The purpose of writing letters is to experience and to understand their own feelings, to cope with strong emotional experiences, which are related to the injuries in the childhood. We present specific examples of the letters from our patients in last 15 years of our experience, when this technique is mainly used in patients with personality disorders, affective and anxiety disorders in the therapy and also using internet.

The result is a profound change in beliefs about themselves and others. The basic types of therapeutic letters are these four: not censured letter, emphatic letter from the “other side”, the letter to the “inner child” of the significant person and the letter “visit-card”. In not censured letter the patients primarily reflect the negative feelings that hurt them in childhood. The emphatic letter from the “other side” is the ideal answer the patients would have wanted to get away from the significant person; patients formulate the particular wishes and expectations, which meet in a fictional response (encouraging selfconfidence, assurance of love, respect). The “visit-card” letter is the censured letter in “adult to adult” mode, written with respect for oneself and significant person, directed towards reconciliation. Fonetický přepis

MZ CR NT 11047-4/2010.

Differences in eating habits/behaviours and eating disorders (ED) symptoms in adolescents from rural and urban schools has not been very considered, particularly in Portugal.

explore differences between students who attend rural and urban schools in eating habits/behaviors and ED symptoms; verify if there are differences regarding Body Mass Index (BMI) by school area.

282 adolescents students (mean age = 14,5; SD = 1,69; variation = 12-18 years old; urban subsample = 126, 44,7%), studying in two schools, one from an urban area and another from a rural area answered sociodemographic questions, eating habits/behaviours items and EAT-25 (Eating Attitudes Test-25).

Most of the adolescents from both schools have breakfast and drink milk daily. Moreover, they eat vegetables and fruits daily or weekly and only rarely fast-food. Adolescents that practice a sport eat more fruits/vegetables. Adolescents attending a rural school ingest more vegetables and less fast-food. ED symptoms (EAT-25) present a lower prevalence, comparing to a young adults sample. There were no significant differences in all the EAT-25 dimensions, EAT total score and BMI by school area.

Eating habits/behaviours seem to be positive in both schools (e.g. most adolescents have breakfast daily). There were only some small differences between the two schools in particular eating habits but adolescents from the two areas do not seem to differ in ED symptoms and BMI, which is not in accordance with the literature that tends to signal urban areas as a “risk factor” for dysfunctional eating behaviors.

Positron emission tomography (PET) detects indirect signs of higher or Loir neuronal activity and we suppose relation between the activity and the brain fiction. Though the anxiety disorders have many common characteristics, but there are also some differences. In our work we compare silent regional brain requirements in some anxiety disorders.

Patients suffering from anxiety disorders were studied with 18FGD PET during rating state before systematic treatment. We studied 25 patients with agoraphobia, 21 with panic disorder, 40 with OCD and eleven with PTSD. Data were analyzed using SPM 99.

There was higher uptake of FDG in patients suffering with OCD compared with PD and AP patients in left side basal ganglia. There was also higher uptake of FDG in patients with PD and AP compared with OCD in right frontal areas. The patients with OCD developer higher uptake compared with PTSD in middle temporal gyrus bilaterally. PTSD patients showed higher uptake of FDG in comparison of OCD in right anterior cingulate. There was higher uptake of FDG in PD an AP patients in comparison with PTSD patients in right inferior temporal gyrus.

There were differences in regional brain activities in FDG between various types of anxiety disorders.

MZ CR NT 11047-4/2010.

In comparison with postnatal depressive symptoms, few studies considered antenatal depressive symptoms risk factors/correlates.

In a multidimensional work our aim was to explore the associations/predictive role of lifetime and current pregnancy variables for antenatal depressive symptoms.

Two hundred and thirty six women (M = 30.5; SD =4.02; variation = 19-41), at the third pregnancy trimester were interviewed with the DIGS/OPCRIT (to make lifetime/current depression diagnoses) and answered a booklet about sociodemographic variables, lifetime/current insomnia, current stress perception, perception of being an anxious person, gynecological variables, past health perception and pregnancy health problems, among others. They filled in the Profile of Mood States to assess anxious symptoms, Negative and Positive affect and the Postpartum Depression Screening Scale (PDSS) to assess antenatal depressive symptoms at pregnancy. Women with a depression diagnosis (DSM-IV/ICD-10, n =5) and on sleep medication at pregnancy were excluded from the analyses.

We found significant associations between antenatal depressive symptoms (PDSS total score), current job situation, perception of being an anxious person, lifetime history of depression (DSM-IV/ICD-10), past health perception, health problems at current pregnancy, stress perception at pregnancy, lifetime and current insomnia, anxious symptoms at pregnancy, Negative and Positive affect. In an hierarquical multiple regression past health perception, negative affect, positive affect and current insomnia were significant predictors of antenatal depressive symptoms.

