Patients with chronic schizophrenia receive medications for long terms. Sialorrhea is a common and usually manageable side effect of clozapine occurring 31–54% of patients receiving clozapine therapy. It usually occurs in the early course of treatment and is more prominent at night. This is a case report about a patient suffering from schizophrenia for 15 years and receiving clozapine for the last 11 years.

The patient has been receiving clozapine for 11 years and had sialorrhea during all this time. He had been hospitalized once at the beginning of schizophrenia and the latter follow up continued with outpatient clinic controls. During this period he has never talked about sialorrhea, he ‘shamed about talking about it’so he never received any treatment for it. He reports that doctors asked about ‘side effects of the medication but not about sialorrhea’.

He mentioned about sialorrhea when he learned that it is a common side effect of clozapine and he reported it when existence of sialorrhea was asked as a special question in a rehabilitation program for schizophrenia.

This case is important to show the insufficient motivation of health professionals to talk the side effects of medications name by name with the patients so a distributive side effect as siallorrhea may elude observation for years. Using screening scales for common adverse effects in routine examinations may provide a beneficial approach.

Maladaptive behaviors and cognitive impairment can be main problems in patients with Prader-Willi Syndrome. Understanding difficulties underlying the maladaptive behavior through early diagnosis and management allow tremendous improvement in the whole clinical picture.

To study the psychobehavioral deviations in a sample of Egyptian children with Prader-Willi syndrome and possible relation to genotype.

We included 15 out of 72 patients of both sexes, aged from 5–15 years old from the National Research Centre. All patient were fulfilling the diagnostic threshold of modified list of Prader-Willi criteria. Detailed cytogenetic analysis was done using: conventional cytogenetic analysis of peripheral blood lymphocytes and Fluorescent in Situ Hybridization. Cognitive and psychological profile of Patients were assessed using

1. (a) standard and semi structured psychiatric sheet and interview

2. (b) Wechsler Intelligence Scale for Children,

3. (c) Child Behavior Checklist for ages 4–18years,

4. (d) Conner’s’ Parent Rating Scale-Revised; long version,

5. (e) Childhood Autism Rating Scale.

66.7 % of the patients were deletion positive and 33.3% were negative. 100% of the sample were mentally subnormal. 26.3% had autistic symptoms ranging from features to severe form, all were deletion negative. High prevalence of inattention, hyperactivity, anxiety, social, cognitive and behavioral problems were evident in the patients, manifested in more frequency and severity in non-deletion patients.

Cognitive and psychological challenges were evident in PWS patients’. There were some clinical differences according to different genotypes.

We sought to obtain an overview of electroconvulsive therapy (ECT) practice in Psychiatry Clinic of Derince Research and Training Hospital which has 25 inbeds and is a new kind of governmental administration for new health policy of Turkey.

From January 2011 to October 2012, a form enquiring about evaluation of ECT was filled retrospectively.

The total number of patients, admitted for psychiatry during the survey period was 77012. A total of 82 patients (10.06% among inpatients and 0.106% in all psychiatric admissions) received 514 sessions of ECT from 815 psychiatric inpatients. Seven patients had multiple hospitalizations. Patients with severe depressive episode with/without psychotic symptoms (include bipolar affective disorder current episode severe depression) received ECT most frequently (54.9%), followed by patients with bipolar affective disorder, current episode manic with/without psychotic symptoms (19.5%), schizophrenia (18.3%), and schizoaffective disorders (3.7%) respectively. All of the patients were reported to have insufficient response to medication and 19 patients had suicidalty (23.1%). There were no pregnant patients. All patients received modified ECT. There were no ECT-related deaths or injuries. 5 (6%) patients needed intervention for bradicardia and one patient had hypersensitivity to anesthetic medication during the survey.

The majority of patients who received ECT were diagnosed with severe depression with/without psychotic symptoms. Suicidalty and insufficient response to medication had an important role at decision of ECT. These results suggest that ECT is still safe and assumes an important role in daily practice of inpatient clinics.

Growing number of research concern high prevalence of specific personality disorders among psychiatric patients and influence they have on course or treatment process of co-occurring mental disorders. Moreover personality disordered patients can derive not enough benefits from psychiatric care.

