Mental illness in the general population are significantly represented, even so psychiatric patients are currently highly stigmatized in the Czech Republic. The main aspect leading to the stigmatization seems to be a lack of information and misinterpretation of psychiatric disorders caused by media.

Our pilot study aims to monitor attitudes of general medicine students toward mentally ill patients. We were interested in students’ personal experiences with psychiatric disorder, including friends and family and also personal experience derived from movies, literature and documents.

We contacted students of General Medicine, Palacky University in Olomouc. They filled out the questionnaire with questions designed to describe the characteristics of psychiatric patients and psychiatrists.

The survey indicates that stigmatizing attitudes are less frequent among the students with personal experience with mental illness. Decrease of stigmatization was also found in students which attended the subject connected with psychiatry and also in students interested in career as a psychiatrist.

Personal experience with psychiatric patients, and formal or informal education is associated with lower levels of stigmatization. The key to the de-stigmatization seems to be in the psychoeducation and training.

This descriptive study aims to determine that nurses who working in medical and surgical clinics for opinions about Consultation-Liaison Psychiatry Unit and the relationship between emphatic tendency and communication skills.

The sample of the study is consisted of 116 nurses who working in medical and surgical clinics between Agust- October 2012 and who are volunteer to participate the study. The data were obtained from Sociodemographic Data Collection Form, Empathic Tendency Scale and the Communication Skills Scale. Correlation, t-test, ANOVA tests were used in data analyzes.

50.5% of the nurses were worked in medical clinics, 52.2% of them were between the occupational experience of 1–5, 85.1% were registered nurse. 58.1% of the nurses directed patients to the Consultation-Liaison Psychiatry Unit (CLPU) and 66.2% nurses wanted to be receive consultancy on psychiatric nurse.

Average point of emphatic tendency of the nurses is 72.62±7.82 and average point of communication skills is 76,22±9.65. There was a positive correlation between emphatic tendency and communication skills score (r=0.499, p=0.00) in nurses. The nurses who working in psychiatric clinic were more empathic tendencies than the others (t=2.618, p=0.014). More experienced nurses are directed to the CLPU (F=8.618, p=0.00). The majority of nurses were correctly identified of function CLPU. The most consultation is required for patients who are suffering from anxiety and depression. Nurses were required to counseling on communication techniques.

CLPU is very important that both nurses and their patients in helping to psychosocial problems.

Research on body image suggests a link between women's perceived body image and sexuality.

The aim of our study was to determine the relationship between body image and sexual satisfaction among Tunisian women and the impact of culture on sexuality.

One hundred women completed a self-administered questionnaire which included:

1. - Clinical data: weight, height …

2. - Women's perception of their body.

3. - The perception of sexuality by women and their spouses.

4. - the impact of body image on sexuality.

The mean age was 36 years and 7 months. They were married for 12 years on average. The rate of menopausal women was 21%.

Two per cent of women were underweight, 38% were overweight, 6% were obese and 54% of them had a normal body mass index (BMI).

Women who were satisfied with their looks had significantly a higher self-esteem (p = 0.013).

Eighty six per cent of women are recognized as good sexual partners and 85% were satisfied with their sexual activity: Eighty seven per cent of these women considered their body a source of sexual pleasure. These women thought they had an erotic body (p = 0.009) and a source of self-confidence (p = 0.002).

This study indicates that there is a difference between western and eastern culture in the impact of body image on sexuality. So, it is imperative for female adolescents to have adequate and appropriate sexual education.

Schizophrenia is related with high risk of aggressive behavior and poor cognitive performance.

To study the relationship between cognitive performance, clinical characteristics and history of aggressive behavior in inpatients with schizophrenia.

In this two year follow-up study 65 inpatients with schizophrenia diagnosis according to ICD-10 criteria were evaluated using neuro-cognitive test WAIS and MMSE, clinical characteristics were based on PANSS and PCL tools and aggressive behavior was assessed based on HCR-20 and medical records. Inpatients were divided in two groups: nonrecidivism group (N-28) and recidivism group with aggressive behavior (N-37). Both groups were compared in terms of difference of means and correlation between socio demographic data, clinical symptoms and cognitive performance.

37 in patients with schizophrenia or 56,9% were recidivist with aggressive behavior (≥1 incident) while 28 of them or 43,1% weren’t recidivist. We find significant difference between groups in age at first violence p < 0,023, past history of treatment p < 0,05 and social status with p < 0,018 level of significance. ANOVA test showed group difference in PANSS test (p < 0,001). Recidivism group of inpatients shows significantly poor cognitive performance in WAIS (p < 0,029) and MMSE (p < 0,025) test. Based on Pearson correlation matrix cognitive variable were significantly correlated with positive and negative clinical symptoms of schizophrenia features.

