The complaints such as weakness, difficulty swallowing and speaking that worsening at evening, may be easily supposed neurotic disorders, in a twenty-two year old male patient, has started about two months ago. In neurology clinic, in requested psychiatric consultation; there were complaints like inability to breathe, sweating, palpitations, reluctance, pessimism and unhappiness.

The patient has diagnosed according to DSM IV-TR as “Agoraphobia without panic disorder” and “Major Depression, Single Episod”. Escitolopram titrated by 20 mg/day has started. Depressive and agoraphobic symptoms have disappeared at the end of four weeks (HAM-A-D:24;11-21;9).

MG patients, especially during the beginning of disease symptoms in almost all patients with the appeal was referred to the psychiatric services and 1/3 of it has been reported as psychiatric mis-diagnosis [1,2]. Choice of psychotropic drugs is important that do not affect the respiratory center and neuromuscular transmission. Agents, used in the treatment of MG, can inflame psychopathology and can create resistance to psychotropic treatment. Therefore, cooperation of neurologist and psychiatrist is important.

The complaints such as weakness, difficulty swallowing and speaking that worsening at evening, may be easily supposed neurotic disorders, in a twenty-two year old male patient, has started about two months ago. In neurology clinic, in requested psychiatric consultation; there were complaints like inability to breathe, sweating, palpitations, reluctance, pessimism and unhappiness.

The patient has diagnosed according to DSM IV-TR as “Agoraphobia without panic disorder” and “Major Depression, Single Episod”. Escitolopram titrated by 20 mg/day has started. Depressive and agoraphobic symptoms have disappeared at the end of four weeks (HAM-A-D:24;11-21;9).

MG patients, especially during the beginning of disease symptoms in almost all patients with the appeal was referred to the psychiatric services and 1/3 of it has been reported as psychiatric mis-diagnosis [1,2]. Choice of psychotropic drugs is important that do not affect the respiratory center and neuromuscular transmission. Agents, used in the treatment of MG, can inflame psychopathology and can create resistance to psychotropic treatment. Therefore, cooperation of neurologist and psychiatrist is important.

Sjögren's syndrome (SS) is a common medical condition which may produce psychiatric disturbances. Psychoactive medications treat psychiatric symptoms, but leave the underlying process unaffected.

To emphasize that psychiatric disorders in primary SS constitute an indisputable clinical reality that each practitioner must be able to recognize and treat.

A systematic review on psychiatric manifestations of SS and two case-reports of mental disorder as clinical presentation of primary SS.

Psychiatric manifestations in primary SS are common and can occur not only during its course, but also at onset of the autoimmune syndrome. A better adapted prescription of corticosteroids and/or immunosuppressive agents (together with specific psychotropic traetments) can induce to a rapid relief of psychiatric dysfunction.

Psychiatrists should keep in mind that primary SS is a potential cause of mental disorders when examining patients with multiple somatic complaints and psychiatric symptoms.

The Munchausen's Syndrome, first described by the English doctor Richard Asher in 1951, refers to a factitious disorder present in patients who are repeatedly admitted in medical emergencies for apparent serious diseases and are looking forward to intensive medical care. The authors present a challenging case report, highlighting the importance of a thorough medical investigation before setting into Munchausen's Syndrome stigmatizing diagnosis.

The authors present a case studied in an Oncological Center, with emphasis on the medical data, diagnostic process, multidisciplinary approach, family-social-occupational implications and outcome. A review on Munchausen's Syndrome, using Medline database, focusing on the last decade publications on the subject, was carried out.

The clinical presentation initially led to strong suspicion towards Munchausen's Syndrome, since it was an young adult, single, health related profession (doctor), with life event triggers (family and social isolation; affective rupture).With the on going diagnostic process, it ended out on an atypical presentation of Crohn's Disease. However, the stigmatizing label had already been set, adding psychological damage to the patient (adjustment depressive disorder).

From the Munchausen's Syndrome review in recent literature, the authors conclude that this rare diagnosis is even rarer on oncologic settings. It should always be an exclusion diagnosis, made after a careful medical screening carried on by an expert and multi-disciplinary team, which should include a liaison psychiatrist. The patient presented classical Munchausen's clinical profile, which can be misleading by it self, incurring into a misdiagnosis.

