In the discussion of the inclusion of an at-risk syndrome of psychosis in DSM-V, the validity of current at-risk criteria had been questioned based on studies reporting much higher prevalence rates of psychotic-like experiences in general population samples (GPS) compared to psychotic disorders. Thus the 3-month prevalence of at-risk criteria and symptoms in GPS, age 16–35, was assessed by trained clinicians in telephone interviews using established standardized assessments.

Of 85 enrolled persons, 60 persons (70.5%) participated, two of them met exclusion criteria (psychosis, language problems). The 22 psychopathological at-risk symptoms were assessed for their occurrence and severity within the three months prior to the telephone interview using the

1. (i) Schizophrenia Prediction Instrument, Adult version (SPI-A) and

2. (ii) the Structured Interview for Prodromal Syndromes (SIPS).

Only one person (1.7%) fulfilled ‘attenuated psychotic symptoms’ (APS)-criteria according to SIPS. At 1.7%, the 3-month prevalence of at-risk criteria was rather low; at 20.7%, the prevalence of sub-threshold at-risk symptoms, however, was much higher. Yet the presence of these sub-threshold symptoms was already associated with lower psychosocial functioning and with psychiatric axis I diagnoses.

Decreased levels of polyunsaturated membrane fatty acids (PUFA) and increased activity of cytosolic phospholipase A2 (PLA2) enzymes (key regulating enzymes of membrane remodelling and PUFA availability) are supporting pillars of the “membrane phospholipids concept of schizophrenia”. Assuming that membrane PUFA profile and PLA2 activity are altered during the at risk phase of disorder and influenced by fatty acid supplementation, we investigated PUFA profiles and PLA2 activity simultaneously in ultra high-risk (UHR) subjects before and after (n-3) fatty acids supplementation.

In 81 UHR patients (aged between 13 and 25 years) PUFA levels were assessed in erythrocyte membranes using gas chromatography, and cytosolic PLA2 activity was measured in blood serum using a fluorometric HPTLC-based assay. Measurements were performed before and after a 6 month interval of placebo-controlled supplementation with n-3 fatty acids.

At baseline significant associations were found between (n-9) and (n-6)-PUFA levels and psychopathology (especially in negative symptoms) assessed by the PANSS according to PACE criteria. (n-3)-PUFA supplementation caused significant changes in (n-3)- and (n-6)-PUFA levels and a significant decrease of PLA2 activity.

Our results support associations between membrane biochemistry and psychopathology (especially negative symptoms) in people at risk to develop psychosis. Supplementation of n-3 PUFA increases PUFA availability at membrane level and modulates membrane repair and remodelling processes. Assuming that PLA2 activity reflects neuronal damage, PUFA supplementation might unfold neuroprotective effects.

Medical education could contribute to the lower appraisal of quality of life in student population.

The aim of the study was to estimate the predictors of higher subjective perception of quality of life among medical students, i.e., to identify association between certain sociodemographic and academic characteristics of students and quality of life.

Sample consisted of 310 medical students of Belgrade University. We used sociodemographic questionnaire and Flanagan Quality of Life Scale (QOLS) for assessment of the subjective perception of quality of life across five categories and fifteen scale items.

In medical students’ population, the predictor variable of worse perception of quality of life was a failed year (F = 2,30, p < 0,05). The other features of study participants (gender, age, grade year, average grade, marital status, parenthood and place of living) were not in a correlation with quality of life.

There is a need for maintenance and improvement of quality of life among medical students in order to create competent physicians.

Parental self-efficacy indicates how effectively parents can manage their parenting responsibility and acts as a predictor of the behavioral and emotional adjustments of children.

Current study was conducted to examine the influencing factors on parental self-efficacy of 2–6 year old children's mothers.

