ADHD is associated with pervasive cognitive, emotional and functional impairments and increased rates of coexisting disorders. Epidemiological studies indicate 25-45% of prison inmates to have ADHD. However, ADHD is often unrecognised in prison inmates and stimulant treatment was not previously evaluated in this group.

Provide effective treatment for prison inmates established with ADHD.

Evaluate efficacy and long-term effectiveness of osmotic-release oral system methylphenidate (OROS-MPH) in adult male long-term prison inmates with ADHD.

A 5-week randomised, double-blind, placebo-controlled, fixed-dose (72 mg/d) trial was conducted in 30 prison inmates with ADHD and coexisting disorders. In a following 47-week open-label extension (OLE), flexible-dosing OROS-MPH was provided alongside psychosocial interventions within a high-security Swedish prison. Primary outcome was change in ADHD symptoms after 5 weeks (CAARS: O-SV). Secondary outcomes included self-reported ADHD symptoms, global severity, global functioning, cognition, motor activity, institutional behaviour and quality of life.

OROS-MPH was highly effective and overall safe, both in the short-term relative to placebo (Cohen’s d=2.17; NNT=1.1), and in the long-term when provided alongside psychosocial interventions. Treatment continued to improve ADHD symptoms, global functioning, motor activity, cognition, quality of life, and behaviour control over the 47-week OLE. No drug misuse was reported and a majority of participants completed rehabilitation programs.

OROS-MPH effectively improved symptoms and functional impairments of ADHD in prison inmates with ADHD. We suggest that OROS-MPH provided alongside rehabilitation programs could be a feasible and effective multimodal intervention for adults with ADHD and coexisting disorders within a prison setting

In a demographic survey in 2005, 13.6% of Italians admitted to have taken CAMs during the 3 years before. A study on hospitalized patients for psychiatric reasons highlighted that 63% of them used CAM in the previous year and 79% did not mention this to their psychiatrists.

To collect the opinions about the use of CAMs in psychiatry among a group of psychiatrists and nurses working in a Mental Health Centre.

To investigate knowledge, opinions and experiences on CAMs.

A mixed qualitative-quantitative method was used: 2 focus groups were conducted in June 2011, involving 12 professionals of one Mental Health Community Centre in Modena, Italy. The audio-recordings of the focus groups were analyzed by 2 researchers, who identified the main themes with an inductive method. The participants were finally asked to fill in a respondent validation questionnaire.

Four main themes were developed:

1. 1) advantages, and

2. 2) disadvantages in the use of CAMs,

3. 3) patients’ and own experiences,

4. 4) variety of therapies under the CAM acronym.

Being realistic, open-minded and ready to listen and cooperate: this could be the best attitude towards patients who take CAMs.

Thalassemia is an inherited blood disorder that requires lifelong adherence to a complicated and burdensome medical regimen which could potentially impact emotional functioning of patients.

To assess the prevalence of depression, anxiety and stress symptoms in adult patients with thalassemia.

To explore possible demographic, medical, and psychosocial correlates of these symptoms.

117 patients (19-61 years old, M age = 37.2Plusmn;9.3; 63% female) took part in the study. Depression, anxiety stress scale (DASS) was used along with SF12 for health related quality of life and a questionnaire about sociodemographic characteristics. Statistical analysis was performed with SPSS 16.

Severe depressive symptoms were found in 17 patients (15%), anxiety symptoms in 11(9.6%) and stress symptoms in 35(30.2%). Sex, age, education, marital status and income had no significant correlation with anxiety and stress. In depression there was a significant difference between single and married patients (x2=6.990 p< .05), with 58.8% of single patients suffering from more depressive symptoms. Higher stress symptoms had a significant correlation with symptoms severity (r=.452 p< .001) and the present socioeconomic situation in Greece (r=.632 p< .001).

Given these findings, regular screening for anxiety stress and depression symptoms could help to identify at-risk patients to provide them with appropriate psychological support with the goal of improving emotional health.