Poor cognitive performance was related with aggressive behavior recidivism and using the methods of behavioral-cognitive programs of rehabilitation is priority for the treatment of inpatients with schizophrenia under measure of psychiatric mandatory treatment.

A dimensional approach in psychiatry strives to identify neurobiological signatures of core (dys)functions such as responses to emotional stimuli across nosological boundaries.

We compared responses to emotional stimuli between major psychiatric disorders and investigated whether there is a psychopathological correlate irrespective of diagnostic group.

We used functional magnetic resonance imaging (fMRI) to assess the functional correlates of responses to unexpected pleasant and aversive emotional pictures in n=175 subjects suffering from alcohol dependence (n=29), schizophrenia (n=37), major depressive disorder (MDD; n=25), bipolar disorder (acute manic episode; n=12), panic disorder (n=12) or attention deficit/hyperactivity disorder (ADHD; n=20) and in healthy controls (n=40). The level of anxiety was measured in all diagnostic groups with the State-Trait Anxiety Inventory, and severity of depressive mood was measured with Beck's depressions inventory in all diagnostic groups with the exception of bipolar patients.

Over all diagnostic groups, a significant activation of BA10 was observed during the presentation of unexpected pleasant pictures, whereas a significant activation of the left amygdala and left insula was found during the presentation of unexpected aversive pictures. We did not find significant effects of group, nor a correlation of neuronal activation with depressed mood or anxiety.

In spite of reported alterations in emotion processing in different psychiatric diseases, responses to emotional pictures did not differ across nosological boundaries in our study. However, a dimensional approach that targets e.g. personality traits or basic learning mechanisms and their neuropsychological correlates across traditional disease categories may be more promising.

Defendants commonly claim amnesia for their criminal actions especially in cases involving extreme violence. While some claims are malingered or result from physiological factors, other cases may represent genuine partial or complete amnesia resulting from the psychological distress and/or extreme emotion associated with the perpetration of the crime. Detecting malingering in such cases is substantial part of forensic psychological and psychiatric assessment.

To identify possible psychological differences among homicide or severe violence offenders presenting amnesia for the event and those who do not.

We examined homicide or severe violence offenders presenting amnesia for the event (n=15) and those who do not (n=15). Methods for assessment of cognitive functions (WAIS-III, WMS), dissociation (DES-20, MID), impact of events scale (IES), and personality (ROR, MMP-II) were used. Further we evaluated social and criminal anamnesis. Offenders with psychotic or schizophrenic symptoms were excluded.

No differences in cognition or personality was found (p < 0.01). Elevated levels of dissociation and score in IES questionnaire was found in offenders presenting amnesia for the event.

This pilot study supports hypothesis that there are no any neuropsychological impairments in nonpsychiatric offenders of murder or severe violence presenting amnesia. Higher level of dissociation and score of impact of events scale (p < 0.05) suggest, that this group of offenders may be more predisposed to dissociative and stressful reactions in overloading events. Thus the question whether the amnesia is malingered or not is still unclear.

To assess the impact of self-esteem on the sexuality of obese patients compared to a sample from the general population.

A cross-sectional case-control study. It involved 40 obese married patients (BMI ≥ 30 kg/m2) and 40 normal weight subjects from the general population. A questionnaire was presented with sociodemographic data, somatic and psychiatric personal histories, data on obesity and sexual life data. Self-esteem was assessed using the Rosenberg Self Esteem Scale (RSES).

The sex-ratio (men/women) of obese patients was 0.53. The average BMI of obese patients was 33.48 kg/m2 (SD = 3.44). The score at the RSES in the obese group was 30.15 (SD = 5.48) versus 32.2 (SD = 4.58) in the control group, with no significant difference (p = 0.808). Among obese patients, the higher the score of self-esteem was, the more frequent sexual intercourses were, without significant difference (r = 0.254, p = 0.119). Sexual satisfaction was significantly correlated with the level of self-esteem (p = 0.022). Obese people with low self-esteem were more likely to have a decrease in sexual desire (OR = 9.625, CI [1.378, 67.246]).

There is a link between low self-esteem of obese and an alteration of the quality of their sexual life. The therapist should check the level of self-esteem in obese patients and try to improve it. In this sense, the collaboration of the endocrinologist with the psychiatrist could be very useful.

The Gender Identity Disorder (GID) is characterized by a strong sense of identity with the opposite gender, by a persistent discomfort with the one's gender and with a feeling of inadequacy to the social role of the biological gender.

