Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.

To inform professionals about patients’ views on receiving clinical letters.

To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.

Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.

The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.

Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.

Non-cardiac chest pain (NCCP) is a common diagnosis among patients visiting an emergency department. 50–90% of patients presenting with chest pain are diagnosed with non-cardiac chest pain. One of the possible causes of NCCP is a psychiatric illness. Previous studies found high prevalence of panic disorder (25%-40%) using structured DSM-IV interviews.

We wanted to review the occurrence of patients with a possible panic disorder in our emergency department. In case of high occurrence further interventions could be warranted.

To examine the frequency of panic disorder diagnosis by emergency physicians in patients with NCCP.

Electronic health records from all patients in the OLVG hospital presenting with cardiac pain at the emergency department with in January 2013 were reviewed in a retrospective cohort study. We substracted the final diagnosis by the emergency physician

In this month 195 patients presented at the emergency department with chest pain. 121 (62%) suffered from non-cardiac chest pain. They were discharged with the following diagnosis: 13 (11%) pulmonal disease, 23 (19%) a musculoskeletal problem, 13 (11%) a gastro-intestinal diagnosis, 4 (3%) drug related, 63 (56%) were described as suffering from atypical chest pain. Only in 5 (4%) a psychologic cause was described as primary diagnosis.

We found a low rate of psychiatric diagnosis by emergency physicians in patients with NCCP compared to previous studies using structured interviews. Interventions are needed to improve the detection of psychiatric symptoms in our emergency department.

Family psychodynamic is closely related to psychological well-being of family members and its impairment affects the family as a whole and a boarder social and organizational structure like family based firms. A significant number of studies on family-business were published but little has been reported on the psychodynamic features of family-business.

The objective is to explore the hidden continuity of the classic themes: family psychodynamic and family dynamics firm. The research aims to identify and to describe psychodynamic characteristics of a family group which held a business through the analyses of some important relational dimensions.

a qualitative and clinical research approach. Sample: voluntary family members of the organization. Instruments: Structured Organizational Interview (SOI) and a rating scale the Group Organizational Scale (GOS). Both were based on previous family studies in a psychodynamic and systemic view. The broader research was approved by a local Ethics Committee and was founded by FAPESP.

The most affected transactional dimensions were communication, conflicts, cohesion, roles, and the quality of leadership within the family organizational group impairing managerial practices. Moreover, important relationship between the family psychodynamic style and the family dynamics firm were found. It also pointed to the validity of the SOI and GOS.

The interview showed a rich material for psychodynamic analysis of family firms. Its rating scale can be included into other future research. This study has major implications for family-business members to understand their own role in their mental health and in the success of a firm.

The study of associated stigma to mental illness has been usually oriented to psychotic disorders. Recently the ASPEN Project has had the objective to study the stigma associated to depressive disorders worldwide. As a part of this study, we present the results of a Spanish sample. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder. Additionally we investigated whether experienced discrimination is related to severity of depression and level of self-esteem.

In a cross-sectional survey, 100 adult outpatients with a diagnosis of major depressive disorder were interviewed with the discrimination and stigma scale (version 12; DISC-12). Severity of depression and self-esteem were measured by the Hamilton-17 questionnaire and the Rosemberg scale respectively. Socio-demographic variables were included.

the life domains where the major proportion of individuals experienced discrimination were: treatment by their family (46%), in marriage or divorce (30%) and been avoided or shunned by people who know their mental health problem (34%). 60% of patients anticipated discrimination avoiding intimate relationships and 67% of them concealed or hid his/her mental health problem from others. Experienced discrimination had a significant association with the severity of depression and with a low level of self-esteem.

Discrimination related to depression acts as a barrier in some fields of social life. Non-disclosure of depression could be a barrier to seeking help. It is important to consider effective actions to prevent stigma and discrimination in the field of depressive disorders. INDIGO-ASPEN Group

There are a number of studies about Quality of Life at Work (QLW). Noteworthy is that few of them focus mental health and show an intervention plan. Psychodynamic work indicates the value of listing to person and psychosomatic indicates the benefits of a body and mental practice like relaxation. Therefore it was developed a QLW project that includes collective interview (psychodynamic work) and relaxation (psychosomatic).

To test the hypothesis that the practitioner would show an increase in coping strategies and a decrease in avoidance strategies.

To identify the relationship between interview, relaxation and how employees deal with stress.

base line with repeated measures. Participants: 10 workers freely enrolled in the project. Measures: a) A questionnaire to identify demographic and health variables; b) The Coping Responses Inventory for Working Settings; c) Collective interview.

final collective interview showed an increase of the experiences of pleasure, and a minimization of the experiences of anguish despite the maintenance of some oppressive organizational features; quantitative results: there was an increase of the Confrontation strategies, especially Positive Revaluation; decrease in the search for external Orientation and in the Avoidance strategies as Resigned acceptance. The findings confirmed the hypothesis that talking sessions and psychosomatic relaxation helps to have a positive and active attitude.

