In the absence of biological measures, diagnostic long-term stability provides the best evidence of diagnostic validity.Therefore,the study of diagnostic stability in naturalistic conditions may reflect clinical validity and utility of current schizophrenia diagnostic criteria.

Describe the diagnostic evolution of schizophrenia in clinical settings.

We examined the stability of schizophrenia first diagnoses (n=26,163) in public mental health centers of Madrid (Spain).Probability of maintaining the diagnosis of schizophrenia was calculated considering the cumulative percentage of each diagnosis per month during 48 months after the initial diagnosis of schizophrenia.

65% of the subjects kept the diagnosis of schizophrenia in subsequent assessments (Figure 1). Patients who changed (35%) did so in the first 4-8 months. After that time gap the rates of each diagnostic category remained stable. Diagnostic shift from schizophrenia was more commonly toward the following diagnoses: personality disorders (F60), delusional disorders (F22), bipolar disorder (F31), persistent mood disorders (F34), acute and transient psychotic disorders (F23) or schizoaffective disorder (F25).

Once it is confirmed, clinical assessment repeatedly maintains the diagnosis of schizophrenia.The time lapse for its confirmation agrees with the current diagnostic criteria in DSM-IV. We will discuss the implications of these findings for the categorical versus dimensional debate in the diagnosis of schizophrenia.

A new generation of synthetic compounds, readily available on the web, has recently come on the market. Designer Drugs are produced with the intent to elicit effects similar to controlled substances getting round the drugs laws. Two of the most recent Designer Drugs are “Spice” and “Bath Salts”. They produce psychoactive reinforcement, are highly attractive, perceived as safe drugs and not easily detectable in urine and blood samples.

The study focused on quantifying the presence of these compounds among the possible illicit substances usually consumed among adolescents and young adults. Besides we aimed to evaluate the existence of websites related to Designer Drugs and aimed at dividing their positions towards drug use in three main categories : Anti Drugs, Pro Drugs and Harm Reduction Approach.

The diffusion of the phenomenon is still at his beginning, although most of the subjects interviewed had some knowledge of the phenomenon. A web mapping has underlined the preponderance of Pro Drugs websites. As regards “Spice”, 77 is the total number of related websites: 53 (69 %) Pro Drugs, 17 (22%) Anti Drugs and 7 (9 %) Harm Reduction Approach.

Although the internet provides a wide range of information about the side effects of Designer Drugs and many Countries have banned them, there is still a high number of Pro Drugs websites that actively promotes their consume. However, the level of use in Italy is still low, according to the data emerging from the sample recruited.

To find out the language disorders in a sample of schizophrenic female patients. Also to explore the relationship between female sex hormone estradiol and language disorders in schizophrenic patients.

Schizophrenic females show language disorders as a part of their overall cognitive impairment. The female sex hormone, estrogen, acts as a neuro- active hormone that is assumed to have effects on the central nervous system and specifically on the cognitive functions.

This case-control study included 30 schizophrenic female patients who were admitted in Al Abasseia Psychiatric Hospital. It also included 15 healthy controls that were matched in age and education. They were assessed using: Psychiatric interviews, The Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms, Serum estradiol level on 3 consecutive weeks and language and speech items of The Luria-Nebraska Neuropsychological Battery (LNNB). General and neurological examinations were performed as well.

There were statistically significant differences between both groups in all the clinical scales (receptive and expressive speech, reading and writing) of the LNNB, as well as most of the factor scales covering a wide range of linguistic abilities. High estradiol levels were correlated with poor performance in speech and language scales.

Female schizophrenic patients had menstrual irregularities and hypo-estrogenism. They performed significantly worse on their linguistic abilities, receptive and expressive speech, reading and writing. Increased estrogen levels correlated with poor performance on the linguistic functions, including writing and reading domains in patients with schizophrenia

In the last decades Sexual Addiction has received increased attention among mental health professionals; however, the phenomenon as a clinical syndrome is still controversial. The DSM-IV TR and CID-10 contain ambiguous categories to correspond with this. The American Psychiatric Association is now debating whether Sex Addiction should be added to DSM-V.

Using a recent movie as background, the authors present the state of art, describing behavior and theories:

1. a) compulsive behavior,

2. b) impulsive behavior or

3. c) addiction behavior.

Textbooks and studies published on Pubmed and Medlink. Analyses of Steven McQueen movie - “Shame”(2011).

