We performed family psychoeducation for depression, and investigated the association between the education and expressed emotion of patients’ families and relapse of depression.

Of 103 patients diagnosed with major depressive disorder, and their primary family members, 53 patients and their primary family members gave consent. The patients were randomly allocated to an intervention or control group, consisting of 24 and 30 patients, respectively. The intervention group underwent 4 educational sessions and education in coping techniques. The relapse rate was compared between the intervention and control groups. In addition, the subjects were divided into high- and low-EE groups based on the EE judgment, and the effect of psychoeducation was compared in each group.

The relapse rate during a 9-month period was 8.3% in the intervention group, being significantly lower than that (50%) in the control group. The relapse rate in the intervention group was slightly lower than that in the control group in the high-EE group, and significantly lower in the low-EE group. Regarding the influence of EE, in the control group, the relapse rate was 70% in the high-EE group, being significantly higher than that (40%) in the low-EE group. On multiple logistic regression analysis, psychoeducation (odds ratio: 25.53, 95% CI: 2.83-229.92) and the Hamilton score at the time of entry (odds ratio: 1.16, 95% CI: 1.045-1.298) were significantly associated with relapse.

It was suggested that the psychoeducation of families is very effective for the prevention of relapse in adult depressive patients.

To investigate characteristics of prehospital period of patients with depressive disorders and their influence on the level of social functioning.

After informed agreement 102 patients with depressive disorders (DD) for the first time admitted to the psychiatric hospital were examined with RDC of ICD-10. For the assesment of the level of social functioning Social Adaptation Self-evaluation Scale (Bosc M. et al., 1997) was used.

The average duration of DD before psychiatric examination was 19,1 months (up to 312 months). The average age was 43,8±11,5 years. Most patient had first depressive episode (61,8%), second 8,9%, third 2,9% and 4,9% had «double depression». The most part of the patients (61,8%) with DD saw their primary care (PC) doctors, 47,1% of them did it more than twice. The average number of visits to PC was 3,6 (up to 49), the average number of investigations was 2,4 (up to 8). The most part of visits to primary care (PC) fell at patients with heart complaints (р=0,02), the less part to patients with loss of energy (р=0,0007). More visits to PC were associated with low level of social functioning (r>-0,2, р<0,05). Low level of social functioning correlated with older age, duration and severity of depression, number of previous episodes and PC attendance.

In ddition to some clinical characteristics of depressive disorders the level of social functioning depends on PC visiting.

Mefloquine is being used as malaria prevention by Plasmodium Falciparum in chloroquine-resistant zones. We describe a woman who developed a manic episode with psychotic symptoms during mefloquine treatment.

A 26-year-old Spanish woman had been working in Mali for the last six months and had started antimalarial prevention with mefloquine. In Mali, the clinical picture had a sudden debut and she related: excessive happiness, incapacity to sleep, and megalomania (she believed to have special powers and to be the mother of all the children). She was admitted in a hospital in Mali for seven days and received treatment with haloperidol and chlorpromazine. Then, she was repatriated to Spain without treatment and she continued suffering the same symptoms. After 15 days, she went to our hospital and she was admitted. Treatment started with risperidone (up to 6 mg/day) and clonazepam (up to 1.5 mg/day). At admission Young Mania Rating Scale (YMRS) was 25 points. Physical examination and complementary tests were normal, and was orientated as a manic episode with psychotic symptoms secondary to mefloquine. She had a quick symptomatic improvement (after 7 days of treatment YMRS was 5 points) and was discharged after 15 days.

Mefloquine more frequent adverse neuropsychiatric effects are: dizziness, vivid dreams and insomnia. Others are confusion, and auditory hallucinations. Side effects are dose dependent. Psychotic symptoms are frequently auto-limited when mefloquine is suppressed but treatment with atypical antipsychotics is often needed. MDR1/ABCB1 polymorphisms may play a role in neuropsychiatric side effects

The investigation included 60 patients. Assessment was made by means of the following instruments:Montgomery-Asberg Depression Rating Scale for DSM-IV (MADRS), Hamilton Rating Scale for Depression (HAMD) and Clinician-Administrated PTSD Scale for DSM-IV (CAPS). The differences between groups were evaluated using Student t test and by means of the correlational analysis of the data with p < 0.05.

Results obtained showed significal clinical severity of the depression commorbid with postraumatic stress disorder. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression.

