Post-Traumatic Stress Disorder (PTSD) affects nearly 10% of soldiers leaved waging war. So far, there is no standard treatment for PTSD. The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. Excessive brain responsiveness to norepinephrine appears to play a significant role in the onset of PTSD. A brain active alpha- 1 adrenergic receptor antagonist used to treat benign prostatic hypertrophy and hypertension, prazosin, is of major interest and might become the main therapeutic treatment for PTSD.

In order to further assess the therapeutic efficacy of prazosin, the present review analyzes the results of Medline-referenced outcome studies conducted.

Confirm the therapeutic efficacity of prazosin in the PTSD.

These studies concern 99 patients included in five clinical trials ran from 2004 to 2008. 24% of the patients have been exposed to civilian trauma and 76% to war trauma. Prazosin significantly (p< 0.05 versus controls) decreases trauma nightmares, distressed awakening, avoidance, sleep disturbance, hyper-arousal, re-experiencing and improves global clinical status in all studies. From a statistical point of view, any significant difference of blood pressure was observed at the end of trials.

Beyond the methodological biases, the present review confirms the effectiveness of prazosin in reducing overall PTSD illness severity and distress. Studies of longer duration in larger samples are necessary to confirm these preliminary findings.

In the United States of America, lifetime prevalence of the post-traumatic stress disorder (PTSD) varies between 8 and 11 %. The pathophysiology of PTSD is complex, involving the prefrontal cortex, the limbic system which amygdala and the locus coeruleus. We don’t have a specific treatment for this pathology but just a symptomatic treatment.

The present review analyzes the results of referenced outcome studies in Medline. The efficacity of prazosin, an alpha-1 adrenergic antagonistis is an evidence to this deregulation.

Confirm the hypothesis of a noradrenergic dysregulation in PTSD.

Of share its projections with the amygdale, the hippocampus and the prefrontal cortex and the reticular formation, the locus coeruleus is one of the main brain noradrenergic structure. It regulates the vigilance and attention in the alert situations and regulates the fear and anxiety. The locus coeruleus regulates the wakefulness-sleep cycle with this projection with the raphe nuclei and the paraventricular nuclei of hypothalamus. During a stress, activation of locus coeruleus causes a release of norepinephrine responsible for symptoms of avoidance, hyper-arousal, re-experiencing and trauma nightmares. Prazosin, significantly decreases the main clinical symptoms of PTSD and improve global clinical status to placebo in all studies. This results constitutes a harmul evidence to the implication of norepinephrine in the PTSD.

Norepinephrenine is a major actor in the pathophysiology of PTSD. The prazosin is led to become the first-line treatment of PTSD but longer studies in larger samples are necessary to confirm these preliminary findings.

Diogenes Syndrome (DS) refers to a collection of features found mainly in older persons which includes social isolation, self-neglect, poor insight, domestic squalor and hoarding behavior. Underlying psychiatric disorders might be identified in most of those elders. Issues of law have been embedded in DS cases, since individuals commonly expose themselves and their neighborhood to preventable health risks, due to extreme self-neglect and poor sanitation.

This cross-section aims to assess health-care, cognitive and civil capacity status of patients with DS, based on data from forensic-medical reports.

Psychiatric-forensic reports concerning to elders living alone, recorded between January 2009 to December 2010 in the archives of the Public Attorney District of the State of Rio de Janeiro, Brazil, were analyzed.

Reports from 40 living alone elders (mean age=79.63 ± 7.84 years; mean schooling= 5.68 ± 5.43 years; 75% female) were eligible for the study. 20 individuals (50%) fulfilled diagnostic criteria for DS. DS individuals presented significantly lower mean scores in MMSE than non-DS persons (p= 0.019). More individuals with dementia were found among DS group. Fewer recent medical consultations (p= 0.038) and higher rates of civil incapacity (p= 0.001) were identified in DS elders. Negative moderate correlation was found between MMSE scores and diagnostic of DS (rho=-0.403; p= 0.016). Medical support (phi= 0.388; p= 0.016) and civil incapacity (phi= 0.554; p< 0.001) also correlated with diagnostic of DS.

