The understanding of neurobiology of eating disorders has received a remarkable contribution from neuroimaging research.

To review the literature on structural neuroimaging in bulimia nervosa.

To discuss recent contributions of structural neuroimaging to the understanding of bulimia nervosa.

MEDLINE and PubMed databases were searched for peer-reviewed studies, published between 2000 and 2012, by using combinations of the Medline Subject Heading terms structural neuroimaging and bulimia nervosa. A selection of relevant articles to the aim of this review was carried out.

Relatively few articles on structural neuroimaging were found in bulimia nervosa, and the studies showed conflicting results. Some studies reported evidence of brain volume loss in patients with bulimia nervosa, possibly related to associated chronic dietary restriction. Other studies have found increased grey matter volumes in frontal and ventral striatal areas. Finally, further studies did not find any structural abnormality at all in patients with bulimia nervosa, compared to healthy control subjects.

The scarce literature available on structural neuroimaging in bulimia nervosa provides conflicting results. Further studies are, therefore, warranted.

Self-harm patients utilize many resources. This is especially so for those with underlying maladaptive personality traits, which, have not been examined locally.

To estimate the prevalence of maladaptive personality traits in self-harm patients.

A 5-months cross sectional study was conducted at Changi General Hospital (CGH). English-speaking patients over 21 years old admitted for self-harm behavior were recruited into our study after being referred to our consultation liaison team. The ICD-10 (WHO 1993) was used for psychiatric diagnoses, and the International Personality Disorders Examination (IPDE) ICD-10 version screening questionnaire and the Depression Anxiety Stress Scale (DASS) 21 were administered. STATA version 10.1 was used for statistical analyses.

Of all patients referred, forty patients were eligible and 37 of them consented to participate in the study. All participants were screened positive for at least one class of maladaptive personality traits, with the majority (89.19%) being screened positive for more than 1 class of maladaptive traits. The three most prevalent classes of maladaptive traits were anankastic (75.68%), schizoid (67.57%) and paranoid (62.16%). More than three quarters (78.38%) of the participants had 3 or more classes of maladaptive traits.

Maladaptive personality traits are common and inherent in self-harm patients, with majority of them exhibiting anankastic, schizoid and paranoid traits in this study. Understanding the nature of maladaptive traits in self-harm patients can help us in tailoring future interventions towards such self-harm behavior to bring about improvements in psychiatric care, reduction of self-harm frequency and reduce health care cost.

The mechanism of psychological stress induced infertility is unknown.

Evaluation of oscillation pattern of GnRH release by the hypothalamus in different mental states.

To clarify whether hypothalamic oscillation is the target of stress.

Twenty two patients were evaluated on four different sessions (day 6 and 14) within two consecutive cycles in addition to the MCMI-III and the Hamilton's depression scale.

The pattern of oscillation was indirectly correlated with Hamilton scale and the anxiety state and showed statistically significant lowering of frequency during anxiety and depression states. Besides, the slope of GnRH between two consecutive sessions (d0GnRH0/GnRH1dt) showed also a prominent reduction and even flattening. In addition the time to ovulation was also postponed in cycles with prominent anxiety.

1. 1. Psychological stress exerts its effect through a reduction of pulsation frequency in GnRH release.

2. 2. The pattern of GnRH pulsation changes in the range of ¼ to 1/15 of baseline by external stimuli.

3. 3. Patients with borderline, schizoid, dependent, depressed and passive aggressive personality suffer most from irregularity of menstruation cycles.

4. 4. Patients with chronic major depression are subject to menstrual irregularity highest during stabilization of disease and in the early phases of recovery due to drug treatment with mostly SSRI.

5. 5. Treatment of depression of anxiety causes a reduction of menstrual cycles even to very short ranges.

6. 6. Measurement of GnRH, FSH, LH and Estradiol on two sessions one week apart is a nice marker for regularity and ovulation.

Personality, also designed as one's identity gives color to the notions, beliefs, social activities, self image … We wondered how personality could affect sexual life and functioning in a systematic way.