The possibility of a higher presence of Borderline Personality Disorder (BPD) in patients with GID has been a subject of research in several studies.

The diagnosis criteria of the BPD includes a global disorder in the individual identity.

Both BPD and GID are associated with a high risk of self-mutilation and suicide.

To analyze and discuss a case report, addressing subjects related to the psychopatology, differential diagnosis and prognosis and therapeutic implications.

Our discussion is focused on a case report, that led us to a non systematic review of the literature.

Our case report is related to a 20 year old man with GID and BPD. This situation is lived in a great social isolation and frequent self-mutilation episodes and suicide attempts.

The clinical outcome is aggravated by a severe instability in the personal relationships, self-image, ambitions and the future projects.

We have discussed the differential diagnosis, psychopatology, prognosis and the identity disorder that the subject presents.

The biologic gender, age and the treatment phase are factors that influence the risk of suicide and self-mutilation in these patients. We did not found a higher probability of BPD in a patient with GID.

Depression is difficult to diagnose in schizophrenic patients although it represents a frequent motive for suicide. In clinical practice nonspecific sadness is more often observed than major depressive episodes. Our analysis of these states led us to the concept of demoralization.

The objective of our study was to demonstrate the existence of demoralization in psychotic patients as a real entity and to see how it could be correlated with other dimensions.

A total of 55 ambulatory patients diagnosed with a schizophrenic disorder were included and distributed in 2 groups according to the level of demoralization. The correlation with residual psychotics symptoms (PANSS), depression (CDSS), despair (BHS), and quality of life (SQoL) as well as the sociodemographic characteristics and past history of suicide attempts was assessed.

More than 94% of our patients were found demoralized, 16,36% of them severely. The degree of demoralization was correlated with the intensity of positive symptoms (p = 0.016), depression (p < 0.001), despair (p = 0.015), suicidality (p < 0.01) as well as poor quality of life (p = 0.007) and low self-esteem (p < 0.000).

Demoralization appears to be a relevant concept during schizophrenia, bound in schizophrenic and depressive process, and impacting the suicidal risk. It could represent an important stake in the care of schizophrenic patients especially for the prevention of relapse and suicidal risk.

Relevance of the topic is due to the difficulty of understanding the true causes of the own experiences of patients with depressive disorder, as well as providing the opportunity to work deeply with these factors as for the patient and therapist.

The role of art therapy (AT) in the treatment of patients with depressive disorder.

40 patients - men and women aged 18 – 30 years.

Tasks: note the extent to which an objective interpretation of the content of the picture with his patient's subjective experience: comparison of results of treatment between patients who had sessions of AT and patients who didn’t have it; determine the regressing symptoms after sessions of AT.

Clinico-diagnostical method; picturesque method, Hamilton Depression scale; Hamilton anxiety scale.

90% of patients have drawn interpretation of the content of their subjective experiences, 70% of patients reduced the level of anxiety, 75% of patients experienced improvement in mood between sessions, 77% of patients self-esteem has increased, 80% of patients had sustained remission, and 68% - a positive outlook for the future has appeared. Thus, this study indicates that AT is a powerful aide in treatment of depression, helps patients cope with depression, returning to their lives a sense of internal control and order, and facilitating the psychodiagnostic work of physician, allowing him to carry out the appropriate psycho-correction, which improves the quality of treatment and rehabilitation of patients with depressive disorder.

Due to the scarcity of mental health professionals, recruitment of psychiatrists is presently a major issue in Portugal. A negative attitude towards psychiatry or the psychiatrist's role has frequently been observed in rather different countries - this is troublesome, given that medical graduates’ attitudes toward psychiatry has been pointed as a predictor of recruitment. On the other side, research suggests that a clerkship may improve the student's attitudes, namely when they are stimulated to participate in the delivery of care.

To assess the impact of a clerkship in the attitudes toward psychiatry among Portuguese medical graduates, as well as in the motivation to choose psychiatry for future training.

Balon's self-reported questionnaires were administered to all 6th year students in a medical school in Lisbon, before and after a 4-weeks full-time psychiatric clerkship.

153 students were evaluated. After the clerkship, perceptions about the overall merits of psychiatry, efficacy, role definition, functioning of psychiatrists and use of legal powers to hospitalize patients were significantly improved. There was also a meaningful increase of trainees considering the possibility to take a residency in psychiatry. However, perceptions of low prestige and negative pressure from family and peers regarding a future choice of psychiatry remained unchanged in about one-third of the students.

Clerkship had an auspicious overall impact on the student attitude towards psychiatry,as well as in the number of students considering a future career in psychiatry. Attitudes toward psychiatry seems a promising outcome indicator of the clerkship's quality.

