Examining the prevalence of externalizing problems, its predictors and the mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children’s externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in logistic regression.

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems and whose parents received home based family support prior to the out-of-home placement had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children’s externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.

The methylation status of the human glucocorticoid receptor gene NR3C1 in newborns has been reported to be sensitive to prenatal maternal mood. This study investigates both the association between maternal cortisol and emotional state during pregnancy and the methylation state of the promoter region of NR3C1 gene.

We examined 83 pregnant women. Psychological data and diurnal cortisol data were assessed to evaluate maternal stress once each trimester. DNA methylation at different loci of the NR3C1 gene, including exon 1B, 1D and 1F, was analyzed in genomic DNA from cord blood mononuclear cells.

Univariable analyses indicated pregnancy related anxiety to be the strongest psychological parameter throughout pregnancy. Most significant findings concerned 1F. Particularly the methylation state of CpG9 was significantly associated with maternal emotional wellbeing. In a multivariable model the proportion of variance in methylation state of F9 explained (PVE) by pregnancy related anxiety was 7.8% (p=0.023) during T1.

Furthermore different CpG-units located at the nerve growth factor inducible protein A (NGFI-A) binding sites of 1F were associated with maternal anxiety [(F20.21: PC PRAQ and fear of integrity in T1: respectively PVE:8.9% and PVE:9.0%; Fear of delivery T2: PVE:8.0%, Fear of integrity T2: PVE:6.0% and STAI T2: PVE:5.9%) - (F12.13: PC PRAQ T1: PVE:6.9%, fear of integrity T2: PVE:6.0% and fear of delivery T2: PVE:8.0%)] and cortisol (F38.39: PVE: 8.9%) in T3.

These data indicate that prenatal maternal emotional state, particularly pregnancy related anxiety, are associated with the methylation state of the NR3C1 gene in the child.

General population surveys of the prevalence of common mental disorders are necessary for the organization of effective mental health services.

Epidemiological studies are useful for the more objective assessment of the mental health needs of the population.

To present data on the pattern and correlates of 12-month use of services by persons with common mental disorders from the recently completed general population survey of psychiatric morbidity in Greece.

The sample (n=4894; multistage stratified random sample) was representative for the Greek population aged 18-70. Common mental disorders were assessed according to the ICD-10 criteria with the revised Clinical Interview Schedule (CISR), conducted by trained lay interviewers.

73,9% of participants with at least one common mental disorder (CMD) do not receive any treatment for their psychological health, 52% have never spoken to the family physician and 73.3% has not spoken to a mental health professional in the past year. The disorder associated with the most frequent use of general health services for any reason (>4 visits to any physician in the past year) was depression (43.7%). Overall, 46.5% of all participants who meet the criteria for a CMD had not spoken to a doctor or mental health professional, with men showing significantly higher rates of no use compared to women (54.6% vs 41.5%).

These findings can help in the better organization of services with the aim to improve prevention and treatment of common mental disorders in Greece, especially in a time of economic hardship.

Attribution style bias, such as a greater tendency to perceive hostility, has been reported to be presented in multi-episode and chronic schizophrenia patients.

The aim of this study was to investigate whether adolescents with Early-Onset-Schizophrenia (EOS) exhibited a perceived hostility bias and whether this bias was correlated with adolescents' clinical characteristics (positive and negative symptoms of schizophrenia, anxiety, depression, self-esteem) and social competence (social behavior, communication, imagination).

Thirteen adolescents with EOS (mean age: 14.7) and 17 healthy adolescents (mean age: 14.2), matched on age and total IQ, completed the Ambiguous Intentions Hostility Questionnaire (AIHQ) and several clinical measures of anxiety, depression, social competences and self-esteem. The AIHQ is a self-report questionnaire about negative outcomes that varied intentionality in different situations (i.e., ambiguous, intentional and accidental situations). The perceived hostility, composite blame and aggression bias scores were calculated.

In comparison with healthy adolescents, adolescents with EOS attributed more hostile intentions to persons in accidental situations (hostility bias); they also exhibited a higher level of negative emotions (blame bias) toward persons in accidental situations. Both, hostility bias and blame bias were associated with a higher level of anxiety and a lower selfesteem in EOS adolescents.

These results suggest that cognitive and emotional biased attribution style in EOS may constitute an important factor of vulnerability to social impairments in adolescents with EOS and suggest that these attributional biases should constitute the targets of early psychotherapeutic intervention with these patients.

An eighty-one-year-old lady presented with mood changes within days of the commencement of prednisolone eye drops, which was prescribed following a cataract operation. She had a history of chronic schizophrenia, with one previous episode of hypomania in the early1990s. She was admitted to our institution on this occasion, with symptoms including elated mood, disinhibition, insomnia, pressured speech, flight of ideas and grandiose ideation. This was a distinctly different presentation from her previous relapses and the duration of this episode was prolonged. Her symptoms persisted despite an aggressive titration of psychotropic medications. After a review of her medication, the possible causal relationship between the prednisolone eye drops and manic episode was made. As the steroid eye drops were necessary following her eye operation, we allowed the completion of its course. Within days of its discontinuation, we saw a dramatIc improvement in her mental state and she was discharged. She currently remains in remission two months from the cessation of prednisolone.

