The recent reforms of mental health legislation occurred in most European countries, together with the continuous advances of technologies and the development of research in all the domains of psychiatry have deeply modified the role of mental health professionals with consequent changes in training needs for early career psychiatrists. The competencies required to psychiatrists today include not only the knowledge of the advances in neuroscience, psychopharmacology, psychotherapy and social psychiatry, but also the ability to understand the different clinical and social needs of the patients. Young psychiatrists report a gap between their knowledge and the skills required during the first years of their job.

The European Psychiatric Association-Early Career Psychiatrists Committee, in cooperation with the European Federation of Psychiatric Trainees, conducted a survey among European young psychiatrists and psychiatric trainees, aimed at evaluating difficulties and perspectives related to psychiatric training residency.

86 respondents completed the Psychiatric Training Questionnaire, a multiple-choice and self-reported questionnaire, which evaluates: 1) satisfaction with training received; 2) self-confidence in theoretical and practical skills included in psychiatric training curriculum; 3) educational opportunities received during training.

Respondents were almost equally split between trainees (54%) and young psychiatrists (46%). Seventy per cent of them were completely or partially satisfied with training received. Early Career Psychiatrists reported higher levels of self-confidence in clinical psychiatry (98%), psychopharmacology (69%) and emergency psychiatry (61%), whereas the most problematic areas were forensic psychiatry (64%) psychotherapy (61%) and child and adolescent psychiatry (57%). 41% of respondents was not assigned a tutor for clinical activities, 73% of them could not rely on a dedicated supervisor for training in psychotherapy and 58% had not the possibility to use a log-book to record the competencies acquired during training. Only 37% participated in exchange programs; all early career psychiatrists who had this opportunity found this experience very useful for their professional growth.

Standards of training in psychiatry in Europe are generally satisfactory. However, our results highlight the need to:

1. 1) upgrade training in some areas, such as psychotherapy, forensic psychiatry and child and adolescent psychiatry;

2. 2) guarantee an adequate clinical supervision;

3. 3) spread the use of log-book;

4. 4) improve the opportunities for exchange programs.

Exposure to traumatic events is common among individuals with substance use disorders (SUD). Self-medication hypothesis posits that substances are used to relieve distressing psychological symptoms. Moreover, few studies have assessed exposure to traumatic events and Posttraumatic stress disorder (PTSD) symptoms among samples suffering from addiction.

To explore SUD inpatients exposure to serious traumatic events both directly (the participant himself) and/or indirectly (the family).

(i) to investigate the prevalence of co-morbid PTSD in SUD clinical inpatients;

(ii) to identify the characteristics, severity and types of trauma experienced;

(iii) to compare SUD patients with and without co-morbid PTSD on psychiatric variables.

This study compared two groups:

(1) those without PTSD,

(2) those with PTSD.

SUD inpatients reported traumatic experiences (Trauma History Questionnaire), PTSD

symptoms (PTSD CheckList-Specific), addiction severity (Addiction Severity Index), and psychiatric symptoms (M.I.N.I.). Khi square or T tests were conducted to compare rates between non-PTSD group (SUD-only; n = 27) and PTSD group (SUD-PTSD; n = 17).

All participants (n = 44) reported having been exposed to one or more traumatic events and 17 (38.6%) met the criteria for probable current PTSD. Significant differences between the “PTSD” and “non-PTSD” groups were found on the crime cluster (p < .04), the composite score of Alcohol (p < .005), and psychiatric variables including depression (p < .001), psychotic syndromes (p < .02) and anxiety disorders (p < .0001).

This study highlights the prevalence of PTSD symptoms among SUD inpatients, and the importance of considering PTSD symptoms to improve quality of care for patients and their families.

To examine the relationship of traumatic experiences and PTSD among a representative population sample of 1,456 German elderly (60 years and above). Several studies have suggested that PTSD, but also traumatic experiences are related to adverse health outcomes. However, many past studies are based on selected samples like combat veterans, or survivors of natural disasters. To our knowledge this is the first representative population study in the elderly.

