Somatization is a common symptom of depression. Somatization is also related to sleep problem including insomnia.Depression is the one of the most common cuase of insomnia. Therefore, it would be needed to investigate the interaction between depression, insomnia and somatization.

To investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization.

To compare somatization of primary insomnia, MDD with insomnia, MDD without insomnia, and normal controls.

A total of 181 participants without serious medical problem were recruited. Subjects were divided into 4 groups based on the SCID-IV and ICD-10 insomnia criteria:

1. 1) normal controls,

2. 2) primary insomnia,

3. 3) MDD without insomnia, and

4. 4) MDD with insomnia.

The somatization subscores of the SCL-90-R were completed by participants.

There were significant between-group differences in somatization (F=25.30, p< 0.001). MDD with insomnia showed higher somatization compared to normal controls (p< 0.001), primary insomnia (p=0.01), or MDD without insomnia (p< 0.001). Primary insomnia had higher somatization than normal controls (p< 0.01), while there was no significant difference between MDD without insomnia and normal controls. Presence of insomnia predicted higher somatization (beta=0.44, p< 0.001), while there was only non-significant association between MDD and somatization (beta=0.14, p=0.08).

In the current study, insomnia was associated with somatization independently from major depression. Subjects with primary insomnia showed higher somatization. Within MDD patients, presence of insomnia was related to higher somatization. Our finding suggests that insomnia may partly mediate the relationship between depression and somatization.

Lower Limb Edema (LLE) is a common finding among admitted psychiatric patients in general and is associated with agitated state. Possible explanations include general medical condition and treatment adverse effects.

To determine association between LLE and the type of psychiatric exacerbations among hospitalized patients.

A retrospective study was conducted using medical data from 2529 patients admitted to Geha mental Health Center between 2002 and 2012. Incident cases of LLE and the type of psychiatric exacerbation were included. A logistic regression models were used to estimate the odds ratio (OR) for LLE among patients admitted to psychiatric hospital for manic episode, psychotic episode or depressive episode.

Lower limb edema was diagnosed in 95 of 2529 admitted patients (3.8%). Edema was found in 38 of 366 cases of manic episode (10.4%), 41 of 1563 cases of psychotic episode (2.6%) and 16 of 600 cases of depressive episode (2.7%).OR of LLE was 4.3 (95% CI, 2.7-6.7) for manic episode vs. psychotic episode and 4.2 (95% CI, 2.3-7.6) for manic episode vs. depressive episode. Applying a multivariate model adjusted for age, sex, number of past admissions, length of hospitalization, substance abuse, cardiovascular and endocrine co-morbidities, pulse, Positive and Negative Syndrome Scale (PANSS) score and blood test results did not substantially altered the risk for LLE associated with manic episode vs. psychotic episode(OR, 4.1 [95% CI, 1.6-9.9]).

Admission to psychiatric hospital for manic episode was associated with significantly increased risk for LLE.

Studies conducted with American and Australian samples of pre-adolescents and adolescent girls support the tenets of Stice and colleagues’ dual-pathway (DP) model. The DP model is a cohesive framework for understanding how sociocultural pressures are translated into behavioural and negative affect risk factors potentially promoting binge eating. Males are likely to exhibit sub-threshold binge eating disorder and are roughly equal to females in regard to the number of cases of any binge eating. To date, only preliminary support has been provided for the validity of the DP model's core predictions with adolescent males.

The current prospective study examined the suitability of the DM model in other western cultures (such as an Italian one) where adolescent boys are characterised by high levels of eating and body-related disturbances in response to sociocultural pressure.

221 Italian adolescent boys (Mage = 14.9) were examined at Baseline and after 1-year through semi-structured clinical interviews and self-reported measures. Data were analysed via a latent variable longitudinal structural equation modeling approach.

Perceived pressure and internalization of societal ideals regarding male body shape led to body dissatisfaction, which in turn led to dietary restriction. Both body dissatisfaction and dietary restriction predicted negative affect, which in turn predicted binge eating. However, data did not support the relationship between body mass index and body dissatisfaction or between dietary restriction and binge eating.

The prospective validity of the DP model was partially supported in adolescent boys: body dissatisfaction predicted binge eating only via negative affect.

Physical appearance is a major component of human sexuality. Body image is associated with females' sexual functioning; and poor body image is strongly related to sexual functioning problems (SFP). SFP are becoming more pervasive throughout Western culture. Objectification Theory (OT) provides a framework for understanding how sociocultural pressure is translated into psychological risk factors that promote body concerns and SFP. Previous research indicated that the core constructs of OT (body monitoring, body shame and appearance anxiety) predicted higher self-consciousness, which according to a recent review of 57 empirical studies, interferes with sexual responses and experiences during sexual activity.

