Interpersonal violence is a major cause of mortality, and morbidity, constituting a serious social concern. The underlying causes of human aggression and violence are certainly multifactorial, although patients with a variety of psychiatric disorders including, but not limited to, personality disorders are at increased risk for developing aggression. It is thus important to understand the neurobiology of aggression, particularly maladaptive aggression.

Better understand the neurobiology of aggression, particularly pathological forms of impulsive aggression, by discussing the circuitry, both cortical and subcortical, as well as the role of neuromodulators.

Understand the neurobiology of aggression, particularly maladaptative aggression.

Literature review on the subject, PubMed was searched using the search terms neurobiology, neuroimaging, violence, aggression.

The failure of 'top-down' control systems in the pre-frontal cortex to modulate aggressive acts that are triggered by anger provoking stimuli appears to play an important role. An imbalance between prefrontal regulatory influences and hyper-responsivity of the amygdala and other limbic regions involved in affective evaluation are implicated.

Insufficient serotonergic facilitation of 'top-down' control, excessive catecholaminergic stimulation, and sub-cortical imbalances of glutamatergic/gabaminergic systems as well as pathology in neuropeptide systems involved in the regulation of affiliative behavior may contribute to abnormalities in this circuitry.

Considerable progress is being made in understanding the neurobiological bases of human adaptive and maladaptive aggression. Thus, the advances already made can contribute meaningfully to a rational assessment and treatment of individuals with pathological aggression and a predisposition to violence.

TBI is a major cause of disability. Depression is one of the major squeal of TBI in both inpatient and outpatient populations. Depression is associated with numerous negative outcome, thus affecting QOL adversely in these patients. Addressing depression in treatment regimen of TBI may improve QOL of these patients.

Present study is designed to evaluate the role of sertraline in post TBI depression and its impact on QOL.

Eighty male patients with post TBI depression were included in study amongst the 250 male patients of mild to moderate TBI recruited for evaluation. Half of the patients were given sertraline 50 mg PO whereas other half served as control without sertraline treatment. Participants were assessed on GCS, PHQ-9 and WHOQQOL at regular interval till the end of 6 months.

Depression was found in 35.6% of total patients recruited. Most of the patients (63.1%)were below 35 years of age. Depression was more common in mild TBI cases than those with moderate TBI(53.7% v/s 46.25%,p=0.04).Left side brain injury (56.25%)with cerebral contusions was more commonly associated with depression(p=0.04). Patients in sertraline group responded well to treatment with significant improvement in mod symptoms(PHQ-9 score 14.88±3.603 v/s 5.33±2.98,p=0.04)). All the four domains of QOL improved significantly in sertraline group than the control group with sertraline treatment.

Management of TBI must focus on treatment of associated mood symptoms which is likely to be associated with poor QOL . Sertraline is effective in treatment of depression with significant improvement in QOL in TBI patients.

Chronic hepatitis C virus (HCV) infection is a disease that afflicts more than 170 million people worldwide and is a major cause of liver disease, cirrhosis, and hepatocellular carcinoma. Standard pharmacologic treatment for HCV infection is the antiviral combination of pe-gylated interferon (IFN) and ribavirin (RBV). Several psychiatric side effects such as depression, anxiety and even psychosis and cognitive impairment were reported.

To review the neuropsychiatric side effects of interferon treatment of HCV infection though the study of a case report.

We present a case of a 45-years-old without personal or familiar psychiatric history, admitted in our inpatient unit with psychotic symptoms during the last 2 weeks, consisting of paranoid delusions and aggressive and bizarre behavior. The patient had history of HCV and HIV infection and had initiated treatment with pegylated IFN alpha e RBV in the prior 6 months. Neuroimaging and laboratory tests were done without significant alterations. He was treated with Olanzapine 15 mg od with improvement of the psychotic symptoms and without important side effects. At the time of hospital discharge, psychotic symptoms had almost disappeared and no behavioral disorder was observed.

IFN-associated psychiatric disorders appear to be much more common than previously thought. The increased in pro-inflammatory cytokines in certain psychiatric disorders was widely reported. We believe that the inflammatory setting may be considered as an important further piece in the puzzle in a genetic-environmental diathesis model of the psychiatric diseases.

There are few data about the quality of life (QOL) level among patients undergoing hemodialysis (HD) and eligible for kidney transplantation.

to investigate the quality of life of patients on hemodialysis waiting for kidney transplantation.

