The purpose of this observational study was an assessment of the incidence and types of serious psychiatric adverse events (SPAE) associated with the interferon-α (IFN-α) plus ribavirin (RV) therapy in chronic hepatitis C (CHC) patients with compensated liver function and without psychotic or bipolar disorder, without substance abuse or an organic brain disorder at the enrollment. Method. SPAE were defined as psychiatric consequences of IFN-α+RV therapy that resulted in discontinuation of the therapy, psychiatric hospitalisation or initiation of chronic psychiatric disorders. Results. A group of 273 patients (144 males and 129 females aged 18-69 years, mean 41) was prospectively observed. Psychiatric assessment prior to the therapy was done in 240 patients (88%). Recombinant IFN-α was used in 89 patients and 184 were treated with pegylated IFN-α. Overall SPAE were present in ten patients (3,7% of the sample). Eight of them received recombinant IFN-α (Fisher's exact test: p<0,01). One suicidal attempt and two cases of psychotic disorders occurred. Mixed states prevailed among serious affective disorders induced with the IFN-α+RV therapy. Premature cessation of the therapy due to SPAE occurred significantly more often in patients treated with recombinant IFN-α than in those treated with pegylated IFN-α (four vs none; Fisher's exact test: p=0,01). Conclusions. SPAE in CHC patients on the IFN-α+RV therapy arise rarely. However, potentially severe psychiatric consequences of the treatment in some patients point to necessity of psychiatric monitoring during the therapy. Treatment with pegylated IFN-α may be associated with less SPAE than treatment with recombinant IFN-α in CHC patients.

Attention Deficit Disorder with/without Hyperactivity (ADD/ADHD) is present at adulthood with a prevalence estimated around 4% in the general population regardless of culture and language. The Wender Utah Rating Scale (WURS) is a 61-item questionnaire aimed at assessing ADD/ADHD symptoms while the subject was a child. Such information is needed in the diagnostic process since ADD/ADHD is a neuro-developmental disorder which starts before age 7. Following WHO's guidelines the WURS was translated into French and back-translated into English. 350 subjects filled out the WURS (students in Paris and parents of a child diagnosed with ADD/ADHD in Nice). Its psychometric properties are presented.

Impulsivity can be measured by self-administered questionnaires, e.g. Barratt's BIS-11 and Eysenck's IVE-7. Impulsive behaviors can be observed from children to elders and adolescents classically show a higher level of impulsivity. Nevertheless, scales have been developed for adults not adolescents or children. We present here a psychometrical analysis of the properties and structure of Dickman's Impulsivity Inventory in a sample of 200 adolescents hospitalized in a paediatric unit chiefly after a suicide attempt. Two factors are expected (Functional Impulsivity and Dysfunctional Impulsivity) although we have reported elsewhere that a third factor, named Cognitive Impulsivity following Barratt's conceptualisation of impulsivity, could be reliably extracted regardless of item format (i.e. dichotomic vs. polytomic).

Attention Deficit Disorder with/without Hyperactivity (ADD/ADHD) is present at adulthood with a prevalence estimated around 4% in the general population regardless of culture and language. The Adult ADD Self-Report Scale v1.1 (ASRS v1.1) is a self-reported questionnaire devised to facilitate the screening of ADHD in primary care settings. It is part of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI). The 18 items are written to reflect the DSM-IV diagnostic criteria for ADHD and are rated from 0 (“Never”) to 4 (“Always”). Following WHO's guidelines the ASRS was translated into French and back-translated into English. 350 subjects filled out the ASRS (students in Paris and parents of a child diagnosed with ADD/ADHD in Nice). Its psychometric properties are presented. The ASRS v1.1 can be found online at http://www.hcp.med.harvard.edu/ncs/asrs.php.

Attention Deficit Disorder with/without Hyperactivity (ADD/ADHD) is a neuro-developmental disorder that affects up to 6% of the children and the adolescents, and up to 4% of the adults in the general population. In French-speaking countries and in France more specifically, there is almost no validated instrument for the diagnosis of ADD/ADHD. Thomas E. Brown created scales to rate symptoms of ADD/ADHD from age 3 to adulthood. There are observer-rated forms (teacher and parent) and self-rated forms (adolescent and adult). Following WHO's guidelines all the forms of the BADDS were translated into French and back-translated into English. Dr Brown compared both English forms to ensure that the meaning of all items had been correctly caught. Students in Paris and children diagnosed with ADD/ADHD in Nice filled out the BADDS. Preliminary analyses are presented. A large epidemiologic study is planned to collect normative data in the French general population.