In-depth talking analysis shed light on the psychodynamic of work. The collective interview associate with the relaxation appears as useful tool to help employees to cope with stress, improving their QLW.

The relationship between neuropsychological and overall performance in people with schizophrenia is known. Smoking and stimulant drugs use can improve neuropsychological outcomes, however the existence of drugs use may be a more severe illness marker.

The purpose of this study is to investigate which clinical and epidemiological variables, including stimulant drugs use and smoking, influence on neuropsychological performance in patients with psychosis.

92 patients with different psychosis were assessed with a battery that included SCIP, to assess neuropsychological performance, PANSS, to evaluate psychotalogy, GAF and SIX as global performance measures. We also explore clinic and sociodemographic data. A binary logistic regresion model was applied on scores on the task ‘words’ of the SCIP (memory and learning), dichotomized at the median. The model included: sex, age, onset age, family history, negative scale, positive scale, global psychopatology and PANSS subtypes, estimated premorbid IQ using Barona Index, stimulant drugs use, smoking and funcionality.

The absence of stimulating drugs use and smoking (trials 2 and 3 of SCIP), was associated with better memory and learning in patients with psychosis. Younger age (trials 1-4 and total of words), higher functionality (trials 1,2 and total of words) and premorbid IQ (trials 2 and 4) were also positively associated with better neuropsychological performance.

Stimulant drugs use and smoking could be markers of poorer previous neuropsychological function in psychotic patients. It is necessary to do longitudinal studies evaluating these variables as markers, risk or protective factors of cognitive performance

to identify the relationship among the yoga practice, the health status (HS) and the quality of life (QL) experienced by students.

it was used a base line before the intervention and repeated measures at the end of the program intervention (pre-and post-test). Participants were a 67 students enrolled in the university program. Measures: a) A questionnaire to identify the participants' health status and their quality of life; b) The Yoga Intervention (YI) developed once a week, lasting one hour during two months at the students' place. Statistical results indicated the positive impact of YI over the students' health and their quality of life (QL). In general, there was an important difference in the degree of health status experienced by students at the end of the program. Even if some health problems remain the students have a better control over them. The QL measure also showed an important difference by the end of the intervention. In addition participants reported the importance of the Yoga in their lives, including better school performance.

The quality life intervention plan was tested. We encourage YI for promoting mental health in the university setting.

Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available.

To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT

We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning.

Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported.

Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.

Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy.

A sample of 450 survivors of the L’Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, was reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).

Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in almost half of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about onefourth in females.

This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD.

Quality of life (QoL) in patients with Type 2 diabetes mellitus (T2DM) is an important factor in analyzing of effectiveness in medical and other care. Except for physical discomfort resulting from disease symptoms, diabetic patients also bear mental stress.

To investigate quality of life in patients with T2DM in relation to demographic, clinical, psychological, metabolic and anthropometric characteristics.

97 in- and outpatients of both sexes (<65 years) with endocrinologist-diagnosed T2DM, duration ≥5 years, treated with either oral therapy, insulin or both, were included in this cross-sectional study. The Patient Health Questionnaire (PHQ) was employed for assessment of depression. The Scaling of Life Events was performed for assessment of life events in the past year. The Psychological General Well-Being Scale (WBQ) was used to assess QoL. The Problem Areas in Diabetes (PAID) was employed for assessment of T2DM distress. Laboratory and anthropometric measures (Body mass Index, Waist circumference) were also performed. The exclusion criteria were determined.

Patients with presence of life events (p=0.000), metabolic syndrome (p=0,002), and polyneuropathy (p=0.000) had significantly lower WBQ score in relation to these without (Student's t-test). Considerable correlation between WBQ score and level of education (r=0,231; p=0,023), PHQ (r= −0,811, p=0,000) and PAID score (r= −0,611, p=0,000) (Pearson's Correlation) were found.

Lower level of education, depressive symptoms, and higher level of diabetes distress as well as presence of life events, metabolic syndrome and polyneuropathy were associated with worse QoL in T2DM patients.

The CVA is one of the most serious medical problems. It represents the third most common cause of death in North Amerika and in most countries of Europe. In Japan and in China is the most frequent cause of death.

We present a 18-month follow-up data on the burden of families of stroke individuals. The purpose of this study is to investigate the degree of family burden in families of patients with chronic CVA.

