Cocaine abuse continues to be epidemic, and yet there are no FDA approved medications for the treatment of cocaine use disorders within the United States.

This 12-week, prospective, double-blind, randomized, placebo-controlled study examined the effectiveness of quetiapine (Seroquel XRTM) versus matched placebo for the treatment of cocaine dependence in non-psychotic individuals. Sixty Individuals with a diagnosis of cocaine dependence were randomized in this study. Those who were randomized to quetiapine (N=29) were titrated up to a target dose of 400 mg/day of quetiapine, while those in the placebo arm (N=31) were given a matched placebo. All subjects had weekly clinic visits and a cognitive-behavioral therapy group session. Outcome measures included questionnaires of cocaine use, money spent on cocaine, and urine drug screens (UDS).

The drop-out rate was substantial at 68%, however there were no group differences between the two arms of the study. Using a repeat measures ANCOVA, as a whole, the subjects in this study improved by reducing their self-reported use of cocaine (p=.018) and self reported money spent on cocaine (p=.041) over the course of the study. However, the quetiapine group was not significantly different from the placebo group. in addition, cox regression analyses yielded non-significant differences (p = .65) between groups in predicting sobriety, as defined as three weeks negative UDS.

This study did not find group differences between the quetiapine and placebo arms, indicating that quetiapine does not appear to be beneficial in the treatment of cocaine dependence.

Depression represent an important and predictable complication in chronic haemodialysis.

The prevalence of depression, QoL indicators, correlations between number of years of hemodialysis, depression and quality of life.

To determine if higher depressive levels are correlated with years spent on haemodialysis.

We used Beck questionnaire two times, one at the beginning of the year, and one at the end for 102 patients, excluding diabetes, who were undergoing hemodialysis three times a week, for 4 hours and SF 36 questionnaire. We considered these values for depression: Normal: 0-10, Mild: 11-15, Moderate: 16-23, Severe: 24-63 according to Romanian Guidelines in Nephrology.

98 pacients answered to the Beck questionnaire. Years of haemodialysis: min=0.25, max=18, average=5.7, standard deviation= 4.37 (n=102). SF 36 has close values distributed between the intervals 80-100, 60-80, < 60%. The linear correlation between average depression and years of hemodialysis is very, very weak, square of the coefficient of regression is 0.00- (by the linear model we can explain < 0.1% of the dates) and also between SF36 total and years of hemodialysis:square of the coefficient of regression is 0.04- (by the linear model we can explain 4% of the dates). We followed other models (logaritmic, polinomial, exponential), for both correlations, but we couldn’t notice better results.

The study proved high levels of mild depression, lack of linear correlation between years of haemodialysis, depression and QoL indicators. Although this, there is an influence of time spent in haemodialysis and QoL.

Physicians have an increased risk of dying by suicide in comparison with the general population.

This difference has been studied in the literature.

To present the characteristics of this phenomenon.

Literature review using Medline and hand search of relevant articles.

The suicide risk is slightly higher for male and substantially higher for female physicians in comparison with the general population (relative risk 1.1-3.4 and 2.5-5.7 respectively). It also varies from 1.5-3.8 in males and 3.7-4.5 in females as compared with other professionals. Depression, drug & alcohol abuse problems, history of prior attempts, availability of method (drugs), physical illness, burn-out syndrome, interpersonal difficulties and loneliness constitute risk factors. Physicians rarely do “unsuccessful” attempts and most commonly die by drug poisoning. This may be due to the fact that they have easy access to drugs, knowing better their lethal doses. Anesthesiologists, Psychiatrists and General Practitioners have the highest risk. The increased risk in female physicians is concerning given the rising number of women in the medical profession. However, as poor status integration has been proposed as an explanation, their increasing proportion in the medical workforce could hopefully help reverse this trend.

Physicians -particularly female- present high risk of suicide. Adequate services of counseling, support and care that provide anonymity and confidentiality should be the cornerstones of preventive efforts. The last are complicated by the fact that restriction in the main suicide method (drugs) seems a hardly applicable preventive measure in this population.

When compared to the general population psychiatric patients smoke at higher rates. in Greek psychiatric wards smoking has been “quietly” allowed up until 2011 and up to date there is no provision of nicotine dependence interventions.

The opening of offered a unique opportunity to establish the first psychiatric ward with a clear no smoking policy.

To describe the effect of this intervention on the smoking behaviour of the inpatients.