Although the cause of autism is not yet known, it is thought that this disorder is related to genetic and environmental factors. Cytogenetic anomalies and single gene disorders are responsible for less than 10% of all autistic cases. We herein present a case of autism, the etiology of which is metabolic cytopathy.

BA is a 25 years-old male and is the only child in the family. He was diagnosed by many doctors as having ‘Attention Deficit Hyperactivity Disorder’ (ADHD) until he was thirteen. The patient has been under our follow-up for the last 12 years since he was 13 and the diagnosis was corrected to Autistic Disorder at his first visit. During all this period, the patient gained 25 kg and he showed no neurological symptoms. On the cranial magnetic resonance imaging, bilateral lesions in the putamen, thalamus, partial lesions in the caudate heads, cerebellar white matter and the dentate nucleus were detected, which were hypointense at T1, hyperintense at T2 and iso-hypointense at FLAIR. The patient underwent evaluation by neurologists, biochemists and radiologists, but no etiologic factors could be detected. The present condition was considered to bean unconfirmed ‘metabolic cytopathy’.

Should autistic cases be stratified into subgroups according to the underlying genetic risks, it may even be possible to define a special subgroup which would cover the metabolic cytopathy present in our case. In conclusion, it is possible that autism due to metabolic causes is of genetic origin; however, this tendency should be detected by a molecular approach.

Clients presenting for mental health assessment may have medical conditions that either contribute to the presentation, require emergent treatment or affect the choice of therapy that follows any admission to Hospital for a mental illness.

Screening for pathology such as substance abuse, trauma and metabolic or electrolyte imbalances must be carried out before the diagnosis of a mental illness may be confidently made.

The consequences of not detecting these conditions is particularly significant as most Mental Health Inpatient Units are typically not well equipped to monitor or care for these pathologies.

A retrospective study of 100 consecutive Mental Health Admissions to Dubbo Base Hospital was conducted and data concerning the type of medical screening performed and the results were compiled and analysed. The screening included physical examination, radiological imaging and general pathology testing.

The findings indicated that there was a lack of uniformity in the approach to medical assessment of mental health patients that may have resulted in relevant organic pathologies not being appropriately detected. The findings also indicated that, in a significant number of cases, organic pathology played an important role in both the diagnosis and subsequent treatment of a number of these patients.

It was concluded that a standard set of routine investigations be carried out on all Mental Health admissions and that the results of the investigations carried out did considerably influence either the diagnosis or treatment of a significant number of the patients in the study group.

Most Movement Disorders demand assessment and management of the psychiatric symptoms, representing an extremely important interface between Psychiatry and Neurology.

In São João's Hospital, the patients followed in the Neurology Department's Movement Disorders ambulatory clinic are referred to the Psychiatry Department's outpatient clinic.

The aim of this study is to characterize the patients followed in our clinic between the years 2005 and 2007 using information collected from clinical files and an investigation protocol especially developed for this purpose. This protocol includes sociodemographic data, neurological diagnoses, psychiatric symptoms and current treatment. Once Parkinson's disease was the most representative diagnosis, the authors explored more detailed features, such as onset type, disease duration and severity, and associated these to the psychiatric clinical picture.

A prolonged duration of untreated illness (DUI) has been indicated as a negative prognostic factor of clinical outcome in schizophrenia(1),affective(2) and anxiety disorders(3). The present study analyzes DUI in anxiety/mood disorders. Study sample included 729 patients:181 Major Depressive Disorder, 115 Bipolar I Disorder, 186 Bipolar II Disorder, 100 Generalized Anxiety Disorder, 96 Panic Disorder and 51 Obsessive-Compulsive Disorder. The main demographic and clinical (age at onset, age at first treatment, DUI) variables were compared between groups using oneway ANOVA, t-tests or chi-squared tests. DUI was defined as the interval between the onset of the disorder and the first adequate treatment.Patients with MDD showed a shorter DUI (F= 25.159; p> 0.0001) whereas patient with BDII showed a longer DUI (F= 12.680; p> 0.0001) compared to the other groups. Present findings indicate that patients with affective/anxiety disorders present significant differences in DUI. It is of clinical interest to assess the extent to which delays until beginning an appropriate treatment influence the course of these disorders.

