The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus.

In this study, the altereration of the ARC neuropeptide/hormone levels in rats were determined as one of the weight gain mechanism. To examine olanzapine's weight gain effects, olanzapine was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides.

Food consumption was found to be increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and α-MSH decreased significantly but CART levels were also reduced unexpectedly. in conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain due to olanzapine therapy.

Attention Deficit Hyperactivity Disorder (ADHD) is the ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed more often in boys than in girls. ADHD has a wide range of symptoms. It may affect cognitive and executive functions; it may also lead to behavioral problems and further psychiatric symptoms and disorders. Currently it has been hypothesized that ADHD may also lead to specific lifestyle that is influenced by core symptoms of ADHD. This specific lifestyle may negatively influence or even induce further mental and somatic problems.

The aim of the study was to compare lifestyle of ADHD and non ADHD boys in age of 6 - 10 years.

We have assessed a group of ADHD boys (n=50) and non ADHD boys (n=50) with structured interview oriented to life style in nutrition and health and free time and social life.

In our pilot study we identified that lifestyle of ADHD boys substantially differs from non ADHD boys - in most of all monitored areas, especially in nutrition and way of spending free time. ADHD life style is characterized by lower level of organization.

Upon the presented study we may suggest that ADHD may lead to specific lifestyle that is characterized by lack of organization and stability. This may lead to further mental or even somatic problems. Clinicians and researchers should pay more attention to these questions.

The prevalence of internet game use among children and adolescents has been increased in the recent years.

Internet addiction has been found to cause various psychiatric symptoms and psychological problems. Internet addiction has been found to cause various psychiatric symptoms and psychological problems.

The aim of this study was to examine the association between problematic internet game use and psychiatric symptoms in a sample of the Child and Adolescent Psychiatric Clinic, Ulsan University Hospital.

We analyzed data from 447 subjects who first visit the Child and Adolescent Psychiatric Clinic of the Ulsan University Hospital. The level of Internet addiction was categorized as either high-risk (≥108; group 3), potential risk (95 to 107; group 2), or no risk (≤94, group 1) based on the total score. Data were analyzed using SPSS version 17.0 and one-way ANOVA and multiple logistic regression method were used.

Thirteen adolescents met the criteria for high risk group of internet game addiction. in the high risk group, 10 were male and 3 were female adolescents. There was an mean difference among group 3 (high risk)< 1 (no risk),2 (potential risk) in AHI ; whereas group 3 (high risk)>1 (no risk), 2 (potential risk) in BDI, BAI, inattention, hyperactivity/impulsivity and K-ARS score. with multiple logistic regression analysis, K-scale was significantly related with male sex, BDI, ARShyperactivity/ impulsivity score.

We conclude that having male sex, happiness and depressive symptoms is associated with the risk of developing internet use disorders.

Valproate (VPA) is widely used for acute and maintenance therapy of bipolar disease and it is the most prescribed drug for epilepsy treatment worldwide. VPA-induced hyperammonemia is a serious and unusual advers effect of VPA treatment.

We aimed to describe the 20 year-old-woman bipolar case of VPA induced hyperammonemic encephalopaty with therapeutic VPA levels and normal liver functions.

The case will be discussed.

The patient complained of confusion, disorientation, somnolance, agitation and slurred speech at the end of the first week of VPA treatment. VPA blood level was 116.5 μg/mL (N:50-125) and ammonia level was 237 μmol/L (N:10-50). Other laboratory tests including serum transaminases (both ALT and AST) and coagulation profile (PT, PTT and INR) were normal. After discontinuation of VPA treatment and hydration, these symptoms have disappeared dramatically. After 24 hours, blood ammonia level was 80 μmol/L and patient returned the baseline mental status.

Hyperammonemia occurs due to inhibition of mitochondrial enzymes in the urea cycle by valproic acid. Hyperammonemia and encephalopathy can develop even at therapeutic concentrations without elevated liver function enzymes. Clinicians should be aware that VPA- induced hyperammonemia and encephalopathy is still one of the most feared side effects of VPA which may require emergent management.

