Attention Deficit and Hyperactivity /Impulsivity Disorder (ADHD) is a highly prevalent neuropsychiatric condition, affecting as many as 1 % of the adult population. The scientific literature suggests that approximately 70 % of patients with ADHD have an additional disorder, making co-morbidity the rule, rather than the exception. Many individuals with ADHD are having more than one co-morbid disorder. The high prevalence of co-morbid psychiatric conditions increases the impairment, and complicates treatment. Furthermore, the societal and medical expenses associated with co-morbid conditions are extensive. The most prevalent co-morbid psychiatric conditions seen in both genders with ADHD are: affective disorders, anxiety disorders, personality disorders and substance use /dependence disorders. It has to be realized that co-morbidity was originally not conceived to signify that a patient had 2, 3, 4 or more psychiatric diagnoses at the same time, but to document the whole symptomatic syndrome in a patient. In this presentation, 100 patients with ADHD in an outpatient facility were consecutively examined with regard to co-morbid conditions. The diagnostic trajectory entailed a semi-structured clinical interview, collateral information, school reports and an extensive neuropsychological battery. Best estimate diagnoses were obtained. Although the results correspond to a large extent with those of similar studies, our sample included a relatively large proportion of patients with co-morbid psychosis. It has been suggested to classify ADHD and psychosis as a separate diagnostic entity. The rationale for this proposal will be discussed.

Noonan syndrome (NS) is a highly prevalent genetic disorder (1 in 1000 to 2500 live births). Inheritance is mainly autosomal dominant. It is autosomal recessive only in a small group of patients. NS is characterized by short stature, facial dysmorphia and a variety of heart defects. Virtually no research is found on cognitive and social functioning in adult patients, although there are some indications that NS is associated with affective processing impairments, inadequate social behaviour, and higher levels of anxiety. For this reason, the present study examines a group of adult Noonan patients (n=30; mean age 27 ± 12,8) on measures of psychiatric and cognitive functioning. Neuropsychiatric and (neuro)psychological characteristics were recorded, as well as information on the patients' medical and developmental history. Data are presented on the hereformentioned aspects, including stature, genetic subtyping, cardial defects, school performance, and social adaptation, the latter aspects being discussed against the background of cognitive functioning. As to psychopathology, only in a small amount of patients (n = 4), criteria for a DSM-IV mood and/or anxiety disorder were met. However, in more than half of the patients, emotion identification and verbalisation defects were found. It is argued that this pattern of disabilities can be understood in terms of the concept of alexithymia.

Executive functions (EF) optimize the efficiency and effectiveness of behaviour, allowing for behaviours that are more goal-oriented, independent, purposive and conceptually driven. Effective EF is vital to human autonomy; higher levels of EF lead to more adaptive, hence successful life.

Several measures of EF exist, but most of them measure only a single aspect of EF or have been developed in clinical populations containing items that tap the extreme (pathological) ends of behaviour, which often do not apply to most healthy adults. Furthermore, while beliefs about maladaptive and dysfunctional behaviour can only exist in the context of beliefs about healthy, effective and efficient behaviour, a person's perception of the effects of executive dysfunctioning on daily life is a major determinant of the perceived quality of life.

To apply the above in the study of EF, we examined psychometric properties of the Dutch version of the Executive Function Index (EFI), a self-report measure sampling a wide array of behavioural consequences in healthy individuals. It consists of 27 items, generated from recent literature concerning the relationships between EF and the prefrontal-subcortical systems. These items are divided into five subscales, named Motivational Drive, Organization, Impulse Control, Empathy, and Strategic Planning. Results lend support for the use of the EFI as a reliable self-report measure.

It is concluded that, in order to improve diagnostic accuracy and to contribute to differential diagnosis, we need instruments which consider the consequences of executive (dys)functioning on daily life in both healthy and psychiatric populations.

A male patient aged 35 was referred for pharmacological treatment of temper tantrums and impulsivity. His history showed feeding problems, growth retardation, delayed milestones, special educational needs and poor social skills. As a child he underwent surgical correction for hemicryptorchidism and benign thymoma. From the age of 19 he was employed in a sheltered workshop. He married at the age of 33.

