To study the effect of vital exhaustion (VE) on relative risk of stroke in female population of 25-64 years during 16 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” (MOPSY) program random representative sample of women aged 25-64 years (n=870) were surveyed in Novosibirsk in 1994. Questionnaire 'MOPSY” was used to measure vital exhaustion (VE). From 1995 to 2010 women were followed for 16 years for the incidence of AH. Cox proportional regression was used for risk (HR) assessment.

The prevalence of high level of VE in women aged 25-64 years was 31.2%.

Stroke was developed in 35 (6.3%) women over 16 years of study. Within 16 years of follow-up women with VE had 3.34-fold risk of stroke (95.0%CI:1.02-10.93; p>0.05) than those without VE. There was a tendency in increasing of stroke rate incidence in those with VE: in married women compared to unmarried ones and widowed; in those with secondary specialized education compared to lower educational levels; in first-line managers and hard manual laborers compared to easy manual workers without VE.

The prevalence of VE in women aged 25-64 years is more than 30%. Women with VE had higher relative risk of stroke over 16 years of follow up. Rates of stroke tend to be higher in managers and manual workers and in married women.

Recent studies support an important role of microRNAs in cancer and major psychiatric disorders, through their regulotory role on the expression of multiple genes. The low incidence of cancer in patients with schizophrenia as a comorbidity status, is an old hypothesis which needs further investigation mainly on microRNAs function, through their oncosupressive or oncogenic activity, in the development of psychiatric disorders.

The expression pattern of a variety of different was investigated in a sample of patients suffering from schizophrenia (n=6), in a another sample wit a solid tumor (n=10) and in a sample of patients with both schizophrenia and tumor (n=8). MiRNAs analysis was performed in whole blood samples using the miRCURY LNA TM microRNA Aray technology.

A number of 3 microRNAs showed a statistically significant differential expression between the 3 groups. Specifically, significant down-regulation of the let-7p-5p, miR-98-5p and miR-183-5p in the study groups of tumor alone and and tumorand schizophrenia.

The results of the present study that let-7, miR-98 and miR-183 might play an important oncosuppressive role through their regulatory impact in gene expression irrespective of the presence of schizophrenia. Further studies are warranted in order to investigate of these and other mico-RNAs in the molecular pathways of schizophrenia and of other major psychiatric disorders.

“Apple” body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders, especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far.

To explore the association between WHR and symptoms of anxiety and depression in a female primary care sample.

Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy Practice. Exclusion criteria: age >40 or >80; use of antidepressants or antipsychotics; previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA.

125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score (β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were found in older groups.

'Pear” body shape (WHR>1), with a peripheral distribution of fat, is inversely associated to symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple” model, with a central fat distribution, could explain the lack of correlations in women >60 years.

Telepsychiatry is a new method of providing medical care with the use of modern communication technologies. The objective of this study was to examine patient's knowledge about the term ‘telepsychiatry’ and to check their opinion about this way of contacting with a doctor.

To achieve this, the anonymous survey has been carried out on a group of 64 patients aged 24-77. 40 women and 24 men participated in the study, all of them were treated in different clinical settings of the Department of Psychiatry and Psychotherapy in Katowice, Poland.

Preliminary results show, that the majority of respondents have never heard of that term and do not know what it means. However, to every question concerning the utility of telepsychiatry (e.g. ‘Can doctor's contact with patient via video connections be helpful in actual well-being assessment?’) more than half of the participants gave a positive answer. 58 % of patients acknowledged, that doctor's contact with the patient via video connection could be complementary to the eye-to-eye conversation, but it could not replace it. What is interesting, people aged 25-49 as well as women are more prone to reply ‘I don't know. Additionally, outpatient and day psychotherapy ward participants seem to be less willing to attribute positive characteristics to telepsychiatry.

Respondents, regardless of their education, age, gender or diagnose, perceive telepsychiatry advantages. In connection with that, implementing this method into Polish medical service seems to be useful and is in accordance with patients opinion.

The presence of multiple pathological conditions in the form of comorbidity is present much more as a rule than an exception in all of the population of psychiatric patients. Medical and psychiatric comorbidity in general is more common in women than in men.

The aim of this study is to assess the prevalence of somatic comorbidity in female patients with different major psychiatric disorders who were hospitalized at the Female ward of the University Psychiatric Hospital Vrapce in 2014.

The data was collected from hospital medical records. The sample consisted of 56 female, all inpatient, diagnoses established by the ICD-10 criteria by attending psychiatrist.

