There are only few reports on the use of aripiprazole during pregnancy. In our case, the patient was treated with aripiprazole throughout the pregnancy and delivered a healthy baby.

A 31-year-old female was admitted to our hospital for the first time in 2005 as she returned from her postdoctoral studies abroad; prior to the hospitalization, psychotic symptoms had been present for a few months. She had auditory hallucinations and was expressing paranoid delusions. After the treatment with risperidone, the psychotic symptoms subsided. Because of extrapyramidal side effects risperidone was replaced with olanzapine. While on olanzapine she experienced cognitive side effects and was switched to 15 mg of aripiprazole. She achieved good remission and started working again. She got married and in 2009 she decided to stop her medication because she wanted to conceive. Without psychotropic treatment she became paranoid again after 7 months. She resumed with 15 mg of aripiprazole and achieved remission once again. In 2010, after discussing treatment options, she decided to conceive while still on aripiprazole. She got pregnant in June 2011 and in she delivered a healthy baby in February 2012 after a normal pregnancy. She didn’t breast feed. The 6-months followup showed that the baby was developing normally; the parents intend to have another child.

In the presented case the benefits of effective and well tolerated antipsychotic treatment outweighed potential risks associated with prenatal exposure. This is the second case report of the use of aripiprazole during the whole pregnancy.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by symptoms of inattention, hyperactivity and impulsivity. Arises in childhood and can persist throughout adulthood, and may cause difficulties in personal, academic, familiar, social and professional life areas of the individual.

To know and describe the parents’ perceptions of teenagers with ADHD about this disorder.

To assist in the understanding of ADHD in adolescence.

Oral thematic research with parents of adolescent assisted in a Child and Adolescent Psychiatric Clinic of Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil. The semi-structured interviews were performed with 5 families at their residences.

The analysis of parents’ narratives identified two categories: “living with a teenager with ADHD” and “adolescent with ADHD in school context”. Parents realize that they, as well as, school professionals have difficulties in dealing with the adolescent with ADHD. Recognize that since childhood their children manifest different behaviors. They mentioned lack of knowledge, information and guidance related to this disorder. They were concerned about the future of these young people and the discrimination they suffer.

Social and family relations established with the adolescents with ADHD can be characterized by constant conflicts. It is necessary to offer support and guidance to parents, with the joint participation of health care and education professionals. The approaches must be constantly evaluated to its improvement and adequacy, following the different phases of young people's development.

The internship system of some institutes and adolescence period could constitute a favorable medium to develop addiction behaviors among students.

The objective of this study is to determine the prevalence of addicted students of an Institute of the vocational training in city of Mohammedia (North-West of Morocco) and the kind of substances used in this addiction.

An epidemiological study is conducted among 460 students of this institute. These students aged from 18 to 26 years, are individually questioned about their consumption of different kinds of drugs.

The obtained results show that only 100 boys speak freely of their consumption of drugs and/or alcohol and only 6 girls confess to be smokers (tobacco) including 2 consumers of drugs. Indeed, the drug most commonly used is cannabis rolled into cigarettes (Hashish). These drugs are used regularly at least once a day and especially at night before bed to facilitate sleep. The kinds of substances used depend also on socio-economic level of students; the students from rich families consume up to 12 joints a day against some puffs of joint shared by many consumers for poor students. In addition, the poor students consume some local preparation called “maajoune” or “cala”. Alcohol consumption is casual during weekends or ceremonies.

This study is an preliminary investigation that lighted the problem of addiction among students in this vocational training institute. So, deeper researches must be done in order to determine the factors causing and/or influencing this kind of pathologic behavior.

Despite improvements in treatment for patients with severe mental disorders, such as bipolar disorder and schizophrenia, there is still a long delay from first symptoms to correct diagnosis and treatment. Since these illnesses usually manifest themselves within adolescence and young adulthood, this time lag impacts chances for an adequate individual development.

