Transsexualism is a rare condition, characterized by permanent conviction of belonging to opposite sex, leading to a request for hormono-surgical sex reassignment.

The personality of transsexual patient is a matter of debate: most psychoanalysts postulate a severe personality disorder, while STOLLER's and biological hypothesis argue for of the absence of specific disturbance.

Fourteen transsexuals patients (9 men and 5 women), referred to the specialized multidisciplinary team of Nantes University hospital were included. All received hormone therapy, 5 patients underwent surgery. The MMPI-2 and SCID-II were used as standardized tools to assess personality.

Using the SCID-II, frequency of personality disorders was 14.29%, showing no statistical difference compared to the general population (10%). The MMPI-2 mean T score was close to the general population 50. Moreover, man versus woman transsexuals have a degree of psychopathology significantly higher than woman versus man transsexuals. Operated versus non-operated patients showed no significant differences in the various tests.

Our results tend to relativize the unique psychopathological determinism of transsexualism, and seem to strengthen the hypothesis of biological factors involved in this problem.

The prognosis is more favorable for woman versus man transsexuals.

Traumatic brain injuries (TBI) may lead to persistent depression symptoms. We conducted several pilot studies to examine the efficacy of mindfulness-based interventions to deal with this issue; all showed strong effect sizes. The logical next step was to conduct a randomized controlled trial (RCT).

We sought to determine the efficacy of mindfulness-based cognitive therapy for people with depression symptoms post-TBI (MBCT-TBI).

Using a multi-site RCT design, participants (mean age = 47) were randomized to intervention or control arms. Treatment participants received a group-based, 10-week intervention; control participants waited. Outcome measures, administered pre- and post-intervention, and after three months, included: Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), and Symptom Checklist-90-Revised (SCL-90-R). The Philadelphia Mindfulness Scale (PHLMS) captured present moment awareness and acceptance.

BDI-II scores decreased from 25.47 to 18.84 in treatment groups while they stayed relatively stable in control groups (respectively 27.13 to 25.00; p = .029). We did not find statistically significant differences on the PHQ-9 and SCL-90R post- treatment. However, after three months, all scores were statistically significantly lower than at baseline (ps < .01). Increases in mindfulness were associated with decreases in BDI-II scores (r[29] = -.401, p = .025).

MBCT-TBI may alleviate depression symptoms up to three months post-intervention. Greater mindfulness may have contributed to the reduction in depression symptoms although the association does not confirm causality. More work is required to replicate these findings, identify subgroups that may better respond to the intervention, and refine the intervention to maximize its effectiveness.

Studying the pathways followed by psychiatric patients is important to plan both mental health services organization and training programmes for doctors and psychiatrists.

Detecting the main pathways-to-care followed by patients.

Finding the reasons why patients look for psychiatric help and the main responses given to patients’ problems by psychiatric services. Evaluating the delays occurring along the pathways.

The study has been done on 420 Italian patients. In one month, patients with a new episode of disease have been included. Each of them has been administered a questionnaire collecting socio-demographical, medical infos and data concerning health workers, timing and delays along the pathways. Diagnosis done using ICD-10 and an Intervention Detection Schedule filled for each patient.

The Carpi’s sample consists of 43 patients. The 58% has seen the General Practitioner (GP) in the first place, the 19% the hospital doctor (HD), the 16% the psychiatric worker. Nation-widely, most patients have firstly referred to the psychiatrist (34%). In Carpi, the 44% has received a diagnosis of “Neurotic, stress-related and somatoform disorders”. The 93% has been treated with psychotropic medications. The longest pathway has occurred for behavioural syndromes associated with physiological disturbances and physical factors, the shortest for affective disorders.

GP, HD and direct access are the 3 main pathways followed by patients. The importance of the GP is confirmed, so as the necessity for training of sanitary workers within the psychiatric field. A greater cooperation between general practice and mental health services should be pursued

The spousal homicide is committed on a partner or ex-partner of intimate life whatever the stature of this one. In France, it represents about 20% of total homicide. Its multifactorial origin makes its spotting complex.

The aim of this study is to determine predictive factors of acting out, by analyzing sociodemographical, psychopathological and criminological features of men committing spousal homicide.