The patient presented with complaints about lowered mood, anxieties, worrying and impulsivity. Neuropsychiatric evaluation revealed symptoms of a mild depression. His total IQ was 74 (WAIS). There were attention difficulties, slow information processing and increased distractibility. Somatic examination demonstrated a short stature, facial dysmorphias and broad thumbs and toes. Because of this combination of features he was examined by a clinical geneticist. A definite diagnosis of Rubenstein-Taybi syndrome (RTS) was established. The patient was given maintenance treated with citalopram in a dose of 20mg daily after which the mild symptoms of depression disappeared and the impulsivity ameliorated.

RTS has been mapped to 16p13.3 and its diagnosis is primarily clinical. It has been suggested that patients with RTS have an increased vulnerability for neuroleptic induced motor side effects. A great variety of somatic anomalies such as cryptorchidism and tumours, like in this case, may be present. Reports on psychopathology in adulthood are scarce and comprise mood disorders and obsessive compulsive spectrum disorders.

From this case report it is concluded that patients who present with lower intelligence and dysmorphias should always be examined for the possibility of a genetic syndrome.

Clinical psychiatry is confronted with the rapid expansion of the diagnostic facilities of molecular genetics and should therefore reconsider its basic diagnostic procedures. Psychiatric diagnosis should be supplemented by information about birth, developmental history, dysmorphias, congenital malformations, somatic anomalies and family history of both psychopathology and genetic disorders. In addition it should be stressed that psychiatric symptoms in genetic syndromes mostly represent a specific psychopathological phenotype, that does not meet categorical criteria. Recently, several genetic syndromes were found in a number of routinely referred adult patients. In none of the patients genetic analysis was considered previously. Some examples are presented. In all cases the genetic diagnosis had a major impact on the psychiatric diagnosis and treatment. It is concluded that psychiatrists have some knowledge about dysmorphias, relevant developmental issues and basis clinical genetics.

Although there is scarce literature on the cognitive and social functioning of patients with Noonan syndrome (NS), some evidence exists for a characteristic pattern of deficits in emotion identification and emotion verbalisation, which seems to be not attributable to intelligence. It has been suggested that this pattern could be best captured with the concept of alexithymia.

The present study examines convergent and discriminant validity of two well-known alexithymia measures, i.e., the Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire (BVAQ) in a sample of 28 patients with Noonan Syndrome (NS). To enable interpretative refinement, results were related to intelligence and to measures of empathy and motivational drive.

It was hypothesised that TAS-20 and BVAQ would show strong positive intercorrelations, independent of intelligence levels. Inverse correlations between alexithymia and both motivational drive and empathy were expected.

In line with expectations, TAS-20 and BVAQ showed positive intercorrelations, although convergence typically was found to be stronger for the cognitive aspects of alexithymia than for the affective aspects. As expected, empathy correlated negatively with alexithymia. However, intelligence nor motivational drive seemed to be related to alexithymia.

The present results lend support to the validity of alexithymia assessment in NS-patients. Interestingly, while empathy and motivational drive can be seen as executive aspects, results also suggest the adoption of a neuropsychological perspective when studying the alexithymia concept.

During the last decade there has been an increasing interest in the role of impulsivity and aggressiveness in psychosocial disturbances. Despite scientific efforts, several aspects of the relationships between these personality features and Personality Disorders, alcohol/drug abuse, and violence are still controversial. A relevant question concerns the reciprocal relationships between impulsivity and aggressiveness, and their interaction with other “action” personality traits or temperamental traits, e.g., sensation seeking. Another controversial topic is the identification of biological and neuropsychological markers of impulsivity and aggressiveness in order to get more objective measures of these personality traits than those produced by subjects' self-reports, and to obtain a deeper understanding of the phenotypic aspects underlying impulsive and aggressive behaviours as manifested in different forms of psychosocial disturbances. Starting from these considerations, the aim is to shed some light on the implications and consequences of impulsivity for psychosocial disturbances, such as criminality, abuse, and violence. The issue will be discussed in terms of development, possible underlying factors, and attitudes, which can be particularly relevant from both forensic and prevention points of view.

