As this is a time of great change in Romanian psychiatry we considered it was useful to analyze the availability of various types of psychotherapy and the commitment of psychiatry residents to psychotherapy training, comparing with data from 1998.

Same protocol study like in 1998 was used. The data from National Centre for Medical Training were analyzed. We examined the total number of residents undergoing psychotherapy training, year of residency and the type of psychotherapy they chose.

In 2009, there are 726 psychiatry residents in Romania (180 in 1998) distributed in 11 (6 in 1998) university training centres. We registered a response rate of 81.8% (77.7% in 1998), and only 30.13% residents are involved/ in a specific psychotherapy training comparing with 48.5% in 1998. The types of psychotherapy were: cognitive behavioural therapy, positive psychotherapy, transactional analysis, psychoanalysis, psychodrama, hypnosis, existential psychotherapy.

Even though training in psychotherapy is included in curricula like compulsory topic since 2007, the availability of psychotherapeutic training for residents is still restricted, due to high costs, the need to self-finance the training, organizational difficulties and low number of training centres and trainers.

Center for mental health is established in May of year 2005. Center for mental health promotes the mental health care in the community.

To evaluate the effect of group psychotherapy on chronic psychoses, ambulatory treated in Mental Health Center in Kotor, Montenegro.

The influence of the effect of group psychotherapy on chronic psychoses in the development of optimal socialization.

The group consists of patients who were coming for regular check-ups in our health center during previous 3 years. The group is semi-opened and it is heterogeneous in respect to gender and age. The effect is estimated by observing the behavior of group dynamics. There were 8 regular members in this group and additional ones who participated occasionally, on suggestion of their psychiatrist.

During the initial group meetings it was noticed that the patients are not familiar with each other, even though they were previously treated in our local psychiatric hospital and are inhabitants of a same, small town. They didn’t communicate with each other and didn’t even know each others names. They were distrustful toward new group members and couldn’t think of the questions to ask when the new members were presented to them. After six months, group members formed friendship relationships.

Evaluation of the effect of group psychotherapy on chronic psychoses treated ambulatory is facilitating the development of optimal socialization as well as optimal interpersonal relationships within group, in respect to the nature and progression of mental disorder.

Psychotherapy is usually viewed as a process of help, reparation and personal growth. Although creativity is the real essence of psychotherapy, few works have approached psychotherapy from its creative aspect. This work investigates some creative potentials of psychotherapy.

We tried to investigate the research question: “Can Psychotherapy follow the same stages/phases of a well known creativity model?” in two different therapy groups; an analytic group held in UK and an interactive dynamic group held in Egypt.

We aimed to follow the evolutionary phases of the therapeutic process in the two groups and find if they could be categorized into certain stages/phases that can match the stages/phases of well-known creativity models; namely Wallas’ (1926) and Barron's (1988).

1. - Clinical data were derived from two therapy groups that were held in the same time in two different cultural contexts; an analytic therapy group held in UK and an interactive dynamic therapy group held in Egypt.

2. - Analysis of the therapeutic work was done using Interpretative Phenomenological Analysis.

The therapeutic processes in the two different groups could follow the same stages and micro-processes of well known creativity models. However, the two therapeutic groups followed two different models of creativty (the British group followed Wallas’ model and the Egyptian one followed Barron's model). This could be explained by many sociocultural factors.

Psychotherapy can be regarded as a creative process in the sense that it can follow the same stages and micro-processes of well known creativity modes.

Behavioral addictions, like computergame addiction respectively internet addiction, have become a growing concern in research. Currently similarities between behavioral addictions and substance dependency are discussed in the scientific community controversially. Unfortunately a mismatch exists between high rates of treatment seeking people and low rates of scientific studies on computergame-addiction, especially concerning risk factors and their contribution to the etiology of computergame addiction.

The aim of this contribution is to shed light on possible etiological factors of computergame addiction concerning personality and vulnerability to stress in clients of the “Ambulanz für Spielsucht”, a specialized outpatient clinic at the University of Mainz.

131 clients were testet with several psychometric measures including ACA-S (Scale for the Assessment of Computergame-Addiction), SCL-90R (Symptom Checklist 90R), NEO-FFI (NEO Five-Factory-Inventory) and Brief-COPE.

