White-matter abnormalities are sometimes associated with mood disorders, and atypical depression may be related with a leukodystrophy.

A case report of a treatment-resistant depression with cognitive deficits and extensive white-matter hyperintensities suggested a literature review on this unattended association.

A 33 yrs. woman was recovered in our psychiatric ward with a recurrent depressive disorder, partially resistant to antidepressant for eleven years. MADRS score was 26 at admission, without significant anxiety or psychotic symptoms. After 12 days, she presented delirium with neurological localisation symptoms. MRI examination put in evidence confluent hypersignal of white matter with demyelinisation, without grey-matter lesion. No biological or enzymatic abnormalities were detected. A severe executive dysfunction with information slowing was detected on neuropsychological assessment. We performed a literature review on the association of depression and leukodystrophy.

The presented case is a probable Childhood Ataxia with Cerebral Hypomyelination (CACH) syndrome lately revealed by treatment-resistant depression. It represents 30% of all causes of leukodystrophy, and as it is described typically in a childhood form, an onset at adulthood has also been reported, sometimes with foreground behavioural and affective disorders. in that form, it may present with a treatment-resistant and atypical depression.

Treatment-resistant depression in young people with an atypical presentation may be related with an extensive white-matter disease, and a complete evaluation including MRI, biological, enzymatic, neuropsychological assessments, is therefore recommended.

The relationship between testosterone levels and depressive symptoms has been described as U-shaped in some previous studies.

To investigate the relationship between testosterone levels and male mental health as well as evening cortisol.

In this community study 534 males were screened, using the Beck Depression Inventory (BDI), Gotland Male Depression Scale (GMDS), Montgomery-Åsberg Depression Rating Scale (MADRS) and a general health questionnaire. Those with signs of depression (n = 65) and randomly selected controls (n = 69) were evaluated by a psychiatrist for Depressive Disorder (DD). in a sub-sample (n = 51) saliva testosterone was measured two times on a single day.

Morning values were significantly higher than evening values (236 vs. 145 pg/ml p = 0.009). Evening testosterone was significantly higher in males depressive according to both MADRS (p = 0.017) and BDI (p = 0.031). This relationship was also present when tested for U shaped connection by dividing the group into three even parts by testosterone levels. Men with depression were significantly more likely to be in the highest third of testosterone levels (BDI p = 0.021; MADRS p = 0.018). There was also a significant correlation between elevated evening cortisol and evening testosterone levels (p = 0.021). However, high evening cortisol and high evening testosterone were not detecting the same depressive cases according to either BDI or MADRS scales. Thus, simultaneous testing for evening cortisol and evening testosterone did not increase specificity for clinical diagnosis of DD.

Males with high evening testosterone seem to be more likely to have depressive symptoms but further studies are needed.

: Human impulsivity is a complex multidimensional construct encompassing cognitive, emotional, and behavioral aspects. Previous animal studies have suggested that striatal dopamine receptors play a critical role in impulsivity. in this study, we investigated the relationship between self-reported cognitive impulsiveness and dopamine D2/3 receptor availability in striatal subdivisions in healthy subjects using high-resolution positron emission tomography (PET) with [11C]raclopride.

Twenty-one participants completed 3-Tesla magnetic resonance imaging and high-resolution PET scans with [11C]raclopride. The trait of impulsiveness was measured using the Barratt Impulsiveness Scale (BIS-11). Partial correlation analysis was performed between BIS-11 scores and D2/3 receptor availability in striatal subregions, controlling for the confounding effects of temperament characteristics that are conceptually or empirically related to dopamine, which were measured by the Temperament and Character Inventory.

The analysis revealed that the non-planning (p = 0.004) and attentional (p = 0.007) impulsiveness subscale scores on the BIS-11 had significant positive correlations with D2/3 receptor availability in the pre-commissural dorsal caudate. There was a tendency toward positive correlation between non-planning impulsiveness score and D2/3 receptor availability in the post-commissural caudate.

These results suggest that cognitive subtrait of impulsivity is associated with D2/3 receptor availability in the associative striatum that plays a critical role in cognitive processes involving attention to detail, judgment of alternative outcomes, and inhibitory control.

The relationship between obesity and Attention Deficit-Hyperactivity Disorder(ADHD) has been studied in recent years. It was indicated that the proportion of ADHD in children with obesity was high and body mass index (BMI) of children with ADHD was also higher than healthy controls [1]. Impulsivity as a trait was found to be associated with obesity and predictor of future weight gain among children with obesity (2,3). From here, we aim to evaluate the impulsivity and ADHD symptoms among adults with obesity.