The present study is a descriptive-post hoc study. 350 mothers were selected from 15 kindergartens of 3 area of Tehran, by multistage sampling method. They completed Rosenberg's self-esteem scale (Rosenberg, 1986), Parental Bonding Questionnaire (Parker et al., 1983), Parenting stress Index (Abiding, 1995), Sources of Social support scale (Koeske & Koeske, 2002), Maternal efficacy Questionnaire (Teti & Gelfand, 1991) and Preschool Behavior Checklist (McGuire & Richman, 1986). Stepwise regression analysis showed that parenting stress, children behavioral problems, mother's self-esteem and parental distress subscale from parenting stress index, in four steps, could explain 32% of variance in maternal self-efficacy.

Parental stress, children's behavioral problems and mother's self esteem are important factors in maternal self-efficacy. Therefore, interventions regarding mentioned factors, can enhance maternal self-efficacy and prevent maladjustments related to mothers and children.

To understood the influence of group psychotherapy to crisis frangibility and coping style in community residents,seek the methods and value of community psychological coping intervention,and provide the basis of psychological theory and practice for the work of community mental health.

The scale of crisis frangibility and BCQ were employed to evaluate and compare the mental state before and after intervention.

1. 1) Crisis frangibility of residents was negatively correlated with positive coping,positively correlated with negative coping.

2. 2) After group psychotherapy,scores of scale for crisis vulnerability and negative coping droped.

3. 3) Through the regression model analysis, the linear relationship between positive coping factor and the crisis vulnerable is closest.

9 Group psychotherapy in community is a effective method to reduce resident's crisis frangibility,and the setup of experimental model has provided the theory and the practice basis for development psychology counseling in community.

Although repetitive Transcranial Magnetic Stimulation (rTMS) is frequently used to examine emotional changes in healthy volunteers, it remains largely unknown how rTMS is able to influence emotion.

In this sham-controlled single-blind crossover study using fMRI, we examined in 20 right-handed healthy female volunteers whether a single high frequency (HF)-rTMS session applied to the left dorsolateral prefrontal cortex (DLPFC) could influence emotional processing while focussing on blocks of positively and negatively valenced baby faces. The task instruction was to focus on one's own emotional status elicited by the visual stimuli.

A single HF-rTMS session selectively influenced the processing of positively and negatively valenced baby faces. When positive information was being processed, one active left-sided HF-rTMS session resulted in enhanced neuronal activity in the left superior frontal cortex (Brodmann area 10) and right inferior parietal cortex (Brodmann area 39). When negative information was processed, one active stimulation session attenuated neuronal activity in the right insula, while sham stimulation did not.

These observations suggest that after one active HF-rTMS session, psychophysiological reactions while processing withdrawal-related stimuli decrease. The increased neuronal activity while processing of positively valenced baby faces might reflect enhanced task-related processing caused by the neuronal activation of the left DLPFC, which could indicate that females are more able to empathize with the depicted happy baby faces. Our results add further evidence as to why HF-rTMS applied to the left DLPFC might improve mood in depressive populations.

Electroconvulsive Therapy (ECT) is a safe and effective technique widely used in our area. Scientific literature related to the application of this technique is continuously developing, specifically with regard to the placement of the electrodes, the amplitude of the stimulus pulse administered, the initial charge used, and the anesthetic agent involved.

The primary aim of this study was to analyze technical variables associated with the use of ECT in our hospital, and compare them to the guidelines of the protocol developed in our hospital and international standards.

We performed a review of Clinical Histories of the patients that were treated with ECT in the “Hospital 12 de Octubre” (Madrid, Spain), in the period comprised between January 1st, 2008 and December 31st, 2009. We collected data related to the application of the technique, socio-demographic variables and clinical profiles. We used descriptive statistics to analyze our data.

During this period, 602 ECT sessions were applied. Placement of the electrodes was unilateral in 58% of subjects with Affective Disorders and 8% of subjects with Schizophrenia. The amplitude of the stimulus pulse was 1 ms. Mean charge administered in the initial and final session was 236.85 mC and 357.16 mC, respectively. Etomidate was used as anesthetic in 68% of cases.

ECT technical variables applied in our hospital are adjusted to guidelines of our area and international recommendations. Longitudinal studies are warranted in order to objectively assess techinical variables associated to ECT.