For a 12month period we conducted a prospective study of smoking avoidance measures in the 2nd Department of Psychiatry of Attikon University Hospital in Athens. We monitored the smoking habits of 330 inpatients before admission, during their hospitalization and at discharge.

From 330 patients, 170 were smokers (51.5%). 101 of them (59.4%) had made at least one effort to quit smoking in the past. Regarding diagnosis, patients with schizophrenia were smokers significantly more than patients suffering from mood disorders (83/177 vs. 56/138, x2=4.8, p=0.03). Concerning the smoking habits during hospitalization, only 12 of the 170 smokers (7%) admitted or were seen to smoke in their rooms despite regulations. The mean difference (before admission/at discharge) was -21.8 cigarettes per day (p< 0.001).

Smoking avoidance measures are effective in a new psychiatric unit.

Fibromyalgia and major depressive disorder (MDD) frequently co-occur. Quetiapine XR has demonstrated efficacy in the treatment of MDD and has recently been shown effective in patients with fibromyalgia.

To evaluate the efficacy and safety of quetiapine XR in patients with MDD and comorbid fibromyalgia.

To report on the antidepressant and analgesic effects of quetiapine XR in a sample of dually diagnosed patients.

An 8-week double-blind, randomized controlled trial in 120 non-psychotic adult outpatients with a confirmed diagnosis of MDD and fibromyalgia. Quetiapine XR was administered once daily in the evening at a starting dose of 50 mg/d for 2 days then 150 mg/d for 2 weeks and up to 300 mg/d if needed. The primary efficacy endpoint was mean change from baseline to week 8 on the HAM-D17 total score. Secondary endpoints included other measures of depression, anxiety, pain, quality of life, global functioning and adverse events.

At week 8, mean change in HAM-D17 score from baseline was significantly greater in the quetiapine XR arm than placebo (-10.0 vs. -5.8, p=0.001). Improvements in the Fibromyalgia Impact Questionaire (FIQ total -11.1 vs. -3.9, p=0.022) and Brief Pain Inventory (BPI-Total -2.1 vs. -1.6, p=0.007) was significantly greater in the quetiapine XR arm versus placebo. Improvements in all secondary outcomes were significantly greater in the quetiapine XR with the exception of the Sheehan Disability Scale total score.

Quetiapine XR demonstrated significant antidepressive and analgesic effects in this population of patients with MDD and fibromyalgia.

The Insomnia Severity Index ISI is a Questionnaire to screen insomnia in clinics;so,it has been translated to many languages.

To determine the Reliability and validity of the Chinese Translation of Insomnia Severity Index(C-ISI) in patients with Insomnia and compare it with Chinese version of Pittsburgh Sleep Quality Index(C-PSQI).

To show the Reliability and validity of C-ISI for using it in chinese speakers.

English version ISI was translated into Chinese base on standard guidelines then Chinese version was filled in 83 patients with insomnia as a clinical group and 45 persons without sleep complain as the control group by themselves in Neuropsychiatery Department of DongzhiMen hospital. For finding Test-Retest reliability they refilled ISI questionnaire 2 weeks later.

Cronbach-α coefficient of C-ISI for the clinical group, control group and both of them was 0.72, 0.75 and 0.91 respectively. The C-ISI component and total scores in test were significantly correlated with their related components and total scores in re-test (P < 0.05). Mean Ranks for All C-ISI components, total score were significantly higher in clinical group than control group that presents low sleep quality in clinical group. There are Significant correlations between C-ISI component and total scores and C-PSQI components and Total scores in related Items.

C-ISI has acceptable reliability and good sensitivity for assessing insomnia patients ;besides,C-ISI can evaluate the insomnia patients similar to the PSQI-C so it can be used as a good scale to measure sleep quality in Chinese speakers.

Polypharmacy continues to be a major concern in psychiatry. Besides the risk of unintended and untoward pharmacological interactions, it carries the potential to cause prescriber liability and increased healthcare costs. Although polypharmacy has been commonly reported in forensic units, there have been no studies examining potentially serious pharmacological interactions in secure settings.

To identify the prevalence of potential pharmacological interactions through a cross-sectional study of prescribing patterns in a medium secure unit in the UK.

Medications prescribed for all 43 patients on 3 male medium secure wards in London in September 2012 were analyzed for potential pharmacological interactions using the Medscape Drug Database/Interaction checker.

