To explore (a) culturally-related differences in anxiety between college students recruited from 18 Arab and four Western countries, and (b) sex-related differences in anxiety in each country.

A volunteer sample (N=10312) of male (n = 4975) and female (n = 5337) college students was recruited from 18 Arab and four Western countries. They responded to the Kuwait University Anxiety Scale (KUAS; Abdel-Khalek, 2000). Arabic, English, German and Spanish equivalent versions of the KUAS were used. The scale has good psychometric characteristics in these four forms.

The highest mean anxiety total scores were found in male Arab students from Syria, Jordan, Palestine, and Egypt, and in females from Syria, Saudi Arabia, Egypt, and Palestine, respectively. The differences between the four Western countries in the mean scores were small. Women had significantly higher mean anxiety scores in 14 out of the 18 Arab countries, whereas only Spanish and USA women had significantly higher anxiety mean scores than men. By and large, Arab participants had higher anxiety mean scores than their Western counterparts (see the diagram).

In this study, Arab college students scored as more anxious than their Western peers. The Arab countries are in transition between collectivism and individualism.

Recent studies have shown the role of sorotonergic system in posttraumatic stress disorder. Terazodone and Nefazodone, (5HT2 antagonist) ameliorated PTSD nightmares but the reports are mixed. This study prompted an open trial of cyprohepatadine for Iran versus Iraq combat PTSD patient nightmares.

25 patients studied in an eight - week, Before - After trial of cyproheptadine, the participants were male and chronic PTSD patients with combat related nightmare the exclusion criteria in clouded current substance abuse or dependence, psychotic disorder and any medical condition that contraindicated the use of cyproheptadine.

Five patients were excluded from the study because of side effects including dizziness and somnolence. Twenty patients completed the study. Average of nightmare severity decreased from 6.85 to 5.05, which was statistically significant (P<0.01).

Cyproheptadine, 5HT2 antagonist may be effective in PTSD nightmare treatment.

As a symptom, aggression is closely related to antisocial personality disorder (ASP). Prefrontal cortex plays a key role in the regulation of anger and violence and in sleep-wake transitions. The aim of this study is to evaluate the quality of the subjective sleep and to determine its relation to the degree of aggression for the subjects with APD.

Among 155 males who were sent to a pretrial forensic psychiatric examination by the court, 60 were suitable and admitted to the study. All of them were being charged with violent offences (murder or assault). 64 subjects were not involved in crimes involving violence were taken as the control group. All of the subjects met the DSM-IV criteria for ASP. Subjects were interviewed with an assessment battery including a semistructured interview form concerning the sociodemographic factors, SCID-I, SCID-II, Aggression Questionnaire (AQ) and Pittsburgh Sleep Quality Index (PSQI).

AQ total point and physical aggression, verbal aggression and anger subscales were found to be significantly higher in the study group. Between the groups significant differences were found in PSQI total points, sleep latency, sleep disorder, use of sleeping pills and in the points of subscales of loss of functionality during day. There has been found a positive correlation between PSQI global point and AQ total point.

This study can contribute to further support to evidence of brain dysfunction predisposing to severe aggression and sleep disturbances of individuals with APD.

Erectile dysfunction is used to signify the inability of the male to achieve an erect penis as a part of the overall multifaceted process of male sexual function. It affects millions of men all over the world.

The objective of the study was to study the erectile dysfunction in adult Yemeni men.

Five hundred and twenty two male Yemeni patients 17-80 years old of different months and years duration were admitted to dermatology, urology and psychiatry clinic of Al-Thawra teaching hospital between January 1992 to December 1995. They presented with erectile dysfunction and evaluated by noninvasive and invasive methods [papaverine test and prostaglandineE1 test were positive].

The clinical data and the investigations showed that about three hundred and thirty six cases were psychological impotence increased in young adults from 17-30 years of 72% and decreased in the age of 40 –80 years of 28%. About one hundred and eighty six cases were psychological premature ejaculation increased in young adults 17-30 years of 72% and decreased in the age 40-80 years of 28%. The intrapsychic, interpersonal and experiential behavioral factors play an important role in these ages and some cutaneous manifestations and diseases were associated. The empirical medical therapy and MASTER and JOHONSON technique were effective 100%.

