We study coping strategies for hepatic, cardiac and renal transplant relatives. Relatives play a major role in the transplant life, and therefore specific psychological support has to be considered for them, something that is yet too rarely done in hospital.

We survey a population of 222 relatives, all volunteer for this research, of hepatic (52), cardiac (88) and renal (82) transplant. Most of them are husband or spouse (70%), the remaining being parents or children of the transplant. Evaluation is done through HAD (anxiety and depression), EAS (social support) and coping scales.

Relatives are confronted to traumatic effects of illness and have to reorganize themselves psychically. They face worrisome situation related to illness itself, heavy medical treatment (possibly at home), medical care, etc. They often regret not to be given room to express their sufferings or fears, a situation that can be a source of tension. Average score on HAD anxiety and depression scale are respectively (with population percentage scoring above threshold of 7.5) 8.81 and 4.53 for cardiac transplant relatives (67% and 16% above threshold), 7.92 and 4.55 for hepatic transplant relatives (48% and 18%), and 8.59 and 4.81 for renal transplant relatives (56% and 20%), thus clearly showing a population that is more anxious than depressed. We note that a depressed relative somewhat tends to get socially isolated and to rely on positive thoughts. Also, they say that they are not prepared to the changes resulting when their relative gets a transplant.

While knowledge of the aetiology of psychiatric disorders is complex and has not been fully elucidated, recently it has been noted that a sizeable proportion of psychiatric patients have coexisting immunological health conditions. Previous work has given weight to the theory that the immune system has important neuromodulatory roles in the brain, and disturbances in this system can lead to psychiatric manifestations.

Epidemiological evidence is needed to explore the strength of the correlation between immune conditions and psychiatric disorders, and this audit attempts to investigate this potential association using the psychiatric patient database of Bedford East Community Mental Health Team.

In this audit, the patient information was analysed to obtain prevalence data for an array of autoimmune conditions. This was then compared to the expected prevalence of the same autoimmune conditions.

The results showed that patients with each psychiatric condition had a higher than expected prevalence of autoimmune conditions overall. The most striking discrepancy was that the percentage of patients with coexisting hypothyroidism was higher than expected in almost every psychiatric condition recorded. Other patterns in prevalence of autoimmune conditions were also noted.

A causative link between psychiatric and autoimmune diseases is still questionable, and this issue needs to be researched further in terms of prevalence data and aetiological evidence.

There are significant implications for clinical practice if a greater incidence of autoimmune conditions among psychiatric patients is proven. This includes screening opportunities and risk assessments, as well as potential for new pharmacological therapies based around immune regulation.

In patients with Anorexia Nervosa (AN), troubles in facial emotion recognition (FER) have been reported using methodologies relying mainly on static tests. The morphing technique allows new perspectives in experimentation, by using dynamic expressions of emotions.

To compare prospectively FER using Multimorph, a morphing technique previously described (Robin, 2012) in anorexic patients and matched controls.

Population: 27 female patients with DSM-IV criteria for AN and 27 healthy individually matched controls were prospectively studied.

Multimorph protocol: Participants had to identify as rapidly as possible the 6 basic emotions. Emotions were displayed progressively by 2.5% incremental stages from neutral (0%) to a full-blend (100%) facial emotion (40 stages were displayed by trial). Each subject completed 36 trials (6 face x 6 emotions). Results are expressed as mean number of stages until the first correct response. Data were analyzed with a 2 (AN versus control) × 6 (anger, disgust, fear, happiness, sadness and surprise) factorial design. Comparisons were made with ANOVA for repeated measurements using Generalized Estimating Equations approach (Lipsitz, 1994). A p value < 0.05 was considered as significant.

Anorexic patients have an increased sensitivity to facial emotions, compared to controls.

Often the clinician is faced with bureaucratic demands and family that led him to opt for a diagnostic entity, despite not having enough natural history of the disease to make an accurate diagnosis, particularly relevant fact in child psychopathology taking into account patoplasty of mental illness.

Neuroleptic Malignant Syndrome (NMS) comprises several systemic manifestations which can be life threatening. Its pathogenesis is unknown but it is known to be associated with the use of antipsychotic drugs. Some cases are still seen in General Hospitals despite the extended use of atypical neuroleptics. The main clinical features includes mental status changes, fever, rigidity and autonomic instability. Due to the potential gravity, the identification of risk factors and early clinical diagnosis is essential in order to prevent or treat it successfully.