Like a train toy that it always going around, caught in the distressing anguish of this damn, the movie’s protagonist lives a circular controlled martyrdom. In this movie full of sexual scenes, there is no eroticism, only discomfort, coldness and oppression. The body is his tether, isolated from the world and self-enclosed. Guilt and shame are his permanent emotions. The debate is coming to a conclusion - a DSM-V diagnose “Hypersexual Disorder”, characterized by a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment.

It’s a reasonable challenge getting a reliable classification to provide easier access and professional help to those who often suffer enormous pain and shame. There are still opinions against this, mainly because the limits of sexual normality aren’t clearly defined, the symptoms patterns aren’t distinct, moral judgments are involved and the label may be a misnomer.

Some patients have a chronic and/or recurrent form of the disorder. Reasons of treatment resistance have been described, but the neurobiological basis of disorder gravity is unclear.

Examine if the hyperactivity of right and left amygdala, left posterior cingulate cortex or left dorsolateral prefrontal cortex predict the treatment effect of Cognitive Behavioral Therapy (CBT).

The aim of our study is to test the hypothesis of treatment predictability in panic disorder patients in fMRI.

24 patients meeting the ICD-10 criteria for panic disorder with or without agoraphobia. Patients were studied in fMRI during the exposition of threat-related words compared with neutral words and emotional faces compared with fixation points. Patients were studied in fMRI scanner before and after CBT treatment. Psychopathology was assessed using Clinical Global Impression rating scale (CGI) and Beck Anxiety Inventory (BAI). Patients were divided into responders and non-responders groups by the 25% reduction in BAI scale.

Significant reduction of activity was observed in responders on the right amygdala, while the left amygdala decreased activity is lower, and could be the effect of habituation. Incresed activation of left Broca’s area 46, and 45 was negative treatment effect predictor.

Negative treatment effect predictor is hyperactivity in left dorsolateral prefrontal cortex BA 46 and 45. Positive predictors are higher reactivity of right amygdala for anxious faces, activation of right angular gyrus, right insula, right temporal pole.

Supported by the project IGA MZ CR NT 11047-4/2010

Drug abuse is typically initiated during adolescence, which is a critical period of brain maturation and vulnerability to drug dependence. Accumulating evidence suggests that the early initiation of drug use is associated with altered brain structure compared to individuals who start taking drugs at a later stage in life, suggesting that these brain abnormalities might reflect neurobiological markers of vulnerability.

Our objective was to identify neurobiological risk markers in the brain structure of cocaine-dependent individuals.

We aimed to investigate the effects of onset of drug use on the brain abnormalities typically seen in adults with cocaine dependence.

Sixty cocaine-dependent individuals and 60 healthy volunteers underwent an MRI brain scan. We used whole-brain voxel-based morphometry to find grey matter abnormalities in the cocaine group. We then performed three whole brain analyses of grey matter volume in the cocaine group using the general linear model with a within-group correlation design, separately for the drugs cocaine, tobacco and cannabis. We identified variance in grey matter uniquely attributable to the age at which each of these drugs was first used; the regressors were orthogonalised to the duration that each drug had been consumed.

The age of first use was associated with a reduction in grey matter volume in distinctly different brain regions for cocaine, tobacco, and cannabis; irrespective of duration of use.

We identified neurobiological markers for three common drugs of abuse that may be associated with the risk for developing dependence.

Postpartum depression (PPD), with a prevalence of about 10-15% in developed countries, has a major impact on both mother and child. Personality traits, mainly neuroticism, have been associated with affective disorders and in particular postpartum depression.

To examine if neuroticism is associated with depressive symptoms in pregnancy and post-partum, controlling for possible confounding factors.

Since September 2009, all pregnant women in Uppsala, Sweden have been asked to participate in BASIC study, which is a population based, prospective study on mental health during pregnancy and post-partum. Women filled in the Swedish Scales of Personality (SSP), as well as the Edinburg Postnatal Depression Scale (EPDS) in pregnancy week 32. EPDS was also administered 6 weeks and 6 months postpartum. A factor analysis of SSP traits was conducted in our material and the three factor structure comprising neuroticism, aggressiveness and sensation seeking was confirmed. The association between personality traits and depressive symptoms was examined using binary logistic regression. High levels of neuroticism, aggressiveness and sensation seeking were defined as the highest quartile of each factor.