Multiple Sclerosis (MS) is an acquired chronic neurological disorder. Studies have shown that prevalence of MS is more in some areas of Iran like as Azarbaijan(Tabriz) and Isfahan. General health problems are prevalent in MS patients. Written Emotional Expression (WEE) is one of the cost-effective self helpers' methods that its efficacy has been studied on mental health, but this method has never been studied on MS patients in Iran.

Aim of this study was to evaluate efficacy of WEE on general health of MS patients.

With experimental study, 40 (8 male, 32 female) MS patients who had completed informed written consent and filled General Health Questionnaire (GHQ-28) were asked to write their negative feeling for 30 minutes daily for 4 consecutive days. After 15 days they filled GHQ again. Finally the Statistical analysis was done.

After intervention of Written Emotional Expression, general health score in patients with multiple sclerosis decreased significantly. (p< 0.01)

Written Emotional Expression may be effective on general health of multiple sclerosis patients.

Psychological problems like anxiety in patients who are candidate for coronary artery bypass graft (CABGs) may increase mortality and morbidity. The effect of reassurance and preoperative information in decreasing anxiety is uncertain.

This study was designed to address the effect of preoperative information and reassurance in decreasing anxiety patients who are candidate for CABGs.

With experimental study and random sampling 85 (55male and 30 female) of 238 patients who were candidate for CABGs were included and completed spilberger anxiety test on the day of admission. Preoperative information and reassurance was done and test was completed again a day before the surgery. At last the Statistical analysis was done.

The Mean score of anxiety in patients with mild anxiety disorder (21 patients) was 34± 4.2 before and 39±5.8 after intervention. In patients with moderate anxiety disorder (39 patients) the score decreased from 52.61±3.8 to 50.76±56. Twenty five patients had severe anxiety disorder formerly with score of 63.88±2.8 which decreased to 53.88±7.6. All of differences were significant statistically.

In patients with mild anxiety intervention of preoperative information and reassurance resulted in increasing of anxiety but in patients with moderate or severe anxiety disorder such intervention decreased the level of anxiety significantly.

Sudden cardiac death (SCD) is responsible for 300,000 deaths annually. The use of ICD has improved survival rates following SCD episodes. However ICD may causes anxiety in patients. ICD shock is suspected as cause of enhanced anxiety.

The aim of present study was to evaluate the prevalence of anxiety disorders in patients with ICD.

In a case- control study with random sampling of 57 patients with ICD (at least 6 month after ICD implantation) they were compared with 57 patients without ICD as control group. In this study the SADS questionnaire and DSM- IV structured interview were used. The relation of gender, age, marital status and shock with anxiety was determined. The analysis was done using descriptive and qualitative statistics.

Frequency of anxiety disorders in ICD patients was 47.4%. 19.3% panic disorder, 47.4% GAD, 12.3% phobia and 5.3% OCD. PTSD was not seen in ICD patients in this study. There was a significant difference in frequency of anxiety disorders between ICD patients and control group (P= 0.001). The most frequent disorders in patients with ICD were GAD. The incidence of anxiety disorders in patients with and without ICD discharge was 84% and 18% respectively. Anxiety disorder was significantly related to the ICD discharge (P< 0.0001).

Among the anxiety disorders GAD was observed to be the most frequent in the patients with ICD discharge rather than patients without ICD.

Medical patients construct schematic representations of illness which may impact on their recovery and adjustment with their medical condition. The purpose of the present study was to examine relationship between the history of myocardial infarction (MI) and illness representations among post-MI patients.

One hundred seventy six consecutive patients following MI admitted to the CCU wards were selected based on the inclusive and exclusive criteria. The patients completed demographic questionnaire and Brief Illness Perception questionnaire (B-IPQ). Their medical data were obtained from medical records and history of MI was confirmed by cardiologist based on one of the following criteria: clinical symptoms, Enzima indices, electrocardiographic changes, echocardiography, and angiography. Therefore, the patients were divided into two groups with and without previous MI. Chi-squared test, Student's t-test, MANCOVA and Covariance were used to analyze the data.

