Since the marketing of anti-depressants these compounds have been used for the treatment of a wide variety of psychiatric and non-psychiatric disorders. To sum just a few: peptic ulcers, migraine, enuresis, narcolepsy, ADHD, urinary stress incontinence, bulimia, neuropathy, cardiac arrhythmia, anxiety disorders, obsessive compulsive disorders etc. ADHD in adults is a clinical diagnosis that can be reliably made. Psychostimulants are the most effective drugs in the treatment of ADHD with impressive effects sizes that are in adults quit similar to those reported in meta-analyses of child and adolescent clinical trials. Stimulants are both safe and effective and are therefore the first line choice for the treatment of ADHD in adults. However, a subset of patients is non-responder or experience adverse effects such as: dysphoria, anxieties, anorectic effects or an exacerbation of seizures. This restricts the use of stimulants in these patients. Moreover, adults with ADHD often show comorbid disorders (depression, anxieties, tics, drug abuse and somatic comorbidity) for which stimulants may be inappropriate. A critical review of controlled clinical trials with antidepressants in adults with ADHD will be presented. This review shows that, in contrast to the treatment of depressive disorders where receptor binding profiles and specific monoamine reuptake inhibition does not predict a clinical response, in ADHD the pharmacological properties of the specific antidepressant is most probably related to efficacy. Only eight trials of good quality were found. Effectsizes are smaller than with stimulants.

The conceptualization of a spectrum of obsessive-compulsive disorders, comprising disorders such as OCD, body dysmorphic disorder, substance abuse, pathological gambling and autism, is increasingly accepted. These disorders share obsessive-compulsive features and show similarities in patient characteristics, course of illness, comorbid disorders and neurobiology. Recent research suggests the possibility that autism spectrum disorder (ASD) in its milder forms may be clinically important among a proportion of patients with OCD. OCD with comorbid ASD should be recognized as a valid OCD subtype. A strange personality, with paranoid, schizotypal, avoidant or obsessive-compulsive traits, may indicate these autistic dimensions in OCD patients. In ASD patients, arguments often arise amongst nosologists, as to what constitutes their repetitive, ritualistic, quasi compulsive behaviour. At a descriptive behavioural level, the majority of ASD patients experience their symptoms as egosyntonic. Nevertheless, they frequently share the same egodystonicity as their genuine OCD counterparts. It has been found that adults with ASD are more likely to show repetitive ordering, checking, lining up, hoarding and touching, as opposed to classic OCD. Their obsessive thoughts are less likely to involve the usual themes of aggression, religion and sex. In general compulsions and rituals seem to be more common than pure obsessions. OCD like behaviours are often conceptualized as an epiphenomenon that is associated with the diagnosis of ASD. Several case vignettes will be presented to provide insight into how neuropsychological phenotypes constitute a workable framework to conceptualise OCD like behaviours as manifested in ASD.

The U.S.1999 Surgeon General's Report on Mental Health documented almost 21% of U.S. children and adolescents ages 9 to 17 had a psychiatric disorder with at least minimal impairment. From this prevalence statistic, one in five children age 9-17 experienced some degree of emotional or behavioral dysregulation. While there are over 60,000 board-certified U.S. pediatricians, current competencies for specialty certification cover minimal mental and behavioral health care. According to statistics from the American Academy of Child and Adolescent Psychiatry, there are less than 6700 sub-board qualified child and adolescent psychiatrists practicing in the U.S. Moreover, due to established third-party payment and reimbursement venues, many children are not eligible for the care of these professionals. Many U.S. children, therefore, do not have adequate access to mental and behavioral health care.

To address this serious need, in 2004, the American Academy of Pediatrics (AAP) Board of Directors (BOD) appointed the Task Force on Mental Health (TFMH), charging it to develop evaluation algorithms, tools and models of third-party payment to assist primary care pediatricians in enhancing the mental health care they provide as they provide care for children and adolescents in the primary pediatric health care setting: the “medical home.” The TFMH, which included representatives from the American Academy of Child and Adolescent Psychiatry, as well as many other related professional and consumer organizations, concludes in 2008 with comprehensive recommendations for improving primary clinical care for U.S. children and adolescents with mental and behavioral health care needs. This presentation summarizes those results.

“OrenProPsy” – Orenburg, Promotion, Psychiatry.