Psychotic symptoms in depression are indicators of severity and poor prognosis. It usually requires psychopharmacotherapy with antidepressants and antipsychotic agents and it may even require electroconvulsive therapy (ECT).

To review the indications of ECT in major depression through the study of a clinical case of a patient admitted in an indoor psychiatric unit.

A 64-year-old woman diagnosed as bipolar affective disorder 20 years ago. Her first manic episode required hospitalization. Afterwards, she remained clinically stable for 18 years with pharmacotherapy with lithium. Lately she was admitted due to a major depressive episode with psychotic features (injury delusions, ruin and catastrophe). Antidepressant and antipsychotic treatment was added, improving her symptoms. However, she had to be readmitted two months later with severe psychotic symptoms that did not improve with pharmacological treatment. ECT was added to her treatment. She improved after a few sessions. During the last years, she has presented depressive episodes with psychotic symptoms at least once a year, and all of them have required ECT.

ECT is an alternative to pharmacological therapy in depression with psychotic symptoms in patients with no response to drugs. According to studies and clinical practice, ETC has been effective as we see in this case. Therefore, ECT is a technique to consider in major depression, not only in patients who do not respond to drug therapy but also in those who do not tolerate psychopharmacological, who suffer from severe or psychotic symptoms, suicide thoughts or those, psychomotor agitation or stupor.

Of patients with depression, up to 20–30% are treatment-resistant. DBS is being investigated as a novel therapeutic modality that could be effective in this group.

Summary of clinical experience with DBS for treatment-resistant depression.

Review of published literature.

DBS is undergoing trials for use in patients with major depression unresponsive to pharmacotherapy, cognitive therapy and electroconvulsion. Targets include the subcallosal cingulate gyrus, the nucleus accumbens, the anterior limb of capsula interna, the hibernula and the lower thalamus stem, areas shown by PET-scan studies to be crucial in development of depression, anxiety and anhedonia.

In published studies, more than 50% of patients have responded or entered remission, as observed by score drops in the Hamilton and Montgomery-Asberg Depression Rating Scales, results that have been sustained over time. Post-op scans of responsive patients demonstarate reduction of both blood flow and metabolic hyperactivity in aforementioned areas- especially the cingulate gyrus- and other cortical and subcortical regions, and an increase in prefrontal blood flow, suggesting that DBS acts by disrupting pathological activity and normalizing function in near and adjacent circuits.

DBS is reversible and adjustable with rare complications: wound skin infections, headaches and hemorrhage, while temporary mood changes, paresthesias, anxiety and autonomie disturbances are easily treated with stimulation adjustments.

DBS has shown promise as new therapeutic means for unresponsive patients. With clinical trials multiplying and neuroimaging providing insight for possible targets, its applications are to become more common in resistant depression and other psychiatric disorders.

Electroconvulsive therapy (ECT) is a safe and effective treatment for certain psychiatric disorders. It has long been known that ECT can produce deficits in anterograde, retrograde memory and non-memory-related cognitive functions.

Our research is focused to test selected cognitive abilities of patients undergoing electroconvulsive therapy. Our main concern was focused on changes in memory, attention, psychomotor speed and intellect.

Changes in cognitive abilities were assessed in 30 patients from the 1st Department of Psychiatry, University of P.J.Safarik in Kosice before and after ECT treatment session. To assess changes in cognitive abilities we have used Rey-Osterrieth Complex Figure Test (REY), Attention-Concentration Test (ACT), Trail Making Test (TMT) and Intelect Potential Test (TIP).

We have observed statistical significant improvement in visual and short-term memory test (preECT REY 10,92 ± 6,7 vs postECT REY 12,73 ± 5,06, p = 0,047), statistical non-significant improvement in psychomotor speed test (preECT TMT 68,88 ± 45,13 vs postECT TMT 65,15 ± 49,74, p = 0,062), statistical significant improvement in attention-concentration test (preECT ACT 0,74 ± 0,3 vs postECT ACT 0,85 ± 0,16, p = 0,021) and statistical non-significant improvement in intellect potential test (preECT TIP 7,45 ± 7,37 vs post ECT TIP 8,28 ± 6,45, p = 0,142).

