The ABCB 1-gene product P-glycoprotein is an efflux pump in the blood-brain-barrier. Different alleles of the single nucleotide polymorphism (SNP) rs2032583 were associated with highly different treatment responses to antidepressants in a retrospective study suggesting a different activity of the P-glycoprotein resulting in different levels of antidepressant in the brain.

To prospectively test whether escitalopram is associated with a stronger REM-sleep suppression in homozygote or heterozygote cytosine-carriers of that SNP than homozygote thymine-carriers, suggesting higher escitalopram brain levels in cytosine-carriers.

10 male and 10 female healthy, young cytosine-carriers, 20 male and 10 female homozygote thymine-carriers received escitalopram 10mg/day for four days. Prior and after that period, polysomnography was recorded.

At baseline, sleep in males was worse in cytosine-carriers than homozygote thymine-carriers as indicated, for example, by a significantly longer time awake (cytosine-carriers: 85±15 min; thymine-carriers: 44±6 min). Sleep in females did not differ between groups. In both groups, REM sleep was significantly reduced after treatment but there were no significant differences (cytosine-carriers: 78±5 min (baseline) to 46±4 min; thymine-carriers: 89±4 (baseline) to 49±5 min. All treatment effects of escitalopram on sleep (prolonged REM latency and sleep onset latency, increased non-REM-sleep, stage 2 sleep, stage 4 sleep, reduced REM sleep) did neither depend on sex nor genotype.

Sleep in males but not in females is relevantly influenced by the alleles of SNP rs2032583 of the ABCB1-gene. However, our hypothesis of a different REM sleep suppression due to different brain levels of escitalopram was not corroborated.

Employing neuroimaging methods in psychotherapy research confronts us with substantial methodological challenges. These challenges are linked to the complexity and plurality of processes involved in the psychotherapeutic treatment. This specifically applies to depression, a multiform psychiatric disorder. The review outlines the state-of-the-art of research in the field with a specific focus on methodological questions. It depicts limitations and strengths of experimental designs employed in psychotherapy studies using functional neuroimaging.

PubMed and PsycInfo were screened for peer-reviewed publications in English or German from 1995 to 2013 using accurate keywords. Studies employing an active condition during neuroimaging were retained. The analysis of selected studies focused on methodological aspects of the experimental design applied: what kind of task was used during functional neuroimaging? Which features characterized the active and control condition? Were neurophysiological findings linked to other data derived from psychological testing? What kind of (control- / treatment-) groups were included?

Most studies have examined effects of Cognitive Behavioural Therapy and Interpersonal Therapy with respect to short-term treatment. During functional neuroimaging, many studies employed emotion regulation tasks, often aiming at the isolation of specific cognitive mechanisms. Results concerning the effects of psychotherapy on hemodynamic activation patterns in depression are heterogeneous, depending on methods employed.

Differences in experimental designs substantially contribute to the incongruity of findings concerning effects of psychotherapy in the treatment of depression. There is a strong need for the development of adequat and accurate experimental designs in the future.

Obsessive-compulsive disorder (OCD) symptoms are remarkably diverse, as regards both clinical presentation and severity1. Studies are conflicting about whether any specific phenotype of OCD is easier to treat or likely to benefit from a particular treatment. Duration of untreated illness (DUI) represents a modifiable parameter, whose reduction may positively influence the outcome and long-term course of specific psychiatric disorders2. The aim of this study was to evaluate possible differences concerning severity, duration of illness (DI) and DUI among OCD subtypes in a sample of OCD patients.

114 OCD outpatients were recruited and assessed using the Y-BOCS. The main OCD phenotypes were identified through the YBOCS- Symptom Checklist. A one-way ANOVA test was performed to compare DUI, DI and Y-BOCS scores in the sample.

Subjects were categorized into 4 clinical phenotypes,: aggressive/checking (n=31), contamination/cleaning (n=37), simmetry/ordering (n=32) and multiple phenotypes (n=14). DUI, DI and YBOCS scores were found significantly higher in aggressive/checking subgroup, compared to other subgroups (One Way ANOVA: F=3.58 p<0.01; F=3.07 p<0.01; F=4.390 p<0.01). Furthermore, the mean DUI of the whole OCD sample, (87.35 ± 110.75 months) resulted approximately half of the mean DI (172.2 ± 132.36 months).

DUI and DI resulted significantly higher in the aggressive/checking subgroup, compared to the other subgroups. YBOCS scores resulted significantly higher in the aggressive/checking subgroup compared to the others, showing that longer DUI and DI may condition a worse clinical outcome in this subgroup. Of note, within the total sample half of the whole DI was spent untreated.

Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. It is of utmost importance to valuation, assessment and pain relief, presenting these as vital elements in contributing to the welfare and quality of life of the individual, and its control a person's right and duty of health professionals.

To understand how nurses cope with the pain phenomenon and its evaluation in the context of a continuing care unit.

This is a descriptive-exploratory study, with qualitative methodological approach. Data were collected based using semi-structured interviews, participant observation and documentary analysis of nursing records. The study included five nurses from a continuing care unit at the Santa Casa da Misericórdia Hospital, Tábua, Portugal. There were conducted 10 interviews, 25 participant observations and consult of 25 nursing records, over a period of 60 days.

The results obtained allow us to know the main problems of the nurse in the identification and characterization of the pain of the user taking into account their individuality, the performance of non-pharmacological and/or pharmacological taking into account the degree of pain and subsequently identified the election by each nurse the information recorded in the register of Nursing.

Education about safe pain management will help prevent undertreatment of pain and the resulting harmful effects. Safety includes the use of appropriate tools for assessing pain in cognitively intact adults and cognitively impaired adults. Otherwise pain may be unrecognized or underestimated.

Symptoms of attention-deficit/hyperactivity disorder (ADHD) appear in childhood and may persist into adolescence and beyond.

Evaluate the efficacy of lisdexamfetamine dimesylate (LDX) and atomoxetine in subgroups of children and adolescents with ADHD.

In this 9-week, double-blind study, patients aged 6–17 with ADHD and an inadequate response to previous methylphenidate therapy were randomized (1:1) to optimized doses of LDX or atomoxetine. Efficacy measures included ADHD Rating Scale IV (ADHD-RS-IV) total score and dichotomized Clinical Global Impressions-Improvement (CGI-I) score (improved, 1–2; not improved, 3–7).

The full analysis set (n=262) comprised 194 children aged 6–12 (LDX, n=93; atomoxetine, n=101) and 68 adolescents aged 13–17 (LDX, n=34; atomoxetine, n=34). Mean optimized doses were: LDX, 52.5 (SD, 16.10) mg/day; atomoxetine, 40.2 (20.05) mg/day. Baseline mean ADHD-RS-IV total score was similar across treatment and age groups. Table shows efficacy results; safety profiles were consistent with previous studies.

Within each treatment group, improvements in symptomatological scales and global improvement ratings were observed in children and adolescents.

Study funded by Shire.

This paper reports findings of a systematic review study (SR), with focus on comfort in nursing practice. There are a lot of research works about this phenomenon on different samples of patients or caregivers, frequently nurses, carried out abroad, that allow us to understand points of view and experiences of those care actors, separately. The elderly person is a client and a patient with specificities arising from the aging process, and this can change the patient's perspectives regarding live, health and comfort as opposed to adult's ones; so, elderly people should be studied separately.

This SR's goal is to identify qualitative studies that were focused in understanding the comforter care, in sample groups of elderly patients and their nurses. The research question is: How does nurse handle care that is experienced as comforter care by the elderly patient?

We used PI[C]OD methodology and a metasummary technique to analyse and integrate data.

We identified only three primary research studies in those circumstances and their findings were analysed and synthesized.

In conclusion, SR findings can only contribute to a partial knowledge about comforter care, and moreover, they don’t allow us to reach any conclusion regarding comforter care of elderly patients, especially due to the mixed nature of samples (adults and elderly people) on primary studies. It seems evident that it is necessary to undertake a research study to obtain knowledge about the way nurses handle care that elderly patients experience as comforter.

Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions.

To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age.

To describe a specific pattern of emotional dysregulation in ED patients.

ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP).

All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20).

The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples.

Clinical implications will be discussed.

The growth of the older population worldwide has been followed by an increase of mental illness, an important cause of morbidity. In the elderly, the coexistence of disability, physical and mental illness and social problems means that older people often have complex needs, which require comprehensive and systematic assessment.

To identify met and unmet needs and their relationship with cognition and functionality.

Elderly patients (≥ 65 years old), with mental disorders (ICD-9), were recruited consecutively from ULSAM, in Portugal.

All patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE, Mini Mental State Examination/MMSE, Clock Draw Test/CDT, Geriatric Depression Scale/GDS, Zung Anxiety Scale/ZAS, Barthel Index/BI and Lawton & Brody Index/LI.

In this sample (n=306), the most frequent unmet needs were daytime activities (46.7%), psychological distress (25.8%), memory (13.4%), social benefits (11.4%) and company (8.2%).

A significant relation between global needs - CANE (met and unmet) and psychiatric diagnoses (F=12,888, p=.000) was found. Patients with dementia had a higher number of global needs and lower functionality.