The interpretation of results in the light of patophysiological mechanisms underlying the symptoms will enable the insight onto possible mechanisams of interaction of two disorders. Both classical and current trends of the psychoanalytical thinking, reffering to melanholia and to transformation of the trauma in the internal world, enabled explanation of the deepening of depression observed after ten years follow-up of the traumatized population.

Like other European countries, the Defined Daily Dose (DDD) of antidepressants prescribed in Scotland increased almost fivefold in the 15y to 2007/8.

To assess the impact of stepped, collaborative care for depression on population antidepressant use.

A depression service (“Doing Well”) was implemented in 15/30 primary care practices in Renfrewshire, Scotland from July 2004 (population 76,013). Prescribing was compared with the remaining 15 “control” practices in Renfrewshire and Scotland nationally.

Doing Well offered prompt assessment and access to guided self-help or brief CBT or IPT. Clinical judgement guided antidepressant recommendations but drugs were not usually recommended for patients with a PHQ score < 15.

Antidepressant use followed a “rational” profile, increasing with depression severity:

Antidepressant use increased by 3.8% in Doing Well practices, 11.8% in control practices and 12.9% in Scotland. This represents a relative reduction in DDDs in the intervention area.

[Antidepressant use over time by area]

Providing rapid, local access to brief psychological therapies and rational prescribing support was associated with a relative reduction in the rise of antidepressant use, but a modest increase in prescribing overall.

Keeping off anxiety from mind & it's bodily symptoms is a challenging task through centuries. Cause of anxiety is broadly viewed as Heriditary & Environmental factors. We have some drugs to lessen acute/ generalised anxiety. What will happen if the environmental stimulus is sharpen or reduced gradually.

In eastern philoshopical doctrine anxiety is seen aroused as either sexual urges oriented or materialistic sences. In psycho-analytical theory of Sigmoid Freud, diguised libidonal senses that are trying to come in surface is viewed as the primary cause of anxiety. There is a similarity that libidonal or sex thoughts, usually socialy unacceptable are seen as the sole cause of anxiety mainly.

Unfolding of eastern spiritual or philoshophical doctrine will show some path in attaining a less anxiety state in an enduring pattern.

Hindu saints saying, “women and financial assettes or materiastic objects are all evils like poison, if you are diped into it, peace will not be achieved in your mind”-Sree Ramkrihna.

Anxiety reliefing is attainable through lifelong practice & devotion. According to Swami Vivekanata who delivered excellent speaches in Religions of Parliament in Chicago, in 1851 said “If you are honest for each moments…you have gained the highest state, nothing (worry or anxiety) could touch you.”

What is practice? Meditation meaning cutting the mind from external world for few minutes or hours and keep the body & mind calm, tranquil & free from all earthly thinking.

In perfoming Work, stay in a non self, or a non “I” doing way of thinking.

Meditation, nonattachment will bring relief.

Dispassionate, non myself sencse woking&de-atachement are key-factors.

Phobias & fearfulness shortly before examination are a common presenting feature in a section of teen aged students, ausing a stress in their own aswellas in their anxious parents. On a longitudinal evaluation of such 120 cases in a remote district clinic in the age group of 15-23 with a median age of 18 years will show their varied underlying morbidity ultimately.

Is it a normal phenomenon or much sressed those may shows some psychological disorders is ascertained here.

Here is a search for their such varient stress prior to examination & an attempt to identify their etiology so that some remedy is seen.

120 cases in those age group who complained of phobia 1-90 days before exam in the rural clinic in Midnapore 126k.m away from capital city of Kolkata & stayed for a follow up for 24 months were analysed. They constite 72 female & 48 males. They were followed up at 2 monthly interval & their pshychological assesment was done by psychologist. Their final diagonosis at the end of 2 year were tabulised asper criteria of ICD-10.

Mild mental retardation & lower side IQ< 80 were found in majority of cases (Apprxm.25%).Acute anxiety disorder was next (15%), followed by generalised anxiety disorders (10%),obsessive compulsive disorder is also revealed in about 5% cases, more in females. Other less common disorders were depressive disorders, conduct & personality disorders, & other bevavioral disorders. No pshycotic ilness like schizophrenia was revealed.

Anxiety Disorders in varient & obscured form may be a common presenting feature of teenagers as examination phobia in first & may yields to therapy with family.