The incidence of the depressive disorder in the studied time frame was 2%, and female gender subjects were more frequently involved. MADRS scores were significantly higher (scores higher than 30) in patients with depression associated with chronic conditions (cardiac, oncological, respiratory). The most frequent condition associated with depression was arterial hypertension (38%). Both MADRS scores, and GAF scores were influenced by antidepressant therapy. Patients under long- term treatment due to medical comorbid condition (74%) have a less satisfactory evolution and prognosis than those without somatic comorbid condition.

Depression has a too large incidence in primary care. Family physicians need to be familiar with the features and monitoring of antidepressant therapy, as therapeutic compliance is the sine-qua-non prerequisite of remission and relapse prevention in depressive disorder.

The severity, prognosis and evolution of patients with depression are more reserved in those with associated medical conditions, than in those without co-occuring conditions.

Joined efforts of experts within integrative narcology built on new concepts ensure more effective humanization of therapeutic approaches,“doctor - patient” positive compliance and improve life quality of the respondents.

Anxiety and depressive disorders may provoke its appearance and also lead to recurrence of psychosomatic diseases (PSD).

In 956 young people with psychosomatic diseases (bronchial asthma (BA), with peptic ulcer of the stomach and duodenum (PU) and arterial hypertension (AH)) investigated the clinical features of the structure and formation of emotional disorders in young persons with psychosomatic diseases.

Pathogenetically substantiated system of forecasting and theirpsychological adjustment and medical and psychological rehabilitation of these patients, based on a systematic approach to evaluating the clinical features of the structure and formation of emotional disorders in young persons with psychosomatic illnesses.

Clinical-psychopathological, psychodiagnostical.

In the clinical structure of emotional disorders (ED) dominated depressive disorders (43,4 ±2,2%) and anxiety disorders (25,1 ±1,2%). In patients with asthma significantly more frequently met panic disorder, agoraphobia, isolated phobia in patients with hypertension in many cases found generalized anxiety disorder (p < 0,01). Identified pathogenetically significant clinical, biological, psychological and psychosocial factors in the development of ED in young people with PSD. Pathogenetic role of psychological characteristics in the development of EP in patients with PSD determined by a combination of psychological traits: aleksytymia, low productivity of psychological defense, low predictive ability, high levels of aggression and hostility (p < 0,05).

Developed and implemented in practice the system of psychotherapy and medical and social rehabilitation of patients with PSD, which confirmed the effectiveness of data of observation after 12 month.

Circadian rhythm pathways are highlighted in a number of etiological models of bipolar disorder (BD). More than 25% of bipolar patients may present seasonal pattern (SP). However, there is very limited scientific data on the prevalence of SP, its clinical manifestations and any gender influence.

Caucasian individuals who met DSM-IV criteria for BD I or II were recruited from three university-affiliated psychiatric departments in France (Paris, Bordeaux, Nancy). SP was defined according to DSM-IV criteria. Clinical and socio- demographic variables were obtained from structured interviews with the patients and their relatives.

Four hundred and fifty-two bipolar patients (n=452) in euthymic state were included in the study, 102 of them (23%) were considered as having SP according to DSM-IV criteria. Multivariate analysis showed a significant association of BD patients with SP for bipolar II subtype (OR=1.99, p=0.013), rapid cycling (OR=2.04, p=0.02), eating disorder (OR=2.93, p=0.003) and the total number of depressive episodes (OR=1.12, p=0.002). 71% of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR=2.89, p=0.02) and total number of depressive episodes (OR=1.21, p=0.002) in males but with rapid cycling (OR=3.02, p=0.003) and eating disorders (OR=2.60, p=0.02) in females.

The high prevalence of SP in BD, its associated clinical characteristics and the observed differences between genders, suggest that SP represents a potentially important specifier of BD.

Literature suggests that schizophrenia (SCZ) could, early in the evolution, involve significant deficits in executive functioning. However, little is known about patients with recent onset first episode. Besides, only few studies focused on symptom-free intervals. Furthermore, most of them included patients on polymedication of antipsychotics including also add on psychotropics.