The global needs correlated negatively with MMSE (r=−.666, p=.000), CDT (r=−.512, p=.000), BI (r =−.541, p=.000) and LI (r =−.854, p=.000), and positively with GDS (r =.385, p=.000).

Cognitive deficits, higher depression and lower functionality were associated with a greater number of needs. These results also suggest that dementia is an important determinant of the functional status and needs.

Besides cognitive behavioral therapy (CBT) and interpersonal body psychotherapy (IBP) psychodynamic psychotherapy (PP) has shown to be effective in the treatment of depression.

Application-oriented psychodynamic diagnostics can contribute to an adequate treatment of depressed patients who have a personality-structure based dynamic, which promotes intrapsychic and/or interpersonal conflicts that lead to triggering of depressive episodes and/or chronification. These dimensions can be measured with the Operationalised Psychodynamic Diagnosis (OPD-2).

Comprehensive psychodynamic and non-psychodynamic diagnostics is assessed within the Zurich depression study. A total of 120 probands (30 depressive patients treated with CBT/IBP/PP respectively and 30 healthy probands) will be measured before, after six months and after one year of psychotherapeutic treatment. This design aims at displaying the effects of different psychotherapeutic techniques with psychodynamic diagnostics. Secondary objective is a differentiation between CBT, IBP and PP.

OPD-2 provides an assessment of psychodynamic dimensions like (dysfunctional) interpersonal relations, intrapsychic and interpersonal conflicts and psychic structure (structural capabilities or deficits). The OPD-interview comprises a multimodal and multiaxial approach with an open, mostly unstructured, but also structured conversation style.

The concept of psychic structure is central in the Operationalised Psychodynamic Diagnosis system. The OPD structure questionnaire (OPD-SQ) reflects a broad spectrum of structure based characteristics using psychological concepts (e.g. empathy, communication of affects, selfreflection) and rather clinically meaningful conceptions (impulse control, affect tolerance, self-object-differentiation).

The Heidelberg Personality Restructuring Scale (HSCS) depicts processes of change on the basis of psychoanalytic concepts.

First results will be presented and psychotherapeutic implications will be discussed.

In the troubled times we are living concerning professional matters, job satisfaction is undoubtedly a highly topical subject. This is a factor that interferes positively in the service user and the relationship of the health care team.

To evaluate the level of job satisfaction of nurses in the study and determine the specific conditions in the work and lives of nurses which their professional achievement and satisfaction, in order to contribute to the progressive improvement of contexts of work.

A correlational study was conducted with 96 nurses from various departments at Hospital São Teotónio of Viseu, Portugal. A questionnaire measuring job satisfaction and professional achievement was used.

The instrument used for data collection was the questionnaire emphasizing the following results, 63.5% of nurses are satisfied with their work, 61.5% of nurses are professionally satisfied and 68.8% are achieved with the profession. The dimensions of job satisfaction are causing greater agreement are: satisfaction with the organization and satisfaction with Hierarchical Superior, on the other hand the dimension that causes the most dissatisfaction it is the Remuneration. Also found that 84.4% of nurses do not wish to leave the current place of employment in the next five years, and 85.4% plan to stay in the same profession in the coming years.

Early detection of psychiatric morbidity through self-administered screening questionnaires, as well as implementation of organizational mental-health promotion programs, is recommended to improve employees mental health and job satisfaction.

The self-medication hypothesis proposes that schizophrenia patients may smoke as an attempt to reduce their cognitive deficits, their symptoms or the antipsychotic side-effects.

to identify the relationship between the smoking topography and psychopathology among outpatients with DSM-IV schizophrenia.

The sample included 26 smoking outpatients with DSM-IV schizophrenia from a Mental Health Center sited in the North of Spain [65.5% males; mean age (SD) = 44.66 (7.83)]. Instruments: (1) Psychopathology: Positive and Negative Syndrome Scales (PANSS); Clinical Global Impression of Severity (CGI-S); n° antipsychotic. (2) Pattern of tobacco use: n° cigarettes/day; Fargerstrom test for nicotine physical dependence; Glover-Nilsson test for nicotine psychological dependence; Expired carbon monoxide (CO ppm).

prevalence was 59.3% for non-heavy smokers [<30 cigarettes/day; Mean CO (SD)= 24 ppm (9.70)] and 40.7% for heavy smokers [≥30 cigarettes/day; Mean CO (SD) = 36 ppm (16.06)]. PANSS mean score (SD) = 54.07 (12.45); CGI-G mean score (SD) = 3.50 (1.17); Mean number of antipsychotic (SD) = 1.79 (0.88). No significant differences were found between the severity of the psychopatology (PANSS, CGI-S, n° antipsychotic) and all the variables of the pattern of tobacco use (n° cigarettes/day; expired carbon monoxide; Fargerstrom; Glover-Nilsson).