With rather unspecific symptomatology in early stages of the development of the disorders and the still existing stigmatisation, a broad and low-threshold strategy is needed. In November 2008 an early recognition and prevention centre for mental disorders was opened at the University Hospital in Dresden.

The aim of this service is to shorten the delay to correct diagnosis and treatment in severe mental disorders. In parallel, early detection instruments are developed and early intervention strategies studied in research projects.

In this specialized centre diagnostics, counselling and treatment are provided for subjects aged 12 to 40 by a multidisciplinary team in a low-threshold setting.

250 youth and young adults were offered diagnostics and, if appropriate, treatment. In about 2/3 of clients, mental disorders had already manifested themselves, in some cases an additional risk for even more severe developments was ascertained. Counselling and transfer to appropriate treatment is offered to all clients, all are followed up on a regular basis to validate the process and assess the prognostic value of our service.

A broad, low-threshold and multidisciplinary approach for early recognition and treatment of severe mental disorders holds the chance of earlier appropriate care.

Bipolar disorders (BD) are characterized by emotional and cognitive impairment reflected in functional MRI studies. Although the default mode network (DMN) would be also impaired, resting-state activity was much less explored in these patients. Our current study aims to assess the DMN functional connectivity in euthymic bipolar patients (EBP) in order to identify potential trait abnormalities of this disease.

Fifteen EBP and 15 matched healthy controls (HC) underwent fMRI exam during 6 min resting state (rest while keeping attention focused on a visual cross on a projection screen). The Independent Component Analysis (ICA) was used to identify DMN network and functional connectivity in each subject. The DMN group maps of EBP and of HS were compared statistically. Additionally, within-group analysis was performed in EBP group to explore the effect of disease duration on functional connectivity.

Compared to HC, EBP showed reduced DMN connectivity within medial prefrontal cortex, right angular gyrus and left occipital lobe as well as abnormal recruitment of right insula and right middle cingulate gyrus. For the EBP group, significant positive correlation between disease duration and functional connectivity has been observed within left amygdala and right middle cingulate cortex.

Our results revealed decreased DMN functional connectivity within frontal and parietal regions in EBP and suggest abnormal internally-focused activity in these patients. Furthermore, the abnormal recruitment of limbic regions such as right insula, middle cingulate gyrus and amygdala may reflect emotional instability and hyperreactivity of EBP, which might be amplified with the disease evolution.

Cognitive deficits belong to the most common symptoms of schizophrenia as well as of disorders related to substance abuse. It is then important to cope with those deficits effectively during the treatment of rehabilitation process of patients with dual diagnosis.

To analyze cognitive changes in patients with dual diagnosis participating in a cognitive rehabilitation program.

120 patients suffering from schizophrenia with a comorbid drug addiction were recruited to the study. All of them participated in a treatment program in a modified therapeutic community (TC) for patients with dual diagnosis. During their treatment they also took part in a program of rehabilitation of cognitive functions with a use of a computerized training battery. The cognitive functions were assessed twice: first time at the beginning of the treatment and second time after six weeks of cognitive rehabilitation. The applied neuropsychological tests were TMT, part A and B, Stroop Test and Verbal Fluency Test. The intensity of schizophrenic symptoms were measured by the PANSS scale. All participants of the study were treated with second generation antipsychotics.

After six weeks of cognitive rehabilitation all patient improved significantly in all applied neuropsychological tests. There were no significant changes in the PANSS scale results.

The above results confirm the necessity of introducing cognitive rehabilitation in therapeutic programs for patients with dual diagnosis. The above results may also be an effect of other therapeutic interventions used in the TC rehabilitation model, antipsychotic treatment or other factors, which need further investigation.

To explore the effect of depression (D) on relative risk of myocardial infarction (MI) and stroke and its relation with awareness and attitude towards the health in female population of 25–64 years in Russia.

Under the third screening of the WHO “MONICA-psychosocial” (MOPSY) program random representative sample of women aged 25–64 years (n=870) were surveyed in Novosibirsk. D was measured at the baseline examination by means of test “MOPSY”. From 1995 to 2010 women were followed for 16 years for the incidence of MI and stroke.