The postulation that the prednisolone eye drops triggered this manic episode can be substantiated by the clear observation that her symptoms completely resolved after the steroid course was completed. This appeared to be the one single factor which coincided with the emergence, maintenance and termination of her symptoms. Steroid-induced psychiatric symptoms are a well documented phenomenon, but are typically seen with higher doses and systemic administration of corticosteroids. This case report is of a rare presentation, and to our knowledge there are no similar cases described.

Physiological aging was associated with emotion recognition deficit. Neuroimaging studies have showed that decoding of emotional prosody cues is linked to a frontotemporal network involving superior temporal gyrus and inferior frontal gyrus. However, little is know about the relationship between affective prosodic processing and age-related change in the functional brain.

The present study aims to investigate the aging brain of early sensory processing of affective prosody.

Fifty-five healthy volunteers with an age-range between 18 and 75 years old underwent functional magnetic resonance imaging, with a mismatch paradigm, while they were presented with emotional prosodic stimuli. Thus, pseudowords spoken with positive and negative emotions were randomly presented among repeated non-emotional stimuli.

The results showed that automatically processing of changes in affective prosody involves bilateral superior temporal lobes. Furthermore, these brain areas were found to be influenced by the normal aging, i.e., advancing age is associated with reduced temporal lobe response.

Together, these findings suggest the involvement of temporal lobe in detection of emotion in language; and that normal aging affects its functioning.

According to the NMDA-R hypofunction hypothesis of psychosis, the administration of certain antagonists at NMDA-R, such as ketamine, may exacerbate psychotic symptoms in humans and provide a preclinical model of psychosis. Both ketamine and antipsychotic drugs induce molecular changes in genes of the post-synaptic density (PSD), involved in glutamate signaling and dopamine-glutamate interplay.

Memantine, an antagonist/partial agonist at NMDA-Rs with procognitive properties, has been proposed as an adjunctive treatment for schizophrenia.

We tested the hypothesis that memantine and propsychotic NMDA-Rs antagonists (ketamine and MK-801) may elicit divergent molecular changes at glutamatergic synapses.

Sprague-Dawley rats were treated by:

1. 1) vehicle;

2. 2) MK-801 0.8 mg/kg;

3. 3) memantine 5 mg/kg;

4. 4) ketamine 25 mg/kg;

5. 5) ketamine 50 mg/kg.

We compared, by in situ hybridization histochemistry, the expression of PSD genes in cortical and striatal brain regions.

Homer1a expression was significantly induced by ketamine 25 mg/kg and reduced by MK-801 in striatum and cortex. Arc expression was significantly induced by ketamine and memantine in the cortex and by MK-801 in nucleus accumbens. Homer1b/c expression was significantly decreased by ketamine compared to vehicle in motor cortex and dorsolateral striatum. PSD-95 expression was significantly decreased by MK-801 compared to vehicle in all striatal regions and by ketamine in dorsomedial striatum.

These results demonstrate that NMDA-Rs antagonists with different pharmacological properties trigger different molecular changes at glutamatergic synapses. These results are consistent with the different clinical profiles of these compounds and with the observation that NMDA-R blockade is not necessarily associated to psychosis exacerbation.

Childhood abuse is inherited in families and mainly associated with poor physical and mental health. Its association with mental health problems in adulthood is not well-studied in Jordanian women.

This study aimed at examining the relationship between history of childhood abuse and experiences of mental health problems in Jordanian women.

To assess the prevalence of childhood abuse in Jordanian women and to examine differences in mental health problems based on type of childhood abuse.

Data about childhood abuse and mental health problems were assessed in 409 women visiting healthcare centers. Statistical analysis included descriptive statistics for prevalence rates and one-way between-groups multivariate analysis of variance (MANOVA) for relationship between mental health and abuse experiences.

Emotional abuse and physical abuse were the most frequently reported during childhood (47.1% and 46.5%, respectively). Statistically significant differences in mental health between women who experienced emotional abuse and childhood neglect and their counterparts were found (Wilks' Lambda for emotional abuse = 0.914, p < .0001; Wilks' Lambda for childhood neglect = 0.83, p < .0001). Mental health problems did not differ significantly between physically and sexually abused women with their counterparts.

Mental health consequences of childhood abuse last to adulthood. Emotional abuse and neglect can be more harmful and more damaging to women's mental well-being than physical and sexual abuse. Mental health consequences of childhood abuse may alter women's commitments and obligations to others. Therefore, professional health efforts focusing on mental health should be established in healthcare centers.

Alzheimer's disease is a progressive neurodegenerative disorder in which the patient experiences progressive loss of cognitive and functional abilities and concomitant behavioural disturbances. Memantine, a moderate affinity, uncompetitive N-methyl-d aspartate (NMDA) receptor antagonist, is approved for the treatment of moderate to sever Alzheimer disease.

