Substance use in pregnancy is an increasingly common problem and become an important public health issue.

To determine the obstetric and perinatal outcomes of self-reported substance use (licit and illicit drugs) during pregnancy in Spanish women sample.

An observational, longitudinal cohort study of 309 Spanish Caucasian women and her newborn child. Psychiatric disorders during pregnancy and neonatal death were excluded. After written informed consent,women and newborn were evaluated at 2nd-day postpartum. Variables included: socio-demographic, obstetric, mothers'psychiatric condition, self-reported substance use, perinatal outcomes.

Sixty-six percent of women reported substance use during pregnancy: 59% caffeine, 26% tobacco, 9% alcohol, and 1% cannabis. Incidence of poor outcomes: Apgar scores <8 at 5 minutes after birth (Apgar5) 9.3% (N=29), gestational age at delivery <37 weeks 4.8% (N=15), birth weight <2.5 kg 7.2%(N=22), congenital malformations 2.9%(N=9). Women with newborn who had Apgar5 <8 have consumed more tobacco (271/124 cigarettes;p=0.004) and caffeine (47/32;p=0.051) in the last month of pregnancy than those with Apgar5 ≥8. Logistic regression analysis showed that the risk of Apgar5 <8 was 18.5 times greater (OR=6.001;95%CI=2.009-170.903) in women with lower educational level comparing with women with higher educational level.

The dose of tobacco and caffeine used during the last month of pregnancy are associated with poor outcome (Apgar5<8) in a sample of women of general population.These results need to be tested in a bigger sample.

This work has been done in part with Grants: Instituto Carlos III: GO3/184; FIS: PI041783.

Many adolescents with serious mental illnesses experience transfer of care from child to adult mental health services, yet few services have specific arrangements for such transition. The TRACK study aims to identify organisational factors that facilitate or impede effective transition from child & adolescent mental health services (CAMHS) to adult services; determine predictors and outcomes of such transition; and explore user, carer and service provider views on the process.

This multi-site mixed-methods study will: a) map transition policies in CAMHS in London and West Midlands; b) evaluate the process of transition by a case note survey of patients who cross the transition boundary in one year; c) conduct a diagnostic analysis across organisational boundaries; and d) explore views of service users, carers and mental health professionals on the process of transition.

Findings from Stage 1 reveal that in London, nine mental health trusts have 13 transition protocols in operation and two draft protocols. In West Midlands there are three CAMHS services with one operational and two draft protocols. The protocols are similar in the principles that underpin transition policies, but differ in definitions of service boundaries and in transition planning. There are also significant differences in information continuity during transition.

Preliminary findings from the TRACK study reveal similarities in principles but differences in transition process across services in the UK. The implications of these findings will be discussed.

We compare the efficacy of 6th week therapeutic program and 6th week follow up in patients suffering with panic disorder and/or agoraphobia and comorbid personality disorder (29 patients) and panic disorder and/or agoraphobia without comorbid personality disorder (31 patients). Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI and support with psychological methods: IPDE, MCMI-III and TCI. Patients were treated with CBT and psychopharmacs. They were regularly assessed in week 0, 2, 4, 6 and 12 by an independent reviewer on the CGI for severity and change, PDSS, HAMA, SDS, HDRS, and in self-assessments BAI and BDI.

A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with panic disorder and/or agoraphobia with or without comorbid personality disorder. The 12th week treatment efficacy in the patients with panic disorder without personality disorder had been showed significantly better compared with the group with panic disorder comorbid with personality disorder in CGI and specific inventory for panic disorder – PDSS. Also the scores in depression inventories HDRS and BDI showed significantly higher decrease during the treatment comparing with group without personality disorder. But the treatment effect between groups did not differ in objective anxiety scale HAMA, and subjective anxiety scale BAI.

Supported by the project n. MŠMT ČR 1M0517

TSH-suppressive therapy is widely used in treatment of thyroid differentiated carcinoma. A common consequence of therapy is subclinical hyperthyroidism which may cause dysfunction of cardiovascular system, metabolism and reduction of bone mass. Thyroid hormones are also involved in regulation of brain function. Therefore, thyroid dysfunctions are associated with frequent comorbid cognitive dysfunctions and depression.

The aim of our study was to assess the cognitive functions in patients treated with suppressive doses of levothyroxine due to thyroid papillary carcinoma.

Twenty three patients with subclinical hyperthyroidism in the course of substitutive treatment with levothyroxine due to total thyroidectomy and 131I therapy were involved in the study. The control group consisted of 13 healthy, euthyroid subjects.