Further research is required to determine changes in cognitive abilities associated with ECT in homogenous patients’ population. The validity and limitations are discussed.

The electroconvulsive therapy (ECT) is an ancient treatment used in psychiatry but sometimes has been forgotten, considered outdated. Since 2008 with the new electroconvulsive protocol in use elaborated in the Hospital of Zamudio, this therapy is part of the usual clinical practice, mainly in the medium stay unit.

The principal aim of this project is to describe the profile and the programs of ECT sessions given to hospitalized patients in a medium stay unit during 2009.

19 of the 344 patients hospitalized in this unit in 2009 need electroshock therapy. Each patient received an initial amount of sessions, in average 5-6, considered as part of what is commonly known as Treatment electrotherapy (sessions required to psychopathological stabilization or remission).

Most of this patients (68,42%) required Maintenance electrotherapy (sessions needed to consolidate the clinical improvement and stabilization achieved with the Treatment electrotherapy) but 15,38% of them refused to continue with the sessions and the treatment. During maintenance electrotherapy, sessions are initially weekly and gradually less frequent.

The profile of the standard patient receiving ECT is woman, between 40 and 65 years old and who suffers from Recurrent Major Depression.

Since the protocol established in 2008, a year has been enough to normalized the use of ECT in a medium stay unit.

ECT is a personalized therapy with different applications in each patient, although the indications and objectives followed are almost the same and are protocolized, because the response, the adverse effects etc have to be taken into account.

Research on deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) shows promising effects on symptoms severity.

To compare outcomes between DBS and bilateral capsulotomy on general functioning, personality traits and quality of life.

Consecutive patients with severe and treatment refractory OCD underwent DBS in the anterior limb of the internal capsule (DBS; n = 14) or anterior capsulotomy (CAPS; n = 14). They were tested before surgery (baseline-BL) and after a mean follow-up time (FU) of 19 months (range 14-31 months). Changes in OCD severity were recorded and global assessment of functioning, personality traits, and quality of life were compared between groups.

Statistically significant differential improvements (p < 0.05, Bonferroni corrected) were seen in

*General assessment of functioning (Mn ± 95%CI) GAF: DBS_BL:32.9 ± 3.6; DBS_FU:68.6 ± 7.2; CAPS_BL:35.0 ± 2.7; CAPS_FU:56.4 ± 5.9)

*Personality traits on MMPI (T-score Mn ± 95%CI) Scale 2-depression: DBS_BL:83.7 ± 6.5; DBS_FU:61.9 ± 6.3; CAPS_BL:81.2 ± 8.6; CAPS_FU:77.6 ± 8.7 Scale 9-mania: DBS_BL:48.8 ± 7.3; DBS_FU:57.0 ± 4.2; CAPS_BL:53.8 ± 7.5; CAPS_FU:45.6 ± 6.2 Scale 0-social introversion: DBS_BL:66.8 ± 5.2; DBS_FU:56.1 ± 4.1; CAPS_BL:67.7 ± 7.0; CAPS_FU:66.4 ± 5.8)

* Quality of life: Q-LES-Q Endicott (Mn ± 95%CI) overall score (1-5): DBS_BL:1.2 ± 0.3; DBS_FU:3.4 ± 0.6; CAPS_BL:1.5 ± 0.3; CAPS_FU:2.6 ± 0.4 and in the sub domains feelings (%): DBS_BL:36.8 ± 4.2; DBS_FU:68.6 ± 8.8; CAPS_BL:39.1 ± 5.1; CAPS_FU:54.0 ± 5.9 leisure activities (%): DBS_BL:30.6 ± 5.9; DBS_FU:68.5 ± 7.9; CAPS_BL:40.2 ± 5.4; CAPS_FU:58.3 ± 7.1 social relationships (%):DBS_BL:43.9 ± 5.5; DBS_FU:70.2 ± 8.0; CAPS_BL:46.9 ± 6.8; CAPS_FU:60.1 ± 6.9

These findings suggest a superior impact of DBS over capsulotomy on general functioning, personality traits and quality of life. Limits of this study are the small numbers, the fact that DBS and CAPS patients were from a slightly different OCD population and were not randomized to treatment, and differences in postoperative follow-up.