The central purpose of the current study was to build upon the extant literature by incorporating internalization of the norms for body shape and weight portrayed by the media and self-consciousness during sexual activity into the OT model. Thus, we aimed to examine a more comprehensive model of women's SFP (i.e., lacking interest in sex, inability to achieve orgasm, trouble achieving or maintaining an adequate lubrication) grounded in OT.

Data were analysed from 391 sexually active Italian college women (Mage = 20.9) using latent variable structural equation modeling approach. Results. Internalization of media ideals led to body surveillance, which was related to body shame and appearance anxiety. The latter were related to self-consciousness during sexual activity, which in turn strongly women's SFP.

The study points to the role of body-image attitudes in sexual functioning and suggests that OT provides a useful framework to identify predictors of women's SFP.

Prevalence of autistic disorder (AD) has increased dramatically in the last three decades. The comorbidity of the disorder with attention deficit hyperactivity disorder (ADHD) is well established, but current diagnostic criteria do not allow a dual diagnosis. In Greece, neither the prevalence of autism nor its comorbidity has been adequately examined.

The aim of the present study was to explore the prevalence of AD in schoolchildren in Crete and to assess its comorbidity with ADHD.

The initial sample was consisted of 7,661 children randomly selected. The study was conducted in two stages. Screening was based on school records. Only children with diagnosis of autism from the formal child psychiatric diagnostic centers were included in the sample. For each autistic child, the Teachers Report Form and the ADHD-IV scale were applied.

Out of 7,661 children, 25 (0.3%) had AD. The estimated prevalence was 0.5% for boys and 0.1% for girls (p< 0.0001). Ten children (40%) fulfilled DSM-IV diagnostic criteria for ADHD. Age and gender were found to be associated significantly with the presence of ADHD. The most prevalent co-occurrent subtype of ADHD was the combined. There was not significant evidence of an association between academic impairment of autistic children and the presence of ADHD.

The prevalence of AD in schoolchildren in Crete, the risk factors and its comorbidity with ADHD were comparable to those reported in other countries worldwide. Younger age and male gender seems to be associated with the presence of ADHD in autistic children.

The original cognitive-behavioural model of bulimia nervosa (CBT-BN) proposes that specific dysfunctional cognitions and behavioural factors maintain BN, and has provided the basis for the widely used cognitive-behavioural therapy (CBT) of BN. However, Fairburn et al. (2003) noted that among treatment completers with BN, only 40% achieved full remission of the bulimic symptomatology. The enhanced CBT-BN model (CBT-E) proposed by the authors describes how four additional factors (i.e., clinical perfectionism, low self esteem, mood intolerance and interpersonal difficulties) interact with the core psychopathology of BN (i.e., over-evaluation of eating, weight, and shape and their control) to maintain the disorder.

The goal of this study was to examine (a) the validity of the CBT-E model and (b) whether each of the four hypothesized maintenance factors intensifies the core psychopathology-bulimic symptomatology relationship in a clinical sample.

Data were analysed from 362 adults seeking treatment for BN (n = 167) or atypical BN (n =195) at four Italian specialized care centres, using latent variable structural equation modeling approach.

Both the measurement and the structural model were good fits for the data. All four hypothesized factors exacerbated the core psychopathology-bulimic symptomatology relationship. Core psychopathology explained approximately 47.7% of the variance of bulimic symptomatology. The inclusion of the direct effects and interaction terms increased the explained variance of bulimic symptomatology to 64%.

Overall, results supported the validity of the CBT-E model and highlighted the importance of assessment and treatment of the four maintenance processes included in the CBT-E model.

Metabolic syndrome (MS) is a set of metabolic abnormalities that occur relatively frequent in patients with schizophrenia. Some scientists define MS as a mild chronic inflammatory state, while for the elevated concentrations of fibrinogen are considered to be significantly associated with MS.

To determine the prevalence of MS and fibrinogen concentrations in patients with schizophrenia.

The study group consisted of schizophrenic patients from the University Clinical Hospital Mostar (n=100). The control group consisted of healthy subjects who came to the systematic medical examinations in the Health Center Mostar (n=100). Diagnosis of MS was made according to ATP III criteria, and on that basis the subjects from both groups were divided into two subgroups, one with and one without MS. The study was cross-sectional.

Statistically MS was significantly more frequent in schizophrenic subjects (46,0%) compared to the control group (29,0%) (p=0,013). Schizophrenic subjects had significantly higher fibrinogen concentrations compared to the control group (p< 0,001). Schizophrenic subjects with MS had significantly higher fibrinogen concentrations compared to the group of schizophrenic subjects without MS (p=0,020), as well as compared to control group without MS (p< 0,001). There were no statistically significant differences in the fibrinogen concentrations between two control subgroups (p=0,054).