Somatic comorbidity was present in 70% of patients. The most prevalent somatic disorder in comorbidity with psychiatric disorder was group of cardiovascular disorder (46%), followed by group of endocrine disorders (25%).

The results of this research show that the incidence of disease such as endocrine disorders (diabetes mellitus, the metabolic syndrome, thyroid dysfunction) and coronary heart disease is significantly higher in schizophrenia patient, than in mood affective disorder. There was difference between the age groups. Comorbidity was not found in younger population (mean age 45), while it was present in older population (mean age 57.1).

Somatic comorbidity is prevalent in psychiatric population with significant impact on their quality of life. There is obvious need to provide prompt and appropriate intervention avoiding iatrogenic complications.

Bipolar disorder is a frequent condition in the general population with a high morbimortality, which consists in dysfunctional temporal fluctuations between different mood phases during which frequently there is a lack of insight. Besides the pharmacological treatment, psychoeducational programs have proved to be a cost-effective approach to help patients recognize early signs and symptoms in order to prevent full-blown episodes, although its broad implementation is still difficult and costly [1].

The main aim of this study is to develop and clinically validate a smartphone application to monitor symptoms and signs in stable bipolar patients along with customized embedded psycho-education contents and empower the self-management of their disorder to avoid relapses and hospitalizations.

The study will be carried out in three different but complementary phases in order to fully include patients and therapist's preferences: 1. Feasibility study using SIMPLe 1.0 app (subjective information only). 2. Feedback-based improvement process which will incorporate the objective information. 3. Randomized controlled trial with two arms of 74 patients each (SIMPLe 2.0+TAU vs. TAU).

After the collaborative development of clinical algorithms to ensure adequate sensibility and specificity to detect relapses and personalize psychoeducational messages, a technical pilot test of SIMPLE 1.0 app is underway and the first patients are being recruited to start the 1st phase of the study in Mid-October of 2014.

The possibility to deliver personalized psychoeducation contents based on monitoring signs and symptoms through a smartphone seems a promising cost-effective method, although a clinical validation is necessary.

To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose.

An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363).

271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3%) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036).

Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research.

Children's beliefs regarding mental disorders depend on their age, but also on their education and contact with this field.

The study aims to explore children's knowledge and views on mental disorders, focusing on the definition and causes of mental illness and the way they perceive people with mental disorders.

A sample of 41 children aged 12-14 was analyzed. They completed a questionnaire designed by the authors including demographic data (age, gender), yes/no questions and open-ended questions about mental disorders. Data were analyzed quantitatively and qualitatively.

Most of the children described mental disorder in terms of thinking or behavioural disturbances, like 'not thinking clearly”, 'acting differently or abnormally” or 'a problem affecting the brain”. When asked to give examples of mental disorders, Alzheimer's Disease and Schizophrenia were the most frequently mentioned. The subjects believed that mental disorders can be caused by trauma, stress, environmental factors or family conflicts. Some of them thought that they are congenital or hereditary. 66% of the children do not know any person having a mental disorder. The ones who had contact with someone suffering from a mental illness were more informed about the subject. 69% of them thought that persons with mental disorders are dangerous and 7% that they are contagious.

Many children have little or no information about mental disorders, leading to false beliefs and stigma. Thus, education in this field and mental health promotion need to start at a young age.

Among 160 million population in Bangladesh most of them are living in the rural area and about 50% of them are female. In our society most of the female psychiatric patients don't come to the hospital or any private consultation centre of a psychiatrist for their treatment. They mostly depend on treatments practiced by the traditional healers.

To assess the pattern of psychiatric illness among the women visited to a private psychiatric consultation service in rural area of Bangladesh.

This descriptive cross sectional study was done among the women attending the authors private psychiatric consultation centre in Tangail district from January 2013 to June 2014. All the new patients were included in the study. Socio-demographic data were collected through a semi-structured questionnaire and psychiatric diagnosis were made by using DSM-IV-TR diagnostic criteria.

Total 1173 female patients were included in the study. Most of them were (68%) belonged to 20 years to 40 years of age group. Among the respondents most of them were housewife (62%) of lower class family. Most common psychiatric diagnosis were found major depressive disorder (19%). pain disorder (16%), somatization disorder (12%), schizophrenia (8%), obsessive compulsive disorder (8%), bipolar mood disorder (6%), conversion disorder (4%), adjustment disorder (4%), post partum psychosis (3%). Rest were diagnosed as phobic disorder, substance related disorder, generalized anxiety disorder, epilepsy and dementia,

The result of the study indicate that further expansion of psychiatric services in the rural area with special emphasis on early diagnosis and management of psychiatric patients. Policy makers and planners should give attention in this regard.

