It has been shown that new antipsychotics (NAP) olanzapine or aripiprazole in combination with valproic acid or lithium are safe and improving the efficacy of the treatment of manic episode, and the mood stabilizing therapy in bipolar disorder (BD). NAP have less potent antidopaminergic action, and lover risk of Neuroleptic Malignant Syndrome (NMS) than typical antipsychotics.

59 years old male, with recent history of cognitive impairment, and long history of BD treated with combination of valproic acid, lithium and olanzapine was admitted to the hospital with acute manic episode. Because of ineffectiveness of the recent treatment there was added aripiprazole (15 mg/d) followed by slow reduction of olanzapine. After following 3 weeks the clinical symptoms of lithium intoxication, and the raising blood level of lithium (1,47 mmol/l) were observed, although the oral dose of lithium was not changed. The symptoms of intoxication disappeared during 10 days after lithium discontinuation. However, after the next 8 days of the treatment with aripiprazole combined with valproic acid - the NMS symptoms rapidly emerged and were lasting for 12 days

We have found in the literature description of NMS in the patient on aripiprazole combined with lithium, and in the patient with mental retardation treated with aripiprazole added to olanzapine. Our presentation reveals increased risk of toxic interactions between lithium and the new antipsychotic Aripiprazole, as so the possible role of neurobiological deficits as risk factors of NMS.

Repeated administration of haloperidol and olanzapine causes a progressively enhanced disruption of conditioned avoidance responding and a progressively enhanced inhibition of phencyclidine (PCP)-induced hyperlocomotion in rats. Both actions are thought to reflect the intrinsic antipsychotic activity.

The present study examined to the extent to which antipsychotic-induced sensitization in one model (e.g. conditioned avoidance response model) can be transferred or maintained in another (e.g. PCP hyperlocomotion model).

Methods: We first induced behavioral sensitization in one model through repeated administration of haloperidol or olanzapine to male Sprague-Dawley rats, then tested its expression in another model, and finally retested its expression back in the first model.

Repeated haloperidol and olanzapine induced a robust behavioral sensitization in both models. Its expression was highly situational specific as it only manifested itself in the model in which it was being induced.

Based on these and other findings, we propose that three behavioral mechanisms regulate antipsychotic sensitization and its situational specificity:

1. (1) Repeated antipsychotic treatment induces an unconditioned and nonassociative enhanced behavioral effect (i.e. sensitization) by progressively decreasing motivational salience of stimuli, an effect attributable to the direct pharmacological action of a drug;

2. (2) Distinct contextual cues develop an association with unconditional drug effects via a Pavlovian conditioning process, thus acquiring the ability to elicit antipsychotic-like effects. This associative learning process may potentiate the sensitized behavioral response in an expected situation;

3. (3) Contextual stimuli and interoceptive drug state also serve as occasion-setters to modulate the expression of sensitized responses.

Investigations of cerebral blood flow (CBF) using SPECT for decades revealed hypoperfusion/ischemia in differerent part of the Brain in many psychiatric patients, including Autists. Studies were of purely academic interest of the scientists without exit into practice.

We study and underwent neurosurgery 4 patients with autism diagnosis,which earlier has been confirmed by psychiatrists.All patieints male,age 3,4–6 years old.Relatives of patients signed agreements with Clinic and gave free-will informed consent to the offered cure.

Create minimal invasive psychoneurosurgery method for treatment Autism.

Patients (exept those with hyperactivity) examined by Transcranial Doppler Ultrasound (TCD) of middle cerebral arteries (MCA) on both sides. In pre-surgery period TCD showed ischemical disturbances of blood flow velocity and Gosling Pulse Index.We create and patented “Method For Treating Brain Ischemia”(patent RF 2312618; patent US11/955,087). Method need not in trepanation and absence any manipulation on brain tissue. Treatment consists in intensification of arterial blood flow due to single-stage sequential ligation of all branches of external carotid artery for redirection blood flow in internal carotid artery system.