Many sexual dysfunctions, either primary or acquired are rooted in deep personality related beliefs and cannot be treated easily.

To find newer ways of treating more profound psychopathology in patients with sexual dysfunction by adding personality guided therapy into the sex therapy sessions.

Fifty four patients with sexual dysfunction were evaluated by Millon's clinical Multiaxial inventory III in addition to Questionnaire on Sexual attitude and function 2009. Half the patients received only sex therapy and if needed drug therapy while the other half received additionally intensive (twice weekly) personality guided therapy which included supportive psychotherapy, cognitive therapy and behavior therapy based on the personality category diagnosed at the beginning. After 12 weeks, both groups were evaluated with the same tools in addition to a clinical interview.

The latter group fared significantly (p< 0.03) better in regard to both personality and sexuality scales. A reduction of anxiety, depression, alcoholism and drug abuse scales was also encountered. Patients in the latter group explained themselves less disturbed, less ashamed and more ambitious to solve their problems as exemplified by the clinical interview.

Personality is a more and possibly the sole prominent risk factor of sexual dysfunction in the majority of patients and inclusion of treatment in this regard is extremely effective and with faster response.

Some personalities are more prone to mood disorders than others and treatment of mood disorders is more difficult in the setting of personality disorders.

Many boots of depression attacks are without major life events. Personality disordered persons show earlier attacks of mood disorders in their life with a tendency to treatment resistance and early recurrence designing a model on mutual interaction of mood and personality might be very fruitful.

To find more practical risk factors for chronic depression and improving the prognosis of these patients.

Three hundred and fifty nine patients with major depression were evaluated with the MCMI-III and Hamilton's depression scale at diagnosis and 12 and 24 weeks after medical treatment. Two sixty patients group with comparable personalities were compared for receiving personality guided therapy or not.

Personality disordered patients have a double chance of developing major depression during their lifetime as compared to normal persons as exemplified by their reference to our center. Hamilton's depression scale was reduced significantly more in personality normal patients than their disordered counterpart (p< 0.04). Those who received personality guided therapy fared also much better after 12 and 24 weeks after treatment.

We conclude that personality is a major risk factor both in developing depression and in reduced responsiveness to conventional treatments. Patients with premorbid personalities should receive more intensive drug therapy in addition to personality guided therapies. Personality acts both cis (in the same side) and trans (in the opposite side) of mood.

Schizophrenic patients have shown by experience to have reduced sense of humor and do not understand jokes completely.

It is unclear whether this is the result of a global emotional numbness, a dysfunctional abstract thinking or problem of semantic field. Besides, the relevance of this issue in mood disturbances in psychotic patients must be reappraised.

Increase of sociability in schizophrenic patients by way of augmenting sense of humor.

Hundred schizophrenic patients were evaluated by way of interview and three questionnaires for their sense of humor and abstract thinking in response to non sexual jokes. They were asked to tell ten jokes and grade them in regard to funniness. In addition ten jokes were told to them and asked them to grade these jokes in a 10 strength scale. These steps were repeated after 12 weeks of conventional antipsychotic treatment in addition to short courses of psychotherapies.

Schizophrenic patients have an overall reduced sense of humor for jokes even if they can understand the core reality of them hence not a matter of deranged abstract thinking. They show also reduced expression of joy in response to jokes that they have rated highest. This denotes some degrees of emotional numbness. Treatment of patients with conventional antipsychotics cannot completely restore the sense of humor even after a 3 months period.

We conclude that sense of humor is a central issue in social functioning and some additional treatments must be used to normalize patients with schizophrenia.

In a society with religious and cultural restrains a standardized tool for sexual evaluation is urgently needed.

To study sexual problems of our patients and standardizing it for patients with different backgrounds we developed a questionnaire with 240 phrases that were extracted from a pool of 1400 sentences addressing sexual problems. Sixty four scales under four headings (sexual general characteristics, deviations, dysfunctions and psychodynamic syndromes) (16 items each) were evaluated based on criteria of DSM-IV and ICD 11. Five validity scales (honesty, desirability, debasement, guilt feeling and overall validity) were also used for better assessment.

