More than 80 % of patients experiencing their first depressive episode will have at least one new episode. Effective interventions to reduce the risk of relapse and recurrence are needed. Psychoeducation is a form of interactive education enhancing knowledge about patients’ illness, including its course, symptoms and treatment. Psychoeducational methods can also act as family intervention – already an evidence-based practice in schizophrenia and bipolar disorder. Only few studies have focused on the effect of psychoeducation, including family psychoeducation, in the prevention of new depressive episodes.

Purpose is to evaluate whether an intervention of psychoeducation for family members, compared to a control intervention, is effective in reducing the risk of new depressive episodes among patients that have achieved remission or partial remission of depressive symptoms after the acute phase of antidepressive treatment.

The project is based on a double-centre, randomized controlled trial where investigator and raters conducting psychometric assessments, will be blinded to treatment allocation. A total of 130 patients with unipolar depression in remission or partial remission will be included together with their closest relative. After baseline assessments, relatives will be randomized to either 4 sessions of a family psychoeducation program or 4 sessions in a social support group without any psychoeducational intervention. Patients will not participate in group sessions and they will continue their outpatient-treatment as usual.

Primary outcome is evaluated after 9 months and include rates of relapse as measured by HAM-D17 and rates of recurrence according to DMS-VI-R and HAM-D17.

National siege mentality, underlying the national threat, is surely socially and politically determined. However, we assumed that certain social attitudinal constructs and psychological predisposition might underlie a belief system such as the concept of national siege mentality is.

We tried to answer whether national collective narcissism, anomie, and psychopathic syndrome we developed may prove valuable in understanding the appearance and development of national siege mentality.

The aim of this research were: (1) To develop valid measure instruments that could be useful and efficient tools for assessing attitudinal and psychological tendencies in political-psychological and psychiatric research. (2) To find out the effects of national collective narcissism, anomie, and psychopathic syndrome on national siege mentality.

Confirmatory factor analysis (CFA) were performed to explore factorial and construct validity of the scales used in this research. A questionnaire was administered to randomly selected adults (N=544). Using structural equation modeling, this study examined the effects of exogenous variables in expressing national siege mentality.

Structural model indicated that national collective narcissism, anomie, and psychopathic personality syndrome showed significant effects on national siege mentality (RMSEA=0.07, SRMR=0.05, CFI=0.96, NNFI=0.95).

The scales used in research proved to be reliable and valid measures of the attitudinal and personality constructs. Given the amount of variance of national siege mentality explained by exogenous variables (46 per cent), it is reasonable to assume that collective frustrations, political mistrust, and psychopathological predisposition may be underpinning the belief system labelled national siege mentality.

The epilepsy literature shows a high prevalence of psychological and social disorders which are considered more handicapping than seizures themselves.

1. - To assess the quality of life (QOL) of patients with epilepsy.

2. - Determine the relationship between QOL and level of anxiety, depression and coping strategies.

It was a cross-sectional study involving 50 subjects with epilepsy and followed in the outpatient psychiatry department. The state-trait anxiety inventory was used to assess the level of anxiety, whereas the Beck depression inventory was used to measure the severity of depression. The QOL was assessed using the quality of life in epilepsy inventory (QOLIE -31). The items of the Brief COPE were used to assess coping strategies.

Coping strategies most frequently used were: emotional support (mean score = 5.52), acceptance (mean score = 5.22) and the emotional expression (mean score = 4.18), but none used the strategies of problem avoidance and self-blame.

The average overall score of QOL of our patients was 71.66. It was significantly higher in patients with a minimum level of anxiety (p = 0.012) and those using active coping strategies (p << 0.005), acceptance (p << 0.005) and distraction (p = 0.015). There was no statistically significant relationship between the level of QOL and that of depression.

Our results emphasize the importance of reinforcing strategies of adjustment to illness and the role of the anxiety associated with the unpredictability of seizures; it seems to have an important impact on QOL of patients with epilepsy.

The association between anxiety disorders and verified coronary heart disease (CHD) remains to be clarified.

To report the prognostic association between anxiety disorder subtypes and subsequent major adverse cardiac events (MACE), report anxiety disorder prevalence in CHD, and the efficacy of randomized controlled trials (RCTs).

A comprehensive literature search was conducted for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE and RCTs. From 4,041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence), no RCTs were eligible.

Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n = 2851). There was a non-significant association between GAD and MACE risk (Risk Ratio = 1.20, 95% CI .86 – 1.68, p = .28) however the effect size was highly significant in outpatient samples with adjustment for covariates (adjusted hazard ratio = 1.94, 95% CI 1.45 – 2.60, p <.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28 – 64.01) and substantial heterogeneity between studies and anxiety disorder subtypes. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also significantly higher in DSM-III-R versus DSM-IV taxonomies (13.40% vs 3.43%, p <001; 11.12% vs. 6.80%, p <.001 respectively).