We aimed to investigate executive dysfunction in first-episode schizophrenia remitted patients with recent onset of the disease, receiving a strict monotherapy of antipsychotics.

Enhance the existence of executive dysfunction early in SCZ limiting the impact of relapses, medication and symptoms.

25 first episode outpatients with schizophrenia, having less than 3 years illness duration were included. All patients received a monotherapy of antipsychotic with no antidepressant, mood stabilizer, hypnotics or benzodiazepines. 25 healthy participants were matched one by one, according to age and educational level. For clinical evaluation, PANSS was applied. Executive functions were assessed with the Davidson et al. (2006) computerized battery designed to manipulate both inhibition and cognitive flexibility. It encompasses interrelated tasks that enabled us to independently vary demands on these abilities.

Compared to controls, patients showed significant differences in the percentage of correct responses and in reaction time attesting difficulties in inhibition and in cognitive flexibility.

Our results emphasize the notion that executive dysfunction in schizophrenia stands for itself early in the disease, cannot be only explained by relapses, duration of the disease, impact of medication nor symptoms.

Iron Chelation treatment (ICT) in beta-thalassemia major (beta-TM) patients undergoing blood transfusions can cause low satisfaction, low compliance, with possible negative consequences on treatment success, patients’ wellbeing, and costs.

The purpose was to estimate the existing correlation between the Chelation therapy factor of the Specific Thalassaemia Quality of life instrument (STQOLI) and certain psychological assessments.

The Chelation impact scale, of the Specific Thalassaemia Quality of life instrument (STQOLI), along with the Depression Anxiety Stress Scale (DASS) and the Satisfaction with Life Scale, were administered to 70 patients with thalassaemia Major on regular blood transfusion, registered with Thalassemia unit at General Hospital of Nikaia Greece.

Statistical analysis revealed that Chelation impact in health related quality of life in patients with thalassaemia has a significant and negative correlation with depression (r=-.325 p< .001), anxiety (r=-.276 p< 0.05) and total DASS (r=-.308 p< .05) and a significant positive correlation with the psychosocial impact scale of the (STQOLI) (r=.463 p< .0001), the Satisfaction with Life Scale (r=.265 p< .05) and the Total scale of STQOLI (r=.784 p< .001).

The better quality of life in the Chelation therapy factor a patient has the less anxious and depressed is feeling. Thalassaemia has a negative impact on emotional, social and well being in thalassaemia patients. Continuing support for better Chelation quality should be given to these patients. More understanding and support especially from health authorities, and the society is essential to enhance their quality of life.

Antidepressants may induce manic or hypomanic episodes. The identification of predictors of antidepressant- induced mania (AIM) is essential to improve the management of bipolar disorder (BD). However, the rare studies on AIM are generally characterized by small sample sizes, varying definitions of AIM and heterogeneous groups of patients, thus leading to conflicting results.

To compare a population of AIM(+) to AIM(-) patients in order to identify specific clinical factors associated with AIM.

All 252 participants met the DSM-IV criteria for BD. Only patients who reported AIM in the 90 days after the beginning of an antidepressant (with or without a mood stabilizer) were diagnosed as AIM (+) and those without any lifetime history of AIM despite lifetime antidepressant prescription were considered AIM (-). Sociodemographic and clinical factors were collected using the DIGS, ALS, AIS BIS and WURS.

AIM(+) (N=74) and AIM(-) (N=178) patients did not differ significantly in terms of age, gender distribution, bipolar disorder duration and age of onset, ALS, BIS and WURS score. However, the rates of rapid cyclers, lifetime history of suicidal acts, alcohol use disorder and AIS score were significantly higher in the AIM(+)group. The type of polarity of onset was significantly different in both groups.

A history of rapid cycling, of suicidal acts and of alcohol use disorder could be considered as risk factors of AIM in BD. Patients with these factors could therefore be identified as a vulnerable subgroup prone to manic switch with antidepressant.

