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

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

Review of clinical record and interview with the patient.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The aim of the study was to evaluate decision-making process and probabilistic bias in patients with obsessive-compulsive disorder (OCD).

Our sample consisted of 80 subjects (40 diagnosed with OCD and 40 healthy controls). To assess the clinical characteristic of the sample we performed a clinical interview and a psychometric assessement using the Barrat Impulsiveness Scale (BIS-11) and the Cloniger's Temperamnt and Character Inventory (TCI-125). To assess decision making processes and probabilistic reasoning we used the Iowa Gambling Task (IGT) and the Beads Task.

OCD group had a significantly lower IGT final netscore (p 0.032). Moreover, controls showed a significant improvement between netscore 1 and netscore 5 (p 0.014) while patients did not (p 0.700). Patients also showed significantly less draws till decision on the Beads Task (p 0.000). We performed four regression analysis to evaluate the influence of clinical variables (duration of illness, treatment resistance, Y-BOCS Score, presence of tics, Barratt Score) and personality traits (TCI sub-scales) on IGT netscore and Beads Task. The results indicated that the four overall models were not statistically significant.

Our data show the presence of a decision making and probabilistic reasoning impairment in OCD. These data could be intareptated in a neurocognitive perspective as executive dysfunction and in a neuroeconomic perspective as a reduced loss avoidance and overconfidence during decision making processes.

Valid animal models are essential to understanding the aetio-pathophysiology of depression psychopathology and therefore its pharmacological treatment.

To establish a mouse model with aetiological and face validity, investigate the mediating pathophysiology, and the effects of reference antidepressants and novel-target pharmacology.

Adult male C57BL/6 mice were exposed to chronic social defeat (CSD) in the form of 15-day distal exposure to, and 1-min daily attack without wounding by, dominant CD-1 mice. Behavioural effects were studied in terms of changes in fear conditioning, generalized helplessness and fatigue. Physiological effects were studied in terms of in plasma levels of pro-inflammatory cytokines and tryptophan catabolites. CNS transcriptome-level effects were studied in terms of de-regulated gene expression in hippocampus, amygdala and medial prefrontal cortex. Pharmacological reversal of CSD behavioural effects were studied using escitalopram and an indoleamine 2,3-dioxygenase (IDO) inhibitor.

Relative to controls, CSD mice exhibited increased acquisition and expression of fear conditioning to CS and context, increased generalized helplessness in terms of 2-way escape failure, and increased fatigue on a 1-way escape-avoidance treadmill. CSD mice exhibited increased plasma levels of TNF and IL-6, increased tryptophan catabolites and decreased serotonin, and splenomegaly. CSD mice exhibited deregulation of immune-inflammation genes in hippocampus and of dopamine and serotonin genes in amygdala. CSD-induced behavioural dysfunction was moderately reversed by escitalopram and more robustly reversed by an IDO inhibitor.

This valid mouse model provides comprehensive evidence for immune-inflammation – monoamine aetio-pathophysiology of depression and the therapeutic importance of targeting this pathway in novel anti-depressant treatment strategies.

Transference and countertransference could be significant sources of insight about the patient's, therapist's and supervisor's inner worlds. Transference phenomena are viewed as a reenactment in the treatment relationship of key elements of previous significant relationships. Countertransference occurs in CBT when the relationship with the patient activates automatic thoughts and schemas in the clinician, and these cognitions have the potential for influencing the therapy process. Countertransference also occurs during supervision and is an indispensable part of the supervisor's response to the supervisee. During the long-term CBT of the personality disorder or other complex cases, high intensity of transference and countertransference can develop.

Schema therapy shares the view that schemas are crucial to understanding of personality disorders, but also can help to understand the emotional reaction of therapist. A mode is the set of schema operations that are in one moment functioning for a person. When therapist suspects that countertransference may be developing, he/she could try to identify her/his automatic thoughts and schemas. More comprehensive approach is to quickly identify in which mode him/her are at that moment and reflect it such reaction is for the patient benefit or not. Understanding therapist countertransference reactions and theirs management are a significant point of supervision. Selfreflection and realizing the countertransference can therapist help to overcome it and may be necessary for overcoming stagnation in therapy.

