Mental Illness is a very unique and intimate experience. Over the ages various art forms, particularly writing have been used to document experiences of mental illness. Though the history of Psychiatry is a feature of mainstream Psychiatric training, complementary study of literature and its relevance to mental illness is underused.

To undertake an exploratory search of writing as tool to reflect the phenomenology of mental illness and to evaluate the role of medical humanities in understanding and coping mental illness.

To present an explorative review of a selection of poems and prose by authors with mental illness who have written in English Language.

We conducted a comprehensive search of online databases including the Madness and Literature Network (UK), Medical Humanities Resource Database (UK), the Arts Literature and Medicine Database (US) and other popular books.

We compare various extracts by well known authors along with the lesser known contemporary accounts of writers to evaluate the role of writing.

There is a long tradition of writing about depression mental illness in the canon of English literature. Compared to autobiographical writing about depression, it is difficult to identify many autobiographical accounts of severe mental illness. Examples of writing projects illustrate that people with severe mental illness, and with dementia, may use the support of others to produce creative writing. It may be useful to Psychiatrists in training, and to wider society, to reflect on the creative agency inherent in their writing.

Poor adherence remains a problem in schizophrenic patients. Treatment guidelines for schizophrenia recommend depot medications for patients who are no adherent to oral regimens. This study aims to evaluate subjective experiences, adverse effects and adherence of depot medicated patients.

Was applied a questionnaire composed by the “Drug Attitude Inventory” (subjectively assesses the attitude and experiences of patients towards their depot medication) and by questions about adverse effects with medications. We took into account four different depot formulations: risperidone, haloperidol, fluphenazine and zuclopenthixol.

Participated 44 schizophrenic patients. The majority is male (77%). Clinically, the mean age of diagnosis is 28 years. About 50% of patients do the long acting risperidone, 31,8% the haloperidol decanoate and 9,1% the fluphenazine or zuclopenthixol. About 52,3% say they do not know the reason they take depot medication and 16% report previous therapeutic abandonment. There are not differences between mean results in “Drug attitude inventory” and all depot medications average in the positive range. Most frequent adverse affects are weight gain (29,5%) and sedation (15,9%). In rating discomfort of adverse affects 54,5% patients score zero (no discomfort) and 2,3% score ten (very uncomfortable) without significant differences between formulations.

Despite reporting adverse effects, patients attribute a low score in terms of discomfort. Although some of them report ignore the reason they are taking depot, patients have positive subjective experiences and attitudes with these medications. This fact may be predictive of good compliance.

Opioid peripheral abnormalities were described in anorexia nervosa (AN). Until now no data have been published on cerebral activity of opioid system in these subjects. Diprenorphine is a ligand with non-specific binding to opiates receptors μ, κ and δ.

To evaluate in vivo brain opioid receptors binding potential (BP) in patients with lean and recovered from restrictive-type AN by comparison with controls and the relationship with eating-related psychochological and hormonal traits.

In 17 lean restrictive-type AN patients, 15 recovered AN subjects and 15 age-matched controls we assessed in vivo [11C]Diprenorphine binding by brain positron emission tomography and eating-related psychopathological traits. Inter-groups differences in [11C]Diprenorphine binding were evaluated by voxel-based analyses.

Lean restrictive AN and recovered AN patients presented with similar decreased [11C]Diprenorphine binding in bilateral medial frontal cortex and temporo-parietal cortex. We noted a lower BP in hypothalamo-pituitary structures and also in anterior cingulate gyrus in lean AN patients. Additionally, only recovered AN patients presented with a decreased [11C]Diprenorphine binding in caudate nuclei and putamen. Direct correlations were found between the anterior cingulate gyrus BP and mean cortisol and between the left amygdala [11C]Diprenorphine binding and eating concern score.

The opioid system is widely affected in AN even after recovery in regions known to be involved in the neurocircuitry of addiction and support the hypothesis of an organic dysfunction in AN.

Stimulant dependence is commonly associated with decreases in cortical volume in inhibitory control regions, such as the orbitofrontal cortex (OFC). Obese individuals similarly show abnormalities in frontal gray matter, with volume reductions correlating with BMI. These structural deficits may contribute to underlying problems with impulsivity or self-control present in both groups.

Shared structural abnormalities relating to over-consumption of food or drugs of abuse could shed light on similar neurocognitive impairments associated with these behaviors (loss of control, poor decision-making), and could provide evidence for the classification of over-eating as an addictive disorder.