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood. It affects about 3 - 5% of school aged children. ADHD may lead to cognitive and behavioural problems and further psychiatric symptoms and disorders. Current research shows possible changes of somatic development of ADHD children comparing to non ADHD children. Etiology of these changes is still unclear. It is hypothesized that it can be caused by ADHD specific endocrinologic changes, medication or a ADHD life style. The growth of children may be influenced by further external factors - i.e. length of breastfeeding.

The aim of the study was to compare how long a group of ADHD children - comparing to non ADHD children had been breast fed after the birth.

We assessed a group of mothers of ADHD children (n=100) and non ADHD children (n=100) with structured interview oriented to breast feeding.

In our pilot study we identified that ADHD children were breastfed substantially shorter time (avg = 2,5 month) than non ADHD children (avg = 7,8 month) at statistically significant level (p< 0.01).

The presented study suggests that ADHD in very young children may influence mother's behaviour leading to shortening time of breastfeeding. This may lead to further developmental changes. The presented study proposes that developmental changes in ADHD - especially somatic ones may be caused by complex ethology and therefore it is necessary assess not only the child but also conditions of its development.

Sleep plays a vital role in both mental and physical functioning. Sleep disturbances are not only associated with psychiatric disorders, but also with many chronic physical conditions.

The aim of this report was to assess the frequency of poor sleep quality, daytime and dream anxiety and their response to subsequent surgical treatment for a representative group of 68 patients with nasal septum deviation.

Nasal airflows and airway resistances were measured employing rhinomanometry and the participants were also asked to fill in Pittsburgh Sleep Quality Index, Beck Anxiety Inventory, and Van Dream Anxiety Scale directly before the submucous resection without turbinectomy and two months later.

Repeated measure analyses of variance models showed that patients reported significantly lower scores of poor sleep quality, daytime anxiety, and as well as dream anxiety after surgical treatment (p< .01).

Nasal septal surgery might have beneficial effects on sleep variables in patients with deviation.

Against a backdrop of poor mental health education in UK schools a group of students from Norwich Medical School have formed a student society called ‘Headucate’ in order to create, deliver and evaluate an educational intervention for adolescents, initially to be delivered in Norfolk schools.

To create an educational intervention that:

• Is the length of a standard lesson

• Is age appropriate and acceptable

• Contains appropriate signposting

• Contains content that challenges common myths and replaces them with knowledge

• Contains content that encourages empathy and understanding towards those with mental illnesses

• Is easily delivered in the same way each time so that its effectiveness can be evaluated

To create an intervention effective at tackling stigma and empowering adolescents to recognise signs of poor mental health and access services appropriately.

Lesson plan created after consultation with psychiatrists, a psychologist, a GP, a university outreach professional, a teacher and secondary school age children, then trialled and revised.

Interactive workshop produced with 5 sections.

1. 1) Myth vs Fact activity that dispels prevalent myths

2. 2) Scenario based activity to demonstrate that mental health is a spectrum

3. 3) An interactive presentation covering the most common mental illnesses and their symptoms

4. 4) An activity focusing on talking to those with mental illnesses, furthering the scenario from the previous activity

5. 5) A question and answer session. Every student leaves with a leaflet containing appropriate signposting.

We have created an educational intervention ready to be delivered and evaluated.

Pathological Gambling (PG) includes extremely different types of game and many gamblers suffer from anxiety disorders. According to the self-medication hypothesis, Gambling Behaviour may be a strategy to tolerate suffering and compensate uneasiness; otherwise social problems related to gambling may lead to anxiety disorders, possibly unmasking an adult form of Separation Anxiety Disorder (SAD).

To investigate possible relationships between PG and SAD, considering the different games, the age of onset, the symptom severity, and the distinction between Adult and Child SAD.