Past health perception, negative affect (anxious and depressive symptoms) and insomnia at current pregnancy seem to be risk factors/correlates for the outcome. Positive affect seems to work as a protective correlate.

When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.

Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.

140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.

73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.

There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.

The PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: “bipolar disorder” and “psychoeducation”. The resources were confronted with our own experiences with psychoeducation in bipolar patients and only most relevant information was included in the text.

The most important target of the psychoeducation is to prevent a relapse by increasing compliance with medication usage, increasing social rhythms, reducing emotional expressivity in the family and increasing coping skills against stress. Studies on psychoeducation in bipolar disorder demonstrate significant effects on rehospitalization rates, compliance and knowledge. Compared with mood stabilizer treatment alone, combination treatment of CBT and mood stabilizers has been shown to reduce the number of bipolar episodes, reduce the duration of episodes that do occur, and reduce the number of hospital admissions due to episodes. The aim of the group psychoeducational program of the Psychiatric clinic in Olomouc is to familiarize patients with the essence of bipolar disorder, the part and principles of pharmacotherapy, the recognition of the warning signs of relapse, to advice about improper and stressful stereotypes in communication within families, and finally the training of social skills. Patients consider this program as a meaningful and helping them to better understanding what happened in their life. Supported by grant IGA MZ CR NT 11047-4/2010.

1. 1) Depression was associated with self-reports of increased impulsivity and rigidity of behavior.

2. 2) Depressed patients reported significantly lower physical energy, tempo of physical activity and plasticity of behavior. The presence of comorbid anxiety further worsened these effects.

3. 3) The ability to sustain attention on a mental task and to learn new information was lower in depressed patients than in other groups.

Comorbid depression and anxiety might be associates, decreasing adaptivity and the self-regulatory balance of behavior, leading to the development of extremes in behavioral reactivity (impulsivity and rigidity).

Patient and visitor violence (PVV) is increasingly recognised as being widespread in General hospital setting, more so in medical wards. Recent International studies showed that it's a worldwide problem. There is little data available detailing prevalence of PVV in UK. The national NHS annual violence data only focuses on physical assaults on staff.

To measure PVV with parameters of verbal abuse, threats and physical assaults over a four week period.

The aim of the study is to identify the prevalence of PVV in high risk medical wards in North Wales

A cross sectional study was conducted with a validated tool (abbreviated SOVES) in six high PPV risk medical wards in three North Wales General District Hospitals.

Of the 158 staff responded 83% were subjected to verbal abuse in the preceding four weeks. 50% reported being threatened and 63% reported being physically assaulted. 56% of those assaulted sustained an injury with three needed medical assessment and/or treatment.

Nurses and Health care support Workers reported being subjected to all forms of PVV more than other staff groups. Direct patient contact correlated more to overall incidence of PVV. Our study could not find any correlation between amount of training received by staff in the management of aggression and the experience of PVV.

PVV is a significant problem in medical wards inspite of regular staff training programmes. Means to communicate risk should be considered by all staff working in high risk medical wards.

Suicide attempts/thoughts are common among psychiatric inpatients and they are burden for the individual, the family and the health system. According to published reports, suicidality in Greece has increased significantly, because of the current economic crisis.

Examine the profile of psychiatric inpatients of the Psychiatric Department of the University Hospital of Crete(PD/UHC), presenting with suicide attempts/ thoughts.

Identify risk factors associated with attempted suicide or suicidal thoughts.

One hundred forty four out of 444 (33%) inpatients admitted in the PD/UHC between Nov 2011- Aug 2012 presented suicidal attempts/thoughts. Data were analyzed using the Pearson's chi-square test and multivariable regression models.

Major Depression, substance abuse, female gender and having a spouse were associated with suicidality in the entire group. Because there was an interaction between gender and having children, the analysis was stratified by gender. Risk factors for suicidality in men were having children (OR=2.26) and shorter time since onset of illness (OR= 0.96), and in women having a spouse (OR=2.47). Low income and unemployment were not significant predictors of suicidality.

Major Depression, substance abuse, female gender, family status and recent onset of illness appear to be risk factors associated with suicidality in psychiatric inpatients. Unemployment/low income, did not correlate with suicidality. Our findings do not support the popular belief of increased suicidality due to the current economic crisis. Finally, there is a need for further understanding of how family, its dynamics and potential stressors associated with it, may influence suicidality.

Psychotherapy requires clinical supervision. This is systematic guidance of a therapist by a supervisor. Inevitably, there is a question of training new high-quality therapists. This is related to supervision of their basic training. Beliefs and attitudes toward supervision in CBT could change during CBT training.