76 end-stage renal disease patients undergoing HD included, that were in this moment (February 2014) on dialysis in Military Medical Academy. The QOL level was compared between HD patients waiting (N=22) and not waiting (N=54) for kidney transplantation. All patients are older than 18 years, have been on HD at least three months. To measure QOL, the SF-36 was used.

Patients waiting kidney transplantation are younger (42.68±12.10 versus 63.17±14.06 years old; p<0.005) and most of them are single (50% versus 9.7%; p<0.001). They less often have diabetes (0% versus13.0 %), hypertension (4.5 versus18.5%) and obstructive uropathy (4.5 % versus13.0%). Mean scores were higher among patients waiting kidney transplantation regarding four dimensions of QOL: PF (Physical Function) (83.8 versus66.9; p>0.001), RP (Role Physical) (58.8 versus 46.8; p>0.1), BP (Bodily Pain) (73.2 versus 60.4; p>0.05); SF (Social Functioning) (96.5 versus77.7; p>0.001. Patients waiting kidney transplantation have higher mean PCS (Physical Component Summary) (p>0.001) and MCS (Mental Component Summary) (p>0.005) scores than patients not waiting transplantation.

Patients undergoing HD and not waiting kidney transplantation are at risk of poor QOL level, mainly regarding role-emotional and role-physical aspects. We recommend psychological ap-proach and physical rehabilitation for those groups of patients.

General Paralysis of the Insane (GPI), or Dementia Paralytica, was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalisation. Syphilis re-emerged worldwide at the turn of the 20th to 21st century, and, considering the incubation period of 10-30 years, a revival of GPI may be expected within the next one or two decades. Early diagnosis and treatment improve prognosis and, therefore, a renewed clinical awareness of signs and symptoms of GPI is needed.

This historical cohort study aims to investigate the clinical presentation of GPI in patients deceased at the Vincent van Gogh psychiatric hospital in Venray, the Netherlands, in the period 1924-1954.

Annual hospital reports and individual patient's records were used for identification of patients with an established diagnosis of GPI, usually based on a combination of clinical data and positive syphilis serology.

Individual clinical records of 105 patients (91 men; 14 women) with GPI were available for evaluation. Median age for men (50.4 years; range 31.5 to 82.1 years) was higher than for women (43.1 years; range 34.4 to 58.4 years): p = 0.01. Most patients completed elementary school only and belonged to the lower working class. Lack of judgement and insight, hyperactivity, and confusion were the most frequently documented psychiatric symptoms, whereas speech disorders, pupillary abnormalities, micturition disorders, dementia, and cranial nerve involvement were the most frequently reported neurological symptoms.

The clinical presentation of GPI displays a wide range of cognitive, affective, psychotic and focal neurological symptoms.

International cardiology guidelines have attracted recent controversy due to recommendations for routine depression screening.

This study aims to report the 6-month outcomes of routine depression screening in cardiac surgery patients.

Depression screening consisted of the Patient Health Questionnaire (PHQ) administered 30-days after cardiac surgery. Complete data was obtained on 481 patients including; 46 patients (9.6%) identified by PHQ ≥10, 90 depressed control group patients (18.7%) identified by anti-depressant use or history of depression, and 345 patients (71.7%) with PHQ ≤ 9. Groups were compared at 6 months on major adverse cardiac event (MACE), hospital readmission, quality of life (SF-12), depression and psychotropic medication use.

Patients identified by screening were at higher risk of MACE (adjusted odds ratio [OR] 2.16; 95% confidence interval [CI] .98 – 4.74, p = .06) and PHQ ≥10 at 6-month follow-up (adjusted OR 6.54; 95% CI 3.16 – 13.53, p <.001). Patients identified by screening were more likely to be initiated on anti-depressant and anxiolytic at 6-months (ORs 5.89 and 4.74 respectively). Sensitivity analyses showed symptomatic patients in the control group were at higher risk of six month depression (adjusted OR 4.49) than the depression screening group (adjusted OR 3.59).

Patients identified by screening had significantly poorer QOL in five domains after adjustment for covariates, preoperative QOL and Bonferroni correction (all p <.001).

Depression screening was associated with an increase in psychotropic medication use however depression, morbidity and quality of life remained poor at six months.

Recent research exploring the relationship between BMI and symptoms of anxiety and depression have reported conflicting results. Changes in common molecular pathways could be the basis of this association. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients.

To measure the association between BMI and symptoms of anxiety and depression in primary care patients.