32 gamblers attending an outpatient psychiatric clinic completed the following tests: SOGS and ASI to investigate the kind of gambling, the age of onset and the social conditions of gamblers; SCI-SAS, SASI, ASA-27 to evaluate the Separation Anxiety in childhood and adulthood; HAM-A; GAF.

There are statistically significant correlations between later age of onset of PG and development of SAD in adults. Higher scores in GAF are related to lower scores in Separation Anxiety scales and HAM-A. There is a strong inter-correlation among the Separation Anxiety scales. Higher scores in HAM-A correlate with higher scores in SASI and ASA-27. Male gamblers have an earlier onset and increasing with the age of onset increases the addiction to “dissociative” games instead of “active” ones.

Our preliminary data do not support self-medication hypothesis; possibly, a later-onset gambling is related to a more neurotic and less impulsive psychopathological pattern.

Postpartum Depression (PPD) is a common problem connected to pregnancy. Related previous data showed a prevalence of depressive symptoms between 8% and 51% and a prevalence of Major Depressive Disorder between 10% and 17%.

Find a correlation between Psychosocial Risk Factors and the develop of Mood Disorders during pregnancy and post-delivery.

Develop strategies of prevention and treatment of PPD.

A population of pregnants has been analyzed, proposing an anamnestic questionnaire, the Edinburgh Postnatal Depression Scale (EPDS) and the Hypomania checklist Symptoms (HCL-32), in two times: between the 35th and the 37th week of pregnancy and 2-3 days after the delivery.

We found that at the first survey were depressed (EPDS score >9) 21 women of 149 (14.1%) and hyperthymic (HCL score >14) 59 women of 149 (39.9%).We noticed that risk factors for depression were a complicated pregnancy (p=0.004), a conflicting relationship with the partner (p=0.009) and a permanence in Italy < 6 months (p< 0.001). An history of illnesses during the pregnancy (p=0.042) and previous psychological problems (p=0.049) were correlated to an hyperthymic state. At the second survey, data were confirmed: the incidence of depression was 17,4% (12 /69 women) and that of hyperthymia was 44% (30/69 women).

Our data confirm previous evidences about the incidence of PPD and the contribution of risk factors of the pregnancy in its pathogenesis; moreover, high scores at HCL can express an hyperthymic dimension peculiar of pregnancy, rather than a mood disorder, considering HCL as a dimensional assessment.

Thyroid function is known to be affected during pregnancy. Risk of depression is particularly high for women during the prenatal period.

Various investigators have attempted to establish a link between thyroid function and post partum depression. While the pathogenesis of postpartum mood disturbances remains unclear.

This study aimed to investigate whether thyroid function differs in women with postpartum depression compared to a control group.

In this case-control study, Forty eight patients suffering from postpartum depression according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition totally revised (DSM-IV-TR), and 65 normal controls underwent diagnostic evaluation using Structured Clinical Interview for DSM-IV-TR. Then the Persian version of Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. Finally, their thyroid functions were assessed. Data analyses were done using the SPSS program 13.

No statistically significant differences were observed between thyroid function tests and postpartum depression. According to multiple regression analysis with stepwise method, subjects with lower serum TSH, T3RU and T3 levels tended to have higher EPDS scores (P-value=0.008).

The present study reports that those women with postpartum depression had a no greater prevalence of thyroid dysfunction than the control subjects. It seems that thyroid dysfunction should be considered in women with postpartum depression individually, but the role of thyroid as an important cause of this condition is not yet established. This suggests that future studies should concentrate on this concept in postpartum depression.

This literature review examines the issues facing foreign mentally disordered offenders (FNMDOs) in accessing psychiatric care in the UK.