In post surgery period we seen restoration of TCD values on MCA in both sides with initials dopplerographics signs of postischemic hyperperfusion. During 3–8 month and more, till 3–6 years,we seen good positive psychoneurological dynamics. Not observed any seriously complications and lethal cases. Catamnesis was followed up 1,5 to 6 years.

We support ischemia signs of CBF in Autists is closely related to pathophisiology,course and outcome of disease. Revascularisation of the Brain by our method showed significant improvement of clinical status and regress TCD values till normal.

Deep brain stimulation (DBS) in different targets emerges as a promising therapeutic option for patients with treatment-resistant obsessive compulsive disorder (trOCD). We here describe the acute effects of different stimulation settings on OCD symptoms and mood states in a patient with trOCD after implantation of DBS electrodes in the bed nucleus of the stria terminalis/ventral striatum-internal capsule (BNST/VS-IC).

Quadripolar DBS electrodes (Medtronic 3387) were implanted bilaterally with stereotactic guidance and microelectrode recordings in the BNST/VS-IC. Electrode location was confirmed via postoperative stereotactic CT. On the following day, the target was stimulated using different amplitudes (1V, 2V, 3.5V) and different contacts (0−/1+, 0−/3+, 2−/3+) with a constant pulse width of 210 μsec and a frequency of 130 Hz for 5 minutes, respectively. OCD symptoms and mood states were assessed by an independent rater using visual analogue scales.

Subjective intensity of obsessive-compulsive thoughts was reduced most by acute stimulation with 2V but, however, deteriorated with higher amplitudes. Subjective feelings of pleasure and spontaneous smiling were induced also at low voltage. Stimulation of different contact pairs located either in the BNST (0−/1+) or in the IC (2−/3+), and combined stimulation (0−/3+) produced differential and particularly specific effects.

We show acute effects on core symptoms of OCD after stimulation in the BNST/VS-IC. The induction of positive feelings accompanied symptom reduction. One hypothesis to explain our finding is that the induction of pleasure and smiling may be an epiphenomenon of stimulation of a ‘sweet-spot’ that ameliorates OCD symptoms after stimulation.

Cognitive Behavioral and related psychotherapies such as Meta-Cognitive Psychotherapy are the most commonly cited and researched psychotherapy modalities in treating Adult Attention Deficit Hyperactivity Disorder (ADHD). The structure and goals of these therapies can be directly adapted to address ADHD symptoms. However, Psychodynamic Psychotherapy is not generally thought of as a common treatment alternative in ADHD. Indeed, psychoanalytically derived psychotherapies are not regularly utilized in the treatment of neurobiological disorders/ADHD. Adults with ADHD have commonalities in psychological developments due to secondary effects ADHD may have on the infant-caregiver interactions and the formation of later psychological structures. Research in the treatment of Adult ADHD demonstrates how patients share common defensive configurations secondary to common sequelae of ADHD such as underachievement and social maladjustment.

The purpose of this abstract is to examine how the application of psychodynamic theory can be successfully utilized in several ways as a beneficial adjunct treatment of ADHD. Case examples of psychodynamic treatments of adults with ADHD will be presented as will common clinical issues in ADHD treatment.

This poster will present 4 case studies selected from a clinical population of a large metropolitan ADHD in Toronto, Canada and will discuss how psychotherapeutic techniques were utilized in conjunction with psychopharmacological agents to treat the symptoms of Adult ADHD.

The use and application of psychodynamic theory can be successfully utilized in significant ways as a beneficial adjunct treatment of ADHD as part of an integrative treatment approach which utilizes both psychotherapeutic and psychopharmacological approaches.

The paper presents a two-year experience of group psychotherapy drug female, fifteen-day rhythm, in a medium-sized group, in the Orthodox community. In the psychological structures of the group members are clearly distinct diagnostic deficit, which require the interpretations that would allow identification introjection of the therapist as a model, and facilities related to Orthodox spirituality can be used in it. The group cohesion contributes the contents related to the difficulty and beauty of common prayer.