1. 1. Altamura AC, Bassetti R, Sassella F, Salvatori D, Mundo E. Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophr Res, 2001; 52 (1-2): 29-36.

2. 2. Altamura AC, Dell'Osso B, Mundo E, Dell'Osso L. Duration of untreated illness in major depressive disorder: a naturalistic study. Int J Clin Pract 2007 b, 61(10): 1697-700.

3. 3. Altamura AC, Santini A, Salvadori D, Mundo E. Duration of untreated illness in panic disorders: a poor outcome risk factor? Neuropsychiatric disease and treatment 2005, 1(4): 345-347.

By this case report the authors will emphasize the importance of systematic psychiatric exploration in clinical practice with gender identity disorders. Standard procedures have diagnostic and differential diagnostic purpose (exclusion of other psychiatric disorders or comorbid psychiatric disorders).

Presented patient is 20 year old female who addressed to Belgrade Team for Gender Identity for routine psychiatric exploration with suspicion of female-to-male transsexualism. As a contribution to mentioned diagnostic category the authors have noted long term persistence of gender dysphoria through puberty and adolescence, persistent wish for partial sex reassignment surgery, specific defense mechanisms and intake of testosterone without medical prescription.

Applied diagnostic procedures and complementary analysis (EEG, NMR) have imposed doubts in primarily suspected transsexualism and leads us toward differential diagnosis analysis for organic or psychotic mental disorder.

Nowadays, over two millions people are developing diabetes worldwide and its prevalence is increasing all over the world. Psychological factors have significant impacts on initiation, symptom presentation, and the trend of the disease. Physical treatments may result in non-compliance due to their bothersome effects like pain, especially in children. In addition, restricted diet, meticulous meal, and the amount of activity give rise to non-compliance and exhaustion.

Diabetes is a risk factor for psychiatric disorders such as depression, anxiety, eating disorders, and adjustment disorders in all ages and learning disorders and deficits in visouspatial ability in children and adolescents. Psychiatric disorders lead to more metabolic disregulation, more adverse effects, and decreased quality of life. Psychosocial adverse effects of diabetes are the most important predictors of its mortality.

Psychosocial interventions including medical treatment as well as psychotherapies are effective to reduce morbidities and mortalities of diabetes; patients' qualities of lives are highly correlated to amounts of psychosocial supports. These supports result in better metabolic controls and improving relationship with family members, for children, and better metabolic control and decreased rates of admission in hospital, for adolescence. Psychiatric and psychological interventions lead to patients improving self-confidence, more self-support and better quality of life.

The objective of this paper is to make a reflection about how the comorbidity of psychiatric and organic disorders can create several difficulties for the diagnostic and therapeutic approach of the both situations. The portuguese type of paramiloidosis disease was for the first time observed in 1939 by Corino de Andrade. In Portugal, the major focus of the disease, it presents a geographic distribution that must be known by the clinician. A thirty five's patient clinical case is described, who was hospitalized in the psychiatry hospital with the diagnosis of paranoid schizophrenia. After two months of hospitalization and four years after the beginning of the neurological symptoms, a complete organic study was developed, including gastroenterology and neurology evaluations. A diagnosis of Familial Amyloid Polyneuropathy (transthyretin-methionine 30 positive) was established, co - morbid with the diagnosis of paranoid schizophrenia. The authors conclued that the comorbidity with a mental disorder, in which delirious interpretation of the organic clinical situation was predominant in the clinical feature, and that took some time to be pharmacologically stabilized, associated with the fact that the patient hide that his mother and relatives of the mother side died because PAF, contributed significantly to the delay of the diagnosis. Beyond this, the clinical diagnosis of paranoid schizophrenia and the poor family and social background do not make him a potential candidate for a hepatic transplant. Influencing negatively the patient's coping, they can compromise the success of the transplant.