In the field of psychiatric expertise, formal quality criteria such as organization, duration and extent of psychiatric exploration are of significant importance to ensure better transparency and reliability. Psychiatric diagnosis should be made according to DSM-IV or ICD-10 criteria. Following an extensive literature review (medline 1980-2007) we will discuss the importance of the use of The Mini International Neuropsychiatric Interview (M.I.N.I.), and other validated clinical diagnosis tools in psychiatric expert practice.

Beside the clinical validated scales, patients with neurotic or personality disorder require particular clinical experience for a good diagnostic assessment, especially because little evidence based medicine in psychiatric expert practice is available. Thus, we emphasize the interest of a good educational program about expert practice for residents.

Large epidemiological studies are required in order to clarify the evolution of patients after the expertise process. Furthermore, randomized studies should optimize the efficacy of a specific combined therapeutic program concerning patients with somatoform disorders.

The creation of an international network of clinicians with experience in psychiatric expert practice could be an important tool, in order to develop and promote evidence based guidelines for diagnosis and therapeutic issues around psychiatric expert practice.

We examined a variety of male patients with gender identity disorder on the basis of a style of “conviction” of gender identity disorder. From the point of view of the clinic, we took the variety as framework of “the core group” and “the periphery group”. The core group consists of those who have, already since childhood, manifested a special longing for feminine clothes and behaviors. The periphery group consists of those with an uncomfortable feeling about their own sex that did not begin until adolescence. The present study is based on the author's clinical experience with 27 subjects, among which 14 patients belonged to the core group and 13 to the periphery group.

In the patients of the core group, their subject was formed by a self-referential statement “I am a woman.” It can be considered that since their early childhood, their “ideal ego” led them to experience this longing and that “I” situating its own body in an “ideal ego”, brought them gradually to express “I am a woman.” This had the structure of a “first-person conviction.”

In the periphery group, on the contrary, a consistent insufficiency and avoidance of masculinity could to be pointed out. We recognized homosexuality, transvestism, adolescent paranoia, and certain neuroses in the background of the periphery group. In the periphery group it may be required to engage in the psychotherapeutic task of investigating what this “disgust with being male” derives from.

Deaf people as a group experience a greater number of mental health problems than the general population (REF). Clinical diagnosis and intervention of deaf patients is particularly complex. This is due to the fact that deaf people very often use a different mode of communication i.e. sign language. In turn, deaf people's psychological and psychiatric intervention requires the establishment of special mental health unit with specialised professionals. These professionals must be highly qualified in alternative methods of communication and on issues relating to Deaf community and culture. The Gregorio Marañon Hospital in Madrid is one of the few mental health units for deaf people in Europe -that is, the Unidad de Salud Mental para Sordos (USMS). This unique service counts with a psychiatrists, a psychologist and a social worker. The aim of this presentation is twofold: to report to the scientific community the particularities of intervening with deaf population; and to highlight the need to adapt the diagnosis process and psychotherapy to this clients' needs. The poster presents descriptive data on deaf patients seen/treated at the USMS during 2007. Results will present patients' spread on the following variables: gender, age, referral, aetiology, age of deafness onset, preferred language, psychiatric diagnosis and treatment.

Self-injurious behaviors(SIB) may be described as a behavior compatible with obsessive compulsive disorder(OCD), as well as part of Impulse-Control Disorders(ICD).

At the mental Health Unit for the Deaf of the Gregorio Marañón Hospital in Madrid we have observed that our Deaf patients as a group experience a greater number of Genetic Syndromes than the general population. Clinical diagnosis and intervention of deaf patients is particularly complex, professionals that work with this population must update their knowledge in ORL, Nephrology and Ophthalmology. Our goal is to show how common are these syndromes among our patients treated at our unit from 2003 and describe their psychopathology. Most common genetics syndromes among our patients are Usher syndrome, Waardenburg, syndrome, Noonan syndrome, Cornelia de Lange syndrome and Pendred syndrome. The Gregorio Marañon Hospital in Madrid is one of the few mental health units for deaf people in Europe -that is, the Unidad de Salud Mental para Sordos (USMS). This unique service counts with a psychiatrists, a psychologist and a social worker.