Evaluation of the clinical relevance of the QSAF 2009.

A total of 1300 patients in the four variants of the test were evaluated during a time span of 7 years. The questions were presented to examinees at 8th grade and higher in a calm environment and the results were evaluated by computer software specifically developed for this purpose.

The last version of the test was completed by 734 patients with excellent compliance. It was rated as polite and comprehensive. For almost all scales the sensitivity and specificity were around 85 and 92% respectively.

QSAF 2009 is an excellent tool both in clinics (diagnosis and follow up) and epidemiology with high sensitivity and specificity. It has also application in cross cultural studies, medico - legal issues and medical documentation. It prevents face to face interviews, breaks patients’ resistance and is less time consuming than scheduled interviews.

Dysmenorrhea causes much morbidity in high percentage of the population and despite its uniform molecular pathogenesis exhibits wide range of symptoms.

Many patients attribute menstrual symptoms to sex while others attribute it to an intra-abdominal organic disease.

To evaluate whether dysmenorrhea patients have peculiar notion about sex

We evaluated 60 normal and 60 dysmenorrhea patients with QSAF-2009. The latter group used routinely drugs for dysmenorrhea in a PRN basis. Dysmenorrhea was not graded according to severity and stress was laid on personal view about the matter (major concern versus no concern).

Patients without dysmenorrhea were sexually more self conscious, became sexually active earlier in their life, had lower scores in most sexual dysfunction scales, had higher scores in experimentation, sensational, erotic, extramarital relationship, sex addiction and lower scales in couple problems while women with dysmenorrhea showed higher scores in couple problems, sexual pain syndromes, vaginism and a series of psychodynamic syndromes (0.04>p>0.07). Curiously, these people showed higher scores in homo- bisexuality scales. They showed high rates of sexual guilt feeling and the overall validity of their test was questioned. They showed increased reluctance to answer the questions, regarded their problems as personal secrets and reported fewer visits to gynecologists. They preferred female gynecologists, and had never been visited by midwives. Most of them preferred cesarean delivery under general anesthesia.

We conclude that dysmenorrhea patients are categorically distinct from normal persons in regard to their sexual attitude and function.

Dysmenorrhea is a pain variant syndrome with wide range of manifestations and intensity even in the same person. Like other pain variants it seems to be very subjective and personality dependent.

Despite uniform molecular basis of dysmenorrhea further risk factors are needed to be clarified.

To find out which subgroup of patients express more severe symptoms and need stronger treatments.

Hundred and twenty consecutive patients (half reported dysmenorrhea of some concern while the other half of no or minor concern) were evaluated with the Millon's Clinical Multiaxial inventory MSMI-III. The former group used routinely drugs for dysmenorrhea in a PRN basis and some used medications as prophylaxis. The former group was free to use psychoactive medication but people using psychoactive medications were excluded from the latter group. Dysmenorrhea was not graded according to severity and stress was laid on personal view about the matter.

Patients with dysmenorrhea had higher scores in passive aggressive, borderline, avoidant, dependent, histrionic and obsessive personality scales (p< 0.04) while patients without dysmenorrhea showed higher scores in narcissistic, schizoid, schizotypal, paranoid personality scales (p< 0.07).

Dysmenorrhea patients show lower pain threshold, increased preoccupation about disease and higher rates of menstrual irregularity, are more regularly visited by their gynecologist, ask more questions about cancer and are more prone to adjustment disorder. We conclude that although the pathophysiological basis of dysmenorrhea can purely be attributed to organic and molecular landmarks the expression of pain and reaction to it is personality dependent.

A recent national survey highlighted the considerable treatment gap for depression (59.6%) in modern Singapore. Asians tend to focus on physical features of a disease than the psychological ones, which might contribute to the relative lack of disease pick up by physicians. Literature suggests a distinct clinical entity of depression among the elderly, with a different clinical presentation from adults.