Pharmacoresistant depression is a challenging clinical condition faced daily by psychiatrists. Although several strategies have been tried to optimize the outcome of this condition, depressive symptoms management remains difficult. Serotonin is regarded as the target neurotransmitter of mood regulation while other monoamines are considered as secondary characters in symptoms management although their role has not been fully explored.

Verify the role of dopaminergic modulation in management of pharmacoresistant depression.

Aim of our study is to evaluate the role of a dopaminergic treatment in pharmacoresistant depression management by administration of transdermal rotigotine.

Pharmacoresistant depressed patients, with a stabilized antidepressant treatment and in lack of symptomatic improvement in last six weeks, underwent a clinical trial with transdermal rotigotine, up to 4 mg/day. Symptoms were evaluated at the beginning of treatment and after one month by three validated scales: Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Global Assessment of Functioning (GAF).

Ten patients (9 F / 1 M; mean age 48,1 yrs) fulfilled inclusion criteria in the roll-in period. The mean scores before rotigotine treatment were: 22.80±5.8 for HAMD, 25.9±4.9 for HAMA and 41.4±11.62 for GAF. After one month of treatment with rotigotine, scores respectively changed in 11.3±3.3 (t=5.76; p< 0.001), 17.2±1.5 (t=6.37; p< 0.001) and 58.3±4.7 (t=-4.24; p=0.002).

Dopaminergic modulation achieved by rotigotine improved mood, motor and anxiety and global functioning scores, in lack of any side effect. In particular, transdermal administration avoided drug plasmatic peacks related to side effects

The combination of lithium and neuroleptic is frequently used in the treatment of bipolar disorder. After a febrile episode, some patients exhibited neurological sequelae including cerebellar, pyramidal and extra-pyramidal signs. Lithium may be the main factor of neurotoxicity but hyperthermic states are probably involved in determining brain damage.

58 year-old Tunisian women with a medical history of bipolar disorder treated by combination of lithium carbonate (700 mg/day) and levomepromazine (50 mg/day), was presented to the hospital with complaint of fever, cough, walking instability, choreic and dystonic abnormal movements. Physical examination found a temperature of 39 C°, rhino- bronchial, cerebellar, pyramidal, and extra-pyramidal syndrome. The additional diagnostic tests such as brain scan, MRI brain and lumbar puncture were normal. Desperate the corticoid treatment the cerebellar syndrome persisted.

This case and some literature reviews illustrate the role of hyperthermic states in brain damage of the neuroleptics-lithium combination. Neuropathological findings showed selective degeneration of cerebellar purkinje cells. Research on this topic is recommended.

Recent studies have shown an increase in the prevalence of infectious syphilis. If not treated, 30% of patients may develop tertiary syphilis, where neurosyphilis is included. Neurosyphilis can present a variety of psychiatry symptoms, including mania, depression, psychosis and dementia.

The authors present a case of a persistent psychosis (similar to late schizofrenia) with 3 years of evolution in a 42-years old man. In the first hospitalization, the patient was clinically studied, namely with Venereal Disease Research Laboratories (VDRL) that was negative. Other possible causes for psychosis were excluded. His clinical state never improved significantly despite the high doses of antipsychotics.

The hypothesis of syphilis was deeply studied with Fluorescent Treponemal Antibody-Absorption (FTA-ABS) and Treponema Pallidum Hemaglutination Assay (TPHA) which revealed positive results.

A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The Computerized Axial Tomography (CAT) had no abnormalities. The patient started the course of treatment for neurosyphilis with endovenous penicillin G.

After the treatment of neurosyphilis, steady improvements were noted in psychotic and cognitive symptoms. After his discharge from the hospital he was medicated only with Lorazepam S.O.S.