The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in the CHD population.

Treatment non-adherence is a major factor contributingto poor clinical outcomes in patients with mental disorders. Patient adherenceto treatment is likely to be influenced by a complex interaction of treatment, patient, and sociodemographic and clinical factors. Understandwhich factors identified by patient may have a high impact in treatmentadherence, can enable thedevelopment of more effective strategies.

a. to assess the factors associated with non-adherenceidentified by patients with mental health disorders(MHD).

The study explored preditors related with non-adherenceidentified by patients with MHD.

In this cross sectional study we use a conveniencesample of patients with MHD. The patients completed a clinical and socio-demographicquestionnaire and additional measures to assess illness perception, symptomseverity, treatment adherence and attitudes towards medication. The completionof the questionnaires took approximately 45 min.

A convenience sampleof 121 patients (mean age= 39.8; ± 9.3) in treatment in a variety of settings is beingcollected in the mental health departments of threegeneral hospitals in Lisbon great area. The majority ofpatients identified the following factors related to treatment as their reasonfor non-adherence: side effects (50.4%;n=61); lack insight (49.6%;n=60) and no recognition the needof treatment (34.7%; n=42)

The results of this study can be used to further our understandingregarding adherence and non-adherence over time, better identification ofpatients who are at risk for becoming non-adherent and who will have difficultydeveloping adherence, and interventions to prevent such problems.

Major depression is the most prevalent psychiatric disorder with high relapse rates. Following usual treatment, mood may improve but neurocognitive difficulties often persist, preventing full return to normal social function. These deficits worsen with repeated depressive episodes and are a significant predictor of relapse. The efficacy of neurocognitive remediation therapy (NCRT) to rehabilitate cognition has been demonstrated in several neurological and psychiatric populations but randomised controlled trials (RCT) have not been conducted in depression.

Conduct two randomised controlled pilot studies to determine the feasibility and obtain preliminary efficacy data of NCRT in (1) acutely depressed, hospitalised patients; and (2) community-living remitters from recurrent depression.

In Pilot1, 24 inpatients hospitalised for major depression were randomised to computerised NCRT or playing computer games for five weeks with four one-hour individual sessions weekly. NCRT targeted divided attention, working memory and planning. In Pilot2, 20 community-living remitters from recurrent depression were randomised to the same intervention arms, but their administration was home-based from the programme start. In both studies, before the intervention start and within a week of the final session, standardised assessments of cognition and depression severity were conducted.

The feasibility assessment demonstrated good recruitment and compliance rates, excellent acceptance of randomisation. Preliminary outcome data showed improvement in 80% of the targeted cognitive domains following NCRT comparatively to the control condition.

These pilot studies support the feasibility and value of conducting an RCT of computerised NCRT for neurocognitive deficits in both acutely depressed and remitted individuals.

Wernicke's encephalopathy is an acute neuropsychiatric disorder which occurs as a direct result of a thiamine deficiency. Prevalence of Wernicke's encephalopathy is 1.4-2.2 % in the general population with an increased rate in known alcoholics of 12.5 %, and 35% in alcoholics with cerebellar damage. Wernicke's encephalopathy is missed on clinical examination in up to 75-80% of cases and only verified on autopsy. Thiamine deficiency can occur due to either alcoholic or nonalcoholic causes.

1. 1. Early and adequate intervention may prevent the development of Wernicke's encephalopathy.

2. 2. Early detection of Wernicke's encephalopathy is crucial in preventing the severe neuropsychiatric complications that may result.

3. 3. Aggressive treatment with high dose thiamine may reverse symptoms of Wernicke's encephalopathy and prevent the progression to Korsakoff's syndrome.

1. 1. Adequate and early prevention and treatment reduces morbidity and mortality associated with Wernicke's encephalopathy.

2. 2. Proper medical intervention significantly decreases the length of stay.

3. 3. By preventing progress of Wernicke's encephalopathy to Korsakoff syndrome, the cost of care can be significantly diminished.

We present a case series of patients with Wernicke's encephalopathy that were identified and treated by consultation-liaison psychiatrist and review of relevant literature.

Seven patients were diagnosed with Wernicke's encephalopathy. All patients were aggressively treated with high dose IV thiamine. All patients improved and were discharged in a stable condition. None of them progressed to Korsakoff.

The role of psychiatry in preventing, identifying, treating Wernicke's encephalopathy and educating the primary team had significant impact on improving patient's care and prognosis.

