Cambridge Prospective Memory Test (CAMPROMPT) which measures time and event based PM. Age, other drug use, mood and IQ were also measured as covariates in the study.

The Non-SHS group recalled significantly more PM items on CAMPROMPT than both the SHS and CS groups, with the SHS group recalling significantly more items than the CS group. This was found after controlling for important covariates.

This is the first study to observe PM deficits in non-smokers exposed to SHS. It is concluded that exposure to other people's SHS can impede everyday memory, but not to the same degree as found in active (current) smokers, when both groups are compared to non-smokers not exposed to SHS.

Binge drinking (BD) has been associated with a range of memory deficits, including prospective memory (PM: remembering future intentions and activities) deficits in the past. However no research to date has distinguished between levels of BD.

To compare heavy binge drinking with non-heavy BD and non-BD groups on objective PM.

To compare varying levels of BD with non-BD upon everyday PM.

An existing groups design was employed to compare a group of heavy BDs (drinking above 15 units per drinking session), with a group of standard BDs (drinking between 10 - 15 units per drinking session), and a group of non-BDs (drinking less than 5 units per session) on objective PM. The Prospective Remembering Video Procedure (PRVP) was used to assess PM, which required the participant to remember a series of actions (e.g. remember to buy “X”) when they reached specific locations (at the Phone Store) whilst viewing a CD Rom clip of a busy shopping high street. Age, other drug use and mood were also measured as covariates in the study.

The Non-BD group recalled significantly more action-location combinations on the PRVP than both the ‘standard’ and ‘heavy BD groups, with no significant difference between the latter groups. This was found after controlling for important covariates.

It appears that BD per se is associated with PM deficits when compared with non-BDs, with heavy BD not adding to the PM deficits observed. Possible reasons and implications are considered further at conference.

The studies of Carroll e Hesse (1987) and the studies of Arntzen e Almas (2002) demonstrate the effectiveness of mand-tact training rather than only tact training on the expansion of the tact repertoire in groups of children with developmental disabilities.

The authors want to show the effectiveness of mand-tact training rather than only tact training on the expansion of the tact repertoire in a child with moderate mental retardation.

In the present work, we conducted an assessment pre-training in which the baseline data of the tact in the child's repertorie was collected, with an assessment choice preference to identify the reinforcers to use in the training. in the training, sessions only-tact training and sessions mand-tact training are alternated, according to the principles and procedures of Applied Behavior Analysis (ABA).

The results obtained show that the mand-tact training is more effective than the only-tact training in the rapid acquisition of tacts.

The mand contingiences represent a facilitation in the acquisition of the tact repertoire.

To estimate the prevalence of suicidal ideation during gestation and risk factors for depression in postpartum.

712 pregnant women answered the PRIME MD, and reported sociodemographic data, obstetric history and history of violence; 427 women answered the PRIME MD at 4-5th month postpartum. Poisson regression was used to estimate the association between suicidal ideation and sociodemographic, obstetric and violence variables, and to estimate the association between risk factors and depressive symptoms in postpartum.

The prevalence of suicidal ideation during pregnancy was 10.3% (n=73). The prevalence of depression was 36.2% (n=258). Suicidal ideation was associated with: 0 to 4 years of schooling (PR=2.88, CI 95% 1.40-5.91), and 5 to 8 years of schooling (PR=2.63, CI 95% 1.45-4.77), being victim of violence in the current gestation (PR=4.35, CI 95% 2.81-6.74), and anxiety symptoms (PR= 5.49, CI 95% 3.58-8.40).

The prevalence of depression in the postpartum was 28.3% (n=121); 45 were incident cases (37%). The following variables were significantly associated with depression in postpartum: < 19 years of age (RR=1.82, CI 95% 1.03-3.22), 20-29 years of age (RR=2.19, CI 95% 1.30-3.66), lower income (RR= 1.49, CI 95% 1.00-2.23), depressive symptoms during gestation (RR=2.9, CI 95% 2.13- 3.97), anxiety symptoms during gestation (RR= 2.96, CI 95% 2.26-3.88), and being victim of violence during gestation (RR=2.04, CI95% 1.50-2.78).

Gestation is not protective of suicidal ideation and common mental disorders. Treating common mental disorders during pregnancy is essential to prevent depression in post partum and to promote maternal's and infant's health.

In literature, individual vulnerability to stress is a predictive factor of a higher risk of developing stress-related disorders and mental health problems. The Stress Vulnerability Questionnaire (23QVS; Serra, 2000, 2004) is a 23-item scale, measuring vulnerability to emotional and social adverse and stressful situations, and overall life satisfaction.

The purpose of this study was to assess the psychometric properties of a Russian version of the 23QVS in a sample of Russian-speaking immigrants residing in Portugal.