DS might be related to poor cognitive status, health care neglect and impaired discernment, which may be of interest to both health and law practitioners.

The “Uncanny” (Das Unheimliche), a concept coined by Sigmund Freud (1919) and presented in art and psychotherapy. It is when an experience can be familiar, yet foreign at the same time, resulting in an uncomfortably strange or familiar feeling.

A theoretical investigation and comparison of the “Uncanny” concept in the cinematic and psycho-therapeutic setting.

1. 1. Exploring the cinematic Uncanny motifs in two films by screenwriter, Charlie Kaufman: “Being John Malkovich” and “Adaptation”.

2. 2. Exploring these motifs and understanding them in the context of a case study of prolonged psycho-dynamic psychotherapy.

3. 3. Outlining practical implications for the use of this concept in psycho-dynamic psychotherapy.

Through cinematic analysis of the films we describe the development of the uncanny experience. Thereafter, through narrative analysis of a case report, we refer to the obstacles created by the “Uncanny” experience in the psycho- therapeutic process.

The cinematic motifs (“The Double” and “The Secret”) involved in the creation of the “Uncanny” experience are present and have a major effect on the therapeutic process. Exemplifying and analyzing their presentation seem to clarify possible obstacles that challenge the therapist.

The “Uncanny” is a concept that describes the human experience of sudden familiarity in a novel and strange situation. In this study we describe this phenomenon through psychoanalytic literature and explore it via popular films. It seems that recognizing the Uncanny in the therapeutic process may assist in engaging a therapeutic relationship and improving therapy outcomes.

This descriptive study was held in the department of Internal Medicine in Hedi Chaker Hospital, (Sfax-Tunisia), during 04 months (From July to October 2012). We have included 50 patients, having corticosteroids with a dose equal or greater than 10 mg of prednisone per day for a period exceeding one month. We used in this study, the HAD scale for anxiety-depression, the SF-36 to investigate the quality of life of these patients, the ANGST score of hypomania and the Morisky score to investigate the adherence to treatments (Corticosteroids).

The average age was 43.43 + / -16.11 years. The age of discovery of the disease was 38.24 + / -14.28 years. An average score of anxiety was 10.6 + / -3.89. The mean score of depression was 8.75 + / -4.035. An average score of hypomania was 8.43 + / -4.025. We noted that 53.7% of patients belong to level 3 of anxiety, and 40.56% have some level depression by the HAD score.

Psychiatric complications were noted in 58.5% of patient with a major depressive state in 12.2%. Patients reported sleep disturbances in 24% with behavioral problems in 9.6% of cases.

The average score of SF36 was 56.55 + / -15.21, and 74% of patients had distorted quality of life, mainly affecting health psychic (92.54%), limitation due to mental state (95.75%).

Our results suggest the interest of a psychiatric examination before the introduction of corticosteroids, in order to detect patients requiring special supervision.

Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation.

To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance.

60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19.

Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p< .05) scores in hetero-evaluation measures of insight and treatment attitudes (ITAQ), yet exhibited no differences in the self-evaluation measures of those dimensions.

Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.

Alcohol dependency can cause serious complications if not managed appropriately.

To evaluate if the local guidelines (based on NICE) for the management of acute withdrawal are followed at the Bede Unit/South Tyneside. These advises a three day course of intramuscular Pabrinex and seven days reducing regime of benzodiazepine (commonly Chlordiazepoxide) with additional PRN (as required) benzodiazepine.

The project's main objective is to identify how the guidelines can be delivered more effectively.

Retrospective data collection from all kardex for all patients (21 identified) who received a reducing regime of benzodiazepines between Oct/11 & Jan/12, for alcohol withdrawal symptoms, examining if they were prescribed bezodiazepines regularly, ‘as required’ or both to treat withdrawal symptoms. Vitamin supplementation as part of their management of alcohol withdrawal was also reviewed.

All patients were prescribed chlordiazepoxide. Seventeen of these were prescribed both regular and PRN chlordiazepoxide, while one received regular only and three patients received PRN only. Period of treatment ranged from 2-11. Five received the recommended seven days reducing regimen.