It is a descriptive and retrospective study of 37 spousal homicides (or attempts of homicides) files judged between 1999 and 2010 by the Court of Appael of Poitiers. An important number of variables concerning the perpetrators, the victims and the facts have been searched. Then, they have been sorted to establish profiles.

Men stand for 88% of spousal homicides perpetrators. Most of them are impulsive (80,4%), have a judicial (64,8%) and domestic violence (70,3%) previous history. Half drinks excessively. The acting out is often motivated by the couple breaking up (64,8%). Homicide is frequently committed with an excessive violence (54%). Before the crime, about half of the perpetrators had expressed death or suicide threats.

Our study showed that spousal homicide is an unpremeditated act committed by men, facing the difficulty to accept their partner leaving. This crime is often linked to domestic violence and chronical alcoholism. Emphasizing these profiles allow to offer better-aimed prevention measures.

This presentation describes and analyses patient characteristics and service usage over one year of a cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity- of-care.

Data were collected from primary care patient notes (n=1150) by trained nurses from 64 practices in England, covering all service contacts from 1st April 2008 to 31st March 2009.

The estimated national rate of patients seen only in primary care was 31.1% and rates of schizophrenia and bipolar disorder were 56.8% and 37.9%. Patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Of those seen in secondary care, 61% had at most two secondary care contacts recorded in primary care notes. Median consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index =< 0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome.

Primary care is centrally involved in the care of people with serious mental illness, but primary care and cross- boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface

Although Lemogne et al, 2010 suggested that Medial Prefrontal Activity does not change after reduction of depressive symptoms, sensitivity of brain regions involved in self-referential processing to antidepressant is unknown. The main goal here was to assess with fMRI early effects of agomelatine, on self-referential processing in depressed patients.

25 acute depressed patients and 14 healthy controls were scanned before and after 7 days treatment, while performing self-referential processing task using emotional pictures. Patients were randomized to agomelatine 25mg/day (n=13) or placebo (n=12), healthy controls received placebo. Subjects were asked to evaluate pictures according to different conditions: Self (Does the picture relate to you?); General (Is the picture positive or negative?). Depression was assessed with Hamilton Scale.

Depressed patients compared to controls at baseline showed hyperactivity in dorsolateral prefrontal cortex, dorsal anterior cingulate and ventrolateral prefrontal cortex (VLPFC). After 7 days treatment, Agomelatine, compared to placebo, normalized the hyperactivity of VLPFC to healthy volunteers’ level.

Agomelatine targets specific brain structures, namely VLPFC, involved in automatic regulation of emotion during self-referential processing. These changes in brain activity at day 7 could contribute to the early clinical effects of agomelatine, suggesting an early set up of the brain for long term response and remission of depression.

Complete voice loss after total laryngectomy represents an important factor influencing the quality of life (QoL) in patients with laryngeal cancer.

To compare the QoL of the patients after total laryngectomy with the patients after partial laryngeal resection.

SF-36 Health Survey was used. The patients (aged 45-60, males) were divided into three groups: control group (n=23), partial laryngeal resection (n=22) and total laryngectomy (n=21). The following scales were used: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH): physical health cluster, and vitality (VT), social functioning (SF), role-emotional (RE), mental health (MH): mental health cluster.

The analysis of the obtained data showed impaired social-psychological functioning and well-being of the patients with laryngeal cancer compared to control group. Thus, the investigated parameters of physical health were decreased by 23,7%, and those of mental health by 22,7%. Interestingly, the group of patients with complete voice loss had impaired QoL compared to patients after partial resection. Thus, the decrease in parameters of physical and mental health in the group after total laryngectomy compared to the patients after partial resection was 12,7% and 5,5%, respectively.

Our study proves that QoL of the patients with laryngeal cancer is significantly lower compared with the control group. The voice loss negatively influences the QoL, which is proved by impairment of all investigated parameters in the group of patients after total laryngectomy compared to patients after partial resection.

Central auditory processing disorders and attention deficit-hyperactivity disorders (ADHD) have become popular diagnostic entities for school-age children. P300 (P3) event-related potential (ERP) putatively reflects central auditory dysfunctions associated with ADHD.