32 female patients with obesity (BMI>30) who admitted to the diet clinic of Çanakkale Onsekiz Mart University Medical Faculty were recruited for the study. ADHD symptoms were evaluated with Wender Utah Rating Scale(WURS) while impulsivity was measured with Barratt Impulsiveness Scale(BIS).

Mean age, BMI, WURS and BIS scores of the patiens were 35.3 ± 10.8 years, 39.2 ± 6.2 kg., 35.8 ± 19.2 and 61.3 ± 10.4, respectively. 42.3% of the patiens had child and adolescent ADHD symptoms and one third still had ADHD symptoms in adulthood (12.5% inattentive, 9.4% hyperactive-impulsive, 6.2% combined). BIS total(p+0.003), BIS attention(p < 0.01) and self control(p = 0.004) sub-item scores were positively correlated with WURS total scores.

Our findings were consistent the literature that patients with obesity were more impulsive than healthy controls(4).

ADHD and impulsivity might have implications for weight regulation. Our findings may provide a frame work for future studies with bigger sample sizes aiming to detect the relationship between impulsivity and ADHD symptoms in patients with obesity.

Healthcare professionals (HCP) suffer from work-related or occupational stress often resulting from high expectations, coupled with insufficient time, skills and/or social support at work, but stress also resolves from everyday life.

The aim of the present study was to measure the stress-related psychological symptoms in HCP and to assess significant differences among different specialties.

Stress as a syndrome that is factorially distinct from depression and anxiety, characterized by nervous tension, difficulty relaxing and irritability, was measured with the stress scale of the Depression Anxiety Stress Scale (DASS). Statistical analysis was performed with SPSS-19.

196 HCP from a public hospital in Greece participated in the study. of them, 33 (16.6%) were males and 166(83.4%) females. 49(24.6%) were nursing staff, 59(29.6%) medical staff (MS) and 91(45.7%) administrative personnel (AP). in stress, Nursing Aid (NA) (M = 14.8 ± 8.4), Paramedics (P) (M = 17.8 ± 10.5) and MS (M = 13.7 ± 10.7) had higher scores from the general population (M = 12.4 ± 9.8). Statistical significant differences were found with Mann Whitney U, in stress between Register Nurses (RN) (M = 8.1 ± 6.4) and MS (M = 13.7 ± 10.7) (z = −2.458 p < .05) and between RN and NA (M = 14.8 ± 8.4) (z = −2.058 p < .05). After ANOVA, MS were found more easily upset, impatient and irritable/over reactive than RN(z = −1.952 −2.034 and −2.408 p < .05 respectively), NA more easily upset and irritable than RN(z = −2.875 and −2.160 p < .05 respectively) and paramedics were more impatient than RN (z = −2.713).

Health care staff experiences stress with significant differences among different specialties that are correlated with the profession and the demands of the job description.

In the treatment of bipolar disorder, mood stabilizers (MS), antipsychotics (AP), antidepressants (AD) and anxiolytics can be used according to the type and severity of the episode.

The frequency of somatic and pharmacological treatments in hospitalized bipolar patients were investigated in this study.

In this study the data of 108 bipolar type I patients who were admitted to psychiatry clinic of a university hospital due to manic episode between 2007–2009 were examined.

The rate of the treatments for mania was %6.6 for MS, %88.8 for MS + AP and %4.4 for AP. For depressive episode it was %33.3 for MS+AD, %38.8 for MS+AP, %38.8 for MS+AD+AP. Lithium (55.5%) and valproic acid (42.5%) were the most preferred MS drugs. Average dose was 1330 ± 43.2 for lithium and 1118 ± 27.9 mg / day for valproic acid. Most frequently (46.2%) preferred antipsychotics was Olanzapine. Average dose was 16.1 ± 0.8 mg / day. 12.9% of the patients had received electroconvulsive therapy (ECT) at an average of 9.7 ± 5.2 sequences.

Lithium treatment in bipolar disorder seems to be first choice for the treatment and prevention of acute episodes. There is an increase in the using of the atypical antipsychotics as mood stabilizers. ECT may be an effective method for patients who do not respond to medications. Considering the diagnosis of patients hospitalized in our clinic, drug selection and treatment modalities were consistent with treatment guidelines.

Syringe exchange has been suggested as a potential conduit to treatment for drug addiction. This has been tried in a few US trials, but never in Europe.

This study aims to assess effectiveness of a syringe exchange for referral of heroin addicts to evidence-based treatment, and to assess, in an RCT design, the contribution of a case management intervention.