Only one patient was managed in accordance with local guidelines (three days of intramuscular Pabrinex/seven days reducing chlordiazepoxide/PRN benzodiazepine)

There was inconsistency in the use of PRN benzodiazepine.

There might be doubts about patients’ knowledge regarding as required medication, and on how withdrawal symptoms are monitored.

The reducing regime of benzodiazepines is limited to the format of the kardex, which made it difficult to identify drug errors or omissions and hence increased the margin for medication errors.

There are few studies in the international and national literature exploring the association between parental rearing styles, eating habits/behaviours and symptoms of Eating Disorders (ED).

To examine the associations between the dimensions of Parental Rearing Style Questionnaire for Adolescents (EMBU-A), the dimensions of a test assessing eating disorders symptoms (Eating Attitudes Test-25/EAT-25), Body Mass Index (BMI), items assessing eating habits/behaviors and sociodemographic family and health variables; to explore which are the predictors of symptoms of eating disorders and eating habits/behaviours.

402 adolescents (girls: n = 241, 60%) between 12 and 18 years old (M = 14,2, SD = 1,62) answered a sociodemographic questionnaire, the EMBU-A and the EAT-25.

We found a negative association between Emotional Support (EMBU-A), all the EAT-25 dimensions and EAT-25 total score. There was, generally, a positive association between the Overprotection and Rejection dimensions (EMBU-A) and the same results of the EAT-25. Sports’ practice was associated with a higher mean score of Motivation for Thinness and the total score of the EAT-25. In the predictive analyses, Emotional Support showed to decrease the likelihood of adolescents manifesting ED symptoms and Rejection to increase that likelihood.

Emotional Support seems to be protective of ED symptoms and dysfunctional eating habits/behaviors appearance in adolescents, while Rejection appears to increase the risk of these two outcomes. These dimensions should be worked together with parents, eventually, by psicoeducational programs. At schools and health centers, programs can be implemented to improve eating habits/behaviors and help prevent ED development

Depression is a common, recurrent, often underdiagnosed and undertreated disorder in older people. 10-15% of the elderly present depressive symptoms and 3% of that same population meet criteria for a major depressive episode.

Several factors, such as psychosocial changes, may be related to the onset of depressive episodes. Retirement (often accompanied with feelings of loss of status, both in the family and in the society), the decrease of social contacts with a tendency to isolation, and the difficulties to adapt to new activities and routines, all lead to feelings of inadequacy, worthlessness and a poor self-esteem.

The aim of this poster is to show and discuss the importance in recognizing some psychosocial factors that can predict the onset of depressive symptoms in the elderly.

We report a case of a 66-year-old man, without previous psychiatric history, who presented a major depressive episode with psychotic features, after an important life event (retirement).

Depression in older people has severe consequences, afflicting not only patients but also the caregivers. The amplification of previous disabilities associated with medical and cognitive disorders, the increased rate of mortality by suicide and the increased costs to the health care system are common consequences.

To reduce such threats we propose a clinical and social approach that evaluates and regards the different stages of the life cycle and valorize the achieved experiences of older patients.

Subclinical hypothyroidism (SCH) occurs in 4-20% of adult population, elderly subjects have the higher prevalence. Although the impacts of overt hypothyroidism on metabolic and neuropsychiatric functions are relatively well documented the effects of SCH remain controversial. Several studies have reported that SCH was associated with increase of metabolic diseases and neuropsychiatric disorders.

The purpose of this work is to report a clinical case of coexisting dementia and subclinical hypothyroidism.

Descriptive analysis of a clinical case supported on the review of literature.

The authors describe a case of an 82 year old man with an established dementia, in the three weeks before hospitalization developed a clinical presentation with increasing agitation, aggression, behavioural disorders, impaired memory and insomnia. He had several co-morbid medical conditions, including atrial fibrillation, hypertension and dyslipidemia, with treatment.