This case emphasizes that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric disorders even with no other signals suggesting this diagnosis. Psychiatric symptoms and cognitive dysfunction intensely respond to the correct treatment of neurosyphilis. Furthermore, this case shows that we should be alert for the VDRL false negatives

Research aims to understand how psychological mechanisms influence mental health. Accordingly, much of the studies in this field has been dedicated to clarifying how emotion regulatory strategies may be associated with increased psychopathology (Gross & John, 2003). Individuals regulate their emotions in a wide variety of ways.

We focus on two commonly used emotion regulation strategies: reappraisal (changing the way one thinks about a potentially emotion-eliciting event) and suppression (changing the way one responds behaviorally to an emotion-eliciting event).

We analyze emotion regulation strategies (Gross & John, 2003) in order to examine their relation with a broad range of psychological problems and symptoms of psychopathology.

Emotion regulation was assessed by means of the Emotion Regulation Questionnaire (ERQ, Gross & John, 2003), which taps two regulatory strategies, suppression and reappraisal. The psychopathological distress was assessed by the 90- item Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994) by indicating the degree of distress on a scale of 0 (not at all) to 4 (extremely) caused by a list of problems during the past 7 days. The sample consisted of 548 individuals (age: M=32.97; DS=3.55 for male; M=31.29; DS=3.64 for female).

Individuals who reported low levels of suppression reported the lowest levels of psychopathological symptoms.

Our findings highlight that the capacity to regulate emotions may be associated with reduced psychopathology and more adaptive functioning

Bipolar disorder is a recurrent disease that can be unpredictable. Several guides provide clinicians evidence- based treatment options for bipolar depression.

The main objective of this study is to investigate the most frequently administered combinations of psychotropic substances and focuses on the use of single drugs in hospitalized patients with bipolar depression.

To assess concordance between clinical acute treatment and recommendations of the guides for bipolar depression.

A cross-sectional study was conducted by interviewing and physical examination of a group of 45 consecutive patients who were hospitalized between February 1 and 30 July 2012, in University Hospital of Psychiatry “Socola” and were diagnosed with bipolar depression according to ICD-10 criteria.

In our cross-sectional study average age of patients with bipolar depression was 55.7 ± 8.55 years, 66.7% female. Average number of drugs received by hospitalized patients with bipolar depression was 1.73 (SD 0.44), which increased to 3 (SD 0.81) drugs if adding sedatives. Classes of drugs most commonly prescribed in the acute treatment were benzodiazepines 86.7%, antidepressants 66.7%, antipsychotics 60% followed by anticonvulsants 40%. Monotherapy had a prevalence of 33.3% of the patients with bipolar depression.

Combinations of antidepressants with mood stabilizers and / or atypical antipsychotics are common in every day acute treatment for patients with bipolar depression. Evaluating indications and conditions of polytherapy are critical issues in future studies on the acute treatment on patients with bipolar depression.

Alexithymia has been studied in several addictive disorders with a special interest in alcohol dependence (Thorberg et al., 2009; Taieb et al., 2002). Nevertheless, recent studies failed to demonstrate the relationship with drinking outcomes (de Haan et al., 2012; Stasiewicz et al., 2012). Evaluation of emotional awareness in these populations could be added to specify the deficits of emotions’ differentiation and to understand the mechanisms underlying the maintenance of abstinence (Bochand & Nandrino, 2010; Carton et al., 2010).

We intend to evaluate short and long-term abstinent alcohol dependent subjects in a dimensional approach for alexithymia and emotional awareness, expecting relationship with drinking outcomes.

Thirty-two abstinent alcohol dependent participants and 28 matched controls were included. The two groups were assessed for anxiety (STAI state and trait) and depression (BDI-II). Alexithymia (TAS 20) and emotional awareness (Emotional Self-Awareness Questionnaire; ESQ) were also evaluated. The severity of alcohol dependence was specified with Alcohol Dependence Severity scale.

Alexithymia was significantly higher in the group of alcohol dependent participants (50.1 vs 45.1; p=0.049). Within the alcohol dependent group, ESQ was negatively correlated to the severity of alcohol dependence (r=-0.29; p=0.028) with subscales “social awareness” and “social skills” negatively correlated to the duration of abstinence (r=-0.37; p=0.03 and r=- 0.38; p=0.01, respectively).

