We aimed to describe aggression according to the subscales formed in the Life History of Aggression (LHA) in relation to life-time psychiatric diagnoses.

178 adults referred for psychiatric evaluations of childhood-onset neuropsychiatric disorders (outpatients) and 92 perpetrators of violent crimes referred to pre-trial forensic psychiatric investigations had comprehensive, instrument-based, psychiatric assessments, including the LHA scales. Total and subscale LHA scores were compared to the categorical and dimensional diagnoses of childhood and adult DSM-IV axis I and II mental disorders, general intelligence, GAF, and personality traits according to Cloninger's biopsychosocial model.

The two groups had similar LHA scores (despite higher scores on the Antisocial scale in the offender group). Higher total LHA scores were independently associated with the hyperactivity facet of attention-deficit/hyperactivity disorder (AD/HD), childhood conduct disorder, substance-related disorders, and low scores on the Cooperativeness character dimension according to the Temperament and Character Inventory. IQ and GAF-scores were negatively correlated with the LHA subscale Self-directed aggression. Autistic traits were inversely correlated with aggression among outpatients, while the opposite pattern was noted in the forensic group.

In these study groups, aggression was predicted by childhood behaviour aberrations, adult substance-related problems, and character immaturity rather than by symptoms associated with the major mental disorders. AD/HD in combined or hyperactive, but not inattentive, forms, was associated with high scores on aggressive behaviours.

To describe reasons for not seeking professional help at the age of 17-18 years, when a need for mental help is present.

In a person identifiable survey among 3278 Finnish adolescents 15-16 years old at baseline, reasons for not seeking professional help were studied among respondents of a two-year follow-up, who had reported a need for help for a mental health problem but had not sought professional help(n=128). The respondents were instructed to choose from the following list all alternatives describing their situation: thought that the symptoms will eventually alleviate anyway, unsure about who to turn to, felt too exhausted to get help, anxious of somebody finding out, negative experiences of dealing with health professionals, distrusted the effectiveness of professional help, turned to parents for help, parents estimated that there was no need for professional help, turned to friends for help,. friends estimated that there was no need for professional help.

The three most common reasons for not searching for professional help were, the notion that the symptoms would alleviate without help (71%), exhaustion (43%) and turning to friends for help (26%). Uncertainty about to whom to turn and exhaustion were more common among those with depression compared to those with no depression (33% vs 14%, p=0.025 and 55% vs 35%, p= 0.042).

Mental health literacy of late adolescents must be enhanced in order to make them take mental health problems seriously enough to get professional help.

Suicidal behavior in adolescence is now well documented with regard to biological and psychological traits, family-environmental factors, and clinical management. In despite of this knowledge, few interventions are based on family therapy.

To examine the association between suicide attempt in the adolescent population in Quebec and family constellation with regard to family structure and family functioning adjusted for socio-economic factors.

Data: Social and Health Survey of Children and Adolescents in Quebec State performed in 1999 (Institut de la Statistique du Québec, Canada). Subjects: 1186 adolescents aged 13 years and 1160 adolescents aged 16, and their parents. Outcome: suicide attempt during lifetime. Independant variables: family structure, witnessing interparental violence and parental emotional support. Covariates: family socioeconomic background and demographic variables.

Statistics: logistic regression analysis.

81 adolescents reported one suicide attempt or more during lifetime, with a significant risk for girls but this risk was independant of age and ethnicity. The adolescents had a 2.5-fold higher risk of suicide attempt when they live in monoparental household (OR=2.46; 95% CI=[1.37-4.42]), a 3.8-fold higher risk when they witnessed interparental violence (OR=3.76; 95% CI=[2.10-6.74], and a 2 to 6-fold higher risk when parental support is low, particularly paternal support. These associations are not modified by familial socioeconomic status.

These results are concordant with family stress perspective in the un derstanding of suicidal beahvior in adolescents, and this independently of familial socio-economic deprivation. They give arguments for family centered therapy in the panel of interventions in health promotion in adolescence.

Neurodegeneration and cognitive deficits may influence the pattern of co-morbid disorders and their possible effects on mortality in late-onset Alzheimer's disease (AD). However, subjects with AD have to live long enough to experience and be diagnosed with dementia. We investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalised AD and elderly controls subjects.

Diseases with a prevalence of more than 1% were compared between 634 hospitalised AD and 72244 control subjects aged above 70 years referred to the University of Birmimgham NHS Trust. Predictors of mortality within the seven year follow-up were identified using regression regression analyses. Confidence intervals of relative risks were used to compare the relevance of risk factors for later mortality between groups.

Subjects with AD suffer more infections, brain diseases and neck of femur fractures than other hospitalised elderly patients. In contrast, cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalised controls. Diseases that might contribute to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalised elderly control subjects.