The objective of this study is to analyze the profile of patients who present NMS and the related risk factor described in the literature.

A sample of patients diagnosed with NMS was selected. They were hospitalized in the 12 de Octubre Universitary Hospital of Madrid over the last 10 years. The demographic variables, signs and symptoms and the risk factors were evaluated by a retrospective and descriptive analysis.

the clinical manifestations were similar to those reported in other series. Several risk factors reported in the literature were observed.

1. 1. It is essential the early suspect of this syndrome in patients with risk factors.

2. 2. In patients in whom the disorder is suspected, treatment should be initiated immediately.

In a previous survey, German psychiatric staff indicated that they are open to religiosity/spirituality (ReS) in the therapeutic setting. According to staff's self-reported attitudes, they are ready to listen and discuss ReS with their patients and cooperate with chaplains.

We aimed to find out how chaplains perceive the attitudes of other psychiatric staff (e.g. medical and nursing staff) toward ReS in the psychiatric process. In the context of a pilot study, Protestant and Catholic psychiatric chaplains in Baden-Württemberg (Germany) were surveyed from mid-November 2012 to mid-February 2013. The main instrument used was a revised version of the Curlin et al. questionnaire on’Religion and Spirituality in Medicine: Physicians’ Perspectives’.

The response rate was 59.38% (38 of 64 questionnaires). Chaplains responded that psychiatric staff is open to ReS discussions with patients; however, psychiatric staff rated themselves more positively in this regard than chaplains. Nurses were considered to have the most positive approach toward ReS and were reported to often encourage patients to practice ReS or share their own ReS with patients.

From chaplains’ perspective, psychiatric staff seems reluctant to regularly integrate ReS into their therapies, as they believe it is not their responsibility. Nevertheless, chaplains indicated that the personal attitude of psychiatric staff toward ReS is an influencing factor for integrating ReS into the clinical setting.

From chaplains’ point of view, psychiatric staff is less comfortable with ReS in psychiatric practice than reported by the staff members themselves. For a representative picture further research is planned.

Johannessen & McGorry, have described patients who are seen to be at an ultra-high risk of psychosis as having a ‘Pluripotent risk syndrome’. This less specific prodrome reflects the unpredictable nature of’Ultra-High Risk’ states which have been shown to be more likely to develop into a non-psychotic mood disorder than schizophrenia.

We aimed to assess whether the concept of pluripotent risk syndrome is valid phenominologically,.

An Audit has been carried out of the patients who have been assessed using the CAARMS tool in order to assess patients who have been judged to have a prodromal psychotic syndrome.

Ten adult patients (6 males & 4 females, aged 19–26 years old) who had been given four broad psychiatric diagnoses for coding, but who were thought to have prodromal psychotic illness (Depression, Schizoaffective disorder, Borderline personality disorder and psychotic illness) were chosen from an anonymised database of the patients and their symptomatology as assessed by CAARMS was retrospectively assessed to see if the presence of depressive symptoms supported the case for a’Pluripotent risk syndrome’.

Though patients diagnosed with depression frequently exhibited depressive symptoms, psychotic symptoms were also apparent, albeit in comparatively decreased severity. Patients diagnosed with schizoaffective disorder had depressive symptoms more frequently than psychotic symptoms, but these were comparatively less severe. Borderline personality disorder patients exhibited depressive symptoms more frequently than psychotic symptoms. Psychotic illnesses frequently had depressive symptoms, but more typically (and unsurprisingly) had comparatively more severe psychotic than depressive symptoms.

The reason that patients were coded according to ICD 10 criteria is because this is obligatory for all patients in community teams for report to central government in the UK. They were all however suspected to be prodromally psychotic. All of these’at ultra high risk mental state’ patients exhibited both some psychotic symptoms and also depressive symptoms.

Since all patients had both attenuated psychotic symptoms and depression symptoms, we canclude that the concept of a’Pluripotent risk syndrome’ is in our view born out.