Alexithymia is significantly higher in the alcohol dependent group, compared to the control group, but within this group, evaluation of emotional awareness may become more interesting to evaluate the characteristics of alcohol dependent subjects and predict their drinking outcomes

Childhood sexual abuse (CSA) is most often associated with sexual problems in adult women. Specialized group therapy is often referred to as the treatment of choice targeting squeal in adults with a history of CSA, but the therapy as well as the outcome measures seldom addresses the sexual problems specifically.

The aim of the study was to investigate the effect of specialized group therapy on sexual function in women with a history of intrafamilial child sexual abuse (CSA).

This prospective multicentre pre-post study of women with a history of hands-on intrafamilial CSA referred to the psychiatric clinics for specialized group therapy included 158 women. Data concerning social and psychological functioning, body image, and current sexual life were collected using self-rating questionnaires and conducting a clinical interview before and after group therapy.

Data were available pre and post treatment for 132 women. There was some effect on unspecific sexual problems and sexual dysfunctions. Still, at the end of treatment nearly half of the women were unsatisfied with their sexual life, and among sexual active women half had still sexual dysfunction. Especially dyspareunia and orgasmic dysfunction were common.

The present study showed that women with a history of intrafamilial CSA who had completed specialized group therapy still have many sexual problems and may need psychosexual therapy. This need to be taken in consideration When designing treatment programs.

References: Lau M, Kristensen E. Acta Psychiatr Scand, 2007;116:96-104.

Kristensen E, Lau M. Sexual and Relationship Therapy 2011;26(3):229-241.

Psychosocial stressors are found in 40 to 80% of patients with psoriasis. The inability to cope with a stressful situation can induce a flare up of psoriasis. Several factors modulate our adaptive response to stress such as affective temperament (AT).

The objective of this study is to determine the dominant AT in patients with psoriasis and the correlation between AT and clinical features of the disease.

It was a descriptive cross-sectional study. A total of sixty five subjects and two examiners were recruited. The evaluation of temperament was made thanks the Tunisian version of TEMPS-A.

Hyperthymic temperament (HT) was the dominant temperament in patients with psoriasis (70%). Patients with poor response to treatment had a higher prevalence of cyclothymic (CT), depressive (DT), irritable (IT) and anxious (AT) temperament. The prevalence of CT (p=0.039), DT and AT (p=0.032) was higher in patient with joint pain and pruritus. The stressful situations induce more flare up of psoriasis in patient with AT (p=0.006) and DT (p=0.06). A patient with HT reported minimal discomfort, the patient with IT, CT, DT and AT had daily to major discomfort.

Patients with psoriasis have the same dominant temperament than general population. However, the patients with AT, CT, DT and IT have more poor response to treatment and more functionally disabling symptoms (pruritus, joint pain). The impact on quality of life and expressed discomfort would be greater.

One of important issue in psychodynamical healt is suicide.more than 60% of people who act complete suicide,suffered from psychological illness.One of important factor for psychodinamic resolutation of this attempt is the survey of their dream.Dream can be used as a tool for deliberation of suicidal intention.refering to this fact that a forth of people who have suicide attempt, may have another attempt within the next year,so we desided to check validity of dream in this kind of people in order to reach an objective relationship to determine peril of a further attempt.

In this study 50 subject of people who have suicide attempt thruogh taking pill and 50 case were selected as the control group.The people studied were asked to record their dream,then these dream were codified on the basis of Hall van de castle method.Data analyzed with and ANOVA with SPSS17.

This study showed that a dead character contents(pv=0/00) and non-speaking activities(pv=0/045)in dreams are more in people who have suicided, and if friendship validity exists the dremer is the recivier of friendship(pv=0/026) and the setting usually are undetermined(pv=0/041).

This result indicate that present of death content and non-speaking activity in dream of persons who get psychological health care can be an Alarm for suicidality in these persents.