Significant gender differences exist in the course, manifestation and treatment of mental illness. Regardless of specific diagnosis age is one of the key factors in gender differences. Such differences between the sexes exist not only concerning origin and perpetuation of specific psychiatric diseases, they are also available and notable in specific fields of pharmacological and psychotherapeutically treatment. That review should sensitize clinicians for their responsibility to provide individualized, optimally effective, gender-specific care to patients suffering from mental diseases in some special topics. It should be a short overview considering some important gender details illustrated in concern with the epidemiological background, the symptoms and general used psychiatric treatment strategies of some frequent psychiatric diagnoses.

Introduction and aim: Posttraumatic stress disorder (PTSD) is associated with increased medical morbidity, particularly from the autoimmune and cardiovascular diseases. Changes in the endocrine and immune system are key mediators in this process. The aim of our study was to investigate weather hormones (cortisol and prolactin), proinflammatory cytokines (interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)), components of HPA-axis (lymphocyte expression of glucocorticoid receptor (GR)), immune function (natural killer cell cytotoxicity) and peripheral blood percentages of various lymphocyte subpopulations (T cells, helper T cells, cytotoxic T cells, B cells and natural killer cells) change in patients with posttraumatic stress disorder over time.

Epidemiological, clinical and post mortem studies indicate that inflammatory and immune reactions are involved in the pathomechanisms of affective and schizophrenic spectrum disorders. However, in psychiatric patients, only sporadic investigation on immunochemistry has been performed and information about immunofunction derived by investigation of immunocompetent cells in the CSF is not available to date.

Here we present an interdisciplinary work of neurologists, psychiatrists and hemato-immunologists focusing on the immunology of psychiatric and neurological disorders. In a first study including 63 patients with therapy resistant affective and schizophrenic spectrum disorders we applied conventional, validated neurological CSF investigation such as analysis of albumin, IgG, IgA, IgM, oligoclonal IgG and specific antibodies, cell count and interpreted the data by Reibergrams.

In a second study, we applied the highly sensitive and specific multicolour flowcytometry of paired samples of CSF and peripheral blood cells to characterize the immunostatus of psychiatric and neurological patients. We demonstrate that flowcytometry technology constitutes an appropriate method to investigate subsets of lymphocytes even with low CSF cell numbers, and therefore as a promising diagnostic tool for routine purposes in the differential diagnosis of psychiatric diseases. Furthermore, knowledge of the frequencies of T cell subsets such as the T regulatory cell type might open new avenues to models of psychiatric and neurological diseases as well as diagnostic and monitoring implications.

CSF analysis contributes to differential diagnosis of noninflammatory diseases by: 1) exclusion of a chronic or acute inflammation. 2) detection of particular brain-derived proteins, surrogate markers, corresponding to the suggested diagnosis (tumor, dementia, brain hypoxia, hemorrhage, autoimmune disease, psychiatric disease, metabolic disorder, rhinorhea, Table 1) and 3. differential cell count in CSF.

Interpretation of brain-derived proteins in CSF uses absolute concentrations (in contrast to CSF/serum quotients for blood-derived proteins) and must discriminate between different sources: Neuronal or glial proteins like NSE, or tau protein are evaluated using their absolute concentrations in CSF for maximal sensitivity without reference to QAlb. The leptomeningeal proteins like beta trace or cystatin C are evaluated as absolute concentrations with reference to QAlb.

As application examples we review the group of dementive and psychiatric diseases.

Alzheimer's disease, Parkinson's disease dementia, Lewy-body disease and frontotemporal dementia are the major causes of neurodegenerative memory impairment and dementia. Combined analysis of Tau-Protein and Beta Amyloid 1-42 in CSF represent the classic approach, meanwhile extended with further surrogate markers. In 15% of psychiatric patients with schizophrenic or affective disorders an inflammatory process could be detected which points to a brain-organic involvement. In 24% of these patients with a psychiatric disease a moderately increased albumin quotient was observed as the only unexplained pathological sign. In psychiatric diseases it has to be regarded as a serious deficit not to make at least once a CSF analysis in the patients which could modify the diagnosis (in 6%).

Electroencephalography has probably represented the first modern and scientifically sound attempt to functionally explore the in vivo activity of the human brain and it has, since ever, attracted attention of psychiatrists, from both the clinical and the research viewpoint.

Probably due to the limitations implied by their traditional low spatial resolution, the use of psychophysiological techniques in psychiatry has been not continuous over the last century; however, the availability of newer EEG-based brain imaging techniques has recently renovated some interest (1)). Furthermore, recent theories proposed that psychopathology may result from the failure to integrate the activity of different areas involved in cognitive processes, rather than from the impairment of one or more brain areas (2)); within this view, a reliable brain imaging tool should be able to explore the dynamics of complex interactions among brain regions, with high sensitivity to the subtle deviation in complex processes that last fractions of seconds; psychophysiological techniques, indeed, offer the possibility to explore the functional correlates of major psychiatric illnesses, as well as to understand of the effects of psychotropic drugs on the central nervous system, with incomparable time resolution. Finally, the recent technical possibility to combine different brain imaging approaches has further fostered a renovated enthusiasm to ward the use of EEG-based techniques in psychiatry.

This contribution will provide an historical overview of the EEG-based brain imaging techniques and an update on some recent advances concerning the use of such techniques within the psychiatric field. Finally, some examples of psychophysiological and ''multimodal'' imaging investigations in subjects with different psychiatric conditions will be provided.