In this sample of schizophrenia patients, there is no relation between the severity of psychopathology and the dependence of nicotine. However, the sample of this study is small.

Regarding the patient clientele with main diagnosis (MD) F19.*[ICD 10] new needs have been seen to emerge. The increase in the number of consumers of N-methylamphetamine (by 29 % in 2011) in Saxony correlates with an impressive increase of the number of inpatients and emphasizes the need of adapted treatment offers.

In this context, in 2009 an open-door ward (8 beds) for detoxification and motivation treatment for adults at age between 18-40 years with MD F19.* was opened which pursues an integrative therapeutic concept including both addiction-specific group- and talking therapy orientation and behavioral therapy approaches.

By using a pre-post study (pre: 2008, post I: 2010, post II: 2011, post III: 2012) selected key figures such as length of stay, readmission rate and kind of discharge, trends in individual substance-related detoxification motivation and associated mental disorders (F19.5) were monitored.

A continuous growing number of patients with MD F19.* has been achieved, marked by an increase of treated cases (pre: 77, post III: 156) and planned admissions (pre: 58 %, post III: 72%). Other data (length of stay, readmissions, treatment discontinuations) showed no significant changes. Individual detoxification motivation data point to a trend in favour of N-methylamphetamine. The number of patients with MD F19.5 (psychotic disorder) increased by >100 %.

The results refer to the necessity of identifying and monitoring valid quality indicators regarding our treatment concept. Therefore, those as yet evaluated indicators may act as a preliminary basis. Further projects are planned.

Mood disorders are very common and associated with significant disability. Stigma because of mental illness is also ubiquitous in the society.

We have created a new course for people with mood disorders to help them learn more and be able to practice ways to overcome stigma in their lives and themselves. The course is a closed group with five to eight participants, co-led by a mental health professional and a person with lived experience. The course consists of 7 two hour sessions and focus on the following topics: Introduction and orientation; Depression, Anxiety and Recovery; Self-Stigma; Social Stigma – Family, Friends and Medical settings; Stigma in Education, Housing and the Workplace; Disclosure; and Conclusion. There is a homework assigned between sessions

A pilot running of the course has been completed. It was used for a fine-tuning of the course and finalizing the course content. Feedback was encouraged and was used for these purposes

The course: ‘Overcoming Stigma in Mood and Anxiety Disorders’ may have a significant role in helping people with those disorders to achieve recovery

Cerebral palsy refers to a wide range of motor abnormalities which result from damage to the developing or immature brain. Parents of children with developmental disabilities experience heightened stress, impaired mental health, sense of devaluation and self-blame, frequently causing conflicts on the couple subsystem.

This paper aims to describe psychiatric and psychosocial maladjustment caused by this emotional and physically demanding pathology.

We describe a 8-year-old boy who developed hetero aggressivity admitted to our outpatient clinic.

His mother refers alert signs since patient's neonatal period, with axial hypotonia and global psychomotor development retardation. He also presented absence seizures, several congenital malformations that led to urological, otorrinolaringological and stomatological surgeries. While performing mental state evaluation we could clinically assess ADHD, as well as marked language difficulties, which made us consider introduction of psycho-stimulants, besides mood stabilizers prescribed by his neurologist, after excluding cardiaovascular abnormalities. During the various appointments serious problems were found within family relationships, specially father's difficulty in accepting his youngest son disability, which made us intervene holistically, supporting and validating patient's mother and brother work and efforts and psychoeducating his father in order to improve his psychosocial emotional development.

Psycho-social programs and coping strategies should be developed to respond to individual changing needs and to provide necessary support for the special needs of these families.

