The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling. Participants were 263 male and 23 female patients seeking treatment for pathological gambling and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for Pathological Gambling was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be reliable with an internal consistency coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.

Pain is a psychosomatic occurrence, primarily considering its neurobiological aspects. Chronic pain patients suffer from psychic comorbidities or even psychic diseases as somatoform disorders which often remain mis- and respectively underdiagnosed and consecutive untreated. Psychic comorbidities influence the pain in a neurobiological sense by lowering the pain threshold. Wrong treatments, somatic fixation, operations, chronification, iatrogenic impairment and psychosocial problems are possible consequences. It is fundamental to integrate the trias of pain, stress and affect into the diagnostics and treatments. The neurobiological stress axis, HPA- and LC-NE, is known to be activated by nociceptive- neuropathic input via cytokinins and influence pain. Chronic negative strain of the stress system may have neurobiological consequences as damage of the pain depressant systems, inter alia degeneration of hippocampus.

An interdisciplinary approach is inevitable and broad clinical diagnostics of high importance. Therefore we established a broad network of interdisciplinary liaisons with rheumatology, internal medicine, orthopaedics and dentistry. In our outpatient clinic we analyzed female and male chronic pain patients from different medical departments. They all had a complex and long lasting history of pain.

We applied clinical interviews and different test-parametric methods and figured out that undiscovered psychic comorbidities, wrong medication and specific biographic aspects in a biopsychosocial kind are inter alia the key factors of chronic pain suffering.

Our data demonstrate that an interdisciplinary approach considering pain as multifactor genesis and integrating neurobiological, biographic and psychosocial components is necessary to treat chronic pain patients and prevent further chronification.

In the present study, the reasons why people ask for psychological support according to their sex is being investigated. Data was obtained from the Association of Psychology & Psychiatry for Adults & Children (A.P.P.A.C.) from January 2002 until December 2006. The sample size was N=100, aged from 22 years to 65 years. Results indicated that there were population differences (62 women and 38 men) and statistically significant differences were found in the primary therapeutic goal of clients as well as their therapeutic course, according to their sex. More specifically, results indicated that women tend to seek counselling mostly for themselves and secondary for a family member: women aged 25-35 want to deal with personal problems, women aged 35-45 seek for counselling (mostly relationship-based), while women aged 45-65 mainly wish to resolve problems with their children. On the other hand, men aged 30-50 years usually require counselling when their symptoms seem to disable them to successfully function in their workplace. Men over 50 years old ask for counselling in order to resolve a problem concerning their children. These men usually end their sessions when symptoms become less severe, while women are found to be more consistent towards therapy. Finally, as far as their socioeconomic status is concerned research results indicated that men of high socioeconomic status do not easily accept that they need counselling, while women of high socioeconomic status are more receptive towards counselling.

Hwabyung meaning anger(fire) disease is an culture-related anger syndrome in Korea. According to the patients' explanation, reactive anger, resulting from being a victim of an unfair social situation, have to be suppressed so as not to jeopardize harmonious family or social relationships. However, if the unfair situations continue or repeat themselves, the suppressed anger "accumulates, becomes dense", and finally causes a disease, hwabyung. The symptoms are subjective anger and feeling unfair with anger-related bodily and behavioral symptoms including heat sensation, pushing-up, respiratory stuffiness, a mass in epigastrium, much talking, sighing, and going-out. Symptoms seem to symbolize the nature of fire(anger) and its partial suppression and/or partial releasing. Diagnostically hwabyung shares some symptoms of depression or anxiety but it was found to be different from depressive disorders or anxiety states by manifesting unique symptoms of subjective anger and anger-related somatic/behavioral symptoms. Based on research on this anger syndrome and other research on anger and anger-related psychiatric syndrome, author suggests a new conceptualization of "anger disorder".

Handicap as a result of cerebral palsy concerns mainly motor function, but is often combined with other problems. The aim of the study is measurements of manual function in children suffering from cerebral palsy, in comparison with epilepsy. The study was conducted on 40 children attending Special School Complex No103 in Poznań in whom cerebral palsy was recognized with accompanying epilepsy. In the investigated group there was one child with monoplegia, four with hemiplegia, seven with diplegia, two with atetosis, 22 children with quadriplegia and four children with mixed form of CP. All children were subjected to complex diagnosing of the functional fitness and functional development.