Issue being presented is part of doctoral thesis, financed by the Polish National Science Center (decision number DEC-2011/01/N/NZ5/05364). General goal of the research is to observe patients during their hospitalization in regard to compliance with therapeutic procedures from the perspective of co-occurrence of personality disorders. Existing results are not unambiguous, notably with general lack of them in Poland.

To answer the question whether there are any differences (and what kind of?) in adherence to psychiatric treatment pertaining to personality and co-occurring personality disorders?

This is a prospective study. 120 patients from 3 psychiatric units have been assessed at the admission (mental state, demographic factors, prior history of treatment, personality) and at the end of hospitalization (adherence to current treatment - interviews with patients and psychiatrists). Among used methods are: Brief Psychiatric Rating Scale (BPRS), Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders (SCID-II), Eysenck’s Personality Questionnaire (EPQ- R) and self-prepared interviews (corresponding with defined indicators of variables studied). Among controlled variables are primary psychiatric diagnosis (although one of the exclusion criteria are: psychosis or mental retardation).

Data on relation between personality dimensions and disorders and patterns of psychiatric care use will be introduced and discussed.

More adequate treatment proceedings may be needed.

Smoking is still one of the important public health problems. Utilizing professional support for cessation increases the rates of success. A retrospective analysis of one year data of a smoking cessation center (SCC) is presented in this study.

Data obtained from 92 patients by using sociodemografic questionnaire and Fagerstrom test for nicotine dependence (FTND). Quitting or remaining in the program and success rates of cessation were determined.

Female/male ratio was 52.2% /47. 8% (mean age 40.67 ± 11.18). The mean FTND score was 5.23 ± 1.76. 66.3% of participants had no previous psychiatric treatment. 18.5 % of participants had history of psychiatric treatment and 15.2% had ongoing treatment. Smokers received pharmacotherapy and CBT; CBT alone or pharmacotherapy alone. After first examination, 33% of all participants continued to their treatment program. There was no difference between the attendants or quitters of the program for sociodemografics, treatment history or FTND scores. Seven attendants in the program (32 % of the attendants) quitted smoking; nine attendants (41%) decreased daily number of smoking more than 50%. Six attendants (27%) had no change. There was no difference between the quitters or no quitters for sociodemografics, psychiatric treatment history or FTND scores.

We presented a preliminary analysis of our SCC program data. It is reported that psychiatric disorders are related with higher rates of smoking and lower rates of cessation. In this study the anamnesis of psychiatric disorders had no negative influence on cessation of smoking.

Studies revealed that prenatal stress (PS) may increase the vulnerability to depression in their offspring, and ERK-CREB signal system might play a role in its mechanism.

The present study investigated the effect of MK-801 on depressive-like behavior and its impacts on ERK2, CREB, Bcl-2 mRNA expression in PS female rat offspring.

The pregnant rats were randomly divided into three groups, the control group (Con) was left undisturbed, the PS-saline group (PS-saline) and the PS-MK-801 group (PS-MK-801) were subjected to restraint stress on days 14–20 of pregnancy three times daily for 45 min, and received an i.p. administration of saline or MK-801(sigma, 0.2 mg/kg) 30 min before the first stress respectively. Forced swimming test was undertaken to assess depressive-like behavior in one month female offspring. ERK2, CREB, Bcl-2 mRNA in the hippocampus, frontal cortex, and striatum were detected by RT-PCR.

PS-saline spent significantly more immobile time compared to Con and PS-MK-801 (P < 0.05). ERK2 and CREB mRNA expression in hippocampus and frontal cortex was significantly decreased in PS-saline compared to Con and PS-MK-801 (P < 0.05), while in striatum CREB mRNA expression in PS-saline was lower than Con (P < 0.05). Bcl-2 mRNA expression in hippocampus and striatum was significantly decreased in PS-saline (P < 0.05), and in frontal cortex, its expression was significantly lower in PS-saline and PS-MK-801 (P < 0.05).

PS may suppress ERK-CREB signal pathway in female offspring rats, which could be partly prevented by MK- 801. (Supported by National Natural Science Foundation of China, No: 30970952).

Metabolic abnormalities are commonly associated with antipsychotics treatment and may increase prevalence of cardiovascular disorders. There are some reports that electroconvulsive therapy (ECT) may reduce weight in depressed patients.

The study is aimed at comparing metabolic safety of combination of ECT and antipsychotics with antipsychotics alone in schizophrenia.