Fear or phobia is an old & basic instincts that may be as old as mankind. Fear is cenrtal feature in numerous mental disorders like Schizophrenia, delusional disorder, depression, anxiety disorders and as the only distressing symptom in phobic anxiety disorder.

Anatomical or physiological pathways of fear transmission also involves circuit that is primitive part of brain including amylgdolia, hippocampus, rhinenochephalon & papez circuit. In social phobia persistent & distressing anticipatory fears in the scenario where there is a chance of several strangers, or an imaginatory scrutiny by others in performnance/in appearance is so intense that the person avoid such situation or dreaded in enfronting such situations.

This study is a clinical review of such cases seen very recently, & look into the patterns of their presentation.

30 cases those were diagonosed as social phobia as per diagnostic criteria of DSM-4TR & were seen in a district clinic 126k.m far from capitol town of Kolkata during the period 1st Jan-31stoct09 are taken here for consideration. 18 males & 12 females, all in the age group of 18-42 with a median average of 25 years, were recorded. There were Panic state mimcking distress to majority of patients who were present into gathering unknown to them or in some sort of performance like public delivery of speach on some subjects, or sing or even in imaginatory situation where scope of escape was not feasible.

Reliefs were partialy achived in 3 weeks of pharmacotherapy using clonazepam, SSRI/Paroxitine/Sertaline/fluvoxamine or TCA's clomipramine & behavior therapy.

An arena of further study.

The thought of death can be frightening and cause anxiety. Death anxiety is a mankind experience, some profession such nursing face with it routinely and communication with dying patients is major problem of nurses that insufficient preparation to deal constructively with the process of dying and death effect on nurses productivity and patients outcomes. Aim of this preliminary study was compare of death anxiety in special and general ward's nurses.

This study was cross-sectional and 387 nurses (155 from general & 232 from special wards) in census method were recruited from Shariati Hospital of TUMS. Demographic information and Death anxiety (Templer's Death Anxiety Scale) were measured by self-report questionnaire then information analyzed by SPSS.

Results show significant difference between mean score of Death anxiety in special (8/262/1) and general (8/302/4) ward's nurses and was correlated with some variables such as marriage (p=0/046), organizational situation (p=0/001) and the ward which nurses now worked (p=0/02). But has not significantly correlated with age, sex, shift, care of end stage patients, partnership in CPR and etc.

Death anxiety effect physical and emotional aspects of nurse's life and so effect process of caring present by them. Results show death anxiety was higher in special ward nurses and they faced more than general ward nurses to dying and death so they need special attention to death anxiety and investigation causes of it, development of institutional support to enable nurses to provide good quality care for patients.

Religiosity and spirituality are transcultural parameter of human experience with a complex, multidimensional construct. However, research shows religious commitment and practices being not only important for the personal beliefs, but also for physical and mental health. Findings suggest also other personal beliefs, such as magical ideation and paranormal beliefs similarly influencing psychiatric disorders and mental health. However, these factors are far more multidimensional than once thought.

The objective of the study is the investigation of the relation of religiosity/spirituality, magical ideation and paranormal beliefs in anxiety disorders and the specification of potential differences in beliefs between OCD and other anxiety disorders.

Unselected patients with OCD and other anxiety disorders as core diagnosis have been equally assessed within the first week after admission with self-rating tests including the Brief Multidimensional Measure of Religiosity/Spirituality (BMMRS), Magical Ideation Scale (MIS) and Revised Paranormal Beliefs Scale (RPBS).

80 patients have been recruited and classified in three groups: OCD, other anxiety disorders and healthy control group. All groups reached in average not significantly deviating RPBS, MIS and BMMRS total scores. However, the three personal belief scales did show an interesting relation to each other. RPBS score correlated significantly with BMMRS (r = .34, p < .01) and with MIS score (r = .56, p < .01), while MIS total scores have shown a significant relationship with almost every subscale of the BMMRS.

This study verifies a significant positive correlation between paranormal beliefs, overall religiosity and magical ideation.

There are many explanations as to why some people bite their fingernails. Anxiety, stress, genetics, boredom, acquired behavior and self-esteem have all been identified as potential causes. Nail biting can be anything from a bad habit to an outward symptom of a medical or emotional disorder. Nail biting is often a common reaction to stress. A child or even an adult uses nail biting as a coping mechanism to relieve pent-up emotions. The severity differs according the psychological cause is.

To identify the pattern of eating nails disorders in children and adults.