This retrospective case series was undertaken to understand the clinical features and management decisions of elderly patients presenting with depression in Singapore.

To describe the demographics, clinical presentation, psychiatric and medical co-morbidities, and management decisions of depression in the elderly.

Inter-departmental referrals to the Department of Psychological Medicine of Tan Tock Seng Hospital from 1/1/2011 to 31/3/2011 for the management of patients ages above 64 with the diagnosis of depression were collated for case description.

A total of 40 inpatients ages 65 to 104 years (mean 76.2 years) were recruited. 14 (35%) were male and 26 (65%) were female. 70% of them does not have a co-existing psychiatric diagnosis. The highest number of referrals were form the department of General Medicine (42.5%) followed by Geriatric Medicine (25%). Most of the elderly were admitted for infection (20%), followed by equal proportions of those admitted for cardiovascular problems (12.5%), recurrent falls (12.5%), psychiatric issues (12.5%), and orthopedic problems (12.5%).

As the population of Singapore ages, clinicians should be mindful that depression often co-exist with medical co-morbidities, and the complex interaction amongst the two entities.

Quality of life is negatively influenced in various degrees in both bipolar and recurrent depressive disorder, predominantly in the acute episode but also during remission.

To compare the degree of negative influence of the two nosological entities on quality of life of patients during remission.

78 outpatients diagnosed with recurrent depressive disorder, 67 outpatients diagnosed with bipolar affective disorder, according to ICD-10 diagnostic criteria and 73 healthy subjects were selected for this study. The assessment of the subjects took place during remission (euthymia), between june 2009 and june 2012. As work-instruments we used the SF-36 Scale for assessing quality of life and the HAM-D Scale (Hamilton Depression Rating Scale) and YMRS Scale (Young Mania Rating Scale) to confirm remission.

The bipolar group scored lower regarding quality of life than the recurrent depressive group. Both affective disorder groups showed significantly lower quality of life scores when compared to the healthy control group.

Bipolar affective disorder and recurrent depressive disorder have a significant negative impact on quality of life even during remission. Bipolar patients may have a lower quality of life than recurrent depressive patients. To improve quality of life, patients need social and familial support.

In the current study, it was aimed to investigate the correlation between the caregivers of schizophrenia and bipolar disorder (BD) patients in terms of burden, depression, anxiety and hopelessness.

Between March and July 2011, 75 schizophrenia and 50 euthymic BD patients' primary caregivers at the outpatient clinic in Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery participated in this study. Informed consent was obtained from all patients and their caregivers. Sociodemographic data form, PANSS, Beck Depression Scale, Young Mania Scale were applied to the patients. Sociodemographic data form, Zarit Caregiver Burden Scale, Beck Depression Scale, Beck Anxiety Scale and Beck Hopelessness Scale were given to the primary caregivers.

The burden level is found to be severe in the schizophrenia and BD patients’ caregivers. Seventy-two percent of schizophrenia patients’ caregivers and 62% of the bipolar disorder patients’ caregivers had depressive symptoms. The anxiety levels of the caregivers of the bipolar disorder patients were found to be significantly higher than that of the schizophrenia patients’ caregivers (p< 0.05). We found a positive correlation between the scores of the Zarit Caregiver Burden Scale in the caregivers of the schizophrenia patients and PANSS positive, negative, and general psychopathology scores in schizophrenic patients (p< 0.05). There was found a positive correlation between the depression levels of BD patients and their caregivers’ burden scores (p< 0.05).

High level of burden in both groups’ caregivers was found. Therefore, this situation can be making it difficult to cope with these diseases.

Multi-factorial aetiology of schizophrenia has an undeniably large genetic component. Attempts to elucidate its genetics with large case control studies have met with limited success and other approaches are warranted.

In an extended family (pedigree 1) in which two sets of siblings - children of a brother and sister - are intermarried; six members with DSM-IV schizophrenia share a 6MB region of homozygosity on chromosome 13q. One out of twelve genes at this locus shows a sequence change in its promoter region.