Psychological erectile dysfunctions in Yemeni adult men were common sexual disorder. Health education, medical, psychological and sexual counseling were necessary needed.

Compare results on the TRQ in patients waiting for a kidney transplantation from cadaveric or living donor.

390 patients included in waiting list for kidney transplantation with cadaveric or living donor were assessed with the TRQ. Since the beginning of the study, 170 patients were transplanted, 148 (87%) with cadaveric donor (CD group), and 22 (13%) with living donor (LD group). The principal component analysis has been performed on 390 patients.

The Principal component analysis of the TRQ has shown 2 factors.The factor “Donor” refers to the recipient concerns about the donor (11 items).The factor “Transplant” refers to the negative attitude of the recipient about the transplanted organ (8 items). The LD group was younger and had more social support than the CD group. It had also higher scores on the “donor” factor and similar scores on the “transplant” factor.

As compared to patients waiting for transplantation with cadaveric donor, patients waiting for transplantation with living donor have more concerns about the donor, and similar representations of their future transplant. Our preliminary results should be confirmed in more powerful studies. Further studies will assess prospectively the transplant representations after transplantation.

To assess relations between religiosity, social and clinical parameters, quality of life and suicidality in breast cancer patients.

115 breast cancer inpatients were included. The measures used were: Santa Clara Strength of Religious Faith Questionnaire (SCSORF), World Health Organisation Well-Being Index Five and International Breast Cancer Study Group Quality of Life Questionnaire (consists of visual analogue scales measuring physical health, mood, tiredness, perceived adjustment, pain, appetite, social support, satisfaction with current condition) and three statements relating to religious coping with cancer: "my faith helps me coping with illness", "illness increased my faith" and "illness decreased my faith" (Likert scale: 1 - strongly disagree to 4 - strongly agree). Suicidality was measured with extracted question from diagnostic questionnaire for depressive patients: "Do you have the feeling that life has no value or suicidal thoughts?” (Likert scale: 0- no; 1- life has no value, it is better not to live; 2- death wish, but without suicidal thoughts; 3 - suicidal thoughts or plans; 4 - suicide, attempted suicide). Clinical variables were tumor grade, hormonal therapy, type of operation.

Suicidality was negatively correlated with well-being (r=-0,549; p=0.001), all health-related QOL dimensions, time passed since diagnosis (r=-0,211; p=0,05), but was not associated with clinical or social variables. SCSORF score, frequency of attendance and prayer were not associated with suicidality, but statement "the illness decreased my faith" was positively correlated with suicidality (r=0,268; p=0,004).

Suicidality of breast cancer patients is associated with QOL domains but not with clinical characteristics of the illness. Decreasing of faith is associated with suicidality.

The level of anxiety depending on existing bruxist behaviour between temporomandibular joint disorder (TMJD) patients and asymptomatic volunteers was compared.

TMJD in 40 patients (mean age 35.5, 76% women) was diagnosed using RDC/TMD Axis I and was confirmed by magnetic resonance imaging. The control group consisted of 25 asymptomatic volunteers (mean age 23.4, 72% women). Bruxism was diagnosed based on case history and clinical findings. The anxiety was confirmed by State-Trait Anxiety Inventory (STAI).

A higher level of anxiety was determined for all examined patients (the mean score in STAI 1=38.43, STAI 2=46.10). There was no statistically significant difference (p>0.05) with respect to the control group (STAI 1=34.25, STAI 2=39.00). Including only patients with determined anxiety depending on age and gender resulted in 62.5% of patients with anxiety according to the STAI 1=42.84, and 72.5% of patients with anxiety according to the STAI 2=44.20. Only 16% subjects from the control group and 40% patients had bruxism. There was a statistically significant difference in scores of both STAI tests in patients with bruxist behaviour (p<0.001). Statistically significant differences between patients with lower (1-4) and higher (5-10) degree of pain were rated on a visual-analogue scale for State-Trait Anxiety Inventory 2 (p=0.012).

This study has confirmed the connection between anxiety and bruxism as one of the central etiological factors. However, patients with TMJD experience a higher level of anxiety. Patients with estimated VAS pain score ≥5 show significantly more anxiety on STAI 2 subscale.