A battery of neuropsychological tests was administered to assess: 1. Working memory and executive functions (the Wisconsin Card Sorting Test- WCST, The Controlled Oral Word Association Test-FAS), 2. Psychomotor speed (the Trial Making Test- TMT) 3. Attention (the Stroop test) and 4. Short term memory (the Digit Span test). Psychometric evaluation was made using 17 items the Hamilton Depression Rating Scale and Beck Depression Inventory.

Patients compared to control group performed poorer in WCST. They made significantly more perseverative errors. Patients were found to perform less well than controls in FAS and in TMT-B. The mean score of HDRS and BI (3,4 and 6,6 respectively) suggest that patients were not depressed during examination.

Our results suggest that suppressive treatment with levothyroxine may affect executive functions, working memory, psychomotor speed.

Suicides rate, especially among young people in Lithuania, is the highest in Europe.

The goal is to define and compare the peculiarities of suicide behavior among teenagers of different sex.

109 teenagers were researched in the age group of 14 to 17 (52 boys and 57 girls), they were treated in Kaunas University of Medicine Psychiatry Clinics Children – Teenagers Department after they had tried to commit a suicide. Medical documentation and authors' concluded structuralized questionnaire were used to evaluate anamnesis data.

More than one half of boys and girls tried to commit a suicide for the first time, the other part of researched teenagers attempted this repeatedly (46,2 % of boys and 42,1 % of girls). Researching suicide environment, the correlation between suicide surroundings and sex was established (χ2=9,21, lls=2, p=0,01). Three fourths (75,4 %) of girls chose parental home surroundings, whereas only every second boy chose the surroundings of parental home (51,9 %) (p<0,05). Quite the same percentage of researched boys and girls - accordingly - 17,3 % and 15,8 % percent chose school and friend environment; the percentage of boys who chose other environment (remote places) was triple larger than the percentage of the girls in this group - accordingly 30,8 % and 8,8 % (p<0,01).

research data suggests that suicidal behavior of teenage boys and girls implies statistically significant differences.

suicide is one of the core health problems in the global society. One of the predominant causes of death among young Europeans is suicide. Recent statistic data on suicide proves that Lithuania is one of the leaders in this range.

The goal is to define and compare the peculiarities of suicide behavior among teenagers of different sex.

109 teenagers were researched in the age group of 14 to 17 (52 boys and 57 girls), they were treated in Kaunas University of Medicine Psychiatry Clinics Children – Teenagers Department after they had tried to commit a suicide.

Researching teenagers' mode of suicide, the correlation between mode of suicide and sex was defined (χ2=19,29, lls=3, p=0,0001). Only every fourth (25,0 %) teenager – boy used medicaments for killing himself, whereas even two thirds of girls (64,9 %) took medicine to commit a suicide (p<0,001). Self inflicted wound (32,7 %) was prevailing in the group of boys comparing with the group of girls (15,8 %) (p<0,05); hanging as a suicide method was eight times more frequent between the boys than the girls - accordingly 13,5 % and 1,8 % (p<0,001).

research data suggests that teenage boys and girls manner of suicide implies statistically significant differences.

There has been increasing number of requests for cosmetic rhinoplastic surgery among Iranians in different age groups in recent years. One risk for those who undergo such plastic operations is the presence of body dysmorphic disorder (BDD) which might complicate the results and decrease the rate of satisfaction from surgery. This study was aimed to find the rate of BDD symptoms and mental problems in people demanding rhinoplastic surgery and a control group.

The scores of General Health Questionnaire (GHQ) and DCQ (Dysmorphic Concerns Questionnaire) were obtained for 50 people who were candidates for rhinoplastic surgery and the results were compared with normal control group.

The total GHQ score (p=0.0001) and scores in anxiety (p=0.009), depression (p=0.009), and social dysfunction (p<0.001) sub-scales were higher among the study group compared with the control. Similarly, the DCQ score in the study group (10.67±2.93) was obviously higher than the control group (2.54±2.34) (p=0.0001). However, the score of somatisation sub-scale of GHQ (p=0.06) was not significantly different between the two groups.

Psychiatric evaluation in candidates of rhinoplastic surgery seems necessary to prevent unnecessary and repetitive surgical operations.

Suicide accounts for almost 2% of the deaths in the world, though the rates between countries vary considerably. Socio-economic factors play a significant role in mental wellbeing and the rate of suicide. There is a strong relationship between socio-economic development and the age-sex structure of a population with changes in one being reflected in changes in the other. Age-sex changes in a population associated with socio-economic development are typically, falling birth rate and increased life expectancy which changes the age ratios between young and old. This study investigated the relationship between population structure and reported rate of suicide.