“OrenProPsy” is an Independent Non-profit Organization, which was founded to make information and services in the sphere of mental health easy to access. The main aims of the organization are to promote the proper information on mental diseases and methods of their treatment alongside with the information on the possible ways of the rehabilitation of those who suffer from mental diseases; stimulate the professional development of the staff; provide all services in the sphere of mental health for the public access; encourage the use of all possible means to solve the problems in the sphere of mental health. “OrenProPsy” activites are aimed at different groups of people such as: patients with mental disorders, their relatives, mental health specialists and the public at large. “OrenProPsy” main activites include publishing activities (books, brochures, booklets, leaflets); informative activities (lectures, discourses, social work, practical work with patients and people from their surroundings, mass media presentations of mental health problems; educational work (seminars and conferences for mental health specialists); direct assistance for the projects which are carried out in the sphere of mental health in partnership with other organizations. On Mental Health Day “OrenProPsy” organized mass media presentations and lectures on the mental health problems for the internists and the general public. Different charity programs get their financial support from private and public organizations in Orenburg and its region. The research work is conducted in association with the Department of Psychiatry and Medical Psychology of Orenburg State Medical Academy.

In a General Hospital without psychiatric clinic, Consultation-Liaison Psychiatry (C/L) plays an exceptional role in the demand to develop and facilitate the collaboration between the patient and the doctors of each clinic in which the patient is nursed.

In a such “orphan” frame, complete psychiatric care and hospitalization are hardly attempted. Here I will present to you the way I worked as a psychiatrist of C/L, with a male schizophrenic patient in Orthopedic Clinic after a serious suicide attempt. The General Hospital in this particular case received a half-dead, bodily and mental, patient. His physical problem was attended intensively so as he could be directed to a Special Rehabilitation Centre for further improvement. At the same time, through the configuration and investment of suitable therapeutic frame, his “mental bleeding” stopped. Through this procedure and slowly by slowly, he learned to invest in a new human relation with the hope and prospect to “stand finally in his legs”.

The comprehension of countertranference was the key for the therapeutic approach of this patient.

The psychoanalytical theory and experience of clinical pioneers (e.g. Mentzos, Benedetti, Racamier) who dealt with the psychotherapy of psychosis are the support in the particular work.

It is worth mentioning that this patient received a psychoanalytical type approach. However, the technique and therapeutic frame suffered modifications so as to be adapted so much to his psychotic pathology as also to the conditions of his long- lasting hospitalization (5 months roughly) in the Orthopedic Clinic.

34-year old patient with haemophilia A, HIV and Hepatitis C (HCV) infection was sent for psychiatric evaluation before starting the treatment of HCV with interferon. He was infected with HIV through plasma concentrate in the age of 12 years. In that time, he has been told to have an HIV infection, without any concrete psychological support. He started the treatment of HIV infection, which was succesful, with seroconversion several years ago. But the psychological problems, such as feelings of stigma, social isolation and uncertainty remained.

At first interview he expressed anger on the hole medical team, including psychitrist. He denied any psychological problems and was trying to devaluate the conversation. Later on, during the once weekly psychotherapy sessions several important issues arose.

1. - For long time he was stigmatised and discriminated inside his family due to HIV infection. His feeling towards the members of his family and stigma due to HIV infection have been adressed during the psychotherapy. Later on in the course of psychotherapy, it became clear that he is stigmatised due to haemophilia and HCV infection, too.

2. - He holds the destructive pattern in intimate relationships. He ended several relationships because of the fear to tell his partner about the HIV and HCV infection.

3. - As defence mechanisms he has been using projection, denial and racionalizations.

4. - He started to talk about his past, often traumatic memories and feelings around haemophilia, HIV infection in terms of manageble disease.

Integral Self Therapy (IST) is a novel transpersonal form of psychotherapy that integrates existential psychotherapy and the work of humanistic psychologists such as Maslow and Rogers, along with eastern meditation and mindfulness techniques.

The theoretical paradigm of IST presupposes a "Universal Self" accessible experientially through meditation, an inherent "intrinsic" self which is similar to the western concept of temperament, and an "extrinsic" self, which has parallels with the Jungian "persona".

IST attempts to balance these psychic structures thereby helping a person transcend existential anxiety

I will present a theoretical overview of IST, practice guidelines, as well as data regarding the use of IST in the treatment of depression and anxiety.