Our study was concentrated in mapping of the expectations from supervision of participants of CBT training in two different phases of training course (after 1st year of the training and after 4th year of the training) and expectation from supervision in participants of training in CBT supervision. As an assessment tool was used the Attitudes and Beliefs about Supervision Scale (ABSS). The expectations of probands with different experience in supervisor were compared to find out the similarities and the differences of the expectations.

The results showed that the students of Supervisory training (n=16) stress especially self-reflection and structure of supervision, Beginners in CBT training (n=36) stress counseling and planning of therapeutic strategies, and Advanced in CBT training (n=34) prefer higher understanding of transference and conter-transference and learning according the model. Surprisingly the self-reflection and therapeutic relation were evaluated as a most important by all groups.

Supported by grant IGA MZ CR NT 11047-4/2010.

Little evidence is available on the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immuno deficiency virus (HIV) in mentally ill populations. In April 2012 routine offering of testing for HBV, HCV and HIV of all individuals admitted at Broadmoor, a maximum secure psychiatric hospital, was introduced.

To elicit screening rates of, and to determine the prevalence of HBV, HCV and HIV in the inpatient population at Broadmoor Hospital.

To critically assess the identification process of blood-borne viruses (BBV) in order to improve patient care.

Retrospective data collection via the electronic patient record (EMIS) ascertained the proportion of the 198 inpatients offered screening and ultimately tested for HBV, HCV and HIV inclusive from April 1st 2012 to September 22nd 2012.

The proportion offered screening for HBV was 95% (189); for HCV was 94.9% (188) and for HIV was 92.9% (184). 129 patients were screened in each hepatitis group and 123 in the HIV group. Within the population of Broadmoor were three cases of HCV, one with HIV and zero with HBV.

This is a group at high risk for BBV infection and with a length of stay of up to five to six years it is important to identify those infected in order to instigate treatment and mitigate risk to both patients and staff. This study demonstrates rigorous screening for BBV is critical and will therefore necessarily impact on planning services for the future.

The scales for the assessment of depressive symptoms, translated and validated in Italian, lacks in the recognition of the psychopathological nuances of the disorder. The Bipolar Depression Rating Scale (BDRS) is a tool specifically built to reflect the characteristics of bipolar depression.

Screening criteria:

1. - aged 18–65 years

2. - diagnosis of BD (DSM-IV-TR) (125 patients) or

3. - diagnosis of MDD (DSM-IV-TR) (30 patients)

4. - manifestation of depressive symptoms

5. - no further psychiatric comorbidity on axis I and axis II (including abuse/addiction)

6. - no serious cognitive deficits

Psychometric battery:

• Bipolar Depression Rating Scale (BDRS),

• Hamilton Depression Rating Scale (HAM-D),

• Montgomery-Asberg Depression Rating Scale (MADRS),

• Young Mania Rating Scale (YMRS).

The analysis of the BDRS scores, according to the Kolmogorov-Smimov method shows a normal distribution; the α Cronbach's coefficient shows that the the scale, in its Italian version, has considerable validity and reliability (r = 0.82). The factor analysis was verified using the Varimax rotational method: after several tests, we found 2 subscales, one linked to mixed/depressive symptoms and a second related to (hypo)manic symptoms.

The BDRS is a valid scale for the measurement of depression in patients with Bipolar Disorder, with a notable internal consistency (Cronbach α 0.82), a significant consistency between items/total (Cronbach α from 0.80 to 0.82) and positive correlation with other scales (MADRS r 0.67, p < 0.001; HAM-D r 0.81, p < 0.001; YMRS r 0.46 p < 0.0001), including the Young Mania Rating Scale (better than the original validation sample Berk et al., 2007).

A suicide attempt is an major event that creates harm on both family and close relatives, that can be measured in terms of traumatic stress and medico-economic impact (costs). Each year, 3.750.000 French people are concerned by a suicide attempt of a relative (or close person).

Male or female, older than 16, being a relative of a suicide attempter (i.e. living in the same house as the suicide attempter). 171 families were included (171 suicide attempters and 171 « family informants »). These subjects were compared to IRDES datas on French population (Institute of Research and Documentation on Health Economy ; sample of 20.000 subjects, representing 95% of the French families). All subjects were reassessed by phone at 3 month and 1 year.

80% of the relatives declare “being fine” at 1 year; the 20% that declare being “not so well” are important to qualify, the sooner after the suicide attempt. An explicative model trying to evaluate the risk of being “not so well” at 1 year is possible ; this model is highly represented by the psychotraumatic impact of the confrontation with the suicide attempt.