The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling. Participants were 263 male and 23 female patients seeking treatment for pathological gambling and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for Pathological Gambling was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be reliable with an internal consistency coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.

Pain is a psychosomatic occurrence, primarily considering its neurobiological aspects. Chronic pain patients suffer from psychic comorbidities or even psychic diseases as somatoform disorders which often remain mis- and respectively underdiagnosed and consecutive untreated. Psychic comorbidities influence the pain in a neurobiological sense by lowering the pain threshold. Wrong treatments, somatic fixation, operations, chronification, iatrogenic impairment and psychosocial problems are possible consequences. It is fundamental to integrate the trias of pain, stress and affect into the diagnostics and treatments. The neurobiological stress axis, HPA- and LC-NE, is known to be activated by nociceptive- neuropathic input via cytokinins and influence pain. Chronic negative strain of the stress system may have neurobiological consequences as damage of the pain depressant systems, inter alia degeneration of hippocampus.

An interdisciplinary approach is inevitable and broad clinical diagnostics of high importance. Therefore we established a broad network of interdisciplinary liaisons with rheumatology, internal medicine, orthopaedics and dentistry. In our outpatient clinic we analyzed female and male chronic pain patients from different medical departments. They all had a complex and long lasting history of pain.

We applied clinical interviews and different test-parametric methods and figured out that undiscovered psychic comorbidities, wrong medication and specific biographic aspects in a biopsychosocial kind are inter alia the key factors of chronic pain suffering.

Our data demonstrate that an interdisciplinary approach considering pain as multifactor genesis and integrating neurobiological, biographic and psychosocial components is necessary to treat chronic pain patients and prevent further chronification.

In the present study, the reasons why people ask for psychological support according to their sex is being investigated. Data was obtained from the Association of Psychology & Psychiatry for Adults & Children (A.P.P.A.C.) from January 2002 until December 2006. The sample size was N=100, aged from 22 years to 65 years. Results indicated that there were population differences (62 women and 38 men) and statistically significant differences were found in the primary therapeutic goal of clients as well as their therapeutic course, according to their sex. More specifically, results indicated that women tend to seek counselling mostly for themselves and secondary for a family member: women aged 25-35 want to deal with personal problems, women aged 35-45 seek for counselling (mostly relationship-based), while women aged 45-65 mainly wish to resolve problems with their children. On the other hand, men aged 30-50 years usually require counselling when their symptoms seem to disable them to successfully function in their workplace. Men over 50 years old ask for counselling in order to resolve a problem concerning their children. These men usually end their sessions when symptoms become less severe, while women are found to be more consistent towards therapy. Finally, as far as their socioeconomic status is concerned research results indicated that men of high socioeconomic status do not easily accept that they need counselling, while women of high socioeconomic status are more receptive towards counselling.

Hwabyung meaning anger(fire) disease is an culture-related anger syndrome in Korea. According to the patients' explanation, reactive anger, resulting from being a victim of an unfair social situation, have to be suppressed so as not to jeopardize harmonious family or social relationships. However, if the unfair situations continue or repeat themselves, the suppressed anger "accumulates, becomes dense", and finally causes a disease, hwabyung. The symptoms are subjective anger and feeling unfair with anger-related bodily and behavioral symptoms including heat sensation, pushing-up, respiratory stuffiness, a mass in epigastrium, much talking, sighing, and going-out. Symptoms seem to symbolize the nature of fire(anger) and its partial suppression and/or partial releasing. Diagnostically hwabyung shares some symptoms of depression or anxiety but it was found to be different from depressive disorders or anxiety states by manifesting unique symptoms of subjective anger and anger-related somatic/behavioral symptoms. Based on research on this anger syndrome and other research on anger and anger-related psychiatric syndrome, author suggests a new conceptualization of "anger disorder".