The purpose of the present study was to examine the relationship between anxiety and hostility among teacher.

Participants were 531 teachers of education organization of Golestan province in Iran. The mean age of the participants was 37.49 years (SD = 5.58) and ages ranged from 21 to 50 years old. There were 215 men and 316 women.

All participants completed a questionnaire booklet containing one self- report measures: The Symptom Checklist-90-R (SCL-90-R).

The results of the present study demonstrate that: 1) Correlation between anxiety and student's hostility is meaningful and positive (r = 0.733, p<0.001).

The present study revealed that a more anxiety is associated with a high level of self-reported hostility.

The most effective treatments of panic disorder (PD) are serotonin selective reuptake inhibitors (SSRI) and cognitive-behavioral psychotherapy (CBT).

Aim was to compare efficacy of SSRI, CBT and combined therapy (CT).

Forty patients (aged 25 to 50 years) with panic disorder were randomly assigned to one of the three treatment groups: CBT (30 hours, or 4 weeks), SSRI (paroxetine 20 - 30 mg daily, 24 weeks), or CT (both of the abovementioned together). All patients were followed for 24 weeks. Symptoms were assessed using Clinical Global Impression scale, Spilberger State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI) and Minnesota Multiphasic Personality Inventory (MMPI).

At week 24, clinical improvement was reached in 61.5% of patients in the SSRI group, in 78.6% in the CBT group and in 92.3% in the CT group. Significant reduction (p<0.05) of the scores of STAI, BDI, and MMPI Hypochondriasis, Depression, Paranoia, Psychasthenia and Schizophrenia scales were registered also in all the three groups. Besides there were differences between CBT and SSRI MMPI profiles – increase (p<0.01) of Masculinity-Femininity, decrease (p<0.05) of Social Introversion and marked trend to reduction (p=0.07) of Paranoia scores in CBT group.

CT seems to be more superior to either monotherapy in the management of PD, whereas clinical effects of SSRI and CBT are close to similar. Obviously, SSRI and CBT exert different influences on personality structure.

Little data is available on psychological factors involved in health-related Quality of Life (Qol) after Percutaneous Transluminal Coronary Angioplasty (PTCA). The present study aims at examining the impact of alexithymia on mental and physical QoL 6 months after PTCA.

We continuously enrolled patients admitted to a cardiology ward of Toulouse University Hospital for PTCA. Within 24 hours of the PTCA, each subject was assessed with the 20-item Toronto Alexithymia Scale (TAS) and the 36-item Short Form Health Survey (SF-36) which provides a Physical Component Score (PCS) and a Mental Component Score (MCS). At 6 months, the SF-36 was re-administered by telephone. Correlations analyses were performed, controlling for sex, age, cardio-vascular risk factors and number of dilated arteries.

Fifty-nine subjects (83.9% male) completed the follow-up interview. Mean age was 65.6(SD=11), mean TAS score was 49.1(SD=12.2), mean baseline and 6-month MCS scores were respectively 44.2(SD=11.7) and 48(SD=13.3) and mean baseline and 6-month PCS scores were respectively 41.3(SD=8.8) and 43.8(SD=9.4). At baseline, TAS was correlated with MCS (p<.05) but not with PCS. At 6 months, TAS was no longer associated with MCS, however, after controlling for baseline PCS, increased TAS scores were significantly associated with poorer PCS scores (p<.05).

According to our findings, patients with high levels of alexithymia may be at risk of poorer physical QoL 6 months after PTCA. Therefore the assessment of this psychological construct may prove useful in detecting patients who might benefit from further support.

1) To know previous psychiatric disorders in patients diagnosed of Fibromyalgia (FM), 2) To identify the different medical specialists that make the diagnosis of FM, 3) Which specialist(s) are in charge of the patient's follow-up, and 4) To asses working status before/after the diagnosis of FM.

77 women (mean: 57.3 yo) that were being treated at our psychiatric unit and who were later diagnosed (2002-2006) as having FM by an array of specialists. Variables studied: year of diagnoses, specialist/s involved, psychiatric diagnosis and social/demographic parameters.