Patients with Alzheimer's disease have a different pattern of co-morbidity, but die from the same diseases as other hospitalised patients. Infections including pneumonia, and diseases that may occur secondary to neurodegeneration and confusion may need special attention in patients with Alzheimer disease who might not be able to identify or report the early symptoms.

To examine whether cognitive testing can be tailored to individual patients by selecting only items of appropriate difficulty from a large and precise neuropsychological battery. The advantage is a combination of measurement precision with the brevity (of shorter tests).

39 patients with cognitive complaints and 8 partners who visited a geriatric day care clinic were randomly assigned to administration of the CAMCOG or an extended CAMCOG i.e. with ADAS-cog and neuropsychological tests. Item difficulties were estimated and their validity examined with Rasch analysis. Tailored testing was achieved by Computerised Adaptive Testing (CAT). CAT repeatedly selected an easier item after an incorrect response and a more difficult item after a correct response to estimate the total score. CAT finished the item selection after reaching sufficient reliability (standard error < 0.15).

For test reductions by CAT ranging from 25 to 15 items, intraclass correlations between the CAT estimated total score and actual total score (CAT administered plus remaining items) ranged from .99 to .98 for the CAMCOG and from 0.98 to 0.91 for the extended CAMCOG. Testing time reduction ranged from 42-55% for the CAMCOG (M testing time CAMCOG 39.6 minutes, M testing times CAT 22.9 to 17.8 minutes) and from 45-68% for the extended CAMCOG (M testing time extended CAMCOG 111.3 minutes, M testing times CAT 61-35 minutes).

Substantial test reductions and excellent agreement with the whole battery supports the use of tailored cognitive testing to economically administer batteries that are time consuming in their entire form.

The aim of this study was to determine the gender differences in knowledge, attitudes and practices toward Mental Illness in a sample of Qatari and other Arab expatriates residing in the State of Qatar.

This is a cross sectional survey.Setting: Primary Health Care Centers.

A multistage sampling design was used and a representative sample of 3300 Qatari and other Arab expatriates above 20 years of age were surveyed. Of the study sample of 3300, 2514 subjects (76.2%) expressed their consent.

Face to face interviews were based on this questionnaire that included variables on socio-demographic characteristics, knowledge, attitude and practice toward mental illness.

Of the study sample, 49.2% were men and 50.8% were women. More women than men believed that mental illness is due to possession by evil spirits (43.5% vs 34.5%; p< 0.001). Also, less than half of the studied women (42.3%) thought traditional healers can treat mental illness. Women were considering people with mental illness as dangerous (58.1%), compared to men (51.5%) (p=0.001). More than women (76.8%), men (82%) were willing to visit a psychiatrist for their emotional problems (p=0.002), while more women (43.7%) preferred a traditional healer (p< 0.001). Women were more afraid to talk to mentally ill (39.5%) than men (28.8%) (p< 0.001). 24.8% of women and 31.1% of men identified schizophrenia as a common mental disorder.

The knowledge of women towards mental illness was poor. Most of the women were afraid and not willing to keep friendship with the mentally ill.

To study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the Fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) dataset.

The CHSS-2003 is a stratified cross-sectional survey which gathers information about personal, familial, peer, school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An Exploratory Factor Analysis (EFA) was performed in order to test the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking.

The construct validity of the school attachment and school commitment scales was supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (student's good grades and school attendance) appears to have a clear inverse association with current smoking (OR=0.46; 95%CI: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16; 95%CI: 0.88-1.53)

School commitment was strongly associated with current smoking. It is important to study further this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.

Treatment of alcohol addiction remains challenging, since only half of all patients achieve long-term abstinence by currently available therapies.

In the last 2 years, there have been promising reports on deep brain stimulation (DBS) of NAc in addiction (animal models, one case report of a patient with severe anxiety disorder and secondary addiction). Our group treated 5 patients with treatment resistant alcohol addiction with DBS so far. Our initial data of the first 3 patients has just been published. However, these very positive results arise from a continuous open stimulation and have not been placebo controlled.

To assess the impact of discontinuation of bilateral DBS of the NAc on craving for alcohol in patients whose addiction remitted after initiation of DBS.

Crossover, double-blinded phase of 2 × 4 weeks with sham-stimulation in one and stimulation in the other 4 weeks.

Until now, one patient finished the 8 weeks of study (remaining patients will finish experiment in December 2009). In this patient, stimulation was continued in the first and stopped in the latter 4 weeks. While he experienced no changes or side effects in the first part, he showed a massive craving for alcohol one day after discontinuation, which again remitted when the experiment was stopped and the stimulator was turned on again after 3 days.

DBS of NAc seems to selectively alleviate craving for alcohol thus enabling patients to remain abstinent. These results justify clinical studies in larger samples of patients with treatment resistant alcohol addiction.

To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.

