Depression is a very common condition in the elderly, underdiagnosed and often an emerging public health issue, especially in developed countries where population is aging.

The participants (103 patients) age 55 years or more, with diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to general medical condition. The depressive status of the participants was determined clinically, using the GDS and the Cornell scale for depression in dementia when MMSE was > 15.

Of the 103 inpatients, 87 had MMSE score less than 24 and were included in the analysis. 23.1% had been clinically diagnosed as suffering from depression and taking antidepressants although 53.8% had CDS>6 and 57.3% had Cornell score >11 both indicative of depression. It appeared that clinicians were able to detect mainly severe major depression with mean CDS score=10.50, (sd = 1.5) and mean Cornell score=18 (sd = 4.3).

In our sample of an elderly long term inpatient population with primary diagnosis of serious mental disorder, depression was under diagnosed and undertreated. Only severe major depression was detected.

It appears that psychometric scales like Geriatric Depression Scale (GDS) and Cornell Scale for Depression in Dementia (CSDD) are valuable instruments for the detection of depression in elderly populations. As depression is very good in hiding or camouphlage its’ symptoms as part of other disorders, regular use of psychometric scales could prove to be an easy way to detect early signs of depression and treat accordingly.

People with severe mental disorders have worse physical health compared with the general population. Metabolic aspects such as obesity, diabetes, hypertension, dyslipidaemia, smoking and antipsychotic medication increase the risk of metabolic syndrome (MetS) and cardiovascular disease. Epidemiological studies have consistently shown excess CVD mortality in patients with schizophrenia, bipolar disorder and depression.

The participants (103 patients) age 55 years or more, had diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to a general medical condition(DSM IV-TR criteria). Metabolic syndrome was estimated using the ATP III definition.

Framingham risk score was calculated using algorithms developed by Wilson for subjects aged 30 years and older.

Overall prevalence of MetS was 34%. (37.1% men, 62,9% women). Among patients with MetS 74.3% had schizophrenia, 8.6.% Mood disorder and 17.1% Mental disorders due to a general medical condition. In our sample 18.8% of patients with MetS were receiving FGAs, 78.1% SGAs and 3.1% combination of FGAs and SGAs but this difference wasn’t statistically significant.

Low risk (FRS < = 14) had 68% of participants (21.4% men and 78.6% women). Moderate risk (FRS > 15) had 32% of participants (66.7% men, 33.3% women).

The results indicate that patients with schizophrenia have higher probability of having MetS, therefore, clinicians should appropriately monitor the risk factors and intervene as required.

There are many types of psychomotor disturbances in individuals with Alzheimer's disease. The kind and depth of these dysfunctions relate to the stage of AD.

The aim of the study is to compare graphomotor efficiency in individuals with mild and intermediate Alzheimer's disease with those parameters in older subjects without dementia.

31 individuals with mild and intermediate Alzheimer's dementia (F.00.0, F.00.1, F.00.2) (MMSE > 13) (26 women, mean age 76.8 ± 6.41 and 5 men, mean age 79.1 ± 5.21), treated with acetylcholinesterase inhibitors, and 30 individuals without symptoms of dementia (matched for age) were examined.

Graphomotor efficiency was assessed by the original drawing test performed in a magnetic field with the use of MedTablet software. The average length of drawing [cm], the average time of drawing [s] and the average speed of drawing [cm / s] were measured.

Statistically significant differences were found in all tested variables: the average length of drawing [cm] (α = 0.05, p = 0.000009), average time of drawing [s] (p = 0, 000205) and the average speed of drawing [cm / s] (p = 0.000015) between the compared groups.

It was found that the level of graphomotor efficiency in individuals with mild and intermediate Alzheimer's disease is statistically significantly lower in comparison to older people without dementia.

There are abnormalities in eye movements in individuals with Alzheimer's disease, which are related to oculomotor frontal-subcortical circuit dysfunctions.

The aim of the study is to compare the parameters of saccadic eye movements in individuals with Alzheimer's disease with those in older adults without dementia.