Despite the numerous advances in psychiatry such as neuroimaging techniques, structured interviews, and comprehensive diagnostic protocols, all too frequently a patient's symptomatology does not fit neatly into a recognized diagnostic category. Given the increasing popularity of treatment guidelines, purportedly predicated on hard science, clinical uncertainty becomes increasingly problematic, precisely because the guidelines are aimed at specific and discrete psychopathological categories. On the one hand, clinical reality is complex, contradictory, and most certainly contested. On the other, medical training and professional demands require that the psychiatrist demonstrate certainty, be it to patients, colleagues, health insurance providers, other third parties, and perhaps most controversially, to themselves. Faced with clinical uncertainty, the clinician may find herself or himself in a difficult situation: recognition of the uncertainty is regarded as an indication of poor professional performance, whereas assertion of a diagnosis or plan of treatment runs a very real possibility of contravening the beneficence principle. Clinical uncertainty is all the more pronounced in the face of certain mental disorders, cultural, age, and gender difference, and training model. This paper will examine some of the key factors related to clinical uncertainty and how it relates to clinical practice. It will be suggested that clinical uncertainty itself represents an important source of diagnostic information and rather than be ignored should in fact be incorporated into the diagnostic and treatment process.

A clinical case of alteration of behaviour is the unit of analysis. The cultural aspects play a major role in physical and mental health and in this case the subject was part of a family where mediunity was seen as a common gift. Even though, she looked for medical help after her mother-in-law had spoken by her mouth. This patient was also exposed to high dosages of corticoids for the treatment of Alopecia Areata (AA). Mental disorders induced by corticoids are well documented, in a variety of symptoms. When observed, this patient also met criteria for Dysthymic Disorder and the episode testified by her family could suggest a narrowing of the field of consciousness in a dissociative experience. The author raises some etiological hypothesis and presents a 2 years follow-up of the case and patient-doctor relationship.

The concept of “diagnosis” is discussed with regard to the fact that different scientific disciplines (i.e. chemistry, genetics, neurology, psychology, sociology, etc.) seem to lack a theoretical basic grid, enabling them to exchange and compare observations and interpretations of data. Various solutions have been offered to this problem: multidimensional diagnostic tools, and at present combining phrases (such as “neuro-psychological” or “psycho-social”) have become modern. Moreover, merely symptom-descriptive systems have evolved (such as the DSM system, ignoring causality). However, none of these solutions seem to resolve the problem of interdisciplinary exchange, but rather avoid it. The discussion explores this problem and suggests tentative interdisciplinary systemic assumptions, and a derived number of possible criteria for inter-disciplinary diagnostic practice.

(The discussion is based on the article “Current Problems in Diagnostic Theory and Practice – A Systemic Approach to Cross-Scientific Terms in the Diagnostic Babylon” by the speaker, published in Clinical Neuropsychiatry (2007), 4, 1, 23 -28) For copies please contact the author or Dr. Giovanni Fioriti, editore, Rome mail: [email protected])

The authors are concerned with the contribution of anxiety in origin of functional behavioural disorders of children. They attribute the intense sensing of anxiety with the shaping of one's personality. They analyse adaptation and adjustment, accommodation and assimilation to stressful conditions producing anxiety. They describe reactions of organism to the circumstances of the CAN syndrome and traumas. In these circumstances, a primary perception of reality is at stake that consequently leads to sociopathological features. The authors also provide opinions of psychoanalytical and behavioural schools on origin of personal decompensation and neurotic disorders. They deal with causes of panic disorder and other diseases, in which a stress trauma plays a role.

For these reasons the authors suggest to classify the CAN syndrome as a separate nosologic unit in the future ICD-11.

Attention Deficit and Hyperactivity /Impulsivity Disorder (ADHD) is a highly prevalent neuropsychiatric condition, affecting as many as 1 % of the adult population. The scientific literature suggests that approximately 70 % of patients with ADHD have an additional disorder, making co-morbidity the rule, rather than the exception. Many individuals with ADHD are having more than one co-morbid disorder. The high prevalence of co-morbid psychiatric conditions increases the impairment, and complicates treatment. Furthermore, the societal and medical expenses associated with co-morbid conditions are extensive. The most prevalent co-morbid psychiatric conditions seen in both genders with ADHD are: affective disorders, anxiety disorders, personality disorders and substance use /dependence disorders. It has to be realized that co-morbidity was originally not conceived to signify that a patient had 2, 3, 4 or more psychiatric diagnoses at the same time, but to document the whole symptomatic syndrome in a patient. In this presentation, 100 patients with ADHD in an outpatient facility were consecutively examined with regard to co-morbid conditions. The diagnostic trajectory entailed a semi-structured clinical interview, collateral information, school reports and an extensive neuropsychological battery. Best estimate diagnoses were obtained. Although the results correspond to a large extent with those of similar studies, our sample included a relatively large proportion of patients with co-morbid psychosis. It has been suggested to classify ADHD and psychosis as a separate diagnostic entity. The rationale for this proposal will be discussed.