The presentation will be divided into two sections. In the first part the author will present theoretical and practical implications of working in a biomedical model. The author will analyze the evolution of the biomedical model and consider:

1. a. The reasons why some psychotherapies fit the concept of evidence based medicine more easily than others.

2. b. How societal and clients' expectations help drive the biomedical approach.

3. c. What are the gains and losses of economically driven health system from psychotherapy point view.

In the second part of the presentation an attempt will be made to describe a mental health system aimed at blending a modern psychiatric service with one based on traditional knowledge and holistic values in a multicultural environment. The author will endeavour to address the following questions:

1. a. Does multicultural approach translate to openness and readiness to use different psychotherapeutic options?

2. b. How can a systemic approach be used to develop culturally sensitive assessments?

3. c. What are the theoretical difficulties and pitfalls faced by a mental health service based on holistic values and traditional knowledge?

Finally with the use of a case presentation consideration will be given to the idea of using a systemic intervention within a cognitive behavioural paradigm of a Child and Adolescent Mental Health Service. Some advantages and disadvantages of using such interventions will be discussed with special reference to the principle of optimal difference (Cecchin).

Autogenic Psychotherapy is a psychophysiologicaly oriented psychotherapy introduced in Europe by JH Schultz in 1930 and in North America by W. Luthe in 1970. It is the pioneer of mindfullness psychotherapies. It is organized around three basic methods: autogenic training, the basic technique described by J H Schultz, Autogenic Neutralization, the advanced technique described by W. Luthe and Autogenic Reconstruction, the advanced technique described by JLG de Rivera.

Posttraumatic stress disorder (PTSD) is a largely under-diagnosed condition probably because clinicians expect it only as a consequence of enormous (thus rare) trauma. Seemingly insignificant life events or incidents may cause typical PTSD or other severe pathologies with great impact on quality of life and mental health.

One such disabling condition, presenting as atypical PTSD, without flash-backs or nightmares and barely discernible restlessness, is ignored by textbooks or classifications and seldom recognized by health and invalidity insurance agencies.

Apparently minor traumatic events may also cause personality disorders, recurrent and resistant depression, phobias, General Anxiety Disorder, Obsessive Compulsive Disorder, dysthymia, somatoform disorder, manic episodes. There is no apparent connection between the objective importance of trauma and the severity of the resulting pathology.

Furthermore, the body itself stores the memory of trauma, and can thus produce various pathologies, sometimes of severe importance, such as backaches, headaches, muscular, joint, or even visceral disorders, whose basic cause is generally ignored. Therefore, post-traumatic physical conditions may generate significant medical expenses in diagnostic and therapeutic procedures, generally with disappointing results.

The economical implications of post-traumatic syndromes are enormous in terms of absenteeism, invalidity, medical and psychiatric expenses.

Since the treatment of psycho-trauma is most often salutary, it is imperative to recognize post-traumatic syndromes: clinicians should thus begin to consider this possibility, carefully detailed anamnesis of life events should be obtained, and subjective importance of traces left by each event investigated.

Significant case reports will be discussed.

Packing therapy is a part of therapeutic approach for children and adolescents with autistic disorder, especially in the case of self-injurious behaviour, and who do not respond to usual psychotropic drugs or who cannot tolerate them. This method consists in wrapping the patient with his under-clothes several times a week, using towels previously wet in cold water. The patient is then wrapped with blankets to help the body warm up in a few minutes. Members of staff are always looking after the patient and are carefully attentive to the quality of the relation with the patient who achieve a greater perception and integration of his body, and a growing sense of containment.

Self-injurious behaviours have previously been related to pain reactivity in autism. The effectiveness of packing could rest on the mobilization of thermo-algic sensitivity. There is a short-circuit of the painful sensations on which the child seems to focus his attention. A sensation, to which the patient has become particularly dependent, is therefore replaced by another type of sensation, which uses the same neuro-physiological pathway.

As there is currently no scientific data available, a randomized, blind and controlled study (supported by the National Grant “Programme Hospitalier de Recherche Clinique PHRC 2007/1918”) is taking place to confirm the effectiveness of packing in clinical practice. We have chosen the methodology used to verify the effectiveness of risperidone in children with autism suffering of severe behavioural disorders. This study should help us specify the therapeutic indications of packing in autism.

A structured psychoeducation is a method of treatment of patients and their families with the approved therapeutical effect.