Aside from medications, no effective physical methods of treatment for insomnia have been reported. The purpose of this study is to evaluate the effect on primary insomnia of sleep electroencephalogram modulated repetitive transcranial-magnetic stimulation (SEM-rTMS) compared with the effect of routine repetitive transcranial magnetic stimulation (R-rTMS).

The 126 patients who volunteered for this study were diagnosed by DSM-IV criteria. Patients were divided randomly into an SEM-rTMS group (44 cases), an R-rTMS group (42 cases), and a sham therapy group (40 cases). Each case was treated for 10d with consecutive rTMS for 30 min once a day with both patient and therapist being blind to conditions. The Krakow sleep score, electroencephalogram, and blood pressure were recorded before treatment, after the 10d treatment, and 30 days after treatment.

During therapy with rTMS, a portion of the patients felt sleepy and their EEG pattern showed signs of sleep. The efficiency of producing sleep signs in the SEM-rTMS group was 79.5% and in the R-rTMS group was 45.2%, with the former being significantly higher (c2 = 9.4065, P = 0.0022). At 30d after completion of therapy, the efficiency of sleep production in the SEM-rTMS group was still higher than in the R-rTMS group (c2 = 16.7998, P = 0.0000). No obvious side effects were observed in any of the three groups during the observation period.

SEM-rTMS therapy for insomnia appears to be more effective and more stable than routine rTMS therapy and appears to be a safe treatment for primary insomnia.

The conventional repetitive transcranial magnetic stimulation (rTMS) has some inadequate of efficacy weak and inadequate for the treatment of depression, easy symptomatic recurrence when stop the treatment. Ours invented the device of sleep electroencephalogram-modulated rTMS (SEM-rTMS) were safe and effective by proved of the animal experiments and clinical pre-test for the treatment of depression. The purpose of this study was to examine the efficacy and safety of SEM-rTMS for the treatment of depression.

After 7 days without psychoactive medication, 164 patients with clinically defined depression, were randomly assigned to receive SEM-rTMS (N = 57), conventional rTMS (C-rTMS (N = 55), or sham-rTMS (N = 52) for 30 minutes/time/day for 10 days. Before and after scores on the 24-item Hamilton rating scale for depression (HAMD-24) and the clinical outcome at the 10th-day of therapy for all subjects were analyzed.

Twenty two cases in the SEM-rTMS group improved mood as compared to 6 in the C-rTMS group and 2 in the sham-rTMS group (c2 = 15.89, p = 0.0004). After completion of the rTMS phase of the protocol, a (51 ± 5) % reduction of HAMD-24 scores from the baseline in the SEM-rTMS group compared with a (34 ± 4)% in the C-rTMS group ((q = 26.09, p = 0.001) and a (14 ± 3)% in Sham-rTMS group (q = 57.53,p = 0.000). The 88% total efficacy ratio in the SEM-rTMS group was significant higher than 68% in the C-rTMS group and 20% in the sham-rTMS group (c2 = 12.01, p = 0.0025). No significant side effects were noted.

It is efficient and safe to treat depression with repetitive transcranial magnetic stimulation. (The registration. No: ChiCTR-TRC-00000438).

To investigate the effects of sleep electroencephalogram-modulated repetitive transcranial magnetic stimulation (SEM-rTMS) and conventional rTMS (C-rTMS) on the activity of hypothalamic-pituitary-adrenal (HPA) axis in patients with depression.

In a double-blind, randomized controlled trial, 164 patients diagnosed with depression were randomized to treatment with SEM-rTMS (n = 57), C-rTMS (n = 55) or sham rTMS (n = 52) for 30 min every day for 10 d. Before and after treatment plasma concentrations of adrenocorticotropic hormone (ACTH) and cortisol (CORT) were measured, and the 24-item Hamilton Depression Rating Scale (HAMD-24) was used for assessment.