A total of 233 regular and 113 ‘as required (p.r.n)’ medications were prescribed. 98 medications were psychotropic and 248 were physical health related. 284 potential pharmacological interactions were present with an average of 6.6 interactions per patient (1-28), involving 31 of the 43 patients(72.09%). These interactions were categorized into four groups: 1.Contraindicated (4.65% of patients;2 interactions) 2.Serious-Use Alternative(30.23% patients;20 interactions) 3.Significant- Monitor Closely(69.6% patients; 232 interactions) and 4.Minor(39.53% patients;30 interactions). Interestingly, 65% of contraindicated/serious interactions involved non-psychotropic medication.

The findings highlight the high prevalence of potential pharmacological interactions in the forensic population. The challenging presentations in forensic psychiatry often necessitate ‘p.r.n. prescribing’ and medication augmentation to treat partial response. However, this can lead to unpredictable and dangerous interactions. Clinicians should be mindful of the pharmacodynamic and pharmacokinetic implications prior to prescribing psychotropic and non-psychotropic drugs.

Diminished Responsibility has formed an important aspect of the law of homicide in England and Wales since 1957. It acts as a partial defence to murder and if successful, reduces the charge to manslaughter. Despite operating for over fifty years in England and Wales, it was subjected to regular criticism leading to the enactment of a revised plea.

This paper examines diminished responsibility, the elements of the revised plea and its legal/ clinical impact.

The core components of the old plea involved abnormality of mind substantially impairing mental responsibility. However, the obscure wording, the lack of psychiatrically recognized concepts and expert-jury role confusion led to a number of proposed reforms to the plea. The revised plea which came into force in 2010 consists of four limbs- abnormality of mental functioning, recognized medical condition, substantial impairment of mental ability and an explanation/causation requirement.

Although the new plea has intended to accommodate medical advances and modernize and clarify the law, its scope has been largely narrowed. Academics have criticized the explanation/causation requirement for being too complex to prove and so restrictive that satisfying an insanity plea might be easier. Concern has been expressed that more contested cases and murder convictions would result from this restriction in the plea's scope. Cases such as mercy-killing and battered spouses which previously could be dealt with ‘sympathetically’, might now be excluded. Interestingly, role confusion continues to be present with medical experts treading onto the jury's territory, opining on legal issues.

For 115 patients with TRS, we divided them into two groups; the one is those with a history of DSP and the other is without DSP, and treatment with RLAI was conducted for 12-month duration. This is an observational study which did not control concomitant medications or dosage of RLAI.

Clinical symptomatology and medications at baseline did not differ between the two groups. The results from the final analysis for remaining 95 patients revealed that the group with DSP showed greater improvements in the change of BPRS total score than the group without DSP.

These results suggested strongly that the dopamine supersensitivity state could be related partly with the etiology of TRS. An atypical agent with long half-life time such as RLAI, can provide beneficial effect for patients with DSP.

There is a high prevalence of cannabis use among patients with psychosis. Persistent cannabis use in firstepisode psychosis affects prognosis and recovery. Understanding the reasons of cannabis use may help improve psychosis outcome. Several studies suggest that cannabis is used to ameliorate symptoms related to the disorder (self-medication hypothesis). Comparing the reasons of cannabis use in first-episode patients with a control group, may help to acknowledge that question. So far few studies with a control group have been carried out.

Identify the reasons of cannabis use in first-episode psychotic cannabis users and compare them to non-psychotic cannabis users.

Thirty-two first-episode psychosis cannabis users and thirty-four non-psychotic cannabis users were included. They completed a self-reported reasons for use cannabis questionnaire, adapted from Dixon et al.

The amount and frequency of cannabis use was higher in patients with first-episode psychosis than controls (6.47+/- 8.2 patients vs 19.59+/- 27.7 controls; p=0.024). The two groups did not differ significantly in any of the reasons for cannabis use. The main factors attracting them to use cannabis were: relaxation, sleep better, getting high and pleasurable experiences.

Both first-episode psychosis and controls seem to use cannabis for the same reasons, which does not support the self-medication hypothesis. However additional research would be necessary to further investigate cannabis use correlation with symptoms to discard that hypothesis. Recognition of the actual reasons of use should help prevention strategists to develop appropriate programmes to general and specific audiences.

Time of profound change, adolescence is a critical period of development and transition between childhood and adulthood. Age life source of conflict, opposition and misunderstanding highlights some psychological fragility of life and the subject is likely to develop psychiatric disorders including psychosis.

Meeting the demographic characteristics of a population of adolescents who had been hospitalized for a first episode of psychosis.