80.5% of patients (62/77) manifested a somatoform disorder (SD), 79.2% (61/77) a mood disorder, or a personality disorder 22.1% (17/77). The FM diagnosis was made by rheumatologists (37.7%), traumatologists (24.7%) and general practitioners (19.5%). Mostly, psychiatrists took care of the patient's follow-up (94.8%); either exclusively (55.8%) or shared with other specialists (39.0%). Before FM diagnoses, 80.5% of the patients were working as housewives or elsewhere versus 16.9% of them that were out of work or on sick-leave due to their long-lasting illness. Following the FM diagnosis, these figures changed to 46.8% and 40.3%, respectively.

Most of the FM cases had been previously diagnosed as having a SD. The FM diagnoses is made by specialists other than psychiatrists. However, the patient's follow-up corresponds to the later. The diagnosis of FM facilitates the attainment of a long-term disease status and their consequences thereof. These facts raise the necessity to review this disease, from the nosological, therapeutic and diagnostic point of view.

Hypothalamic-pituitary-adrenal (HPA) axis function has been reported to be abnormal in almost all psychiatric disorders, particularly in depression. The aims of the study were to test the hypothesis that HPA axis dysfunction is present in various psychiatric disorders and not only in depression, and to evaluate if the HPA axis dysfunction is associated to specific symptoms and to life events.

The dexamethasone (dex) suppression test was made in order to identify HPA axis dysfunctions in 73 patients with at least one DSM-IV axis I diagnoses (SCID-I) and in 23 controls. The ability of glucocorticoids to suppress the HPA axis (suppression index, IS) was measured by using the ratio between cortisol levels after and before dex administration The Florence Psychiatric Interview was used in order to evaluate the symptoms of the current episode, life events and patients's socio-demographic characteristics.

Significant higher basal cortisol levels were found in patients compared with controls at 8 p.m. (p<.05). After dex administration, patients showed significantly higher cortisol levels than controls (p<.05). The IS was lower in controls than in patients (p<.05), while indicating that these latters are characterized by a reduction of the ability of glucocorticoids to suppress the HPA axis.

Amongst patients, the condition of non suppression was associated with specific symptoms irrespective of the diagnosis, such as depressed mood, anhedonia, low self-esteem and energy, indecision, low affectivity, lack of concentration and panic attacks. No relationships were found between the exposure to life events and HPA axis dysfunctions.

Main features of antisocial personality disorder (APD) are aggression, tendency to violence, poor frustration tolerance, impulsivity, difficulties in learning from experiences. Attention deficit hyperactivity disorder (ADHD) is characterized with difficulty to sustain attention, hyperactivity and impulsivity. Association between ADHD and violent behavior is well known. Childhood onset ADHD carries a high risk of persisting into adulthood as antisocial behaviors.

In the present study, comorbidity of adult ADHD was screened in a group of patients with APD. Executive functions and attention were assessed by using neuropsychological test instruments. In addition, their relation to ADHD subtypes was investigated.

A total of 90 male subjects with APD were included. Also, 90 age- and sex-matched healthy control subjects were involved into the study. The patients and control subjects were assessed by a semi-structured socio-demographic form, SCID-II, Turgay's Adult ADHD Rating Scale, Wender Utah Rating Scale, Wisconsin Card Sorting Test, Stroop Test, Continuous Performance Test, and Trail-Making Test.

Comorbidity rate of adult ADHD was 83.3% in APD group while 6.7% of control subjects had a diagnosis of adult ADHD. The most frequently diagnosed ADHD subgroup was combined type in both APD and control group. In APD group, executive functions were significantly more deficient as compared to the control group. Among all ADHD subgroups, inattention subtype had the worst performance in neuropsychological assessments.

Comorbidity of adult ADHD was quite common in APD subjects. Executive functions were generally deficient in APD patients with a co-diagnosis of adult ADHD.

The purpose of this study is to evaluate the psychiatrists' stress factors related to their work in order to find methods that could improve the work environment.

A 30 items questionnaire was designed for the study, based on discussions with the trainees and psychiatrists and reviewing articles related to this topic. Each item was quantified from 0 to 9, 0 meaning “ no stress”, and 9 meaning the highest level of stress. The questionnaire was distributed to 200 psychiatrists (72% response rate) from 5 university centers in Romania. The results were analyzed, using the SPSS medical statistic program.