The influence of parents’ psychiatric disorders on the mental health of their children, has grown considerably due to the development of epidemiology, genetics and notions of vulnerability or gene-environment interactions. Early interactions between the mother and her child have a direct impact on the psycho affective child development. Mental disorders in children are, at their turn, generator of a psychiatric disorder among parents, especially the mother. This’loop’ in which the mental health of the child and mother are constantly interacting needs a specialized and targeted intervention.

The aim of this work is to describe the profile of mothers of children with psychiatric disorder and to link the mental disorders diagnosed in children and their mothers who receive care in psychiatry.

We focused on the cases of the mothers whose children were followed in the consultation o child psychiatry in Razi hospital and who are themselves suffering from a psychiatric disorder. Data collection was made ??from the patient records.

We collected data in ten cases of patients suffering from psychiatric disorders. On our preliminary results, maternal depression is the disorder most frequently observed. We plan to expand the study population.

Regardless of the mental disorders of the child, the therapy is mainly based on parental guidance. The psychiatric disorders among parents and especially the mother is important to detect to guarantee a successful therapy. This work emphasize on the importance of the collaboration between psychiatrists and child psychiatrists.

The underlying diagnoses in catatonic patients can be affective disorder, schizophrenia, schizoaffective disorder and a range of medical/neurological illnesses. Benzodiazepine and 6 to 12 sessions of electroconvulsive therapy (ECT) have been considered the first-line treatments for almost all types of catatonia.

To discuss when ECT should be started, its risks and lateral effects, pointing the maximum number of sessions and if there are patients that need a higher number of ECT than what is referred in literature.

A revision about catatonia etiology, diagnosis and treatment was done, based on two clinical cases.

The number of ECTs recommend in literature is 6 to 12, and although there isn’t a maximum number defined, the treatment should be reconsidered if there isn’t response after 6 sessions. The lateral effects of higher ECT number are not known to differ with ECT number. We present a case of a 63 years old woman with major depressive and catatonia whose symptoms only resolved after the 21 ECT, with a previous psychotic depression treated with 17 ECT. The second case is a 60 years old woman with the diagnosis of paranoid schizophrenia with catatonic symptoms that only recovered after 17 ECT. In both patients, the clinical improvements where noticed only after a higher number of sessions.

The maximum ECT number should be adapted to each patient and the clinical response obtained, always considering the possibility of exceeding the numbers recommended in literature.

Modern psychosomatic research has found multiple evidence for an impact of psychosocial factors on the development of arterial hypertension.

To evaluate the burden of these factors among the two sexes.

A sample of 198 hypertensive patients (89 men – 108 women, mean age 52,9 years, SD = 11,81 ranged 26–78) participated to the present study. The questionnaires included: a) questionnaire recording social-demographic characteristics and clinical features, b)The Short Form 36 (SF-36) General Health Survey questionnaire, c) the Beck Depression Inventory –II, d) Eysenck Personality Questionnaire and e) The Cardiac Anxiety Questionnaire (CAQ-greek version). SPSS for Windows 14.0 and STATA 10 were used for statistical analysis.

Age was not differ significantly among the two sexes (t = −1.638, p =.028). Models of stepwise approach logistic regression, examining the associations between gender and psychological issues, were performed. Model 1 was adjusted for age, socio-demographic variables and clinical parametres. Quality of life, depression, personality traits, and cardiac anxiety scores were introduced in step model 2. In model 3, after controlling for age, socio-demographic variables and clinical features female hypertensive participants had a higher risk of somatization (OR=1.46, 95% CI=1.02–1.29), paranoid ideation (OR=1.23, 95% CI=1.04 –1.46) and psychotisism (OR=1.37, 95% CI=1.14–2.45).

Findings support the hypothesis that hypertensive women shows a serious psychological dysfunctional behaviour, which can be attributed to their gender. Since this relation was not explained by relevant confounders there is a need for create preventive methods or treatment programmes in order to minimaze these effects

The investigation of emotional intelligence seems helpful for understanding of pain experience of adolescents with burns as well as specificity of psychosomatic development of children and adolescents after the deforming impact. The tendency to focus on pain feelings and negative emotions, which are caused by these feelings, may be the reason for atrophy of other aspects of victim's emotional reality, in particular, in understanding of other people's emotions.

To study structural features of emotional intelligence in burn adolescents.