Retrospective and descriptive performed on patient records adolescents whose ages are between 16 and 19 years hospitalized for a first episode of psychosis in psychiatric wards of Hospital Razi between January 2004 and June 2008. The socio-demographic data were collected using a pre-established form and analyzed using SPSS software version 11.

Our series consisted of 27 boys and 13 girls with a sex ratio was 2.07. The average age of our sample was 17.9 years. About 65% of their patients were students, 20% held irregular work and 15% were unemployed. For socio-economic conditions, they were poor in 60% of cases, moderate in 35% of cases and good in only 5%.

Despite the study of socio-demographic characteristics of this population, the onset of first episode psychosis in adolescents has still practical difficulties in preventing the occurrence of this disorder remains uncertain outcome which the clinician cannot predict how scalable.

Time of profound change, adolescencethis is a period of development where a psychodynamic point of view, can be activated archaic defense mechanisms to meet psychological difficulties that may be encountered adolescents. Once the defense mechanisms fail, the evolution towards schizophrenia can be.

Study of clinical and therapeutic aspects of first psychotic episodes occurring in adolescence, having evolved later to schizophrenia.

Descriptive retrospective study on 40 subjects whose ages are between 16 and 19 years admitted to our psychiatric institution for entry into schizophrenia. The information was collected through a pre-established form. Data analysis was performed by SPSS software version 11.

71.4% of subjects who received the initial diagnosis of schizophrenia were male, family history of schizophrenia and mood disorders were found with respective rates of 19% and 14.2%. The average time of treatment was 13.5 months. The first problems identified by families were: sleep disturbance, irritability, aggressiveness tend to hetero, difficulties in attention and concentration, exaggeration of social isolation and somatic complaints. Psychotic symptoms were found most emotional blunting, delusions and auditory hallucinations. After 2 years of follow up, 38% of subjects who carried the diagnosis of schizophrenia were reinstated at least once, and only 28.5% of subjects had continued their studies.

Schizophrenia is the major fear facing psychotic disorders occurring in adolescence. and it is important to note the diagnostic difficulties and the frequent confusion between schizophrenia and bipolar disorder in adolescence. Great care practitioner is required before any diagnostic decision.

The psychiatric expertise, medical discipline in the legal system, is an act in which the expert must establish the existence of mental illness at the time of the offense and the latter results.

Describe the socio-demographic profile of the subjects appraised in order to help to improve and clarify the mission of expertise.

Retrospective study, involving 120 subjects examined records within a forensic psychiatric assessment over a period ranging from January 2004 to May 2009. Socio-demographic data collected were processed using Microsoft Excel. Our results were compared with those of literature.

Our series consisted of 113 men and 7 women representing 94.1% and 5.9% (sex ratio F / M = 1/16). The average age was 34 years 2 months with a peak at 20-29 years (41% of cases). A solitary life characterized 70.0% of the subjects examined, with a predominance of single (64.2%). Educational level was relatively low and the employment situation was precarious for the majority of subjects with a frequency up to 35% without occupation.

At the end of this study, we find that the socio-demographic and clinical profile of subjects appraised consistent with conventio.

Given the concept of bipolar spectrum which extends across the family, healthy relatives of bipolar patients, which are a population at high risk for developing mood disorders, may have temperamental deregulations.

To compare the mean scores of affective temperaments among patients with familial bipolar I disorder and their unaffected first-degree relatives.

This was a cross-sectional study, concerning 50 families of bipolar I disorder which have at least two patients with bipolar I disorder (DSM-IV-TR). We have included 80 clinically recovered patients with bipolar I disorder and 120 unaffected first-degree relatives. The affective temperaments were assessed by Tunisian version of TEMPS-A. Dominant affective temperament is the temperament witch score was more than 2 SD of mean scores.

Mean scores of cyclothymic and hyperthymic temperaments were higher in bipolar I patients than in their healthy relatives. The difference was significant for only hyperthymic temperament (p=0.038) but it was not significant after adjustment for age, sex and school level. The rate of dominant affective temperament was not differed between bipolar I patients (26.3%) and their healthy relatives (20%). Investigating the role of family, we showed a significant association with depressive (p< 10-3), cyclothymic (p=10-3), irritable (p=0.023) and anxious (p=0.003) temperaments.

Our findings suggest that patient with family bipolar I disorder and their unaffected first-degree relatives had a temperamental deregulation which confirms the concept that affective temperaments are a potential phenotype of bipolar condition.