Understanding own mode and their flipping into the therapeutic session is an important tool in psychotherapy and supervision.

Telomeres are nucleoproteic structures arranged in a double helix, located at the end of chromosomes protecting them from deterioration. Each time a cell divides, the enzymatic machinery is unable to replicate integrity of telomeres and by this way, they became smaller, leading to cell aging and death. This shortening can be accelerated by inflammation, oxidative stress, radiation and toxins.

Several studies have shown that the adverse early-life experiences may also contribute to premature aging of the telomeres.

This work aims to make a review of the literature published about the impact of adverse life experiences in the shortening of telomeres and premature aging.

Bibliographic review.

Several studies show that early childhood abuse contribute to accelerated shortening of telomeres, some suggest that there is a direct relationship between the severity and duration of abuse and the degree of shortening. Some studies also show that exposure to trauma in adulthood contributes to the accelerated aging, particularly in individuals who develop PTSD.

The interaction of the environment in the biology of the organism seems very deep and precocious. These findings will possible allow the reconstruction the of the biopsychosocial model, opening up new avenues for holistic understanding of the human being.

Despite the fact that anxiety disorders are the most common mental disorders in general population specific predictors associated with a good response to treatment were still not found.

In our study, we aimed to investigate the clinical and demographic predictors of response to combined (congitive behavioral therapy and pharmacotherapy) in patients with panic disorder (n = 62), social phobia (n = 50) and obsessive compulsive disorder (n = 33). Probands were recruited from psychotherapeutical department of department of psychiatry, that is concentrated mostly on pharmacoresistant patients. We focused on basic clinical and demographical data.

In the case of panic disorder was a treatment success defined as decline in Beck anxiety inventory (BAI) by 25%. Using stepwise regression we identified three statistically significant predictors of response: marital status, presence of other anxiety disorders, and the difference in scale BAI between the first and second weeks. In the case of social phobia treatment success was defined as a decrease in the Liebowitz Social Anxiety Scale (LSAS) of 25% between the first and final measurements. Change in LSAS scale was positively correlated only with age of onset of illness. In patients with OCD was a treatment success considered as a decrease of the Y-BOCS by 35%. In this disorder decrease in Y-BOCS correlated with level of insight and the presence of comorbid personality disorders.

In our study we found few statisticaly significant predictors of treatment response. Further research is needed to refine the findings.

The presence of cancer in pregnant generates important emotional impact on everyone involved, especially to the young women. Pregnancy and cancerare not infrequently. This study objective to investigate the emotional dynamics of patients diagnosed with cancer and pregnancy. The aims were: to understand why a person with cancer gets pregnant or maintain pregnancy; assess if the experience of pregnancy determines changes in the perception of these women's lives; to analyze the importance of psychological features and to identify failures in family planning guidance.

A qualitative and clinical research approach was used. The framework was content analysis based on thematic categorization. Semistructured interview was used in eleven women who were divided in two groups, one with six cancer patients and the other with five healthy pregnant women classified as low-risk.

pregnant women with cancer showed great difficulty in dealing with the diagnosis, strong sense of mourning, fear of death, ambivalence between fear and joy, life and death. The pregnancy also gave them a feeling of being healthy and able to create life. Psychological care was valued by pregnant women with cancer. Interesting was the way the patients deals with time. To fear face with the fear of death they used shortterm goals in order to stay strong and to fight the disease.

Women showed a clear concern for protecting the conceptus, both during intrauterine and post –natal. It was noticed the importance of psychological care helping them to cope with emotional issues and adherence to treatment.

This research based on psychodynamic theory objective to analyse organizational culture in its intangible aspects related to work mental health. It aims to identify femininity and masculinity characteristics as well as to understand how these dimensions make innovation easier or harder in some organizational cultures.

A mixed investigation strategy has been chosen (quanti and qualitative design), including quantitative survey and qualitative analysis. The sample is formed by 15 companies in São Paulo State, Brazil.

