The study was a comparison of two retrospective studies led in the department of emergency and external consultation of the Razi hospital. The first study had concerned 300 patients examined within the framework of a medical supervision during year 2001. The second study had concerned 430 patients having consulted for the first time in our department during the year 2012 and benefited from a long term sick leave.

Forty was the age the most represented with a net feminine ascendancy in both studies. More than 60% of the patients were married in both study but a decrease of the number of single men has been reported in2012. The middle manager was the most represented professional category: the transport had been the most represented body employer in 2012. Depression was the most represented diagnosis.

The economical impact of the long term sick leave can be important but never considered. The low social support, the dissatisfaction, the workload and the indistinctness of the professional task are at the same time inductive but also aggravating factors.

The clinical differentiation of schizophrenic and mood disorders is frequently challenged by co-occurring affective and psychotic symptoms. Thus, it has long been discussed whether these disease groups are subserved by common or distinct neurobiological surrogates.

The detection of diagnostic biomarkers for schizophrenic and mood disorders could facilitate clinical decision making in ambiguous cases.

To evaluated whether multivariate pattern classification of structural MRI enables the differential diagnostic classification of 158 patients with schizophrenia (SZ) and 104 patients with major depression (MD).

T1-weighted patient scans were processed using voxel-based morphometry. Diagnostic features were extracted from the age- and sex-adjusted GM maps using PCA and linear SVMs. Repeated nested cross-validation was emplyoed to assess the generalizability of diagnostic performance.

Cross-validated classification accuracy was 76% based on a discriminative pattern involving perisylvian, limbic, medial prefrontal and precuneal GM volume reductions in SZ vs. MD. GM volume reductions in MD vs. SZ were detected in the premotor, sensorimotor, parietal, cerebellar and brainstem structures. The 'SZ-likehood' of MD was correlated with the age of disease onset, leading to a significantly higher misclassification rate among MD patients with an age of onset between 15 and 30 yrs.

The findings suggest that SZ and MD can be identified at the single subject level using neuroanatomical pattern recognition. The decreased diagnostic separability of MD patients with an early disease onset may challenge the traditional nosological boundaries and may relate to higher levels of chronicity and unfavorable disease outcomes in this patient population.

patients suffering from psychic disorders are characterized with postponed health-seeking. The aim of this study was to find out factors affecting the activity of health care seeking behavior (HCSB).

200 inpatients took part the study. Most of them were female (74%). Mean age was 44,6±13,5. Among patients 29% suffered from affective disorders, 71% – from neurotic, stress-related and somatoform disorders. Patients were divided into 2 groups with active - aHCSB (n=99) and passive - pHCSB (n=100).

Coping-strategies (Lazarus) test, personality test and attitude towards disease test were used.

Higher degree of combination of moderate seeking of social support coping and moderate planning of problem-solving coping was present in aHCSB compared with pHCSB group (57% Vs 35%, p=0,001). Patients with pHCSB compared with aHCSB were characterized with higher degree of mild seeking of social support coping and mild planning of problemsolving coping (8% Vs 2%, p=0,049). Mild anxiety traits were more common in patients with aHCSB than pHCSB (31% Vs 19%, p=0,041). In contrast severe anxiety traits were more common in patients with pHCSB than aHCSB (15% Vs 6%, p=0,042). Sensitive type of disease attitude resulted in pHCSB (30% compared with 11% in aHCSB group, p=0,012). Hypochondriac type of disease attitude was more common in aHCSB (21% Vs 11% in pHCSB, p=0,047).

health care seeking behavior is affected with complex of psychological factors. Knowing of these factors can be used in prevention of passive health care seeking behavior.

Numerous studies have applied novel multivariate statistical approaches to the analysis of brain alterations in patients with schizophrenia. However the diagnostic accuracy of the reported predictive models differs largely, making it difficult to evaluate the overall potential of these studies to inform clinical diagnosis.

We conducted a comprehensive literature search to identify all studies reporting performance of neuroimaging-based multivariate predictive models for the differentiation of patients with schizophrenia from healthy control subjects. The robustness of the results as well as the effect of potentially confounding continous variables (e.g. age, gender ratio, year of publication) was investigated.