The prevalence of D in women aged 25–64 years was 55.2%. With growth of D levels positive self-rated health reduced and almost 100% of those women have health complaints. Women with major D significantly extended negative behavioral habits: smoking and unsuccessful attempts to give it up, low physical activity, they are less likely to follow a diet. Major D associated with high job strain and family stress. Risk of MI development in women with D during 16 years of study was higher in 2.53 times (95%CI=1.26-24.34; p< 0.05), risk of stroke was higher in 4.63 times (95%CI=1.03-20.89; p< 0.05 MI and stroke rates were more likely in married women having D with average educational level who being in both “managers” and “physical labor” social classes.

The prevalence of D in women aged 25–64 years more than 50%. Women with D had 2.53-fold risk of MI and 4.63-fold risk of stroke over 16 years of follow-up.

The literature mentions that being burned is one of the most traumatic situations that an individual can experience physically and emotionally. The burned patient has to fight the physical discomfort and the pain, as well as with early and late psychological problems, as delirium, regression, depression and altered body image.

To understand the physical and emotional pain of a group of people who suffered burns.

To understand the suffering of people who have burn injuries.

This is a qualitative participant observation study. 11 groups conducted with 10 patients in a burn unit of a public university hospital were analyzed. Meetings occurred weekly and were 30 minutes to 1 and a half hours long.

The themes related to feelings, fears and doubts resulting from the burn and its treatment were frequent. Patients could only speak of internal pain when they had space to report physical pain. In those moments, some of them could expose themselves to reveal that the burn had been an attempt of suicide. They realized that their problems, fears and fantasies related to recovery, consequences and social isolation were not unique; and they had the opportunity to share them, feeling so relieved.

The experience with the studied group identified some goals for groups with burned patients: to inform about the procedures and questions that cause anxiety; decrease the sense of isolation, stimulating exchanges, instilling hope in recovery; encourage the sharing of concerns about the consequences and social isolation; and identify destructive behaviors.

Group music/art therapy in patients with schizophrenia may not contribute to the treatment outcome but it certainly offers an opportunity to monitor patient's progress during psychiatric treatment. In our case we followed the patient's improvement through ten drawings.

A 24-year-old female psychology student was admitted to our hospital for the first time. She presented with unusual posturing, mannerisms, disorganized speech, auditory hallucinations, and paranoid delusions. According to her mother, the symptoms started about two years prior to the hospitalization. She was unsuccessfully treated with olanzapine at maximum dose. Additional treatment with a maximum dose of amisulpride also proved unsuccessful. After switching her to clozapine and aripiprazole her behavior normalized and the psychotic symptoms subsided. Because of epileptic seizures as a side effect of clozapine treatment she was given valproic acid. She achieved solid remission and was transferred to the day hospital. As an inpatient she attended group music/art therapy sessions once a week. At the beginning her drawings were abstract, disorganized and perseverative. As her mental status improved, her drawings became more and more realistic.

While it is difficult to imagine the way someone with a mental illness perceives the world, drawings produced by the mentally ill offer a hint of this experience. In itself, realistic expression is not ’better’ than abstraction; moreover, it could be ventured that in her early drawings our patient was more responsive to musical stimuli than later when her regaining control produced more organized but also more schematic and stereotypical drawings.

Expressed Emotion (EE) reflects the “emotional temperature” of a family. High EE and low EE families can be identified. The degree of family EE correlates with patients’ outcome, being a high family EE predictive of a greater likelihood of relapse, an increased need for care and inpatient treatment.

Firstly, to evaluate EE, life events and anxiety in a mixed sample of psychiatric, oncological and obese patients recruited from the Psychiatry, Oncology and Nutrition Wards of the “Maggiore della Carità” General Hospital, Novara (Italy). Secondly, to compare these parameters among the three subgroups of patients. Furthermore, we also recruited a cohabiting relative for each patient and compared the relative's EE and EE as perceived by patients.

