Cocaine, already a significant drug problem in North and South America, has become a more prominent part of the European drug scene. No specific effective pharmacological treatment is available for cocaine addiction, although a number of medications have shown promising results. Behavioural therapies have demonstrated some effectiveness and are currently the standard type of treatment for cocaine addiction. At the present time, Cognitive-Behaviour Therapy (CBT) and Contingency Management (CM) techniques have the strongest empirical support for application with cocaine users. Cognitive behaviour approaches, such as relapse prevention, are grounded in social learning theories and principles of operant conditioning. Several randomised clinical trials have demonstrated the efficacy of cognitive-behaviour therapy (CBT) in the treatment of cocaine-dependent outpatients, particularly more severely dependent cocaine users and depressed. Contingency management approaches are based on principles of behavioural pharmacology and operant conditioning. It is a procedure that decreases the reinforcing efficacy of cocaine via the delivery of reinforcement contingent on abstinence and/or the delivery of punishment contingent on cocaine use. The two most commonly used CM strategies for treating cocaine and stimulant use disorders are voucher-based reinforcement therapy extensively investigated by Higgins and colleagues, and variable magnitude of reinforcement popularized by Petry and colleagues. CBT and/or CM possibly have additive effects when combined with pharmacotherapies.

A variety of other types of behavioural treatment like motivational therapy (MT), community reinforcement and the Matrix model have also been shown to be potent interventions for cocaine addiction. These behavioural interventions, excepted CBT and MT, are not used in France. It seems necessary to evaluate these approaches.

To date, there is an absence of curative treatment for very early onset schizophrenia. The antipsychotic drugs that are currently recommended have very little effect and are often badly tolerated by children. We report a case-study which results show a beneficial and significant efficacy of fMRI-guided rTMS in the treatment of pharmaco-resistant hallucinations. Moreover, rTMS applied over several cortical regions provided the means to reveal for the first time a functional dissociation between auditory-verbal hallucinations and agency impairments. These results demonstrate the efficacy of rTMS for young patients suffering from drug-resistant hallucinations but they furthermore question the physiopathology of the hallucinatory process by suggesting that agency and hallucinations may be sub served by different neural networks.

In neuropsychiatric disorders, serotonergic dysfunction may contribute to negative affect in alcoholism and major depression, while dysfunction of central dopaminergic neurotransmission has been associated with motivational disorders in addiction and schizophrenia. Animal experiments revealed that 1) neurodevelopmentally early social isolation stress exposure is associated with altered serotonin turnover and transporters and 2), neurodevelopmentally early lesion of the temporolimbic cortex is associated with increased striatal dopamine release. In human studies, dopamine and serotonin transporters and receptors interact with central processing of reward-indicating and affectively positive and negative stimuli, and specific alterations in these interactions can be observed in schizophrenic, alcoholics and affective disorders. Monoamine effects on central processing of emotionally salient stimuli are genetically influenced, and besides single gene effect, gene-gene interactions have been postulated. Additive gene-gene effects are often assumed but difficult to test in behavioral genetics due to the small explained behavioral variance. Processing of unpleasant stimuli in the amygdala has been associated with a functional polymorphism (val158-met) in the catechol-O-methyltransferase (COMT) gene and independently with a functional polymorphism in the regulatory region of the serotonin transporter (5-HTT) gene. 5-HTT function may also be affected by a recently detected A/G exchange in the long allele (insertion) of the 5-HTT regulatory region. In individuals with more COMT met158 alleles and with more s or lG alleles of the 5-HTT regulatory region, aversive stimuli elicited greater neuronal activity in the bilateral amygdalae and hippocampi. These genotype effects were additive on amygdala and hippocampus activation by aversive versus neutral stimuli, indicating that COMT val158-met and 5-HTT genotype were additively associated with increased processing of aversive stimuli in the amygdalae. Functional brain imaging may be used to assess the interaction of multiple genotypes on neuronal activation in neuropsychiatric disorders.