The basic method of operation is based on newly discovered faith in God the Holy Trinity. The Psychological methods in the therapeutic process in the Community are: witnissing - the clients speak about the previous life experience, work on personal commitments - this is the feature which is not sufficiently developed, the division - through the lens of evangelical talking about the realization of personal commitments.

We follow the role of group psychotherapy in the milieu of other therapeutic methods. Through group psychotherapeutic process, we monitored the level of introjection of spiritual experiences.

The contents of spiritual experience in group psychotherapy protocols determining transferance-countertransference relationship and the course of the therapeutic process. Knowledge of the theoretical assumptions of Orthodox spirituality allows the therapist effectiveness of using countertransference.

During the two years of psychotherapy clients have accepted psychotherapeutic setting limits, enabling transmission and psychotherapeutic process.

The clients who have remained in the Community have developed the ability to create deeper introjection and more lasting benefits of spiritual and emotional contents.

Revealing of personal factors, personal biography factors which influence formation of aggressive behavior.

With questionnaires and analysis of personal biography we have revealed factors influencing formation of aggression. We have examined 158 men at the age of 32–58 years. 62% of men were in the second marriage. 73% of men had one or more children. 38% were in not registered marriage. Only 43% had stable high paid work, the rest had problems both with earnings and presence of job.

Factors influencing formation of aggressive behavior:

1. - Jealousy, which is pathological in nature, more unfounded

2. - Control over the behavior of his wife or other relatives

3. - A quick marriage.

4. - Emotional immaturity

5. - Brutality towards animals

6. - The destruction of objects, this pattern of behavior persists in his own family.

7. - Hypersensitivity, use of violence in the family, unrealistic expectations, the presence of brain injury, problems with law enforcement authorities in their teens, frequent changes of jobs, bad relationships with other family members, beatings in the past, lack of friends, a constant circle of friends, high level of conflict, a categorical decision challenging task.

Thus, the presented markers of personal characteristics surveyed indicate a propensity for violence. If a man finds several above features (three or four), then the likelihood of violence is high enough, the richer the set of these characteristics, the greater the likelihood of violence.

Group psychodynamic psychotherapy (GPP) has shown some promising evidences to ameliorate the target symptoms of psychiatric patients.

To examine the efficacy of adding GPP to pharmacotherapy treatment of Mixed anxiety-depressive disorder outpatients.

To investigate into the symptom relief effects of GPP in a developing setting.

21 psychiatric outpatients who entered long-term group psychodynamic psychotherapy plus pharmacotherapy protocol (Combined therapy) and 22 psychiatric outpatients who entered pharmacotherapy alone protocol of a psychotherapy clinic in the capital (Tehran), were matched against each other and analyzed on an intent to treat basis. HAM-D-24 Q, and HAM-A were used to rate the symptoms at baseline and after 6 months of each therapy (Dropouts reported < 5%). The percentile reduction in symptom scores and the response rates for each group were compared. Age, sex and baseline depressive and anxiety scores were also examined for their confounding effect on the response rate of patients.

Compared with pharmacotherapy alone, Combined therapy caused more reduction in both depressive (53% vs. 44%) and anxiety (54% vs. 45%) symptoms and also a greater response rate (62% vs. 38%) among participants. Although not significant, the asymmetric distribution of 95% confidence interval rates of the difference (PROP test,R) indicated a higher proportional response rate for combined therapy. No confounding effect was found for proposed variables.

The results for combining GPP with pharmacotherapy to improve the symptomatic outcome of Iranian psychiatric outpatients are in line with the developed settings studies.

HIV is often related to psychological distress, after the diagnosis and the beginning of HAART. Brief Psychological approaches are important but they give only support, enhancing the relationships of the patients. In many cases these relationships are disfunctional too. Psychotherapies don't focus on the indidvidual's autonomy but on the support from the others.