For an accurate diagnosis is important to exclude organic pathology. The elderly patients have generally been reported to have associated multiple co-morbidities and polimedications with serious implications in psychotropic medications. This overlap with other diseases is an important confounding factor in the older population. Management of these patients presents a continuous challenge in the context of a General Hospital.

Pregnancy and postpartum are periods of increased vulnerability for psychiatric disorders, such as mood disorders, anxiety and psychotic disorders, that, when left untreated, imply serious consequences for the pregnant and the fetus. Since 1995, the Psychiatric Liaison Consultation in Bissaya Barreto Maternity (MBB) is part of the Early Intervention Unit (UIP), which consists of a multidisciplinary team that ensures a specific intervention in pregnant and postpartum women with psychiatric illness.

The purpose of this study was to evaluate the effects of prenatal exposure to psychiatric medication on obstetrical and neonatal outcomes.

The authors conducted a case-control study to compare obstetric and neonatal outcomes among pregnant women exposed to psychotropic drugs (antidepressants, antipsychotics, mood stabilizers and benzodiazepines), observed at the Psychiatry - Obstetric Consultation (n= 69), with those of women followed at the Obstetric Consultation, without psychopathology during pregnancy, who were not exposed to psychiatric medication (n=69). The study was performed during a period of six months (October 2011 - March 2012).

The results were analyzed using the Statistical Package for the Social Sciences - SPSS (19th version).

Preliminary results show that obstetrical and neonatal outcomes in the group exposed to psychiatric medication are, at least, as good as in the control group, supporting that the use of psychotropic drugs during pregnancy is safe, as long as used with caution. Early psychiatric intervention during pregnancy, in conjunction with obstetrics, seems to be the best way to follow up pregnant women with mental illness.

Altered levels of phenylalanine and its metabolites in blood and cerebrospinal fluid have previously been reported in schizophrenia. This study attempted to examine whether phenylalanine kinetics is altered in schizophrenia using the 13C-phenylalanine breath test (13C-PBT).

Subjects were 20 patients with schizophrenia and the same number of controls. 13C-phenylalanine was administered and then 13CO2 concentration in breath was monitored for 120 minutes. The Δ 13CO2 at each collecting time, the maximal Δ 13CO2 (Cmax), the time to reach Cmax (Tmax), the area under the curve of time course of Δ13CO2 (AUC), the cumulative recovery rate (CRR) at each collecting time of the 13C-PBT were calculated for each subject.

Body weight (BW) and diagnostic status were significant predictors for Cmax. BW, age and diagnostic status were significant predictors for AUC and CRR at 120 minutes (CRR0-120). A repeated measures ANCOVA controlling for age and BW revealed a different pattern of change in CRR over time between the patients and controls and that Δ13CO2 in schizophrenia were lower than that in healthy control at all sampling point during 120 min, with an overall significant differences between healthy control and schizophrenia. The ANCOVA controlling for age and BW, showed that Cmax, AUC and CRR0-120 were significantly lower in schizophrenics than in controls.

Our data indicate the different change of Δ13CO2 and CRR over time and the decreased Cmax, AUC and CRR0-120 of 13C-PBT in schizophrenia patients compared to healthy controls, suggesting the altered phenylalanine kinetics in schizophrenia.

Many of patients suffering with psychiatric disorder describe significant stressful experiences from childhood. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security, acceptance or approbation.

We describe approach in processing these painful events during the therapy. Among basic principles in the treatment of the patients who developed psychiatric disorder and have stressful events in childhood or adolescence belongs the creation of collaborative therapeutic relation, explanation and psychoeducation what happens with the patient and reducing or correct stigmatization and guilt feelings. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life. The transcription of traumatic or stressful events follows after cognitive restructuralization of core schemas and conditional assumptions. Therapeutic process can be divided into of several steps:

1. (a) creation of therapeutic atmospheres (with feelings of security and control, acceptance, approbation);

2. (b) exposition to the painful memories in imagination;

3. (c) expression of negative emotion to the aggressors, or persons that the didn’t guard against stress or trauma;

4. (d) formulation the needs of the child to significant adult person;

5. (e) experience better end in imagination - transcription of the story;

6. (f) general calm down.