One hundred consecutive Turkish female immigrants referred by their General Practitioner to a mental clinic between 1998 – 2000 were assessed for their social background, educational, linguistic capabilities and support network. They were assessed for their mental health problems and were given psychiatric diagnosis including mixed anxiety depression, panic attacks, PTSD, obsessionality and severe mental health problems i.e. bipolar affective disorder and psychosis.

7 years later the same cohort were reviewed for their psychiatric problems.

It is interesting to note that 75% of all women who warranted a psychiatric diagnosis on the first assessment were free of symptoms on the second assessment. They had aclimatised to their host country and had improved psychologically.

The study will present the personal and social factors that contributed to the psychological well-being, stability and integration of this cohort.

Clinical experiences in war areas: Croatia for Bosnian Women, Rwanda and kabul

1. 1. Immediate reaction

   1. 1.1 Disclose of war rape in medical secrecy following

   2. - Mental health acute disorder

   3. - Genital Infections or haemorrhages

   4. - and mostly when women got unwanted pregnancy

   5. 1.2 Unwanted pregnancies may be an indicator of war rape

   6. - Some women disclose rape during the first trimester and ask for terminations even if the country has not legalized abortion in its law.

   7. - Other book lately their pregnancy because either they conceal it to their family or they deny it. Some experience harmful or violent thoughts against the fetus. Newborns are at risk of neonaticide and abandonment at birth. Some do not want to disclose their identity while coming to maternity wards.

   8. 1.3 A collective panic may happen if the war rape is disclosed in the media. In this case every effort should be made to prevent stigmatization of babies born as the result of war rape.

2. 2. Long-term reaction

3. Most of women victim of war rape keep silent for a long time.If they develop symptoms like depression, PTSD, social phobia, sexual dysfunction, psychosomatic diseases, etc., they may disclose later the abuse during a medical examination, another pregnancy, a psychiatry follow up or a psychotherapy.

4. Women who have brought up children as the result of rape may ask child psychiatrists for managing their boundings and their questions.

Mental health care shifts from the hospital to the community. Belgium has a nation wide network of specialized mental health centres for the community treatment of sexual offenders. These centers are linked to three centres of reference, one in Flanders, Wallonia and Brussels. Our Flemish reference centre (Universitair Forensisch Centrum, www.ufc.be) treated and/or assessed 835 sexual offenders or patients with abnormalities of sexual preference (paraphilias). Most of them are sexual abusers of children or adolescents (87%). We developed an original out patient treatment program based on cognitive behavioral therapy combined if necessary with medication (SSRI or hormonal therapy).

The following problems will be presented and discussed:

• • A multi step treatment model in order to enhance the motivation and adherence of the offender for the proposed treatment

• • The best interest of the patient versus public safety issues in the treatment approach

Catamnestic studies of sexually abused children have found an elevated risk of adulthood offending. Studies among offenders have repeatedly reported an elevated prevalence of childhood sexual abuse (CSA), especially among sex offenders. This study aimed to examine differences between offenders with and without a history of CSA. From correctional and court files socio-demographic, psychiatric and criminological data were collected for a representative sample of violent (n = 292) and sex offenders (n = 159) in the Canton of Zurich, Switzerland. Logistic regression analysis showed sexually abused offenders differed substantially from those not sexually abused. They were more likely to have grown up under a combination of distressing living conditions, to be mentally ill, and to prostitute themselves. They were also more likely to commit a sex offence, to have a pertinent criminal record (OR = 2.6) and a history of court-ordered therapy (OR = 2.6). The findings corroborate the association between CSA and sex offending. CSA appears to be associated with persistent offending and lack of therapy success.