A case is described of a forty year old single man who made incriminating admissions about multiple perverse sexual practices during a psychiatric assessment including exhibiting in public places and putting a four year old girl's hand in his trousers for sexual stimulation. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. When groups of adolescent and adult patients were asked whether they would seek medical care or divulge personal information without a promise of confidentiality, many said no. We discuss issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor–patient relationship and failure to disclose in some situations could have serious implications for the well-being of the wider society. We draw comparison from cases in several jurisdictions and conclude that all doctors should be aware of the basic principles of confidentiality and the legal framework around which they are built. Doctors should not hesitate to discuss problem areas with their legal advisors before decisions are made regarding disclosure.

The aim of the present study was to determine the prevalence of mental disorder among male prisoners in Greece and to examine possible association between psychiatric disorders and the criminal history of the subjects. A randomly selected sample of 495 convicted prisoners was investigated, with structured psychiatric instruments. Psychiatric disorder was diagnosed in 45.06% of the sample. The main diagnoses were personality disorder 15.96%, substance misuse 14.54%, depression 4.44%, neurosis 3.64% and psychosis 2.63%.

Offenders were also classified according to the type of offense with which they were charged, in three major crime categories: non-violent, violent, and drug related crimes. Non-violent crimes represented 40.7% of all investigated criminal records, followed by drug related crimes 30.3%, and violent crimes 28.0%. Concerning the association between psychiatric diagnosis and criminal records personality disorders was significantly related to violent crimes p<0.05. There was also significant relation between substance misuse and drug related crimes p<0.05. Depression was also correlated to drug related crimes p<0.05. No other mental disorder related significantly to any crime category investigated.

Many authors have described early signs of abnormal sexuality as predictors of endogenous psychotic disorders, or their premonitory, initial or manifest symptoms. Differences in clinical presentation of abnormal sexual behaviour (ASB) in different nosologic forms have been discussed.

103 persons that committed sexual crimes were examined during a complex forensic sexologic and psychiatric evaluation to compare a clinic presentation of sexual disorders in different mental disorders (MD). Clinical psychopathological and sexological methods were used. MD was diagnosed primarily during the psychiatric evaluation in 82 cases (79.1%). 26 persons had schizophrenia and schizotypal disorders (F20-F21 in ICD-10, group 1), 35 had MD due to brain damage and dysfunction (F06-F07, group 2), 21 had disorders of adult personality and behaviour (F60-F61, group 3). Diagnostic criteria of ICD-10 (F65) and The Scale of Sexual Dysontogenesis were used to assess the elements of ASB.

Statistic analysis showed that the chance for ASB to precede the clinical presentation of MD is higher in the group 1 (26.9%). ASB emerged later or simultaneously with MD in groups 2 (88.6%, 5.7%) and 3 (80.9%, 14.3%).

Modern schizophrenia pathogenesis theories relate emerging of primary negative alterations to pathology of brain systems that modulate functions of the frontal cortex. Early ASB may be attributed to involving limbic and prefrontal structures into the primary pathologic neurofunctional process. These structures participate in forming of sexual behaviour and primary gender identification. Thus, ASB is a marker of increased risk of endogenous MD and can be used for early diagnostics of the disorders.

We are witnessing increased divorce rate, and consequently the need to resolve problems related to child custody. According to some data, every third marriage results in disintegration. The child often becomes an object and tools in resolving this complex issue.

Family environment is a natural environment of a child, one of the crucial factors in process of child's socialization. Basic generator of named socialization is a family atmosphere conditioned by predominant feelings in domestic relations. These relations are realized within the mother-child-father triangle adjoined by other members of the family. The evolution of civilization leads to changes in behavior and concept of human rights.

Divorce proceeding itself is one of the rights of both parents, i.e. adult members. From legal point of view, position of minors is passive, defensive. Therefore, divorce may be presented as exercising divorce rights consumed by adults. The most dramatic conflict in divorce proceeding is so called child custody, used by the parents as figurehead for exercising rights on their child.