Weight, abdominal circumference, body mass index (BMI), fasting plasma levels of cholesterol, HDL, LDL, triglycerides, glucose, blood pressure (BP) were recorded for 12 schizophrenic subjects (4W and 8M, age 29.2±9.4 year) before (pre-ECT) and after (post-ECT) 12 to 15 bilateral ECT sessions combined with antipsychotics treatment. These were compared with data for 44 schizophrenic subjects (25W and 19M, age 35.7±13.8 year) collected before (pre-AP) and after (post-AP) in-hospital antipsychotics treatment.

Results (mean±SD are given in Table 1.

Table 1

Our results might indicate that bilateral ECT neither improves nor worsens metabolic parameters in subjects with schizophrenia treated with antipsychotics.

Biological psychiatric research relies on the determination of biological markers. Cortisol (COR) level is one of peripheral marker frequently used in psychiatric research. COR has a well established circadian pattern of secretion, with levels peaking early in the morning. Studying circadian rhythms in big samples is challenging because of the necessity of sampling blood several times during the day. The aim of this research is to study serum COR levels at three different times of the day.

48 drug-free, healthy subjects participated in the study. None of them had a history of medical, neurological or psychiatric disease. Blood was sampled at 09:00, 12:00 and 00:00 hours. After each extraction, blood samples were centrifuged at 3.000 rpm for 10 minutes, and serum was separated and frozen at –30°C until assayed for COR. Serum COR was determined by ELISA methods. Data are presented as mean ± SD in μg/dl.

There were significantly different serum COR levels at the different studied times (F: 131.8, p < 0.0001). Serum COR concentrations were significantly higher at 09:00 h than COR levels at 12:00 and 00:0 h (09:00 h: 11.9 ± 5.1, 12:00: 8.0 ± 3.3, 00:00: 3.9 ± 2.7, all comparisons were significant at the level of 0.05).

Serum COR levels present clear day/night changes. It is strongly advisable to take into account this variability when researching in this field.

To discuss the issue of post-traumatic stress disorder (PTSD) rat apoptosis-related genes Bcl-2, Bax and medial prefrontal cortex (mPFC) neuronal apoptosis, and to provide experimental evidence to reveal PTSD pathogenesis.

The single-prolonged stress(SPS) method was used to set up the rat PTSD models There were five groups after SPS 1 day 4 days 7 days 14 days groups and control group Serum corticosterone level was determined with chemiluminescence, mPFC neuronal apoptosis changes and detection of apoptotic index were detected with transmission electron microscopy, hoechst 33342 staining and in situ nick end labeling method (TUNEL) staining. Immunohistochemistry, immunofluorescence, RT-PCR and western blotting were used to detect the expressions of Bcl-2 and Bax in the medial prefrontal cortex neuronal.

PTSD rat mPFC neuron cell apoptosis, the number of apoptotic cells gradually increased with time and reached a peak at 7 days after SPS stimulates. Bcl-2 expression reached a peak at 4d and Bax expression reached a peak at 7d after SPS stimulates, Bcl-2/Bax ratio transient increased and then gradually decreased, reached a lowest point in seventh days after SPS stimulates.

The expression of apoptosis related genes Bcl-2 and Bax increase and their ratio imbalances are likely to be one of the reasons that lead to PTSD in rat mPFC neurons apoptosis, which may provide the pathophysiology basis for PTSD.

Although schizophrenia is generally regarded as an illness with onset in late adolescence or early adult life, a sizeable minority of patients first become ill in middle or old age. Inconsistencies in diagnostic systems and nomenclature have led to such cases occupying an ambiguous position in relation to schizophrenia.

To present a case study describing a late-onset schizophrenia and to clarify the position of this diagnose in the current nosology.

The concept, nosological status, diagnostic and associated clinical features involved in late-onset schizophrenia are reviewed.

A case report is presented in detail and a literature review of the theme is surveyed.

We report a case of a 66-year-old woman with no psychiatric background up until 2010 when she was compulsively admitted to our department due to a clinical picture, which she has been developing since 2008, of mystical and persecutory delusions and visual and auditory hallucinations (she believed she was persecuted by little witches whom insulted her and invaded her home). This led to a behavioral disturbance with intense aggressiveness and anguish. The neuropsychological evaluation didn’t detect any cognitive impairment. She was treated with high doses of an antipsychotic and discharged being medicated with injectable antipsychotic and followed in compulsory treatment.