Based on self-report data and using regression analyses, we investigated the association of traumatic experiences and PTSD with several medical conditions.

Traumatized subjects had a significantly increased risk for all the medical conditions under study compared to those participants without a traumatic exposure (OR = 1.37 for hypertension up to 5.12 (CI = 2.25–11.6) for cancer). There are significant associations of current PTSD with cardiovascular diseases (Angina pectoris/coronary artery disease; congestive heart failure, peripheral vascular disease) and cardiovascular risk factors (hypertension, elevated cholesterol) (OR = 1.94 for peripheral vascular disease up to 3.76 for elevated cholesterol), as well as with asthma, cancer, back pain, hard of hearing, osteoporosis, stomach problems and thyroid disorders.

Our study delivers additional evidence for the association of traumatic stress and PTSD with impaired physical health in a general population sample in the German elderly. It underpins the importance of traumatic experiences and PTSD not only for mental health, but also for physical health as a long-term consequence.

Compared to the general population, siblings of patients with schizophrenia have a higher risk of developing schizophrenia.

This study analyzed population-based data to examine the risk of hospitalization for schizophrenia and affective disorders among full vs. half siblings of patients with schizophrenia, and among persons with 1 or more siblings with schizophrenia vs. those with 2 or more.

This study assessed the familial influence of schizophrenia on the development of schizophrenia and other mental disorders in siblings.

The full (n = 12,555) and half (n = 2,707) siblings of 6,115 patients with schizophrenia (ICD F20.0–20.9) were identified from the Israeli Psychiatric Hospitalization Registry. Age and gender matched controls (n = 61,048) were identified from the Israeli Population Registry. The sample's psychiatric hospitalizations were recorded from the registry.

Compared to controls, risk for schizophrenia was higher among persons with one or more (OR = 9.36, 95%CI: 7.73–11.33) or 2 or more (OR = 13.76, 95%CI: 8.84–24.15) full siblings with schizophrenia. Similarly, persons with one or more (OR = 7.91, 95%CI: 5.15–12.14) or 2 or more (OR = 8.44, 95%CI: 3.57–19.94) half siblings with schizophrenia had a higher risk of schizophrenia. Similarly, risk for hospitalization for affective disorders was higher among persons with one or more (OR = 7.29 95%CI: 5.60–9.49) or 2 or more (OR = 10.25, 95%CI: 5.50–19.10) full siblings with schizophrenia.

This population-based study strengthens existing knowledge that schizophrenia has a strong familial, perhaps genetic component; and the greater the familial load, the greater the risk. Familial schizophrenia also increases risk for affective disorders, emphasizing the overlap between these disorders.

The number of beds in forensic psychiatry has increased more than two-fold since 1990 in many countries, mostly due to an increasing number of admitted male patients with psychotic disorders. Most of these patients had previous admissions to general psychiatric units.

To develop a manual for interventions aiming on the prevention of violence based on cognitive behavioural therapy and to test its feasibility.

A manual comprising of 11 different domains of possible interventions was developed. For each patient, the three most relevant domains should be identified. A pilot study was conducted in two psychiatric hospitals. Included patients should receive two sessions as in-patients and consecutively three more as out-patients.

Out of 368 male patients with a diagnosis of a schizophrenic or schizoaffective disorder, 89 (24.2%) had a relevant history of violence. Only 15 (17%) could be recruited for the study, 13 (14.6% of eligible patients) completed the intervention. A considerable proportion refused to participate. The manual was considered to be applicable and relevant. Domains used most frequently were anger management, substance abuse, and medication adherence.

The intervention based on a flexible manual and five sessions was feasible and well accepted by participating patients. However, it turned out to be difficult to recruit this group of patients for an intervention programme and for a study. To conduct a randomised controlled trial, a screening of about 4.000 patients with schizophrenia will be necessary.

The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk.

A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials.

Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions.

We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence.