31 individuals with mild and intermediate Alzheimer's dementia (MMSE > 13) (26 women, mean age 76.8 ± 6.41 and 5 men, mean age 79.1 ± 5.21) and 30 individuals without symptoms of dementia (matched for age) were examined.

The parameters of saccadic eye movements were measured with the use of Saccadometer Advanced. Two experiments were performed: Latency Trials (LAT) and Reflexive with Gap (RXG). Saccadic latency [ms], the reaction time [ms] and the number of executed saccades were measured.

Results:

LAT:

Statistically significant differences in the number of saccades (α = 0.05, p = 0.000024) and in average latency [ms] (α = 0.05, p = 0.039) between the individuals with AD and the healthy ones were found.

RXG:

Statistically significant differences were found in all the variables tested: number of executed saccades (α = 0.05, p = 0.0265), average latency [ms] (α = 0.05, p = 0.043) and average duration [ms] (α = 0.05, p = 0.000035) between persons from the control group and those from the experimental group.

It was found that the level of oculomotor efficiency in mild and intermediate Alzheimer's disease is significantly lower in relation to older people without dementia.

We describe a case of OCD and movement disorders associated with anti basal ganglia antibodies.

A 17 year old patient was referred to our unit in February 2010 because of movement disorder. He denied personal or family history of psychiatric disorders and substance abuse other that occasional cannabis use. His symptoms had began 6 months earlier when he started presenting intrusive thoughts associated with various compulsions such as complex arm and leg movements and bizarre postures: he was treated with Olanzapine and Sertraline which lead to partial improvement of symptoms but he self-discontinuated the medication in january 2010. Upon admittance in february 2010 the patient showed obsessive thoughts associated with bizarre postures and upper limb complex movements.

He was treated with 100 mg of Clomipramine which lead to partial regression of symptoms. Autoimmunity screening was performed revealing anti neuron specific enolase and anti pyruvate kynase antibodies. The patient was treated with Desametasone which did not lead to any improvement.

Anti neuron specific enolase and anti pyruvate kynase antibodies are directed against antigens specifically expressed in the basal ganglia. According to literature data these autoantibodies can be associated with movement disorders and OCD and we hypothesize that our patient's symtptoms were caused by autoimmunity. Although cortison was not successfull, recents reports in scientific literature have shown that other non psychopharmacological treatment, such as plasmapheresis, or IV immunoglobulins could be effective in similar patients: we are considering this as our next treatment option.

Immune power personality is a term coined by H. Dreher to describe 7 personality traits which had previously been found in empirical research to be associated with better functioning of some aspects of the immune system. These traits included the ACE (attend-connect-express) factor, the capacity to confide, assertiveness, healthy helping, the affiliative trust, hardiness, self-complexity. The objective of this study was to operationalize the concept of the immune power personality in the form of a psychometrical questionnaire.

Literature analysis was applied to elicit the psychological contents of the immune power personality traits. For each trait, initial pools (from 36 to 50) of items were generated. Four consecutive studies were carried out in order to select psychometrically most suitable items for the final version of the instrument.

Item properties were calculated and, at each stage of the study, items with insufficient psychometric properties were eliminated to yield, finally, 6 items for each trait. As some traits were found to be highly correlated with social desirability, the control subscale was developed and introduced into the instrument in order to control the effect of excessively positive self-presentation. Reliability coefficients for each trait were found to be high. Exploratory factor analysis yielded a six-factor solution for the questionnaire, with the vast majority of the items loading highest on the pre-assumed subscales. The items measuring the ACE trait were diffused within other factors.

Immune Power Personality Questionnaire seems a promising psychometric tool which may enhance future research on the personality-health relationships.

Asthma can negatively affect the daily functioning, quality of life and psychological well-being of patients, requiring adjustment to their multiple life domains. Studies have shown that patients often use avoidance and denial coping strategies, which have been negatively associated with poor clinical and psychological outcomes.

To analyze the relationship between coping strategies, anxiety and control of disease in asthmatic patients.