In terms of epidemiology, symptom profile, and identified pathophysiology, the diagnose of late-onset schizophrenia (illness onset after 40 years of age) has face validity and clinical utility. General adoption of this category will foster systematic investigation of such patients.

Agitation is a broad term used to describe a cluster of symptoms that may range from mild to severe. It is a common feature of psychotic and bipolar disorders, and can be distressing both emotionally and physically. Patients with agitation are unable to relax and show signs of restlessness such as pacing, pressured speech or shouting. Severely agitated patients are at risk of causing harm to themselves and others. Although milder forms of agitation may be managed with psychological interventions, more severe agitation may need pharmacological treatment.

1. 1) to systematically review the evidence for the clinical effectiveness of pharmacological interventions used to management agitation associated with psychotic or bipolar disorders,

2. 2) to identify gaps in the research evidence base to inform decisions on research priorities.

Electronic databases including Medline, EMBASE, PsycInfo and The Cochrane Library were searched for relevant published literature of randomized controlled trials (RCTs). Predefined inclusion criteria were applied to citations in a two-stage process. Outcome measures included change in agitation levels as measured by accepted standard scales (e.g. PANSS-EC) clinical improvement as measured by The Clinical Global Impression rating scales and treatment emergent adverse effects.

In total, 17 RCTs with a total trial population of 4104 were included in the review. Of these, 11 compared one or more antipsychotics and 6 compared an antipsychotic with a benzodiazepine. Final results of the data synthesis will be reported.

The results of the review will summarise the current evidence base and identify future research needs.

The systematic review help determinated of RCT’s quality at Russian speaking patients.

Were search the Russian Scientific Journals in Consilium medicum Database for RCTs comparing quetiapine with any other pharmacotherapy or placebo in the treatment of patients with schizophrenia. Effect sizes were combined in a fixed-effects model. To quantify heterogeneity was used the Q test. Funnel plots, regression tests were used to evaluate publication bias. Analyses were performed using RevMan 5. Methodological quality of controlled trials was assessed by Jadad score.

From 25 relevant trials only 5 trials were finally included in the review; None of that trials were identified in main Western data bases. All studies were randomized; None of the authors reported about study blinding; Only 2 studies reported about withdrawals and dropouts; None of the studies reported voluntary participation. Median Jadad score - 3 (57%). Quality of the study in most trials was low, and sample sizes were small. Mean quetiapine dose was slightly lower than in Western studies. Quetiapine at Russian speaking patients with schizophrenia was more effective and better tolerated than haloperidol but had no differences in those parameters between risperidon and olanzepine.

Was found: low quality of RCTs in Russian speaking patients; comparative antipsychotics had similar profiles of tolerability and safety for positive, negative symptoms and patient’s compliance. Coming RCTs must be thoroughly planned for studying in initial criterion safety and tolerability of all antipsychotics for schizophrenia treatment. We need further long-term studies for side effects monitoring.

Deinstitutionalization in Crete and the closure of the only Psychiatric Hospital in 2006, has resulted in a significant shift of treatment options that were available for chronic psychiatric patients. Specifically, psychiatric care shifted from long-term or even lifetime hospitalization, to short-term hospitalization and community-based treatment.

To examine the residential/occupational status of the patients discharged from the Psychiatric Hospital after its closure and the profile of residence, psychiatric profile and sociodemographic data of inpatients of the Psychiatric Department of the University Hospital of Crete (PD/UHC).

To explore the burden of family members living in the same home with chronic psychiatric patients.

We examined the residence status of the patients discharged from the Psychiatric Hospital. Furthermore, we examined the psychiatric profile and sociodemographic data from 400 inpatients that were admitted between Nov 2011 and August 2012 in the PD/UHC. We analyzed the data by using frequencies.

Among Psychiatric Hospital residents, 72% returned home after its closure, while 2.5% were referred to community services. Among psychiatric inpatients, 82,9% return home after discharge. From a subset of 212 patients, 64% live with their own/paternal families, while 24.5% live alone, and 63% of patients living with family/relatives, remain unemployed/on welfare.

Psychiatric reform and inadequate community-based psychiatric services, has resulted in an increasing family burden, since most psychiatric patients remain unemployed, under the care of their family. There is a need for development of community-based services to provide care and assistance to chronic patients and their families.