The presence of social competences, such as tolerance to ambiguity and error in solving conflicts, supportive leaderships, open communication and cohesion, encouragement to change and creativity ease the innovation and worker's mental health. Despite of these results, femininity characteristics appears insufficiently developed in the observed companies and female gender was unvalued during the group interview.

The innovation is positively related to the existence of specific organizational culture. Despite of that, the innovation culture aspects insufficiently developed are mostly femininity characteristics in the observed companies.

Mental disorders can be manifested through varied symptomatology. Consequently, there are various clinical pictures which are observed in multiple dimensions and which affect the individual's social functioning. Social perception of people suffering from mental disorders keeps changing and, to a large extent, depends on cultural and social norms. Typically, the more often the behaviour or emotion is considered to be typical, i.e. manifested by almost all the sufferers, the more it reflects the social stereotype rather than the real reflection of disorders met in practice.

To recognise the opinions about people with mental disorders and to obtain information about the knowledge of the mentally ill.

1000 people from high schools and universities/colleges were interviewed. A survery designed by researchers was used.

The analysed data suggests that there is a stereotypical perception and attitude towards mentally disordered people. All the analysed groups reported that mentally disordered people were more commonly referred to with negative terms. The interviewees classified mental disorders as the second worst disease. In terms of role function, the interviewees disapprove of people with mental disorders functioning as carers, doctors, policemen, lawyers. 45% of the interviewees claimed that people with mental disorders should use birth control not to get pregnant. 7% of the people interviewed considered mental disorders incurable. Only 44% of the interviewees do not worry about their mental health.

Attention Deficit Hyperactivity Disorder (ADHD) is the neurobehavioral disorder most common in school-age children. It is estimated to persist into adulthood in about 65% of cases, causing significant impact on job performance, social functioning and overall quality of life.

Assess functional and quality of life impact in young adults diagnosed with ADHD as children/adolescent.

Cross-sectional study between January and March 2013 with telephone interviews to patients aged over 18 years previously diagnosed with ADHD and followed in a pediatric consultation. We analyzed sociodemographic variables, co-morbidities, performance at school/work, interpersonal relationships and risk taking activities. Statistical analysis done using SPSS.

40 young adults were included, the mean age 20 years. 42.5 % were still students and 20% were unemployed. about 12–18% of cases had a problematic relationship with superiors. In some cases we found risk taking habits, mainly tobacco, alcohol and drug use. A minority of them reported being evolve in some sort of crime or violence. There was no statistically significant association between that and the duration of use of medication. Only 12.5 % of cases were followed in adult psychiatry.

As described in literature, there's a high rate of unemployment and tobacco, alcohol and drug use. It is possible that this sample is not representative of the population with ADHD as doesn’t include severe cases (followed by child psychiatrists). Most patients didn’t have followup showing the importance a better transition of care from adolescence to adulthood.

Currently there exists a need of individualized approach to the diagnostics and treatment of organic depression.

is to explore the relationship between age of onset and the etiological factors of organic depressive disorder (F06.32 according to ICD-10).

clinical, clinical-psychopathological, anamnestical-catamnestical, statistical.

50 patients with organic depressive disorder (F06.32) in comparing to 25 patients with major depressive disorder (F33) were studied.

Differences in age of onset is shown in the Figure 1.

Distribution of patients with organic depressive disorder (n = 50) and recurrent depressive disorder (n = 25) by age of manifest.

Overall age of onset of depression in patients with organic depressive disorder was significantly later than in patients with recurrent depressivedisorder (p<0.05).

The patients with organic depressive disorder with onset after 45 years constitute relatively homogeneous pool, with a clear tendency to separate from the rest of the patient`s population. They have a different spectrum of etiologic factors compared to patients with earlier onset of disease.

Births, episyndrome and infectious-allergic encephalopathy as etiologic factors identified in our material only in patients with onset younger than 45 years. Coronary heart disease, myocardial infarction, atherosclerotic encephalopathy, operations, pancreatitis were identified only after 45 years.

Hypertension was more common after age 45. An uncertain etiological factor is much greater in case of late onset. An earlier onset was characterized by more clear causality of depression.

These data support the view of the necessity of separation involutional depression from the other depressive disorders.