In adults with intellectual disability and autism, psychosis is rarely detected due to misinterpretation of psychotic symptoms being autism or idiosyncratic communication. The patients can poorly communicate the delusions and hallucinations they experience. Observable indicators are therefore necessary.

To establish reliable and valid behavioural indicators of psychosis in adults with intellectual disability and autism.

The aim was to investigate behavioural indicators of psychosis in adults with intellectual disability and autism.

Forty-three patients with intellectual disability and autism from a hospital-based study were recruited. Eight of these patients were assessed as having schizophrenia-like psychosis. They were further examined through a case-report study. Both statistical analysis and data from the case reports were included. Case report data were compared with scores from a validation study of the Psychopathology in Autism Checklist, PAC.

Behavioural disorganisation, severe decreased global functioning, suspected hallucinations and decreased sociability were observed in the eight psychotic patients. The level of disorganisation was significantly higher in the psychotic patients than in the non-psychotic patients - this included patients with “plain” autism. Adequate treatment significantly decreased the level of disorganised behaviour.

Disorganised behaviour, occurring concurrent with disorganised speech, severe decreased global functioning, suspected hallucinations and negative symptoms, were found to be reliable and valid indicators of psychosis.

This study frames anomalous functional brain organization among persons with Schizophrenia (SCZ) within an evolutionary model of brain development, the Dual Trends Theory (DTT). The DTT argues that neural architecture develops along two separate pathways: the dorsal’archicortical’ trend and the ventral’paleocortical’ trend. The DTT dovetails with visual system organization, which is also comprised of two independent pathways: a visuomotor dedicated dorsal stream and a perceptual dedicated ventral stream.

The present study examined the integrity of these pathways using a size-contrast visual illusion. Prior research has shown that, normally, perceptual estimations of object size are susceptible to visual illusions, whereas goal-directed actions are resistant. We hypothesized that, unlike control participants, SCZ patients’ goal-directed actions would be susceptible to the illusion, reflecting selective dorsal stream dysfunction.

Here, 42 SCZ patients and 42 healthy control participants grasped and estimated the size of target blocks in both control and illusion conditions. Movement kinematics were measured using a magnetic motion trracking system (Flock of Birds). During estimation, both groups were equally perturbed by the illusion; however, grasping movements of patients alone were influenced by the illusion.

These results suggest disrupted dorsal brain circuitry in SCZ but relatively intact ventral brain circuitry.

It's evident that abnormalities of subcortical brain structures asymmetry are related with schizophrenia pathogenesis.

Basal ganglia participate in memory processes. Estimation of relationship between their asymmetry parameters and memory characteristics should be examined.

To investigate correlations between nucleus lentiformis (NL) MRI parameters and memory peculiarities (semantic aspect) in schizophrenia 96 patients and 51 controls were examined.

3D MR images were acquired on magnet 0.5 Tomikon S50, Bruker (69 patients‘and 34 controls‘groups) and 1.5T GE Signa System (27 patients‘and 17 controls‘groups). Volumes (V) of left and right NL and their asymmetry coefficients (2 x (right NLV- left NLV) x 100/ (right NLV+left NLV),%) were calculated.

Psychological pictogram method1,2 estimating mnestic activity including semantic aspect was used. Quantitative (retention productivity score (RPS) was analyzed.

Decreasing of the right (more prominent, p = 0.046, p = 0.044) and left NL (p = 0.048, p = 0.048) volumes were demonstrated in both patients groups. The RPS was less in both patients groups as compared with controls (p < 0.01). Correlation between NL asymmetry coefficients and RPS was revealed in patients underwent 0.5 and 1.5T scanners (r = -0.51, p < 0.05; r = - 0.57, p < 0.05 correspondingly).

The data confirm significance of brain asymmetry and memory dysfunction in etiology of schizophrenia.

One salient impact of information technology on students’ lives is the ever-increasing use of the Internet. Although there exist many reports in the media regarding the unhealthy Internet use among students, research is still limited.