The findings showed that 30.1% had previous MI. The results of MANCOVA indicated that Significant difference between two groups in B-IPQ scores (F= 2.653, P= 0.025). Also, the results of covariance showed that significant differences in three domains of illness perception including identity (F= 4.776, P= 0.03), consequences (F= 70671, P= 0.006) and timeline (F= 10.092, P= 0.002). However, there were no significant differences in controllability (F=0.165 P= 0.687) and treatability (F=0.26, P=0.611) between two groups.

Generally, post MI patients with previous MI likely develop negative schema about MI. Also having previous MI may impact on perception of identity, consequences and timeline of MI.

The aim of this study was to assess the course of quality of life and emotional status outcomes during the six months after elective CABG.

In a prospective study, we followed up for 6 months 138 of the original 147 CABG patients. A series of psychometric self - rating scales were administered.

The ratings obtained from the BDI reflected significant decreases in levels of depression from preoperative to 6 - month follow - up assessments (before surgery = 6.5 ± 4.9; at 6 - month follow - up = 4.6 ± 4.7; p < 0.001). The PTSS - 10 ratings from the whole sample reflected significant decreases in levels of PTSD symptoms from preoperative to 6 - month follow - up evaluations (before surgery = 18.2 ± 6.7; at 6 - month follow - up = 17.3 ± 8.0; p < 0.01). The measurements of health - related quality of life indicated significantly higher SF - 36 values on all of the eight health - related domains from preoperative to 6 - month follow - up. However, at 6 - month follow - up, patients with clinical depression and posstraumatic stress symptoms had significantly lower SF - 36 values on a variety of SF-36 domains.

Elective CABG is associated with significant improvements in HRQOL relative to the preoperative period, but impairments in HRQOL were found in a subgroup of post - CABG patients with evidence of PTSD, or depression at 6 - month follow - up.

To present a case of Huntington's Disease and discuss neuropsychiatric management.

Case presentation.

We would like to present a case of Huntington's disease in an adult asian-indian male. The poster consists of a case report followed by a discussion on Huntingtons. We discuss the aetiopathogenesis, presentation and recent management trends of this neuropsychiatric condition.

Mr. H was an Asian Indian immigrant in the United Kingdom. He presented with gradually worsening chorea, personality change and cognitive decline. Psychiatric symptoms closely followed with the development of aggression, paranoid delusions and visual and auditory hallucinations.

Management included a multidisciplinary approach involving psychiatrists, neurologists, the local Huntington's disease service and a host of Para clinical teams.

In the discussion, we trace the aetiology of Huntington's disease, the epidemiology and regional variations in Incidence and prevalence rates. The presentation, disease process and prognosis of Huntington's Disease is discussed. We present recent trends in management including the use of Omega 3 Fatty Acids.

Though there has been a significant increase in the amount of research on the condition, this appears to have been concentrated mainly on those populations with a higher prevalence. Studies on the causes of lower prevalence in Asian, especially Indian populations are still few in number. Such research could provide valuable clues including detection of protective factors in these populations. These in turn could prove useful in the management of the disease on both an individual and wider socio-economic level.

Treatment of medical catatonia sometimes requires management of presenting psychiatric syndrome as well as treatment of causative medical illnesses. Treatment response to these approaches may, however, differ even in the same patient suffering a relapse of a similar clinical picture, and this presents a therapeutic challenge for physicians. We therefore report a case of medical catatonia due to Graves’ disease which responded to antithyroid therapy in the first episode but required electroconvulsive therapy (ECT) when relapsed, then discuss the possible mechanism which caused different treatment response.

We describe the clinical course with the laboratory findings of recurrent catatonic episodes of a patient with Graves’ disease.

A 25-year-old woman manifested stupor, catalepsy and echolalia accompanying goiter, proptosis and tachycardia. Laboratory findings on thyroid function were consistent with Graves’ disease. Treated with thyamazole (TMZ), her psychiatric and physical symptoms gradually subsided. She had remained euthyroid and symptom free for 10 years on TMZ 5 mg every other day. However, at age 35, she exhibited stupor with mannerism and stereotypy. Laboratory findings revealed mild exercerbation of thyroid function. Though antithyroid therapy regained euthyroid, her psychiatric symptoms persisted. Further treatment with neuroleptics did not ameliorate her symptoms. She was thus administered bitemporal ECT and recovered after 7th trial.