Studies/reports relevant to FNMDOs in Healthcare, Probation services, Inspectorate of prisons, Crime reduction charities, Department of Health were examined. Keywords searched on MEDLINE and Psychinfo: ‘foreign, mental,*offender,*criminal.*’

According to 2009 statistics, 14% of UK prisons consisted of foreigners of which 80% suffered mental health problems. FNMDOs face a number of issues like negative stereotyping, racism, poor family contact, language/cultural barriers, which hinder accessing psychiatric help. Indefinite detention of foreign prisoners, post-amendment of the UK Borders Act 2007, has been found to result in increased depression and suicidal ideation. Self-inflicted deaths increased since 2006. Research on migration-morbidity hypothesis and refugees/asylum-seekers demonstrates higher psychiatric morbidity. A 2005 meta-analysis reported worse outcomes for institutionalized refugees. Detention centres often have poor healthcare provision, though prevalence of PTSD, depression, anxiety, somatoform disorders is high. FNMDOs face limitations in availability of legal aid and immigration advice across the prison system. Lack of a clear care pathway compounded by poor inter-agency communication and understanding of immigration procedures adversely affects treatment and continuity of psychiatric care.

FNMDOs are a vulnerable group with complex needs which may go unidentified. Improving care and outcomes for FNMDOs requires adequate prison staff training, ready interpreter access, facilitation of family visits/cultural contact. Effective multi-agency collaboration in early identification, intervention, clarity in care pathway and immigration advice would result in reduced psychiatric morbidity in this vulnerable group of offenders.

Traumatic injury, advanced age, concomitant somatic disorders promote the development of the elderly with hip fractures of various mental disorders.

To establish the prevalence, nosological spectrum, dynamics and prognosis of mental disorders in elderly and senile patients undergoing hip fracture or femur.

The study included 101 patients aged 60 years and older (mean age - 76.4 + 8.2 years) with a fractured neck of femur or femur, being treated at the trauma wards of several hospitals of Moscow.

A survey of patients in elderly undergoing hip fracture or femoral found that 82.2% of the patients at the time of the study had various mental disorders. Fracture of the femoral neck or the femur can be seen as provocative or etiological factors such as mental health states of confusion (19.8%), due to situational depressive disorder (8.9%), which appeared isolated sleep disorders (5.9%), alcohol delirium (3%). Depressive spectrum disorders in the background of hip fracture or hip are more common in younger persons (p < 0.03), whereas the state of confusion - in older individuals (p < 0.01). By the time catamnesis (on average, a year after the first examination) died 27.8% of persons included in the follow-up of the group.

The study confirmed the expected high rate of adverse outcome of hip fracture or femur in elderly and senile patients with a state of confusion or dementia. Probability of reduction of mental disorders occurring against hip fracture or femoral increases significantly when the surgical treatment.

Child protection guidelines within a London mental health trust state that all mental health professionals should identify patients who have dependents, if so it should be established that these dependents are safe, and any concerns should be taken forward to relevant agencies.

Establish if child protection guidelines are being followed in emergency psychiatric assessments.

Establish whether patients are being asked whether they have dependents, if the dependents are safe, and whether concerns are being discussed with child protection services.

An audit was carried out in which documentation from 3 days of emergency assessments where examined to see whether the above questions were being asked.

In cycle 1, 11 out of 18 patients asked about dependents, 7 had dependents, 4 were documented as being safe, 3 raised child protection concerns, 0 taken forward.

In cycle 2, 7 out of 17 patients asked about dependent, 6 had dependents, 3 documented as being safe, 0 child protection concerns were raised.

Obesity hypoventilation syndrome is a multifactorial clinical condition developing in obese people. The symptomatology of the disease is dominated by disorders of breathing during sleep, and hypoventilation leading to chronic hypercapnia with underlying metabolic and hormonal disorders leading to complications of the cardiovascular disease.

Here we describe a case of a patient treated for many years because of pulmonary hypoventilation syndrome accompanied by obesity and metabolic syndrome followed by a reduction in blood oxygen tension.