69.4% (91 clients) fulfilled criteria for computergame addiction, 30.6% (40 persons) showed no psychopathology. The examination unveilled several caracteristics in addicted computergamers: They revealed higher levels concerning Global Severity Index (GSI), with increased subscales of depression and social insecurity. They showed significantly higher scores in the personality factor “Neuroticism” and decreased scores in the factors “Extraversion” and “Conscientiousness”. Addicted computergamers stand out from normal gamers in respect of nature of coping strategies, making predominantly use of avoiding ones.

The results contribute to a better understanding of underlying mechanisms leading to and sustaining addictive computergame behavior. The role of maladaptive coping strategies and social insecurity points out the necessity to add appropriate elements to psychotherapeutic intervention strategies.

The aim of our study was to compare the cognitive distortions in learning-disabled male sex-offenders before and after the administration of full 52-weeks Sex-Offenders Treatment Programme(SOTP).

As a part of the CBT-based Sex-Offenders Treatment Programme, 17 male adults were referred for therapy(over a period of 2 years) out of which 12 were accepted for SOTP. Mean age of the subjects was 32.5 years(Range: 22-50 years) and mean IQ was 65.16(Range: 53-75).

SOSAS(Sexual-Offenders Self-Appraisal Scale) was administered both pre and post treatment. This instrument consists of 20 statements from four sub-scales: Denial, Victim Blaming, Minimization and Realism to which each respondent was asked to indicate his degree of agreement or disagreement.

We noticed an improvement in Denial and Minimization scores in 58% of cases, Victim Blame scores in 25% of cases and Realism scores in 67% of cases.There was a little (< 5%) or no change in 25% of Denial scores, 17% of Victim Blame scores and 9% of Minimization and Realism scores.A deterioration in 17% of Denial scores, 58% of Victim Blame scores, 33% of Minimization scores and 24% of Realism scores.

Our results reveal beneficial effect of SOTP on the cognitive distortions of Denial, Minimization and Realism in more than half of the patients but deterioration in the cognitive distortion of Blame.

While the results suggest CBT-based Sex Offenders Treatments are beneficial in modifying cognitive distortions, further research is needed to validate the effectiveness of this approach, especially in long-term follow up studies.

Cognitive impairment is considered to be one of the central features of schizophrenia and it has been so since original descriptions of illness by Kraepelin and Bleuler. Deficits are already present at the first-episode of illness. Some researches conclude that deficits do not change over time, while others suggest that deficits can be reduced. The objective of this research is comparison of cognitive functions of psychotic patients who participated group psychotherapy with those ho did not.

In this paper, by means of Revised Beta Examination (measure of non-verbal intellectual ability) we observe changes in cognitive functioning of 29 psychotic patients who participated in the psychodynamic group psychotherapy within the Early Interventions Program and compare their cognitive achievements with results of matched 32 psychotic patients who received “treatment as usual”. Answers were analyzed qualitatively and quantitatively.

Improvement in cognitive functions was observed in both investigated and control group, but improvement in patients who are participants of long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner with statistical significance.

Psychiatric hospital “Sveti Ivan” offers an extensive outpatient Early Intervention Program for psychotic patients in the critical period of their illness - up to five years from onset. The program includes psychoeducation workshops for the patients and their family members together, group psychodynamic psychotherapy for the patients and group psychotherapy for the family members. Our results indicate better effectiveness of Program when compared to “treatment as usual”.

Few studies have suggested the efficacy of cognitive-behavioural therapy (CBT) in inpatients suffering from major depressive disorder (MDD). The present study aims at examining the efficacy of Ultra-brief CBT (UCBT) in depressed inpatients.

Twenty-two patients (age>18) admitted to the psychiatric ward of Toulouse University Hospital for MDD were randomised to receive for two weeks either UCBT (n=11) or treatment as usual (TAU) (n=11). UCBT consisted in 6 sessions of CBT while TAU consisted in supportive sessions. Both types of sessions were performed by psychiatric residents. Both groups also received pharmacological and institutional cares. Primary outcome was depressive symptoms assessed by the Beck Depression Inventory (BDI-II) and the Hamilton Depressive Rating Scale (HDRS) before and after treatment (2 weeks).