Data were provided by US Census Bureau and WHO. Non-parametric correlation (Spearman's rho) was used to examine the relationship between population structure and reported rate of suicide. Initially, median age was used to describe population. In order to take into account the complexity of population age structure the data were described and indexed using the UNEX30 algorithm.

A significant correlation was observed between the median age of the population and the rate of suicide (0.311; p < 0.001), but a higher level of correlation was observed between population structure and the reported rate of suicide (0.526; p < 0.001).

The findings support the hypothesis that the population age affects the reported rate of suicide, but more significantly, the age structure of the population shows a better relationship to the reported rate of suicide. This knowledge should be used to guide the direction of future research.

To compare various methods of visual stimulation (threshold and subthreshold) in psychophysiological diagnosis of paraphilias.

A total of 45 male sexual offenders were examined. All of them look through abnormal sexual photos. Physiological reactions such as skin-galvanic, cardiovascular, muscular reactions, and changes in chest and diaphragmatic respiration/breathing were recorded. During subthreshold stimulation slides' exposition time with masked image was 10 ms. During threshold stimulation slides' exposition time without masked image was 5000 ms. Psychophysiological examination's data were compared with results of clinical interview.

Two patients's groups were studied: with paraphilias (27 pts) and without paraphilias (18 pts). In the first group the concurrency of threshold stimulation data was observed in 88,9 % of cases, at subthreshold stimulation - in 77,8 %. In 37 % at one method stimulation we were observed reactions to stimulus, relevant to paraphilias, on which reactions at the other method were absent. Only at subthreshold stimulations appeared reactions to those stimulus which were submitted in behavior, but not in imaginations and dreams. In these cases realization sexual perversion on altered states of consciousness, and in a post-criminal period was observed the parcial amnesia. In the second group more than in half of cases were marked reactions only for normative sexual stimulus.

The threshold and subthreshold stimulations' data supplement each other in paraphilias' diagnosis.

To study the role of psychosocial stressor factors in formation of neurotic and affective disorders in patients with PU of duodenum and stomach.

In Borderline States Department of MHRI TSC SB RAMSci we examined 245 patients (male - 111; female – 134; mean age 43,28±8,86 years) with peptic ulcer and mental disorders (MD) of neurotic and affective level appearing to be causes of seeking by patients for a psychiatrist. In 24,9% of them PU was diagnosed for the first time under conditions of a psychiatric hospital.

Method of logistic regression along with convenient for PU factors of “aggression” and “defense” predictors of psychosocial disadaptation and prognosis of PU development have been revealed in men (Concordant=84,6%, Somers'D=0.693), in women (Concordant=82,8%, Somers'D=0.660). From the first step sign “heredity” according to PU has constituted 24% (p=0.0001). Of significance were somatic factors: gastroduodenitis infected HP (p=0.0015), duodenogastric reflux (p=0.0015), gallstones (р=0.003), indices of immune status (р=0.0174). Significant psychosocial (stressor factors) predictors have been revealed: life events (p=0.0021), medical (p=0.0002), working, everyday ones (p=0.037). Mental disorders of depressive, anxious, asthenic spectrum (р=0.0001), duration (р=0.001) and age of onset of mental disorders (р=0.001), psychopathological syndrome (р=0.0009). Non-specific symptoms of PU are represented by psychovegetative paroxysms of fear of death (p=0.0006), cardialgias (p=0.008), abdomenalgias (p=0.005), hypochondriac fixation (p=0.001), hypothymia (р=0.0003), demonstrativeness (р=0.004). Perspective is assessment of interrelationship of somatic and mental factors in development of schemata of complex somatic and psychopharmacotherapy, psychotherapy of PU patients.

A comparison between Pyridoxine (vitamin B6) and a placebo for the treatment of premenstrual syndrome (PMS).

A double blind randomized clinical trial was performed on 160 university students who were suffering from PMS (according to the retrospective diagnostic criteria which had been recorded during the last 3 menstrual cycles). Then the patients were randomly assigned into two groups, and finally 94 patients who had finished the study were statistically analyzed.

In the Pyridoxine group (46 patients) vitamin B6 was prescribed at a dose of 40 mg twice daily (total 80 mg), and in the placebo group (48 patients) a tablet similar to vitamin B6 tablets in size, smell, shape and taste was prescribed 1 tablet twice daily. In both groups the tablets were started from the first day of the fourth menstrual cycle and continued for the next two cycles, and during these two cycles the symptoms were recorded.