Despite the exacerbation of the underlying disease (parameters on admission 66mmHg pCO2, pO2 29mmHg, SaO2 43%) our patient showed no signs of a mental disorder. Slight short-term memory problems, decreased mood and drive relevant to the degraded state of somatic were present. During the hospitalization, the use of oxygen therapy led to the improvement of blood parameters, however the mental state became more complicated. The patient started to develop symptoms of delirium with a delusional interpretation of reality. Despite administered pharmacotherapy and further improvement in respiratory parameters (at discharge pCO2 62mmHg, pO2 59mmHg, SaO2 89%) the patient's cognitive dysfunctions showed no further improvement and delusions of persecution were still present. This required further psychiatric care alongside with patient's somatic treatment.

A strong link exists between disorders of cognition, and chronic respiratory failure (hypoxia with concomitant hypercapnia). This may be also accompanied by psychiatric symptoms, which may become difficult to treat even if the somatic parameters are successfully improved.

The shift work has various negative influences on health, performance, activity, and social relationships as well as causing impairment in cognitive functions.

We aimed to investigate the effects of shift work on participants’ cognitive functions in terms of memory, attention and learning, and on oxidative stress indicated by total oxidant status, total antioxidant capacity, and oxidative stress index.

90 health workers participated in the study (45 subjects were night shift workers). The neuropsychological tests were applied to the participants for assessing the cognitive functions and blood samples were taken to detect their total antioxidant capacity and total oxidant at 8.00 in the morning. Depression, anxiety, chronobiological characteristics, cognitive functions were assessed by using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Morningness- Eveningness Questionnaire (MEQ), Wechsler Memory Scale- Revised (WMS-R), Auditory-Verbal Learning Test (AVLT) and Stroop Test.

Night shift workers reported significantly lower scores on the verbal memory, the attention-concentration, and the digit span forward sub-scales of the WMS-R as well as the immediate memory and the total learning sub-scales of the AVLT. Oxidative stress parameters were significantly associated with some types of the cognitive functions in both groups.

The findings suggest that health workers in night shift generally revealed significantly poorer performance in cognitive assessment as compared to day shift workers. The oxidative stress indicators associated with the cognitive functioning.

The review the successfulness of efforts to decrease suicides in Finland in the light of scientific studies.

The rate of suicide has decreased considerably and its association with the use of alcohol has weakened. Although the use of alcohol increased in the 1990's the rate continued to decrease. Two studies have linked the decrease in rate of suicide with the sale and use of antidepressants. This trend appears to be especially pronounced among men. Additionally, evidence shows that the replacement of hospital-based services with outpatient care has had a positive impact on suicide mortality of patients, who have received care in psychiatric hospitals. The decrease in suicide rate is associated with intensive outpatient care.

In the long run, the national suicide prevention project has been successful, although other factors, such as increase of standard of living and general wellbeing among citizens of Finland, have been likely contributors.

Structured diagnostic interviews performed by non-clinicians are today frequently used for research purposes and are increasingly common in clinical practice. The validity of such interviews is theoretically unexamined and only poorly empirically studied.

To assess the validity of structured psychiatric diagnostic interviews using the SCID (Structured Clinical Interview for DSM-IV) as a representative.

A sample of 100 diagnostically heterogeneous, first-admitted inpatients were interviewed and diagnosed by a forthe- purpose trained non-clinician rater using the SCID. The DSM-IV diagnoses yield from the SCID interviews were compared with consensus Life-Time Best Estimate DSM-IV diagnoses. These diagnoses were assessed by two experienced research clinicians based on multiple sources of information, which included videotaped comprehensive semi-structured narrative interviews.

The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by the SCID were 19% and 100% respectively.

Structured diagnostic interviews in a first-admission inpatient sample are not a valid way of allocating psychiatric diagnoses and are not recommendable for clinical work. These interviews should only be used in research on the condition of certain prior precautions. It is suggested that a revival of systematic theoretical and practical training in psychopathology is an obvious way forward in order to improve the validity and hence, a therapeutic utility, of the psychiatric diagnosis.