Cross-sectional study with 253 patients diagnosed with asthma, recruited consecutively in University Hospital. A subsample of 247 patients was evaluated with: Ways of Coping with Asthma in Everyday Life, State Trait Anxiety Inventory, Asthma Control Questionnaire.

The participants were mostly females (78.5%), with mean age 40.6 (15.3) years. The majority (78.7%) had severe persistent asthma and mean illness duration was 20.8 (15.4) years. The use of Avoidance (p < 0.05) (ignoring, denying or avoiding asthma), Worrying with Asthma and Restricted Lifestyle (p < 0.01) (passive affective reactions to the problem) were higher in asthmatics with poor control of the disease. Avoidance and Worry with Asthma correlated with state (p < 0.05/p < 0.01) and trait (p < 0.01/p < 0.05) anxiety. Further, a negative correlation was found between Active Coping and trait anxiety (p < 0.05).

Avoidance or Passive coping strategies were both negatively associated with poor asthma control and higher anxiety. However, further studies will be needed to identify the most adaptive coping strategies that are associated with optimal asthma outcomes. This could provide important directions for development of intervention programmes aimed to improve outcomes in adults with asthma.

Depression is a highly prevalent comorbidity in patients suffering from chronic obstructive pulmonary disease (COPD). Both, depression and COPD are believed to be associated with inflammation. The aim of our study was to verify hypothesis that altered inflammatory response causes depression in patients with chronic obstructive pulmonary disease.

Blood was collected from 45 patients of whom 18 had COPD, 18 were depressed and 9 had COPD with comorbid depression. Total of 27 age and sex matched healthy controls were also included in the study. IL-2, IL-8 and IL-17A concentrations were assayed by ELISA technique in sera of all subjects.

We observed significantly decreased concentration of IL-17A in a group of depressed patients (D) when compared with controls, 4.46 ± 0.573 pg/mL vs. 8.87 ± 1.182 pg/mL, respectively, P = 0.0005. Increased concentration of IL-2 in depressed patients (D) as compared with controls, 3.00 ± 0.223 pg/mL vs. 2.30 ± 0.176 pg/mL, respectively, P = 0.013 was also revealed. There was also increased concentration of IL-8 in COPD subjects if compared with controls and depression group, 4.55 ± 0.176 pg/mL vs. 3.71 ± .132 and 3.95 ± 0.118 pg/mL, respectively, P = 0.008.

The results from our study suggest that there is significant difference between depression and COPDs with respect to IL-8 concentration also a lower concentration of IL-17A was noticeable in depressed patients (P = 0.06). We need more data on depressed COPD patients to argue the role of inflammation on depression in COPD patients.

S100B is a 21 kDa protein expressed primarily in astrocytes and has been related with brain dysfunction. There is evidence for increased S100B in schizophrenia, including first-episode psychosis (FEP), and in epilepsy specially after seizures. Pico and nanomolar levels of S100B are neurotrophic and micromolar levels are toxic and apoptotic.

To assess serum levels of S100B at admission and at discharge in a patient with FEP who had comorbid juvenile myoclonic epilepsy (JME).

A 23 year-old male was admitted for injury delusions, suspicion and auditory hallucinations that had started in the last three months. In the last year the patient presented progressive social isolation and stopped attending classes. He was diagnosed JME at age 14 and was treated with 1300 mg valproic acid per day. The last seizure was two years ago. Risperidone was started up to 8 mg per day and valproic acid was continued. He had a progressive clinical improvement and in two weeks was discharged. Serum levels of S100B were determined at admission (3528.23 pg/ml) and discharge (3553.78 pg/ml).

This patient had high levels of serum S100B both at admission and discharge. These levels were ten times higher than previous studies in epilepsy (without psychosis), hundred times higher than previous in psychosis and thousands times higher than in healthy subjects. We interpret these results as an intense activation of astrocytes by a double brain insult. Monitoring this patient during more time will show the evolution of S100B with antipsychotic treatment.