To identify overlapping regions of gray matter volume loss associated with both stimulant dependence and increased BMI, specifically in the OFC.

Structural MRI scans of stimulant dependent and healthy control individuals were compared using voxel based morphometry analysis. OFC volume was correlated with BMI in all participants, as well as years of drug use in stimulant dependent individuals.

Both stimulant use and BMI negatively correlated with bilateral OFC gray matter volume. Additionally, select OFC regions showed decreases relating to both variables, indicating an overlap between volume loss associated with years of use and BMI in both stimulant dependent and control individuals.

Overlapping decreases in OFC gray matter volume that correspond to both overeating and drug use severity indicate underlying commonalities between these two behaviors. This suggests there may be shared cognitive deficits maintained in the OFC, such as poor inhibitory control or decision-making abilities, that preclude these types of behaviors.

Psychomotor agitation is a relatively frequent condition in Psychiatric Emergency Services. It consists in excessive motor activity and without purpose, with high tension and inability to maintain attention. It carries the risk of compromising the physical integrity of the patient himself or others, usually accompanied by hostility and destructive and / or aggressive behaviors.

The authors intend to describe the epidemiological characteristics and the approach of agitated patients in a Psychiatric Emergency Service.

It was randomly selected a sample of 52 patients who attended the Metropolitan Psychiatric Emergency Service at Centro Hospitalar São João - Oporto for episode of moderate to severe psychomotor agitation, from January 2012 to August 2012.

The authors proceeded to retrospective data collection, including gender, age, diagnosis, the need of physical restraint, the psychotropic therapy instituted and the medical orientation of the patients.

In a sample where the average age of patients is 39.7 years and in which 54% are women, the most common diagnoses were psychosis and manic episodes.

Physical restraint was required in 17% of patients and 48% accepted oral treatment. Diazepam and olanzapine were the most used drugs orally and haloperidol was the most frequent intramuscular / intravenous treatment.

Hospitalization was required in 73% patients.

With the development of new psychotropic drugs, including benzodiazepines and antipsychotics, the need of physical restraint decreased. In agitated patients, immediate action is essential to enable effective and rapid control of symptoms, as most situations are serious and require hospitalization.

Chronic pain can lead the subjective emotional pain response of an individual and has the potential to play a very decisive role in determination of pain intensity and pain duration.

This study examined the effect of fear of pain on chronic pain.

The present study aimed the relationship of fear of pain with chronic low back pain (CLBP) and the differences between genders of patients with CLBP.

Two hundred and one patients with CLBP participated in the present study (53 men - 148 women, mean age±SD 37,4 ± 13,7). The measures used were: Fear of Pain Questionnaire - FPQ-III (McNeil & Rainwater, 1998) and another questionnaire with socio-demographics, attitudes and self-reported questions data on the impact of the chronic pain in their life.

The mean scores (±SD) for men and women with CLBP and the p values from the T-tests were respectively: for total FPQ-III, 67,92 ± 17,46 and 78,48 ± 18,88, (P=0,000), for minor pain 16,06 ± 5,02 and 19,56 ± 6,19, (P=0,000), for severe pain 30,74 ± 8,42 and 34,82± 7,57, (P=0,001), and for medical pain 21,13 ± 7,66 and 23,91 ± 8,54, (P=0,038),

The results of the present study revealed the high levels of fear of pain in patients with CLBP. Furthermore, the gender was established as another potential variable that is related to isolated differences in emotional responses to pain.

National Programme of Mental Health was established by the government in 28.12.2010. It specifies direction of health care development. The main goals of National Programme of Mental Health are: 1. Promotion mental health and prevention of mental disorders 2. Provision of support and easy access to psychiatric health care and other forms of care necessary for living in families and society.3. Development of research and information about mental health. Nevertheless there is still lack of the separate, coherent programme on promoting and preventing mental health among children and adolescents.

To indicate the main barriers in current development of child and adolescent psychiatry in Poland.

Quality and quantity assessment of national programmes, analyses of distribution of child and adolescent mental heath services.

However a significant improvement in area of child and adolescent psychiatry took place, some barriers are still noticeable: the insufficient number of child and adolescents psychiatrists, low numbers of programmes related to early intervention, low availability of psychotherapy and sociotherapy, insufficient number of centres to help dysfunctional families and families in crises, low number of programmes on mental health promotion implemented as regular activities in schools.

There are needs of coordination in service planning and regular evaluation of child and adolescent mental heath services.