Tattoo prevalence among young people assumed epidemic. It transformed into tattoo-addiction (tattoo-mania) and influences significantly on personality psychology and mind. Youth addict-audience with searching, delinquent and psychopathy-like radicals, generated drug addictions is one of tattoo configurations habitation key cohorts.

was to study tattoo-addiction prevalence scale and clinical peculiarities for identification in narcology as sustantional addiction new form.

for the research were information sources: 1) mass media; 2) Internet-monitoring results; 3) own research of students' youth cohort; 4) testing cohort of chemical and substantional addicted respondents.

of the research gave evidence that tattoo-problen in modern human has pivotal constituents of addiction syndrome conforming to ICD-10 clinical criteria: 1) specific tattoo-sensations search («acute intoxication»); 2) stable desire for tattoo-designs persistent refreshing (pathological drive syndrome); 3) (psychological and emotional discomfort sensation on the eve of new tattoo-interventions (withdrawal syndrome psychic equivalent); 4) expansion of dimensions and volumes of tattoo-design and colour scale (tolerance symptom); 5) thirst for tattoo-rage while covering the body with diverse patterns, combined tattoo and piercing (dipsomaniacal state symptom); 6) change of integument localization zones at tattooing (rotation of sensations); 7) tattoo-aggression consequences evidence (skin defects, chronic septic foci, innervation disorders, mental, behavioural disorders). Large-scale involvement, stability and further spread of tattoo-phenomenon: 12% of youth assess situation as «bad» and «awful», the rest 88% – as «excellent», «good», «not bad».

New problem of tattoo-addiction emerged in clinical narcology requires study, identification, working out the program of treatment, prevention and needs considering in new ICD-12 Version.

Hyperkeratosis is characterized by abnormal palmoplantar skin thickening. These lesions can extend to other organs and be associated with a multiplicity of pathologies.

This paper aims to describe the features of psychosocial maladjustment in a patient firstly diagnosed as having hyperkeratosis of unknown etiology.

We describe a 14-year-old boy admitted to our outpatient clinic after verbalizing suicidal thoughts to his endocrinologist.

His medical condition had been evolving since he was six, when his palms and specially soles became grossly thickened and painful and he would be found awake at night clawing at his severely scaly and itchy lesions. He was seen by geneticists, dermatologists and plastic surgeons. However, the thickened patches continued to progress over the years, with almost no response to treatment. He was unable to keep up with his friends walking and had to give up on sports. Due to medication he has a reduced stature and low puberty development. On his first appointment he was reported to be unable to manage routine affairs or handle money matters and his scholastic performance was poor. During mental state examination one could assess restricted interests, social and communication defficits, tantrums, self and hetero aggressions and IQ below normal, despite an extraordinary visuo-spatial memory and no suicidal intent. He was medicated with risperidone and structural family therapy was applied, with good response.

Helping individuals and families dealing with behavioural problems improves family dynamics and quality of life even in the presence of such incapacitating diseases.

Maternal depressive risk has been linked to several dysfunctional outcomes. Empirical data indicate that the lack of adequate maternal responses over feeding may affect the quality of the early eating habits of the baby. Such a conclusion, however, is mainly based on cross-sectional research, which does not allow to establish causality.

The aim of the study was to explore in a longitudinal way the link between pre-partum depression and subsequent mother-child feeding interactions.

Participants were 64 women who voluntarily agreed to take part in the study. During their 3rd trimester of pregnancy, all completed a number of self-report instruments, including the CES–Depression scale (CES-D) and Multidimensional Scale for Perceived Social Support (MSPSS). Seven months after the delivery, mother-child dyads were videotaped during a meal session, and the Feeding Observational Scale (FS) was used so as to rate the quality of the feeding interactions.

During pregnancy, the CES-D negatively correlated with the MSPSS, r = -.32, p = .01. For three of the FS scales, the quality of the dyadic feeding interactions at seven months of age of the baby was significantly predicted by the CES-D, β ≥ .30, p < .05, but not by the MSPSS. In contrast, one of the FS scales was significantly predicted only by the MSPSS, β = -.29, p < .05, but not by the CES-D.

Clinical screening during pregnancy may help preventing the establishment of early dysfunctional eating behaviors, by identifying early risk factors for dysfunctional feeding interactions.

To evaluate the initial (3 months) all-cause discontinuation and safety of aripiprazole once-monthly 400mg (AOM-400mg), an extended release injectable suspension of aripiprazole, stratified by previous treatment.

These two studies (NCT00705783 & NCT00706654) were double-blind, placebo- or active-controlled assessing the efficacy and safety of AOM-400mg. Detailed study designs have been reported previously (1, 2). This analysis was conducted on the pooled population in the first 3 months after initiating AOM-400mg treatment, on patients who received at least one dose of AOM-400mg. Outcome measures are reported for groups stratified by prior treatment.

During the first 3 months of treatment, discontinuation due to all-causes (except for those who discontinued due to the sponsor stopping the NCT00705783 study early after pre-specified efficacy parameters were met) as well as due to adverse events are presented in Table 1. The rates of insomnia and akathisia are shown in Table 1

Aripiprazole once-monthly 400mg appeared equally safe and effective (as measured by all cause discontinuation) in the first 3 months after initiation, regardless of treatment prior to entering trials.