[Pedigree 1]

Another family (pedigree 2) with two affected brothers has revealed two loci of homozygosity on chromosomes 5 and 9.

[Pedigree 2]

A third family with nine cases of psychosis is being investigated.

An approach which focuses on families with multiple cases in one generation and evidence of consanguinity in parents may be particularly successful for identifying recessive genes.

Longitudinal studies reporting the association between cannabis use and developing depression provide mixed results. The objective of this study was to establish the extent to which different patterns of use of cannabis are associated with the development of depression using meta-analysis of longitudinal studies.

Peer-reviewed publications that compared the risk of development of depression in cannabis users and non-userst were located using searches of EMBASE, MEDLINE, PsychINFO and ISI Web of Science. Data on measures of cannabis use, measures of depression and control variables were extracted. Odds ratios were extracted by age and length of follow-up.

After screening 3,905 articles, 55 articles were selected for full-text review, of which 12 were included in the quantitative analysis. The odds for cannabis users developing depression compared to controls was 1.26 (95%CI=1.10-1.44). The odds for heavy cannabis users developing depression was 1.72 (95%CI=1.27-2.34), compared to non-users or light users. Meta-regression revealed no significant differences in effect based on age of subjects or length of follow-up in the individual studies. There was large heterogeneity in the number and type of control variables in the different studies.

Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. Despite limitations due to heterogeneity in control variables, this study represents the current state of knowledge on this association. In order to establish a more precise dose-response relationship between cannabis use and the risk of developing depression, future longitudinal exploration should take into account cumulative exposure to cannabis.

Pseudocyesis have been crossing several centuries under different terms. Recently there has been an evolution around the factors involved, being recognized a complex relation between psychological mechanisms, neuroendocrine imbalances and sociocultural factors.

To present a clinical case and revisit the literature about pseudocyesis. A reflection about the etiological factors potentially involved and the importance of the cooperation between Psychiatrist, Family Physician and Obstetrician on Somatoform Disorders.

Literary review for understanding the clinical case and diagnosis and treatment discussion.

A woman, followed at Psychiatric appointments for history of drug addiction, presents a clinical chart compatible with pseudocyesis recurrent episode. Several questions are raised about the possible factors associated, considering pathophysiological, neuroendocrine and psychological models. It's also assessed the best therapeutic approach to motivate the patient towards therapeutic compliance, being crucial the coordination between the several health care professionals.

There aren’t many case reports about pseudocyesis, and there is even less data related specifically to patients with an addictive disorder. Besides the psychological factors classically associated with this somatoform disorder, it is necessary to consider endocrine and neurophysiological factors in outlining the etiological mechanisms. It is also acknowledged the crucial importance of a multidisciplinary approach between the several health care professionals, that should be aware to these cases in order to promote the therapeutic compliance by the patients. Early detection and empathic communication with the patient are the most important factors to be valued on an approach which should be socio-familial, biomedical and psychotherapeutic.

Sixty eight patients with epilepsy (mean age 28.1±2.9 years) were studied (DTI MRI, EEG-mapping, neuropsychological tests). Patients of control group (n=32) took AED at therapeutic doses and had side effects at 97%. Patients of experimental group (n=36) treated with low AED doses and 1 Hz rTMS over the temporal lobe with focusing on hippocamp projection.

There were depression at 48.5% and high anxiety level at 40% of examined patients what correlated with position of epileptic focus in left hemisphere (OR=6.7, p=0.045), presenting of “spike-slow wave” complexes (OR=9.6, p=0.0001), female gender (OR=4.2, p=0.04) and focal onset of seizure (OR=2.1, p=0.039). Dynamic monitoring at control group did not reveal any differences at epilepsy course during 12 monthes.

At experimental group significant decreasing of seizure frequency and severity during 12 weeks after rTMS onset was determined. Antidepressive and anxiety effect was obtained at 46% patients to tenth procedure (p=0.004). Increasing of quality of life was registered by QOLIE-31 (p< 0.05). Received effect remained during six monthes in 40% experimental patients (p< 0.05).