Consecutive heroin addicts attending the syringe exchange of Malmö, Sweden, who are willing to participate, are referred to maintenance treatment (methadone or buprenorphine, medication based on clinical assessment and outside the study design), and randomized to either a strength-based case management intervention in order to facilitate referral, or referral-only. If eligible for treatment, patients are initiated on the maintenance treatment after 12 days. Study outcome is successful transfer from syringe exchange to treatment initiation.

The study is currently being finalized, and final results (N = 70–75) will be available before presentation at the EPA congress. Pilot data from the first phase of recruitment revealed that among 21 patients, 16 (76%) were willing to join the study. Among them, all 16 successfully showed up for medical assessment, and all but one (94%) successfully initiated medication. Preliminary follow-up until today confirm a similar picture.

Pilot data indicate that syringe exchange can be used for transfer to evidence-based treatment in heroin addiction. High rates of patients are successfully transferred to treatment, with or without a facilitating case management intervention. Final results will be presented at the congress.

Although the lifetime prevalence of bipolar disorder is not different between men and women, some of the features of the disease vary between the genders.

To compare the clinical and sociodemographic features of bipolar disorder according to gender.

In this study the data of 125 bipolar disorder tip I patients who had been admitted to Department of Psychiatry of Gulhane Military Medical Faculty between 2009–2011 were examined. Data of these patients were obtained by examining the patients files.

95 of 125 patients (%76.0) were male, and 30 (%24.0) were female. Age of disease onset in bipolar male patients was 22,5 ± 6,9; %6.3 had a history of suicid attempt and %11.6 had a history of substance abuse. Age of disease onset in bipolar female patients was 28,7 ± 9.7. %23.3 had a history of suicide attempt. There was no history of substance abuse in female patients. Psychotic features and history of substance abuse were more prominent in men. The later age of disease onset and longer duration of hospitalization were determined in women.

Our results were appeared to be in line with the results of the studies about gender differences in bipolar disorder. Making prospective studies about this subject is considered to be useful to determine the epidemiological characteristics of mood disorders.

Bipolar disorder usually begin at an early age and often need hospitalization. in this study, we aimed to investigate the clinical characteristics of patients with bipolar disorder

The data of 108 bipolar type I patients who were admitted to psychiatry clinic of a university hospital due to manic episode between 2007–2009 were examined.

45 of 108 bipolar patients (41.6%) episodes of mania was just across diseases. 18 of these 45 patients were diagnosed with first-episode mania. Percentage of these patients according to their diagnosis index episode, mania was 65.7%; hypomania was 15.7%; hypomania and depressive episode was 18.5%. The number of entrants as a manic episode was approximately 3 times as depression disease beginners. Maximum rate of admission to clinic was in November and December (14.8% and 10.1%). The distribution of hospitalization rate was 21.2% in winter, 25.9 and 24% in spring and summer, 28.7% in autumn. The mean length of hospitalization was 22.4 ± 16.0 days and patients were hospitalized 2.75 ± 2.34 times during their diseases. Patients had manic episodes average of 3.1 ± 4.4 times and depresif episodes average of 1.4 ± 2.5 times during their diseases.

There is no consensus regarding the types of seizures in first episode bipolar disorder. The first period of mania or depression is likely close to each other. in our study, the most prominent was mania with 65.7%. Major depressive periods usually begin in winter and autumn and improves in summer.

Sleep apnea (SA) is a common chronic disease that leads to higher morbidity and mortality; however, illness perceptions (IP) in patients with SA remain not well explored.

We aimed to assess the IP in patients with SA and to correlate them with the level of sleepness, the severity of the disease and the existence of a concomitant depression.

Sixty four untreated patients investigated for sleep apnea (mean age: 54 years, sex ratio = 2/3) participated in our study.

Excessive daytime sleepness (EDS) was assessed by the ESS, the severity of the disease by the apnea/hypopnea index (AHI) and the depressive symptoms by the HADs. Illness representation was measured by the Brief Illness Perceptions Questionnaire (B-IPQ); High scores reveal a more threatening perception of the illness.

In terms of cognition, our patients feel quite bothered by their symptoms (7/10) and enable to control their illness (1.3/10), but they believe that their treatment will be effective (7/10). Emotionnally, they feel pretty concerned (6/10) and negatively affected by their disease (6.1/10).

We also observed that the score of the B-IPQ (6/10 ± 1.5) was positively correlated to EDS (p = 0.004), the severity of the disease (p = 0.02) and the coexistence of a depression (p = 0.005).

Several factors seem to have an impact on the vision of the sleep-apnea's patients towards their disease and their life as well. The study of the IP seems interesting to better understand the coping behaviour of such patients so that their adherence to the treatment would be improved.