We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.

Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.

As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.

Historically, the treatment of mental illness in Australia has been inadequate. Clinical Supervision [CS], a structured staff support arrangement, has shown promise as a contribution to the clinical governance agenda; however, little is yet known about CS implementation issues. This study aimed to examined the effects of providing regular Clinical Supervision to nursing staff who worked in mental health settings, on their levels of personal well being, the quality of care they delivered and the outcomes for patients

A large scale landmark Australian randomised controlled trial [RCT] of CS, funded by the Queensland Treasury/Golden Casket Foundation [A$248,000], was located in 17 mental health facilities, across the State. The RCT trained 24 Supervisors and tracked their subsequent year-long personal experience [the Intervention] using psychometrically established instruments, supplemented by qualitative data, which was also collected from mental health nurses, other clinical staff, patients and administrators.

Supervisors and Supervisees were found to value Clinical Supervision. The positive effect this had on the quality of care and patient outcomes was demonstrated in a controlled setting within this RCT, but remained elusive across a broad front. The importance of the prevailing service/managerial culture to the outcome of CS implementation was revealed.

Novel findings will help to conceptualise Clinical Supervision education, management and policy decision making in the future. They will provide the basis for the best contemporary advice for service development and/or a framework for future CS evaluation, sufficient to be tested in another environment with other mental health disciplines.

Social implications and long-term consequences of mental disorders regarding sick days at work, unemployment rates and early retirement are substantial. There is no clear understanding

1. 1) whether and which social psychiatric strategies of vocational rehabilitation and

2. 2) whether and how atypical antipsychotics are successful in supporting vocational rehabilitation in schizophrenia.

Primary objective was to demonstrate the enhanced ability of schizophrenic patients to be successfully in employment after attending specific “job-consulting” programs. Secondary objective was to demonstrate positive effects of ziprasidone and risperidone on work-related functions.

Aim of the study was to enlighten the complex relationship between working performance of schizophrenic patients, their social psychiatric and medical treatment, and their cognitive capabilities in a first step.

The study was conducted in inpatients, day-clinic- or outpatients diagnosed with schizophrenia, paranoid type (ICD 10: F20.0). All patients received regular pharmacological treatment and intense cognitive training, additionally one group completed specific “job-consulting” programs. ANT, CPT, WCST, PANSS and WBN were performed after 3, 6, 12 and 24 months.

At present eighteen schizophrenic patients (6 female and 12 male, mean age: 33.6 years) have been included in the study. Analyzing the data after 3 months the results are:

1. 1) specific “job-consulting” programs increase the probability of employment

2. 2) both, ziprasidone and risperidone, exert positive and comparable effects in work-related functions,

3. 3) the better the cognitive capability the better the vocational outcome.

Specific “job-consulting” programs constitute a clinically relevant therapeutic option in vocational rehabilitation of schizophrenic patients.

Although mental disorders are a major contributor to the Global Burden of Diseases, in many low- and lower-middle-income countries, mental health care is still accessible to only a minority.

Psychiatric disorders haven’t benefited from dramatic progresses seen in other fields as pandemic diseases.

To increase equity in access to care for psychotic patients in low- and lower-middle -income countries.

Through mental health facilities at the primary care level, availability of psychosocial support, accessibility of medicines, awareness and reduced stigma, the program addresses what is seen as the main barriers to access to care. To achieve this objective, institutional partners (Ministries of Health), a worldwide NGO (World Association for Social Psychiatry), and a leader of the pharmaceutical industry (sanofi-aventis) are associated through PPPs. The complementary expertise and resources of the partners are pooled to build-up the existing health infrastructures and increase efficacy in patient care.

In partnership with local psychiatric networks, pilot projects have been launched in Morocco and Mauritania, and others are in preparation (such as Armenia and Guatemala).

The programs combine actions dedicated to:

• • Advocacy efforts towards political and administrative decision makers;

• • Increase awareness of communities of mental health issues;

• • Psycho-educate patients and families;

• • Encourage the creation of associations of patients’ families;

• • Train health care professionals;

• • Organize a sustainable supply of high quality antipsychotics.

The FAST project encourages the collaboration of all partners. It could be an example of innovative ways to address mental health challenges in developing countries.

Working memory (WM) deficits are among the core cognitive abnormalities in schizophrenia. WM is subserved by widely distributed fronto-parietal networks and is undergoing robust development during adolescence. Studying the neural correlates of WM dysfunction in early-onset schizophrenia (EOS) will advance our understanding of aberrant neurodevelopmental processes in the disorder.

Nineteen patients with EOS aged 13-19 and 20 matched healthy participants underwent functional Magnetic Resonance Imaging (fMRI) as they performed a N-back verbal WM task with 3 levels of difficulty (1-back, 2-back, 3-back). Following matching for task performance, 14 patients were compared to 20 controls, using non-parametric whole brain and region of interest approaches followed by psycho-physiological interaction analysis (PPI) with seed voxel from the left parietal cluster.