112 patients attending the Psychiatry (n=34), Nutrition (n=56) and Oncology (n=21) Wards were involved. Patients were assessed by means of the following scales: Level of Expressed Emotion (LEE) scale, Paykel Life Events scale, State Trait Anxiety Inventory 1 and 2.

Data collection is ongoing. Anyway, preliminary results suggest that psychiatric patients are more likely to have a longstanding diagnosis, to have received inpatient care but they are less likely to suffer from comorbid organic disorders. Consistently with current literature, obese patients get higher scores than the other subgroups of patients at EE.

Clinical implications are discussed, focusing on the need to carefully address the issue of high EE families in order to reduce the need for inpatient treatment, increase compliance and improve patients’ and relatives’ quality of life.

Alzheimer's Disease (AD) surges as a major issue in public health, and so does quality of life of patient's informal caregivers, who are exposed to negative outcomes such as increasing psychological distress and burden, depression and anxiety, which are also often associated to a poor knowledge of the disease, of its symptoms and of patient's needs.

The purpose of the ITINAD project is to demonstrate the effectiveness of a psychoeducational program in reducing the negative impact of caregivers’ coping with an AD patient and in increasing the knowledge.

The study involved 185 caregivers from 10 Italian centers: 89 of them were assigned to the control group, while 96 belonged to the experimental group, which was submitted to a 12 sessions psychoeducational program that developed themes such as clinical aspects of the illness, relatives’ roles and coping strategies. Socio-demographic data for the caregivers were analyzed, while the Hamilton Rating Scales were used to assess the symptoms of anxiety (HRSA) and depression (HRSD); the Psychological General Well-Being Index (PGWBI) measured psychological distress; the QPF (Familiar Issues Questionnaire) was used to evaluate caregivers’ burden and their consciousness towards AD.

Caregivers belonging to experimental group showed a significant decrease in anxiety (p=0,00) and depression (p=0,00); the program led also to a better self control in caregivers as shown by the PGWBI (p=0,04). The QPF demonstrated an improvement in AD's symptoms’ management (p=0,00).

These findings suggest the utility of a psychoeducational group in preventing negative outcomes in AD's caregiver.

Violence is one of the most serious forms of discrimination on account of sex /gender. It is a phenomenon that affects women of different social classes, ethnic and professional groups. Some of these women end up involved with situations that leads them to imprisonment.

To identify histories of gender violence in a feminine jail population; to analyze the relation of this violence with the imprisonment.

Understand the circumstances of gender violence that imprisoned women were exposed.

Thematic oral history research, carried out at the Female Penitentiary in Ribeirão Preto (SP) - Brazil. A semistructured interview was applied to 15 female prisoners.

The analysis of the prisoners’ narratives allowed the identification of two categories: “involvement with criminal partners” and “victimization and violence cycle”. In both, the interviewed women understood that they were dominated by men and considered the violence against them deep-rooted in human culture. They claimed that their involvement in criminal activities, mainly drug trafficking, was under the influence or enticement by companions. Some of them were arrested because they carried drugs to their partners inside male penitentiaries. They said that they had no alternative to the criminal activity as there were no social support and opportunities.

The complexity of violence against women makes necessary the implementation of health, social assistance and education public policies that comprise combat, prevention, assistance and assurance of women’s rights.

A modest body of research has emerged documenting the characteristics of 170 PICU populations in the UK (2006). No specific data is available about Crisis Management of patients diagnosed with Borderline Personality Disorder (BPD) in Female PICUs.

To offer the first service evaluation project in the UK of the BPD group in PICU and to review compliance with the NICE guidelines, ‘Borderline Personality Disorder: Treatment and Management’, 2009.

To measure rates of compliance with NICE guidelines as a gold standard.

Retrospective cross sectional review of patient records.