There were no differences between the groups on any baseline variables. Mean age was 48.4 (SD=12.7) and 36.4% (n=8) were of male gender. Mean baseline HDRS scores were 23.3(SD=6.3) and 19.3(SD=3.9) and BDI scores were 36.7(SD=12) and 36.1(SD=7.5) for the UCBT and TAU groups respectively. At the end of treatment, mean HDRS scores were 12.3(SD=10.1) and 14.4(SD=7.8) and BDI scores were 18.8(SD=16.8) and 20.6(SD=11.4) for the CBT and TAU groups respectively. Both groups displayed a significant decrease on HDRS and BDI scores (all p< 0.05). An analyse of variance showed an interaction time by group in favour of the UCBT group on HDRS score (F=6.66; p=0.018).

Our results suggest that UCBT might be more efficacious than supportive therapy in depressed inpatients.

The International Headache Society (IHS) defined chronic tension type headache (CTTH) in adult patients as attacks of headache that occur on at least 15 days per month over a period of at least 6 months. CTTH is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. Drugs do not adequately benefit many disabled headache sufferers. Behavioral headache treatments are rooted in the conceptualization of headache as a psychophysiological disorder. Such treatments target the patient's headache-related physiological responses (relaxation training, biofeedback) or behaviors, emotions, and cognitions (cognitive-behavioral therapy, stress-management). The aim of present research was examine the efficacy of cognitive-behavioral therapy for reduction of headaches in patient with chronic tension headache.

The method of this study was field/experimental. The target population of the study consisted of patient with CTTH that referred to psychiatric or neurology clinics in kashan. The sample consisted of 38 women with CTTH were assigned randomly to drug plus cognitive behavioral therapy (experimental, n=18) and drug alone (control, n=20) groups. Subjects were completed the headache diary for one week before and after intervention.

An analysis of covariance showed significant differences between experimental and control groups in variable of frequency, intensity and duration of headache attacks. Drug plus CBT was found to be more effective in reducing of headache than the drug therapy alone.

Drug plus CBT is better than drug alone in treatment of tension headache.

Several neurocognitive deficits present in the euthymic state of bipolar disorder suggest that some of them could be seen as vulnerability trait markers of the illness. Psychoeducation proved as effective therapeutic approach which decreases the risk of relapse and prolongs remission. In our study we aimed to examine the psychoeducational effects on cognitive functioning in the sample of euthymic bipolar outpatients.

A neuropsychological tests battery for assessing selective attention (Emotional and Colour-Word Stroop), cognitive control (Emotional Go/NoGo task) and social cognition (Face recognition task and Recognition of emotional expression task) was administered to 29 bipolar euthymic outpatients before and after attendance at six weeks psychoeducation program. The same procedure was applied on 10 bipolar euthymic outpatients without participating in psychoeducation.

Despite statistically insignificant differences between groups in cognitive performance, some considerable within group differences in domains of selective attention and cognitive control of emotional stimuli emerged. In the Emotional Stroop there was faster processing speed of emotional stimuli after psychoeducation compared to baseline in the intervention group which was not found in the control group. Similarly, coping with emotional stimuli in different emotional contexts markedly improved in the intervention group compared to the control group. Changes in social cognition, in particular better recognition of negative affect were found in the bipolar group with psychoeducation but not in the control group.

Though preliminary, our results support psychoeducation as clinically feasible way of cognitive rehabilitation in terms of improved cognitive control of emotional stimuli in bipolar patients.

Schizophrenic patients may be more susceptible to bone fractures because of the mental illness and/or the effects of psychotropic drugs. However, these patients also suffer from other medical conditions which may further increase their risk. The objective of this study was to make a general assessment of previous bone fractures in schizophrenics seen in an Internist's office.

We questioned 115 consecutive patients with the primary diagnosis of schizophrenia, seen in an Internist's office, for a wide variety of medical problems. Of these seventy nine (68.7%) were males and thirty six (31.3%) were females. Their ages ranged from 19 to 81. They were all on psychotropic drugs and under the care of a psychiatrist.

Of the total number of 115 patients, fifty one (44%) gave a history of previous bone fractures. Thirty eight (33%) gave a history of single fractures and thirteen (11.3%) gave a history of multiple fractures. Twenty six (22.6%) involved fractures of the upper limbs and twenty three (20%) involved fractures of the lower limbs and eight (6.9%) involved fractures of both the upper and lower limbs. Thirteen (11.3%) had non-extremity fractures. Of these eight (61.5%) had only non-extremity fractures and five (38.5%) had non-extremity fractures in addition to extremity fractures.