Detection of central auditory processing (higher auditory functioning) as measured by P300 in ADHD children. Determine the role of stimulants in central auditory processing and P300 in ADHD children for a better understanding of the nature of the deficit in these children.

Forty children with a diagnosis of ADHD according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. and 39 normal children were included in the study and were subjected to P300 ERP, audio-vocal items of Illinois test of psycholinguistic abilities.

This study found a significant difference in P300 latency, amplitude, and most of the audio-vocal subtests between the patients and the controls. This difference was obvious in older children for the Illinois test, but was not observed in P300 results.

There was a CAPD in children with ADHD (as indicated by Illinois subtests) and higher auditory central cognitive function (indicated by decreased amplitude of P300 and prolonged latency in such children). Audio-vocal abilities are more defective in older children (8-10 years) than in younger children. Children with ADHD should be assessed for CAPD. Stimulants may decrease the P300 latency and hence improve the attentive ability and auditory process.

The objective of the present study was to examine the short-term effectiveness of a 11-week chess training course for children with ADHD. This is a naturalistic, descriptive clinical intervention study.

Sample and procedure: Parents of 44 children between 6 and 17 of age with a primary diagnosis of ADHD consented to take part into the present study. Parents completed the Spanish version of the Swanson, Nolan and Pelham Scale for parents (SNAP-IV) and the the Abbreviated Conners Rating Scales for parents (CPRS-HI) prior to 11-week chess training course. Statistical Analyses: We used a paired t test statistic to compare pre- to post- intervention outcomes, and Cohen-d calculations to measure the magnitude of the effect. Statistical significance was set at p< 0.05.

After 11 weeks of these pilot programme, more than 80% of children showed improvement in the severity of ADHD. T-test revealed that children with ADHD improved in both the SNAP-IV (t=6.23; d.f.=41; p< 0.001) and the CPRS-HI (5.39; d.f.=33; p< 0.001). Our results suggest a large effect in decreasing the severity of ADHD as measured by the SNAP-IV (d=0.96) and the CPRS-HI (d=0.92)

The ability to maintain relevant information mentally while performing complex cognitive tasks, e.g. decision making, reading comprehension, and problem solving, memorizing a poem or even driving a car is conceptualized as Working Memory (WM), which became a workspace to general mental functioning. Nevertheless, as to yet, this topic is relatively ignored in literature in the Arab World.

The aim of the current investigation was to explore gender related differences in WM performance among Kuwaiti children.

The participants were 200 Kuwaiti pupils living in Farwaniyah governorate. The participants aged 128.76 ±6.75 months (100 girls aged 128.76 ±6.75 months and 100 boys aged 128.76 ±6.75 months. Moreover, the participants were identical in age, economic level and school grade. All participants in the two groups were compared on how they performed in the Automated Working Memory Assessment (AWMA), a computerized instrument developed by Alloway (2007). Independent Sample t Test was used to examine gender differences in WM performance.

The mean score for visuospatial WM boys and girls samples (13.95±4.43) and (9.23 ±4.07) respectively. It was significantly lower in girls (t=7.85, p< .001). Also, the mean score for verbal WM boys and girls samples (15.75±4.01) and (10.94 ±5.12) respectively. It was significantly lower in girls (t=7.40, p< .001).

Gender differences in working memory capacity exist. Results showed that gender contributed to the variations in WM resources, which were efficient among the Kuwaiti children. This warrants further investigation.

Providing of mental health service is the main task of every country. Its implementation obviously depends on the number of professionally active psychiatrists. So the issues of a great importance for current psychiatry are determinants and consequences of the decision of specialization in this medical domain.

The aim of our work was, most of all, the assessment of motives of the choice of specialization in psychiatry from the perspective of physicians-practitioners.

In order to do it, we prepared an original questionnaire, which contained 22 questions (some of them were of multiple choice) concerned with, i. e. sociodemographical and professional aspects. The study group was created from 132 psychiatrists (including 33 men), participating in international scientific-training conference in Wisla in 2011. Average age was 43 years (SD=9.7), and seniority in psychiatry - 15 years (SD=9.8). The obtained results were statistically analyzed using Statistica 8.0. Detailed results of our analysis will be presented during conference.