The sample comprised 110 patients with CVA aged 40–90 years old and their caregivers. The form-questionnaire consisting essentially of the Family Burden Scale (MG Madianos and M. Oikonomou). Descriptive statistics are used for the presentation of the results

The caregivers were in the majority the spouse (50%), and the children (39%).

The results show that the increased burden was related more to leisure of the caregivers and less to their daily activities.

The type of CVA Is not associated with caregivers burden. Family burden is strongly dependent on the initial inability of the patients as well their age and the time elapsed from the start of the disease.

The age of the caregiver does not play any role in family burden,

Furthermore the financial burden is related only with the disability.

The factors that have been implicated for the family burden were mainly the severity of disability, the duration of the illness and the age of the chronically ill, factors which can influence severe the caregivers.

9–20% of subjects facing bereavement may develop symptoms of unresolved grief associated with significant distress and impairment that have been recently identified as a distinct post-loss syndrome named complicated grief (CG). Aim of this study was to: 1) explore anxiety, adult separation distress and panic spectrum symptoms in CG; 2) correlate these symptoms with social and occupational impairment 3) provide additional evidence of complicated grief diagnosis through analysis of CG symptoms in a clinical data set consisting of bereaved individuals with CG, Post-Traumatic Stress Disorder (PTSD) and healthy controls (HTC).

201 bereaved subjects were consecutively enrolled: 72 with CG; 78 with PTSD; 51 HTC. Assessments included: the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I/P), the Italian version of the Inventory of Complicated Grief (ICG), the Adult Separation Anxiety Questionnaire (ASA_27), the Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) and the Work and Social Adjustment Scale (WSAS).

CG patients reported a significantly (p<.001) higher scores in the ASA_27 compared to PTSD patients and HTC. Moreover, CG patients reported significantly higher total PAS scores compared to PTSD patients and HTC. When we analyzed the single PAS domains, we found a statistical difference for CG versus PTSD in regard to separation sensitivity (I), panic-like symptoms (II), stress sensitivity (III) and anxious expectation (V). Only in CG patients, higher ASA_27 scores correlated with greater functional impairment.

This study shows how anxiety separation is a core symptom of CG and provides additional medical evidence on the proposition that CG is an independent diagnosis.

Despite the relative lack of controlled data, psychostimulant drugs are frequently used as augmenting therapy for refractory depression. Modafinil is a nonamphetamine stimulant approved for narcolepsy often prescribed for off-label indications. While its mechanism of action is not yet fully understood it is known to be a well tolerated drug with high selectivity for the central nervous system. It also appears to have a lower abuse potential than other stimulants.

It will be presented a case report of a refractory depression that achieved symptom remission following augmentation with modafinil.

Review of clinical record and interview with the patient.

A 60 year old patient suffering from Major Depression has been highly resistant to several first-line pharmacological treatment as well as several conventional augmentation strategies and psychotherapy. The clinical picture was characterized mainly by anergy, excessive sleepiness and fatigue. Along the course of the disease the patient has been admitted to the psychiatric ward several times. During the last admission 50 mg/day of modafinil were added to the antidepressive treatment. The patient improved throughout the followup and full remission was achieved, currently being asymptomatic with modafinil monotherapy.

Modafinil proved to be an useful pharmacological option for augmentation of antidepressive therapy specially regarding symptoms of sleepiness and and fatigue. Its prescription has been increasing mostly due to off-label indications. As concerns have been raised about hypersensitivity reactions and neuropsychiatric adverse effects, further studies are needed to increase the safety of its use in this specific group of patients.

There is no distinct answer to the various, complex and multilevel ethical questions that therapists may be exposed to during treatment of their clients.

The most frequently cited ethical concerns in psychotherapy are related to professionalism, therapeutic boundaries and confidentiality. Ethically oriented therapists serve the well-being of their clients above all other benefits or obligations. Principlebased medical ethics is a valuable tool for resolving ethical dilemmas in psychotherapy in that the therapeutic aspects of ethical dilemmas can be better expressed than in other methods. The main four principles of bioethics, i.e. autonomy, beneficence, non-maleficence and justice, may be adapted for ethics in psychotherapy. However, the context must be reflected because of exceptions in the use of this general concept. On the other side, a client in psychotherapy can be abused economically, sexually and emotionally. This process may be intentional as well as unintentional. Another important dilemma is the dual role in psychotherapy. This dilemma is linked to the tension between psychiatrists’ obligations of beneficence towards their clients and conflicting obligations to the society, third parties, other health care colleagues or the continuation of knowledge in the field. The issue of confidentiality often causes ethical dilemmas for the psychotherapist. Since confidentiality is essential for clients to engage in therapy, it is important to protect psychotherapy notes. On the other hand, there is a difference between confidentiality and legal right; how, why and when it can be broken. and the reasons for doing so are not well understood by many therapists.