Connexin43 (Cx43) is the main protein of brain astrocytic gap-junctional network, which plays an important role in the ion and glutamate homeostasis, intercellular signaling, cell adhesion and migration during brain morphogenesis. Earlier we obtained monoclonal antibodies to the E2 extracellular loop of Cx43 (MAbE2Cx43) which could block the functions of astrocytic gap-junctions in vitro and in vivo.

The aim of the current study was to elucidate the influence of MAbE2Cx43 on the cognitive function in animals treated during neurogenesis.

The antibodies were injected intravenously to wild pregnant female rats in a dose of 5 mg/kg on the 10thday of gestation. The saline solution was used as a control medicine. Behavioral experiments were conducted on 1-month old offsprings in the following order: the Y-maze, novel object recognition test (NORT) and passive avoidance (PA) task.

The Y-maze test revealed a significant decrease in the spontaneous alternation behavior of experimental rats treated with MAbE2Cx43 in the perinatal period compared to control rats. In the NORT rats treated with MAbE2Cx43 have shown significant impairments of the recognition memory after a 24-hour delay. The PA test revealed no significant difference in avoidance latency in the retention trial on the day 2-nd, but it appeared on the day 7-th.

These findings confirm memory deficiency after one-time administration of MAbE2Cx43 in the perinatal period. We conclude that the injection of anti-Cx43 antibodies in the perinatal period could alter some Cx43-dependent processes during neurogenesis resulting in cognitive deficiency in adulthood.

Research across a range of disaster types has identified that psychological disturbances are common in the aftermath. The consequences of these disturbances can be long lasting.

This study assessed the long-term mental health effects of a wildfire disaster which happen in a rural area of Greece in 2007.

a) to assess the course of psychopathology associated with the disaster, b) to evaluate if there are differences in psychological distress between victims and controls 3 years after the disaster.

The population for this cross-sectional study was a random sample of adult population (18–65 years old) of victims and controls who had been assessed 2½ years before. The measured variables were: a) demographics b) Symptom Checklist 90-Revised (SCL-90-R).

530 participants (301 victims and 229 controls). Attrition rate: 13.8%. Psychological distress was significantly (p < 0.05) lower 3 years after the disaster compared to initial assessments. However, victims of the wildfires still had more distress compared to controls. Similarly, the number of caseness (as it is defined by the SCL-90-R) was significantly higher in the victims’ group compared to controls’. In contrast, there was a significant reduction of the rates of caseness in both victims and controls compared to initial assessments.

Most psychological problems decreased from the initial (6 months after the disaster) to the second survey (3 years after) among affected from the wildfires participants. Although their psychological problems decreased, victims still had more psychological problems (e.g. anxiety, somatisation, phobias) than the participants in the control group.

Ekbom's syndrome or delusional parasitosis (DP), is an “uncommon psychiatric syndrome” characterized by the presence of delusion of infestation.

The syndrome may be seen in association wiht a number of neuropsychiatric conditions, including bipolar disorder, paranoia,schizophrenia, dementia, depression as well as abuse of drugs, such as cocaine or amphetamines. Previously, DP was often considered to be a monosymptomatic hypochondraical psychosis. Delusions of parasitosis has also been reported in association with a number of medical conditions that are characterized by itching.

To review the literature through a case report.

A 52 year-old female, unmarried who lives alone, was admitted for parasitosis delusions that had started in the last two months. She complained of vermins crawling through her skin, mainly on her face and scalp. The illness began with pricking and itching sensations on her head. She used to put the “little animals” in a piece of paper to prove their existence. Risperodone was started up to 3 mg per day. She had a progressive clinical improvement and in one week was discharged.

In conclusion, rather than a unique illness, DP is a neuropsychiatric syndrome that can follow primary psychotic and depressive disorders, dementia or other organic diseases. The typical patient is an elderly woman who is unmarried or living along.

There have been no double-blind studies confirming that atypical antipsychotics are more effective than pimozide in the treatment of DP. Further trials are warranted to study the true efficacy of atypical antipsychotics in the treatment of DP.