25 males patients 6-25 years old presented with shortining, non lusturing and onychoirregularity and nail deformities. Nail scraping for yeasts and fungi was negative.

The clinical data and invistigations showed the nails of those patients were eated and bitted by thier teeth.

Many chlidren and adults had onychophagia in thier nails. Anxiety, stress, genetics, boredom, acquired behavior and self-esteem have all been identified as potential causes.

Psychological disorder such as anxiety and depression have been related to increased mortality in both healthy individuals and medical patients. This study has been done for evaluation of prevalence of anxiety and depression and comparison with a control group (A&E's patients 1.

We checked three hundred patients of internal medicine and A&E (as a control group) department. They have chosen by a Purposive accessible sampling method. The psychopathological profile was assessed using the SCL-90 questionnaire by Iranian version. Data have been computed and analyzed by SPSS V.17 and we used Student t test for parametric variables and Mann-Whitney for the analysis of nonparametric variables and Linear regression was used to identify the impact of independent variables. The results have been considered significant when the two tailed p-value was less than 0.05.

In internal ward 69.3% and A&E department 42% of patient have had depression (OR= 3.5; 95% CI, 1.9 to 6.5). Anxiety were observed in 50.7% of internal medicine patients and 12% of A&E's patients (OR= 1.94; 95% CI, 5.1 to 23.7).

Prevalence of the depression and anxiety in internal ward patients was significantly higher in compare to A&E's patients. Therefore, it's necessary to consider these patients in order to diagnosing for the early treatment.

Experiential Avoidance (EA) has been conceptualised as one of the main vulnerability processes for psychopathology, including social anxiety, in the so-called ACT (Acceptance and Commitment Therapy) model - one of the “new wave” behavioral-cognitive approaches. EA refers to the degree to which an individual fuses with thoughts, avoids negative feelings, and is unable to act in the presence of difficult private events.

This study is aimed at exploring the role of EA in subjects with social anxiety.

Participants were 113 subjects recruited from the general population and with high levels of social anxiety as measured by means of the Liebowitz Social Anxiety Scale. Participants were classified into high and low experiential avoiders according to results from the Italian version of the Acceptance and Action Questionnaire.

The two groups did not differ in gender, marital status, educational level, or age distributions. Between-groups differences on several psychological measures, including depression, general psychopathology, quality of life and well-being were explored. Results indicated that individuals with social anxiety reporting higher levels of EA showed higher levels of depression and psychopathology, and lower levels of quality of life and well-being than low-EA participants.

Consistent with theoretical predictions in the ACT model, these findings suggest that EA may play a significant role in moderating negative psychological outcomes in subjects with social anxiety.

Individuals’ self-image and how they view their personal qualities can be of great importance for how and where they seek help for their health problems. Few have studied in-depth the connection between self-image and the use of text-based Internet communication.

We examined how members of two Internet-based Alcoholic Anonymous groups explained their preferences for using Internet-based AA groups, either alone or in combination with face-to-face AA groups.

Data were obtained over the course of one year by means of participant observation and in-depth e-mail interviews with 11 members from different countries. The first author participated in two online AA groups by posting and responding to the topics in the e-mail meeting, bulletin board and discussion forum. The 11 e-mail interviews were semi-structured and asynchronous, that is, they were not conducted in real-time but over a period ranging from five weeks to three months.

Online AA members explain their preferences for using Internet-based self-help groups by referring to their self-image and personal qualities as well as their self-diagnoses (e.g. social anxiety, aspergers syndrom, compulsiveness and impulsiveness). Some use a combination of online and face-to-face groups which helps them to overcome their social phobia.

Internet self-help groups seem to represent an important alternative for people who experience difficulties with face-to-face communication. Participation in online AA groups is easier to combine with everyday life. The Internet groups provide a more anonymous context for people who want to be heard, but not necessarily seen.

The aim of the current study is to analised our clinical experience with pregabalin, evaluate his efficacy and safety in the treatment of generalised anxiety disorder in elderly people.

And safety in the treatment of generalised anxiety disorder in elderly people.

The patients sample was selected of 3 psychogeriatric centers, considering patients 65 years and older with a clinical diagnosis of generalised anxiety disorder with or without psychiaric comorbidity.

The treatment with pregabalin has improved both somatic and mental symptoms of generalised anxiety disorder in the 15 patients analised.