Cross-sectional study. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age <40 or >80; use of antidepressants or antipsychotics medication; previous stroke or heart attack; psychosis or major depression; obesity due to hereditary. Psychometric assessment: HADS (Hospital Anxiety and Depression Scale). Anthropometric measures: weight and height. Statistical analysis: SPSS. Whole sample stratified by age on the basis of literature data about the prevalence of obesity.

209 subjects examined (84 men and 125 women). Of those, 76 (36.7%) were overweight and 60 (29.1%) obese. BMI statistically correlated with anxiety (β(SE)=.54(.12), p=.00) and depressive symptoms (β(SE)=.32(.09), p=.03), also after stratification by age, especially in females.

- BMI has a critical value in predicting the presence of anxious and depressive symptoms, especially in females. Further studies could examine the pathophysiological reasons for such association.

For the present study patients with GIS symptoms who directly presented to psychiatry (n=61), and who were referred from other clinics (n=54) were compared with each other via chi-square test and independent samples t-test. The patients were diagnosed according to the DSM-IV criteria, and relative risks for the risk groups were computed.

Direct presentations to psychiatry were more likely to be women, older, married, and believed that their symptoms had a psychological explanation (RR:2.430). Patient who were referred were more likely to have undergone invasive diagnostic tests, and to have been prescribed drugs for their symptoms (RR:3.150). Direct presentations suffered more from abdominal distention (RR:1.434) whereas those who were referred suffered more from abdominal pain (RR:3.761), constipation (RR:2.298) and swelling (RR:1.674). Patients who directly presented were more likely diagnosed with depressive disorders (RR:1.802), trauma related disorders (RR:1.605) and personality disorders (RR:2.174). Patients who were referred were more likely to be diagnosed with psychotic disorders (RR:2.271). In terms of personality traits, patients who directly presented were more likely to be impulsive (RR:1.629).

These results suggest that patients who directly present or who are referred to psychiatry clinics differ from each other on demographic, clinical and psychiatric parameters, and provide some evidence to the clinical experience and observations.

Alexithymia is further linkedwith psychosomatic disorders such as migraine headaches, lower back pain,irritable bowel syndrome, asthma, nausea, allergy, and fibromyalgia, is correlated with particularillnesses, such as hypertension, inflammatory bowel disease, functionaldyspepsia and some anxiety disorders.

956 young persons with psychosomaticdiseases: bronchial asthma, peptic ulcer of the stomach and duodenum, arterialhypertension.

To investigate interconnections of clinical,psychological and psychosocial factors in the development of emotional disorders in young patientswith different psychosomatic diseases.

Clinical-psychopathological, HARS,HADS, TAS, Buss-Durkey Inventory, Predictive ability inventory.

Anxiety disorders were observed in25,1 ± 1,2% of the total number of patients, alsodominated by anxiety reactions (10,8 ± 2,2%). In patients with asthmasignificantly more frequently met panic disorder, agoraphobia, isolated phobia. In patients with hypertension in many cases found generalized anxiety disorder(p < 0,01). The frequency of psychopathological symptoms that met ICD-10 F54category (38% ± 3,1% of patients with PSD) and their role as risk factors for emotionaldisorders and in the course of somatic diseases. Based on a survey of patientswith different psychosomatic diseases, identified specific combination of psychological features(alexythymia, low predictive ability, high levels of aggression), which are thepredisposition to the development of psychosomatic illness, and interconnectedwith emotional (anxiety and depressive) disorders.

Identified specific combination of psychological features(alexythymia, low predictive ability, high levels of aggression), which are thepredisposition to the development of psychosomatic illness, and interconnectedwith emotional (anxiety and depressive) disorders.

To assess the attachment styles in obese patients and to compare it with normal weight individuals.

in a cross-sectional study, 159 patients with obesity referred to obesity clinics, and 183 subjects without obesity were enrolled to complete Hazan and Shaver’s measure of adult attachment, and provided reports regarding height, weight and socio-demographic status.

Prevalence rates for secure, avoidant and preoccupied attachment in obese patients were 66%, 17% and 15%, respectively. Attachment styles showed no significant difference in obese and non-obese individuals (P>0.05). There were significantly lower medical co-morbidities in subjects with secure attachments (P<0.05). In regression models the determinants of higher body mass index were increased age, undergraduate education level, using medications and being housewife as the job.

The findings were supportive of the studies revealed the association of insecure attachment styles and psychosomatic disorders.

Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. The prevalence and clinical features of this syndrome have not been studied sufficiently in patients in this clinical setting.

To determine the prevalence and clinical features of catatonia in patients referred to a liaison psychiatry service at a general hospital.

Prospective, descriptive study.