The severity of PMS in the second cycle of the treatment (in both groups) showed a statistically significant decrease (p <0.05, Pair T test) and the comparison between the two groups showed that the severity of PMS in the Pyridoxine group decreased more than the placebo group (p < 0.05, Student T Test) and this was because of the reduction in the psychiatric rather than somatic symptoms of PMS.

Regarding the effect of Pyridoxine in reducing the severity of PMS, it can be suggested as a treatment for PMS, at least for the psychiatric symptoms.

Cultural competence is often defined as the understanding and integration of patients' cultural themes including culturally-based syndromes, diagnostic process, and treatment. Cultural competence is essential to the advancement of global healthcare for it allows greater understanding of individual patients, focuses on combined interventions, and maximizes adherence. However, healthcare professional's culture and culture of medicine itself must also be considered. In westernized medicine, especially America, advances in technology and therapeutics play a large role in changing medical culture; but medical economics is as significant for one now witnesses a once noble profession changing into a “business.”

Commentary on clinical medicine practices and changes in medical culture.

Managed care and Medicare DRGs strongly affect American medical economics with resultant: decrease in physicians' incomes, increased number of patients seen daily, decreased time spent with each patient, and decreased subjective/objective quality of care. Physicians' roles have blurred with duties delegated to lesser qualified healthcare professionals in order to maximize patients seen and income generated by physicians. In psychiatry, performing multiple psychopharmacology visits hourly is economically more productive than an hour therapy session.

Doctors need to understand that in entering medicine they enter a life's career of nobility in which they serve others and do not expect to become wealthy, but at life's end are able to state “a job well done with caring for all.” Perhaps then less harm will be done to patients in the doctors' haste to earn more money by seeing too many patients too briefly.

Unresolved grief and perception of loss result in impaired relationships and increased psychopathology. Grief research and therapy support a beneficial response to emotional expression of grief in the context of search for meaning (Neimeyer's “mean-making”). Further, there are multiple forms of expression of grief be it verbal, artistic, or written. This paper addresses poetry therapy as an effective expression of grief.

Poetry therapy with analysis.

Too often we take life and friendship for granted. Frequently, it is only with death that our thoughts crystallize and the meanings of relationships become clear, powerful, and at times overwhelming. It is then that we truly understand our own mortality and our responsibilities to others. Poetry affords a therapeutic means for the expression of grief while serving as a monument to those now lost, but always remembered.

Too often it is difficult to express one's emotions and the meaning of loss during the grief process. All forms of expression should be afforded the bereaved. Poetry therapy is a unique means wherein special feelings and meanings can be effectively expressed and result in a therapeutic grief process.

Knowledge of the long-term course of childhood Attention Deficit Hyperactivity Disorder (ADHD) is limited by the lack of longitudinal studies that extend beyond age 25. Information about the later adult status of children with ADHD, one of the most common disorders of childhood, is important since the disorder is widely reported to persist through adulthood. Findings from this prospective 30 year longitudinal study also address the claim that bipolar disorder masquerades as ADHD.

We report on the psychiatric status of 90 males at mean age 41, diagnosed with ADHD at ages 6-12 (Mean, 8), and 102 non-ADHD males matched for age and SES in childhood, interviewed blindly by trained clinicians.

As expected, ADHD at follow-up was significantly elevated in probands (13% vs.1% in comparisons, p<.001). When the number of ADHD criteria is reduced, as recommended for ADHD in adults, rates rise to 36% and 12%, respectively (p<.001). Other disorders significantly more prevalent in probands were: antisocial personality disorder (APD) (10% vs. 0%, p<.001), drug (non-alcohol) disorders (17% vs 7%, p<.03), and nicotine dependence (29% vs 9%, p<.001)). Childhood ADHD was not associated with elevated rates of mood or anxiety disorders in adulthood.

The extended clinical course of ADHD appears diagnostically specific, consisting of ADHD, APD and drug (non-alcohol) use disorders. Findings are not consistent with expectations that ADHD persists through adulthood in the majority, or that bipolar disorder was misdiagnosed as ADHD in childhood. Findings pertaining to other functional domains also will be presented.

To explore changes in daily functioning (C-GAS) and quality of life (ILC) in adolescents (12-18 years) with ADHD treated with OROS®-MPH and their parents.

Post hoc analysis. Open label non-interventional trial in adolescents (ADHD; ICD-10 criteria) treated with flexible dose OROS-MPH for 3 months (42603-ATT-4001). Effectiveness parameter were IOWA Conners' parent rating scale, C-GAS, ILC adolescents and parents at baseline and endpoint, physician's and parents' rating of treatment.