The aim of the research is to study personality traits of alcohol-dependent women, to reveal the personality-related factors preconditioning the disease onset and distinctive features of the clinical course of alcohol dependence.

A group of 60 women (average age of 42,5) was examined using the structured interview method and personality test questionnaires – MMPI, TCI, BIG-5, WAIS.

Labile, epileptoid, cycloid, and hysterical (histrionic) traits were prevalent in women under examination. According to the MMPI results, the average personality profile is characterized by high values on Scale 6 (Pt), Scale 8 (Sc), Scale 4 (Pd), while the values on Scale 10 (Si) and Scale 1 (HS) were low. The respondents can be described as disharmonious, prone to affective responses, and low conformity. As a rule, such women have poorly developed self-control, solve their problems in irrational ways, and sometimes lose touch with reality. They do not adhere to socially accepted norms of behavior and mostly reside in the world of their subjective experiences. Therewith, these women feel a deep need for support, attention and empathy. All of the above-mentioned prevents them from achieving success in their activities and causes an emotional distress relieved through alcohol consumption. They perceive alcohol as a means to cope with the problems.

Further study of personality traits of alcohol-dependent women along with consideration of biological and social factors will enable to determine the pathoplastic influence of the constitutional basis on the alcoholism clinical course. This will help to develop the methods of person-centered psychotherapy and to increase the efficiency of medical treatment.

The studies investigating antisocial personality disorder are mostly applied to subjects in prison.) In the literature, it is shown that 50% – 75 % of the prisoners are diagnosed as ASPD, and only 15% -25% of the patients can be defined “psychopathic”. Comorbidity rates may change in different populations.

In this study, we aimed to investigate comorbid disorders in a Turkish patient sample with the diagnosis of antisocial personality disorder (ASPD) who are not in prison and we investigated its relationship with psychopathy levels.

140 male subjects were included in the study. None of them had been in the prison on admission. They all had the diagnoses of ASPD according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) diagnostic criteria. Socio-demographic data form, Structured Clinical Interview for DSM- Axis 1 Disorders and Axis 2 Disorders (SCID-I, SCID-II), and Hare Psychopathy Checklist-Revised (PCL-R) were applied.

Most commonly seen comorbid disorders were as follows: substance use disorders (66,9%), alcohol use disorders (65,4%) and adjustment disorders (36,4%). In the high psychopathy group 'Current and Lifetime Alcohol and Substance Use Disorder” and 'Generalized Anxiety Disorder” were detected significantly more than those of the low psychopathy group.

This study supplies important epidemiological data about ASPD comorbidity. Of note, none of the subjects were in the prison during the study. Psychopathy also seems like a predictor in comorbid situations.

HCV is the most frequent cause of chronic hepatitis and a risk factor for liver cirrhosis and hepatocellular carcinoma. Despite recent advances in HCV therapy, Pegylated Interferon Alpha (PegIFNα) remains the treatment backbone, even if it can cause serious neuropsychiatric symptoms (from irritability to psychosis) that could reduce treatment compliance to the point of failure.

To describe the neuropsychiatric symptoms during PegIFNα treatment in a group of HCV patients without any psychiatric morbidity at enrolment, and drop-out rate.

Eleven HCV+ outpatients, scheduled for PegIFNα treatment, were assessed at enrolment (T0), and after one (T1) and two months (T2) to investigate psychiatric symptoms by means of SCID-I, HAM-D, HAM-A, PHQ-9, MDRS and MRS. A pharmacological therapy, based on clinical evidence, were provided at their onset.

Comparing T0, T1 and T2 mean scores, we found a increasing trend in all psychometric scales, statistically significant for HAM-D and HAM-A.

An item-by-item analysis showed a significative increase in the mean scores of HAM-D somatic items (#11 to 14), and HAM-A Anxious mood(#1), Tension(#2) and somatic items (#8 to 10, 12, 13).

Drop-up occurred in two outpatients (18%), both after T1 assessment, due to HCV relapse (one patient), and serious somatic side effects (one patient).

Patients at early stages of PegIFNα treatment may develop a psychiatric comorbidity, particularly tension, anxiety and somatic symptoms, even without a psychiatric hystory.

This confirmes a need for psychiatric assessment in patients scheduled for antiviral therapy, to identify early symptoms and reduce drop-out rates.

The Five Personality Factors Model received tremendous empirical attention in the conceptualization of personality structure in the current literature. This model is comprised of five factors: Neuroticism, Extraversion, and Openness to Experience, Agreeableness, and Conscientiousness.

Examining differences between Kuwaiti and Egyptian undergraduates in the Five Personality Factors.