Mindfulness is rooted in old and philosophical traditions, but its practice does not require the domain of those cultures or their vocabulary, allowing it to become widespread and increasingly popular. In this way and having its psychological concept of focusing of attention and awareness, Mindfulness is desirable for many clinicians worldwide. Over recent years many doctors were enthused by the technique and many others are still learning and integrating it in their clinical and therapeutic work, particularly in Mental Health.

The authors aim to describe in what way the Mindfulness technique is being applied to the psychiatric field and what type of results are being achieved for the different psychiatric disorders.

Exhaustive review of the literature in what concerns Mindfulness and its applications in Psychiatry, using PubMed database.

Studies show that Mindfulness has different results and outcomes accordingly to the different psychiatric diagnostic categories. The literature shows an overall improvement in the different populations of psychiatric patients, raising the hypothesis that the discrepancy may be related to differences in the duration of the illness, its baseline severity, individual characteristics, motivation for adherence and maintenance of the practice, among other factors.

Mindfulness practice, inherited from ancient traditions, is now being applied to several mental pathologies with some positive outcomes, particularly in Depression, Anxiety, Post-traumatic Stress Disorder, Psycho-Oncology, Obsessive-compulsive Disorder and Substance Abuse. More studies are needed to validate this trend but so far it seems to be a promising psychotherapeutic technique for specific situations and patients.

Psychological functioning of the subject is essential for proper socialization proces, particularly with regard to the fulfillment of social roles and for establishing proper interaction with the environment. The ability to cope with impulsivity and aggression, the stability of the subjects’ priorities and their ability to maintain it are extremely important.

An analysis of the psychological functioning, evaluation of the incidence and severity of suicidal ideation.

A population 1000 secondary school and university students was examined. The methods included Inventory Psychological Aggression Syndrome, Evaluation Crisis Questionnaire and survey designed by the researchers.

Four important factors that increase the risk of suicidal thoughts were finally achieved: 1) gender, women are by 52% more prone to suicidal thoughts than men, 2) smoking, increase in smokers by 40%, 3) the age of initiation of alcohol, the lower the higher the risk, such as drinking before the age of 10 increases the risk by 189%, 4) alcohol problem in the family (58% increase). Also isolated three factors that significantly reduce the risk of suicidal thoughts: a good relationship with parents, having one's own room and having brothers, the greater the number of brothers, the lower the risk: having one brother reduces the likelihood of suicidal ideation by 29%, two by 39% and 3 brothers by 67%.

Persons who support ideation showed higher level of violence. They were characterized by difficulty in hierarchy of values. The crisis of evaluation was important variable determining the presence of suicidal ideation.

• - The clinical and neuropsychological estimation of vascular dementia.

• - Highlighting the clinical and neuropsychological and CT correlations depending on the degree of evolution in disease severity.

• - Assessing the possibility of establishing prior positive diagnosis, differential diagnosis, evolution and prognosis.

32 patients aged from 47 to 74 years (17 female and 15 males) diagnosed with vascular dementia were included. For diagnosis patients were examined clinically and neuropsychological, and CT.

According Mini Mental Score:

• - 17 patients: 16–23 items

• - 11 patients: 6–15 items

• - 4 patients: <6 items

Ischemic Score Hachinsky:

• - 7 patients: <8 points

• - 15 patients: 8–11 points

• - 6 patients: 11–14 points

• - 4 patients: >18 points

Hamilton Depression Scale:

• - 11 patients: <7 points

• - 10 patients: 7–9 points

• - 8 patients: 10–12 points

• - 2 patients: >12 points.

Evolutionary studies of vascular dementia were correlated with psychometric assessments and anatomical gap size revealed by brain CT.

Differential diagnosis was made with Alzheimer's disease.

• - In the onset and evolution of vascular dementia on the neurological examination predominant presence of signs of outbreak

• - Neuropsychological changes are manifested by cognitive symptoms

• - The direct link to increase the neuropsychological symptoms, depending on the severity of cerebral atrophy and volume of ischemic site on brain CT.

• - Clinical, neuropsychological tests and CT revealed that early positive diagnosis, differential diagnosis, progress and prognosis.