12 adolescents with burning injury (n=15) and 17 uninjured adolescents (n=15) underwent testing. They were assessed by the following methods: Lyusin's Emotional intelligence questionnaire, Guilford's social intelligence test, Etkind's color test of attitudes.

The study hasn’t revealed any statistically significant differences between indices of general, interpersonal and intrapersonal emotional intelligence of burn adolescents and uninjured ones. But there were discovered statistically significant differences between indices of social intelligence level. Low indices were also revealed for intrapersonal level of emotional intelligence of the adolescents, who got their burn at early age, between 3 to 9 months. At the same time indices of the level of general emotional intelligence in this group are average. Uninjured adolescents think about themselves more positively, while burn adolescents usually more often feel tension when they think of themselves, furthermore they associate themselves with their burn.

These were only preliminary results and the study should be continued with not only quantitative but qualitative methods as well.

A recent meta-analysis showed that lack of early improvement is able to predict absence of later treatment response in Major Depressive Disorder. Whilst the majority of studies are based on depressive symptoms reduction, early variability of negative and positive emotions could be even more informative.

2938 adult outpatients with MDD were included in this observational study to receive agomelatine. QIDS-C, CGI, and MATHYS scales were completed at inclusion, W2 and W6 for 1565 subjects. The MATHYS rates tonalities of emotions during the previous week, including sadness and happiness, on a Likert Scale with 5 frequencies: from’never’ to’constantly’.

Responders were 25.72% at W2 (N=402) and 58.02% (N=908) at W6. QIDS-C score decreased from 18.78 at inclusion to 9.28 at W6. At W6, 26.00% patients were remitters (QIDS-C<6). At W2, 67.72% of patients (577/852) with decreased negative emotions, and 72.30% of patients (261/361) with increased positive emotions, were treatment responders. The increase of positive emotions is more specific (84.78% versus 58.14%), with a better positive predictive value (72.30% versus 67.72%) than the decrease of negative emotions. The global predictive value for positive emotions increase (Yule Q=38.40%, 95%CI[35.99%–40.81%] was overlapping with the one derived from the decrease of negative emotions (Q=41.55, 95%CI[39.10%–43.99%]).

Beside depressive symptoms, considering early changes in positive and negative emotions could be a relevant choice, as the more specific value for symptoms reduction (QIDS-C) was 72.5% in the same study and the specificity detected for the increase of positive emotions is 84.8% in this analysis.

Living Kidney transplantation leads to better outcomes for the transplant recipient and is associated with low morbility and mortality to receptors and donors.

This study aims to describe the narratives, motivations and distinctive characteristics of kidney donors, and changes in psychopathology and life quality.

We evaluated all kidney donors candidates in Hospital São João Centre, between January 2004 and September 2012, using a semistructured questionnaire.

A total of 62 donors candidates were evaluated, all were receptors family, most were non-practicing catholic and few participated in voluntary activities or were blood donors. The decision was spontaneous, the main aim was to improve the health of the family and the negative consequences were devalued. about the candidates in which the donation happened (30.6%), the majority would repeat the decision, they felt more valued and there self-esteem was higher. They took more responsibility for the health of the receptor and they thought that after transplantation the kidney belonged to both. In general, the donation strengthened the relationship with the receptor and didn’t affect donor's life quality.

The decision to donate is more dependent on the relationship with the recipient than altruism feelings. After the donation, donors will experience a period of renegotiation of identity (usually with increased self-esteem and enjoyment of life), redefinition of roles (changing activities, multiple roles and feelings of heroism) and changes in the relationship with the receptor (stronger, with feelings of debt and recognition).

Much discussion has occurred about the idea that different antipsychotics can be combined in order to reduce the dose and the side effect profile of each one. Present Guidelines do not support this approach.

We decided to carry out a literature review to establish the evidence which supports this approach.

We carried out a literature search using Google Scholar and Pubmed databases.

Clozapine augmentation with another antipsychotic, usually sulpiride, amisulpride or aripiprazole, has been most studied. Many studies focus on efficacy rather than side effect profile.

A number of short studies and case reports, often with the use of Aripiprazole as the augmenting medication,

suggest that combinations of antipsychotics can reduce side effect profile; larger studies are beginning to emerge.