Regions within the left prefrontal cortex, the left insula and bilateral anterior cingulate cortex showed reduced activation in EOS patients compared to healthy participants at the 2-back condition. In addition, ROI analysis at the same condition revealed hypoactivation in the EOS group with large effect sizes for left prefrontal and parietal regions. The PPI results revealed negative functional connectivity in the healthy participants’ group but not in EOS between left parietal and right parietal and bilateral frontal regions.

Our results support compromised function within the left prefrontal-cingulate network and left insula during the N-Back verbal WM task in patients with EOS compared to healthy participants. They also indicate the possibility of more widespread fronto-parietal network dysfunction, most noted in the left hemisphere in the disorder.

To describe the main features of the younger group of patients hospitalized (January 1st and December 31st) in the Acute Psychiatry Unit of a General Hospital in Bologna (Northern Italy), comparing their socio-demographic and clinical characteristics and their needs with those of the adult patients admitted.

Retrospective consultation of case-histories concerning 111 subjects (60.4% men) randomly selected. Chi-square and independent sample T-test used to compare 33 cases (≤21 years) and 78 controls (35-49 years).

Young-cases had a higher prevalence of parental separation (31% vs 2.7%; p< 0.001) and were more frequently adopted (18.8% vs 0%; p=0.01). Psychomotor agitation or etero/self-aggressiveness (36.4%) and personality disorders (12.1%) were the most prevalent causes of hospitalization among the younger group, whereas psychosis (32.1%), mood disorders (19.2%) and alcohol-substances dependence (11.5%) were more common in controls (p< 0.001). Presence of unfavorable life-events was two-fold higher in cases than in controls (p=0.074). In particular, quarrels with family (40%) or friends (20%) and substance abuse (13.3%) occurred especially in young individuals. In adults, mournings/separations and rejection therapy were more frequent (p=0.017).

Hospitalization's features (type, length, number of laboratory and instrumental exams) were not significantly different among the two groups, except for frequency and number of interviews and childpsychiatrists and educators’ care provided that prevailed in cases.

The young population admitted in our acute psychiatric ward has a complex sociorelational and clinical situation requiring a multi-professional management. The frequent need of care in emergent/urgent situation highlights the importance of further studies on this issue.

To investigate the risk factors of self-harm behavior in Polish adolescents.

Patients hospitalized in Adolescent Psychiatric Clinic during a 4-year period were surveyed by attending psychiatrists. The survey contained categories such as: demographic data, familial, social and school problems, history of violent experience, and mental disorders. Stepwise logistic regression was used to evaluate predictors of self-harm behavior.

Out of 611 (362 females and 249 males, mean age 16.1±1.5 years) adolescents who participated in the study, 261 (42.7%) patients admitted to deliberate self-harm behavior by having attempted suicide. Patients with a diagnosis of behavioral or emotional disorders were more prone to selfharm behavior (p< 0.001). Risk factors retained in the final regression model were: female gender, diagnosis of behavioral disorders, skipping classes, romantic disappointment, sexual abuse and family conflicts (table).

Acts of deliberate self-harm in adolescence are due to an accumulation of several factors. School-based programs focused on dealing with psychosocial stressors may be considered a feasible means of self-harm prevention.

Depression is one of the most common mental health problem and it grows greater every year around the world.

The main aims were to analyze the possibility of using functional and structural neuroimaging methods in diagnosis of different depression types and to find the predictors of pharmacological resistance.

46 patients with depression syndrome were distributed into 3 groups: 1) Neurotic Depression (Diagnosis: Adjustment disorders) - ND group; 2) Endogenous Depression (Diagnosis: Recurrent Depression, Bipolar Affective Disorder - current depressive episode, Schizoaffective disorder, depressive type) - PD group, 3) Depression due to organic pathology (Diagnosis: Organic depressive disorder, Organic mixed affective disorder) - OD group. Controls were 18 years old- and gender-matched healthy participants. We used several methods of functional (positron-emission tomography, functional magnetic resonance imaging) and structural (voxel-based morphometry, diffusion-tensor imaging) neuroimaging.

We found several functional and structural abnormalities in limbic structures within all three groups. Some of them were the same, some were different. Also we found several functional and structural predictors of pharmacological resistance.

We found several functional and structural abnormalities in all three depressive groups. Almost all of them were parts of so-called frontal-subcortical circuits, dysfunction of which, according to the present knowledge, could play crucial role in depression pathogenesis.

Summarizing our own results and analyzing the data of our colleagues, we complement a theory of depression pathogenesis and propose an original point of view for neurobiological basis of different types of depressive disorders and its pharmacological resistance.