Aggravation of thyroid function associated with catatonic symptoms when relapsed was milder compared to the first episode. This suggested that dysregulation of thyroid homeostasis in the central nervous system might have persisted despite the peripheral euthyroid and could affect the treatment response.

The objective of this study was to investigate the relationship between anxiety personality trait, Quality of Life (QoL) and severity of disease in a Greek population of patients with Chronic Heart Failure (CHF).

Twenty-seven consecutive CHF outpatients (22 males, 5 females; age: 56±12) were asked to answer the Greek version of the Trait Anxiety subscale of the State-Trait Anxiety Inventory (STAI), as a part of a thorough cardiological and psychiatric clinical evaluation. QoL was assessed with the Greek version of the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Multiple linear regression was conducted to determine the best linear combination of Trait Anxiety scores and severity of disease scores, for predicting KCCQ Overall Summary Score. The indices of disease severity that were used were New York Heart Association (NYHA) class in the first model and VO2peak in the second model.

For the first model (adjusted R2=0.557, F(2,20)=14.816, p< 0.001), NYHA class (B=-8.430, SE=3.965, beta=-0.323, p< 0.05) as well as Trait Anxiety (B=-0.886, SE=0.225, beta=-0.597, p< 0.05) significantly predict KCCQ Overall Summary Score.

For the second model (adjusted R2=0.616, F(2,19)=17.848, p< 0.001), VO2peak (B=17.998, SE=8.374, beta=0.317, p< 0.05) as well as Trait Anxiety (B=-0.884, SE=0.208, beta=-0.626, p< 0.001) significantly predict KCCQ Overall Summary Score.

Trait Anxiety predicts QoL independently of disease severity in CHF and therefore should be considered in the assessment of patient health status as well as in the design of treatment interventions and rehabilitation.

To illustrate, with a case report, the risk of suicide in general hospitals among inpatients with acute confusion or delirious states.

The review of a patient record who represents an instance of this risk is reported.

A Brazilian farmer, with incomplete elementary education, was admitted to the General Infirmary of Adults, from the Clinical Hospital of the State University of Campinas-Brazil (Unicamp), diagnosed with a hypothyroidism mixedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. An accidental iatrogenic levothyroxine poisoning precipitated or exacerbated the confusion in this previously weakened patient, leading to psychiatric symptoms of delirium. When a bed was brought to the corridor by nurses, he considered it an ambush. Anxious, wanting to flee, he pitched himself from the 6th floor (8 meters). The fall was partly contained by a protection net. Following the episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.

Physicians should recognize confused states to identify and treat the underlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection and intervention in any mental disorders; assessment of suicide risks before hospital discharge.

To exemplify the role and relationship of Consultation Liaison Psychiatry with other areas of knowledge involved in the health-disease process, intending to propose solutions, under a biopsychosocial perspective, to clinical (care delivery) or institutional (service-related) problems.

The review of a patient record who represents an instance of this need for integration of approaches is reported.

The case of a patient who presented an unusual pathophysiological manifestation of Behçet's Syndrome (pseudo tumor neurological inflammation) and also developed psychiatric manic symptoms after the pharmacological treatment with corticosteroids is described. Despite both the remission of mental and behavioral symptoms with psychopharmacological treatment of short duration, her clinical outcome made it necessary to reintroduce corticotherapy, with recrudescence of psychiatric manifestations and the need for maintenance treatment to assure its management.

Besides illustrating a rare clinical condition, the described report exemplifies the benefits of joint and planned actions between psychiatrists and other professionals involved in integral assistance to inpatients at hospital wards.

End stage renal disease (ESRD) is a chronic disease that shortens the life span of individuals. Renal transplantation is accepted as good choice in the treatment of patients with ESRD. Many physical, psychological and social problems have been observed for many years in receivers after renal transplantation. The problems encountered after renal transplantation may adversely affect the life quality of the individuals. This study is carried out to define the life quality of the receivers after a year of renal transplantation.

54 patients that were followed in a transplantation centre of a university hospital between January 2007 and January 2009 were included into the study. The data is obtained through personal data forms and SF-36 life quality scale.

It was defined meaningful negative relation between the age and life quality of the receivers was found (p< 0.00), as the age increases the life quality of the receivers decreased, the life quality of women receivers and the ones living in large families was found to be lower.