Hysterical psychosis has never been part of the standard nomenclature. Janet postulated that a psychosis could be considered hysterical if its dissociative nature could be established. Breuer and Freud emphasized the traumatic origins and oneiroid form of the disorder. Hollender and Hirsch focused mainly on descriptive features: the dramatic onset, the temporal relation to an upsetting event, the short duration and the preponderance of females with histrionic behavior.

To demonstrate the traumatic origins and distinct features of hysterical psychosis.

A clinical case was followed and reviewed.

A 48-year-old female presented acutely with disorganized behavior, negativism, loosening of associations, delusions of demonic influence and a fluctuating level of consciousness. Symptom onset was temporally related to severe family stressors. A complete medical evaluation ruled out the presence of an underlying organic factor. Dissociative conversion disorder was chosen as our working diagnosis. Rapid clinical response was achieved on low dose paliperidone. After the abatement of symptoms, our patient provided a comprehensive history of her experience, describing an oneiroid state in which she transiently submerged in vivid fantasies based upon past traumatic life events. Pharmacotherapy was gradually withdrawn and psychodynamic psychotherapy was introduced as a means to help her abreact the past traumata and integrate them into a cohesive self.

This case supports Janet's formulation of hysterical psychosis and demonstrates the usefulness of the dissociative component in forming a diagnostic impression and treatment approach. It also underlines the need of distinctly classifying this clinical entity among dissociative disorders.

The first isolated case of folie à deux was reported by Harvey (1651). In 1873, Lasègue and Falret coined the term folie à deux or folie communiqué. Nowadays, defined as Shared Psychotic Disorder (DSM-IV-TR).

A case report of folie à deux involving two sisters, is described. The historical concept of shared psychotic disorder, its epidemiology, etiological hypothesis, clinical presentation and treatment is briefly reviewed.

A detailed clinical history was obtained from several interviews concerning the individuals taking part in this case; a literature review of the theme shortly surveyed.

A woman of 49 years, without any psychiatric history prior 2003, who developed hallucinatory activity and delusions of persecution concerning her neighbours, claiming they were attempting to test new technology using electromagnetic energy on her body. The patient constantly communicated the experience of these phenomena to her sister of 56, with whom she lived, during these 8 years. This second one, with schizotypical personality traits, accepted these delusions without question and, moreover, found proof of them in her own interpretations. Both patients were admitted to the inpatient ward and treated with antipsychotics.

Folie à deux is the transmission of delusional ideas from a psychotic to closely-associated individuals, who have experienced his domineering influence for a prolonged space of time. Most writers agree that prolonged social isolation, strong emotional ties, domination and forceful suggestive powers in one, coupled with a high degree of suggestibility and submissiveness in the other, play an important role in shared psychotic disorder.

To evaluate if individuals with seasonal changes in mood and behavior are more susceptible to present psychopathology than the general population.

We applied the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Mental Health Screening Scale (ER-80) to 160 individuals. The variables studied were gender, age, marital status, education, SPAQ score index (SSI) and presence of psychopathology.

The prevalence of individuals with seasonal changes in mood and behavior was very high, about 43.1% of the total. Out of those, 23.1% viewed seasonal changes as a moderate to severe problem. Individuals with seasonal profile (SSI ≥ 11) had more psychiatric morbidity than those without seasonal profile. This difference is statistically significant (t = 4.279, p < 0.001), which corroborates the hypothesis that seasonality is associated with psychopathology.

The authors recognize that the study of seasonality may contribute to the prevention, identification and better characterization of psychopathology.

Folie à deux or induced psychotic disorder is a rare psychiatric illness and was first described in the 19th century. The essential feature is a psychotic disorder shared by two emotionally close persons, usually a blood relative or spouse, while living in relative isolation. The disorder is characterized by a primary psychotic person, usually older, more intelligent and better educated who gradually imposes her delusional beliefs on the other person, who is often dependent on or submissive to the person with the psychotic disorder. The disorder usually resolves in the more passive person when the two are separated.

To describe two case studies of two couples who shared psychotic illness and make a review of the literature.

Search in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.

Even though Folie a deux is rare to diagnose, clinicians should be aware of this condition, since it is tremendously important to treat properly both people involved.