Thus, the purpose of the present study was to examine the relation of internet addiction with family functioning and mental health among students. Two-hundred and eighty students from high school and guidance school were selected by multiple cluster sampling method. They participated in the present study by completing internet addiction questionnaire, family functioning scale and mental health questionnair.The method of this study was descriptive and correlational in order to analyze the results, descriptive statistics (frequency and percentage) and inferential statistics (correlations and regression) were used.

The results showed negative significant correlation between internet addiction and some subscale of family function such as assertiveness, entertainment orientation and religious emphasis. Results also indicated positive significant correlation between 3 subscales of family functioning including dissociation, conflicts and authoritarian family style with internet addiction. No significant correlations were found between other subscales and internet addiction.Regarding the relationship between mental health and addiction to Internet, research results indicate a significant positive correlation between overall mental health score and two subscale of depression and somatization with internet addiction.

The results of this study confirmed the negative effects of Internet addiction on mental health and emphasized the importance of family on intensifying internet addiction. Hence in designing treatment programs, family environment must be considered.

We compared the efficacy and safety of lamotrigine versus placebo for the treatment of acute alcohol hallucinosis comorbid depersonalization disorders.

10 days, randomized, double-blind, parallel study. A total of 40 patients with an ICD-10 diagnosis of acute alcohol hallucinosis comorbid depersonalization disorders were randomized to lamotrigine 300 mg/d (n = 40), or placebo (n = 40). The primary efficacy measure was the PANSS subscale for hallucinosis and Cambridge Depersonalization Scale (CDS).

Iamotrigine treated patients demonstrated a statistically significant greater improvement in PANSS subscale for hallucinosis and CDS than placebo-treated patients.

Lamotrigine demonstrated greater efficacy than placebo in treatment of acute hallucinosis comorbid depersonalization disorders and was generally well tolerated.

Over the last decade a series of guidelines and recommendations have been published in the UK by the Department of Health, the Home Office, Professional and Non-Professional bodies. However, an optimal strategy and consensus in the management and care of opioid dependent pregnant users has yet to be established.

Determination of existing methods for identifying and managing pregnancy in opioid users prescribed methadone by NHS Treatment Services and regional differences.

To survey the management, treatment and follow-up of pregnant opioid users prescribed methadone by Drug Treatment Services in England and Wales.

In 2006 a POSTAL survey was conducted among 223 Community Drug Treatment Services (CDTS).

Sixty-six percent of CDTS responded to the survey (n = 154/233). A Chi-square, Mann_Whitney U Test and/or Kruskal-Wallis analysis revealed significant differences in the composition of CDTS and service provision across regions. Half of CDTS (55.3%) provided a methadone dosage regime lower than that recommended for non-pregnant drug users. There were also significant variations on how professionals approached the management of pregnant opioid users. CDTS with an addiction specialist were significantly more likely (p < .01) to advocate high doses of methadone whereas those with a midwife, obstetrician or social worker involved were more likely (p < .05) to suggest low dose methadone and/or detoxification.

Service provision for pregnant opioid users is comprehensive but there is still variability in some aspects of the treatment received. The way in which methadone is prescribed is not always optimal. Further work is required in this area.

Opioid dependence has increased greater that 150% from 1965–2008. Almost 2 Million Americans are currnetly opioid depndent. Approxmately 4.4 million teenagers and adults have used opioid prescription painkillers for nonmedical purposes. Greater than 75% of opioid dependnet patients in the U.S. go untreated. Greater than 60 % of opioid dependent patients don’t seek reatment due to lack of accessibility of treatment centers or programs.

100 opioid dependent patients (illicit street and iatrognenic) volunteered and entered a “TELE-PSYCIATRY MODEL” for treatment of their depencence (age range 19,– 61. 58 males,42 females). Utilizing the Bupernorphen protocol, all patients were intrviewed, examined, induced, and regularly followed, ALL utilizing SECURE VIDEOCONFERENCNG interactive treatment methodologies. No in-person contact was made with any patients.

2 patients dropped out, 98 remain in treatment, and opioid free after a 7 month average. All patients found the Tele Psychiaty model to be acceptable, effective and prefeable.