In 1880 Cotard introduced the term, “délire de negation”, which referred to nihilistic delusions and has come to be known as Cotard’s syndrome. This condition is thought to be characterized by various degrees of delusional beliefs in which different aspects of existence are negated or experienced from a negative perspective.

The historical concept of Cotard’s syndrome, its clinical presentation and treatment is briefly reviewed.

To report a case study of Cotard’s syndrome associated with self-starvation and to review the concept and clinical features of the condition.

A detailed clinical history was obtained from several interviews and a literature review of the theme is shortly surveyed.

A woman of 66 years, without any psychiatric history prior 2012, developed a clinical picture of depressed mood and sudden onset of delusions of ruin, ill health, guilt and self-starvation. She believed that her esophagus and stomach were glued together, so that it was not possible for her to ingest any food. She also refused to go outside because she believed she was malodorous (she had olfactory hallucinations). The patient started experiencing these symptoms after her husband’s unexpected death, a few months prior to admission. She was treated with high doses of antidepressants and an antipsychotic.

Cotard’s syndrome in this case study is associated with depression. Attempting to understand individuals with the condition from both a phenomenological as well as biological viewpoint may eventually pave the way for clearer connections between psychological and biological causation of the syndrome.

According to this preliminary case series evidence for anxiety/somatization disorder were evident in 50% (5/10) before the development of PPV while in 30% (3/10) anxiety symptoms appeared in parallel or sequential to the development of PPV. In 20% (2/10), no signs for anxiety symptoms detected during evaluation.

The results of this case series suggest that PPV is a heterogeneous diagnosis that in part includes patient with previous anxiety/somatization disorder and patient in which vertigo is the presenting sign of anxiety disorder.

Farther research is needed in order to farther characterize PPV patients and promote suitable interventions.

Children with autism have developmental motor profile that differ from other healthy children. This is evident since early childhood, sometime noted by parents and neglected by clinicians. These motor deficits are related to other domains of dysfunction in children with autism as social and language skills .Improving motor deficits can help better prognosis for these children.

To detect motor deficits in a sample of autistic children and correlate them with the severity of autistic symptoms.

We recruited 20 autistic children ranging from 3 to 6 yrs from the Institute of psychiatry outpatient child psychiatry and rehabilitation clinics of Ain-Shams university hospital .We excluded patients having total intelligence less than 75 or having other developmental disorder. We matched them with healthy controls for age and sex and compared both motor development and self help skills using Brigance scale. We confirmed diagnosis of autism in each patient by applying ICD-10 criteria of autism by a senior psychiatrist and by having a Childhood Autism Rating Scale (CARS) score above 30. Relation of autism severity and motor deficits was assessed later by Correlation co-efficient test.

Compared to controls, autistic children showed statistically significant low Brigance test scores on; gross movement, fine movement and self-help skills subdomains .Motor delay was significantly correlated with the severity of autism.

Motor deficits were evident in autistic patients and could indicate severity

Kleine-Levin syndrome (KLS) is a rare disease characterized by recurrent episodes of hypersomnia, hyperphagia and behavioural symptoms, mainly hypersexuality.

We report the clinical course of KLS in a 18-year-old male. The clinical onset and evolution are described.

The boy was diagnosed as having KLS after two episodes of hypersomnia lasting for 13 to 15 days each one. When awake, he was depressed and with megaphagia. He also had phases of hypersexuality. The initial interval between episodes was 6 weeks. After the second episode was treated with lithium and remained free of symptoms for 11 months. He had a third episode that lasted 6 days. Serum lithium level was low. In this third episode he had only hypersomnia. He had a relapse two years later with a duration of 4 days, without further relapses.

KLS is more frequent in young males with a mean duration of 8 years and around 7 episodes that lasted 10 days. The pathogenesis remains unknown. It has been related with functional disturbance in the hypothalamus, viral infections, triggering stimulus...Some authors consider KLS as a variant of bipolar disorder. Treatment includes methylphenidate, neuroleptics, antidepressants and mood stabilizers as lithium. With lithium has been reported fewer relapses, shorter duration of episodes and disappearance of behavioural symptoms.

Despite being a rare disease, is thought to be underdiagnosed, because diagnosis is mainly clinical, and tests such as EEG, PSG and MSLT reinforce the diagnosis but are not pathognomonic. Today, lithium is the best treatment option.