129 out of 598 patients were adolescents (Ø age 14.2 years; 84.5% male) and 88.4% completed the study. Treatment was discontinued due to adverse events (3.9%), insufficient effectiveness (4.6%), lost to follow up (3.1%). Mean dose of OROS MPH increased from 34.6 mg/day ± 13.4 at baseline to 39.2 mg/day ± 13.4 at endpoint. C-GAS improved from 60.2 ± 14.0 to 72 ± 14.4 (p<0.001). Mean sum score on ILC-adolescents improved from 18.7 ± 3.6 to 20.6 ± 3.7 (p<0.001) and ILC-parents increased from 16.7 ± 3.9 to 19.6 ± 3.8 (p<0.001). Effectivity and tolerability was rated as at least good by >80% of physicians. 80.6% of parents were at least satisfied with therapy. 46 treatment - emergent adverse events were reported in 30 patients. AEs listed overall in ≥2% of patients were insomnia (3.9%), infection (2.3%), headache (2.3%), and nervousness (2.3%).

Transitioning onto OROS®-MPH in adolescents was associated with a clinically relevant improvement of Qol and daily functioning. Treatment with OROS MPH was well tolerated.

Youth and their caretakers exchange information with health providers in order to participate in shared decision-making or to make autonomous treatment choices. Tools supporting these exchanges for psychotropics are not readily available.

In partnership with the Provincial Centre of Excellence for Child and Youth Mental Health, two pharmacists and a psychiatrist with advanced knowledge in psycho-pharmacotherapeutics designed a psychotropic resource to support the tripartite (i.e. youth, parents/caretakers, health providers) relationship in therapeutic, collaborative, decision-making. The resource promotes a framework for understanding psychotropics, their therapeutic goals, and the methods by which these goals will be reached. Best available evidence for psychotropics and factors influencing uptake of patient-oriented materials informed the content and resource format. Focus groups of youth with mental illnesses, health providers, and stakeholders were conducted during resource development. A graphic designer used focus group feedback to develop layouts and characters. A plain language writer edited the content.

A booklet with a companion passport was chosen. The booklet has several components including frequently asked questions (FAQs), a section on psychotropic medication groups, checklists, appointments, monitoring forms for medications, symptoms, side effects, and functioning, notes pages, and a glossary. The passport, intended for youth, primarily contains monitoring forms (e.g. checklists, medication list, symptoms, side effects, functioning). Clay character photos and colored section schemes enhance visual appeal of the resource.

The goals of the resources are to improve youth and caregiver involvement in psycho-pharmacotherapeutic decision-making and monitoring to enhance collaboration. A qualitative assessment of its impact is planned.

Sleep disturbance is prominent in fibromyalgia (FM). This 14-week, randomized, double-blind, placebo-controlled study, evaluated the effect of pregabalin on pain and sleep-related outcomes in FM.

Patients meeting ACR (FM) diagnostic criteria were randomized to pregabalin 300, 450, or 600mg/d (BID) or placebo for 14 weeks (A0081077). Primary efficacy parameter: LOCF endpoint mean pain score (MPS). At baseline and endpoint, patients completed the Medical Outcomes Sleep (MOS) Sleep Scale. Mean Sleep Quality scores (11-point numeric ratings) were derived from patient daily diaries.

745 randomized patients: 95% female, mean age=50 years, baseline MPS: 6.7. Placebo-corrected differences from baseline to endpoint in MPS were: 300mg/d, -0.71 (p=.0009); 450mg/d, -0.98 (p<.0001); 600mg/d, -1.00 (p<.0001). For MOS Sleep Disturbance, all 3 pregabalin groups demonstrated significant improvements versus placebo (300, 450, and 600 mg/d, -8.91 [p=.0006]; -10.63 [p<.0001]; and -14.93 [p<.0001], respectively). Similar improvements were seen in Sleep Quality (300, 450, and 600mg/d; 0.42, p=0.0030; 0.48, p=.0006; and 0.68, p<.0001 respectively) and MOS Sleep Adequacy (300, 450 and 600mg/d; 5.86, p=.0324; 7.89, p=.0036, and 11.16, p<.0001 respectively). Endpoint Mean Sleep Quality scores across all 3 treatment groups showed significant improvements (300, 450 and 600mg/d; -0.74, p=.0006, -1.12, and -1.35, both p<.0001 respectively). Most common AEs: dizziness (all pregabalin, 35.8% vs placebo, 7.6%); somnolence (18.0% vs 3.8%). Incidence of AEs appeared to be dose-related; most were mild to moderate.

Pregabalin treatment demonstrated significant improvements in pain and patient reported measures of sleep disturbance, adequacy, and quality.

Study funded by Pfizer, Inc.