The participants were 3915 first year undergraduates: 2109 Kuwaitis (900 males and 1209 females; mean age = 19.47±1.14) and 1806 Egyptian (888 males and 918 females; mean age = 19.87±1.33). The Arabic version of NEO-PI-R was administered to participants. Alpha reliability and two-way ANOVA were used in this study.

Internal consistency was satisfactory for the Neuroticism, Extraversion, and Openness to Experience, Agreeableness, and Conscientiousness subscales respectively (Cronbach’s alpha = .83, .82, .79, .81, .84) for Kuwaitis and (Cronbach’s alpha = .84, .78, .78, .82, .85) for Egyptians. The results revealed significant cultural differences where the Egyptians obtained a higher score than Kuwaitis did on neuroticism, extraversion, agreeableness and conscientiousness. Moreover, the results revealed significant gender differences in which Kuwaiti males obtained a higher score than females on extraversion and conscientiousness, while females obtained higher scores than males in neuroticism and openness. Additionally, there were significant gender differences in the Egyptian sample in where females obtained higher scores than males on neuroticism and agreeableness. Furthermore, the results demonstrated an interaction between genders and cultures on neuroticism, extraversion and agreeableness.

The current data provides strong evidence that the interaction between both genders and cultures on personality deserves further investigation.

Emotion dysregulation and impulsivity are considered an hallmark of personality pathology (Livesley & Jang, 2000), even though research has mainly regarded Borderline Personality Disorder (BPD; e.g., Linehan, 1993). Recently, some scholars proposed that facets of emotion dysregulation and impulsivity are likely to be associated with different PD traits across all clusters (Garofalo et al., 2014; Sarkar & Adshead, 2006), highlighting significant association with all PDs included in the DSM-5 (APA, 2013).

We sought to expand extant research exploring whether also PDs not included in the DSM nosography, yet clinically relevant and suggested for future research, were associated with facets of emotion dysregulation.

In a community sample, we tested the unique associations between facets of emotion dysregulation and impulsivity with traits of 3 PDs Not Otherwise Specified: Sadistic PD, Depressive PD, and Passive-aggressive PD.

We recruited 399 community-dwelling participants (mean age= 37.91; 56.6% male). They were administered the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), the Barratt Impulsiveness Scale (BIS-11, Patton et al., 1995) and the Millon Clinical Multiaxial Inventory (MCMI-III; Millon, 2006).

Multiple regression analyses showed that different facets of emotion dysregulation were associated with all PD traits considered. Further, impulsivity accounted for a significant amount of additional variance in Sadistic and Passive-aggressive features above and beyond emotion dysregulation.

Emotion dysregulation and impulsivity seemed to confirm their role as relevant features of personality pathology across different forms of PDs.

Depression is common in patients suffering from somatic diseases particularly chronic, life threatening and disabling diseases such as renal impairment requiring hemodyalisis. It contributes to further deterioration of the quality of life. The goal of consultation psychiatry is to advise screening and early interventions for this most often treatable disorder.

To assess and compare presence and severity of depression, and subjective assessment of QOL between patients on hemodialysis and healthy subjects.

This study included 80 subjects age between 19 and 82 (× 49.6 ± 14.2) on continuous hemodyalis and 40 subjects from the general population of Zenica. Assessment instruments used: Beck Depression Inventory – BDI; SF36- QOL, and sociodemographic questionnaire.

The subjects in the experimental group had significantly higher (p<0.05) average score on BDI, 17.1 ± 9.4, corresponding to mild to moderate depression compared with the subjects in control group who scored an average of 8.5 ± 7.0 (range 2-39), which corresponds to absence of depression. Comparison of results on a scale for assessing the quality of life SF 36, indicates that the subjects in the control had a higher average score or higher quality of life compared to the experimental group.

The research results indicate a significant difference in the presence of depressive symptoms and in the subjective assessment of QOL in patients on hemodialysis compared to healthy subjects. This justifies routine screening for depression in this group of patients.

Deficits in social cognition are related to functional disability in schizophrenia. Therefore, new treatment programs should address these deficits in schizophrenia.

The goal of this study was to test if neurocognition, social cognitive deficits and functional disability improve after group cognitive remediation with a neuropsychological tool: the REHACOP program.

One hundred and one patients with schizophrenia were randomly allocated into experimental or control groups. The patients allocated on the experimental group (N= 52) received a group cognitive rehabilitation treatment using REHACOP. They attended 36 sessions of 90 minutes during three months. During the same time and frequency, patients under control condition (N=49) received Occupational activities. Both groups received treatment as usual (TAU). Patients underwent clinical, neuropsychological, social cognitive (Theory of mind, emotional perception, attributional style and social perception) and functional outcome (UPSA) pre- and post treatment assessments.