Handicap as a result of cerebral palsy concerns mainly motor function, but is often combined with other problems. The aim of the study is measurements of manual function in children suffering from cerebral palsy, in comparison with epilepsy. The study was conducted on 40 children attending Special School Complex No103 in Poznań in whom cerebral palsy was recognized with accompanying epilepsy. In the investigated group there was one child with monoplegia, four with hemiplegia, seven with diplegia, two with atetosis, 22 children with quadriplegia and four children with mixed form of CP. All children were subjected to complex diagnosing of the functional fitness and functional development.

Despite the numerous advances in psychiatry such as neuroimaging techniques, structured interviews, and comprehensive diagnostic protocols, all too frequently a patient's symptomatology does not fit neatly into a recognized diagnostic category. Given the increasing popularity of treatment guidelines, purportedly predicated on hard science, clinical uncertainty becomes increasingly problematic, precisely because the guidelines are aimed at specific and discrete psychopathological categories. On the one hand, clinical reality is complex, contradictory, and most certainly contested. On the other, medical training and professional demands require that the psychiatrist demonstrate certainty, be it to patients, colleagues, health insurance providers, other third parties, and perhaps most controversially, to themselves. Faced with clinical uncertainty, the clinician may find herself or himself in a difficult situation: recognition of the uncertainty is regarded as an indication of poor professional performance, whereas assertion of a diagnosis or plan of treatment runs a very real possibility of contravening the beneficence principle. Clinical uncertainty is all the more pronounced in the face of certain mental disorders, cultural, age, and gender difference, and training model. This paper will examine some of the key factors related to clinical uncertainty and how it relates to clinical practice. It will be suggested that clinical uncertainty itself represents an important source of diagnostic information and rather than be ignored should in fact be incorporated into the diagnostic and treatment process.

A clinical case of alteration of behaviour is the unit of analysis. The cultural aspects play a major role in physical and mental health and in this case the subject was part of a family where mediunity was seen as a common gift. Even though, she looked for medical help after her mother-in-law had spoken by her mouth. This patient was also exposed to high dosages of corticoids for the treatment of Alopecia Areata (AA). Mental disorders induced by corticoids are well documented, in a variety of symptoms. When observed, this patient also met criteria for Dysthymic Disorder and the episode testified by her family could suggest a narrowing of the field of consciousness in a dissociative experience. The author raises some etiological hypothesis and presents a 2 years follow-up of the case and patient-doctor relationship.

The concept of “diagnosis” is discussed with regard to the fact that different scientific disciplines (i.e. chemistry, genetics, neurology, psychology, sociology, etc.) seem to lack a theoretical basic grid, enabling them to exchange and compare observations and interpretations of data. Various solutions have been offered to this problem: multidimensional diagnostic tools, and at present combining phrases (such as “neuro-psychological” or “psycho-social”) have become modern. Moreover, merely symptom-descriptive systems have evolved (such as the DSM system, ignoring causality). However, none of these solutions seem to resolve the problem of interdisciplinary exchange, but rather avoid it. The discussion explores this problem and suggests tentative interdisciplinary systemic assumptions, and a derived number of possible criteria for inter-disciplinary diagnostic practice.

(The discussion is based on the article “Current Problems in Diagnostic Theory and Practice – A Systemic Approach to Cross-Scientific Terms in the Diagnostic Babylon” by the speaker, published in Clinical Neuropsychiatry (2007), 4, 1, 23 -28) For copies please contact the author or Dr. Giovanni Fioriti, editore, Rome mail: [email protected])

The authors are concerned with the contribution of anxiety in origin of functional behavioural disorders of children. They attribute the intense sensing of anxiety with the shaping of one's personality. They analyse adaptation and adjustment, accommodation and assimilation to stressful conditions producing anxiety. They describe reactions of organism to the circumstances of the CAN syndrome and traumas. In these circumstances, a primary perception of reality is at stake that consequently leads to sociopathological features. The authors also provide opinions of psychoanalytical and behavioural schools on origin of personal decompensation and neurotic disorders. They deal with causes of panic disorder and other diseases, in which a stress trauma plays a role.

For these reasons the authors suggest to classify the CAN syndrome as a separate nosologic unit in the future ICD-11.