The results of our questionnaire may be used to improve the image of psychiatry as attractive path of professional career (almost 95% of questionnaired physicians do not regret their decision!).

The results may also become an essential argument during the discussion about current problems in psychiatry, for example problem of occupational burnout, and possibilities of their solution.

Schizophrenia (SCH) is one of the major and potentially severe mental illness that is characterized by both genetic and clinical heterogeneity. Thyroid hormone plays an important role in the development of the brain and nervous system both in the basic process of neurogenesis and of terminal brain differentiation. Type II deiodinase (DIO2) enzyme which has a critical role on thyroid hormone metabolism to convert pro-hormone thyroxine (T4) to the active hormone triiodothyronine (T3). Recently, DIO2 gene variations have been identified in association with mental disorders.

To investigate the potential genetic contribution of the DIO2 gene to SCH, we studied DIO2 Thr92Ala (rs225014) and ORFa-Gly3Asp (rs12885300) polymorphisms in a Turkish cohort of 290 unrelated SCH patients and 198 healthy controls. All subjects were genotyped by Taqman SNP genotyping assays.

Single marker analysis showed a positive association of SCH and rs225014. Particularly, Thr92Ala genotype frequency was significantly higher in patients with SCH than controls (p=0.045) and in male patients with SCH, both allele and genotype frequencies were significantly higher compared to male controls (p=0.03). Allele and genotype frequencies of ORFa- Gly3Asp polymorphism were no different within the study group.

These data show a potential role of DIO2 as a candidate gene for susceptibility to SCH and provide a strong evidence for a role of the DIO2 Thr92Ala allele and genotype in the etiopathogenesis of SCH with sexual difference.

Transition from adolescent to adult mental health services is extremely important since most mental illnesses start in late adolescence. Although often discussed, this issue is rarely studied.

The aim of this study is to gather information of how transition from adolescent to adult mental health services is yielded across Europe.

The study was conducted during the EPA and the IACAPAP conferences in 2012 as a joint project of the European Federation of Psychiatric Trainees and the Early Career Psychiatrists Committee. The survey contained 14 questions related to general data, situation of transition in participant’s country and participant’s opinion on the concept of transition process. It was given to the randomly chosen participants (N=397).

The questionnaire was completed by 166 European participants from 28 European Countries. They were mostly men (N= 88, 53 %) and specialists (N=107, 64.5%). Nearly half (N=76, 45.8%) have contact with transition issues at least once per month. Data analysis is in progress, but preliminary results show that more than half of participants think the transition process could be significantly improved (N=94, 56,6%), and they are manly from Italy, Portugal, Germany, Ireland and Spain. Only one fourth is quite satisfied with the current situation (N= 45, 27,1%). The latter group in mainly from the UK.

We plan to use these results to broaden the study and gather more details regarding this issue in every European country

Researches indicate that traumatized people besides development of mental and physical disorders can experience positive changes.

Investigate relationships between war trauma, social support, psychological distress and posttraumatic growth.

Determine the predictors of posttraumatic growth in war displaced persons in Bosnia and Herzegovina.

The test sample was composed of 71 refugees, who were due to war-related events been forced to leave the original residence, and their new residence is on the territory of Bosnia and Herzegovina. Subjects were recruited by snowballing method, and the starting point of inclusion in the study were acquaintances of the medical staff at the Clinical Hospital Mostar. The study used General Demographic Questionnaire, the Harvard Trauma Questionnaire-version for BiH (HTQ), Brief Symptom Inventory (BSI), Social Support Appraisals Scale (SS-A) and Posttraumatic Growth Inventory.

In the first predictive model (R2=0.053; F=4.889; P=0.030) that included BSI, HTQ and SS-A questionnaires, a linear regression analysis showed that a stronger social support leads to greater posttraumatic growth (standardized β coefficient=0.257; P=0.030), same as greater sensitivity in interpersonal relationships (standardized β coefficient=0.698; P=0.014), while growth in the number of positive psychological symptoms have a negative impact on posttraumatic growth (standardized β coefficient=-1.008; P=0.042). In the second predictive model (R2=0.043; F=1.226; P=0.299), of all demographic factors only the economic status was a significant predictor, where persons with stable economic status had greater posttraumatic growth (standardized β coefficient=0.337; P=0.040).