Chronic pain is one of the most underestimated and undertreated health care problems worldwide. It has major consequences either on the quality of life of the sufferer or on the health care system. Consequently, social burden is very high. The main reasons for this rely on inadequate evaluation and understanding of pain as well as lack of knowledge about the psychiatric disorders that may occur in many pain conditions.

The authors aim to define the role of psychiatrists in chronic pain management.

Literature review in PubMed and Cochrane databases using the following words: 'chronic pain', 'psychiatric disorders', 'comorbidities' and 'pain treatment'.

There is a clearly established link between chronic pain syndromes and psychopathology. The influence of chronic pain is especially prevalent in depression, anxiety, personality disorders, substance abuse and posttraumatic stress disorder. There are several reasons for including the psychiatrist in the management of chronic pain syndromes: 1) the high prevalence of psychopathology: 2) psychiatrists are more skilled to understand and evaluate the role of the cognitive and affective dimensions of pain as well as to identify susceptibility traits to the patient's experience, such as sexual abuse and neglect that predispose individuals to pain, substances use and concurrent mental health disorders.

Treatment of the patient with chronic pain is often ineffective. Chronic pain management requires a comprehensive workup and thoughtful treatment plan which balances comfort with function and rehabilitation. For this, it is necessary an interdisciplinary approach, in which psychiatry can play an important role.

To report a clinical case of SS in a 62-yr-old woman with postmastectomy pain syndrome, resulting from the addition of duloxetine to a medication regimen of sertraline and fentanyl. The review of the literature serves as an overview of the epidemiology, pathophysiology, clinical features, differential diagnosis and prevention of SS.

Literature review and clinical case description.

To our knowledge, few case-reports have been published including duloxetine as a precipitant agent of SS. Clinicians should be alert to this potential iatrogenic adverse interaction of serotoninergic antidepressants with commonly prescribed opioid analgesics in chronic pain patients.

Decreasing the hyper excitability of neurons through opening of voltage-gated potassium (Kv7, also termed as KCNQ) channels has been suggested as one of the protective mechanisms in the effective management of neuropathic pain. Reactive oxygen/nitrogen species and inflammatory pathways are well implicated in the pathophysiology of neuropathic pain. Further, M current generated by opening of KCNQ channels has been modulated by reactive oxygen/nitrogen species.

The present study has been designed to elucidate the nitric oxide modulatory mechanism in the protective effect of retigabine against spinal nerve ligation induced neuropathic pain in rats.

Ligation of L5 and L6 spinal nerves resulted alterations in various behavioral (as evident from marked increase in thermal and mechanical hyperalgesia and allodynia), biochemical (raised lipid peroxidation, nitrite, & depletion of GSH, SOD, catalase) and inflammatory parameters (raised TNF-alpha) as compared to naive treatment.

Administration of retigabine (10 mg/kg) for 28 days attenuated these behavioral, biochemical and inflammatory cascades as compared to control. Further, L-arginine (100 mg/kg) pretreatment with retigabine (5 mg/kg) significantly reversed the protective effect of retigabine in spinal nerve ligated rats. However, L-NAME (10 mg/kg) pretreatment with retigabine (5 mg/kg) significantly potentiated their protective effects which were significant as compared to their effect per se respectively.

Present study highlights the involvement of nitric oxide mechanism in the protective effect of retigabine against L5/L6 spinal nerve ligation induced behavioral and biochemical alterations in rats.

Nurses in the Western world have given considerable attention to the concepts of vulnerability and self-autonomy in recent decades.

A qualitative study was conducted with nurses to analyze the problems found by health care professionals in their ethical practices when providing care to patients with terminal diseases, in particular concerning aspects of self-autonomy and vulnerability, in respect to those patients and health care providers.

Using bioethics approach, an analysis of the context was carried out to apply a rigorous methodology in this studied area and fundamental concepts in ethical practices that are intermix. We recruited a purposive sample of research participants from among nurses who worked at a hospital located in the middle part of Portugal.

The transcribed interviews of 8 nurses were analyzed. The results identify the types of difficulty with ethical nuances, found by health care providers, in which constitutes a challenge to ethical practices. The interviewed nurses emphasized the need to broaden the arguments about this subject with other health care professionals faced with these cultural changes and ethical paradigms.

The staff's ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork.

In the last ten years it has sought a connection between the psychoanalysis and the neuroscience. The meeting point between these two branches is the neuropsychoanalysis [1].