Thereby, including of rTMS into combined epilepsy therapy with low doses of anticonvulsants has a determining function and leads to significant antiepileptic effect improves the psychological condition, quality of life of these patients and allows avoiding of psychotropic drugs prescription.

This is the first European psychiatric exchange programme and it aims to promote an intercultural professional exchange and cooperation among psychiatric trainees across Europe, with a focus on individual experience.

To provide trainees with the opportunities to:

• promote awareness of intercultural aspects of psychiatry

• engage in clinical, and/or research, and/or teaching activities

• become acquainted with different mental health systems

• gain experience of different illness manifestations and treatment options

• experience a different training programme

• socialise with peer group, promote networking and discuss coping strategies regarding work life balance

The programme was developed by the exchange working group of the EFPT in 2011 and it offers 2-6 weeks in observational placements across Europe in diverse areas.

Feedback from pilot phase (January-July 2012) has shown excellent overall satisfaction of participants in the project. In the 2nd phase (August-December 2012) the programme has expanded offering more observational placements in 8 countries such as: Croatia, Denmark, France, Italy, Portugal, Slovenia, Spain and UK. In the 3rd phase (January-July 2013) it expanded further to include Ireland, Netherlands and Romania in a total of 11 hosting countries. Placements are offered in many subspecialties such as: psychotherapy, emergency psychiatry, child and adolescent psychiatry, eating disorders, family therapy, liaison psychiatry and psychosomatics, drug addictions, learning disabilities, forensic psychiatry and old age psychiatry.

We hope that the diversity of placements offered by this innovative programme will constitute a new approach to the improvement of psychiatric training and practice across Europe.

Previous evidence shows that STON2 was associated with synaptic function and schizophrenia. The aim of this study is to explore the relationship STON2Ser307Pro, Ala851Ser and cortical surface area in schizophrenia patients and healthy volunteers.

MRI whole cortical surface area which was computed by an automated surface-based technique (FreeSurfer) and genotypes were obtained from 74 individuals with first-episode schizophrenia and 55 controls. Multiple regressions analysis was performed using genotype subgroups to effect on cortical surface area.

There was significant genotype-by-diagnosis effect on cortical surface area, Pro-allele-carriers having larger right inferior temporal surface area in schizophrenia patients, but there was no significant on the same area in healthy volunteers, have not detected that Ala851Ser was associati[on with cortical surface area in our subjects.

These data demonstrate that STON2 gene may be alter cortical asymmetry on the right inferior temporal, and that abnormal gene may be a core role that contributes to the pathogenesis of schizophrenia.

The US Drug Enforcement Agency maintains a tight leash on drugs of abuse and has already banned newer designer drugs like Spice and Bath Salts. However, there is increase in the use of a new drug called pump it (PI). There is some evidence that it contains Geranamine Methylhexamine (DMAA). This is a report of a patient who exhibited unusual behavior after using PI.

A 40-yo male was brought to the Emergency Room after he stabbed himself in the abdomen using a knife sustaining laceration to the liver. Psychiatry consult was requested for attempted suicide. The patient had total amnesia surrounding the event. Collateral information from the wife revealed that his pupils were widely dilated and he appeared agitated, paranoid and diaphoretic just before stabbing himself. Six weeks prior, he began snorting to self detoxify himself from opioids. He experienced a 40 lb. weight loss, severe insomnia and impulsive behavior translating into dangerous acts like medication overdose and walking into oncoming traffic. He had no such symptoms prior to using PI.

Geranamine is a stimulant is presumed to act by releasing norepinephrine. It is used as a dietary supplement for weight loss and energy gain. It has been reported to produce paranoia, hallucinations, mood lability and seizures.

Substance induced mood disorder should be considered as a differential diagnosis of suicide attempt and clinicians should be aware about the fact that some “dietary supplements” may pose severe danger to patients.