We found a significantly high prevalence of previous bone fractures in this schizophrenic population. Further study is necessary to elucidate whether this elevated risk is due to the mental illness, the use of psychotropic drugs, both, or some other associated etiology.

Hypothyroidism is common in the general population. Since symptoms and signs of hypothyroidism often mimic or overlap those of schizophrenia, they might be an under diagnosis of hypothyroidism in this population. Further, these patients may not be regularly seen by an Internist and may not be subject to routine thyroid profile testing. Treating occult thyroid abnormality is critical in these patients.

We studied the thyroid panel in 64 consecutive patients with schizophrenia seen in an Internist's office. Of these forty six (71.9%) were males and eighteen (28.1%) were females. The age ranged from 19 to 82. They were all on psychotropic medications. None were on lithium or thyroid supplementation. None of the patients exhibited clinical signs or symptoms of hypothyroidism. All of these patients underwent a routine thyroid profile testing.

Of these 64 patients, two (3.1%) patients were found to have elevated TSH. One had normal T3 and normal free T4, indicating subclinical hypothyroidism. The second patient had low T3 and low free T4 indicating overt hypothyroidism. Sixty two (96.9%) patients had an euthyroid profile.

In our study of 64 consecutive schizophrenic patients seen in an Internist's office, two were found to suffer from undiagnosed and untreated hypothyroidism. This limited study suggests that although not as common as suggested by the literature, undiagnosed and untreated hypothyroidism does exist in this population. All patients with schizophrenia should undergo a routine thyroid profile testing as part of a regular medical physical exam.

Both tricyclic antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase QTc interval to a moderate extent (10-20 msec). Moreover, electroconvulsive therapy (ECT) also increases patients’ propensity to arrhythmias. Finally, females are more prone than males to both drug-induced QTc prolongation and torsades-de-pointes. Thus, the combination of all the above treatments raises serious safety concerns. We investigated the safety of the co-administration of ECT with a tricyclic-ziprasidone-quetiapine combination with respect to QTc interval in six female patients with severe major depression resistant to pharmacotherapy.

Each patient underwent a series of 10-11 sessions of bilateral ECT. QTc intervals were calculated at baseline and several times up to 10 min after seizures cessation in a total of 63 patients/ECT sessions.

A small initial decrease of QTc after the administration of pre-ECT medications was followed by its steady statistically non-significant increase during the first 20 sec after seizure cessation. Thereafter, a steady larger and statistically significant decrease of QTc emerged during the ensuing 21-50 sec interval. Finally, this decrease was gradually reversed within the following 2 min approximately with return of QTc interval to stable baseline levels.

Overall, QTc interval changes remained within normal limits (fixed at 470 msec in women), without the occurrence of any cardiac adverse events, especially severe arrhythmias such as torsades-de-pointes. Our findings suggest that the co-administration of these treatments might be safe, at least with respect to QTc interval changes.

Using high and low doses of cerebrolizin at patients with rezidiual schizophrenia

The purpose of the present research was comparative clinical-pharmacological studying with estimation cognitive functions of high and low doses Cerebrolysinum at patients with residual schizophrenia.

In total 37 patients the majority from which were male (89%), at the age of 50-55 years have been included in research. Duration of disease mainly 5-10 years. All patients had physical inability of 2 groups on mental disease, accepted neuroleptics throughout all illness, and last year - in invariable doses.

Patients in any order were distributed on three therapeutic groups:

1. 1. high doses “Cerebrolysinum” (10 ml) - 17.

2. 2. low doses “Cerebrolysinum” (1 ml) - 10.

3. 3. not accepting “Cerebrolysinum” - 10.

Duration of research - 4 weeks.

By the end of therapy at 10% of patients of 1st group the expressed improvement, at 73% - substantial improvement, and only in 17% cases - minor improvement. In 2nd group of the patients accepting low doses “Cerebrolysinum”, efficiency of therapy was essentially more low: at 27% of patients minor improvement, at 69% - minimum has been reached, and in 4% cases of positive dynamics by the therapy end wasn’t observed. In control group (3rd) at 90% of patients by the end of therapy the condition remains without changes, and 10% - had insignificant deterioration.