“Folie à deux” is also known in the ICD-10 as Induced Delusional Disorder. A subtype is “folie imposee” where the primary individual holds delusional beliefs shared by a secondary individual. When the delusional beliefs of the primary individual cease it is observed that the beliefs of the secondary individual also disappear. Mr A was a 36 year old Caucasian male presenting with an array of psychotic symptoms centred on a task which involved finding an energy source at the centre of the earth. Mrs A was highly resistant to his treatment and further investigation revealed a case of folie à deux.

To demonstrate the phenomenon of folie à deux.

Individual and combined interviews were held with Mr and Mrs A where the psychotic symptoms were discussed. A comprehensive study of Mr A's past and current psychopathology was also undertaken.

Mrs A shared the delusions of her partner and was strongly against treatment as it would nullify his delusions rendering him incapable of completing his task. Once treatment was facilitated, Mr A experienced a drop from his unusually high levels of energy which reflected an equal and immediate drop in energy levels of his partner which led her to further discourage him from medication. When Mr A's delusional beliefs lifted, it was apparent that his partner no longer held the same delusional beliefs.

We concluded this case fulfilled ICD-10 and DSM IV criteria for a shared delusional disorder (folie à deux) with specific sub-type “folie imposee”.

To examine the factors that influence mental health professional's prescription of antidepressant.

There are many studies on factors affecting decision of mental health professionals regarding selection of antidepressant. The clinical experience of the developing countries is different from that of the developed countries where nonpharmacological attributes of a drug like affordability and availability play a greater role in prescription of drug.

A semi-structured questionnaire was used to investigate which antidepressant was the preferred choice of psychiatrists and nurses and factors which influenced their decision making. Ethical permissions were obtained from local research and ethics committees.

The results of this study show that health professional would consider efficacy (64%) and tolerability (24%) to be the most important factors in choice of anti psychotics for themselves while efficacy (56%) and cost (24%) would be considered important factor while prescribing drugs to the patient.

Beside efficacy other factors like cost & affordability found to be the important factor in influencing the decision of the psychiatrists.

Divorce rates are high among wives of alcoholics and the most frequently identified cause is domestic strife in the form of harassment, torture or beating from the husband and or in-laws. However, there is only limited literature in this regard.

To study the stress, various coping styles and domestic violence among the wives of alcohol dependent individuals, who are admitted to the de-addiction centre of a tertiary care psychiatric centre in India.

An exploratory descriptive design was adopted. Wives of 75 alcohol dependent individuals, admitted in the deaddiction centre of National Institute of Mental Health and Neuro Sciences, Bangalore were selected. Data was collected by personal interviews with all 75 wives using socio-demographic information schedule, Perceived Stress Scale, Coping with Drinking Questionnaire, and Domestic Violence Questionnaire.

Wives of alcohol dependent patients had high levels of perceived stress. Avoidance, discord, fearful withdrawal and sexual withdrawal were the most common coping components identified. Domestic violence was experienced by 90% women, mostly intellectual (69%), emotional (59%), social (58%), physical (47%), economic (42%) and sexual violence (27%). Domestic violence was found to increase the stress and influences the coping styles of these women.

Domestic violence is a major problem in wives of alcoholics. Routine screening for domestic violence is needed during the intake of alcoholic for substance abuse treatment so that appropriate interventions can be planned. There is a need for substance abuse treatment providers to be trained on the issue of domestic violence.

Premature termination is common among patients treated for depression with either pharmacotherapy or psychotherapy. Yet little is known about factors associated with premature treatment termination among depressed patients. in other hand, there is conflicting evidence about the influence of personality disorder on outcome in depressive disorders.

The present study assesses whether personality may predict the dropout of a psychotherapy group for patients with depressive disorder.

A personality disorders (PDs) self-report questionnaire based on the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) was completed by 39 depressed outpatients. All patients attended a group-based CBT program for depression consisted of 10 weekly 90 minutes sessions. Patients were categorized in groups as completers vs. dropouts. Dropout was defined as attendance at less than 7 sessions. Differences between groups were tested using Student's t-test and in order to measure the specific contribution of personality on dropout a logistic regression analyses were performed.

Comparing treatment completers (67%) vs. dropouts (33%), groups differed significantly on number of items in schizotypal, narcissistic and borderline PDs. The dropout group scored significantly higher on these PDs than the completer group. Scores on borderline personality disorder emerged as a significant predictor of dropout.

Depressed outpatients with comorbid borderline traits are at higher risk of premature termination and may require modified treatment strategies.