On the economic plan, we can observe a great stability in healthcare contacts at 1 year (hospitalizations, GP or Specialists contacts, other kind of care contact…), contrasting with a big increase in medication use (× 2.37 in comparison with IRDES population); all the medication types being concerned, psychotropic and others.

The question of a self-medication partly unconscious is raised.

For our investigation we observed 167 patients with paranoid schizophrenia according to the criteria of ICD 10. Patients were randomized into 3 groups. Patients of 1st group (n = 52) received sertindole monotherapy 16–20 mg per day, patients of 2nd group (n = 67) received paliperidone 9–12 mg per day and fluvoxamine in combination with zuclopenthixole depot 150–200 mg per day.

Social functioning in patients with schizophrenia significantly improved in all three groups especially in group №3. We suppose that it was connected with activating activity of fluvoxamine.

Thus the results of the study indicate the significance of differences of dynamics of neurocognitive deficit in schizophrenia and the importance of choice of biological therapy for correction of neurocognitive deficit in patients with schizophrenia.The use of modern atypical antipsychotics and drugs which can influence on sigma-receptors can restore the social functioning in young patients with schizophrenia.

The rate of non-suicidal self-injurious behaviors (NSIB) is reported to be between 12–35% of adolescents. The previous studies revealed that around 9% of adolescents admitted to attempting suicide.

The aim of the study was to determine the lifetime incidence of suicidal ideations, suicide attempts (SA) and NSIB in girls diagnosed with Conduct Disorders (CD) who were educated and treated in Youth Sociotherapy Center (YSC).

42 girls aged 13–18 years suffered from CD participated in the study. All participants were residents of YCS due to previous educational and behavioral problems or juvenile delinquency. Based on psychiatric and psychological examination, medical and psychiatric history, the lifetime incidence of suicidal thoughts, SA and NSIB were estimated. The age of onset of symptoms and behaviors was also assessed as well as numbers of SA and NSIB.

Among the studied group 20 (47.6%) girls confirmed the occurrence of suicidal ideations, 9 (21.4%) patients SA and 26 (61.9%) NSBI during their lifetime. The median age of onset of both SIB and SA was 13 years. Median numbers of SA and NSIB was 4.4 and 12 respectively.

Adolescent girls suffered from CD are at high risk of early onset and recurrence of suicide attempts and nonsuicidal self-injurious behaviors.

The sample comprised 542 adolescents with 218 females (40,2%) and 324 males (59,8%). The mean age was 15,5 years. The main experimental group (46 adolescents) included only those respondents who had high levels of Internet addiction combined with the objective data from the questionnaire. The control group consisted of adolescents with no signs of Internet-dependent behavior of comparable age and sex (213 adolescents).

The group of adolescents with Internet-addictive behavior revealed the predominance cyclothymic, labile, asthenoneurotic, sensory, anxiety-pedantic, introverted, excitable, demonstrative and unstable types. We suggest that when characterological traits reach a level of accentuation, that becomes the factor associated with the formation of Internetaddictive behavior. The adolescents with problems of using the Internet show the general emotional instability, the tendency to experience the polar emotions simultaneously; they are excitable and have the aggressive style of communication. One of the main features of their characters is sensitivity to the danger, anxiety that caused the need to escape from the “harsh” reality. It could also be proposed that the adolescents with Internet addictive behavior separate emotions and cognitions, physicality and mentality. They isolate their own feelings and attach greater importance to the intellect. That cause the feeling of themselves as the subjects, more to do with information than with emotions, which could be poorly understood and classified.

The task of supervision is to increase the value of the therapeutic process in patient's best interest. There are many ethical questions rising in supervisors thinking about patients and also about therapist during CBT supervision.

The first aim was review the literature about ethics of CBT supervision and to compare the attitudes and belief about ethical questions in trainees of CBT a CBT supervision. The second aim was to find if there were any relations between ethical self-reflection and therapeutic skills of CBT trainee.

The first method was narrative review. A literature review was performed using the National Library of Medicine PubMed database, Scopus and Web of Science, additional references was found through bibliography reviews of relevant articles up to July 2011. Databases were searched for articles containing the following keywords: cognitive behavioral therapy, therapeutic relationship, training, supervision, ethics, self-reflection. The review also includes information from monographs referred to by other reviews. The second step was using the self-reflect questionnaire about ethical questions and assessment of the therapeutic skills of CBT trainees by their CBT trainers.

Strengthening ethical self-reflections in supervisees is valuable way of improving the development of ethical aspects of professional growth throughout all stages of their career. Training and supervision focused on self-reflection on ethical aspects are beneficial to both supervisees and their patients. Preliminary results show, that therapist with high level of ethical self-reflection are significantly better in therapeutic skills assessed by trainees.

Supported by grant IGA MZ CR NT 11047-4/2010.