Violent and aggressive behavior in prison is considered to be a constant problem in most penal institutions and it not only poses a threat to prison staff and fellow inmates, but is also a source of additional cost. An early identification of inmates who tend towards violent or ag-gressive behavior in prison should therefore be a central goal, in order to both protect the staff and other inmates from becoming victims of violent actions and to lower the overall costs of the penal system. Furthermore in-prison behavior is suspected to be good predictor of legal probation after release to the community. There is an ongoing debate concerning the useful-ness of actuarial risk assessment instruments in predicting intramural violence as studies on their predictive validity show mixed results. In this study the predictive validity of PCL-R, PCL:SV and the VRAG for different types of prison misconduct (violent and verbally violent infractions) was examined on a sample of 106 violent and sex offenders of the largest Swiss state penitentiary.

The relationship between physical violence and PCL-R score was not significant but the sum score did predict the occurrence of verbal aggression. For the PCL:SV and the VRAG similar results were found as there were significant effect sizes for verbal aggressive behavior of sex-ual offenders but not for violent offenders.

These results highlight the need for further research on the usefulness of risk assessment instrument in the prediction of intramural violence.

Suicidal behaviours comprise significant part of the workload of Accident and Emergency (A&E) departments. In the UK around 140,000 young people present to A&E with self harm, and there are 6000 deaths from suicide each year. Substance misuse is an acknowledged risk factor for suicide and self harm: the mortality of substance misusers is between 9-16 times higher than the general population. The UK has some of the highest levels of substance misuse in young people in Europe, this relationship give rise to particular concern.

Previous self harm is the strongest predictor of subsequent suicide. Thus it is important to detect and treat effectively as it is estimated that approximately 20% of suicides are likely to be preventable. Indeed, reduction of suicide is a key aim of the National Suicide Prevention Strategy which has a specific objective of promoting the mental health of substance misusers.

However, the indications are that self-harmers are not receiving adequate assessment and treatment. Furthermore, while some forms of psychological and pharmacological treatments are effective for self harm, these results are limited. Most studies do not include substance misusers or have substance misuse as an outcome measure. Effective treatment interventions for substance misusers generally do not focus on suicide or self harm. Indeed, such patients are often excluded. Recent epidemiological evidence that that suggests that attendance for substance misuse treatment may impact upon suicide will be outlined, and the clinical practice and policy implications will be explored with reference to young people.

The treatment of alcohol withdrawal with delirium implicate evaluations of multiple factors and even numerous guidelines are available the clinical practice shows important differences between centres.

The purpose of study is to evaluate the pharmacological intervention in delirium tremens in different Romanian settings.

Alcohol related visits account for 10 to 46 % of all emergency department visits each year (D'Onofrio et al. 2006; Nassisi et al. 2006; Baleydier et al. 2003). This presentation focused on psychiatric guidelines and the clinicians’ position about the management of agitation due to substance intoxication. American Psychiatric Experts' recommendations (Allen, 2005) for managing agitation are discussed.

The use of psychiatric validated scales to assess agitation seems to ameliorate the quality of care in emergency psychiatry. Several standardized tools could be useful for assess a diagnosis of alcohol abuse or dependence in emergency for adults and adolescents (AUDIT, CAGE, CRAFFT, et RAPS-QF), even if the clinicians are often sceptical about this issue.

The use of medication to protect the patient, staff and to prevent an escalation of violence remains a personal choice for each practitioner, depending on individual patient needs and context. In the treatment of agitation due to substance intoxication in emergency, a balance needs to be found between the subjective dimension and data issue from evidence based medicine.

Personality disorders represent the dominant background features in evolution of addictive behaviours. In psychiatric emergency units these kind of conducts are able to start or maintain psychopathological manifestations and behaviours which have at their limits manifest selfaggression and on others and the irreversible failure of vital organs.

We have evaluated these specific conditions considering the main premorbid personality dimensions in two groups of pacients on records of Psychiatric Clinique 2 from Tg. Mureş.

The agravant and/or pathoplastic role of personality disorders is confirmed, considering that it influents also – and sometime in a decisive way – the compliance and efficiency of therapeutic relation and of rehabilitation strategies.

The presence of a personality disorder proves itself to be also a predictive factor for the precocity of psychopathological manifestations which require emergency assistance as well as for the frequency and complexity of associations between them.