The final sample consisted of n=37 studies studies including n=1491 patients with schizophrenia and n=1488 healthy controls. Metaanalysis of the complete sample showed a sensitivity of 80.7% (95%-CI: 77.0 to 83.9%) and a specificity of 80.2% (95%-CI: 83.3 to 76.7%). Separate analysis for the different imaging modalities showed similar diagnostic accuracy for the structural MRI studies (sensitivity 77.3%, specificity 78.7%), the fMRI studies (sensitivity 81.4%, specificity 82.4%) and resting-state fMRI studies (sensitivity 86.9%, specificity 80.3%). Moderator analysis showed significant effects of age of patients on sensitivity (p=0.021) and of positive-tonegative symptom ratio on specificity (p=0.028) indicating better diagnostic accuracy in older patients and patients with positive symptoms.

Our analysis indicate an overall sensitivity and overall specificity of around 80 % of neuroimaging-based predictive models for differentiating schizophrenic patients from healthy controls. The results underline the potential applicability of neuroimaging-based predictive models for the diagnosis of schizophrenia.

Bright light therapy acutely reduces anxiety in patients suffering from Seasonal Affective Disorder (SAD) and in low anxious subjects. Further evidence suggests it might also be effective in highly anxious subjects. Transcranial bright light (TBL) seems to alleviate depressive symptoms in SAD patients.

Depression and anxiety commonly co-occur, hence TBL might also have anxiolytic effects.

To test the acute anxiolytic effects of TBL exposure.

Twenty-eight participants (F=19, M=9, mean age ± SD: 44 ± 14 years) with moderate anxiety and depressive symptoms (Beck Anxiety Inventory: mean ± SD: 19 ± 9; Beck Depression Inventory-II: mean ± SD: 21 ± 9) were randomly assigned to either 12 minutes of TBL or sham exposure (double-blind) under laboratory conditions between 9am and 12am. Acute anxiety symptoms were measured using the Spielberger State-Trait Anxiety Inventory (STAI-Y1) 5 minutes prior and 10 minutes after the exposure.

Mean anxiety symptoms (STAI-Y1 score) in the TBL group decreased by 12.1 ± 7.3% from 43.7 ± 2.0 to 38.1 ± 1.4 (p<0.001), whereas symptoms in sham-control group reduced non-significantly by 3.7 ± 11.3% from 45.6 ± 2.2 to 43.4 ± 1.7 (p=0.115). P-values for relative and absolute difference between groups regarding mean STAI-Y1 scores were 0.024 and 0.048, respectively.

This is the first randomized, sham-controlled study showing that TBL acutely alleviates anxiety symptoms. Further studies on long-term efficacy of TBL therapy for anxiety symptoms are warranted.

A fundamental aspect of Borderline Personality Disorder (BPD) is emotional dysregulation. Dialectic Behavior Therapy (DBT) is a widely used therapy program developed specifically for improving emotion regulation in BPD.

To date little is known about the neural mechanisms associated with the amelioration of BPD symptoms after DBT.

In the present study we investigated pre-post therapy changes in a) brain activity during cognitive reappraisal, one commonly acquired skill during DBT and b) brain gray matter volume attributable to successful participation in a DBT skills training.

Before and after a 12-week in-patient DBT treatment program 22 female BPD patients and 22 healthy control subjects participated in two fMRI sessions of a well-established emotion reappraisal paradigm. Using voxel-based morphometry (VBM) changes in gray matter volume were analysed. Pre-post therapy changes were compared between the group of DBT-Responders (n=12) and DBT-Non-Responders (n=10).

After participating in a DBT skills training, DBT responders exhibited a reduced activity in vlPFC compared to the first scanning session and to DBT non-responders during reappraisal of aversive stimuli. The reduction in vlPFC activity correlated significantly with symptom improvement after therapy. After therapy DBT-Responders showed a significant higher gray matter volume in an extended cluster comprising anterior insula, caudate nucleus, and putamen.

In the current study, we provide evidence that a successful participation in DBT is associated with altered activity in the vlPFC and changes in gray matter concentration in anterior insula and striatum.

Nonpsychotic mental disorders in children, bio-psycho-social assistance to children with mental and behavioral disorders, Center for comprehensive psychosocial rehabilitation of children, medical and psychological support, multi-modal system of providing medical and psychological assistance, psychotherapy is combined with animal-assisted therapy, psychocorrectional work in the «in / out door» system.

Develop a medical and psychological treatment system, support and prophylaxis disadaptive psychological disorders in children.

Diagnostic and advisory work, correctional work, rehabilitation work, social and psychological work, methodical work.