All patients referred to a liaison psychiatry service were screened for catatonic phenomena using the Bush–Francis Catatonia Screening Instrument (BFCSI), between January and May 2012. The prevalence and clinical features of catatonia were recorded.

236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Three of these patients suffered simultaneously with delirium. All patients presented with the inhibited variant of catatonia and 5 to 12 catatonic signs. 100% presented with immobility/stupor and staring gaze, 84,6% with mutism, 76,9% with rigidity, and 69% with negativism and withdrawal. Sixty-one percent presented with posturing/catalepsy, 53,8% with echophenomena and automatic obedience and 46,1% with stereotypies and grasp reflex, whilst 38,4% presented with grimacing and waxy flexibility. Mitgehen, Gegenhalten and autonomic abnormalities were found in 23% of cases. In 15,3% there were verbigeration, impulsivity, perseveration and combativeness. Excitement, mannerisms and ambitendency were not observed in any case.

Catatonia is not infrequent in patients referred to a liaison psychiatry service at a general hospital, and it presented with its inhibited variant in all cases. In 23% of patients catatonia occurred simultaneously with delirium.

Catatonia is a neuropsychiatric syndrome described in a variety of general medical, neurological and psychiatric conditions. Response to treatment has not been sufficiently studied in patients in this clinical setting.

To determine the response to treatment of catatonia in patients referred to a liaison psychiatry service.

Prospective, descriptive study.

All patients referred to liaison psychiatry were screened for catatonic phenomena with the Bush–Francis Catatonia Screening Instrument (BFCSI) between January and May 2012. Their response to treatment was recorded.

236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Nine of the 13 patients received treatment with oral lorazepam. Five underwent total remission with doses between 1.5-3 mg/day within 5-13 days of treatment initiation. Two cases received up to 3 mg/day for more than 5 days resulting in a very mild improvement, one of them did not improve following eight sessions of ECT. One patient who received up to 10mg/day, died of the complications of the background health problem and complications. One patient died after the first day of treatment with lorazepam 1 mg/day. Another patient died the day after the diagnosis of catatonia and prior to starting treatment. Three patients with associated delirium improved completely with treatment for the underlying cause.

Catatonia can be effectively treated. 62% of our patients treated with lorazepam achieved complete resolution of symptoms. 100% of de catatonic patients with delirium also completely improved after treatment of the underlying condition.

Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral and autonomic abnormalities that occurs in the context of general medical, neurological and psychiatric conditions. The complications of this syndrome have not been sufficiently studied in patients in this clinical setting.

To determine the rate and type of complications of catatonia in patients referred to a liaison psychiatry service.

Prospective descriptive study.

All patients referred to liaison psychiatry were screened for catatonic phenomena with the Bush–Francis Catatonia Screening Instrument (BFCSI) between January and May 2012. Any complications of catatonia were recorded.

236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Of these, six patients (46%) suffered from complications secondary to the catatonic syndrome. These patients were also those with the longer duration of catatonia (more than10 days). The complications observed were malnutrition, dehydration, hyponatremia, hypoglycaemia, and problems related to immobility such as pressure ulcers (the more frequent complication, present in all six patients), acute coronary syndrome, aspiration pneumonia, urinary retention and urinary infection. Three patients died as a result of these complications and their underlying conditions.

Medical complications of catatonia were frequent (46%) and were more common in those patients with longer duration of catatonia. Death was also frequent (23%).

Postpartum depression is a non-psychotic depressive episode occurring in postpartum period or continuing from pregnancy. Prevalence of PPD is about 12% in general population. The most dangerous consequences of PPD are mother’s suicide and infanticide.

Assess symptoms of PPD in the first month after delivery at regular home visits to new mothers using Edinburgh Postnatal Depression Scale (EPDS) and symptoms of acute stress reaction using Impact of Events Scale revised (IES-R). Determine correlation between EPDS and IES-R scores. Determine risk factors for PPD comparing results of EPDS scale and socio-demographic questionnaire.

Study included 50 women, ages between 21 and 42 who gave birth less than a month prior to assessment. Instruments used for this study were: EPDS, IES-R and socio-demographic questionnaire specifically designed for this study.

16% of women had EPDS scores indicating possible PPD, 16% had clinically insignificant symptoms, while 4% had clinically significant symptoms of postpartum PTSD. A significant correlation between EPDS and IES-R score was determined. These variables showed statistically significant influence on EPDS score:, age of mother at first pregnancy, education, work status, smoking during pregnancy and Caesarean section. All women who had EPDS indicating possible PPD had 3 or more risk factor for PPD.