Social support is significant positive predictor of posttraumatic growth, which is also supported by sensitivity in interpersonal relationships.

Risk-taking (RT) and self-harm (SH) occur across the lifespan, but many types of RT and SH typically appear for the first time in adolescence. According to Vrouva, Fonagy, and Fearon (2010), it is important to measure RT and SH simultaneously because they are clinically, empirically, and conceptually linked.

1. (1) analyse the prevalence of risk-taking and self-harm behaviours in community adolescents, controlling the effect of genderand age;

2. (2) examine the link between RT and SH behaviours;

3. (3) investigate the relationship between attachment style and RT and SH behaviours.

346 adolescents (girls: n = 194, 56%) aged between 12 and 18 years (M = 15.10, SD = 1.77) completed a sociodemographic questionnaire, the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA) and the Attachment Questionnaire for Children (AQ-C).

RT behaviours more prevalent are taking chances while doing one’s hobbies, smoking tobacco and cheating. SH behaviours more frequent are self-demeaning thoughts and behaviours intentionally. Boys showed higher RT behaviours than girls. There is a positive association between age and both behaviours (RT and SH). Insecurely attached teenagers reported higher SH behaviours than did securely attached adolescents.

This study shows the prevalence of RT and SH behaviours in a community sample of adolescents, showing how gender and age can influence the expression of both behaviors. It seems that secure attachment may be protective to the engagement in SH behaviors, strengthening the important role of quality of relationships on psychological adjustment in adolescents

Barahona Fernandes (1907-1992) is considered one of the most distinguished portuguese psychiatrists and perhaps the most known outside the country. He did part of his studies in Germany, under orientation of prominent professors such as Carl Kleist and Kurt Schneider, and got contact with the philosophic theories of Karl Jaspers and Nicolai Hartmann. In Portugal, he leaded the Lisbon University Clinic where he developed his countless studies on mental health.

The authors shortly revisit the biography and some aspects of Barahona Fernandes’ works.

This communication points out the singularities of his personality and work, and draws attention to the importance of his contributions on mental health.

Review of the literature concerning the author’s publications and biography.

Through his whole work emerges the effort in a “converging view” that tries to integrate different influences and perspectives, in order to better achieve a coherent explanation of the human being. One of his theoretical models discusses the Personality - “Personalidade em Situaao” - in which he describes a complex organization based on comunicating hierarchical layers (from a biological foundation to a more noologic apex), subject to the interaction with the environmental features, in a homeostatic balance that can be disturbed.

The unique work of Barahona Fernandes constitutes an important material to apprehend the psychic experience. His “converging” theories try to capture a multi-dimensional structure of the human being and help clinicians to get a deeper understanding on the process of getting mentally ill

Collaborative care is a community based intervention which typically consists of a number of components. The intervention aims to improve the physical and/or mental health and health care of people with a severe mental illness (SMI).

• To explore how collaborative care is implemented.

• To assess the effectiveness of collaborative care approaches in comparison to standard care for people with SMI who are living in the community.

A Cochrane Review: The Cochrane Schizophrenia Group Specialised register was searched in April 2011. Fifty one experts in the field of SMI and collaborative care were also contacted.

We included one RCT (306 participants; US veterans with bipolar disorder I or II) in this review. The trial provides data for one comparison: collaborative care versus standard care The reanalysis of data from the one included study indicated that collaborative care significantly reduced psychiatric admissions at year 2 in comparison to standard care (N= 306, 1 RCT, RR 0.75, 95% CI 0.57 to 0.99). Direct intervention (all-treatment) costs of collaborative care at the three year follow up did not differ significantly from standard care,mean difference -$2981.00 (N= 306, 1 RCT95% CI $16934.93 to $10972.93).

One trial at moderate risk of bias suggests that collaborative care may significantly reduce psychiatric admissions. More large, well designed, conducted and reported trials may be required to determine the effects of collaborative care and help inform healthcare professionals and policy makers about the value of collaborative care for people with SMI