Centralized ratings by telephone have proven feasible for assessment of psychiatric diagnosis, symptom severity, and suicidality, and may be used for safety assessments in non-psychiatric trials with sites that do not employ staff experienced in psychiatric assessment.

To assess whether centralizing assessments with mental health experts enables immediate clinical follow-up and actionable diagnostic support for investigators.

To examine the feasibility of centralized ratings in a Phase III dermatology clinical trial for safety assessments.

1127 subjects enrolled in a trial of medication for their dermatologic condition were assessed via telephone by central raters who administered the SCID-CT, C-SSRS and PHQ-8 at screening. At monthly visits, central raters performed the C-SSRS, PHQ-8, GAD-7 and items designed to detect emergent psychotic symptoms.

Results:

34 subjects were excluded on the basis of SCID-CT diagnosis. Based on diagnosis or severity, subjects were classified as being in no need of mental health services, having mild psychiatric symptoms (referred to local mental health service provider; n=33), moderate (immediate referral for psychiatric evaluation; n=17), or severe (immediate escort to emergency room; n=0).

One subject reported suicidal ideation on the C-SSRS, 10 reported self-injurious behavior, and 5 reported suicidal behavior in the last year.

No subjects reported suicidal ideation or behavior at any of the 6861 follow-up assessments. One subject reported self-injurious behavior and two reported emergent psychotic symptoms.

This study established the feasibility and acceptability of routine screening and monitoring of psychopathology and suicidality by central raters in a non-psychiatric population.

Eye movements are closely related to cognitive and emotional functions. Information of saccadic dynamics during certain tasks may indicate disorders of mental functions that can help to explain the neurobiology of sensory-motor systems and be useful in neuropsychiatric diagnosis.

This study aims to assess the impact of a therapeutic dose of methadone on eye movements (saccades) in opioid addicted subjects with HIV(+) and HIV(-).

Sixty patients (29 patients with HIV(-) and 31 of HIV(+)) from the substitution program were examined. The examination was conducted twice: before and 1,5 hours after the administration of a therapeutic dose of methadone. Performed Latency Test (LT) with saccadometr diagnostic system.

Mean duration of latency measured by LT Test after the administration of a therapeutic dose of methadone increases significantly in HIV(-) subjects but the mean peak velocity decrease in the study group. Mean peak velocity latency in HIV(+) subjects is not statistically significant. Mean duration and amplitude of latency after the administration of a therapeutic dose of methadone is a statistically significant in opioid addicted subjects with HIV(+). It was found that the mean peak velocity before the administration of a therapeutic dose of methadone was statistically significantly different in HIV(-) subjects as compared to HIV(+) ones.

The increase of saccadic refixation parameters values in opioid-addicted subjects after the administration of a therapeutic dose of methadone was observed.

Dementia is a health problem that needs a careful diagnosis and treatment. The authors investigated the prescription habits of neurologists and psychiatrists in patients with dementia and analyzed the differences.

An online questionnaire was sent to Portuguese psychiatrists and neurologists about the initial diagnosis and treatment in dementia.

103 questionnaires were validated (46% psychiatrists). The Cholinesterase Inhibitors (IChE) were the most subscribed substances in both specialties, followed by memantine by neurologists (82%) and antipsychotics by psychiatrists (86%). The least prescribed drugs are benzodiazepines (7% : neurologists; 24%: psychiatrists) and nootropic drugs (8% in both). The combination of IChEs is more used by psychiatrists than neurologists, but the combination with memantine is similar in both. The majority does not associate nootropics (80%), but in those who do 77% are psychiatrists. In the treatment of depressive symptoms the majority uses Serotonin Uptake Inhibitors (79%). In sleep disorders 46% prescribe antidepressant and 31% antipsychotics. In the initial evaluation 94% of physicians request CT scan and blood work. Neuropsychological assessment is requested by 65% of psychiatrists and 44% of neurologists.

In our sample the diagnostic and therapeutic approach in dementia is in accordance to the international guidelines. In some cases the initial investigation to exclude treatable dementias is not requested, which points to the importance to the professionals’ sensibilization. It is also interesting to discuss the differences of prescription between the two specialties, namely nootropics, benzodiazepines, antipsychotics and the association of two IChE.

Leprosy is an infectious disease with high physical disability and is strongly associated with chronic pain, since there may be significant impairment of the peripheral nervous system. Additionally, the stigma associated with the label of leprosy persists and imposes a high social commitment of the disease.