A literature search was conducted on March 2014. PubMed and Scopus databases were used to find studies for inclusion in the systematic review. The keywords used for the literature search were: ‘psychoanalysis”, ‘psychoanalytic psychotherapy”, ‘psychodynamic”, ‘psychodynamic psychotherapy”, ‘fmri”, ‘functional neuroimaging” and ‘functional magnetic resonance”. keywords were used together with the logical operator ‘and”. Only studies wich compared functional magnetic resonance imaging results before and after psychoanalytic psychotherapy in adult subjects were taken into account. Two (n=2) potentially relevant studies were obtained for the systematic review.

As shown in the table, Buchheim et al. study results demostrate that the therapy hours modulated the attivaction of brain areas. After treatment, Fischmann et al. found a marked reduction in activation pattern.

The common results of the studies investigated in this systematic review is represented by a reduction, a modulation or a normalization of the activation areas before and after the psychoanalytic psychotherapy.

We aimed to evaluate the outcomes of Petals: a charitable organisation in Cambridgeshire. Petals provides counselling for women and couples who have suffered perinatal bereavement, or trauma during pregnancy or birth. This paper attempts to evaluate the effect of counseling interventions at this difficult time.

Outcomes were recorded in 42 patients using the CORE (Clinical Outcomes in

Routine Evaluation) system. CORE was developed to assess the effectiveness of psychological therapies. CORE-OM (CORE Outcome Measure) involves a

questionnaire that assesses subjective well-being, symptoms/problems, function, and risk to self and others. The CORE-OM questionnaire was completed before and after the counselling sessions.

The CORE-OM scores were summated into a global representation of severity.

Severity decreased in all patients. Symptoms of psychological pathology were also decreased in all cases.

A review of the available literature indicates that little is known about the efficacy of therapy for perinatal bereavement and trauma. These original data suggest convincing efficacy and benefits, but the numbers involved are small. Further trials with greater sample sizes are required.

In a case series of 100 patients presenting to psychiatric services with psychotic symptoms, Dalmau and colleagues identified that often young women, with key features such as tiredness and short-term memory impairment, were found to be suffering from NMDA-receptor autoimmune encephalitis (AIE). However, distinguishing AIE from true psychotic illness can be challenging. As a consequence, there is a need to help clinicians identify potential patients suffering from AIE.

To identify relevant clinical features of AIE and to propose a strategy that will help psychiatrists screen for AIE.

A review of the recent literature, and illustration with a clinical case.

AIE should be considered especially in female patients presenting in the context of headache, fever, and viral illness-type prodromes, with atypical psychotic symptoms such as agitation, bizarre behaviour, disinhibition, and poorly formed and segmented delusions. Neurocognitive symptoms such as rapid language disintegration and short term memory loss should also prompt further investigation. Progression of AIE leads to motor dysfunction (seizures, dyskinesia), and secondarily autonomic instability and hypoventilation. A young female with a prolonged and severe episode of manic psychosis presented with some of these features, which is why we considered AIE as a differential diagnosis.

Clinicians should consider AIE when they are faced with a young female presenting with psychotic symptoms and a history of autoimmune illness, with a protracted and unusually severe illness. Investigating for AIE provides an exciting opportunity for psychiatrists to work with neurologists within a multidisciplinary team.

Depressive episodes are common in bipolar illness. Treatment of bipolar depression is often problematic because standard antidepressants carry a number of disadvantages: apparent lower efficacy than in unipolar depression; risk of inducing mania; risk of inducing rapid cycling. Anticonvulsants such as carbamazepine, valproate and lamotrigine are useful in the management of bipolar disorder and they can prevent episodes of depression. There is less evidence that they have antidepressant efficacy but lamotrigine was shown to produce antidepressant effects in a placebo-controlled trial in bipolar depressed patients. Lamotrigine has a role in acute management of bipolar depression and is probably free of a risk of inducing mania or rapid cycling.

To determine the efficacy of lamotrigine in treatment of patients with bipolar depression.

Investigation of lamotrigine efficacy with bipolar depression in 3 month-follow-up and 6 months follow-up treatment with lamotrigine.

The sample consisted of 30 patients with bipolar depression, age range between 26 and 58. All subjects received monotherapy with lamotrigine in the period of six months. Subjects were assessed prior to therapy and in 3 and 6 months follow-up using the following instruments: The Clinical Global Impressions scale (CGI), and Hamilton Depression Rating Scale (HAM-D-21).

The difference between three assessments on CGI was statistically significant. The results indicate statistically significant reduction of depression on HAMD-21 following six months treatment with lamotrigine.

Lamotrigine proved to be efficient in the treatment of patients with bipolar depression for the subjects in this study.