A brief-grouppsychotherapy focused on major objectives of each person but with the main common objective to enhance the psychological individual indipendence and to promove a self-maturation; understanding the disfunctional dynamics realized in the past that are enhanced by the HIV-status, to promove individual indipendence with the objective of focusing the good and valid relationships and change the disfunctional ones and to allow the person to be able to open to the world again.

A brief group psychotherapy, supportive but mostly expressive.

a small group 3 male, 1 female: were choosen for group psychotherapy after 2–3 individual meetings. 16 psychotherapy meetings, weekly, lenghth 1 hour 40–45 minutes.

First time patients worked on their disfunctional affective part, that was pre-hiv. In a second time they worked promoting their possibility of indipendence to find their lost self esteem. in the last time they focused to improve their relationships where possible but mostly to think that they can go out alone from the darkness after HIV diagnosis.

Quality of life of HIV patients can be focused on changing their disfunctional parts, first enhancing the process of indipendence and individual esteem of the person.

Majority of patients after surgery intervention had anxiety, depression and obsessive disturbances. The aim of this study was provided the rehabilitation program based on multimodal model of psychotherapy of anxiety and depression on patient undergoing hand and fingers reconstructive surgery.

In this interventional study 80 randomly patients, based on convenience sampling, who had the required criteria were selected and divided into two groups marked as experimental and control groups. The data were collected by two questionnaires: The Spielberger anxiety scale the Beck depression inventory. Both groups answered these questionnaires in three periods: on discharge from hospital, at the middle and after psychorehabilitation program. The control group reserved only routine program of physical rehabilitation.

The results revealed that after psychorehabilitation program there are significant statistical differences in depression level between groups (p ‘ 0.001) as well as reactivity anxiety but in personality anxiety level, there was no statistical difference (p ’ 0.05) between groups.

Several studies have found that women who have experienced child sexual abuse (CSA) develop Post-Traumatic Stress Disorder (PTSD) related to their victimization experiences. The current study evaluated the presence of PTSD symptoms five years after discharge among adult women suffering from sequalae from CSA.

This randomized prospective 5-year follow-up study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. PTSD symptoms were evaluated at baseline, discharge and 1 and 5 years after discharge, using the crime-related post-traumatic stress disorder scale (CR-PTSD) from the Symptom Checklist-90-Revised (SCL-90-R). ANOVA was performed using treatment group as a between factor and the four time points as repeated measures.

PTSD symptoms were significantly reduced during therapy for both groups (P < 0.000), but the systemic group exhibited significantly more reduction of PTSD symptoms than the analytic group (P < 0.002) at discharge. Difference in trajectories was found for the two groups (P > 0.005). No difference in reduction of PTSD symptoms was found between groups at 1 and 5 year follow-up.

Symptoms of PTSD were reduced in women with a history of CSA participating in both analytic and systemic specialized incest group psychotherapy. Improvement was maintained for both groups at 5-year-follow-up. The trajectories of PTSD symptoms for the two groups differed significantly, however. Implications of the difference in trajectories for treatment planning will be discussed. The findings in the present study stress the importance of long-term follow-up studies in evidence-based research.

Mental disorders are a primary cause of occupational impairments. This study investigated long-term changes in occupational functioning for patients referred to psychotherapeutic treatment at a Danish mental healthcare centre in 2004 and 2005.

We recruited 761 consecutive patients and 15,220 matched-control subjects. Data on number of days per year on sick leave, unemployment, and disability pension were collected from central registries over a 5-year observation period from 2002–2007. Differences in number of days with occupational impairments between and within groups were analyzed with t-test and with ANCOVA one and two year pre-post treatment.

Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients’ days on sick leave increased significantly from 15.7 days two years before treatment to 23.1 days two years after treatment (p < 0.000) and significant more than the control group (5.4days : 7.5 days). Similar results were found for days on disability pension (p = 0.013). Unemployment did not show any significant change for completer patients compared to the control group (p = 0.569). Variations in results were seen, depending on treatment status as no-show, responder or non-responder.