Describe the frequency of psychiatric comorbidities in leprosy patients and check if they had been previously diagnosed and were in psychiatric care.

The study was conducted with a sample of 120 leprosy patients treated at two hospitals for leprosy: Hospital Dom Rodrigo de Menezes and University Hospital of Federal University of Bahia, in Salvador, Bahia, Brazil. Survey participants were older than 18 years of age, had confirmed the diagnosis of leprosy and were in antimicrobial treatment. Patients were evaluated face to face with a socio-demographic questionnaire and the Mini-International Neuropsychiatric Interview (MINIPlus) in Portuguese. The period of data collection was limited from October 2009 to June 2012.

The assessment using the MINI-Plus showed that 34 (28.33%) patients did not have any psychiatric diagnosis and 86 (71.66%) had at least one. Of these 86 patients, 25(20.83%), met the criteria for one diagnosis, 26 (21.66%) had two diagnoses and the rest, 35 (29.16%), had three or more psychiatric diagnoses. All patients with moderate or high risk for suicide had one or more psychiatric comorbidities.

Leprosy patients have a high prevalence of psychiatric comorbidities. Beyond that, most of them had no previous psychiatric diagnosis and the absolute majority were not in treatment.

Living kidney donors (LKDs) are usually motivated by their willingness to save a near relative's life besides adopting altruistic attitude which reduce their concern about the risks of post-donation morbidity or mortality. They rarely express psychological suffering related to donation, with the possibility that this suffering takes an indirect pathway to be expressed such as via somatic complaints. objectives: To assess the prevalence of unexplained somatic symptoms among LKDs and the factors contributing to its existence.

50 LKDs who were almost related to their recipients. Both physical and psychiatric examination was done for them besides psychometric assessment with Middle Sex Hospital Questionnaire (MSHQ).

58% of donors (Ds) had somatic complaints, but only 16% had underlying physical causes for it and the other 42% were considered to have unexplained somatic symptoms (USSs). The mean score of Ds on the somatization subscale of MSHQ (7.12 ±3.67) was significantly higher than their mean score on other subscales. Females had higher score than males, and the current physical status of recipients rather than that of donors was the most influential on the degree of somatization.

USSs are common among LKDs and seem to be a substitution for expressing anxious or depressive feelings. More psychological care -pre- and post-donation- should be afforded to living donors to avoid selection of risky subjects and to minimize the development of post donation conflicts.

Recently many studies have suggested more brain morphometric changes occurring in people with schizophrenia who use antipsychotic medication compared to those who do not.

We will study the brain morphology of subjects with schizophrenia spectrum disorder with and without antipsychotic medication.

Our aim was to compare the brain morphology of subjects with schizophrenia spectrum disorder with and without antipsychotic medication after in average ten years of illness, and analyse the association between cumulative dose of lifetime antipsychotic medication and brain morphology.

Data of 66 subjects with schizophrenia spectrum disorder (mean duration of illness 10.4 years) from the Northern Finland 1966 Birth Cohort were gathered by interview and from hospital records. Structural MRI data at age 34 years were acquired from all participants on a GE Signa system operating at 1.5T.

Of the subjects 16 (24%) had taken no antipsychotics during the previous year. We found no significant differences on total grey matter volumes (TGM) between subjects with and without antipsychotic medication. In the voxel-based analyses subjects with medication had lower volume in left parahippocampal gurys (p = 0.003), when adjusted for sex, onset age, TGM and remission status. There were no associations between lifetime antipsychotic dose and brain morphology.

We were able to study effects of antipsychotic medication in population-based sample. Brain morphology in medicated and non-medicated persons were similar and the cumulative lifetime medication had no effect on brain morphology, which suggests that possible medication effect in cross-sectional measures of brain morphology is small.

Alcohol is the third leading risk factor for Europeans disease and mortality. Romania has one of the biggest alcohol consumption per capita. The county of Vrancea comprises around 100.000 people, and is a well known wine grapegrowing region.

The assessment of patients with psychiatric disorders related to alcohol consumption hospitalized in the Psychiatric Department of the Hospital of Vrancea, over a 10 year period.

Patients with psychiatric disorders related to alcohol consumption hospitalized between 2002 and 2011 were analyzed in terms of socio-demographic variables: primary diagnosis at discharge, gender, age, residence, average number of hospitalization days. We used the computerized system of the hospital to evaluate those variables. For the primary diagnosis we have used the International Classification of Diseases (ICD-10).