Repeated measures of MANOVA showed that Group (REHACOP vs occupational therapy) x Time (pre vs post-treatment) interactions were significant for neurocognition total score (F=16.54, p<0.001), social perception (F=8.05, p<0.01), theory of mind (F=14.19, p<0.001) and UPSA (F=12.14, p<0.001) showing that experimental group obtained significant improvement when compared to controls. Attributional style did not show significant improvements.

Our results suggest that REHACOP is an effective group cognitive remediation program for minimizing existing cognitive, social cognitive and functional disability.

Psychiatric comorbidity is an important aspect of neurological disorders. It affects about 30-50% of neurologic patients but is frequently underrecognized.

Our objective was to determine the prevalence and severity of the symptoms of mental disorders in neurologic in-patients.

Between May and September 2014, all neurologic in-patients of a university neurologic center were asked to complete two self report questionnaires for assessing symptoms of mental disorders, namely the Beck Depression Inventory (BDI) and the Brief Symptom Inventory (BSI), which allow to assess a range of nine different psychiatric domains. We performed a multivariate covariance analysis in order to relate the type and frequency of symptoms of mental disorders with the neurological discharge diagnosis, while age, gender, and duration of in-patient treatment served as putative covariates.

Of all responders (n = 157), 51% stated to have suffered from psychological distress within the past seven days, and 43% indicated depressive symptoms (21% mild, 17% moderate, 5% severe). The mean global severity index GSI (M = 0.64, SD = 0.52) exceeded the 1 SD range of healthy persons but was lower than that of psychiatric in-patients known from the literature. Furthermore, our subanalysis revealed different patterns of symptoms of mental disorders between neurologic patients with degenerative, vascular, demyelinating or epileptic disoders.

Psychometric measurement is useful to characterize the burden of the symptoms of mental disorders and will be used to further develop the psychiatric liaison services.

Although many international guidelines emphasize the need to provide psychoeducational family intervention (PFI) together with pharmacological treatments for optimal management of bipolar I patients, this intervention is not routinely provided in mental health centres.

The Department of Psychiatry of the University of Naples SUN has promoted a study to identify obstacles for the implementation of the PFI in the routine care.

To identify mental health professionals’ benefits and difficulties in the implementation of PFI.

The Family Intervention Schedule was administered to mental health professionals at baseline, at T1, T2, T3, T4, T5 supervision meetings.

Twenty-two mental health professionals were recruited, 45% were psychiatrists, with a mean age of 37.4(±7.3). The participants had been working in psychiatry for a mean of 9.1 (±6.5) years and the majority of them stated to be routinely in contact with patients and their relatives. At the beginning of the study, the highest levels of difficulties regarded:1)the integration of PFI with other work responsibilities;2)the lack of time to run the intervention;3)the identification of suitable families. Among benefits, participants reported an increased feeling of confidence in relation to their work (p<.05) and an improvement in the relationships with the service users’ families (p<.01). Difficulties tended to decrease over time, being absent at the end of the protocol.

Although mental health professionals recognize that PFI has a positive impact on their work, many organizational obstacles prevent its routine use. A possible solution may be the promotion of peer-led PFIs, as already done by the US NAMI.

Attention deficit hyperactivity disorder (ADHD) has been found to be related to overweight/obesity in children and adolescents.

However, it is a heterogeneous disorder, and the relationships between the dimensions of ADHD and overweight/obesity are not clear.

The aim of this study was to explore which dimensions of the disorder are specifically associated with overweight/obesity.

The study sample consisted of 300 treatment naive children with ADHD and 75 healthy controls aged 7–17 years. The ADHD module of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Versionwasused to diagnose ADHD. The severity of ADHD symptoms was assessed via Conners’ Parent Rating Scale (CPRS). The weight, height, and breast-feeding duration of the study samples and controls were recorded. The body mass index (BMI) of the participants was categorized according to the national age and sex speci?c reference values.

The rate of overweight/obese children was higher in the ADHD group. The association between ADHD symptoms and BMI percentile scores was evaluated using structural equation modeling. In that model, it was observed that the inattention and oppositionality subscores of the CPRS had a positive predictive effect on the BMI percentile scores of the children. However, the duration of breastfeeding showed a negative predictive effect on the BMI percentile scores.

These results showed the importance of inattention, oppositionality and breastfeeding durationon overweight/obesity in children and adolescents with ADHD. Longitudinal studies are needed to more fully understand this relationship and the mechanisms underlying the association between ADHD and overweight/obesity.