During the course of exercising parental rights, there are some parents where we can identify a competence and confrontation of equal rights or conflict of individual parental rights.

An expert being summoned to the court in divorce proceeding, related to issues of child custody is most frequently a psychologist, psychiatrist, social worker by its vocation, and seldom, pedagogue or psychotherapist.

Family, school and society are somewhat similar to the palace- If you take away a stone from its foundation, everything starts to collapse.

The city of Marrakesh is the first capital of the tourism in Morocco, because of its cultural and patrimonial wealth. Since these last years, Marrakech displays a rise important of the rate of occupation of its tourist lodging establishments, the French tourism occupies an important community.

In the same way, we noticed, an increase of the number of the foreign nationals hospitalized to the mental hospital Ibn Nafis of Marrakech from where the interest of this retrospective study in order to determine the context of hospitalization, the clinical profile and factors of starting point of the psychiatric illness.

We carried out a retrospective study on a sample of 63 patients between 2000 and 2007, 80% of them were hospitalized; the mean age was 39 years. The two third of these patients met to Marrakech for a tourist journey, 46 % were French, and 12,7% were German. Most these patients were treated; in to pay them of residence for a chronic psychiatric illness. The causes of relapse were a stop of treatment or comsuption of cannabis.

Some problems of legal order, culture, language and adaptation to a different environment have been met, making difficult in charge procedures of repatriation.

The State Center of Social and Judicial Psychiatry of V.P. Serbsky

The aim of an investigation is to study the correlation between abuse and leaning to aggressive violent crimes among the children and adolescents.

The Level of Service Inventory-Revised (LSI-R) was developed by Andrews and Bonta in 2001. It consists of static and dynamic variables and provides information about an offender's risk of recidivism and about the need for treatment and supervision.

In the past, most validation studies analyzed rather short follow-up periods and focused on non-violent offenders serving short sentences. Studies that investigated the predictive validity for offenders serving long-term sentences found a moderate performance.

The purpose of the present study was to show whether the LSI-R is predictive for recidivism of offenders in Switzerland and whether it qualifies for short-term prognosis (one year) as well as long-term prognosis (seven years).

The sample consisted of 107 violent and sex offenders. Follow-up time was seven years.

The ROC-analyses showed a moderate predictive validity for recidivism within one year (AUC=0.66) and a good predictive validity for recidivism within seven years (AUC=0.78).

The results suggest that the inclusion of dynamic items does not necessarily limit the predictive validity of an instrument to short follow-up periods or to specific criminal justice systems or cultural settings.

We previously reported an association of Dysbindin gene (DTNBP1) variants with Bipolar Disorder I (BPI) patients (Pae, C. U., A. Serretti, et al. (2006)). This paper extends previous results investigating the possible role of DTNBP1 variants on response to acute mood stabilizer treatment. Moreover, we recently reported positive association results of heat-shock -70 family proteins (HSP70) and genetic variations and antidepressant response (Pae, C. U., A. Serretti, et al. (2007)). Since evidence stands for a possible involvement of chaperone activity in Bipolar Disorder pathophysiology, a pharmacogenetic approach was used to investigate the role of HSP70 on acute antimanic effect. A sample of 45 BPI were treated for an average of 36.52 (±19.87) days with mood stabilizers (lithium, valproate, carbamazepine), evaluated using the Clinical Global Impression (CGI) scale and the Young Mania Rating Scale (YMRS) and genotyped for their DTNBP1 variants (rs3213207 A/G, rs1011313 C/T, rs2005976 G/A, rs760761 C/T and rs2619522 A/C) and HSP70 variants (rs2227956 C/T, rs2075799 A/G, rs1043618 C/G, rs562047 C/G, rs539689 C/G). No association was found between the investigated variations and response to mood stabilizer treatment even considering possible stratification factors. The small number of subjects is an important limitation to our study, nonetheless, Dysbindin and HSP 70 seem not to be involved in acute antimanic efficacy.