A minority (9–20%) of subjects facing bereavement may develop symptoms of unresolved grief associated with significant distress and impairment that have been recently identified as a distinct post-loss syndrome named complicated grief. The Inventory of Complicated Grief is a self-report instrument to assess complicated grief. Aim of this study was to: 1) validate the Italian version of the Inventory of Complicated Grief; 2) provide additional evidence of complicated grief diagnosis through analysis of complicated grief symptoms in a clinical data set consisting of bereaved individuals with complicated grief, Post-Traumatic Stress Disorder, bipolar disorder and healthy controls.

229 bereaved subjects were consecutively enrolled: 64 with complicated grief; 72 with post-traumatic stress disorder; 35 with bipolar disorder; 58 healthy controls. Assessments included: the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I/P) and the Italian version of the Inventory of Complicated Grief.

The mean total ICG score was significantly different among the study groups [F(3.228)=94.19, p<.001]. Post-hoc Games-Howell comparisons indicated significantly lower scores in HCS than in the other three groups, and significantly higher scores in CG patients with respect to the other three groups. The scale resulted to have a high level of internal consistency: Cronbach's alpha value computed on the whole sample was 0.947. An exploratory factor analysis (PCA) revealed two components, both with high level of internal consistency (Chronbach's alpha 0.945 and 0.821, respectively). The two components emerged seem to cluster symptoms of separation distress, anger and bitterness, shock and disbelief, behavior change on one side; while hallucinatory symptoms on the other, besides specific symptoms of estrangement from others and one symptom of separation distress.

This study provides evidence of the validation of the Italian version of the ICG, tested in a large and well-characterized clinical help-seeking population. It also supports the proposition that complicated grief is an independent diagnosis.

Acromegaly is a rare, severe, life-threatening disease, with mortality twice at that normal. It is characterized by increased and disregulated growth hormone (GH) production, usually caused by a GH-secreting pituitary tumor (somatotropinoma). Pituitary lesions are supposed to alter mood and personality.

To assess point prevalence of mental disorders in patients with acromegaly.

This is a cross-sectional cohort study of 118 patients with acromegaly (aged 21-78 years) included into the Registry of acromegaly of the Moscow Region with total population of 7 million. All patients met international diagnostic criteria for acromegaly, including laboratory measurements and brain MRI. Mental disorders were diagnosed according to ICD-10 criteria; with additional use of MINI, Hypomania Checklist and cognitive battery.

In total mental disorders were found in 88/118 (74,6%) patients. 56% of all patients referred to cluster of organic mental disorders, including mild dementia, mood, anxiety, personality, asthenic and mild cognitive disorders. 4,2% had alcohol dependence, 5,1% - schizophrenia spectrum disorders. Affective disorders were diagnosed in 30%, including bipolar disorder II - 12,7%, cyclothymia - 5,1%. Neurotic, stress related and somatoform disorders were discovered in 12,7% of patients; personality disorder - in 1,7%. Mutual comorbidity among mental disorders reached 1,39.

Study performed with the large sample of patients with acromegaly shows a higher prevalence of psychopathology. This fact evidence that patients with acromegaly need special mental care.

The predominance of bipolar disorder with hypomania might be the result of stimulating effect of GH.

Psychotic morbidity significantly exceeds that in total population, which can be explained by dysfunction of dopaminergic pathways.

The task of supervision is obvious – to increase the value of the therapeutic process in the client's best interest. There are many ethical questions rising in supervisors thinking about patients and also about therapist during CBT supervision.

The first aim was review the literature about ethics of CBT supervision and to compare the attitudes and belief about ethical questions in trainees of CBT a CBT supervision. The second aim was to find if there were any relations between ethical self-reflection and therapeutic skills of CBT trainee.

The first method was narrative review. A literature review was performed using the National Library of Medicine PubMed database, Scopus and Web of Science, additional references was found through bibliography reviews of relevant articles up to September 2013. Databases were searched for articles containing the following keywords: cognitive behavioral therapy, therapeutic relationship, training, supervision, ethics, self-reflection. The review also includes information from monographs referred to by other reviews. The second step was using the self-reflect questionnaire about ethical questions and assessment of the therapeutic skills of CBT trainees by their CBT trainers.

Strengthening ethical self-reflections in supervisees is a valuable way of improving the development of ethical aspects of professional growth throughout all stages of their career. Training and supervision focused on self-reflection on ethical aspects are beneficial to both supervisees and their patients. Preliminary results show, that therapist with high level of ethical self-reflection are significantly better in therapeutic skills assessed by trainees.