Some of these studies do not demonstrate greater efficacy for the combination, and in these, the combination use can only be justified on the basis of improvement of side effect profile.

What can be done pragmatically in clinical trials is to compare the effect of a combination with that of each medication separately, or in some cases with placebo. Efficacy of the combination needs to be balanced against side effect profile.

Before this approach can be recommended in guidelines, it is necessary that more trials of larger samples need to be carried out.

The Humanitarian Assistance Programmes UK & Ireland (HAP) work in partnership with mental health professionals in Bosnia-Herzegovina (BH), the country affected by war 1992-1995, providing knowledge and expertise in the treatment of trauma, and specifically in the use of EMDR (eye movement desensitisation and reprocessing). In this way we aim to build a body of qualified and experienced professionals who can establish and sustain their own EMDR training and professional associations in BH.

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.

The trainers from HAP UK & Ireland completed two EMDR trainings in Tuzla than in Sarajevo for 50 recruited trainees from different BH health institutions from different cities and entities in BH. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK&Ireland supervisors. Supervision is organized via Skype Internet technology. Up today three trainees completed their supervision successfly and became European Accredited EMDR Psychoitherapists.

Two training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland resulted with foundation of Bosnia-Herzegovina EMDR Association. The next training is organized in Sarajevo again in 2013-2014 and it will increase psychotherapy capacities in postwar BH.

5-HTTLPR (serotonin transporter linked polymorphic region) has long (l) and short (s) allelic variations. The s allele is linked to depression, anxiety, and slower response to selective serotonin reuptake inhibitors (SSRI). Both depression and SSRI's are associated with bone loss and fractures. We explored the relationship between the 5-HTTLPR and bone loss.

IRB-approved retrospective chart review of adult psychiatric patients during a 10-year period with both 5-HTTLPR genotype and bone mineral density (BMD) assessment (hip and spine BMD stratified by age, Z-scores < 50, T-scores ≥50 years). Age, gender, and BMD scores were compared between the 5-HTTLPR categories of s allele (l/s and s/s genotypes) versus l/l genotype using one-way ANOVA.

Of 3016 with 5-HTTLPR genotyping, 239 had BMD, with 157 (66%) s allele and 82 (34%) l/l genotypes. Among men and women < 50 years, s allele had lower Z-scores in the hip (−0.6628/n=43 vs −0.1306/n=36, p=0.012) and spine (−0.9762/n=42 vs -0.1000/n=41, p=0.0019) than l/l. There were no differences in T-scores between the s allele and l/l genotypes for men and women ≥50 years. Gender analysis (n=198 women, n=41 men) showed women with s allele had lower Z-scores in the hip (−0.68182/n=33 vs −0.08788/n=33, p=0.0146) and spine (−1.0250/n=32 vs − 0.0586/n=29, p=0.0020) than the l/l genotype.

The s allele is associated with lower bone density at the hip and spine in younger adults, particularly in younger women. Our results suggest 5-HTTLPR variants may mediate serotonin effects on bone in a gender-specific or hormonal/ menopausal-dependent interaction.

Above 60 years, prevalence rates of neuropsychiatric disorders double with every 5.1 years of age (from 0.7% at 60-65 years to 23.6% for those aged 85 or older). As aged people are dramatically increasing in Portugal, a Country under a serious financial crisis, it is important to understand whether health services are being used appropriately.

to characterize the use of health services among the elderly, as part of the implementation of the 10/66-Dementia Research Group Population-based Research Protocol in Portugal.

A cross-sectional survey was implemented of all residents aged 65 or more in a semi-rural area in Southern Portugal. Core evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). A structured questionnaire assessed the use of services, including health care providers (public, private), inpatient episodes, medication and costs.

703 participants were evaluated. Almost half of the participants (48,9%) were in contact with public primary care facilities, but only 22,5% had a contact with a hospital service. In both settings, nurses and other non-doctor professionals were rarely involved (6,4%) as principal care providers. 11,8% had at least one contact with a private doctor. Inpatient episodes in the last 3 months were very infrequent (3%). The National Health Service covered most costs.

Previous research strongly suggests that health services are not provided equitably to people with mental disorders, namely the elderly. Reliable and cross-culturally comparable information about patterns of care may guide the implementation of adequate management in this area in Portugal.