Several studies suggest mental disorders and substance misuse to be associated with a higher rate of violence and crime.

The aim of this study was to determinate the correlation between addictive behaviours and criminal offences in patients suffering from bipolar disorder.

Twenty-eight subjects with bipolar disorder were recruited from the forensic psychiatry service in Razi hospital and each one was compared with two patients suffering from bipolar disorder, correlated in gender and age and without history of criminal behavior. Data were analyzed using SPSS 11.5

The most frequent crimes committed by patients (about two thirds) were nonviolent (theft, pyromania, fraud, falsification of documents, damage to a property…).

The rate of criminal behavior was highest during manic episodes: 51, 7%.

Substance use was present in 66,7% of patients with history of criminal behavior against 30% in the comparative group.

This association was significant (p = 0,002). The odds ratio was about 5.

Our study suggests that comorbid bipolar disorder and addictive behavior may significantly increase the risk of criminality.

Sexual function is one aspect of physical functioning. Sexual dysfunction, no matter the etiology, could cause distress. in people with chronic renal failure, sexual problems have often been neglected in clinical practice and research. The aim of this study was to assess the sexual functioning of patients with chronic renal failure.

A total of 50 patients with chronic renal failure on hemodialysis were included in this study. The questionnaire included thirty items: sociodemographic data, clinical factors and history, sexual functioning before and after hemodialysis. Data were analyzed using SPSS 17.

Twenty seven per cent (27%) of the patients stated having no sexual activity at all. Eighty-three per cent (83%) of sexually active patients had sexual dysfunction. Sexual dysfunction in men was due to erectile failure, to loss of sexual interest, and to fatigue. Women reported essentially asthenia, loss of sexual interest and finally dyspareunia. These disorders appeared on average three years after being on hemodialysis.

The prevalence of sexual dysfunction was high among patients with chronic renal failure. This disorder needs special attention and management from doctors.

The debates about depressive disorder and cognition impairment are supported by controversial data.

We launched the study to investigate cognitive change in first onset depressive patients over a 6 year period.

A prospective cohort was performed. Participants included 206 cases of first onset depressive Chinese outpatient aged from 17 to 60 year old and followed from Apr. 2003-Feb. 2004 to Apr. 2009-Feb. 2010 in Shanghai. During the first 48 weeks, case management service was delivered. Participants were assessed by 17-HAMD and HAMA scale at baseline, week 12, week 32, week 48, and year 6. Cognitive changes were assessed using the WMS-RC, WAIS-RC, and WCST at baseline (n = 116), week 12 (n = 80) and year 6 (n = 24), 41 normal participants as control.

1. (1) During the first depressive onset, cognitive performance deteriorated comparing with those of control group (P < 0.01).

2. (2) At week 12,effective medication could relieve symptom and improve cognition function (P < 0.05), cognitive performance compared between patient and control with no obvious difference (P > 0.05). While patient group had a significantly larger proportion (whose Memory Quotient below 85) than control group did (χ2 = 5.66, P < 0.05).

3. (3) Using a general linear mixed model to estimate cognitive change,patients with more severe depressive retardation and lower education had a worse short-term memory over 6 years (estimate = -1.65, SE = 0.80, P < 0.05;estimate=1.63, SE = 0.30, P < 0.01), adjusting for demographics and medical status.

The first onset depressive patient has cognitive defects. Memory does not full recovery after symptom relief. Short-term memory impairment persists over 6 years with relative factors.

The aim of this study was to compare the sociodemographic and clinic characteristics of patients with bipolar disorder type I with and without history of depressive episode.

In this study the data of 108 bipolar type I patients who were admitted to psychiatry clinic of a university hospital due to manic episode between 2007–2009 were examined.

According to these data, 16 of 108 bipolar disorder type I patients (14.8%) had inhabited at least 4 manic episodes throughout their lives and there was no history of depressive episode although the disease had continued at least 4 years. with and without a history of depressive episode of bipolar type I patients have not been identified differ in terms of sociodemographic and clinical characteristics, but patients not having a history of depressive episode during their lifetime was found to be more than the number of hospitalizations.

Current information seem to be not sufficient to define unipolar mania as a separate nosological class. Largescale, prospective designs and illuminating the pathophysiology and etiology studies needs to be done in this issue.

Hypomanic Personality Scale (HPS) is a self-report questionnaire designed to identify high risk and vulnerable subjects to bipolar disorders in non-clinical samples.

To identify HPS factorial structure in a French non-clinical sample and to compare for different factors solutions described in the literature.