The project included data of 46 admissions (from 2007 to 2010). Ninety-seven percent of patients were White British. The median length of involvement with mental health services prior to the first admission to ECH was 12 years. Seventy percent of patients showed mixed engagement with services. All patients presented with complex needs, all were detained under the Mental Health Act. The commonest primary reason for admission was self harm or threatening behavior. Seventysix percent of patients were provided with the copy of the multi-disciplinary care plan at the time of admission. Antipsychotic polypharmacy and prescription of antidepressants was reduced during the admission. In 80% of admissions discharge planning was discussed with the patient and documented. In 54% of discharges the care coordinator was involved and at discharge 26% of patients were informal.

Specific target criteria in the NICE guidelines were not complied with fully. For 85% of admissions the initial purpose of admission was fully achieved.

The participation rates in epidemiologic studies have declined in recent decades. Missing data reduce sample size, statistical power, and scientific quality.

To study use of home interviews in recruiting individuals with a psychosis.

To evaluate effect of home-recruitment on non-response bias.

In the Northern Finland 1966 Birth Cohort, field surveys on psychosis were conducted in 1999-2001 and 2008-2010. In order to increase participation in the follow-up sample, cases were offered to be interviewed at home. We studied symptoms, illness severity, functioning, cognition, antipsychotics use, and grey matter (GM) volume between home-recruited and regular participants (RP), and non-participants (NP). Effect sizes (d) were calculated to compare the differences.

Altogether 18 (33%) out of the follow-up sample (n=54) were home-recruited, 27 did not participate. Home-recruited had more symptoms, lower functioning, cognition and GM volume, and they had used more antipsychotics compared to RP and NP in baseline. NP did not differ from RP. The same differences occurred when home-recruited were compared with RP in the follow-up study.

[Selected information from baseline study]

Owing to the home-recruitment we were able to collect data that may be reasonably non-biased in terms of nonresponse bias, which will yield valid estimates in our future studies on change over time in brain and cognitive ability, prevalence and severity of psychotic illnesses, outcome, medication use, and other issues of interest.

Men make up approximately 10% of the diagnoses of specified Eating Disorders (ED), with Bulimia Nervosa more common in men than Anorexia. However, Eating Disorder Not Otherwise Specified (EDNOS) are more prevalent in men than Anorexia and Bulimia combined. Rates of concurrent depression and personality disorders are also high in men with EDNOS, as well as rates of medical co-morbidity.

To describe a sample of male patients attending a Psychiatric Day Hospital.

To understand possible links between the diagnosis of ED and medical and psychiatric co-morbidity among male subjects.

Clinical data about male patients attending the Psychiatric Day Hospital of Modena from 05/01/2009 to 13/06/2012 were collected and analyzed. Psychiatric diagnoses were defined according to DSM IV criteria, medical comorbidities according to ICD10 criteria.

Male patients with ED were on the whole 11 (7.9% of total patients). Nine of them (81.8%) were diagnosed with EDNOS; 7 had medical co-morbidity, namely gastrointestinal (36.4%), respiratory (9.1%), renal (9.1%), rheumatologic (18.2%), cardiac (9.1%) and hypertension (16.6%); 9 had psychiatric co-morbidity, namely personality disorders (46.2%), major depression (30.8%), substance abuse (15.4%) and anxiety disorders (7.7%). Only 1 male patient (9.1%) was suffering from the ED, with no medical or psychiatric co-morbidity.

Male patients suffering from ED are increasing and knowledge on their clinical features are less clear than for female subjects, resulting in a more difficult and less effective clinical management. Despite the small sample size, this study attempts to increase the understanding of this clinical population.

Long duration of untreated psychosis (DUP) has been associated to brain morphological changes in schizophrenia in cross sectional analyses. It is unclear DUP relates to brain volume change over time.

Our aim was to analyze the association between length of DUP and total brain volume change in schizophrenia in a general population based sample.

All members of the Northern Finland 1966 Birth Cohort (NFBC1966) known to have had psychotic illness were invited for a field study at the age 34-years (in average 10 year after onset of psychosis) and follow up nine years later at the age 43-years. DUP was assessed from medical records. The total brain volume scan interval change and the DUP information were available for 32 subjects with DSM III R schizophrenia. We analysed the correlation between length of DUP and the mean annual whole brain reduction, adjusted for age of illness onset and sex.