The 23QVS was administered to Russian-speaking immigrants in 12 Local Immigrant Support Centers in Portugal, along with a number of other self-report tests as part of a larger mental health status immigrants' study.

The Russian version of the 23QVS has an internally consistent measure Cronbach's α, 710 for the total scale (Item 7 was excluded). PCA was carried out in order to re-examine the factor structure of the scale. Seven factors were identified, overall matching the ones foreseen by the author of the scale.

The findings suggest that the Russian version of the 23 QVS addressed adequately the original concepts and dimensions, and demonstrated a high level of equivalence with the original version.

Impairments in oculomotor performances such as saccade tasks were reported in patients with schizophrenia. Correlation between oxidative stress markers and ocular saccades has not been studied.

To explore the relationship between markers of oxidative stress (antioxidant enzyme activities and glutathione levels) and saccadic parameters (frequency and latency) in a sample of patients with schizophrenia.

Thirty clinically stable patients with schizophrenia (24 men and 6 women, mean age = 29.9 ± 6.3 years) and 25 control subjects matched for age (13 men and 12 women, mean age = 29.3 ± 4.9 years) were recruited. Frequency and latency of saccadic tasks (anticipatory and compensatory saccades) were recorded with an oculometry. The erythrocyte activities of antioxidant enzymes: Superoxide Dismutase (SOD), Glutathione Peroxidase (GSH-Px) and Catalase (CAT) were measured. Glutathione (GSH) levels were determined in blood samples.

Patients had significantly lower activities of all antioxidant enzymes and levels of total and reduced GSH compared with controls. High saccades frequency was found in patients compared to controls. The saccade latencies were higher in patients compared to controls. in the patients, a negative correlation was found between total and reduced GSH and frequency of compensatory back-up saccades. Square-wave-jerks were negatively correlated with oxidized GSH level and SOD activity.

The decrease of antioxidant defenses (SOD activity and GSH levels) was associated with the saccadic frequency in patients with schizophrenia, suggesting the involvement of oxidative stress in the pathophysiology of oculomotor abnormalities in schizophrenia.

Internet over-consumption can cause dysfunctional usage resulting in several deleterious outcomes. The “Internet Use Disorder” is gaining importance in diagnostic manuals as its prevalence increases.

The objective of the study was to examine how this upcoming disorder is assessed at present.

We present the actual status of Internet addiction assessment tools and develop a theoretical framework for optimizing “Internet Use Disorder” assessment tools design.

A factorial structure analysis of tools assessing Internet addiction for adolescents and adults published between January 1993 and October 2011 was performed and a theoretical framework for optimizing tools design was developed. The descriptive properties of 14 questionnaires were measured and the position of the instruments’ methodology, validity, reliability and model fit was presented, along with the preferred factorial analysis method and validation technique.

Results indicate some heterogeneity in study methodology and differences in descriptive and dimensional aspects of assessment tools. The three factor categories compulsive Internet use, negative outcomes and salience were central to Internet addiction questionnaires. Furthermore, the social dimension was often under-represented. No significant difference was observed in the distribution of factor categories across Internet addiction questionnaires and DSM-IV-TR and ICD-10 diagnostic criteria for substance dependence.

The validity and reliability of the evaluated questionnaires reflect the newness of this field. The underrepresentation of the social use of Internet is a problematic situation as it is causing considerable damages. Future research should consider that Internet addiction evaluation questionnaires need refinement. Appropriate strategies are proposed.

In recent years the number of youth given the diagnosis of pediatric bipolar disorder (PBD) has escalated and the question of overdiagnosis has been raised. The existence of the diagnoses on Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome PANS) has also been the subject of controversy.

This poster compares the symptoms of these two groups of disorders and presents one case to demonstrate how these disorders may confound the diagnostic presentation of a youngster with mood and behavioral symptoms.

The goal is to familiarize the reader with the symptomatic presentations of PBPD, vs. PANDAS and PANS and how to approach assessment and treatment issues.

Similarities and differences in the diagnostic criteria for all three disorders will be compared. A case demonstrating the importance of recognizing both groups of diagnoses for maximizing therapeutic interventions will be presented.

Comparison will indicate how one or both of these disorders may be responsible for a child's mood and behavioral symptoms. The importance of this in determining the approach to treatment will be discussed.

It is hypothesized that part of the significant rise in the number of youngsters being given the diagnosis of Pediatric Bipolar Disorder, may be due to the lack of recognition of PANS and / or PANDAS. Detailed history of symptomatology, past medical history, laboratory testing, family history of psychiatric illness as well as autoimmune disorders, may play an important role in the approach to treatment.