Of 13.738 patients hospitalized over the study period (10 years), 3.376 (24.57%) were admitted for psychiatric disorder related to alcohol consumption (compared to schizophrenia - 18.19%). The most frequent disorders were: alcohol induced withdrawal (F10.3) - about one third; alcohol induced delirium tremens (F10.4) - around 20% and alcohol induced acute intoxication (F10.0) - around 20%. The majority of the patients were men (87.02%) and most of them were from the rural area. The average number of hospitalization days was around 5.5. Most of the patients were between 35 and 45 years old.

The greater percentage of alcohol induced disorders in our psychiatric unit indicates that we have to increase our efforts to reduce the harmful use of alcoholl, its health and social consequences.

Worldwide, the Irish diaspora experience elevated psychiatric morbidity across generations, not accounted for through socioeconomic position. The present study assessed the contribution of intergenerational migration and settlementrelated adversity in accounting for adult mental health, in second generation Irish people.

Analysis of prospective data from a nationally representative birth cohort from Britain, comprising 17,000 babies born in a single week in 1958 and followed up to mid-life. Common mental disorders were assessed at age 44/ 45.

Relative to the rest of the cohort, second generation Irish children grew up in marked material and social disadvantage, which tracked into early adulthood. By mid-life, parity was reached between second generation Irish cohort members and the rest of the sample on most disadvantage indicators. At age 23 Irish cohort members were more likely to screen positive for common mental disorders (OR: 1.44; 95% CI: 1.06, 1.94). This had reduced slightly by mid-life (OR: 1.27; 95% CI: 0.96, 1.69). Adjustment for childhood and early adulthood adversity fully attenuated differences in adult mental health disadvantages.

Social and material disadvantage experienced in childhood continues to have long-range adverse effects on mental health at mid-life, in second generation Irish cohort members. This suggests important mechanisms over the lifecourse, which may have important policy implications in the settlement of migrant families.

Patients with schizophrenia generally perform worse than control subjects on all cognitive domains, and particularly in memory functions. It is still unclear, how cognition changes during years of illness in schizophrenia.

Our aim was to analyze the change in verbal learning and memory functions in subjects with schizophrenia and healthy controls during a 9-year follow-up.

The sample was the general population based Northern Finland 1966 Birth Cohort. In 1999-2001 and in 2008-2010 field studies were performed, including repeated measures of clinical status and the California Verbal Learning Test (CVLT). CVLT was used for the estimation of the course of a possible change of verbal learning and memory during the follow-up. The sample included 41 individuals with schizophrenic psychoses and 74 non-psychotic controls.

Both cases and controls had statistically significant decline in measures of CVLT. However, the change in verbal learning and memory in the 9 -year follow-up was not statistically significantly different between cases and controls. Among cases, age of illness onset and sex had no statistically significant effect on change of verbal learning and memory.

According to our unselected, population based sample with long follow up, the impairments during the life span in verbal learning and memory in schizophrenia was not different compared to controls. These results imply that schizophrenia is not a progressing degenerative illness.

Donepezil, a centrally acting acetylcholinesterase inhibitor (AChEI), is approved for symptomatic relief of cognitive impairment in patients with Alzheimer's disease and Vascular Dementia (VD). Several adverse effects were reported and the most common are gastrointestinal disturbances. Others include bradycardia, agitation and confusion. Although epileptic seizures are listed as a side effect, there are few reports.

To present a case-report of donepezil-induced epileptic seizures and a review study regarding the theme available in Medline.

Brief literature review.

A case report is presented and literature of this theme shortly reviewed.

The case involves a 62-year-old female diagnosed with VD 6 months previously. Her medical history included a cerebrovascular accident 24 months earlier. She started the treatment with donepezil 5 mg and 48 hours later she was admitted in the Emergency with convulsions. She was unconscious for 20 minutes with urinary incontinence and bitten tongue. Normal blood analyses. A contrast brain CT showed a mild degree of cortical atrophy without new structural lesions. EEG showed mild and diffuse neuronal dysfunction with no grafoelements indicative of epilepsy. Donepezil was discontinued, no therapy was instituted and the patient has been convulsion free.

The mechanism of convulsive action of AChEIs isn’t clear. There are reports about centrally acting AChEIs inducing convulsions in patients with Dementia without any underlying neurological condition. Further research is needed to delineate the frequency of this effect and to extend our knowledge of the underlying pathophysiological mechanism in order to determinate the safety profile of AChEIs.