After the medical and psychological adjustment in four study groups (children with F90.0 – 1st group, F94 – 2nd group, F81 – 3rd group and F82 – 4th group) the following results were obtained:

-Positive’+’ marker of social adaptation (the stabilization of family relationships, positive academic performance and normalization of interpersonal relationships with peers) in 1st group was 74,5%, in 2nd group – 86,0%, in 3rd group –50,0% and in 4th group – 48,1%;

1. 1. The system of medical and psychological support for children with mental and behavioral disorders.

2. 2. The basic criteria for the effectiveness of medical and psychological treatment: the formation of a constructive type of family relationships and social adaptation.

3. 3. Testing results on the primary stage of the work of the Center has demonstrated its effectiveness in 74.5% of children diagnosed with F 90, in 86.0% - with F 94, in 50.0% - with F 81 and in 48.1% with F 82, who underwent medical and psychological correction.

In this study we evaluated long-term effects of frontal beta EEG-neurofeedback training (E-NFT) in healthy subjects. We hypothesized that E-NFT can change frontal beta activity and that changes in frontal beta EEG activity are accompanied by altered cognitive performance changes.

19 healthy women and 6 healthy men participated in this study. The subjects were randomly adjusted to a real E-NFT or a placebo E-NFT. EEG was recorded by means of a Deymed Truscan 32-channel system with 19 channels before E-NFT (t1), post to the training sessions (t2) and 3- years after E-NFT (t3). For E-NFT an average of respectively 14.3 and 13.2 training sessions were completed for experimental and control group. Each trainingsession took approximately 45 minutes; training-protocol: increase 12-18 Hz at Fz-electrode, auditory and visual feedback was given if EEG activity was increased at Fz for at least 1second.

Compared to the sham E-NFT, which was used for the control group, real E-NFT increased beta activity in a predictable way (postmeasurement1 after NFB training, t2, post-measurement after 3years, t3). However, regarding our sample of healthy subjects E-NFT did not result in significantly improved cognitive performance.

The main finding of the present study was an increase in cortical frontal beta activity after E-NFT. We also found evidence of a long-term effect on the basis of a follow-up measurement after three years. Based on our results we conclude that EEG-NFT can selectively change EEG beta activity, in the short and long term.

Over the last decade, the study of functional connectivity networks has dramatically expanded across diverse research fields as functional MRI connectivity (fcMRI) or EEG connectivity. The aim of this study was to evaluate functional connectivity in the course of the day using two different imaging methods.

27 healthy subjects (male and female students in the age-range between 18-30 years) underwent 6 repeated fcMRI measurements over 12 hours in a 3T Philips Achieva MR scanner. The subjects were instructed to close their eyes and not to think on anything in particular. Resting State EEG was recorded outside the MR scanner with eyes closed and eyes open using a Brain MR Amplifier with 32 channels. Sleep deprivation was kept constant across subjects and the subjects were restricted to low-calorie food. EEG was analysed for coherence and EEG-phase between all EEg channels in sensor and source space.

The time course of 20 functional MRI networks were extracted and previous described functional networks were found. Eyes closed and eyes open EEG showed similar and distinct spatial correspondence. We found a good overlap for the Default Mode Network and the Frontal-parietal network. Day of time influenced the EEG measurements partly.

The findings of fcMRI and EEG connectivity are unique with high spatial resolution for fcMRI and high temporal resolution for EEG. Both measurements methods contribute further to our understanding of complex functional connectivity networks.

It is believed that mentally disturbed offenders commit their crimes closer to their residence compared to other offenders; however, scientific data in this area is scarce.

Do mentally disturbed homicide offenders commit their crimes closer to their residences than other offenders?

To examine the distances between homicide offenders’ residences and crime scenes, and correlate distance to occurrence of severe mental disorder.

All homicide offenders in Sweden between January 1, 2007 and December 31, 2009 were identified through an official crime register and a forensic medicine database (n=249). Offender data was collected from police files, court verdicts, forensic psychiatric evaluations, and the National reception unit at the Prison and Probation Services. Coordinates for offenders’ homes and crime scenes were used to calculate Euclidic distance. Data is presented using descriptive statistics. As outcome data (distance travelled to crime scene) was highly skewed, non-parametric tests were used (Mann-Whitney test).

7% of offenders had a psychotic disorder (n=17). All but one committed the crime within, or close to, their residence (mean distance 0.7 km; median 0 km) compared to other offenders (mean distance 25.7; median 0.9 km). Offenders who committed the crime >100 km from their residence were rarely found to have a severe mental disorder, and more often had an instrumental motive; e.g. money or sexual abuse.