The life quality of the receivers after a year of transplantation was good in low level. It is necessary that the receivers be cared with holistic approach and supported them to have quality life considering life quality of the individuals.

This study is realized as a descriptive study in order to investigate the fatigue, anxiety and depression in cancer patients.

The study was conducted on 80 patients who stay in an oncology hospital between 1st of February and 31st of July 2009 with the diagnosis of the cancer. The data of the study was collected with personal information form (PIF), Cancer Fatigue Scale (CFS) and Hospital Anxiety and Depression Scale (HADS).

A positive significant relation was determined between fatigue, anxiety and depression levels of the patients (p< 0.05). As the fatigue increased, anxiety and depression also increased. It was determined that there was a negative significant relation between hemoglobin level and fatigue, anxiety, depression. As the hemoglobin level decreased, fatigue, anxiety and depression increased. The level of fatigue, anxiety and depression was higher in female patients. Patients who have another disease and indicated that the disease hinders the activities of daily living had a higher level of physical ad cognitive fatigue. Literate patients had high level of physical, emotional, cognitive fatigue and depression; patients who are high school graduates had higher levels of emotional fatigue.

There is a close relationship between fatigue, anxiety and depression in cancer patients. As the fatigue increases, anxiety and depression also increase. Convenient attempts should be planned in order to evaluate the case of fatigue, anxiety and depression comprehensively in treatment and care process of the cancer patients.

Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet. The present study aims to assess alexithymia, hypochondriasis and obsessive-compulsive symptoms in patients with chronic prostatitis.

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated for the presence of alexithymia, hypochondriasis and obsessive compulsive symptoms using respectively the following psychometric tools: Toronto Alexithymia Scale (TAS), Whiteley Index (WI) and Leyton Obsessional Inventory (LOI). Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.

57 patients (median age 40 yrs old; IQR 32-51.5 yrs) have been evaluated so far. Median CPSI score was 18 (IQR: 13-24). Median TAS score was 44 (39-57), median LOI score was 13 (10-15) and median WI score was 28 (22-38). An abnormal LOI score indicative of obsessive-compulsive features was noted in 58% of patients and an abnormal WI score indicative of hypochondriacal beliefs in 45%. CPSI strongly correlated with TAS score (r=0.57, p=0.007).

High rates of alexithymia, obsessive compulsive symptoms and hypochondriasis are present in chronic prostatitis patients. Alexithymic features were strongly correlated with quality of life measures such as the CPSI. These findings necessitate further elucidation and suggest that patients with chronic prostatitis may need psychiatric counseling and therapy.

Chronic kidney disease (CKD) has profound effects on the quality of life (QoL) of patients with serious mental health, physiological, and socio-economic implications. The co-occurrence of inflammation and protein-energy wasting in patients with CKD (called the Malnutrition-Inflammation Complex Syndrome (MICS)) is known to be associated with adverse medical outcomes and increased mortality. We designed this study to examine the relationship between nutritional and inflammational status and QoL in patients with kidney transplant.

Data from 100 randomly selected patients were analyzed in a cross-sectional survey. Socio-demographic parameters, laboratory results, transplantation related anamnestic data, co-morbidities and medication were tabulated at baseline. MICS was assessed with a recently developed scoring system (Malnutrition Inflammation Score - MIS). Health related quality of life (HRQOL) was assessed with the KDQOL-SFTM questionnaire.

Mean age was 51±13 years, median (Interquartile range, IQR) time since transplantation 65 (83) months, 57% were males and 19% had diabetes. The median (IQR) MIS was 3 (3). The MIS significantly and negatively correlated with almost all HRQOL domains analyzed, and this association remained significant or near significant in multivariate linear regression analysis for the log-transformed scores on Energy/fatigue (beta=-0.059 p< 0.001), Bodily pain (beta=-0.056 p=0.004), Physical functioning (beta=-0.029, p=0.072), Emotional well-being (beta=-0.024 p=0.077), Symptoms/problems (beta=-0.023 p=0.005) and Sleep domains (beta=-0.027, p=0.056) after statistical correction for age, gender, renal function, dialysis time, comorbidity and occupational status.

Malnutrition Inflammation Score is independently associated with different dimensions of health related quality of life in kidney transplanted patients.