Patients that received psychotherapeutic intervention showed long-term increases in days on sick leave and disability pension.

Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care services for patients referred to psychotherapeutic treatment in 2004 and 2005.

The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment.

Of the 761 patients, 216 patients did not show up for treatment, while 545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES = 0.58) in the four year pre-post comparison, while the control group only increased with 99% (ES = 0.23). Four years after ended treatment completer patients still showed a consumption of health care services significantly above the control group on five out of eight health care parameters. Response status only affected one health care parameter.

Over a long-term period psychotherapy patients increased their utilization of health care services with a factor 3 compared to a control group.

Psychosis often leads to stigmatization and reduction of social power and prestige of the individual, hence leading further o social rejection and shame.

The current study assessed the role of external shame on psychiatric patients.

The present study aimed at evaluating external shame in psychiatric patients who where cared by the Department of Psychiatry at the University Hospital of Alexandroupolis, Greece.

45 patients suffering from schizophrenia participated to the present study (18 men and 27 women with mean age of 44.09 SD = 11.55, ranged 19–75). The measures used were: a) the Other As Shamer scale (OAS) b), a questionnaire concerning socio-demographic information,

The average of the external shame (OAS total) was 11.11 ± 5.22, without any statistical significant difference among gender in their comparison with the t-Test (p = .864). This ismuch lower than the average normal external shame the Greek population (17.74 ± 9.02).The analysis of variance between age groups showed that age, place of residence and educational level did not affect the external shame in psychotic patients. The marital status demonstrated a significant effect on external shame of psychotic patients where the application of the Bonferonni criterion was found that a) married participants demonstrated statistical significant difference from widowed (p = .030) and b) differed significantly from divorced widows (p = .011). Indeed, the widowed psychiatric patients exhibited greater levels of external shame.

Low levels of external shame may reflect difficulties in interpersonal relationships. Our findings illuminate the external shame in psychiatric patients.

The primary objective will focus the first of all on Eye Movement Reprocessing and Desensitization (EMDR) as an evidence based intervention in the treatment of psycho-traumatized individuals. Its effectiveness has been validated by extensive research. It outlines in particular an EMDR Humanitarian Assistance Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in EMDR to enable them to treat psychological trauma symptoms of war survivors.

Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK &Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH.

Highly dedicated internationally approved trainers from HAP UK & Ireland provided completed EMDR training for 19 trainees: neuro- psychiatrists, residents of neuro-psychiatry and psychologists from eight different health institutions from six different cities in BH. Training started with 24 trainees, but five of them were prevented to complete training. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK & Ireland supervisors. Because of physical distance between supervisors and trainees, supervision is organized via Skype Internet technology.

Training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland will increase psychotherapy capacities in postwar BH.

The primary objective will focus the first of all on Group Analysis (GA) as the psychotherapy method and theory of group analysis applied particularly in post-war environments. It outlines in particular a Zagreb Institute for GA Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in GA to enable them to treat psychological trauma symptoms of war survivors.

Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Institute for GA, Department for Psychology Medicine, School of Medicine in University of Zagreb, Croatia in sharing skills of GA to mental health therapists in BH.

Highly dedicated internationally approved trainers from GA provided completed training for trainees: neuro- psychiatrists, residents, nurses, psychologists, social workers, special educators, paediatrician, and gynaecologist from several different institutions from seven different cities in BH and Croatia. Training started during the war period with introduction course and continues with Diploma Courses. To be accredited GA therapists all trainees are obliged to practice GA therapy with clients under the supervision process of GA supervisors. Nowadays there are 7 graduated Group Analysts in BH. Three of them are in process of training for educators.

Training of Bosnia-Herzegovina mental health workers to effectively use GA with enthusiastic help of GA trainers from Institute for GA Zagreb will increase psychotherapy capacities in postwar BH.