The results indicate considerable presence of PPD in women in Sarajevo Canton, and the need for screening for PPD and timely interventions that can prevent possible complications some of which can be serious.

This duplication in typing information was consuming a considerable amount of this Teams time and resources which could have instead been spent with patients.

To identify how much time is spent by Staff typing information on to the psychiatric electronic patient records.

We electronically checked for the preceding three months the amount of time spent typing information on to the electronic records after every liaison psychiatry assessment.

We were then able to obtain the average for every week.

On average about 36 to 40 hours were spent every week typing information on to the electronic records.

Liaison Psychiatry should dispense with the requirement for information to be duplicated on to the electronic patient records and should instead scan the written entry made in the Medical notes.

This should lead to a saving of about £50,000, enough to employ an additional member of Staff every week.

Death has always been a part of Greek culture and loss was treated among family and friends. This is something that recently has changed and more people are seeking psychological help when they experience loss.

of this study was to explore demographic differences in individuals referring for psychological help after loss.

113 individuals between 2010 and 2014 participated in the study. Chi-Square Test was used in order to evaluate significant differences among the sample variables with SPSS 21.

40(35,4%) males and 73(64,6%) females between 11 and 79 years old (M= 44,1 ±14,3). 73(64,6%) had just lost a close relative, 29(25,7%) in the last month, 9(8%) had preparatory grief while 2(1,8%) were about to lost a loved one. 25(21,2%) were refereed from the nursing staff, 60(53,1%) from the emergency room while the rest w ere refereed from the rest of the clinics. There was a statistical significant difference between the department of referee and the kind of treatment(x²=25,863 p=,001) with the majority of nurses referring for CISM(66,7%) while the clinics for support(73,1%). There was also a significant difference between gender and treatment(x²=11,675 p=,02) with women receiving support for children, husband and parents while men for siblings and friends. There was no significant difference between age and gender or between diagnose and relationship with the diseased.

It seems that women are seeking more easily help than men w hen they encounter loss while men are still accepting help in the form of CISM and are avoiding counseling.

Patients’ perception of their own illness affects how they follow management plans and how they react to various signs and symptoms of cardiac diseases.

to evaluate the perception of heart disease in adults with heart disease in Riyadh, Saudi Arabia.

To evaluate the perception of symptoms, timeline, cure, consequences and causes of heart disease in adults with heart disease in King Khalid University Hospital (KKUH) in Saudi Arabia, and to assess the effects of demographic factors.

A cross sectional study was conducted on 59 patients in KKUH using the Illness Perception Questionnaire (IPQ) with demographic questions added to questionnaire, participants had heart disease and were between the age of 18-75 and were recruited from the inpatient wards and outpatient clinics.

The majority of the participants were males (78.6%), over the age of 40 (83%), married (81.4%), half of the participants did not reach a high level of education (52.5% secondary or less). no statistical difference in IPQ scores in age, gender, out or in patients and area of residency. More than 70% of the participants recognized ‘Dyspnea”, ‘Chest Pain”, and ‘Loss of strength’ and ”Irregular heartbeat” as symptoms of heart disease. About half of the participants (52.6%) agreed that ‘Heart disease is likely to go on and on”. Three quarters of the total participants (76.2%) agreed that ‘Heart disease is a serious condition”. Almost all (91.5%) agreed that ‘Changing one’s diet (less fat) will help to control heart disease”.

participants have less misconceptions about their illness than expected.

Psoriasis is connected with a high risk of social stigma of patients and thus the risk factor of depression as well as the worsening of their quality of life. Consequently, the more the human beings’ characteristics are divergent from existing social-cultural pattern, the higher the stigma risk is.

The aim of the study was to determine the biopsychosocial variables in predicting depression among psoriasis patients.

The study was a cross-sectional examination and involved 219 patients with psoriasis. The following assessments were employed: BSA (severity of psoriasis), DLQI (quality of life), ASI-R (body image), BDI (depression).

In the examined group moderate depressive symptoms were recorded, however, those symptoms already indicate the risk of major depressive disorder. The relevant depression predictors were only the factors connected with the body image and the assessments of the psoriasis impact on patient-reported health-related quality of life. The severity of psoriasis were not significant predictor of depressive symptoms.

The psychosocial factors were more important predictors of depressive symptoms in patients than the severity of psoriasis. The work on improvement of the patient’s body image, reduction of the frustration linked with the patient self-comparison with the cultural created ideal body image as well as correction of beliefs about the psoriasis may help patients to improve their quality of life and decline the risk of depression.