Using high doses of “Cerebrolysinum” gives high results in treatment of residual schizophrenia.

The aim of our study is the evaluation of co-administration of N-acetyl-cysteine (NAC) in cognitive functions in a sample of patients affected by schizophrenia diagnosed according to DSM IV-TR criteria, and treated with stable atypical antipsychotic therapy.

We administered NAC (1800 mg/die) to 12 male patients, tested each patient at baseline and re-tested after 90 days using a battery of neurocognitive tests (Wisconsin Card Sorting Test, Verbal Fluency Test, Stroop Test) and PANSS scale for severity symptomatology evaluation. The results obtained in each test at baseline were compared with those at the end of the study.

A significant improvement for WCST error numbers (sig. 0.049), VFT fonemic (sig. 0.049), PANSS positive (sig. 0.028), negative (sig. 0.002) and total (sig. 0.024) was observed.

Our results show that co-administration of N-acetyl-cysteine added to atypical antipsychotic therapy improves the cognitive-executive functions. The effectiveness on reducing positive and negative symptoms was confirmed.

In spite that the patients with long-acting neuropletics(LAN)can drop out and have relapses,its use allows a more long-lasting time and more stable plasmatic concentrations that supply clinical and neurocognitive advantages.

To analyze the symptomatology and neurocognitive differences(P300)among the patients that relapse after withdrawing from the previous treatment with oral antipsychotic as regards those treated with LAN.

34 schizophrenic patients with a history of at least one admission in a acute adult psychiatric ward.All the patients have been assessed with the Positive and Negative Syndrome Scale (PANSS) and with potential auditory evocations(wave P300).

Clinical profile: 73.5% suffers from paranoid schizophrenia.Only 32.4% shows antipsychotic monotherapy;the 61.8% have been prescribed with long-acting Risperidone.

PANSS: The patients who had at least two admissions and who in the previous admission received long-acting Risperidone,showed a PANSS-N punctuation lower than the rest of the patients(21.64±4.6 vs. 25.4±3.2)at the end of the last admission(p=0.037).The same takes place with PANSS-PG at the end of the last admission(30.71 ± 3.8 vs. 3.61 ± 5.89(p=0.012).

P300: The latency measures of P300 are lower in those patients who in the previous admission received a long-acting Risperidone treatment(average of 314±34.65msec vs. 344.67±24.67msec),being the differences statistically relevant(p=0.012).The ranges are higher in the patients treated with long-acting Risperidone in the previous admission(average 5.3 ± 2.44vs.5±2.64 μV),though the differences are not statistically relevant.

At the end of the last admission,the patients who in the previous admission received long-acting Risperidone,showed a PANSS-N,a PANSS-PG and a latency of P300 lower than the rest of the patients but the range of P300 was higher.

Although language deficits have often been reported in schizophrenia, the specific relevance of single linguistic levels of processing is still under debate. Moreover, little is known about language disturbances in bipolar disorder.

The aims of this study were to:

1. 1) investigate micro-linguistic (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) dimensions of speech production and

2. 2) evaluate syntactic comprehension skills in both schizophrenia and, for the first time, bipolar disorder.

A story telling task and a computer-based test of syntactic comprehension were administered to 30 Italian speaking DSM-IV patients suffering from schizophrenia, 30 participants with bipolar disorder and 30 healthy controls, comparable for age and educational level (p>0.05). Analysis of variance with post-hoc correction was performed to compare linguistic performance between groups.

In comparison to healthy participants, patients with schizophrenia had significantly impaired productivity, syntactic complexity and local/global discourse coherence and bipolar disorder subjects showed deficits in mean length of utterance (p< 0.05). Also, both groups of patients collected more grammatical errors than controls (p< 0.05), but they differed in regard to the grammatical type of construction they missed (passive-affirmative and active-negative, respectively).

Our results showed the presence of both micro and macro-linguistic deficits in linguistic production in schizophrenia, but not in bipolar disorder, suggesting that these abnormalities are specific for schizophrenia. On the contrary, syntactic construction comprehension was altered in both schizophrenia and bipolar disorder, potentially representing the target of innovative rehabilitation strategies.