The NMDA receptor subtype of glutamate receptors is involved en regulating synaptic plasticity and likely plays a role in learning and memory. The stimulation of this receptor can result in excessive intracellular calcium concentrations and might possibly contribute to both acute and chronic forms of neurodegeneration. Memantine has been shown to improve symptoms and reduce the rate of clinical deterioration among patients with moderate to severe Alzheimer's disease.

A safety anlysis of Alzheimer’s disease patients from four randomized placebo controlled, double-blind memantine dementia studies included 50 and 50 memantine and placebo the aled patients. A vast majority of the patients received memantine 20 mg/day for a duration of at least 12 weeks, with most receving treatment for 28 weeks. Active and placebo groups were well matched demographically.

Overal, memantine showed statistically significant benefits on global and statistically significant benefit on cognition. Memantine consistently benefited patients in all stages of Alzheimer's disease and was well-tolerated.

Psychiatric deinstitutionalization has been frequently associated with an increase in family burden in most Western countries. Research shows that notwithstanding of evidence of its usefulness, family interventions for psychotic disorders are not routinely applied in most public mental health services. This applies especially to countries where family issues are not so well documented, such as Portugal. To address that issue, the Ministry of Health hurled a training program on family interventions for the severe mentally ill, ensuing the recommendations of the National Mental Health Plan.

1. a) to launch a family intervention training program on a national level, and

2. b) to identify the obstacles to implementation in routine settings.

Professionals from public mental health services throughout Portugal attended a 3 days full-time course in which they were trained in the family intervention, consisting in guidelines presentation and discussion, demonstrative audios/videos and role-playing sessions.

The trainees' acquisition of competences was found rather encouraging. Perceived obstacles to the implementation of the family intervention in routine practice comprised work overload, the nuisance to integrate weekly family sessions with other professional tasks, and the stunted availability of time to run the intervention on a regular basis.

Arrangements need to be envisaged in order to overcome deal with barriers limiting the implementation of family interventions in routine settings. Amelioration have to focus on changing the organisation of the mental health facilities, like greater handiness of dedicated hours and career inducements for professionals working with the families of psychotic patients.

The science of implementation consider the steps that influence the translation of evidence-based treatments into routine use. The implementation of a new Portuguese National Mental Health Plan started in 2007. In order to improved the way that services are delivered, an implementation process of a case-management (CM) was initiated by the National Programme for Mental Health.

To assess the results of a implementation programme considering the following dimensions:

1. a) mental health services main characteristics,

2. b) leadership profile,

3. c) main obstacles to implementation,

4. d) implementation fidelity.

40 public and private mental health services were included for evaluation. Implementation activities included a CM training programme. Implementation degree and main obstacles to implementation were rated by: Barriers and Facilitators Assessment Instrument (Peters, 2001) and Illness Management Fidelity Scale (Mueser, 2009).

Assessment of services showed: liaison (50%), guidelines use (57%), single clinical records (50%), in service formal education plan (85%), research practice (21%). Regarding professionals profile, 70% used case management in practice, only 20% with formal training. Full implementation occurred in 36,3% of services, fair implementation in 45,4%, but still not enough implemented in 18,3%. Main barriers were lack of time (61%), lack of dedicated facilities (61%), low motivation (38%) and absence of financial incentives (38%).

In spite the efforts to implement evidence based practices in Portuguese mental health services, there are still several obstacles that difficult full implementation. Structured implementation programmes may constitute coadjutants to ameliorate the delivery of effective practices.

Women remain under-represented in cardiovascular clinical trials even though, in Europe, 55% of female deaths are caused by cardiovascular disease. Women have less extensive and less severe disease but poorer outcome compared to men. Gender related specificities in risk factors and adaptation to illness, or both, might further explain this.

As part of a larger study examining the impact of depression and type D personality in cardiac patients, a sample of 243 (148 females) highly educated controls (mean age = 41 ± 10 years) were evaluated on demographic, behavioral, psychosocial [BDI-II (Beck Depression Inventory, 2nd edition); HADS (Hamilton Anxiety and Depression Scale); DS-14 (Type D personality)] and clinical risk factors known to be implicated in cardiovascular disease.

Women had significantly less alcohol consumption (p< .001) and exercise (p< .05), but had higher cholesterol and triglycerides (p < .05) than men. Past psychiatric complaints (p< .05), current depression (p< .05), moderate levels of anxiety (p< .05), and negative affectivity (p< .05) were all significantly more common among women. Age-adjusted multivariate analyses confirmed that lack of exercise together with dietary concerns and increased levels of mental distress (depression, anxiety and negative affectivity) tend to cluster in women. Importantly, no gender differences were detected in traditional cardiovascular risk factors such as hypertension and diabetes, or Type D personality prevalence.

In a highly educated sample, women presented with increased behavioral and psychosocial difficulties than men. These vulnerabilities may augment the impact of putative pathophysiological risk factors for cardiac disease.