The majority of the respondents were young psychiatrists, in their first 2 years of practice. Even if most of the fellow psychiatrists do not consider themselves stressed at work, they reported high level of stress at several items. The major causes of stress are: “ the lack of space in the clinic”, “insufficient equipment”, “lack of drugs”. The items with the lowest scores, meaning that there are not stress factors are: ”too much work on emergency room”, “working extra-hours”, “doing somebody else's job”.

All 5 universities reported the same causes of stress as being the most frequent ; these factors are correlated more with economical problems then with medical ones. This reflects the economical status of our country. The stress level can be reduced through economical and administrative measures.

A close relationship between anxiety and pain has been demonstrated in different conditions. The nocebo effect, whereby a verbal stressor is capable of inducing hyperalgesia, has been shown to be a good model to study such a relationship. In particular, nocebo hyperalgesia has been found to be associated to the hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and benzodiazepines can antagonize both nocebo hyperalgesia and HPA hyperactivity, thus suggesting that anxiety play a major role. Here we investigate how stressful stimuli can modulate pain.

As a stressor, we used a nocebo procedure whereby verbal suggestions of hyperalgesia were given to healthy volunteers before administration of either tactile or low-intensity painful stimuli. Pain perception was assessed by means of a Numerical Rating Scale (NRS), raging from 0= no pain to 10= unbearable pain. The nocebo procedure was carried out after a pre-conditioning session in which two different conditioned stimuli were associated to either pain or no pain.

We found that the conditioned stimulus that was associated to pain was capable, when presented alone, of turning a tactile stimulus into pain.

These data suggest that a stressor, probably through anticipatory anxiety, can induce allodynic effects, whereby tactile stimuli become painful. These findings, along with previous data about placebo effects, indicate the powerful modulation of pain by placebos and nocebos.

Adaptative disorder included in ICD-10 is considered a residual category in DSM- IV. We hypothesize that having a high amount of recent life changes could determine having a higher incidence of psychiatric pathology.

A random sample of 197 primary care attendees aged 18-65 was selected from 3 primary care centres in the area of Madrid (Spain). Of them, 191 (97%) completed the Spanish version of Prime MD PHQ, and a recent life changes checklist (RAHE) in the previous 6 months and between 6-12 months. Data about medical conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), was also collected.

73 (38%) had a PHQ diagnosis (including subtreshold conditions). 121 were women (63,4%). We found that work, home and familiy and personal and social changes both reccent and long lasting were significantly higher in men with PHQ diagnosis (p<0,05) and only recent finacial changes were related with a PHQ diagnosis (p=0,002). In women only long lasting personal and social and home and family (p< 0,05) changes had a significant relationship aswell as recent health changes (p=0,017).

Recent life changes seems to have a relationship with psichiatric symptomatology in both men and women. There are some differents between the changes that could infuence men and women.

This case report suggests that Conversion Disorder may take years to become evident, so this diagnosis may place the clinician in difficulties and sometimes in misdiagnosis.

A 39 years old woman admitted in Neurology Department (September 2005) to determine the nature of her seizures and other motor symptoms. The first symptoms appeared 12 years ago after marital conflicts. Some days later she presented motor symptoms such as, impaired coordination and balance, “epileptic” seizures and convulsions. She was diagnosed as suffering from Epilepsy and was treated with antiepileptic drugs for many years. During last year she presented a variation of motor symptoms, seizures, convulsions and some sensory symptoms, loss of touch (in the left side of the body), and because of instability. Neurological and laboratory examinations ruled out neurological disorders including epilepsy (normal EEG and CT). Psychiatric consultation followed.We realized that our patient met the diagnostic criteria (DSM-IV) for conversion disorder. Gradually, we discontinued antiepileptic drugs and began to treat with fluoxetine at maximum dose 40mg/day. Three months later she was released from previous symptoms, so we continued to treat with 20 mg/day for ten subsequent months. At present days she lives without motor or sensory symptoms. The patient has provided us with a video registration of her “crisis” recorded by her brother.

The clinicians should raise the awareness about this diagnosis. They have to be careful and improve knowledge about treatment and diagnostic techniques.