The HAMD-24 scores and plasma ACTH and CORT concentrations of these depressive patients before treatment were significantly different from those of the normal control group (P < 0.05). The HAMD-24 scores and plasma ACTH and CORT concentrations in the SEM-r TMS group and conventional rTMS group were decreased significantly (P < 0.05). There was a significant positive correlation between the HAMD-24 scores and plasma ACTH (n = 240, r = 0.105, P = 0.048) and CORT concentrations (n = 240, r = 0.126, P = 0.023) in the patients with depression before and after treatment.

The antidepressant effect of rTMS, including SEM-rTMS, may be related to its decreasing HPA axis activity. (This trail was registered. No: ChiCTR-TRC-00000465).

Efficacy of conventional repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD) is limited. The authors report here on an alternative treatment using low energy synchronized TMS (sTMS) at the intrinsic frequency of subjects’ alpha electroencephalogram (EEG).

Establish efficacy and safety profile of sTMS in MDD.

1. (1) Examine the clinical effectiveness of sTMS.

2. (2) Identify adverse effects associated with sTMS.

Fifty-two MDD subjects with 17-item Hamilton Depression Rating Scale (HAMD17) scores >17 were enrolled into a randomized, sham controlled, double-blind trial. Current medication remained unchanged during the trial. Depressive symptoms were evaluated by HAMD17 administered weekly.

EEGs were recorded at baseline to determine the stimulus frequency and at week 4 to evaluate the physiological effect. sTMS was delivered through three 6000-G cylindrical neodymium magnets synchronously rotating at a rate equal to the subject's intrinsic alpha frequency.

Forty-five subjects completed at least 1 week of treatment and were evaluable. Those who received active treatment had superior clinical response to sham (t = 2.54, P = 0.01), where 55.2% in the active treatment group were clinical responders versus 12.5% in sham (X2 = 7.82, P = 0.005). No significant side effects were reported. The clinical improvement was correlated with the degree of EEG improvement (r = .46, P = 0.009).

A therapeutic effect in MDD subjects can be achieved through administration of sTMS at the subject's alpha EEG frequency. Because of minimal side effects, this appears to be a safe and effective treatment option.

Transcranial magnetic stimulation (TMS) is a non-invasive method that induces functional changes in a relatively small area of the cerebral cortex. It is supposed that the effect of the method in therapy of neuropatic pain is based on the induction of spinothalamic tract inhibiton, which leads to the symptom withdrawal.

To prove the clinical and electrophysiological effect of rTMS in the therapy of chronic neuropatic pain.

29 patients with medication-resistant neuropatic pain were examined by Visual analog scale (VAS), McGill Pain Questionnaire (MPQ) and QST(Quantitative sensory Testing, consisted of von Frey and thermic treshold examination),then treated by high frequency rTMS in the study using double-blind randomized sham-controlled parallel design. rTMS parameters: 5 rTMS sessions (2 weeks treatment), where each session consisted of three 10 Hz rTMS series using:

1. 1) 85%MT (motor treshold),

2. 2) 90%MT and

3. 3) 95%MT.

Each rTMS série consisted of 20 pulses in 12 trains. Location of the active coil was administered over the contralateral motor cortex, directed specifically to facial area of homunculus (according to funcional location). Sham coil was angled 90° degrees away from the skull.

Confirmation of a significant decrease of VAS item in active group, trend to improvement in tactile sensation of severed patient faces. The changes of thermic treshold were not found. Sham rTMS did not show any trend for improvement.

Although no general recommendations can be drawn based on our result, our study is another one that suggest rTMS should be considered as an effective and safe treatment option for chronic neuropatic pain.

The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses.

Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and nonpsychiatric Controls (matched groups, n = 15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p = 0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p < 0.03 ; Control/NECT p < 0.01) and the Spatial Recognition Memory (SRM) task (p < 0.05 ; Controls/NECTs p < 0.05) ; ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p < 0.01 ; Controls/ECTs p < 0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H = 11, p < 0.01) but ECTs who completed SOC performed comparably to the other two groups.

A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT dépressives.