The mean annual whole brain volume reduction was 0.66%. The reduction was 0.76% among those with shortest DUP, 0.58% among those with median DUP, and 0.63% among those with longest DUP. There was no statistically significant correlation between DUP and annual brain volume change when adjusted for onset age and/or sex.

We did not find an association between long DUP and brain volume decrease in schizophrenia in 9 years follow up. Although long DUP has been associated with differences in brain volume in cross sectional analyses, the significance of DUP on brain morphology in long term is unclear.

Standardised and timely restricted care for anxiety disorders has replaced former treatment in the Mental Health Services in the Capital Region of Denmark. Currently, there is no documentation regarding the impact of treatment standardisation on patient outcome and on service delivery.

The aim is to investigate

1. i) the effect of standardised treatment on patient outcome, and

2. ii) the implementation outcomes of standardised treatment programs for anxiety disorders in clinical practice.

The study is conducted as a quasi-experimental prospective pre-post study in a naturalistic setting in which patients are referred randomly to the two mental health centres. Patients included in the study are aged above18 years and referred to standardised treatment for anxiety disorders (F40-41). The Conceptual Model of Implementation Research [1] distinguishes between outcomes at three different levels: implementation, service and client (patient), and argues that client outcomes depend on outcomes of the previous levels. This study includes outcomes at all levels. The clinical outcome data include the Symptom Check List-90R, Beck Anxiety Inventory, Global Assessment of Functioning and WHO Wellbeing Index.

The first patient was included in October 2012. The study design will be described in details and preliminary results presented.

From January 2013 standardised and timely restricted care for anxiety disorders are introduced at a national level in Denmark, which further increase the relevance of the present study.

Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient’s life quality.

To investigate the correlation between anxiety, pain and perceived family support in a sample of lung cancer patients.

The sample consists of a total of 101 lung cancer patients hospitalized at the oncology department of a general hospital. Anxiety, pain (severity and interference) and perceived family support were assessed using Spielberger’s State - Trait Anxiety Inventory (SSTAI), the Brief Pain Inventory (BPI) and the Family Support Scale (FSS) respectively.

Analysis showed that there is a correlation between anxiety, pain and family support as perceived by the patients. Pain intensity (severity and interference) has a positive correlation to both state and trait anxiety and a negative correlation to family support. The effects of pain in everyday life also exhibit a positive correlation to state and trait anxiety and a negative correlation to family support. Anxiety (state and trait) has a significant negative correlation to family support.

Pain intensity in lung cancer patients seems to have an effect on patient anxiety and perceived family support. Treating patients’ pain could lead to a decrease in anxiety symptoms as well as an increase in perceived family support.

Lithium remains the gold standard of prophylactic treatment in bipolar disorder. However 10–40% of patients are not responder to lithium and there is still no operational predictive markers of lithium response. Moreover, previous studies relate some conflicting results due to the absence of an unanimous definition and evaluation of prophylactic lithium response. Our objective was to identify clinical factors associated with prophylactic lithium response assessed by Alda questionnaire that includes 6 categories of prophylactic response from no response for at least two years of treatment to no relapse for three years.

To study characteristics associated with lithium response.

All 516 participants met the DSM-IV criteria for bipolar disorder. They all received at least once in their life lithium (for at least two years) and all completed the Alda questionnaire. They were compared on several sociodemographic and clinical factors which were collected using the DIGS. Psychological dimensions were assessed with the ALS and AIS (for affective lability and instability), the BIS (for impulsivity) and the WURS (for ADHD screening) and history of childhood trauma.

Among the 516 subjects, 132 (25,6%) were lithium responders with no relapse during at least two years of treatment; 106 (20,5%) were poor lithium responders. These groups were compared for clinical, dimensional and childhood trauma characteristics, using both univariate and multivariate analyses.

Characteristics associated with lithium response may help to define personalized strategies.