MS is more frequent in schizophrenic subjects compared to the control subjects. Schizophrenic subjects have significantly higher fibrinogen concentrations compared to the control group.

Dizziness is a defining condition of many pathologies within DSM4. There are many emotional and behavioural impacts on the balance system. EVestG is a purported test of the balance system that has been applied to the detection of schizophrenia. However, there is a need to show whether the EVestG recordings indeed contain vestibular signals.

To investigate a clear vestibular response in EVestG recordings by analysing the signals in response to whole body passive tilts.

EVestG signals were recorded in the ear canals of 5 healthy controls (50-69yrs) and 3 unmedicated Schizophrenics (29-53yrs) in response to whole body tilts. The signals were bandpass filtered (700-4000Hz) to remove muscle interference. The Root Mean Square (RMS) of the filtered signals was measured across 0.5 sec running windows (one sample at a time) and compared between the background and tilting responses.

A typical example of the RMS signal for control subjects is shown in Fig 1. During the movement phase t=20-23 and 40-43 sec wherein the vestibular is active the RMS signal showed a marked increase for all signals of all subjects. The typical Schizophrenic response had the peaks seen at t=20-23 skewed to the left.

Fig. 1

[figure 1]

EVestG signals do show a vestibular component. When validated with larger sample size may be assistive in neurological disorder diagnosis.

Inhalant abuse among U.S. adolescents is a common occurrence. Unlike the illegal drugs, inhalants are readily available in an average household in many forms. According to the National Inhalant Prevention Coalition, between 100–125 deaths are attributed to inhalant abuse annually. We will describe a case of a Kenyan immigrant who developed acute psychotic episode following inhalation.

A 17 year old Kenyan immigrant was brought to the ED after inhaling shoe polish. She has a history of PTSD from being raped while on the street in Kenya. She was later adopted and brought to the USA. Her psychotic symptoms resolved after she was treated with olanzapine 5mg.

Medical complications include, but are not limited to the following central nervous system, cardiovascular, pulmonary, gastrointestinal, renal, hematologic, and dermatologic. In addition to medical complications, there are psychiatric complications as well. Adolescents abusing inhalants may often present with hallucinations, emotional disturbances, inappropriate affect, manic symptoms, or suicidal ideation. Inhalant use has also been associated with conduct disorder in adolescents, as well as major depressive disorder and substance abuse disorder later in life.

The use of inhalants to achieve a “high” continues to be a dangerous occurrence within the adolescent population. The consequences of inhalant abuse go beyond the immediate medical complications or social effects. An adolescent's mental health may be severely impaired, with psychiatric effects extending well into adulthood. Physicians and parents should be aware of the possibility of psychosis cause by inhalant abuse.

Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) have common clinical features in the diagnosis. Factors included in the development and neurobiology of BD and BPD, as early stress and neuroendocrine markers, may represent indicators to difference them.

Assess early life stress and HPA axis associated with diagnosis of BD and BPD.

Evaluation of 26 subjects, subdivided in groups of BD and BPD diagnosis, and health controls. Diagnostic was confirmed by Structured Clinical Interview for Axis I and II Disorders; early life stress was investigated by Childhood Trauma Questionnaire and classified in subtypes physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect. HPA axis was assessed by cortisol plasmatic levels.

Early life stress is significantly higher in BD and, especially, BPD patients compared to controls, as well emotional abuse and neglect types; however, it didn’t differentiate the clinical groups. Cortisol levels was lower in BD group in relation of BPD, although without a significantly difference. In BPD group, cortisol levels was positively correlated to sexual abuse severity; in the same way, in BD group cortisol levels was correlated positively to emotional neglect.

Early life stress is more prevalent and severity in patients than in health controls, independently to diagnosis. BPD presents early life stress more severity compared to BD group. Moreover, cortisol levels was lower in BD. Cortisol levels was positively correlated to subtypes of early life stress and severity. This study indicates a promissory field to be better differentiate BD and BPD.

Understanding through empathy is defined as an interpersonal process, the objective of which is to positively influence the course and outcome of psychotherapy. In such understanding, the harmony between our intellectual apprehension and our emotional perception of the patient is crucial.

The research was concerned with the influence that the criminal act has on the therapist's initial view of and attitude toward the patient. This fact, so remote from the therapist's own experience, somewhat diminishes the therapist's level of empathy at the beginning of the treatment.

The study covered 46 psychiatrists who treated persons with mental illness who committed criminal acts. The level of empathy was measured at the beginning of the treatment and after three and six months. Emotional Empathic Tendency Scale (EETS, Bryant) and Interpersonal Reactivity Index (IRI, Davis) were used for the assessment.