We carried out a survey within a student population with a French version of HPS. The factorial structure of HPS was tested first by a scree plot with simulation (using R “psy” library) in an Exploratory Factorial Analysis (EFA) with promax rotation. Secondly the number of factor was fixed for a Confirmatory Factorial Analysis (CFA) performed with AMOS.

A total of 347 students (mean age 23 years, 80% of women) were included in PCA (incomplete questionnaires were not included). Scree Plot with simulation revealed a 5 factors solution which accounted for 33% of the total variance. We also tested the 3 and 4 factors solution to compare respectively with factors solution obtained by Rawling et al. (2000) and more recently by Schalet et al. (2011). Our 4 factors solution was identical to Rawling et al. (2000) but the 3 factors solution was different from Schalet et al. (2011). Goodness of fit indices showed that the 5 factors solution “fits” our data better compared to other factorial solutions.

French version of the HPS showed a factorial structure composed of 5 factors in a non-clinical student population. However, this result needs to be confirmed with a more important and representative sample.

All children presenting to the Paediatric department at Ealing Hospital with self harm are admitted for joint assessment by the Ealing Child and Adolescent Mental Health Service (CAMHS) and Social Services within the next working day. This protocol is based on NICE guidance on the acute assessment and management of children presenting with self harm (NICE guidance 2004).

To conduct an audit of all self harm referrals to Ealing CAMHS and explore adherence to the existing protocol for referral of paediatric inpatients presenting with self harm to the CAMHS team.

A retrospective audit was conducted between the period 1st April 2011 to 31st March 2012.

67 self harm referrals were received. Presentations ranged as below:

Presentation Number

Self Poisoning 27

Cutting 5

Suicidal/self harm ideation 6

Attempted jump from height 1

Alcohol intoxication 26

Cannabis intoxication 2

57 cases were assessed; 40 jointly with Social Services. 55 cases were assessed within the next working day. 10 cases were not assessed however telephone contact was made and our service offered in 9. Ealing CAMHS followed up 22 cases. 4 were offered follow up by our service but declined. We had a 100% adherence rate to follow up with no repeat presentations.

To disseminate our findings to our Paediatrician colleagues and colleagues in social services and re-audit in 12 month's time. Our model is simple and can be adopted in other centres.

Violent conflict in Mollucas, Indonesia which started in 1999 had displaced more than 500.000 of the province's inhabitants and claimed more than 10.000 lives. The conflict was believed to be mainly a religious war between Christian and Moslem. Despite of the dangerous situation in the province, most of the inhabitants did not leave the province. After a short peaceful condition, another episode of conflict started in 2004.

This paper aims to investigate the difference of psychological distress and the risk factors of psychological distress of Internally Displaced Persons (IDPs) within the shorter period after the outbreak of conflict in 2004 and in the longer period.

Data were gathered from a longitudinal community based study conducted among internally displaced persons in Ambon island for two consecutive years in 2005 and in 2006. The number of IDP participants was 471 in 2005 and 399 in 2006. Data from 390 participants was analyzed.

There was a significant decrease in prevalence of psychological distress between 2005 and 2006, and the mean of psychological distress scores also was significantly lowered. in general the participants indicated improvement in mental health within one year interval of data collection time. Further investigation found different risk factors for psychological distress for shorter and longer period from the outbreak of the violent conflict.

This study explored the mental health of people affected by violent conflict in a more extensive way. Mental health initiatives were crucial in the process of rebuilding communities after devastating conflict.

Polycystic ovary syndrome (PCOS) is a common disease in women during the reproductive period. Studies have shown a reduction in the quality of life in patients with PCOS. But there is no consensus on which symptoms of PCOS influence the quality of life more.

In this study, we aimed to compare the quality of life, depression and anxiety levels of patients with PCOS to healthy controls.

53 reproductive-age women with PCOS and 53 healthy women who admitted to obstetrics and gynecology outpatient clinic of a university hospital were included in the study. For the evaluation of the quality of life of all patients, Polycystic ovary syndrome quality of life scale (PCOS-Q), Beck depression and anxiety levels of depression (BDI) and Beck Anxiety Inventory (BAI) was used.

While mean BDI scores were higher in patients with PCOS compared with control group, no significant difference was observed between the two groups in terms of BAI score. At the PCOS group; the total score of quality of life scale and the subscale scores of emotional deterioration, weight problems, infertility and menstrual disorders were significantly lower than the control group, but no significant difference was detected at the hirsutism subscale between the two groups.

PCOS has a negative impact on patients’ quality of life. To improve the quality of life of patients it should be taken into account the symptoms which are affecting the current state and the treatment should be planned toward this direction.