The aim of therapist is to help the patient memorizing the stressful events and expressing affective experience and then help him/her to rescript experience to less painful.

There are some case examples of traumatic rescription in the article.

MZ CR NT 11047-4/2010.

In the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment. The goal has therefore changed from the alleviation of symptoms to improvement of the patient's satisfaction with social activities. Self-evaluations by people with schizophrenia were previously thought to lack reliability because of the presence of psychopathological symptoms and poor awareness of the disease. Recently the importance of evaluating the satisfaction of patients themselves, however, has been recognized in schizophrenia. Studies on this field showed us, that QoL data from patients with chronic mental illness were reliable and concluded that subjective QoL evaluation was applicable to such patients.

The purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remission with healthy controls and examine the extent of the effects of subjective cognitive functioning on QoL in these patients.

Data were obtained using the quality of life questionnaire (Quality of Life Enjoyment and Satisfaction - Q-LES-Q), and subjective questionnaire for cognitive dysfunction (Cognitive Failures Questionnaire - CFQ) for 40 schizophrenia patients in clinical remission and 40 healthy controls.

Cognitive function correlates negatively with subjective QoL in patients with schizophrenia.

Supported by grant IGA MZ ČR NT11047.

Executive functions (EF) are associated to frontal lobes and cognitive decline (CD) with worse results on EF tests.

Analyze if the Frontal Assessment Battery/FAB assessing EF discriminates elders with CD (vs. with no CD; Montreal Cognitive Assessment/MoCA), and if the results obtained with the Rey Osterreith Complex Figure Test/ROCF (copy's quality, immediate, and delayed memory) are associated with the CD presence/absence. Moreover, we wanted to assess if copy's quality and 3 minutes memory test are associated with FAB results, since these two tests are supposedly associated with EF and with frontal lobes assessed by the FAB, contrarily to the 20 minutes memory (supposedly related to the temporal area).

556 institutionalized elders (age: M ± SD =80.2 ± 5.23; range=60-100) filled in voluntarily a sociodemographic questionnaire, ROCF, MoCA and FAB.

FAB and all ROCF tests were associated with the absence/presence of CD. Regarding variables stratified by age and education, FAB was associated with immediate memory but not with copy's quality nor with delayed memory. With no stratified ROCF and FAB, correlations confirmed the previous associations, but also between FAB and copy's quality.

Results follow the literature regarding the association between immediate memory and EF (associated to frontal lobes), in contrast to the long-term memory which is associated with the temporal area and that was not associated with FAB. Results concerning copy's quality (ROCF) are not consensual.

The literature recognizes differences in the prevalence, eating disorders (ED) symptoms and eating habits/behaviours by sex, but few studies in Portugal considered this subject.

To explore associations between sex, Body Mass Index (BMI), Eating Attitudes Test-25 (EAT-25) dimensions and items, the EAT-25 score dichotomized by the cutoff of 19 (a score equal/above 19 indicates “possible” ED) and, finally, some items about eating habits/behaviors; to verify possible associations between sociodemographic variables and items assessing eating habits/behaviours.

308 adolescents (M = 14,5 years; DP = 1,67; girls, n = 184, 59,7%) answered a sociodemographic questionnaire and the EAT-25.

There were no significant associations between sex, categorized and dimensional BMI, EAT-25 dimensions, categorized EAT-25 (cutoff of 19) and items assessing eating habits/behaviors. However, some items of the EAT-25 revealed a significant association with sex. Most adolescents from both sexes presented a score below the cutoff of 19. The frequency with which young people drink sodas and eat vegetables is associated with father's educational level. The frequency with which adolescents eat vegetables and fast food is associated with the school area they attend.

Eating habits/behaviours are not as much negative as documented in some literature. There does not seem to exist significant sex differences regarding eating attitudes, “possible” ED, BMI and eating habits/behaviours. However, there are sex differences regarding some of the specific symptoms of EAT-25. It is good to verify that both sexes reveal a low prevalence of “possible” eating behaviour disorder, although girls reveal a higher value.