The results obtained show that the level of empathy measured was low on both scales at the beginning of the therapeutic process, but empathy increased after three and six months. These results were significantly influenced by the type of crime and the established diagnosis.

The initial position defined by “what the patient has done” disrupts the therapeutic relationship. Hence it is important to make as sharp distinction as possible between an objective image of the patient and the therapist's own projections. This enables the therapist to better understand the patient, gain his trust, skilfully manage the mutual relationship and achieve the therapeutic objectives.

All elements of prescription writing and drug administration are susceptible to error. Drug errors are an important cause of morbidity and mortality.

To assess the accuracy and clarity of inpatient drug prescriptions within the Brooklands Hospital and their compliance with the Trust medication prescribing policy.

To reduce the number of drug prescription errors which will subsequently diminish drug administration errors.

The currently used medication kardex of all adult inpatients were assessed in June 2010 (total 82 patients) and reassessed in September 2012 (total 74). An updated standard proforma obtained from the audit department was used to collect the data.

The patient ID number was present in 85% (vs 72%). The date of birth was noted in 95% of kardex. Allergies section has been filled in all kardex. The route, time and administration of regular medication were always written. All prescriptions were signed and dated. The number of charts were minimized in 97% (vs 87%). 100% of all multiple charts were numbered (vs 75%). All prescriptions for limited duration (eg: antibiotics) had an end date (vs 87%). The cancelled prescriptions were signed in 83% (vs 43%) and dated in 90% (vs 37%).

A global improvement was observed. Most improvement was observed in writing patients ID number, clarifying the end date of prescribed medication with limited durations and cancelled prescriptions being signed and dated. The process of auditing itself, pharmacist amendments and requests for clarification in addition to widespread circulation of policy could explain the above improvements.

Psychiatry wards are witness to violent behavior. Mental health professionals are called upon to prevent/deescalate potential violence.

Understand the causal factors that led to a serious group violence event in a psychiatric ward and review strategies to minimize the risk.

Provide a better understating and review current evidence.

Description of a group violence event. Non-systematic literature review concerning violence on psychiatric wards.

In a 29-bed acute closed-door mixed-gender general-hospital psychiatry ward staff had detected that a small group of patients increasingly defied instructions, refused treatment and intimidated users. Later, two of these patients, on cue from the psychotic content of another user with schizophrenia, intruded patients’ bedrooms and assaulted a 63 year-old female patient. These two patients, with bipolar disorder, were unemployed and had a history of previous psychiatric admissions, drug abuse, criminal offenses and treatment drop-out. De-escalation techniques failed and security was summoned. Offending patients were admitted to seclusion bedrooms and restrained. Upon a crisis meeting these two patients were transferred to two nearby psychiatric departments. There are several risk factors for violence in psychiatry wards, pertaining to the ward, staff, patients and psychopathology. Prevention measures are typically related to the timely detection of these variables and deescalation techniques. When these fail, seclusion, forced medication or mechanical restraint may be necessary.

This case report confirms that violence rarely erupts without warning. Additional staff training on violence prevention and tackling is required. Some variables (e.g. overcrowding) are current structural weaknesses of the health system.

NMDA receptor ligands have been shown to rapidly treat depression but are associated with psychotomimetic effects. GLYX-13 is an NMDA receptor glycine site functional partial agonist with ~ 25% of the agonist activity of glycine or Dserine. Animal models suggest a single intravenous dose may produce long-term efficacy without psychotomimetic effects.

A phase II randomized, double-blind, placebo-controlled trial was conducted to assess the efficacy of GLYX-13 with central raters.

To examine the effects of a single dose of GLYX-13 in subjects with inadequate response to previous treatment for MDD.

48 male and 68 female subjects received a single dose of GLYX-13 (1-/5-/10-/30-mg/kg) or placebo. Central raters assessed subjects via telephone using the HDRS-17 at Screening, Baseline, Days 1, 3, 7, 14, 21 and 28.

The a priori primary efficacy ANCOVA on pooled drug dose versus placebo was not significant for change from baseline to Day 1 on HDRS-17 total score. MMRM revealed a statistically significant reduction in HDRS-17 total score versus placebo at Day 3 for 5-mg/kg (−4.4; p < .05) and a trend at Day 1 for 5-mg/kg (−3.5; p = .068) and at Day 7 for 5 and 10-mg/kg (−4.0 for both; p's = .059 and .073). GLYX-13 did not cause psychotomimetic side effects at any dose studied.

This study suggests that GLYX-13, an NMDA receptor glycine site functional partial agonist, rapidly reduces depression scores without eliciting psychotomimetic effects at therapeutic doses as assessed by central raters. Further study is indicated.