Mentally disordered offenders seem to commit offences in close proximity to their residence. This finding may have implications for police investigations, geographic profiling and forensic psychiatric evaluations.

Monthly affective symptom status ratings for 30 patients with BP-II were based on interviews conducted at 3- or 6-month intervals during 5 years of prospective follow-up. The clinical characteristics and number of shifts in symptom status and polarity were examined.

In these 5 years our patients with BP-II were symptomatic 61.2% of all follow-up months: depressive symptoms (55.4% of months) dominated over hypomanic (13.4% of months) and mixed (7.3% of months) symptoms. Subsyndromal (minor) depressive and hypomanic syndromes were evaluated in 23% of months. With mixed syndromes together it is 30.3% of months!

We propose the introducing of INTERMEDIATE STATE (subsyndromal depression, mixed and hypomanic states) in course of bipolar affective disorders, with special importance of this new clinical concept for etiological research and more targeted pharmacotherapy. We think that the new name/diagnosis TRIPOLAR affective disorders (depressive, manic and intermediate states - subsyndromal depression, hypomanic and mixed states) is more adequate for the course of this chronic affective illness.

Eating disorders are characterized by a persistent disturbance of eating behaviour that results in altered consumption of food and that significantly impairs physical health or psychosocial functioning. Treatment of eating disorders is complex and challenging and sometimes patient's hospitalization is needed. The Santa Maria Hospital's Eating Disorders Unit is a specialized multidisciplinary team with long experience in the treatment of such disorders.

To present and discuss the results of the inpatient treatment program for patients with eating disorders held at the Santa Maria Hospital's Eating Disorders Unit.

review of clinical files of all patients hospitalised at Santa Maria Hospital's Eating Disorders Unit during a twelve month period and statistical analysis of data collected using SPSS program.

The sample included mainly female patients with anorexia nervosa with a significantly low body weight. In this presentation we show the results of the statistical analysis performed for sample characterization (both demographic and clinical variables), evaluation of patient's clinical outcome and features associated with good or poor prognosis.

The results of this study show the importance of inpatient care especially for patients with anorexia nervosa with a significantly low body weight.

The addiction to buprenorphine hight dose (Subutex®) is a new plague of drug addiction in Tunisia. The absence of a substitute treatment in this substance as well as the only ambulatory care of these drug addicts, make that is the weaning in the BHD is difficult. The aim of this study was to describe the follow-up and the weaning of these patients.

A retrospective study was conducted on the records of 23 patients who consulted the outpatient service of Razi hospital, addicted to BHD, since January 2012 until now.

Forty eight percent of patients (11 patients) were lost sight at the end of the first consultation. Only 13% of patients (3 patients) are followed up until now. Most of the patients had been put under classic neuroleptic essentially chlorpromazine in association with a benzodiazepine. 2 patients have weaned at the end of 13 months. These 2 patients are at present in relapse but in lesser doses than their initial dose of BHD.

The coverage of the patient dependent on drug was upset by the substitution treatments. But BHD don’t benefit from it and this hinders the care of the patients.

Anorexia nervosa is an uncommon but life threatening psychiatric disorder that is characterized by persistent energy intake restriction associated with intense fear of gaining weight and disturbance in self-perceived weight or shape. The nutritional compromise associated with anorexia nervosa affects most major organ systems, including the brain.

To present and discuss the case of a patient with restricting-type anorexia nervosa who presents brain cortical atrophy.

interview with the patient, analysis of patient's clinical file (including neuroimaging studies) and literature review on brain changes, especially focused on cortical atrophy, in restricting-type anorexia nervosa patients using the Pubmed/Medline databases.

a 21 year-old female patient, with diagnosis of severe restricting-type anorexia (BMI < 15 Kg/m2), hospitalized for severe low body weight without any signs or symptoms besides memory complaints. The neurological exam was normal. Brain CT scan revealed generalized brain cortical atrophy.

In anorexia nervosa, long-term persistent energy intake restriction is associated with brain volume changes, particularly global gray matter reduction which can be reversed by normal eating and associated weight gain. Although most cases of brain cortical atrophy are reversible, some will still persist despite normal eating. This report presents a challenging patient with restricting-type anorexia nervosa with brain cortical atrophy whose successful clinical outcome will depend on anorexia's prompt and effective treatment.