The mean age was 71 years (women 68%). Significant improvement has been observed in the control of psychic and somatic anxiety symptoms in 10 of the 15 patients. In 3 patients the control of the symptoms was partial.

The tolerability of the product has been good in medium doses of 250 mg/day. The most frequently adverse events were somnolence and dizzeness. Discontinuations due to adverse events were in 2 patients

Pregabalin is a novel compound, a structural analogue of gamma-aminobutyric acid (GABA), one of the key inhibitory neurotrnsmitters in the brain. Its mode of action is believed to be mediated by alpha-2-delta-1 subunit protein of voltage-gated calcium channels to bring about its anxiolytic, anticonvulsant and antinociceptive effects.

Pregabalin has been shown to be safe, well tolerated and effective in the treatment of generalised anxiety disorder in patients 65 years old and older.

We report the case of a patient with treatment-resistant obsessive-compulsive disorder (OCD) that had a significant reduction in obsessive-compulsive symptoms after the addition of the atypical antipsychotic to the Selective serotonin reuptake inhibitors (SSRIs)

Ms. A, a 31-year-old woman, with no family history of psychiatric disorders has been suffering from OCD for 4 years. His main obsession was contamination, and his compulsions (washing rituals) occupied 12 hours a day, rendering him unfit for work in there house or employment. Various treatments had been ineffective. His Yale-Brown Obsessive Compulsive Scale total score (Y-BOCS) at his first psychiatric interview was 38. He was taking clomipramine, sertraline, haloperidol, amisulpride, and alprazolam. Previous trials did not result in clinically meaningful responses (side effects prevented titration to higher doses), however all psychiatric drugs were discontinued except sertraline (100 mg/day) associated with olanzapine (5 mg/day).

After 10 days, Ms. A reported significantly lessened anxiety and, after three months, significantly lessened obsessive-compulsive symptoms. By the fourth month, his symptoms were occurring for only few hours week Y-BOCS total score of 16). At this point, the addition of olanzapine would appear to be a useful short- and long-term strategy for augmenting SRI effectiveness in resistant OCD patients.

Current options for treatment-resistant OCD include switching to an alternative selective serotonin reuptake inhibitor or augmentation with other agents. Our case suggests that olanzapine may be an option for treatment-resistant OCD, but controlled studies are needed to substantiate this observation.

To point out to the medical community who believes in, ‘Prevention is better than cure’ that the alarming report of cause of sudden increase in PTSD sufferers, especially in young war veterans is very clear. The memory of human suffering imprints an indelible legacy in the minds of the young people for the rest of their life ultimately voiding them into a life of social burden. As health workers like always and ironically we deal with the victims of various socio-political decisions made by world leaders, dictators and even by the terrorists. Now do we think it's a time to give a lonely message to all that ‘war should be stopped?’

This is a personal audit on studying over 500 news reports and published papers written on PTSD incidence after a major war in the last decade.

Remove the cause PTSD will be eradicated. On the other PTSD victims i.e. abused in childhood, rape victims, road traffic accident victims or witnesses, fire fighters, policemen we hardly can manoeuvre in the field of prevention. However weak it is; we can give a message to the warring powers to save youngsters from future PTSD.

• • PTSD is preventable but has very bleak curative achievement.

• • We should not deprive our youngsters of the peaceful life, most of us are enjoying in our 40s, 50s and 60s.

• • European congress can raise a voice against the proven cause of PTSD.

This study aims at scrutinizing the action of Behavior-Brain systems in patients with obsessive-compulsive disorder and patients with Phobia by comparing them. The study is based on Jeffry Gary personality Theory.

20 patients with obsessive-compulsive disorder and 20 patients with Phobia that matched together by age, education level and gender were selected from patients referred to consulting clinics in Ardebil in 2008. Gary & Wilson personality questionnaire administered for assessing the Behavior-Brain systems action. The collected data were analyzed using descriptive and independent T-test to test the hypothesis generated in the study.

Analyzing the collected data shows that there is no significant difference between Phobic and obsessive patients in behavior activating systems and behavior inhabitation systems; but there is significant difference between two groups in fight -flight system.

The results of this study are in agreement with basic hypothesis of Gary's Reinforcement Sensitivity Theory and neuro-psychological status of patients with disorders. The reason of no significant difference between two behavior activating systems and behavior inhabitation systems in phobic and obsessive patients might be due to the similarity of behavior roots in these two disorders.