There is emerging evidence that organizational culture and leadership profiles influence the way health services implement their systems of care. Studies regarding organizational culture of services are widespread in economical and managerial areas but very few evaluate mental health care contexts. Most of these studies aim to help in the management of human resources.

To assess the organizational culture and leadership profiles in the Portuguese mental health services.

Cross-sectional study, made in public and private mental health services. Evaluation was made by means of the competing values framework tool (Quinn, 1990) (Portuguese version - MJ Felício, 2007), which includes dimensions such as organizational culture and leadership profiles in the framework of more open or close systems and with more control or flexibility strategies.

There is no organizational or leadership profile clearly outstanding in the Portuguese mental health services. However Director and Coordinator leadership profiles scored higher in the results. These higher scores profiles were linked with assignment of duties, delegation of tasks and planning activities. Innovation profiles had the lowest scores, linked with the ability to cope with change and to manage change.

Further studies are critical to develop a clearer view regarding the influence of organizational culture and leadership profiles in the organization of mental health services. Low scores on innovation components may influence the way evidence based practices are welcomed and implemented in services.

Modern antipsychotics can successfully fight productive symptoms and prevent the development of negative symptoms of schizophrenia. Among them - the development of metabolic disorders, including abdominal obesity. According to researches 40–80% of patients receiving antipsychotics has increased body weight of 20% or more, and obesity in patients with schizophrenia occurs in 2 times more often than in general population. Abdominal obesity pathogenetically linked to hypertension, type 2 diabetes mellitus, it also determines decrease of life quality of these patients and their compliance.

To study other factors which impact on the condition of these patients and determine the quality of their lives.

Clinical, PANSS.

Patients reported a lower life quality as compared to patients with normal weight. Their body mass index was 30–35 kg/m2, corresponding to 1 degree of obesity. Analysis of adherence to therapy of the patients showed that compliance was good in patients with a predominance of productive symptoms. At the same time, some of the patients often had thoughts to stop treatment due to the development of obesity. Thus, the results show the relationship between degree of abdominal obesity and adherence to therapy in patients with paranoid schizophrenia.

Growing evidence in the field of psychoneuroimmunology indicates an interconnection between psychiatric disorders, in particular schizophrenia and mood disorders, and cytokine alternations. Gender and aging are commonly reported to affect cytokine levels, but contrasting conclusions still represent a topic for debate.

Our aim was to investigate the role of age and gender in the serum levels of Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α), in patients with schizophrenia (SCH) and major depression (MDD).

We measured serum levels of IL-6 and TNF-α in acute exacerbation of illness, in 37 patients with MDD, and compared them to 43 patients with SCH. The serum levels were measured by the enzyme-linked immunosorbent assay (ELISA). All patients fulfilled the ICD-10 criteria.

The significant interaction between gender and psychiatric disorders on serum cytokine levels, and the association between IL-6 and TNF-α and age, in both groups of patients, were not detected. However, when applied the linear regression model with the serum cytokine levels as dependant variable, and age, gender, and psychiatric disorder as independent variables, the significant predictive effect of age on levels of both investigated cytokines was detected. The patients over 35 years of age had higher levels of IL-6 and even significantly lower levels of TNF-α, regardless of the diagnosis.

The results suggest that the aging process could be a relevant factor influencing the immune status of patients with SCH and MDD. Further prospective studies are essential to further investigate biological mechanisms that underlie these multidimensional interconnections.

To determines effect of massage therapy on menopausal symptoms.

This Randomized Clinical Trial was conducted at menopausal clinic of one of the main referral gynecology hospital of Tehran University of Medical Sciences in Tehran (2011–2012). Study population comprised 60 healthy volunteer Menopause women that were assigned to massage therapy and control group. Each subject in the massage therapy group received massage sessions, twice a week for 4 weeks with plane oil and no treatment was provided to subjects in the control group. The outcome measures in this study were psychological, somatic and urogenital symptoms of menopause as obtained through the Menopause Rating Scale. All outcomes were compared by using Paired- samples T Test for testing intra group change, and the Independent- samples T Test for between groups.

There were no significant difference between pre and post application of psychological and somatic score in intervention groups (p < 0.001), whereas the urogenital score did not differ significantly. When the massage therapy and the control groups were compared, the participants’ psychological and somatic score after 4 weeks of intervention in the massage therapy group were found to be significantly lower than the control group (p < 0.01), while urogenital score did not differ between groups significantly.

This study indicated that massage therapy was effective in reducing psychological and somatic symptoms during menopause. But, has no effect on urogenital symptoms.