Noonan syndrome (NS) is a highly prevalent genetic disorder (1 in 1000 to 2500 live births). Inheritance is mainly autosomal dominant. It is autosomal recessive only in a small group of patients. NS is characterized by short stature, facial dysmorphia and a variety of heart defects. Virtually no research is found on cognitive and social functioning in adult patients, although there are some indications that NS is associated with affective processing impairments, inadequate social behaviour, and higher levels of anxiety. For this reason, the present study examines a group of adult Noonan patients (n=30; mean age 27 ± 12,8) on measures of psychiatric and cognitive functioning. Neuropsychiatric and (neuro)psychological characteristics were recorded, as well as information on the patients' medical and developmental history. Data are presented on the hereformentioned aspects, including stature, genetic subtyping, cardial defects, school performance, and social adaptation, the latter aspects being discussed against the background of cognitive functioning. As to psychopathology, only in a small amount of patients (n = 4), criteria for a DSM-IV mood and/or anxiety disorder were met. However, in more than half of the patients, emotion identification and verbalisation defects were found. It is argued that this pattern of disabilities can be understood in terms of the concept of alexithymia.

Executive functions (EF) optimize the efficiency and effectiveness of behaviour, allowing for behaviours that are more goal-oriented, independent, purposive and conceptually driven. Effective EF is vital to human autonomy; higher levels of EF lead to more adaptive, hence successful life.

Several measures of EF exist, but most of them measure only a single aspect of EF or have been developed in clinical populations containing items that tap the extreme (pathological) ends of behaviour, which often do not apply to most healthy adults. Furthermore, while beliefs about maladaptive and dysfunctional behaviour can only exist in the context of beliefs about healthy, effective and efficient behaviour, a person's perception of the effects of executive dysfunctioning on daily life is a major determinant of the perceived quality of life.

To apply the above in the study of EF, we examined psychometric properties of the Dutch version of the Executive Function Index (EFI), a self-report measure sampling a wide array of behavioural consequences in healthy individuals. It consists of 27 items, generated from recent literature concerning the relationships between EF and the prefrontal-subcortical systems. These items are divided into five subscales, named Motivational Drive, Organization, Impulse Control, Empathy, and Strategic Planning. Results lend support for the use of the EFI as a reliable self-report measure.

It is concluded that, in order to improve diagnostic accuracy and to contribute to differential diagnosis, we need instruments which consider the consequences of executive (dys)functioning on daily life in both healthy and psychiatric populations.

A male patient aged 35 was referred for pharmacological treatment of temper tantrums and impulsivity. His history showed feeding problems, growth retardation, delayed milestones, special educational needs and poor social skills. As a child he underwent surgical correction for hemicryptorchidism and benign thymoma. From the age of 19 he was employed in a sheltered workshop. He married at the age of 33.

The patient presented with complaints about lowered mood, anxieties, worrying and impulsivity. Neuropsychiatric evaluation revealed symptoms of a mild depression. His total IQ was 74 (WAIS). There were attention difficulties, slow information processing and increased distractibility. Somatic examination demonstrated a short stature, facial dysmorphias and broad thumbs and toes. Because of this combination of features he was examined by a clinical geneticist. A definite diagnosis of Rubenstein-Taybi syndrome (RTS) was established. The patient was given maintenance treated with citalopram in a dose of 20mg daily after which the mild symptoms of depression disappeared and the impulsivity ameliorated.

RTS has been mapped to 16p13.3 and its diagnosis is primarily clinical. It has been suggested that patients with RTS have an increased vulnerability for neuroleptic induced motor side effects. A great variety of somatic anomalies such as cryptorchidism and tumours, like in this case, may be present. Reports on psychopathology in adulthood are scarce and comprise mood disorders and obsessive compulsive spectrum disorders.

From this case report it is concluded that patients who present with lower intelligence and dysmorphias should always be examined for the possibility of a genetic syndrome.

Clinical psychiatry is confronted with the rapid expansion of the diagnostic facilities of molecular genetics and should therefore reconsider its basic diagnostic procedures. Psychiatric diagnosis should be supplemented by information about birth, developmental history, dysmorphias, congenital malformations, somatic anomalies and family history of both psychopathology and genetic disorders. In addition it should be stressed that psychiatric symptoms in genetic syndromes mostly represent a specific psychopathological phenotype, that does not meet categorical criteria. Recently, several genetic syndromes were found in a number of routinely referred adult patients. In none of the patients genetic analysis was considered previously. Some examples are presented. In all cases the genetic diagnosis had a major impact on the psychiatric diagnosis and treatment. It is concluded that psychiatrists have some knowledge about dysmorphias, relevant developmental issues and basis clinical genetics.