High levels of neuroticism were strongly associated with depressive symptoms during pregnancy as well as at 6 weeks and 6 months post-partum, while aggressiveness and sensation seeking were not. After controlling for confounding factors, such as previous history of depression, employment, education, partner support and breastfeeding, neuroticism remained a significant predictor for depressive symptoms, at all three time-points.

Neuroticism is an independent strong predictor of depressive symptoms during pregnancy and the postpartum period.

Psychoform and somatoform dissociation in anorexia nervosa (AN) and bulimia nervosa (BN) is yet to be studied in Portugal.

Explore the severity of psychoform and somatoform dissociation in ED; explore the differences between ED and other psychiatric disorders (PD), and between AN and BN.

From two psychiatric clinics, 29 women with ED (AN = 16; BN = 13) and 35 women with different PD (posttraumatic stress = 9; panic = 4; major depression = 4; obsessive-compulsive = 8, social phobia = 10), matched sociodemographicaly (mean age = 26.69 ± 7.31), were voluntarily assessed with the Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ-20).

ED patients had higher scores on DES (M ± SD= 28.10 ±19.76, p < 0.05) and on SDQ-20 (M ± SD= 38.41 ±13.19, p < 0.05) than PD patients (DES: M ± SD= 19.27 ±12.84; SDQ: M ± SD= 38.41 ±13.19). Comparing with PD, BN had higher scores on DES (M ± SD= 31.13 ±21.25, p < 0.05), and on SDQ-20 (M ± SD= 42.45 ±17.36, p < 0.01). Finally, there were no differences between AN (DES: M ± SD= 25.65 ±18.80; SDQ-20: M ± SD= 35.63 ±8.98) and BN (p = 0.01).

Our findings point out to the need to of watchfully assessing ED for dissociative symptoms and, accordingly, include the treatment of dissociation.

Lack of insight is a major obstacle in treating patients with anorexia nervosa (AN). In everyday practice, clinicians often describe as delusional AN patients who strongly deny their emaciation.

Despite their diagnostic and clinical significance the level of delusionality of body image beliefs in eating disorders (EDs) has not yet been systematically investigated.

In the present study we assessed for the first time the delusionality of body image beliefs in AN subtypes and BN. We hypothesized that body image beliefs would be delusional only in a subgroup of AN patients and that the patients with restrictive AN would demonstrate the higher levels of delusionality.

We used the Brown Assessment of Beliefs Scale (BABS) to assess the degree of delusionality of body image beliefs in seventy-two participants: 39 with AN and 33 with BN. We also investigated the relationship between body image delusionality and other clinical characteristics in AN.

Only patients with anorexia nervosa (28.8%) had delusional body image beliefs, whereas overvalued ideas appeared to be frequent in both AN and BN. Body image delusionality in AN was associated with restrictive eating pathology, early onset of the disorder and body dissatisfaction.

Results suggest that a delusional variant of anorexia nervosa represents the one end of a continuum of insight among patients with eating disorders. Delusionality constitutes a clinical feature independent of weight loss or eating pathology and thus a distinct component of AN psychopathology, contributing to treatment resistance and illness chronicity.

Pragmatic language skills were examined in schizophrenia patients compared to IQ-matched control subjects measured by the decoding of the flouting of the four Gricean maxims.

19 schizophrenic patients and 19 matched controls were evaluated. Five experimental conditions (all included four stories) were used, such as „quantity maxim” (QNM) condition, „quality maxim” (QLM) condition, „relevance maxim” (RM) condition, „manner maxim” (MM) condition and "control” (C) condition. An investigator presented the stories and asked for the hidden communicative intentions. PANSS scores and general intelligence were also measured.

Patients with schizophrenia performed significantly worse than controls in each of the conditions containig the flouting of the Gricean maxims. The response accuracy in the C condition was not differed significantly between the two groups (QNM:p< 0.001; QLM:p< 0.001; RM:p< 0.001; MM:p< 0.001; C:p=0.487). Significant positive correlations were found between QLM and IQ (p< 0.001) and between RM and IQ (p=0.025), and there was no significant correlatios between PANSS scores and response accuracy. Full scale IQ was not differed significantly between the two groups (p=0.095).

We found that a complex pragmatic language deficit exists in schizophrenia. The impairment do not seem to have a relationship with symptom severity. Besides, it seems, that good intellectual function supports pragmatic language skills in schizophrenia.